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Special Populations > Lesbian, Gay, Bisexual, Transgender
Scholars suggest that smoking is currently one of the most critical issues for the LGBT population.1
Last updated: May 09, 2012
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 reserachers study Lesbian, Gay and Bisexual individuals as a separate community from Transgender individuals.
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 regards to tobacco prevention and cessation. Studies reveal that the LGBT community has higher smoking rates than heterosexual individuals.1 2 5 6 Scholars suggest that smoking is currently one of the most critical issues for this population.1 The American Cancer Society estimates that approximately 30,000 LGBT people die due to tobacco related diseases per year.8 In a study conducted by Greenwood and colleagues (1999) examining data from the Gay Men’s Tobacco study found that sexual minority men smoke at significantly higher rates, regardless of education level (at 31.4% compared to 24.7%). 2
To better understand if this population is at increased risk for smoking compared to the general population, Ryan and colleagues (2001) reviewed 12 studies that included lesbian, gay, and bisexual (LGB) smokers, all of which were conducted between 1987 and 2000. They found that smoking rates ranged from (38% to 59%) among LGB youth and from (11% to 50%) among LGB adults over this period. These rates are higher than the national smoking rates during the same period, ranging from 28% to 35% for adolescents and 28% for adults.1
Influences and risk factors
There are several possible factors contributing to increased smoking prevalence for the LGBT community. LGB people not only have to deal with normal, daily stressors, but also have to deal with discrimination due to their sexual orientation.1 For this reason, those in the LGB community can experience higher stress levels, which have been positively correlated with smoking rates.1 In addition, LGB people tend to frequent bars and social settings, where smoking, drinking and drug use tend to be more prevalent, most individuals that are part of a group make use of these substances to enhance their feelings of acceptance. Understandably, this is a high priority for a highly stigmatized group.
Data collected among women in the general population suggest that common psychological factors associated with smoking are stress, lack of support, negative affect, maladaptive coping skills, and other substance use3. Scholars suggest that the same factors affect sexual minority women (SMW).3 In addition, SMW face stress related to their sexual minority position which place them at a higher risk for smoking when compared to the general populations. For instance, women who are part of a SMW group where smoking is prevalent are more likely to smoke to feel a sense of belonging to that particular group. More research is needed to determine if sexual minority stress is for a significant contributing factor to smoking behavior.
Youth risk factors
LGBT youth, similar to the LGBT adult community, are at higher risk for smoking than their non-LGBT peers. Studies of LGBT youth have found that this population experiences higher rates of depression, suicidality, and substance use when compared to heterosexual population4. Research has found that substances are used by LGBT youth as a coping mechanism for social rejection (by parents and others) and discriminative actions4. In addition, Saewyc and colleagues (2006) conducted a survey which 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 experiment with and abuse substances.4 Another well-documented risk factor is the victimization of LGB youth at schools which is also associated with negative health outcomes4 In a recent survey conducted in Massachusetts, LGB students were more likely than non-LGB students to initiate tobacco use before age of 13 (48% vs. 23%).5
Current treatment research
Several health organizations have pointed out the need to create specific programs for the LGBT community; however, very few studies have researched the efficacy of tailored interventions for this population.
Walls (2011) conducted a study to evaluate the effectiveness of a class tailored to meet the needs of the LGBT community. This class was created in a small Colorado community; participants attending the class were current smokers that identified themselves as LGBT and were interested in quitting. The class included “culturally appropriate language,” incorporated specific risk factors for LGBT individuals, and used tailored materials, such a, manuals and pamphlets.6 The course consisted of a series of seven 2-hour sessions held over six weeks. At the end of the sessions a survey was given to the participants to find their smoking status. Walls found that out of 44 individuals who entered the class, 36 finished the class, and 88.9 % of them successfully quit smoking. This study suggests that tailored interventions could be effective way to help LGBT individuals quit smoking.
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. This survey was given to youth who identified themselves as gay, lesbians, and transgender 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, such as parents. Some of their suggestions for effective preventive interventions included: 7
- Discussing tobacco effects and cessation.
- Building social support/boosting 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 in the community by an agency in San Francisco also found that (90%) of the LGBT youth would prefer LGBT-specific interventions. The majority of respondents suggested that ex-smokers (56%) and physicians (55%) teach the classes.7
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, to address psychosocial problems, and to be culturally sensitive to obtain positive results.
The National Networks for Tobacco Control and Prevention: LGBT Priority Population 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." http://www.gaysmokeout.net/
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.": The Last Drag, CBHS
- Ryan H, Wortley PM, Easton A, et al. Smoking among lesbians, gays, and bisexuals: a review of the literature. Am J Prev Med 2001;21:142-9.
- Greenwood GL, Paul JP, Pollack LM, et al. Tobacco use and cessation among a household-based sample of US urban men who have sex with men. Am J Public Health 2005;95:145-51
- Matthews, A. K., Hotton, A., DuBois, S., Fingerhut, D., & Kuhns, L. M. (2011). Demographic, psychosocial, and contextual correlates of tobacco use in sexual minority women. Research In Nursing & Health, 34(2), 141-152
- 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.
- Remafedi, G., Jurek, A. M., & Oakes, J. (2008). Sexual identity and tobacco use in a venue-based sample of adolescents and young adults. American Journal Of Preventive Medicine, 35(6, Suppl 1), S463-S470.
- Walls, N., & Wisneski, H. (2011). Evaluation of Smoking Cessation Classes for the Lesbian, Gay, Bisexual, and Transgender Community. Journal Of Social Service Research, 37(1), 99-111.
- Remafedi, G., & Carol, H. (2005). Preventing tobacco use among lesbian, gay, bisexual, and transgender youths. Nicotine & Tobacco Research, 7(2), 249-256.
- American Cancer Society. (n.d.). Tobacco and the GLBT community. Oklahoma City, OK: Author.