Scholars suggest that smoking is currently one of the most critical issues for the LGBT population.1
LESBIAN, GAY, BISEXUAL, AND TRANSGENDER
Note: It is important to keep in mind that while most researchers study Lesbian, Gay, Bisexual and Transgender individuals as one group, some researchers study Lesbian, Gay and Bisexual individuals as a separate community from Transgender individuals.
Press Release: MDQuit's 11th annual Best Practices Conference addresses tobacco use and cessation among the LGBT population. Read Here.
Smoking and the LGBT community
Lesbian, Gay, Bisexual, and Transgender (LGBT) smokers have several social, historic, and individual risk factors that make them a priority population of concern with regard to tobacco prevention and cessation. Studies reveal that the LGBT community has higher smoking rates than heterosexual individuals.1-3 The American Cancer Society estimates that in 2019 approximately 45,000 LGBT people die due to cancer per year and with cigarette smoking being the leading cause of lung cancer and linked to 11 other types of cancer this is a significant link to be explored within this population.4 For example, data from the 2020 National Health Interview Survey reported that 16.1% of lesbian, gay, or bisexual (LGB) adults smoked cigarettes – compared with 12.3% of heterosexual adults.1 Use of any commercial tobacco product was also higher among LGB, compared to heterosexual adults (25.1% vs 18.8%).1 Most notable was that this survey found that those of the LGB community utilized e-cigarettes more than double the rate of heterosexual adults (8.7% vs 3.5%).1 A similar trend has been noted within the transgender community where transgender adults have more than 4 times the prevalence in current use of a commercial tobacco product than adults who are not transgender, also known as cisgender, (21.3% transgender vs. 5.0% cisgender).2
In terms of cessation, LGBTQ populations often are concerned with or have experienced stigmatization or discrimination from healthcare professionals which can lead them to be less likely to seek medical care; this mistreatment is especially noted within the transgender community where 23% avoided healthcare they needed because of these issues.5 Anticipated discrimination being perpetrated by healthcare professionals may be snubbing conversations around cessation out before they can even begin. Recent research has also shown that LGB smokers report less prevalent usage of cessation counseling or medication (14.5%) than heterosexual smokers (31.7%).6 Additionally, LGBT smokers are more likely to smoke menthol cigarettes than heterosexual smokers (36.3% vs 29.3%), which is important to note as menthol cigarettes are generally easier to use, yet harder to quit which puts them at higher risk for tobacco-related diseases.7
Influences and risk factors
There are several possible factors contributing to increased smoking prevalence in the LGBT community. Not only are LGBT individuals faced with normal, daily stressors, but also with discrimination, stigma, and unjust policies and practices which can lead to a lack of access to adequate care/ treatment. As a result, members of this community who experienced high levels of past-year sexual orientation discrimination reported a higher probability of past-year cigarette smoking than those with lower levels of discrimination.8 In general, sexual minorities, and sexual minority women (SMW) in particular face stress related to their sexual minority identity, which places them at a higher risk for smoking compared with the general population.9 For example, women who are part of a sexual minority group, where smoking is prevalent, are more likely to smoke to feel a sense of belonging to that particular group.10
It has been shown that the gay community has been targeted by the tobacco company since 1938 with the focus being to normalize tobacco use within the LGBT community.11 For example, Big Tobacco created a campaign named “Subculture Urban Marketing” or “Project Scum,” which targeted the LGBT community (specifically youth) and the homeless in the early 1990s.12 Targeted campaigns are still an issue, as the tobacco industry continues to campaign specifically in geographic locations with higher LGBT populations and social settings such as bars frequented by members of the gay community.12 Additionally, Big Tobacco has utilized marketing efforts including sponsoring pride parades and providing funds to AIDS and LGBT organizations.13 LGBT adults reported greater exposure to e-cigarette advertising and coupons or discounts for tobacco products where higher levels of tobacco media exposure were significantly associated with a higher likelihood of tobacco use.14
LGBT Youth Smoking & Risk Factors
Percentages of Current Use of Tobacco Products from the 2018-2019 Youth Risk Behavior Survey (YRBS) for Maryland
LGBT youth, similar to the LGBT adult community, are at higher risk for smoking than their non-LGBT peers. Among middle school students, any current tobacco product use was 3 times higher for LGB youth than heterosexual youth.15 Data collected in 2020 noted that about 1 in 5 LGB middle and high school students currently used electronic cigarettes in 2020 compared to about 1 in 8 heterosexual students.16
Studies of LGBT youth have found that this population experiences higher rates of depression, suicidality, and substance use when compared to the heterosexual community population.17 LGBT victimization and psychological distress were both correlated with a higher probability of smoking and predicted heavier smoking (i.e., greater number of cigarettes smoked).18 Research has found that substances are used by LGBT youth as a coping mechanism for discrimination and social rejection (by parents and others).17 Furthermore, a survey provided evidence that LGBT youth suffer from more verbal and physical abuse than their non-LGBT peers. Such abuse has been found to have an effect on negative health behaviors, making this population more sensitive to experimenting with and abusing substances.17
Current Treatment Research
Several health organizations have pointed out the need to create specific tobacco cessation programs for the LGBT community; however, very few studies have researched the efficacy of tailored interventions for this population.
A recent evaluation of a community-based LGBT group smoking cessation treatment showed that 42.4% of participants completed more than 75% of the sessions, with 32.3% self-reporting cessation at the end of treatment.19 These results are comparable to smoking cessation rates in the general population. Similar results have been found in other tailored-smoking cessation studies in this community.20 Specifically, The Last Drag, an LGBT specific smoking intervention program, found that 46% of participants completed the program. The program had an overall quit rate of 59%, and between 36% and 65% of program completers were still tobacco free at 6 months.20 However, more research on effective interventions in this community is warranted.
Possible Future Directions for Prevention Efforts among LGBT Youth
A survey was conducted among the LGBT youth in a community to find out what they would consider an effective preventative effort.21 This survey was given to youth who identified themselves as gay, lesbians, and transgender, and who were currently smoking or had recently quit smoking. It was also given to individuals who had knowledge on the subject of smoking among LGBT youth (e.g., parents). Some of their suggestions for effective preventive interventions included:
- Discussing tobacco effects and cessation
- Building social support/boosting an individual’s self-esteem
- Creating culturally specific approaches (age, ethnicity)
- Creating programs sensitive to specific issues for the LGBT youth community
Another survey conducted among the LGBT youth found that 90% of the LGBT youth would prefer LGBT-specific interventions. The majority of respondents suggested that ex-smokers (56%) and physicians (55%) should teach the classes.21
Based on these surveys, LGBT youth could benefit from and would prefer tailored interventions. In addition, since sexual identification stress is central to tobacco consumption, it is important for these LGBT interventions to incorporate positive identity formation, address psychosocial problems, and be culturally sensitive to obtain positive results.
Smokefree.gov & ThisFreeLife: This website provides tobacco cessation resources like apps, text programs, and Instagram. “This Free Life is a campaign that proudly celebrates the lives of the lesbian, gay, bisexual, and transgender (LGBT) community. We wave our colors high and seek to improve LGBT people’s health by encouraging tobacco-free lifestyles. We focus on tobacco because of the damage it is causing in our community. Think about all the progress we’ve made. We’ve simply come too far to set ourselves back by using tobacco. This Free Life wants to keep our momentum going by encouraging our community to live tobacco-free.”
The National Networks for Tobacco Control and Prevention: Gay American Smoke Out "The Gay American Smoke Out is an opportunity for Lesbian, Gay, Bisexual and Transgendered (LGBT) individuals to challenge themselves to quit smoking. It is also an opportunity for LGBT organizations to provide resources for quitting and host fun events to raise awareness about tobacco use."
Chase Brexton Health Services (CBHS), Inc., The Last Drag (Baltimore, MD): Chase Brexton offers "The Last Drag" smoking cessation classes at their Mt. Vernon Center free-of-charge, which the Baltimore City Health Department helps fund. Chase Brexton is a "growth oriented provider of patient-centered interdisciplinary health care for our diverse communities including those individuals who are gay, lesbian, bisexual, and transgender; HIV infected and affected; and all others who face barriers accessing quality health care." Check out Chase Brexton's LGBT Health Resource Center.
LGBT HealthLink: a network of experts and professionals who aim to improve LGBT health by promoting best practices for tobacco reduction and other health disparities.
1. Cornelius, M. E., Loretan, C. G., Wang, T. W., Jamal, A., & Homa, D. M. (2022). Tobacco product use among adults - United States, 2020. Morbidity and Mortality Weekly Report, 71(11), 397–405. https://doi.org/10.15585/mmwr.mm6946a4
2. Buchting, F. O., Emory, K. T., Scout, Kim, Y., Fagan, P., Vera, L. E., & Emery, S. (2017). Transgender use of cigarettes, cigars, and e-cigarettes in a National Study. American Journal of Preventive Medicine, 53(1), e1–e7. https://doi.org/10.1016/j.amepre.2016.11.022
3. Operario, D., Gamarel, K. E., Grin, B. M., Lee, J. H., Kahler, C. W., Marshall, B. L., & ... Zaller, N. D. (2015). Sexual minority health disparities in adult men and women in the United States: National Health and Nutrition Examination Survey, 2001–2010. American Journal of Public Health, 105(10), e27-e34. doi:10.2105/AJPH.2015.302762
4. American Cancer Society. Cancer Facts & Figures, 2020. [accessed 2022 July 28].
5. James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). Executive Summary of the Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.
6. Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quitting Smoking Among Adults — United States, 2000–2015 (2017). Morbidity and Mortality Weekly Report, 65,1457–1464. DOI: http://dx.doi.org/10.15585/mmwr.mm6552a1.
7. Fallin, A., Goodin, A. J., and King, B. A. (2015). Menthol cigarette smoking among lesbian, gay, bisexual, and transgender adults. American Journal of Preventative Medicine, 48(1), 93-97. doi: 10.1016/j.amepre.2014.07.044.
8. McCabe, S. E., Hughes, T. L., Matthews, A. K., Lee, J., West, B. T., Boyd, C. J., & Arslanian-Engoren, C. (2019). Sexual orientation discrimination and tobacco use disparities in the United States. Nicotine & Tobacco Research, 21(4), 523–531. https://doi.org/10.1093/ntr/ntx283
9. King, B. A., Dube, S. R., & Tynan, M. A. (2012). Current tobacco use among adults in the United States: Findings from the National Adult Tobacco Survey. American Journal of Public Health, 102(11), e93-e100. doi:10.2105/AJPH.2012.3010027
10. Youatt, E. J., Johns, M. M., Pingel, E. S., Soler, J. H., & Bauermeister, J. A. (2015). Exploring young adult sexual minority women's perspectives on LGBTQ smoking. Journal of LGBT Youth, 12(3), 323–342. https://doi.org/10.1080/19361653.2015.1022242
11. Washington, H.A. (2002). Burning love: Big tobacco takes aim at LGBT Youths. American Journal of Public Health, 92(7) 1086-1095.
12. Stevens, P., Carlson, L.M., Hinman, J.M. (2004). An analysis of tobacco industry marketing to lesbian, gay, bisexual, and transgender (LGBT) populations: Strategies for mainstream tobacco control and prevention. Health Promotion and Practice 5(3) 129-134. doi: 10.1177/1524839904264617.
13. Truth Initiative (6 October 2016). LGBT History Month: Why are Smoking Rates Higher in LGBT Communities? Retreived from http://truthinitiative.org/news/why-are-smoking-rates-higher-lgbt-commun....
14. Emory, K., Buchting, F. O., Trinidad, D. R., Vera, L., & Emery, S. L. (2019). Lesbian, gay, bisexual, and transgender (LGBT) view it differently than non-LGBT: Exposure to tobacco-related couponing, e-cigarette advertisements, and anti-tobacco messages on social and traditional media. Nicotine & Tobacco Research, 21(4), 513–522. https://doi.org/10.1093/ntr/nty049
15. Gentzke, A. S., Wang, T. W., Cornelius, M., Park-Lee, E., Ren, C., Sawdey, M. D., Cullen, K. A., Loretan, C., Jamal, A., & Homa, D. M. (2022). Tobacco product use and associated factors among middle and high school students - National Youth Tobacco Survey, United States, 2021. Morbidity and Mortality Weekly Report, 71(5), 1–29. https://doi.org/10.15585/mmwr.ss7105a1
16. Gentzke, A. S., Wang, T. W., Jamal, A., Park-Lee, E., Ren, C., Cullen, K. A., & Neff, L. (2020). Tobacco product use among middle and high school students - United States, 2020. Morbidity and Mortality Weekly Report, 69(50), 1881–1888. https://doi.org/10.15585/mmwr.mm6950a1
17. Heck, N. C., Flentje, A., & Cochran, B. N. (2011). Offsetting risks: High school gay-straight alliances and lesbian, gay, bisexual, and transgender (LGBT) youth. School Psychology Quarterly, 26(2), 161-174.
18. Newcomb, M. E., Heinz, A. J., Birkett, M., & Mustanski, B. (2014). A longitudinal examination of risk and protective factors for cigarette smoking among lesbian, gay, bisexual, and transgender youth. Journal of Adolescent Health, 54(5), 558-564. doi:10.1016/j.jadohealth.2013.10.208.
19. Matthews, A. K., Li, C., Kuhns, L. M., Tasker, T. B., & Cesario, J. A. (2013). Results from a community-based smoking cessation treatment program for LGBT smokers. Journal of Environmental and Public Health, 2013984508. doi:10.1155/2013/984508
20. Eliason, M. J., Dibble, S. L., Gordon, R., & Soliz, G. B. (2012). The last drag: an evaluation of an LGBT-specific smoking intervention. Journal of Homosexuality, 59(6), 864-878. doi: 0.1080/00918369.2012.694770
21. Remafedi, G., & Carol, H. (2005). Preventing tobacco use among lesbian, gay, bisexual, and transgender youths. Nicotine & Tobacco Research, 7(2), 249-256.