Tobacco Exposure And Influencing Factors Among Lesbian,Gay,Bisexual(LGB) College Students In China

Objective: To understand the epidemic characteristics and influencing factors of cigarette use,e-cigarette use and dual use of cigarette and e-cigarette among LGB college students,as well as the second-hand smoke exposure of non-smokers,so as to identify the high-risk subgroups of tobacco exposure among LGB(Lesbian,Gay and Bisexual)college students,and provide targeted information for tobacco-related prevention and control strategies and interventions in colleges and universities.Methods: A questionnaire survey was conducted by the snowball sampling method among college students self-reported as homosexual or bisexual,who were recruited from social applications(i.e.,Blued,Soul,the L and Lesfun)and QQ groups named “Rainbow Wall” of universities(popular online chatting rooms in China)from May to September in 2021.The survey collected their demographic characteristics,tobacco exposure,alcohol use,psychological condition and sexual minority stress.Multinomial logistic regression model was performed to explore correlates of smoking status and the quantity of smoking.Binary logistic regression model was used to analyze influencing factors of current e-cigarettes use,dual use,and second-hand smoke exposure.And ordinal logistic regression model was used to analyze influencing factors of frequency of second-hand smoke exposure.Results:(1)Of 1635 LGB college students,approximately 7.1% were former smokers and 7.5% were current smokers.Female(AOR=3.78,95%CI: 2.32-6.15,P<0.001),current drinking(AOR=2.87,95% CI: 1.91-4.31,P<0.001),and depression(AOR=1.02,95% CI: 1.00-1.04,P=0.038)was positively associated with former cigarette use.Female(AOR=1.59,95% CI: 1.01-2.50,P=0.044),monthly expenses at and above 2000 yuan(AOR=1.84,95%CI: 1.22-2.78,P=0.004),current drinking(AOR=4.50,95% CI: 2.94-6.88,P<0.001),and depression(AOR=1.03,95%CI: 1.01-1.05,P=0.005)was positively associated with current cigarette use,while internalized homophobia(AOR=0.97,95%CI: 0.94-1.00,P=0.058)was negatively associated with current cigarette use.(2)Among 1632 LGB college students who reported the daily amount of smoking,approximately 5.6% were light smokers and 1.7% were moderate or heavy smokers.Homosexual(AOR=4.73,95%CI: 1.37-16.38,P=0.014),monthly expenses at and above 2000 yuan(AOR=3.31,95%CI: 1.47-7.45,P=0.004),current drinking(AOR=6.37,95%CI: 2.48-16.36,P<0.001)and depression(AOR=1.04,95%CI:1.00-1.08,P=0.058)was positively associated with moderate or heavy smoking,whereas friend support(AOR=0.92,95%CI: 0.85-1.00,P=0.051)may decrease the likelihood of moderate or heavy smoking.(3)Approximately 3.2% are current e-cigarette users among 1635 LGB students.Urban residents(AOR=2.60,95%CI: 1.16-5.81,P=0.020),monthly expenses at and above 2000 yuan(AOR=2.12,95%CI: 1.16-3.86,P=0.015),current drinking(AOR=3.30,95%CI: 1.75-6.24,P<0.001),LGBT violence(AOR=1.07,95%CI: 1.01-1.13,P=0.023),friend support(AOR=1.08,95%CI:1.01-1.16,P=0.023)and depression(AOR=1.03,95%CI: 1.00-1.07,P=0.038)was positively associated with current e-cigarette use,while internalized homophobia(AOR=0.93,95%CI: 0.88-0.97,P=0.001)was negatively associated with current ecigarettes use.(4)Of 144 current tobacco users,77.8% were single users and 22.2%were dual users.Freshmen(AOR=8.14,95%CI: 1.84-35.97,P=0.006),LGBT violence(AOR=1.11,95%CI: 1.00-1.22,P=0.059)and friend support(AOR=1.10,95%CI: 1.00-1.22,P=0.054)was positively associated with dual use of cigarettes and e-cigarettes.(5)36.2% were exposed to second-hand smoke among 1512 non-current smoking LGB college student.Junior college(AOR=1.69,95%CI: 1.05-2.74,P=0.031),third grade and above(AOR=1.75,95%CI: 1.28-2.39,P<0.001),humanities and social sciences major(AOR=1.39,95% CI: 1.09-1.75,P=0.007),current drinking(AOR=1.55,95% CI:1.24-1.93,P<0.001)and depression(AOR=1.02,95%CI: 1.01-1.03,P=0.007)were positively associated with the prevalence of second-hand smoke exposure.(6)Of 1512non-current smoking LGB college students,7.1% were exposed to second-hand smoke almost every day,4.0% were exposed 4-6 days per week,and 25.1% were exposed 1-3days per week.Junior college(AOR=2.07,95%CI: 1.33-3.21,P=0.001),third graders and above(AOR=1.75,95%CI: 1.29-2.37,P<0.001),humanities and social sciences major(AOR=1.48,95%CI: 1.18-1.86,P=0.001),current drinking(AOR=1.52,95%CI:1.23-1.89,P<0.001)and depression(AOR=1.02,95%CI: 1.01-1.03,P<0.001)were positively associated with the frequency of second-hand smoke exposure.Conclusion:(1)The prevalence of current smoking and moderate or heavy smoking among LGB college students in China was slightly at a low level,but female,homosexual,current drinking,higher monthly expenses and depression students was likely to smoking,which should be focused on in tobacco control interventions.(2)The prevalence of e-cigarette use among LGB college students was not optimistic in China.Colleges and universities should carry out tobacco control publicity and education for students in urban areas,higher monthly expenses,current drinking,LGBT violence,higher level of friend support and depression.(3)Dual use of cigarette and e-cigarette among LGB college students was widespread in China.We should concentrate on freshmen and those with higher LGBT violence and depression,work at tobacco-related publicity and education,and strengthen peer education and anti-discrimination education to reduce their risks of dual-use behaviors.(4)The prevalence and frequency of second-hand smoke exposure among non-smoking LGB college students in China was at a high level,especially for junior college students,third-year students and above,students majoring in humanities and social sciences,current drinkers,and those with depression.It is recommended that relevant departments take those students as key groups and carry out targeted tobacco control education to strengthen the risky avoidance awareness.