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, Queer (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 in 2019 approximately 45,000 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
In terms of cessation, recent research has also shown that LGB smokers report less prevalent usage of cessation counseling or medication (14.5%) than heterosexual smokers (31.7%).17 Additionally, LGBT smokers are more likely to smoke menthol cigarettes, which are generally easier to use, yet harder to quit.15
Influences and risk factors
There are several possible factors contributing to increased smoking prevalence for the LGBT community. Not only are LGBT individuals faced with normal, daily stressors, but also with discrimination, stigma, and lack of access to adequate care/ treatment. As a result, many members of this community tend to frequent bars and social settings where substance use (e.g., alcohol, tobacco, illicit drugs) is more prevalent and socially acceptable. 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.7 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.6
Additionally, the LGBT community is aggressively targeted by the tobacco industry's advertising campaigns, attempting to normalize tobacco use within the LGBT community.1 It has been shown that the gay community has been targeted by the tobacco company since 1938.8 For example, Big Tobacco created a campaign named “Subculture Urban Marketing” or “Project Scum,” which targeted the LGBT community (specifically youth) and homeless in the early 1990s.9 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.9 Additionally, Big Tobacco has utilized marketing efforts including sponsoring pride parades and providing funds to AIDS and LGBT organizations.16 Furthermore, 24% of leaders of LGBT advocacy groups view smoking as a priority health concern, yet 22% of these leaders have accepted funding from the tobacco industry.10
LGBT Youth Smoking & 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 the heterosexual community population.11 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).4 Research has found that substances are used by LGBT youth as a coping mechanism for discrimination and social rejection (by parents and others).11 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 experiment with and abuse substances.11
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.12 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.13 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.13 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.14 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 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.14
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.
Smokefree.gov & ThisFreeLife: This website provides tobacco cessation resources like apps, text programs, and an 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.
- American Lung Association. The LGBT community: a priority population for tobacco control. American Lung Association, Smokefree Communities Project. http://www.lung.org/assets/documents/tobacco/lgbt-issue-brief-update.pdf
- 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.
- 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.2012.301002
- 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.
- American Cancer Society. (2003). Tobacco and the GLBT community. Oklahoma City, OK: Author. Retrieved from http://www.glbthealth.org/documents/GLBTTobacco.pdf.
- 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
- 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.
- Washington, H.A. (2002). Burning love: big tobacco takes aim at LGBT Youths. Am J Public Health. 92(7) 1086-1095.
- 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 Promot Pract 5(3) 129-134. doi: 10.1177/1524839904264617.
- Offen, N., Smith, E.A., & Malone, R.E. (2008). Is tobacco a gay issue? Interviews with leaders of the lesbian, gay, bisexual and transgender community. Cult Health Sex. 10(2): 143-157. doi: 10.1080/13691050 701656284
- 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.
- 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
- 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
- Remafedi, G., & Carol, H. (2005). Preventing tobacco use among lesbian, gay, bisexual, and transgender youths. Nicotine & Tobacco Research, 7(2), 249-256.
- Fallin, A., Goodin, A. J., and King, B. A. (2015). Menthol cigarette smoking among lesbian, gay, bisexual, and transgender adults. American Journal of Prevantative Medicine, 48(1), 93-97. doi:
Truth Initiative (6 October 2016). LGBT History Month: Why are Smoking Rates Higher in LGBT Communities? Retreived from
Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quitting Smoking Among Adults — United States, 2000–2015 (2017). MMWR Morb Mortal Wkly Rep 2017;65:1457–1464. DOI: http://dx.doi.org/10.15585/mmwr.mm6552a1.