Smoking and LGBT Community: How Stress and Stigma Create Smokers

Lesbian, gay, bisexual and transgender (LGBT) people smoke more often than their straight and cisgender colleagues and friends. The well-known and serious risks of smoking mean that the association between smoking and LGBT people represents a serious threat to their health and well-being. 

Around 3.8 % of the U.S. population is either lesbian, gay, bisexual or transgender (LGBT), according to a Williams Institute report. While more and more people are openly accepting of LGBT people, they still face many challenges, and their high smoking rate is a big sign of the issues that still persist. Smoking and LGBT people are closely linked, with many surveys finding substantially higher smoking rates in the group than among straight and cisgender (i.e. non-transgender) individuals. The reasons for this are complex, but it undoubtedly represents an area where anti-smoking public health messages, support and quitting advice are particularly important.

Smoking and LGBT People: The Statistics

The CDC reports that 20.6 % of lesbian, gay and bisexual people were current smokers in 2015, compared to 14.9 % of straight people. This difference in smoking rates is substantial, and makes LGBT people one of the most in-need groups when it comes to reducing the impact of smoking.

As you may have noticed, the statistics don’t cover transgender individuals, and this is because there simply isn’t enough information to make an estimate. However, transgender people are more likely to abuse substances, suffer from depression, be infected with HIV and face discrimination than cisgender individuals, and all of these factors are linked to higher smoking rates. In other words, while we don’t have clear evidence, it’s safe to assume that trans people have a bigger issue with smoking than the general population too.

Smoking Cessation and LGBT People

Unfortunately for the problems with smoking and LGBT people, it appears that LGBT individuals are also less likely to quit smoking than non-LGBT people. For example, research suggests that gay, bisexual or lesbian people are five times more likely to say they’ll never call a quit-line for smoking. Similarly, gay, bisexual and transgender men are less likely to be aware of the existence of such quitlines than straight men.

Another factor is that LGBT individuals are less likely to have health insurance than non-LGBT individuals. This wouldn’t necessarily stop LGBT individuals from attempting to quit smoking, but makes it more difficult to access cessation medications and interventions like counseling.

Why Do LGBT People Smoke More than Non-LGBT People?

The connection between smoking and LGBT people might seem puzzling, but ultimately it comes down to the stress and stigma individuals may face. Although social acceptance of LGBT lifestyles has been increasing in recent years, many LGBT people still face discrimination, stigma and other challenges. For example, even the process of “coming out” to friends and family can be a source of stress, and any negative reactions from loved ones can obviously have a substantial psychological impact. Even governmental actions – such as states banning same-sex marriage – can lead to an increase in issues like depression and substance abuse.

All of this leads to stress, which makes smoking seem more appealing. Although smoking only provides superficial relief from stress (and nicotine withdrawal actually makes it worse), it can seem like a useful ally when you’re facing stigma and rejection. Research has directly shown that LGBT individuals who are rejected by friends and family are more likely to do dangerous things like smoke or use drugs.

In addition, numerous other issues also play a role in the link between smoking and LGBT people. Peer pressure, combined with the bar culture common in LGBT communities, also contributes to higher smoking rates. Tobacco companies targeted LGBT individuals with marketing campaigns too, which again can make smoking more likely.

Helping LGBT People Quit Smoking

The association between smoking and LGBT identity isn’t an easy one to break, but as well as promoting tolerance and understanding both at the social and legislative levels, quit-smoking campaigns and educational programs targeted at LGBT individuals can make a big difference.

Unfortunately, there isn’t much evidence regarding what the best approaches for helping LGBT people quit smoking are, but programs like the American Lung Association’s (ALA’s) The Last Drag campaign have been successful. This was started in the early 90s, and focused on providing safe spaces and supportive group environments for LGBT smokers who wanted to quit. Although the program has now ended, the ALA recommends recruiting LGBT-friendly support group leaders, choosing locations well-known in the LGBT community and using educational materials suitable for LGBT individuals.

If you’re an LGBT smoker hoping to quit, the best advice is to find some form of support. Whether it’s counseling, stop-smoking medications or alternative nicotine products, most approaches are more effective than quitting unsupported (i.e. “cold turkey”). If you’re struggling to cope without nicotine, it’s worth considering using e-cigarettes or smokeless tobacco to at least reduce the associated health risks.

LGBT people are among the most affected by smoking, but now is the time to break the link.