Gregory L. Greenwood

Battering Victimization Among a Probability-Based Sample of Men Who Have Sex With Men

OBJECTIVES This study measured the prevalence of battering victimization (i.e., experience of psychological/symbolic, physical, and sexual battering) among men who have sex with men (MSM) and identified characteristics of these men. METHODS A probability-based sample of 2881 MSM living in 4 cities completed telephone interviews between 1996 and 1998. RESULTS Prevalence estimates were 34% for psychological/symbolic battering, 22% for physical battering, and 5% for sexual battering. The strongest demographic correlate independently associated with all forms of battering was age 40 or younger, whereas education and HIV serostatus were associated with physical and psychological/symbolic violence. CONCLUSIONS Rates of battering victimization among urban MSM are substantially higher than among heterosexual men and possibly heterosexual women. Public health efforts directed toward addressing intimate partner battering among these men are needed.

Correlates of heavy substance use among young gay and bisexual men: The San Francisco Young Men's Health Study

Correlates of heavy substance use among a household-based sample of young gay and bisexual men (n=428) were identified and the odds ratio (OR) was calculated. A total of 13.6% reported frequent, heavy alcohol use and 43% reported polydrug use. Compared with men employed in professional occupations, men in service positions (OR=3.77) and sales positions (OR=2.51) were more likely to be heavy alcohol consumers. Frequent gay bar attendance and multiple sex partners were related to heavy alcohol use, as well as to polydrug use. Polydrug users were more likely to be HIV seropositive (OR=2.05) or of unknown HIV serostatus (OR=2.78). HIV serostatus was similarly related to frequent drug use. These correlates of heavier substance use among young gay and bisexual men could be used to identify and intervene early with members of this population who are at risk of substance misuse, as well as HIV/AIDS risk.

Cigarette smoking among gay and bisexual men.

OBJECTIVES This study measured the prevalence of cigarette smoking among gay men and identified associations with smoking. METHODS Household-based (n = 696) and bar-based (n = 1897) sampling procedures yielded 2593 gay male participants from Portland, Ore, and Tucson, Ariz, in the spring of 1992. RESULTS Forty-eight percent of the combined sample reported current smoking, a rate far above prevalence estimates for men in Arizona (z = 14.11, P < .001) or Oregon (z = 24.24, P < .001). Significant associations with smoking included heavy drinking, frequent gay bar attendance, greater AIDS-related losses, HIV seropositivity, lower health rating than members of same age cohort, lower educational attainment, and lower income. CONCLUSIONS Rates of cigarette smoking are very high among gay men. Tobacco prevention and cessation campaigns should be designed to reach the gay male community.

Disparities in Smoking Between the Lesbian, Gay, and Bisexual Population and the General Population in California

OBJECTIVES We conducted a large, population-based study to assess tobacco use in Californias lesbian, gay, and bisexual (LGB) population. METHODS Standard measures of tobacco use from 2 separate, statewide household-based studies were used to compare basic prevalence rates in the LGB population and the general population in California. Data were derived from a 2003-2004 survey of LGB individuals living in California as well as from the 2002 version of the California Tobacco Survey, which gathered data on the states general population. RESULTS Smoking prevalence rates were higher in our sample of lesbians, bisexual women, and women who have sex with women than among women in the general California population. In the case of men, the only significant difference was that rates were higher among gay men than among men in the general population. Disparities in tobacco use between the LGB population and the general population were still evident after we controlled for key demographic variables and in comparisons with other tobacco use indicators such as average cigarette consumption. CONCLUSIONS Tobacco control efforts targeting the LGB population are needed to reduce this groups high rate of cigarette smoking.

Tobacco Use and Cessation Among a Household-Based Sample of US Urban Men Who Have Sex With Men

OBJECTIVES We examined tobacco use and cessation among a probability sample of urban men who have sex with men (MSM) living in 4 large US cities. METHODS Of the 2402 men who were eligible for follow-up from a previously recruited probability sample, 1780 (74%) completed tobacco surveys between January and December 1999. RESULTS Current smoking rates were higher for urban MSM (31.4%; 95% confidence interval [CI]=28.6%, 34.3%) than for men in the general population (24.7%; 95% CI=21.2%, 28.2%). Among MSM, 27% were former smokers. A complex set of sociodemographic, tobacco-related, and other factors were associated with cessation. CONCLUSIONS Results support earlier reports that smoking rates are higher for MSM compared with men in the general population. Findings related to cessation underscore the need to target tobacco control efforts for MSM.

Relapse outcomes in a randomized trial of residential and day drug abuse treatment

Relapse outcomes at 6-, 12-, and 18-month intervals were compared between clients randomly assigned to day (n=114) versus residential (n=147) drug abuse treatment. Day clients were more likely than residential clients to relapse 6 months post-admission (OR=3.06, p<0.001); however, no setting differences at 12 or 18 months were found. Few baseline predictors were prospectively related to relapse at 12 and 18 months. These predictors were usual employment status (part-time OR=17.47, p<0.001; full-time OR=2.54, p<0.001), history of drug injecting (OR=5.39, p<0.01), multiple sex partners (OR=1.16, p<0.01), and not having a gay sexual partner (OR=0.05, p<0.03) during 6 months prior to admission. Still, these baseline predictors, together with the existing literature, could be used by drug treatment professionals to identify individuals who may be at high risk for relapse over time, and to offer specialized treatment and aftercare resources as intervention and prevention measures.

Cigar and smokeless tobacco use in the lesbian, gay, and bisexual population

Large population-based studies of alternative tobacco use in the lesbian, gay, and bisexual (LGB) population are needed to more fully measure tobacco use outcomes. This descriptive study used standard measures of alternative tobacco use from two separate, statewide household-based studies to compare basic prevalence rates in the LGB population and the general population in California. A total of 1,950 adult lesbians, bisexual women, heterosexual women who have sex with women, gay men, bisexual men, and heterosexual men who have sex with men, all living in California, completed surveys between 2003 and 2004. From a general population-based sample (California Tobacco Survey, 2002), a total of 11,037 adult women and 9,488 men were used as comparisons. The prevalence rates for lifetime and current cigar smoking and smokeless tobacco use were lower for all LGB subpopulations compared with the general population.

LGBT Tobacco and Alcohol Disparities

The literature is replete with a discussion of the health disparities facing the lesbian, gay, bisexual, transgender (LGBT) population in the United States. Against the backdrop of effective, comprehensive tobacco and alcohol control programs at the state and local levels during the past decade (Fichtenberg, 2000; Scott, 2003) are the high rates of smoking (Stall et al., 1999; Gruskin et al., 2001; Ryan et al., 2001; Greenwood, 2005; Tang, 2004) and drinking (Cochran & Mays, 2000a,b; Greenwood et al., 2001; Gruskin et al., 2001; Stall et al., 2001) reported for the LGBT population. It makes sense that there are tobacco and alcohol health disparities for LGBTs given the evidence of well known risk factors facing this community that other priority populations such as ethnic/racial minorities and lower socioeconomic communities have confronted.

GREENWOOD ET AL. RESPOND

We agree that disparities in health (e.g., physical, behavioral, mental) can indeed be thought of in terms of sexual orientation and gender identification as well as in terms of race/ethnicity. The data reported by Archer and colleagues are consistent with other studies showing that lesbian, gay, bisexual, and transgendered (LGBT) populations experience higher rates of smoking than others.1 Beyond measuring the prevalence of tobacco use, however, we have few data on consumption patterns and rates of tobacco cessation for LGBT populations similar to those that are available for the general population. To address such questions large-scale data sets are typically needed, particularly when they take into account the intersections of race, class, and access to health care to model smoking and cessation outcomes for LGBT populations. The addition of sexual orientation and gender identification questions to ongoing large-scale tobacco use surveys is an essential first step toward addressing LGBT disparities in tobacco use. Furthermore, as Archer and colleagues note, tobacco misuse is just one of a cluster of comorbid conditions that appear to be more prevalent in LGBT populations than in the general population: depression,2 substance abuse,3 HIV/AIDS,4 victimization,5 and childhood trauma.6 These health conditions are known not only to coexist but to interact and amplify each other’s effects in classic syndemic fashion.7 It is possible that reducing the prevalence of these co-occurring problems in LGBT populations might result in a parallel decline in prevalence of tobacco use. At a minimum, it is important that national, state, and local tobacco control efforts work in partnership with LGBT populations to take full advantage of current best-practice models of effective tobacco control programs,8 which include multilevel efforts designed to reduce tobacco-related morbidity and mortality. Finally, in addition to the influence of the tobacco industry’s targeting of LGBT populations, it is important to identify other risk and protective factors associated with smoking and quitting for LGBT smokers. For example, tobacco (and other health) disparities in the LGBT population are likely related to high levels of societal discrimination and daily stress.9 Research is needed to uncover how identity (gender, sexual, and ethnic), socioeconomic status, and other key individual, interpersonal, social, and environmental factors combine to contribute to tobacco use and cessation. In addition, we need to know more about the resilience that helps some LGBT individuals remain smoke-free.