摘要：Objectives. We examined cross-sectional and longitudinal associations between smoking and romantic attractions and relationships. Methods. We used data from the National Longitudinal Study of Adolescent Health to assess associations of smoking at Waves I and II with same-sex, both-sex, and opposite-sex romantic attractions or relationships as determined at Wave I. We used logistic regression to predict smoking at Wave II by sexual orientation. Results. Both adolescent boys and adolescent girls with both-sex attractions or relationships were significantly more likely than those with opposite-sex attractions or relationships to be current smokers. Adolescent boys and girls with both-sex attractions or relationships who were nonsmokers at Wave I were more likely to be current smokers at Wave II than those with opposite-sex attractions or relationships. Conclusions. Our findings support previous research on smoking among youths who report same-sex or both-sex romantic attractions or relationships and demonstrate the increased risk bisexual youths have for smoking initiation and smoking prevalence. Tobacco use prevention programs targeting gay and bisexual youths are warranted, particularly among adolescent girls and boys who have had both-sex romantic attractions or relationships. In a literature review, Ryan et al. 1 found that smoking among lesbian, gay, and bisexual (LGB) youths was higher than that among youths overall. The review, which included all peer-reviewed, published articles in English from 1987 to 2000, identified 4 studies that included smoking and sexual orientation. Estimated smoking rates for LGB youths ranged from 38% to 59%; national smoking rates during comparable periods ranged from 28% to 35%. Of the 4 studies identified that examined smoking by sexual orientation, 2 were statewide school-based probability surveys and 2 used nonprobability sampling to recruit youths through advertisements or community-based agencies. 2 – 5 The statewide school-based surveys included the 1993 and 1995 Massachusetts Youth Risk Behavior Survey. Both were cross-sectional school-based surveys of students in grades 9 through 12. 2 , 3 The nonprobability-based surveys consisted of convenience samples of young adults. 4 , 5 Prevalence of smoking in these studies, whether defined as current, current daily, or ever smoking, was consistently higher among youths who identified as lesbian, gay, or bisexual than among students who identified as heterosexual. A recent cross-sectional study 6 of youths aged 12 to 17 years that used data from the Growing Up Today Study found that lesbian and bisexual girls were 9.7 times more likely to smoke at least weekly than their heterosexual counterparts. Gay and bisexual boys, by contrast, were not more likely to smoke than their heterosexual counterparts. Although LGB adults, like other economically or socially marginalized people, may be more likely to smoke to manage daily stress, 7 , 8 additional influencing factors such as homophobia and discrimination may be more complex among LGB youths. In general, youths smoke for various reasons, including modeling (i.e., peer influence and norms), social desirability (i.e., presenting oneself in a manner that will be viewed favorably by others), access to cigarettes, risk taking, rebellion against established social norms, low self-esteem, and negative mood states. 9 , 10 For LGB youths, increased risk of depression, feelings of loneliness, attempted suicide, and being physically and verbally victimized may contribute to increased substance use. 11 – 13 Additional factors may include the role of smoking during identity formation; the stress of “coming out”; lack of support from parents, family, and friends; feelings of isolation and loneliness; and antigay harassment, victimization, and violence. 14 , 15 Targeted marketing by the tobacco industry may also play a role in higher rates of smoking among LGB youths. 16 – 18 Given the lack of nationally representative data on adolescent smoking and sexual orientation, we examined the National Longitudinal Study of Adolescent Health (Add Health Study), a longitudinal and nationally representative survey of youths in grades 7 through 12. Using data from Waves I and II, we determined cross-sectional smoking prevalence estimates by sexual orientation and examined longitudinal data to assess the relationship between sexual orientation as determined at Wave I and the onset of smoking by Wave II.
