Cigar and smokeless tobacco use in the lesbian, gay, and bisexual population Elisabeth P. Gruskin, Gregory L. Greenwood, Marilyn Matevia, Lance M. Pollack, Larry L. Bye, Victoria Albright Received 31 May 2006; accepted 6 October 2006 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. Introduction Research has shown higher rates of current smoking cigarettes in the lesbian, gay, and bisexual (LGB) population compared with the general population (Greenwood et al., 2005; Tang et al., 2004). In the first statewide random sample of LGB households in California, for example, we (Gruskin, Matevia, Pollack, & Bye, in press) found that 28.7% of lesbians, 26.9% of bisexual women, and 43.6% of women who have sex with women were current smokers compared with 12.1% of women in general. Current smoking rates also were higher in gay men (27.3%) than in men in general (19.7%). No study to date, however, has measured basic indicators of alternative tobacco use in the LGB population and compared these prevalence estimates with those found for the general population. These results are typical of studies on smoking in the LGB population; however, no studies have been published that explore the rates of cigar or smokeless tobacco use. State and national household surveys routinely monitor standard measures of alternative tobacco use in the general population. Cigar use, for example, increased dramatically in the early 1990s in California (Gilpin & Pierce, 1999) and in the rest of the United States. Cigars, in particular, are potent nicotine-delivery devices (Baker, Ainsworth et al., 2000; Baker, Thun et al., 2000). Prevalence rates of smokeless tobacco use among U.S. adult men has been high but with a notable decline from 1987 to 2000 (Nelson et al., 2006). Smokeless tobacco use among adult women, on the other hand, has been low and relatively unchanged since the late 1980s (Nelson et al., 2006). Cigar smoking and smokeless tobacco use are strongly associated with cardiovascular diseases (Henley, Thun, Chao, & Calle, 2004). Alternative tobacco use also is associated with numerous forms of cancer (e.g., esophageal, laryngeal, lung, oral, pan- creatic, and stomach) and other chronic diseases such as emphysema (Alguacil & Silverman, 2004; Chao et al., 2002). Because the use of alternative tobacco products could be perceived incorrectly as safer than cigarette smoking it is critical to understand ISSN 1462-2203 print/ISSN 1469-994X online # 2007 Society for Research on Nicotine and Tobacco DOI: 10.1080/14622200701488426 Elisabeth P. Gruskin, Dr.P.H., Marilyn Matevia, M.Phil., Division of Research at Kaiser Permanente, Oakland, CA; Gregory L. Greenwood, Ph.D., M.P.H., United Behavioral Health, San Francisco, CA; Lance M. Pollack, Ph.D., University of California, San Francisco, San Francisco, CA; Larry L. Bye, M.A., Victoria Albright, M.A., Field Research Corporation, San Francisco, CA. Correspondence: Elisabeth P. Gruskin, Dr.P.H., Kaiser Permanente Division of Research, 2000 Broadway, 3rd floor, Oakland, CA 94612, USA. Tel: +1 (510) 891-3552; Fax: +1 (510) 891-3606; E-mail: lpg@dor.kaiser.org Nicotine & Tobacco Research Volume 9, Number 9 (September 2007) 937–940