Tobacco and the LGBT community

The LGBT community is disproportionately affected by tobacco

Context

Members of the LGBT community are characterized by more frequent risky behaviors resulting from various factors. Among these risky behaviors, smoking is particularly high compared to the average prevalence recorded. Until recently, little data related to the smoking epidemic among LGBT people was available since sexual orientation criteria were not retained in surveys. It is only in recent decades that research has been able to demonstrate this very high prevalence within this community.[1] According to a 2011 report from the Institute of Medicine,[2] Researchers face many challenges in better understanding the health needs of LGBT populations due to this lack of data.

There is, however, some data available regarding the tobacco industry's actions toward this community. Indeed, for years, tobacco manufacturers have sought to attract LGBT consumers through targeted advertising campaigns in the LGBT press, but also aggressive promotions made up of free offers and gifts. Today, The LGBT community is part of those most seriously affected by the tobacco epidemic.[3] [4]

Smoking rates in the LGBT community

• In the United States, 20.6% of LGB adults and 35.5% of transgender adults are cigarette consumers. For comparison, 14.91% of heterosexual adults are. In 2013, transgender adults were 2.1 times more likely to smoke than cisgender adults; [5] ^[6]
• THE Lesbian, gay and bisexual adults smoke up to 2.5 times more than heterosexuals [7];
• Currently, only 11.8% of young heterosexual American adults indicate being smokers against 19% of homosexuals, 16.9 % of bisexuals and 33.2% of transgender young adults[8] ;
• Bisexual women are up to 3.5 times more likely to smoke, they try their first cigarette at a younger age and are more addicted to nicotine than heterosexual women ^{[9] ;}
• Furthermore, smokers LGBT are significantly more likely to smoke menthol cigarettes, whose addictive-reinforcing characteristics are well established. According to the 2018 National Survey on Drug Use and Health in the United States, 51 percent of lesbians and gay men smoke menthol cigarettes compared to 29 percent of heterosexuals.[10] A study from the University of Medicine and Ontology of New Jersey found that menthol cigarette smokers absorb more nicotine and carbon monoxide because menthol masks the irritating effects of cigarette smoke. As a result, menthol cigarette smokers are easier to smoke and more likely to smoke. stop more complex[11] ;
• Smoking prevalence ofother types of tobacco products like hookahs, cigars, cigarillos, is also higher among LGBT adults than in heterosexual adults[12]
• Not only do LGBT people have a relatively higher smoking prevalence, but they are also more likely to experience secondhand smoke (passive smoking). A 2011 study found that patrons of LGBT bars in the United States were 38.1 times more likely to be exposed to secondhand smoke in bars.[13] Additionally, another study highlights the increased likelihood of a non-smoking sexual minority woman being exposed to second-hand smoke.[14];

Moreover, although youth smoking rates have generally declined to 6% in 2016,[15] The proportion of smokers among LGB youth remains considerably higher. According to an analysis of data from 1987 to 2000,[16] more of double of LGB students enrolled in classes from third to final year smoked a cigarette before the age of 13 compared to their heterosexual peers.[17] Furthermore, Lesbians and bisexual girls are 9.7 times more likely to smoke cigarettes regularly than their heterosexual peers.[18]

 

The Tobacco Industry's Long Tradition of Targeting the LGBT Community

The social and political acceptance of the LGBT community in the 1990s led marketers to want to target this segment of the population in particular. Internal documents prove that the tobacco industry was well aware of the high smoking rates among sexual minorities, and that marketing strategies clearly highlighted efforts to capitalize on the LGBT market.

For example, one industry document from 1997 stated: “ A large percentage of gays and lesbians are smokers. In order to increase market share and brand awareness (…) it is imperative to identify new markets with growth potential ".[19]

The tobacco industry has been targeting the LGBT community since at least 1991. That year, to put an end to the boycott launched against it, the cigarette manufacturer Philip Morris committed itself with the promise of juicy donations for programs and research to fight against AIDS.[20] The boycott was led by the AIDS Coalition to Unleash Power (ACTUP), which was protesting the tobacco company's support for Sen. Jesse Helms, R-N.C., a leading opponent of AIDS funding and a vocal opponent of LGBT civil rights.[21] By highlighting the company's donations as evidence of its support for the LGBT community, Philip Morris quickly gained access to this market., paving the way for other tobacco companies to follow suit.

Tobacco companies have also started their advertising campaigns in the gay press in the early 1990s. Their aim was to normalize tobacco use in this community by presenting smoking as integral part of LGBT life. In addition, many advertisements for products other than cigarettes made smoking seem attractive, and many items unrelated to cigarette smoking were illustrated with images of tobacco.

In 2000, confidential documents from tobacco company RJ Reynolds were leaked revealing the controversial marketing strategy "Project SCUM" (Sub-Culture Urban Marketing) aimed to increase cigarette sales by targeting gay men and the homeless with strategically placed ads and displays in community centers and specialty stores.[22] In addition to donations, giveaways and increased advertising, the tobacco industry has developed community outreach by hosting events such as "LGBT bar nights" that specifically promote certain cigarette brands.

   

Breaking ties with the tobacco industry and supporting smoking cessation

Campaign for Tobacco Free Kids (CTFK), an American non-profit organization, emphasizes the need for LGBT organizations to break all ties with the tobacco industry because the latter continues to sponsor many events such as Pride marches. The latter also appropriates the LGBT visual (use of symbols and references such as the rainbow) and continues to target this community through advertisements in the specialized press.

This highly segmented marketing strategy of the tobacco industry may not be the only factor responsible for these high prevalences. Added to this are restricted access to care, higher levels of stress generated by social discrimination and finally the increased incidence of drug addiction in this part of the population. CTFK highlights the need for further research to better understand the factors contributing to the high rate of smoking among LGBT people.1 The higher average prevalence is also associated with a lower proportion of attempts to quit compared to the heterosexual smoking population: respectively 14.5% v/ 31.7% have used support and treatment for smoking cessation[23]. Better accessibility to smoking cessation care services for LGBT people could help the community reduce its high level of smoking.[24]

New tobacco and nicotine products, a new opportunity for the tobacco industry

While it is well established that tobacco use is higher among LGBT people, this trend is also reflected in the use of new tobacco and nicotine products. According to the results of the 2020 study “E-cigarette use and risks behavior among Lesbian, Gay, Bisexual and Transgender” conducted by the Kansas Journal of Medicine, LGBT adults use nearly three times more new tobacco and nicotine products than heterosexual adults (prevalence of 13% vs. 4.8%).[25] The study highlights that these minorities are more likely to adopt risky behaviors than their heterosexual peers, notably by consuming, proportionally, more traditional cigarettes, electronic cigarettes and marijuana. This pattern is found among both LGBT men and women, regardless of the age group concerned.

It is true that this community continues to be the subject of sustained targeted actions by the tobacco industry for these new products. According to a 2013 survey, LGB adults were much more exposed to advertising for tobacco and new nicotine products with many promotions through coupons or discounts. The researchers of the study "Does tobacco industry marketing excessively impact lesbian, gay and bisexual communities?" point out the weight of these marketing strategies.[26]

In France

In general, in France, data on smoking within the LGBT community are not yet available. Although a study on Stigmatization of sexual minorities and their health status was published on May 17, 2021 by Public Health France, it does not report on the prevalence of smoking or addictive behaviors among members of the LGBT community. American studies on the subject remain, for the moment, the reference in this area.

For more information on the disproportionate impact tobacco has on certain populations, including racial minorities, low-income communities, and those with mental illness, you can visit truthinitiative.org (in English).

Note : This document is an adapted version of the Truth Initiative page on the smoking among the LGBT community. Terminology used in this document varies across studies that are summarized in order to accurately reflect the original sources. Truth Initiative recognizes that some terms used are no longer those advocated by the LGBT community.

  Photo credits: ©Truth Initiative ©Generation Without Tobacco

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[1] Bach L, « Tobacco use in lesbian, gay, bisexual and transgender (LGBT) communities », Campaign for tobacco Free Kids, March 29, 2021 [2] Institute of Medicine, “The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding” National Academies Press 2011 https://www.ncbi.nlm.nih.gov/books/NBK64806/ [3] Smith EA, Malone RE, “The Outing of Philip Morris: Advertising Tobacco to Gay Men” American Journal of Public Health 2003 https://ajph.aphapublications.org/doi/10.2105/AJPH.93.6.988 [4] Stevens P, Carlson LM, Hinman JM, “An Analysis of Tobacco Industry Marketing to Lesbian, Gay, Bisexual, and Transgender (LGBT) Populations: Strategies for Mainstream Tobacco Control and Prevention” Health Promotion Practice 2004 https://journals.sagepub.com/doi/10.1177/1524839904264617 [5] Centers for Disease Control and Prevention, “Current Cigarette Smoking Among Adults-United States, 2005-2015” Morbidity and Mortality Weekly Report. 2016 https://www.cdc.gov/mmwr/volumes/65/wr/mm6544a2.htm [6] Buchting FO, Emory KT, Scout, et al, “Transgender Use of Cigarettes, Cigars, and E-Cigarettes in a National Study” American Journal of Preventive Medicine 2017 https://www.ajpmonline.org/article/S0749-3797(16)30623-7/fulltext [7] Lee JGL, Griffin GK, Melvin CL “Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review” Tobacco Control 2009 https://tobaccocontrol.bmj.com/content/18/4/275 [8] Rath JM, Villanti AC, Rubenstein RA, et al, “Tobacco Use by Sexual Identity Among Young Adults in the United States” Nicotine & Tobacco Research 2013 https://academic.oup.com/ntr/article/15/11/1822/1543805 [9] Fallin A, Goodin A, Lee Y, et al, “Smoking characteristics among lesbian, gay, and bisexual adults” Preventive medicine. 2015 https://pubmed.ncbi.nlm.nih.gov/25485860/ [10] Delnelvo CD, Ganz O, Goodwin RD, “Banning menthol cigarettes: a social justice issue long overdue” Nicotine & Tobacco Research 2020 https://academic.oup.com/ntr/article/22/10/1673/5906409 [11] Partnership to End Addiction Menthol cigarettes harder to quit, researchers find », 2009 [12] King BA, Dube SR, Tynan MA “Current Tobacco Use Among Adults in the United States: Findings From the National Adult Tobacco Survey” American Journal of Public Health 2012 https://ajph.aphapublications.org/doi/10.2105/AJPH.2012.301002 [13] Fallin A, Neilands TB, Jordan JW, et al, “Second hand exposure among young adult sexual minority bar and nightclub patrons” American Journal of Public Health 2014 https://ajph.aphapublications.org/doi/10.2105/AJPH.2013.301657 [14] Cochran SD, Bandiera FC, Mays VM, “Sexual Orientation–Related Differences in Tobacco Use and Second hand Smoke Exposure Among US Adults Aged 20 to 59 Years: 2003–2010 National Health and Nutrition Examination Surveys” American Journal of Public Health 2013 https://ajph.aphapublications.org/doi/10.2105/AJPH.2013.301423 [15] Truth Initiative, " Youth smoking rate falls to 6 percent », 2016 [16] Ryan H, Wortley PM, Easton A, et al, “Smoking among lesbians, gays, and bisexuals: a review of the literature” American Journal of Preventive Medicine 2001 https://www.ajpmonline.org/article/S0749-3797(01)00331-2/fulltext [17] Kann L, Olsen EO, McManus T, et al, “Sexual identity, sex of sexual contacts, and health-risk behaviors among students in grades 9-12--youth risk behavior surveillance, selected sites, United States, 2001-2009” Centers for Disease Control and Prevention 2011 https://pubmed.ncbi.nlm.nih.gov/21659985/ [18] Austin SB, Ziyadeh N, Fisher LB, et al, “Sexual orientation and tobacco use in a cohort study of US adolescent girls and boys” JAMA Pediatrics 2004 https://jamanetwork.com/journals/jamapediatrics/fullarticle/485675 [19] Truth Initiative, " Tobacco use in LGBT communities », 2018 [20] Ramirez Antony, " Philip Morris to Increase AIDS Donations », The New York Times, May 30, 1991 [21] Offen N, Smith EA, Malone RE, “From adversary to target market: the ACT-UP boycott of Philip Morris” Tobacco Control 2003 https://tobaccocontrol.bmj.com/content/tobaccocontrol/12/2/203.full.pdf [22] CNCT, " “Freedom” and “Choice”: How Tobacco Companies Target the LGBTQ Community ", November 29, 2016, accessed June 18, 2021 [23] Babb S, Malarcher A, Schauer G, et al, “Quitting smoking among adults – United States 2000-2015” Centers for disease control and prevention 2017 https://www.cdc.gov/mmwr/volumes/65/wr/mm6552a1.htm [24] Lee JGL, Matthews AK, McCullen CA, et al, “Promotion of tobacco use cessation for lesbian, gay, bisexual and transgender people” American Journal of Preventive Medicine 2014 https://www.ajpmonline.org/article/S0749-3797(14)00452-8/fulltext [25] Al Raifai M, Mirbolouk M, Jia https://journals.ku.edu/kjm/article/view/13861/13630 [26] Dilley JA, Spigner C, Boysun MJ, et al, “Does tobacco marketing excessively impact lesbian, gay and bisexual communities? » Tobacco Control 2008 https://tobaccocontrol.bmj.com/content/17/6/385.info National Committee Against Smoking |