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LGBT Community and Tobacco: Up in Smoke
by Amy Wooten

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Considering that tobacco use within the LGBT community is reported to be significantly higher than the general population, the fact that tobacco kills more people than AIDS, alcohol, car accidents, murder and illegal drugs combined is causing concern in the community.

' [ HIV, drugs, etc. ] never come close to the kind of thing that tobacco has in our community,' said Juan Carlos Velázquez, director of training and research at the Praxis Project. The Praxis Project is a Washington, D.C.-based non-profit organization that partners with local organizations to influence policymaking that addresses the causes of community problems.

Cigarettes continue to be synonymous with LGBT culture, even in a day and age where the repercussions of smoking are well-known. Although the topic has not been adequately researched, there is evidence that LGBTs smoke at twice the rate of heterosexual adults. The tobacco industry continues to target the community, which may result in high smoking rates among LGBT youth and adults. This development poses serious health threats to the entire LGBT community, even to those who do not smoke. These numbers have also sparked the community's interest in taking action.

'Yeah, we know the health consequences are bad, but in our community, we have these other health problems that we perceive as more imminent and dangerous and risky, which is interesting because smoking kills more people in this country than AIDS and all these other things combined,' said Simone Koelinger, Howard Brown Health Center's project coordinator. 'I think the community is very educated, but it's also still not perceiving tobacco as a serious health problem.'

That lack of concern is killing the community. According to the American Cancer Society ( ACS ) , tobacco kills at least 30,000 gays and lesbians each year in the United States. The National Coalition for LGBT Health calls the estimate 'conservative' because it presumes the LGBT community smokes at the same rate as the general population.

The National Coalition for LGBT Health found that LGBTs are 40-70 percent more likely to smoke than non-LGBTs—one of the highest smoking rates among disproportionately affected subpopulations. The ACS found that 50 percent of LGBT youth use tobacco, compared to 35 percent of non-LGBT teens.

The Chicago LGBT community is no anomaly. Howard Brown is currently investigating and comparing smoking rates within the local LGBT community, said Koelinger and director of community services, Scott Cook. They will compare lesbians, gays, bisexuals and trans individuals to each other and attempt to discover differences between the community's racial and ethnic groups. 'We're actually concerned that we are going to start seeing that, but we don't know for sure,' Cook said. They also wish to investigate indicators associated with smoking, such as depression, substance abuse and the amount of an individual's social support.

One of the large pieces of data they hope to collect regards transgender individuals—a subcommunity often overlooked in such research. Koelinger and Cook fear that additional oppression might cause this group to smoke at higher rates, but preliminary data indicates otherwise. Although the data needs to be confirmed, ' [ r ] ight now it's looking like LGBT folks in general smoke much more than the general population' in Chicago, Cook said.

'Which is as high as 50 percent of LGBTs,' added Koelinger. The national average for adults is around 22 percent. So far, the Chicago preliminary numbers indicate that the city's LGBT community has similar smoking rates to national statistics.

Although LGBT tobacco use does not receive much attention compared to methamphetamine use or HIV infection rates, many health workers and smoke-free activists feel it is a much larger concern.

Tobacco use impacts the LGBT community's health. LGBT smokers should not be the only ones concerned, especially since the community emphasizes social opportunities at bars and restaurants. Second-hand smoke is the third leading preventable cause of death in the nation, according to the National Coalition of LGBT Health. Research shows that second-hand smoke alone causes roughly 3,000 cancer deaths per year in the nation. Both smoking and second-hand smoke increase the risk of heart disease, stroke, cancer and other diseases. Although not a significant amount of research has been done, findings indicate that smokers living with HIV/AIDS put themselves at higher risk for heart disease, cancer and other illnesses.

For many, the high rate of LGBT smokers is no surprise. Anti-tobacco and pro-LGBT organizations predict that several factors contribute to the community's high smoking rates, including additional social stress; targeted advertising; frequent attendance at bars and clubs; and high rates of alcohol and drug use.

'When you consider all that doctors might contribute to the smoking problem, it's not a surprise,' Velázquez said. 'Whether that be smoking as a coping mechanism against homophobia or any of the other stressors that LGBTs still have to go through, when you look at the data, there's no wonder.'

The ACS feels that the tobacco industry targets the LGBT community in three ways: direct advertising; indirect advertising; and sponsorships of events and organizations that support LGBT issues. Because the industry was an early supporter of LGBT causes when others were not, tobacco companies gained an appreciative community response, the National Coalition for LGBT Health states on its Web site. Even today, tobacco companies offer money for LGBT festivals, bars, media and organizations. Tobacco giants are also accused of carefully placing prominent LGBT leaders on their boards, added Velázquez.

'Some organizations are still taking the money,' Robert Starkey, creator of Smokefree Revolution and a longtime gay and anti-smoking activist, said. Smokefree Revolution is Starkey's non-profit organization that advocates smokefree environments and anti-tobacco policies.

Those advertising dollars result in the creation of a larger health disparity, added Velázquez. 'That is one of the ugliest parts of this situation,' he said.

Why the LGBTs are not quitting is a difficult question to answer. But the first step towards correcting the problem is discussion and knowledge. 'I think probably the best thing we can do right now is just to get it on our radar screen,' Cook suggested. 'It's another way for us to take care of ourselves and to nurture our community.'

Awareness of the problem of LGBT tobacco use is key. After watching numerous members of his community fall to AIDS in the 1980s, Starkey said it is heartbreaking to watch more people in the gay community 'totally turn their back [ s ] on the biggest problem' just because the effects are not immediately visible.

Chicago is doing more than blowing smoke. It is taking action. In addition to Howard Brown's current research, the organization just completed general data collection through surveys and questionnaires; conducted focus groups; and tested and ran numerous smoking cessation groups. These efforts gave Howard Brown insight into the community's awareness of smoking as an issue and ways to further educate the community and tailor intervention.

Howard Brown also partnered with the Lesbian Community Cancer Project ( LCCP ) to offer free drop-in smoking cessation support groups for lesbian and bisexual women.

Clearer Howard Brown data probably will not be available until the fall, and complete data will not be finished for two years. 'On the other hand, we are not willing to wait until we get there,' said Cook, who wants to spread information to the community as soon as it is available.

Besides getting the word out, the LGBT community can take other steps to stay healthy. Some people are under the impression that tobacco companies cannot be stopped because 'they've had the strings on the puppets for so long,' Starkey said.

'The thing that disturbs me the most are the people who believe that it can never really go away completely,' he said. 'And I don't believe that. I've been harmed too much.' According to Starkey, he suffers from several diseases directly related to second-hand smoke. In addition, both his niece and father died from lung cancer.

Starkey has launched an LGBT smoke-free destination portion on his web site, . So far, he has only discovered one destination on his own, but hopes to add more soon.

Legislative action is another strategy for change. Indoor clean air legislation appears to be well-received. A recent national survey by Harris Interactive found six out of 10 adults prefer smoke-free bars and clubs, and LGBT people were willing to pay extra to attend such a destination.

For Velázquez, both grassroots efforts and national efforts need to be made. Also, LGBT communities need to continue integrating within the larger tobacco control movement. However, that can be difficult. 'We have competing interests, whether it be HIV, syphilis or drug abuse,' he said. 'So it's not easy to talk about tobacco when people have all these others priorities.'

Although the numbers of LGBT-tailored cessation programs are growing, many do not have access to them. But Chicagoans are lucky—Illinois offers places for LGBTs to turn and is trying to make programs more LGBT-specific. Howard Brown and the LCCP offer LGBT-specific programs, and Illinois is one of a handful of states to have a statewide smoking cessation hotline.

The ACS and other organizations advise smokers to quit, but realize it may take five to seven tries and a number of strategies including prescriptions, nicotine replacement aids ( the patch or gum ) and support groups. Members of a support group are up to 50 percent more likely to quit, added Koelinger. Also, everyone should avoid second-hand smoke and try to become more involved in the anti-smoking movement.

'Somehow our community, I think in many ways, has been associated with smoking,' Cook said. 'We need to start to break that association. Yes, we can quit and yes, smoking doesn't have to be a part of our identity.'

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