Does coming out about sexual identity increase the likelihood of smoking?


Children and teenagers who are LGBT have been shown to engage in some risky behaviors, moreso than their contemporaries. A new investigation looks at whether they are more likely to smoke or start smoking than their peers.

Previous research has shown that children and teenagers who are LGBT engage in some likely harmful behaviors at a higher rate than their non-LGBT peers. An investigation in JAMA Pediatrics examines whether teenagers who come out are more likely to start smoking and then maintain smoking than their peers who are heterosexual or who have had a consistent LGB+ identity.1

The researchers used data from the Population Assessment of Tobacco and Healthy Study, which was nationally representative. The data were from 4 waves: wave 1, 2013-2014; wave 2, 2014-2015; wave 3, 2015-2016; and wave 4, 2016-2018. Teenagers and young adults aged 14 to 29 years who were never smokers at wave 1 of the study were included in the study. Identities were distinguished as bisexual, lesbian, gay, and other nonheterosexual identities.

There were 7843 people in wave 1 who had never smoked. In this cohort, 6991 of the participants said that their sexual identity had been consistent across the waves and 852 of the participants had come out about their sexual identity across the waves. The average baseline age for a participant who reported consistent heterosexuality was 20.1 years; for consistently LGB + participants it was 20.0 years; coming out at LGB+, 18.0 years; and for other LGB+ patterns it was 20.3 years. At wave 4, a total of 14.1% (weighted) had initiated smoking and 6.3% were current smokers. When compared to participants with a consistently heterosexual identity, consistently LGB+ identities (17% vs 13%; odds ratio [OR], 1.45; 95% CI, 1.03-2.04), other LGB+ patterns (17% vs 13%; OR, 1.47; 95% CI, 1.04-2.08), and coming out as LGB+ (23% vs 13%; odds ratio [OR], 1.72; 95% CI, 1.34-2.20) were all positively linked with initiating smoking by wave 4. When compared with consistently heterosexual identities, the ORs for smoking initiation were 1.99 (23% vs 13%; 95% CI, 1.20-3.29) for consistently LGB+ with change to/from bisexual, 2.24 (28% vs 13%; 95% CI, 1.72-2.92) for coming out as bisexual, and 2.20 (23% vs 13%; 95% CI, 1.40-3.46) for other LGB+ patterns with change to/from bisexual identity.

The investigators concluded that coming out was linked with smoking initiation and current smoking, when compared to consistent heterosexual identity. Additionally, this risk was particularly noted in participants who either came out as bisexual or reported a change to/from being bisexual. They urged further research to determine the mechanisms behind the association.


1. Harlow A, Lundberg D, Raifman J, et al. Association of coming out as lesbian, gay, and bisexual+ and risk of cigarette smoking in a nationally representative sample of youth and young adults. JAMA Pediatr. October 26, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.3565

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