Source: FDA’s This Free Life (This Free Life Campaign | FDA)

June is Pride Moth. It’s celebrated annually to honor the 1969 Stonewall Uprising in Manhattan, which was a catalyst for the gay rights movement. The purpose is to recognize the impact that lesbian, gay, bisexual, and transgender individuals have had on history. This post will highlight tobacco use among the LGBTQ+ community.

Tobacco Industry Marketing

The tobacco industry was one of the first industries to target the LGBTQ+ population. The tobacco industry has:

• Advertised in LGBTQ publications and at Pride festivals and other LGBTQ+ community events
• Sponsored local and national LGBTQ+ organizations and HIV/AIDS organizations
• Encouraged menthol use among LGBTQ+ populations

LGBTQ+ and Housing^1,2,3,4

Note: wanted to acknowledge that LGBTQ individuals are more likely to experience homelessness. That can create challenges. However, this section focuses on the challenges that the seeking housing and the housed members of the community face.

According to Freddie Mac, only 49% of LGBT individuals own a home compared to 64% of the general population. The percentage for LGBT ranged from 33% for gender-expansive individuals to 52% each for lesbian and gay individuals. This means that most LGBT individuals rent. Most of these people live in some type of multiunit housing entity. LGBT individuals live in every town size, whether it’s a small town or a big city.

However, discrimination can occur in this community, even in the rental market. Notably, 50% of LGBT people live in states that do NOT prohibit housing discrimination based on sexual orientation or gender identity. Another 2% live in states that don’t prohibit housing discrimination based on gender identity (discrimination based on sexual orientation is prohibited for these people).

Alaska is one of the states that doesn’t have explicit prohibitions for discrimination based on gender identity or sexual orientation. Therefore, it relies on the federal Fair Housing Act to prevent discrimination among this population. (Sexual orientation and gender identity were recognized under the Fair Housing Act in 2021).

A study has shown housing providers were less likely to make an appointment to show a unit with gay couples. Gay couples were told about fewer rental units and were quoted yearly rent costs were $272 higher. Transgender individuals were also told about fewer available units than cisgender individuals. Another study shows that 17.6% of LGBTQ people live in public housing compared to 2.5% of non-LGBTQ people.

Tobacco Use^5,6,7

According to the Human Rights Campaign analysis of Census data, about 8% of the U.S. reported being LGBT. About 1% reported being transgender.

About 1 in 5 LGB adults smoke cigarettes compared to 1 in 6 heterosexual adults. That number is closer to 1 in 3 for transgender people. About 36% of LGBT smokers use menthol compared to 29% of heterosexual smokers.

Among youth, about 17.5% of LGB people use e-cigarettes compared to 13.2% of heterosexual people. Adolescents and young adults who have ever used e-cigarettes are 3x more likely to start smoking than those who never used e-cigarettes.

Transgender people are 3.5x more likely to have use cigars in the past month and 5x more likely to have use e-cigarettes in the past month. LGB people were over 2x more likely to have ever used a water pipe, such as hookah, than heterosexual people.

Health Impacts^6-11

Note: Terminology is based on the reports pulled from.

Due to higher smoking rates, the LGBTQ+ community may see higher rates of smoking related diseases. Some health impacts that may be less talked about than others include:

• Tobacco use coupled with HPV infection:
  • Worsens the response to HIV treatment and live shorter lifespan than those who have HIV and do not use tobacco
  • Increases the chances of
    • Lung cancer and other non-AIDS defining cancers
      • HIV is an independent risk factor for smoking-related diseases
    • Heart disease
    • Lung infections
    • Chronic obstructive pulmonary disease
    • Bacterial pneumonia
  • LGB and “Something Else” (this was how the data source identified this group) people were more likely to have
    • Asthma
    • COPD
  • Tobacco use increases stress and anxiety. It’s common to think smoking helps with stress relieve. However, stress decreases when a person quits.
  • Tobacco use while living with HIV can weaken the immune system and increase many health related risks
  • People who use tobacco on antiretroviral therapy (HIV) are 6-13x more likely to die from lung cancer than other AIDS-related causes
  • Tobacco use in combination with estrogen therapy can increase the risk of venous thromboembolism (blood clot), which is a leading cause of heart attack and stroke
  • Menthol Cigarettes
    • Increase the likelihood of becoming addicted and the degree of addiction
    • Masks early warning symptoms of smoking-induced respiratory problems
    • Makes it harder to quit

Surgery^12-13

These apply to surgery in general. However, it’s important to take them into consideration prior to gender affirming surgery.

• Continuing tobacco use can
  • Delay surgery
  • Complicate anesthesia
  • Increase chances of scarring
  • Harm chances of success
  • Increase the chance of breathing problems during or after surgery
  • Increase the risk of complications, like heart attack, stroke, sepsis, or shock
  • Inhibit proper healing
• Smoking during recovery can
  • Increase the chance of infection
  • May result in skin tissue death

It’s recommended that people quit tobacco at least a week prior to surgery and abstain during recovery (Though for good is suggested to help reduce the chance of other health impacts.)

Source: FDA’s This Free Life (This Free Life Campaign | FDA)

Quit Tobacco

• LGBT & Smoking | Smokefree – includes general info, apps and texting options for quitting, and a resource finder for LGBT friendly healthcare providers
• This Free Life: Instagram account promoting tobacco free LGBTQ+ lifestyles
• Alaska State Quitline – 1-800-QUIT-NOW (784-8669)
• Live Vape Free – teen focused plus resources for parents and educators
• American Lung Association Adult Cessation
• American Lung Association Teen Cessation

Tobacco Marketing to LGBTQ+ Community

• Pride and Prejudice: 17-minute video from the Public Health Law Center

General Resources

• Identity Inc. – healthcare, education, connectivity, and advocacy for the LGBTQA2S+ community
• Choosing Our Roots – Alaska based entity that ensures all queer youth and young adults have access to safe housing, supportive communities, and opportunities to thrive
• The Trevor Project – support for LGBTQ+ considering harming themselves or need support. Educational resources are available as well, such as being an ally or understanding gender identity.
• Living with cancer? Check out the National LGBT Cancer Network’s Peer Support Program.
• Pride Foundation – provides funding opportunities for the Northwest states, including Alaska
• Human Rights Campaign Education Resources – educational resources around LGBTQ+ related topics. Available in English and in Spanish (en Español)
• Why Pronouns Matter

References

1. Microsoft PowerPoint – LGBTStudy_Final.pptx [Read-Only] (freddiemac.com)
2. Movement Advancement Project | Nondiscrimination Laws (lgbtmap.org)
3. Five Facts about Housing Access for LGBT People | Housing Matters (urban.org)
4. LGBTQ Equity and Housing Fact Sheet – Opportunity Starts at Home (opportunityhome.org)
5. We Are Here: LGBTQ+ Adult Population in United States Reaches At Least 20 Million, According to Human Rights Campaign Foundation Report – Human Rights Campaign (hrc.org)
6. Tobacco-Fact-Sheet.pdf (indypride.org)
7. Lesbian, Gay, Bisexual, and Transgender Persons and Tobacco Use | CDC
8. The American Lung Association Celebrates LGBTQ+ Pride Month | American Lung Association
9. Tobacco Smoking Increases Immune Activation and Impairs T-Cell Function in HIV Infected Patients on Antiretrovirals: A Cross-Sectional Pilot Study | PLOS ONE
10. Lung Cancer Mortality Associated With Smoking and Smoking Cessation Among People Living With HIV in the United States (bhchp.org)
11. Smoking and HIV | HIV.gov
12. Overview of feminizing hormone therapy | Gender Affirming Health Program (ucsf.edu)
13. Gender-Transition-and-Tobacco-Fact-Sheet-Final-2.pdf (californialgbtqhealth.org)