Cigarette smoking among individuals who are LGB in the U.S. is higher than among individuals who are heterosexual/straight. About one in five adults who are LGB smoke cigarettes compared with about one in six adults who are heterosexual/straight.1
Limited information exists on cigarette smoking prevalence among people who are transgender; however, cigarette prevalence among adults who are transgender is reported to be higher than among the general population of adults. The population of people who are transgender is considered especially vulnerable because they suffer from high rates of substance abuse, depression, HIV infection, and social and employment discrimination, all of which are associated with higher smoking prevalence.2
Individuals who are LGBT often have risk factors for smoking that include daily stress related to prejudice and stigma that they may face.3
Individuals who are LGB are five times more likely than others to “never intend” to call a smoking cessation Quitline.4
Individuals who are LGBT are less likely to have health insurance than individuals who are straight, which may negatively affect health as well as access to cessation treatments, including counseling and medication.5
Tobacco companies advertise at “gay pride” festivals and other LGBT-focused community events and contribute to local and national LGBT and HIV/AIDS organizations. Tobacco advertisements in publications focused on people who are gay and lesbian often depict tobacco as a “normal” part of life for people who are LGBT.6
The tobacco industry encourages menthol cigarette use among populations of people who are LGBT. Approximately 36% of people who are LGBT and who smoke report smoking menthol cigarettes compared to 29% of smokers who are heterosexual/straight.7
Several factors such as higher levels of social stress, frequent patronage of bars and clubs, higher rates of alcohol and drug use, and direct targeting of consumers who are LGBT by the tobacco industry may be related to higher prevalence rates of tobacco use among people who are LGBT compared to the general population.8
What We Know About What Works
A pilot study provides preliminary support for the effectiveness of a Facebook smoking cessation intervention tailored to young adults who identify as sexual and gender minority (SGM).9
Data from 233 participants in The Last Drag, a seven-session, six-week group education and support intervention tailored for people who are LGBT and who smoke were collected during the first and last sessions, and at one, three, and six months post-intervention. As with many interventions over time, missing data is a challenge in determining success rates, but even using the most conservative estimates, nearly 60% were smokefree at the end of the intervention, and 36% remained smoke-free by six months post-intervention. This success rate is comparable to, or better, than many mainstream smoking cessation interventions reported in the literature. The Last Drag is an effective, low-cost, community intervention specific to people who are LGBT that can be replicated in other communities.10
Although there is a lack of validated randomized controlled studies confirming specific interventions among tobacco users in this population, it is likely that evidence-based tobacco use interventions will benefit members of the LGBT community. Cultural competency training and targeted outreach can increase utilization of state quit lines among people who are LGBT and who smoke.11
Increase the saliency of coaching by providing information specific for people who are LGBT.
Use current best practices to guide smoking cessation services for people who smoke and are LGBT.
Offer smoking cessation treatment programs at locations that are safe and affirming to individuals who are LGBT.
When possible, provide treatment to groups that are specific to people who are LGBT to increase comfort, trust, and mutual support.
Broader policy recommendations include adding LGBT questions to health monitoring and evaluation surveys, making LGBT-focused community events and living environments for people who are LGBT smoke free, including LGBT elements in media campaigns, and providing training and resources for all health care providers.12
What’s Relevant in Pennsylvania
In 2018, the rate of smoking in Pennsylvania for adults who are lesbian, gay, or bisexual was 40% compared to 17% for adults who are straight.13
In 2018, Pennsylvania partnered with Bradbury-Sullivan LGBT Community Center to conduct an LGBT Health Needs Assessment in collaboration with LGBT HealthLink. Key findings included:
One in four respondents sometimes, often, or always experience a health care provider who reacts poorly when they come out as LGBT.
Over a third of respondents reported their health was fair, poor or very poor.
Respondents identified mental health needs as a priority when considering community health of people who are LGBT.14
This Free Life is a Health and Human Services Site that works to prevent and reduce tobacco use among young adults who identify as lesbian, gay, bisexual, and transgender (LGBT). It also links to https://smokefree.gov/ and quit START app which allows for sign up to receive smokefree daily text messages with advice and tips for quitting.
Funded by the Pennsylvania Department of Health, the Pennsylvania LGBT Health Needs Assessment is a biannual survey conducted to evaluate health needs, health disparities, and barriers to care impacting LGBT Pennsylvanians. The PA LGBT Health Needs Assessment collects data on healthcare experiences, nutrition, exercise, tobacco use, drug and alcohol use, sexual health, mental health, and food and housing security.
Erin A. Vogel et al., “The Put It Out Project (POP) Facebook Intervention for Young Sexual and Gender Minority Smokers: Outcomes of a Pilot Randomized Controlled Trial.” Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco. September 28, 2019. https://doi.org/10.1093/ntr/ntz184.