Risk factors that could be considered unique to sexual minorities included internalised homophobia and reactions to disclosure of sexual orientation. It is unclear whether there is empirical evidence examining if either socialisation at bars or targeted marketing bear significantly on the epidemic of tobacco use among sexual minority populations. A total of abstracts were reviewed independently, with 26 papers meeting all inclusion criteria. Thus, the variability in operationalising sexual minority status decreases the probability of having enough study samples similarly defined in a way to justify combining them. Additionally, gay bars are steeped in LGBT history as places of advocacy and socialisation within a safe space.
Risk factors that could be considered unique to sexual minorities included internalised homophobia and reactions to disclosure of sexual orientation. Methods Sets of terms relevant to sexual minority populations and cigarette smoking were used in a simultaneous search of 10 databases through EBSCOhost. There is robust evidence, through independent research 47 - 49 and tobacco industry-authored documents, 50 , 51 that sexual minority populations have been specifically marketed to by tobacco companies. See figure 1 for results of initial abstract review. Specific search parameters included reviewing only the peer-reviewed literature for articles up to January Systematic reviews typically take one of two forms: For inclusion, the paper must have: The search term consisted of the following: At best, a researcher who measures all three components of sexual orientation must navigate disparate responses across each category, and at worst, a researcher risks selection bias by measuring only one category. Some studies also indicated common smoking risk factors experienced at higher rates among sexual minorities, including stress, depression, alcohol use and victimisation. Most recently, the Institute of Medicine issued a consensus report confirming deficits in knowledge about sexual minority health and urging sexual and gender minority demographics be collected in federally-funded surveillance. Results Studies used various measures of sexual orientation and of smoking. It is unclear whether there is empirical evidence examining if either socialisation at bars or targeted marketing bear significantly on the epidemic of tobacco use among sexual minority populations. Studies were excluded if they only reported differences in smoking prevalence or only discussed theoretical risk factors ie, did not empirically investigate relationships among variables. More generally, although prevalence studies of smoking are numerous, 3 , 53 , 54 the breadth of research about potential reasons for elevated smoking among sexual minorities lacks summary and synthesis. While this systematic review focuses on the synthesis of empirical results and not a synthesis of theories, frameworks, or models applied to sexual minority smoking, there is a common theoretical underpinning to much of sexual minority health disparities research. Additionally, gay bars are steeped in LGBT history as places of advocacy and socialisation within a safe space. Government and foundation funds should be directed towards research on the origins of this disparity. For inclusion, the paper was required to: Thus, the variability in operationalising sexual minority status decreases the probability of having enough study samples similarly defined in a way to justify combining them. Second, research with sexual minority populations remains challenged by the limited number of studies available and by wide variations in quality. Blosnich and colleagues found that a sample of sexual minority college students had higher prevalence of acute respiratory illnesses eg, bronchitis, sinus infection, strep throat than their heterosexual peers, and that smoking mediated some of the association between sexual orientation and respiratory outcomes. Although studies on smoking among lesbian, gay and bisexual ie, sexual minority populations first identified inequalities in smoking prevalence through convenience samples, 4 - 12 a growing number of probability-based studies confirm the disparity. First, research with sexual minorities differs substantially from that of different minority groups given the variable ways in which researchers measure sexual minority status: This is especially the case when there are smoking risk factors that are either 1 unique to sexual minority populations eg, internalised homophobia or 2 common among the general population but experienced at disparately higher rates among sexual minorities eg, depression. Additionally, 17 abstracts that were not in the search results, but potentially met the inclusion criteria were identified by the authors through citations, resulting in a total of abstracts for review.
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