Lesbian, Gay, Bisexual, & Transgender (LGBT)

Individuals in the LGBT population are more likely to smoke than those in the general population, increasing the risk for tobacco-related illnesses.

Contributing factors for tobacco use in the LGBT population:¹

• STRESS: Smoking is more prevalent among groups that experience high levels of stress. As an economically and socially marginalized community, the LGBT population may face a disproportionate amount of daily stress.
• ENVIRONMENT: Places where smoking is prevalent, such as in bars, have historically been an important social component of LGBT culture. This increases the exposure to smoking and thus the risk for tobacco use.
• ADVERTISING: Evidence suggests that since the 1980s when youth advertising was banned, the tobacco industry has targeted the LGBT population through direct advertisement, sponsorship, and promotional events.
• ASSOCIATED BEHAVIORS: Behaviors associated with smoking, such as alcohol and drug use, may be higher in the LGBT population than among heterosexuals.

Contributing factors for substance use (including tobacco) among LGBT youth:²

• LGBT youth are more likely to be depressed, to attempt suicide, and to be physically and verbally victimized than heterosexual youth.
• Smoking may play a unique, although misconceived, role in identity formation among these youth (e.g., masculinity for males, independence and power for females).
• The stresses associated with being "in the closet" and "coming out," potential lack of support from parents, other family members, and peers, and feelings of isolation and loneliness may contribute to tobacco risk for these youth.

A population-based study of tobacco use in California's LGB population showed that:³

• Women who are lesbian, bisexual, or have sex with women are significantly more likely to smoke than women in the general population.
• Of those interviewed, 28.8% of lesbians, 26.9% of bisexual women, and 43.6% of women who have sex with women (WSW) smoked, compared to only 12% of women in the general population.
• Between 21.5-51.3% of lesbian, bisexual, and WSW have never smoked, while a greater percentage of women in the general population (68%) have never smoked. 
• 27.3% of gay men interviewed smoked, compared to 19.7% of men in the general population, a significant difference.
• Significant differences between men in the general population and bisexual and men who have sex with men were not observed.
• While 53.3% of men in the general population have never smoked, only 20.7% of men who have sex with men have never smoked.

Program and Policy Issues

• Higher rates of smoking among these groups place them at higher risk for tobacco-related illness such as smoking-related cancers and cardiovascular diseases. Thus, LGBT-specific tobacco cessation and prevention programs and smoke-free services are required to adequately address the above concerns.
• Tobacco use often co-occurs with other substance use, mental health problems (depression), and other health concerns (HIV). Thus, integrating tobacco cessation and prevention into a whole-health approach may prove most useful.
• Health care providers and LGBT community advocates should build networks to seek funding increase tobacco use awareness and cessation programs.
• Programs need to be developed at the federal, state, county and city level.
• To significantly reduce the high rate of smoking in this group, tobacco control efforts which counter the tobacco companies' ads that specifically target the LGB population are needed.
• Gathering data on sexual orientation and same-gender sexual behavior in behavioral surveys is necessary to design LGBT specific tobacco control efforts.³

LGBT Youth Prevention & Intervention:²

• Youths respond that they would like LGBT-specific anti-smoking services, perhaps taught by LGBT ex-smokers and physicians. 
• Services should directly involve LGBT youth in prevention activity planning.
• There is a need to improve self-esteem and positive identification within the LGBT population that corresponds with tobacco use prevention.

Helpful Links

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