The objective of this study is to assess the health, healthcare utilization, and economic impacts of smoking in the CA lesbian, gay, bisexual, and transgender (LGBT) population. While studies of smoking among many other marginalized subpopulations have long since been completed, such studies have not been conducted for the LGBT population. This absence of research, coupled with the documented high smoking rates within LGBT communities, means that community members lack salient information about smoking behavior and the resulting costs within their identity group. CA has a large self-identified LGBT population. There are data uniquely available for CA that include information on sexual identity, smoking behavior, health, and healthcare utilization. Thus, CA is an ideal place to conduct a study of the impact of smoking on the LGBT population. This study will be the first to analyze the health and economic impact of the high smoking rates in the CA LGBT community and also the first to look at the impact of smoking on nonsmokers through the analysis of the impact of SHS in this group.
This study is based on the premise that the LGBT population has characteristics and smoking behaviors that make it more vulnerable to negative smoking-related health outcomes, and lead to higher smoking-related healthcare utilization and costs compared to the heterosexual population. The study will address four specific aims using data from the 2001-2011 CA Health Interview Survey:
Aim 1: Determine smoking prevalence, smoking patterns, and SHS exposure of LGBTs; compare these with heterosexuals; and analyze changes in these measures over the decade from 2001 to 2011.
Aim 2: Compare specific health outcomes among CA LGBT smokers, LGBT never smokers, and heterosexual smokers. Compare specific health outcomes among CA LGBT nonsmokers who are exposed to SHS, LGBT nonsmokers who are not exposed to SHS, and heterosexual nonsmokers who are not exposed to SHS.
Aim 3: Assess healthcare utilization and costs among CA LGBT smokers, and compare these with LGBT never smokers and with heterosexual smokers. Assess healthcare utilization and costs among LGBT nonsmokers exposed to SHS and compare these with heterosexual nonsmokers exposed to SHS.
Aim 4. Estimate the number of deaths attributable to smoking and secondhand smoke exposure among LGBT adults in CA.
Econometric models will be used to analyze the impact of sexual identity on smoking behavior controlling for sociodemographics and other risk factors. Smoking-attributable deaths will be determined for 22 fatal diseases causally linked to smoking and 2 diseases causally linked to SHS exposure.
This project is responsive to Research Priority 4: Prevent and reduce the use of tobacco products and tobacco-related health disparities in CA's disproportionately impacted populations and advance our knowledge regarding the neuroscience of addiction. Previous studies suggest that tobacco has not been considered to be an “LGBT” issue and the harms of tobacco have been largely minimized or ignored by the LGBT community. The results of this study will provide information that can be used to inform the LGBT community about the toll from tobacco in terms of morbidity, mortality, and health care costs. The project is also responsive to Research Priority 5: Advance the ability of communities throughout California to assess and limit the influence of the tobacco industry. While the targeting of the LGBT community by the tobacco industry has been documented in a number of studies, the community response has not reflected an acknowledgement of the resulting harms. This project will provide much-needed data that can be used to substantiate the negative health and economic impact of smoking on LGBT smokers and nonsmokers alike. This information is necessary to begin to counteract the powerful marketing efforts of the tobacco industry.