sexual self-identified with same-sex partners in the past 5 years (n = 71), and exclusively heterosexual self-identified reporting no same-sex partners (n = 3,723). The authors found that, relative to the exclusively heterosexual women, the odds of past-year tobacco use were more than three times greater in the bisexual women and two times greater in the heterosexual women reporting same-sex partners. There was no significant difference in past-year tobacco use between the lesbians and exclusively heterosexual women. Using the same data set, Trocki and colleagues (2009) examined tobacco and marijuana use among lesbians (n = 36), gay men (n = 57), heterosexual men (n = 3,201) and women (n = 3,723) with only different-sex partners, bisexual men (n = 27) and women (n = 50), and heterosexual self-identified men (n = 83) and women (n = 71) with same-sex partners. They found that the bisexual and heterosexual women reporting same-sex partners had higher rates of cigarette smoking than the exclusively heterosexual women. They also found significantly higher rates of marijuana use among the bisexual women, lesbians, and heterosexual women with same-sex partners than among the exclusively heterosexual women. Among the gay men, marijuana use was significantly greater and tobacco use was elevated compared with the heterosexual men. These findings suggest that marijuana and tobacco use differ by sexual identity, particularly among women.

With regard to alcohol use, several population-based studies suggest that nonheterosexual women consume alcohol in greater amounts and more frequently and may be at greater risk of alcohol dependency than heterosexual women. Cochran and Mays (2000b) examined differences in psychiatric syndromes among homosexually and heterosexually active women and men in the 1996 National Household Survey of Drug Abuse. Homosexually active women were more likely than other women to be classified as having alcohol or drug dependency syndromes. Other evidence (Gilman et al., 2001), based on the previously mentioned National Comorbidity Survey, provides support for similar differences in alcohol use between women with same-sex and different-sex partners. Women with same-sex partners had a significantly earlier onset of alcohol use disorders than women with different-sex partners.

Burgard and colleagues (2005) examined alcohol use among heterosexually and homosexually experienced women using data from the California Women’s Health Survey, described above. Sexual orientation was based on self-reports of same-gender behavior. Findings revealed that the homosexually experienced women were more likely than the exclusively heterosexually experienced women to consume alcohol more frequently and in greater quantities. Also, recently bisexually active women were more likely than women who were exclusively heterosexually active to report consuming alcohol in the past month, had more drinks per drinking day, and exhibited drinking patterns indicative of being binge drinkers.

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