title: Community-level determinants of tobacco use disparities in lesbian, gay, and bisexual youth: results from a population-based study.
abstract: OBJECTIVE
  To determine whether characteristics of the social environment surrounding lesbian, gay, and bisexual (LGB) youth contribute to their rates of tobacco use after controlling for established community-level risk factors.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Population-based study of youth.
  
  
  METHODS
  A total of 31,852 eleventh-grade students (1413 LGB individuals [4.44%]) in Oregon completed the Oregon Healthy Teens survey in 2006-2008.
  
  
  METHODS
  We created a composite index of the social environment in 34 Oregon counties. This measure included the proportion of same-sex couples, the presence of gay-straight alliances in schools, and school policies (nondiscrimination and antibullying) that specifically protected LGB students.
  
  
  METHODS
  Any tobacco use in the past 30 days.
  
  
  RESULTS
  A more supportive social environment for LGB youth was significantly associated with reduced tobacco use (odds ratio, 0.92; 95% confidence interval, 0.90-0.94). This effect remained robust after controlling for sociodemographic variables and multiple community-level risk factors for tobacco use, including median county-level income, exposure to cigarette advertisements, exposure to teacher and peer smoking in schools, and school smoking rules.
  
  
  CONCLUSIONS
  This study documents an association between an objective measure of the social environment and sexual orientation-related disparities in tobacco use. These results highlight the need for structural-level interventions that reduce smoking behaviors in LGB youth.
authors.affiliation: Center for the Study of Social Inequalities and Health, Columbia University, New York, NY 10032, USA. mlh2101@columbia.edu
authors.forename: Mark L
authors.initials: ML
authors.lastname: Hatzenbuehler
authors.forename: Nicolien F
authors.initials: NF
authors.lastname: Wieringa
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Keyes
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001727:Bisexuality / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D020010:Heterosexuality / Q000706:statistics & numerical data; D018452:Homosexuality, Female / Q000706:statistics & numerical data*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D016017:Odds Ratio; D009922:Oregon; D012016:Reference Values; D012111:Residence Characteristics; D018570:Risk Assessment; D012907:Smoking / Q000453:epidemiology* / Q000208:ethnology; D012931:Social Environment; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires