Study reveals intersection of sexual orientation and demographic factors in vulnerability to tobacco ads

A new study reveals how an interplay of factors including gender, sexual orientation, race, and ethnicity may influence individuals’ vulnerability to tobacco product advertising, say researchers from Dana-Farber Cancer Institute.

Traditional analyses of disparities in exposure to tobacco advertising have tended to examine differences between population groups based on race, ethnicity, and gender independently, said Andy Tan, MBBS, MPH, MBA, PhD, corresponding author of the report in Tobacco Control published by BMJ. “But these traditional analyses may not give us the whole picture, since in the real world, individuals may belong to more than one marginalized and vulnerable group” such as sexual minorities (individuals who identify as lesbian, gay, or bisexual) who also identify with diverse racial and ethnic groups.

The new study found that young adult bisexual women reported higher levels of exposure to cigarette, e-cigarette, and cigar ads compared to young adult heterosexual women. The authors noted that these results are consistent with previous research showing that young adult bisexual women had 4.0 to 5.5 times higher odds of regularly using cigarettes, e-cigarettes, and cigars compared with young adult heterosexual women. “These findings suggest that increased tobacco product marketing exposure may be an important risk factor associated with tobacco use disparities among young adult bisexual women,” said the authors of the new study.

The study also revealed higher levels of exposure to tobacco product advertising among bisexual women of color, heterosexual black women and men, and heterosexual Hispanic men compared with young adults who were heterosexual white or non-Hispanic.

According to the authors, “These findings inform several future research directions and potential targets for regulatory and public health interventions.” Research is needed to determine the root causes of these differences in tobacco advertising exposure, impact on tobacco use within multiple minority groups, effectiveness of tailored public health education, and impact of industry monitoring.

Tan is an investigator in Dana-Farber’s Center for Community Based Research in the Division of Population Sciences. He and his co-authors on the study, who are from Michigan State University, The Fenway Institute, and Beth Israel Lahey Health, analyzed data on young adults, ages 18 to 24, who participated in the U.S. Population Assessment of Tobacco and Health (PATH) Study in 2013 and 2014. The PATH survey asked respondents about their recollection of ads for cigarettes, electronic cigarettes, cigar, and smokeless tobacco. The survey inquired about demographic variables such as race and ethnicity, and asked whether respondents identified as heterosexual, lesbian/gay, bisexual, or something else (a sexual orientation or identity other than heterosexual, lesbian/gay, or bisexual).

When all these factors were taken into account, the study found that bisexual women had significantly higher prevalence of “encoded exposure” – a term referring to one’s memory of having seen an advertisement – to cigarette and cigar ads compared with heterosexual women. Bisexual women also had significantly higher prevalence of exposure to e-cigarette ads compared with both heterosexual and lesbian/gay women, the researchers found.

There were no significant differences in ad exposure between lesbian versus heterosexual women or between gay or bisexual men versus heterosexual men. Compared with heterosexual white individuals, increased tobacco ad exposure was reported by heterosexual black women (cigarette and cigar ads), black heterosexual men (cigar ads), and bisexual black women (cigarette and cigar ads.) The researchers concluded that “sexual minority women of color and black heterosexual women and men have increased encoded exposure to certain forms of tobacco ads.”

Tan said sexual minorities are at higher risk of tobacco-related cardiovascular and respiratory illness than are heterosexuals, because of greater prevalence of cigarette smoking and other tobacco use and are potentially at higher risk of developing tobacco-related cancers, although there are no published data on this point. Tan said that sexual minorities are especially susceptible to starting tobacco use for a variety of reasons, including “the tobacco industry’s targeted marketing among sexual, racial, and ethnic minorities.”

 “What we don’t know is whether people of color who also identify as LGB are even more exposed than their heterosexual white counterparts,” he said.

 The availability of data from the large PATH study enabled Tan and his colleagues to examine the intersection of these factors. The PATH study included more than 9,000 young adults. Approximately 1% identified as female and lesbian/gay, 4% as female and bisexual, and 1% as female and other sexual identities. One percent identified as male and gay, 1% as male and bisexual, and 1% as male and other sexual identities.

In the PATH study, each individual was shown 20 tobacco advertisements selected from a pool of more than 900 print, television, or internet ads. They were asked if they had seen the advertisement in the past 12 months. If they answered yes, the individuals were considered to have had “encoded exposure” to the ad.