The decline of tobacco consumption throughout the previous decades is worth celebrating. Increased tobacco cessation programs, awareness surrounding the health effects of tobacco, and legislation to limit consumption have worked together to create an environment where more people can either quit tobacco or not start smoking at all. However, this decline has not affected all people and communities equally. Rates of tobacco use among the LGBT+ community have remained disproportionately higher than in the general population.
National data from 2016 shows that the rate of tobacco use among lesbian, gay, and bisexual adults is 20.5% compared to 15.3% in heterosexual adults. There are even larger disparities for transgender adults as 32.6% of transgender adults currently use tobacco compared to 23.6% of cisgender adults. For transgender youth, the rate of smoking cigarettes is nearly 4x compared to cisgender youth. These disproportionately high rates remain consistent among all tobacco products, and more information on how tobacco use compares within the LGBT+ community can be found here.
Big Tobacco and the LGBT+ Community
When we discuss differing rates of tobacco use, it is important to examine why these disparities exist. Big tobacco has strategically marketed to the LGBT+ community through LGBT+ publications and events. In particular, R. J. Reynolds (the parent company of Newport, Camel, Pall Mall, and Doral) launched Project SCUM (Subculture Urban Marketing) in the 1990’s. This campaign targeted the LGBT+ and homeless populations in hopes of increasing their tobacco use. R.J. Reynolds is not the only company to market cigarettes as a normal and exciting part of LGBT+ life. Other companies within big tobacco have exploited the community through targeted advertisements, sponsoring pride events, and funding LGBT+ and HIV/AIDS organizations. These marketing tactics may no longer exist today, but their impact on the health of the community remains.
How Health Inequities Impact Smoking Cessation
Beyond the history of what led more folks within the LGBT+ community to start using tobacco, there are also barriers that make quitting more difficult as well. LGBT+ individuals are more likely to experience discrimination or have negative experiences with healthcare providers. Providers may be ignorant or have preconceived notions regarding LGBT+ health issues, which can lead to inadequate care or a lack of care altogether. One study found that 18% of LGBT+ individuals reported avoiding seeking out healthcare due to fears of discrimination. When discrimination around one’s identity is combined with the stigma surrounding tobacco use, it can be challenging to find a provider who is empathetic and committed to addressing everyone’s unique needs.
LGBT+ folks are also more likely to experience financial barriers when seeking out healthcare. The Affordable Care Act and legalization of same-sex marriage have helped to provide health insurance to the LGBT+ community, but healthcare still remains unaffordable for many. Though data on LGBT+ health is limited, it is suggested that LGB adults are more likely to avoid necessary care due to cost. Transgender adults experience the same inequity when it comes to the cost of care, and they are also less likely to have insurance compared to cisgender adults. These inequities can make it more difficult for LGBT+ folks to receive nicotine replacement therapy, counseling, and other cessation support.
Tobacco Reduction and Cessation Resources
Learning about health disparities can be discouraging, but more people are taking the time to educate themselves on these inequities and work to change them in their personal and professional life. Southeast Michigan has various organizations that provide physical and behavioral healthcare to the LGBT+ community.
- Here at UHHB we provide inclusive care and resources to people living with HIV in the Detroit, Ypsilanti, and Jackson areas. This includes our tobacco reduction program that offers counseling, support groups, and other resources to individuals looking to reduce their tobacco use.
- Ruth Ellis Center in Detroit has a variety of services for LGBT+ youth and young adults, including a Health and Wellness Center with behavioral health services.
- The Corner Health Center in Ypsilanti offers physical and behavioral health services to LGBT+ youth, including support with tobacco reduction.
- Ozone House provides shelter and support for at-risk youth. Some of their programs include LGBT+ support groups, counseling, and substance use support.
- LGBT Detroit supports the Detroit LGBT+ community through advocacy and education. They offer various programs to provide a safe space and increase the wellbeing of Detroit’s community.