At-risk communities are often disproportionately targeted by tobacco advertisements and have higher tobacco use as a result. The APHA 2022 session “Health Equity: Tobacco Use and Cessation in Historically Marginalized Population” explored ways to encourage smoking cessation in vulnerable communities, including LGBTQ populations.

Mirandy Li, of the Louisiana State University Health Science Center, said LGBTQ individuals face higher levels of stress than the general population, often due to discriminatory or stigmatizing experiences, which may be why their smoking rates are higher. After conducting a study of LGBTQ smokers in the Deep South in summer 2021, Li said there’s a need for smoking prevention and cessation outreach among LGBTQ communities.

Her research explored minority stress through 15 individual, semi-structured online interviews with LGBTQ smokers in the Deep South. Interview topics included LGBTQ identity, smoking/quitting, minority stress, mental health and social support.

Li said in a survey of 1,296 smokers who identify as LGBTQ, many said they smoked to relieve the stress of struggling with their sexuality and identity — particularly in the Deep South. The smokers surveyed said they also used smoking as a social outlet, and some continued to smoke because it is seen as rebellious. 

“Perceived stigma [against LGBTQ individuals] can lead to people smoking to cope with it and increased nicotine dependence,” Li said. 

Joanne Patterson, of the Ohio State University College of Public Health, studied ways to reach out to LGBTQ populations to encourage smokers to quit. Specifically, Patterson studied community-engaged and culturally targeted cessation programs with the purpose of evaluating the efficacy of culturally targeted, health care provider-focused intervention.

Patterson said LGBTQ individuals tend to start smoking at a younger age, smoke for longer and have significantly lower perceptions of the hazards of smoking when compared to heterosexual and cisgender individuals.

“If we can get LGBTQ people to evidence-based cessation, they have about the same abstinence rates as the general public,” Patterson said.

In her research, Patterson and her team trained health care providers and created a communication aid targeted at LGBTQ populations. 

Patterson said it is important to encourage smoking cessation by relating it to LGBTQ issues, such as pointing out that people who smoke while taking estradiol for hormone replacement have increased cardiovascular health risks. She said health care providers can also encourage smoking cessation before and after gender-affirming surgery. 

“We can influence social perception,” Patterson said. “We can encourage people [to quit smoking] by framing it as, ‘Quit for your partner, quit for your community.’” 

Photo by Track 5, iStockphoto.