Sexual orientation disparities in smoking vary by sex and household smoking among US adults: Findings from the 2003-2012 National Health and Nutrition Examination Surveys

Objective. This study examined whether sexual orientation-related smoking disparities in males and females varied by household smoking behaviors in a nationally representative sample of American adults. Methods. Data were drawn from the 2003-2012 National Health and Nutrition Examination Surveys, which assessed 14,972 individuals ages 20 to 59 years for sexual orientation, current smoking status, and household smoking. Weighted multivariable logistic models were fit to examine whether differences in current smoking status among sexual minority adults compared to heterosexuals was moderated by household smoking and sex, adjusting for covariates. Results. The main effects of identifying as a sexual minority, being male, and living with a household smoker were all associated with a significantly higher odds of being a current smoker. However, there also was a significant three-way interaction among these variables (adjusted odds ratio = 3.75, 95% confidence interval: 1.33, 10.54). Follow-up analyses by sex indicated that the interaction between sexual identity and household smoking was significant for both males (AOR=6.40, 95% confidence interval: 1.27, 32.28) and females (AOR=0.43, 95% confidence interval: 0.23, 0.81) but was in the opposite direction. Among males, living with a smoker was associated more strongly with greater odds of smoking among gay and bisexual males, compared to heterosexual males. In contrast, among females, living with a smoker was more strongly associated with greater odds of smoking for heterosexuals compared to lesbians and bisexuals. Conclusions. Future research is warranted to examine characteristics of households, including smoking behaviors and composition, to guide more effective and tailored smoking cessation interventions formales and females by sexual orientation. (C) 2015 Elsevier Inc. All rights reserved.