LGBT Community

Lesbian, Gay, Bisexual, Transgender (LGBT) Community: Priority Population for Tobacco Control

LGBT adults and youth smoke at substantially higher rates than the general population. Studies have reported smoking prevalence among gay and bisexual men is 27% to 71% higher and for lesbians and bisexual women, 70% to 350% higher than prevalence observed for comparable gender groups in the general population.11 The factors driving LGBT disparities in tobacco use include stress due to social stigma and discrimination, peer pressure, aggressive marketing by the tobacco industry and limited access to effective tobacco treatment. 1

Adults

Bisexual men and women appear to have the highest smoking rates of any subgroup for which data is readily available. Smoking rates fro this group was higher than 30 percent. Among bisexual women, the odds of smoking ranged from 1.5 to 3.5 higher than for straights women. Lesbians had between 1.2 and 2.0times the odds of smoking compared to straight women. The odds of smoking for bisexual men were 0.9 to 2.6 , when compared to straight men. Compare to straight men, gay men have between 1.1 and 2.4 times the odds of smoking.2  The 2004 California Tobacco Use Survey found that about 2 percent of all LGBT adults identify as transgender. At 30.7 percent, transgender smoking prevalence was very close to the overall LGBT rate of 30.4 percent.

Youth

Estimates of smoking prevalence among LGBT youth range from 38% to 59%, compared to a prevalence rate of 28% to 35% for the total youth population.3  In a study of 10,685 adolescents living throughout the U.S., researchers found that compared to heterosexuals, lesbian/bisexual girls were 9.7 times more likely to smoke at least weekly. In contrast, however, gay/bisexual boys were not more likely to smoke than heterosexual boys.4

While LGBT people face the same pressures to smoke as the general population, LGBT individuals are at risk for a number of additional reasons including: 

Stigma and Discrimination

LGBT populations often experience high stress due to marginalization and discrimination in personal interactions and in society at large. Actual or even perceived stigma causes stress, and research has shown that smoking rates, as well as other negative health behaviors and outcomes are higher in groups that experience high levels of stress.5 Among LGBT youth, stress due to homelessness, coming out at an early age, rejection by family and peers and discrimination are among the most frequently cited reasons for smoking.6   

Social Bonding and the Bar Culture

LGBT people in some areas have limited opportunities to interact with peers outside of smoking venues.7  Historically, bars were among the few safe spaces for LGBT people, and they have played an important social role in the LGBT community for many decades. 

Lack of Access to Quality Treatment and Care

Individuals in same-sex relationships are significantly less likely to have health insurance than those in opposite-sex relationship.8  Additionally, in one study, LGBT participants were twice as likely to report being denied or given inferior medical care as their straight counterparts.9 

Targeting by the Tobacco Industry

The tobacco industry aggressively targets LGBT audiences for advertising. Tobacco advertisements in gay and lesbian publication often depict tobacco use as a “normal” part of LGBT life. According to a 2005 study, 30% of non-tobacco advertisements in LGBT publications, such as those that promote entertainment products and venues, sexual services, clothing and even rehab programs—feature tobacco use.10 

 1  Ryan H, et al. Smoking among lesbians, gays and bisexuals: a review of the literature. American Journal of Prevention Medicine. 2001; 21:142-149; Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey Raw Data, 2008. Analysis performed by the American Lung Association Research and Program Services Division using SPSS and SUDAAN software.

 2 Behavior of Risk Factor Surveillance System (BRFSS). 2003-2006, Center for Health Statistics, Washington State Department of Health. Available online: www.doh.wa.gov/ehsphl/chs/chsdata/brfss/BRFSS_tables.htm.

 3 Lee JG, Griffin GK and Melvin CL. Tobacco use among sexual minorities in the USA, 1987 to May 2007: A systematic review. Tobacco Control. 2009; 18:275-282.

 4 Lesbians, Gays, Bisexuals, and Transgender of Color Sampling Methodology: Strategies for Collecting Data in Small, Hidden, or Hard-to-Reach Groups to Reduce Tobacco-Related Health Disparities. 2009, Tobacco Research Network on Disparities (TReND), National Cancer Institute. Available online: http://cancercontrol.cancer.gov/tcrb/trend/lgbt/docs/LGBTReport508.pdf.

 5 Ryan C, et al. Family rejection as a predictor of negative health outcomes in white and Latino lesbian, gay, and bisexual young adults. Pediatrics; 2009;123(1):346-352.

  6 Remafedi G. Lesbian, gay, bisexual, and transgender youths: who smokes, and why? Nicotine Tobacco Research. 2007;9(Supl 1):S65-S71.

 7 Buchmueller T and Carpenter CS. Disparities in health insurance coverage, access and outcomes for individuals in same-sex versus different-sex relationships, 2000-2007. American Journal of Public Health. 2010;100:489-495. 

 8 Mays V and Cochran S. Mental health correlates of perceived discrimination among lesbian, gay and bisexual adults in the United States. American Journal of Public Health. 2001;91(11): 1869-76.

 9 Smith EA, Offen N and Malone RE. What makes an ad a cigarette ad? Commercial tobacco imagery in the lesbian, gay and bisexual press. Journal of Epidemiology & Community Health. 2005;59:1086-1091.

 10 Offen N, Smith EA and Malone RE. Is Tobacco a Gay Issue? Interviews with leaders of the lesbian, gay, bisexual and transgender community. Culture, Health, and Sexuality. 2008; 10(2):143-157.  

 11  Burkhalter J, et al. Intention to quit smoking among lesbian, gay, bisexual, and transgender smokers. Nicotine & Tobacco Research, 2009; 11(11):1312-1320.