Substance Use
Sexual orientation disparities in perinatal tobacco use Sarah McKetta* Sarah McKetta Brittany Charlton
Introduction. Sexual minority women—SMW, i.e., those with same-sex partners, attractions, or lesbian/bisexual sexual orientation identities—have twice the risk of cigarette smoking as their heterosexual peers. During pregnancy, SMW are 50% more likely to smoke cigarettes than heterosexual women, with bisexual women having the highest risks. The prenatal period is a critical time not only for fetal development but also as an opportunity for healthcare engagement and to encourage women to start healthy habits, like smoking cessation, that may persist long after the pregnancy. However, very few studies have examined tobacco use across the perinatal period, i.e., from conception to the postpartum.
Methods. Using data from Nurses’ Health Study 3, we investigate sexual orientation disparities in cigarette smoking at various timepoints: study baseline, prior to conception, during pregnancy, and in the postpartum. Participants’ sexual orientation was categorized as completely heterosexual; heterosexual with same-sex attractions/behaviors or prior identity; bisexual; mostly heterosexual; lesbian/gay. We used log-binomial general estimating equations controlling for age, marriage status, and education, and multiple imputation for missing data.
Results. Relative to heterosexual participants, SMW reported more tobacco use at study baseline (risk ratio [RR]: 1.98 [1.35–2.89]), prior to conception (RR: 1.70 [1.27–2.29]), and in the postpartum (RR: 2.36 [1.35–4.13]), but not during pregnancy (RR: 1.67 [1.00–2.79]). Bisexual women had the highest risk both at baseline (RR: 2.55 [1.23–5.29]) and prior to conception (RR: 1.91 [1.09–3.36]), but lesbian women had the highest risk at postpartum (Figure 1; RR: 5.76 [1.88–17.60]).
Conclusion. Compared to heterosexual women, SMW were more likely to use tobacco before and after pregnancy, suggesting the need for clinicians to tailor perinatal anti-smoking efforts to this population.
