title: Smoking initiation, tobacco product use, and secondhand smoke exposure among general population and sexual minority youth, Missouri, 2011-2012.
abstract: BACKGROUND
  Research indicates disparities in risky health behaviors between heterosexual and sexual minority (referred to as LGBQ; also known as lesbian, gay, bisexual, queer, and questioning) youth. Limited data are available for tobacco-use-related behaviors beyond smoking status. We compared data on tobacco age of initiation, product use, and secondhand smoke exposure between general population and LGBQ youth.
  
  
  METHODS
  Data for general population youth were from the statewide, representative 2011 Missouri Youth Tobacco Survey, and data for LGBQ youth were from the 2012 Out, Proud and Healthy survey (collected at Missouri Pride Festivals). Age-adjusted Cochran-Mantel-Haenszel tests were used to examine differences between general population (N = 1,547) and LGBQ (N = 410) youth, aged 14 to 18 years. Logistic regression models identified variables associated with current smoking.
  
  
  RESULTS
  The 2 groups differed significantly on many tobacco-use-related factors. General population youth initiated smoking at a younger age, and LGBQ youth did not catch up in smoking initiation until age 15 or 16. LGBQ youth (41.0%) soon surpassed general population youth (11.2%) in initiation and proportion of current smokers. LGBQ youth were more likely to use cigars/cigarillos, be poly-tobacco users, and be exposed to secondhand smoke (SHS) in a vehicle (for never smokers). Older age (odds ratio [OR] = 1.39, 95% confidence interval [95% CI] = 1.18-1.62), female sex (OR = 1.64, 95% CI = 1.13-2.37), LGBQ identity (OR = 3.86, 95% CI = 2.50-5.94), other tobacco product use (OR = 8.67, 95% CI = 6.01-12.51), and SHS exposure in a vehicle (OR = 5.97, 95% CI = 3.83-9.31) all significantly increased the odds of being a current smoker.
  
  
  CONCLUSIONS
  This study highlights a need for the collection of data on sexual orientation on youth tobacco surveys to address health disparities among LGBQ youth.
authors.affiliation: 306 Medical Sciences Bldg, University of Missouri, Columbia, MO 65212. E-mail: jnjxv8@mail.missouri.edu.
authors.forename: Jenna N
authors.initials: JN
authors.lastname: Jordan
authors.affiliation: University of Missouri, Department of Family and Community Medicine, Columbia, Missouri.
authors.forename: Jane A
authors.initials: JA
authors.lastname: McElroy
authors.affiliation: University of Missouri, Department of Family and Community Medicine, Columbia, Missouri.
authors.forename: Kevin D
authors.initials: KD
authors.lastname: Everett
mesh_terms: D000293:Adolescent; D016902:Air Pollution, Indoor / Q000706:statistics & numerical data; D040343:Behavioral Risk Factor Surveillance System; D016000:Cluster Analysis; D004781:Environmental Exposure; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006716:Homosexuality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008913:Minority Groups / Q000523:psychology* / Q000706:statistics & numerical data; D008923:Missouri / Q000453:epidemiology; D018986:Motor Vehicles; D011159:Population Surveillance; D012309:Risk-Taking; D012574:Schools; D012737:Sex Factors; D019529:Sexuality / Q000523:psychology; D012907:Smoking / Q000453:epidemiology*; D013334:Students / Q000523:psychology / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D062789:Tobacco Products / Q000706:statistics & numerical data*; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data*
chemical_list: D014028:Tobacco Smoke Pollution