Tobacco addiction doesn’t discriminate – a person can be addicted to the nicotine in cigarettes regardless of race, gender identity, sexual orientation, religion or age. However, smoking is much more common in certain populations, including among some racial minorities, low-income individuals, those with mental illness, and the LGBTQ population.
The LGBTQ community includes people who are lesbian, gay, bisexual, transgender and queer/questioning. Though data is limited because many surveys do not ask about sexual orientation or gender identity, the data we do have suggests that the prevalence of cigarette smoking among lesbian, gay and bisexual people is higher than that of the heterosexual population, approximately 21% vs 15%.
Data on the prevalence of smoking among adults who identify as transgender (someone whose gender identity does not correspond with their sex assigned at birth) is limited. A 2013 study found a smoking rate of approximately 36%, compared to a prevalence of approximately 21% among adults whose gender identity aligns with their birth sex (cisgender).
Why do so many members of the LGBTQ community smoke?
It’s important to understand the reasons why one in five lesbian, gay, or bisexual adults might smoke. Understanding the factors that may contribute to this high rate can help start a conversation about smoking cessation in this community.
Coming out refers to the action of an LGBTQ person’s self-disclosure of their sexual orientation or gender identity, which can be an anxiety-ridden process that takes a toll on one’s emotional, physical, and social well-being. Though it has decreased in recent years, there is still a stigma associated with being in a sexual minority. Discrimination is still a factor in many LGBTQ people’s lives and fear of discrimination may even cause an LGBTQ person to remain in the closet. Research has shown that smoking rates are higher in groups that experience high levels of stress due to actual or perceived stigmas. However, lesbian, gay and bisexual individuals who are out to others have lower stress hormone levels and fewer symptoms of anxiety, depression, and burnout as compared to those who are still closeted.
Similarly, having a circle of supporters can help someone throughout their quit smoking journey. A quit team can include individuals such as friends, family, and coworkers, as well as a healthcare provider and a smoking cessation group support program. When seeking smoking cessation programs, it’s important to find one that is supportive and welcoming to LGBTQ people, one where the quitter feels comfortable sharing the details of their life that relate to their quit.
Historically, gay bars have been known as safe spaces for members of the LGBTQ community – a place where individuals could relax, be themselves, and socialize with others in their community. These spaces allow for social bonding, but they also highlight the behavioral and social links between drinking and smoking. Although bars in many places are now smokefree, it’s likely that many LGBTQ people became addicted to cigarettes during a time when bars allowed smoking.
When a person quits smoking, they may need to switch up their routines or avoid the places where they used to smoke, such as bars. This may mean taking a break from alcohol, too. Because of this, it’s important to create safe, supportive environments that do not remind quitters of the places where they used to smoke.
The tobacco industry was one of the first major consumer industries to target the LGBTQ community, a group that had been largely ignored by mainstream advertising. Advertising in LGBTQ media and bars helped to normalize smoking, emphasizing the link between the community and the use of tobacco.
Quitters should know that there are many health and cosmetic benefits of quitting smoking – benefits that are more glamorous than how the tobacco industry depicts smoking. This Free Life, a US Food and Drug Administration site that speaks specifically to the LGBTQ community about quitting smoking, reminds quitters about looking and feeling better while living tobacco-free.
Discrimination & lack of access to healthcare
LGBTQ individuals may deal with discriminatory healthcare practices or lack health insurance coverage. A large national survey found that individuals in same-sex relationships were significantly less likely to have health insurance than those in different-sex relationships. And as those without health insurance are more than twice as likely to delay or forgo needed care as those who are insured, many members of the LGBTQ community may not receive needed treatment.
More employers now offer domestic partner benefits, and the 2015 Supreme Court decision on marriage equality enabled more LGBTQ individuals to have access to healthcare benefits. Additionally, a number of states have laws that protect LGBTQ patients from discrimination by a healthcare provider. Support from a healthcare provider that includes counseling and medication can double one’s chances of quitting smoking successfully. For an LGBTQ quitter, it’s important to find a healthcare provider they feel comfortable being open and honest with. Speaking honestly about stressors and other factors specific to LGBTQ individuals can help a doctor better support the quitter, as well as develop a personalized quit plan that works for them.
Proud to Be Smokefree
It is estimated that over 9 million people in the United States identify as lesbian, gay, bisexual, transgender, or queer/questioning. This diverse population has many reasons to be proud. Though some members of the community may face discrimination, tremendous progress has occurred, enabling more LGBTQ individuals who smoke to access the resources and support that may help them become smokefree.
Though quitting smoking can be difficult, it is possible for any person in any community to quit. Whether you’re looking for a healthcare provider, interested in downloading the Quitter’s Circle app, or curious about posting your story on the Quitter’s Circle Facebook page, know that this community is available to support you along your quit journey.