Smoking in the LGBT community

Abstract

Tobacco use is the single most preventable cause of cancer. Smoking prevalence among lesbian, gay, bisexual, and transgender (LGBT) persons is significantly higher than in the general U.S. population. This health disparity likely originates during sexual minority adolescence, when smoking initiation occurs earlier and maintains at higher rates than for their heterosexual peers. Among youth, identifying as bisexual and being female, and experiencing more victimization increase risk for smoking. For LGBT adults, alcohol, substance use, and depression are often associated with smoking. One hypothesis proposes that disparate LGBT tobacco use is driven by sexual minority stress resulting from externally imposed and internally incorporated stigma and victimization. If true, does engagement ina validating LGBT community protect against the risk of smoking? Research finding ssuggest a more complex question, depending upon age of the person, number and type of LGBT organizations, and perhaps whether they have active tobacco control programs. Definitive answers await further research. LGBT tobacco control advocates have developed community-based smoking cessation programs, such as The Last Drag, tailored to LGBT persons, held in LGBT-serving venues, and assuring a supportive context for smoking cessation. Evaluations of community based programs are encouraging. A marked paucity of LGBT-tailored or targeted randomized controlled cessation trials exist, and some studies not tailored or limited to LGBT smokers show cessation rates equivalent for LGBT and heterosexual persons. Multi-site studies encompassing different regions of the country beyond the two coasts could address the likely complex efficacy issues of tailored vs. non tailored smoking cessation interventions for LGBT smokers.