LGBTQ+ Community and Lung HealthThe Lung Association recognizes and is committed to addressing the health inequities experienced by those in the LGBTQ+ community.
Transgender Cultural Fluency & LGBTQ+ Lung Health Disparities
Sexual Orientation & Gender Identity
LGBTQ+ is an umbrella term that represents a range of sexual orientations and gender identities. These letters stand for Lesbian, Gay, Bisexual, Transgender, and Queer. The plus sign is to indicate the infinite number of identities and orientations such as Pansexual, Questioning, Two-Spirit, Intersex, and Asexual. The language used to talk about LGBTQ+ people is constantly evolving. To learn more, use this glossary of terms. Even though you see sexual orientations and gender identifies all together in this acronym – someone's gender identity tells us nothing about their sexual orientation. To learn more about the spectrum of sex and gender, check out this resource from the Trevor Project. Creating safe and inclusive spaces is essential to adequately address health disparities faced by the LGBTQ+ community. Using inclusive language, including correct pronouns, is an important first step.
Why Pronouns Matter
Using a person’s chosen name and correct pronouns is a form of mutual respect and basic courtesy. For some of us, our biological sex and gender identity/expression/presentation all align and the people around us correctly assume our pronouns. However, for some of us, this is not the case. It’s important to remember that gender identity is not visible—it’s an internal sense of one’s own gender. A culture that readily asks or provides pronouns is one committed to reducing the risk of disrespect or embarrassment for both parties. For a more complete overview about why pronouns matter in the workplace, read this resource from the Human Rights Campaign. Whether you identify as a part of the LGBTQ+ community or not, you should consider getting into the habit of sharing your pronouns when introducing yourself and adding your pronouns to places like your social media profiles and e-mail signature.
Gender neutral pronouns, such as the singular use of “they”, are often used in place of “he” or “she”.
American Dialect Society declared the singular “they” as the 2015 word of the year. Merriam-Webster did the same in 2019. For more information about gender-neutral pronouns, use this resource from the University of Minnesota.
Examples of Pronouns
Examples of Pronouns:
- She is an award-winning Pulmonologist.
- He was wearing a Fight For Air Climb t-shirt.
- This is (name) and they are a LUNG FORCE Hero.
- Zi wrote a carefully researched article on asthma.
Lung Health and the LGBTQ+ Community
Asthma is a chronic (or lifelong) disease that makes it harder to move air in and out of your lungs and can be serious—even life-threatening. From 2013-2018, according to CDC data, gay and bisexual men and women were significantly more likely to have ever been diagnosed with asthma than straight men and women, respectively. Among those with asthma, gay men were significantly more likely to have had an asthma attack in the past year than straight men.4 Learn more about the basics of asthma.
Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, is a long-term lung disease that makes it hard to breathe. The disease affects millions of Americans and is the third leading cause of disease-related death in the U.S. While 2013-2018 COPD rates did not differ by orientation for either men or women,4 other CDC data from 2017-2019 found sexual minorities (gay, lesbian, or bisexual; 10.3%) were more likely to report having been diagnosed with COPD compared to heterosexuals (6.9%).5
Gay men were significantly more likely to have received a flu vaccination in the past 12 months than straight or bisexual men or those who identified as something else according to a 2013-2018 NHIS results. Straight women were more likely to have received a flu vaccination in the past 12 months compared to women of any other orientation. Gay men were significantly more likely to have ever received a pneumonia vaccination compared to straight men, while gay/lesbian and bisexual women were less likely to have done so compared to straight women.4
The CDC surveys utilized in this webpage only ask about sexual orientation and not gender identity. Similarly, cancer registries do not collect information on either sexual orientation or gender identity. Acknowledgement of this deficiency is growing, including the American Society of Clinical Oncology in 2017 recommending sexual and gender minority data collection by cancer registries. Even if cancer registries added fields for such information tomorrow, they are only aggregating information from healthcare providers who generally do not ask about or document sexual orientation and gender identity, and work is required to change these practices and norms. Finally, despite combining multiple years of data, some sample sizes were too small to allow for accurate estimates for some groups on some measures. Fortunately, such occurrences were rare.6
*Selection options offered by the CDC for respondents were Straight, Gay/Lesbian, Bisexual, Something Else and I Don’t Know the Answer.
Proud LGBTQ+ Programs & Partnerships
San Bernardino, California
LGBTQ+ Tobacco Control Project
Rehoboth Beach, Delaware
State of Iowa
To reduce tobacco use rates in the LGBTQ+ community, the American Lung Association in Iowa created the Proud Quitter campaign. This campaign highlights diverse members of the LGBTQ+ community in their own words on how they quit tobacco. The campaign promoted the Iowa Quitline and American Lung Association cessation resources through handouts, social media and video testimonials.
Bradbury-Sullivan LGBT Community Center
The American Lung Association in Pennsylvania partners with the Bradbury-Sullivan LGBT Community Center to provide cessation resources and tobacco free signage at pride events. Bradbury-Sullivan LGBT Community Center develops LGBTQ+ health programs and after school art and culture programs. The American Lung Association also provides technical assistance to local LGBTQ+ health clinics and advocates for inclusive health systems changes. The Bradbury-Sullivan LGBT Community Center also serves in leadership in the statewide tobacco control coalition.
For more information on these programs, please contact [email protected].
Tobacco Use & the LGBTQ+ Community
Tobacco products are one of the most heavily marketed consumer products in the U.S. In 2018, the nine major cigarette and smokeless tobacco companies spent $9.06 billion to promote and advertise their products.1 The tobacco industry was one of the first to develop marketing materials specifically targeting the LGBTQ+ community. The most infamous example of this was so-called Project SCUM (which stands for "Subculture Urban Marketing"), a plan by RJ Reynolds in the mid-1990s to market their Red Kamel brand to gay men in San Francisco's Castro District and homeless people in the city's Tenderloin neighborhood.2 Learn more here.
Lesbian, gay, bisexual and transgender (LGBT) adults and youth smoke at substantially higher rates than the general population. 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 cessation treatment.3 According to date from the Centers for Disease Control and Prevention (CDC) from 2013-2018, gay men and those who identified as something else (not gay, lesbian or bisexual) had significantly higher cigarette smoking rates compared to straight men, as did gay/lesbian and bisexual women compared to straight women. Straight males had higher rates of e-cigarette use than either gay, bisexual, or males who answered “Not Sure,” while bisexual females had the highest rate of any group, and gay/lesbian females had a greater rate than straight females. E-cigarette use was also greater among gay/lesbian and bisexual females than males.4
Quitting isn't easy but more than 50 million ex-smokers in the United States are proof that it's possible. Despite what e-cigarette companies want you to believe, switching to vaping (e-cigarettes) is not quitting smoking. E-cigarettes are tobacco products, they contain nicotine, and FDA has not approved any e-cigarette as a quit smoking device. Enrolling in a tobacco counseling program, such as American Lung Association’s Freedom From Smoking®, can increase your chances of success by up to 60% when used in combination with FDA-approved medication.
In addition to a comprehensive quit program, we encourage quitters to join our Freedom From Smoking Inspire Online Discussion and Support Community to stay connected with others along their quit journey, give and receive peer-to-peer support every step along the way, all staying connected and engaged, while following social distancing guidelines.
If you or someone you know is interested in quitting and would like to take advantage of the Lung Association’s support, they can visit bit.ly/ALAFFSPLUS, register today and begin their journey to freedom. For more information about quitting visit the American Lung Association website at: Lung.org/ffs or call us at 1-800-LUNGUSA (1-800-586-4872).
Listen to a June 2021 episode of our monthly podcast series, Lungcast,™ where our chief medical officer and podcast host Albert Rizzo, M.D., highlights the contributions of Dr. Alan L. Hart in honor of LGBTQ+ Pride Month. Dr. Hart, a trans man and medical researcher, was a pioneer in using x-ray technology to diagnose tuberculosis (TB) years prior to the development of epidemiological tests for the disease.
- Centers for Disease Control and Prevention. Tobacco Industry Marketing. 202. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/marketing/index.htm.
- Centers for Disease Control and Prevention. Smoking & Tobacco Use: Lesbian, Gay, Bisexual and Transgender Persons and Tobacco Use. 2019. https://www.cdc.gov/tobacco/disparities/lgbt/index.htm.
- 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 2013-2018. Analysis performed by the American Lung Association Research and Program Services Division using SPSS and SUDAAN software.
- Heslin KC, Hall JE. Sexual Orientation Disparities in Risk Factors for Adverse COVID-19–Related Outcomes, by Race/Ethnicity — Behavioral Risk Factor Surveillance System, United States, 2017–2019. MMWR Morb Mortal Wkly Rep 2021; 70:149-154.
- Gomez SC, Duffy C, Griggs JJ, John EM. Surveillance of cancer among sexual and gender minority populations: Where are we and where do we need to go? Cancer 2019; 125: 4360-4362.