LESBIAN, GAY, BISEXUAL, TRANSGENDER, & QUESTIONING (LGBTQ)
Nebraska Tobacco-Related Health Disparities
Tobacco use and exposure to secondhand smoke are related to the social determinants of health which impact the conditions in which people are born, grow, live, work and age. These conditions are shaped by the distribution of money, power, and resources at multiple levels ranging from the global and national levels to the state and local levels.1
- Approximately 3.8% of adults in the United States self-identify as lesbian, gay, bisexual, or transgender (LGBT).2 An estimated 38,000 people in Nebraska are LGBT.3
- LGBTQ people face challenges to accessing healthcare services and experience health disparities.4
- In 2012, the smoking rate was 68% higher among LGBT adults (32.8%) than the general population.5 Sexual minorities are 1.5 to 2.5 times more likely to smoke cigarettes than their heterosexual counterparts.6
- According to a 2011 report from the Midlands Sexual Health Research Collaborative (MSHRC), 26% of Midlands LGBT Needs Assessment survey respondents indicated they smoke cigarettes and about 2% reported chewing tobacco. Nearly 62% of the smokers in the study, smoked every day. More than half of all respondents indicated that they were at least a little concerned about tobacco.7
- Based on a survey conducted with Heartland PRIDE (Omaha PRIDE Festival) participants in 2013, 29.4% of LGBTQ respondents were current smokers and 24.8% were former smokers.8
- Using tobacco has been socially accepted for a number of reasons. First, tobacco is often used for coping with stress related to stigma, weak family support, and discrimination.4,9 Second, smoking norms have been established in LGBT social venues such as bars, which were historically among the few safe spaces for LGBT people.10 Finally, the tobacco industry has deliberately and aggressively marketed tobacco products to the LGBTQ community.11 In fact, Phillip Morris began advertising in the gay press in 1993.7 In 1995, “Project SCUM” (Sub Culture Urban Marketing), a tobacco marketing initiative was launched in San Francisco targeting the LGBTQ community, drug users, and the homeless.12 Over the last 25 years, the tobacco industry has made both direct appeals within the LGBTQ community and indirect advertising in the mainstream media.13
- LGBTQ youth use tobacco at higher rates than their heterosexual peers.9 Studies have shown that LGB youth are more likely to experience risk factors which contribute to substance use, such as low self-esteem, alienation, and depression.14
- Data on tobacco use risk and protective factors, interest in quitting, cessation attempts, and tailored interventions among the LGBTQ community are limited. Additional research is needed.9
Impact of Tobacco Use:
- Tobacco use is the leading cause of preventable death in the United States. In fact, more than 480,000 people die each year from cigarette smoking.15
- The American Cancer Society estimates that over 40,000 LGBT people die each year of tobacco-related diseases.16
Outreach, Engagement, and Intervention:
- The toll-free Nebraska Tobacco Quitline, 1-800-QUIT-NOW (784-8669), gives Nebraska residents 24/7, free access to counseling and support services available.
- Tailored programs, services, and campaigns are important for increasing awareness of tobacco as a threat to personal and public health; increasing cessation among LGBTQ individuals; preventing tobacco use among youth; and leveraging community support to improve health and well-being. Addressing factors such as minority and chronic stress, intersectionality, and socioecological influences across the life course may increase the effectiveness of such interventions.17
Revised: January 29, 2016
 World Health Organization. (2012). What are the social determinants of health? http://www.who.int/social_determinants/sdh_definition/en/
2 Newport, F. (2015). Americans greatly overestimate percent gay and lesbians in the United States. Gallup. Retrieved January 29, 2016 from http://www.gallup.com/poll/183383/americans-greatly-overestimate-percent-gay-lesbian.aspx
3 ACLU Nebraska. LGBT Rights. Retrieved January 29, 2016 from https://www.aclunebraska.org/en/issues/lgbt-rights
4 Fenway Institute. Achieving health equity for LGBT people. Retrieved January 15, 2016 from http://www.lgbthealtheducation.org/training/learning-modules/
5 King, B.A., Dube, S.R., and Tynan, M.A. (2012). Current tobacco use among adults in the United States: findings from the National Adult Tobacco Survey. American Journal of Public Health, 102(11): e93-e100.
6 Lee, J.G., Griffin, G.K., and Melvin, C.L. (2009). Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review. Tobacco Control, 18(4):275–282.
7 Fisher, C.M., Irwin, J.A., Coleman, J.D., McCarthy, M., and Chavez, J. (2011). The Midlands LGBT needs assessment community report. Retrieved January 29, 2016 from http://www.unomaha.edu/college-of-education/health-physical-education-recreation/research/mshrc/docs/midlands-lgbtq-communityreport.pdf
8 Ramos, A., Burns, T., Rogel-Mendoza, D., Nubel, C., Harris, J., and Dixon, A. (2013). MOTAC Heartland PRIDE Survey.
9 National Youth Advocacy Coalition. (2010). Coming out about smoking: a report from the national LGBTQ young adult tobacco project. Retrieved January 29, 2016 from http://lgbttobacco.org/files/Coming_Out_About_Smoking_NYAC.pdf
10LGBT Health Link. Achieving health equity in tobacco control. Retrieved January 29, 2016 from http://www.lgbthealthlink.org/Assets/U/Documents/achievinghealthequityintobaccocontrol.pdf
11 Johnson, Y. (1997). Philip Morris USA. CEM’s Gay and Lesbian Marketing Efforts. Legacy Tobacco Documents Library. Bates No. 2071145109/5110. Available at: https://industrydocuments.library.ucsf.edu/docs/#id=xrwn0172
12 RJ Reynolds. (1995). Project SCUM. Legacy Tobacco Documents Library. Bates No. 518021121/1129. Retrieved January 29, 2016 from http://legacy.library.ucsf. edu/tid/mum76d00/pdf
13 Stevens, P., Carlson, L.M., and Hinman, J.M. (2004). An analysis of tobacco industry marketing to lesbian, gay, bisexual, and transgender (LGBT) populations: strategies for mainstream tobacco control and prevention. Health Promotion Practice, 5(3 Suppl):129S-134S.
14 American Legacy Foundation. (2005). Lesbian, gay, bisexual & transgender communities & smoking. Retrieved January 5, 2016 from http://www.lgbttobacco.org/files/legacy%20lgbt%20factsheet.pdf
15 U.S. Department of Health & Human Services. The Health Consequences of Smoking—50 Years of Progress: A Report of the Surgeon General, 2014. http://www.surgeongeneral.gov/library/reports/50-years-of-progress/
16 American Cancer Society. Gay & bisexual men: access to care and cancer disparity fact sheet. Retrieved January 29, 2016 from http://www.glbthealth.org/documents/FactSheetRevised-GayandBisexualMen.pdf
17 Institute of Medicine. (2011). The health of lesbian, gay, bisexual, and transgender people building a foundation for better understanding. Retrieved January 11, 2016 from http://iom.nationalacademies.org/Reports/2011/The-Health-of-Lesbian-Gay-Bisexual-and-Transgender-People.aspx