LGBTQ+ People Encounter Barriers to Quitting Successfully
Most people who smoke want to quit, and more than half of them try to do so each year.3 Proven treatments, such as FDA-approved medicines and behavioral counseling, make it more likely that people will quit smoking successfully, but LGBTQ+ people who smoke run into barriers when trying to find and use these treatments:
In a national study in 2009-2010, a lower percentage of gay, bisexual, and transgender men (66.7%) were aware of tobacco quitlines than their non GBT counterparts (83.9%), though quitline use was similar.41
- In a study of smoking adults in one state, lesbian, gay, and bisexual adults who were aware of their state quitline were less likely to report an intention to call the quitline than their heterosexual counterparts.42
- In 2015, fewer gay, lesbian, and bisexual adults who smoked reported using counseling and/or FDA-approved medication to help them quit than straight adults who smoked (14.5% vs 31.7%).43
LGBTQ+ people often fear or experience discrimination or disrespect from medical professionals.44 People who are afraid of discrimination from doctors and other health workers are less likely to seek medical care, including preventive screenings. The 2015 U.S. Transgender Survey found that nearly 1 in 4 transgender people (23%) reported avoiding looking for health care they needed in the past year because they were afraid of discrimination or mistreatment on the basis of gender identity.44
- LGBTQ+ people may rank tobacco use as a lower health priority than other issues that affect the LGBTQ+ community (e.g. HIV/AIDS, hate crimes, suicide).45
Connecting every person who wants to quit with treatment proven to help them quit for good is important for improving people’s health.
Some strategies that states and communities can use are:
Provide barrier-free, widely promoted coverage for all evidence-based cessation treatments by all types of health insurance. For example, as of 2018, only 15 state Medicaid programs fully covered tobacco cessation (quitting) services for all enrollees of traditional Medicaid.46
Increase access to culturally tailored cessation services. When it comes to health issues, one size does not fit all. Different people and communities have varying needs and make decisions in different ways. For example, some LGBTQ+ people may think of smoking as a way of rebelling against traditional gender roles.47 Tailored cessation resources and improved access to these resources could be helpful, including acknowledgment that some experiences and stressors associated with smoking may be unique for LGBTQ+ people.48
Share health messages that feature LGBTQ+ people and their experiences. Mass media campaigns are proven to increase smoking cessation, prevent tobacco use initiation, and reduce the prevalence of tobacco use.7,49 However, anti-smoking messages rarely appear in media designed for LGBTQ+ people.48 Anti-commercial tobacco* messaging and mass media campaigns can feature testimonials from LGBTQ+ people.48 CDC’s Tips From Former Smokers® (Tips®) is one example of a campaign that has done this. Educational and outreach campaigns should consistently include and reach out to LGBTQ+ people.44
† The term “LGBTQ+” is used on this page to refer to people who are lesbian, gay, bisexual, or transgender, with the plus sign indicating inclusion of people who are queer, questioning, intersex, asexual, or who hold other gender/sex/romantic identities not specifically identified. Many studies cited on this page only looked at certain groups within the greater LGBTQ+ community. When single terms like “gay” or “lesbian,” or acronyms like “LGB” are used on this page, this corresponds with how terms are used in the cited studies. More studies are needed to understand the ways that commercial tobacco and exposure affects other groups in the LGBTQ+ community.
- Cornelius ME, Loretan CG, Wang TW, Jamal A, Homa DM. Tobacco Product Use Among Adults — United States, 2020. MMWR Morb Mortal Wkly Rep. 2022; 71:397–405 [accessed 2022 Apr 28].
- Buchting FO, Emory KT, Scout, Kim Y, Fagan P, Vera LE, & Emery S. Transgender Use of Cigarettes, Cigars, and E-Cigarettes in a National Study. Am J Preventive Med, 2017;53(1): e1–e7 [accessed 2022 Mar 1].
- Gentzke AS, Wang TW, Cornelius M, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students — National Youth Tobacco Survey, United States, 2021. MMWR Surveill Summ. 2022; 71(No. SS-5):1–29 [accessed 2022 Apr 28].
- Gentzke AS, Wang TW, Jamal A, Park-Lee E, Ren C et al. Tobacco Product Use Among Middle and High School Students — United States, 2020. Morb Mortal Wkly Rep, 2020;69(50): 1881-88 [accessed 2022 Mar 1].
- Caceres BA, Brody A, Luscombe RE, Primiano JE, Marusca P et al. A Systematic Review of Cardiovascular Disease in Sexual Minorities. Am J Public Health, 2017;107(4): e13–e21 [accessed 2022 Mar 1].
- Gawlik KS, Melnyk BM, Tan A. An Epidemiological Study of Population Health Reveals Social Smoking as a Major Cardiovascular Risk Factor. Am J Health Promot. 2018;32(5):1221-1227 [accessed 2022 Mar 1].
- U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014 [accessed 2022 Mar 1].
- American Cancer Society. Cancer Facts & Figures, 2020 [accessed 2022 Mar 1].
- HIV.gov U.S. Statistics. U.S. Department of Health and Human Services. Updated June 2021 [accessed 2022 Mar 1].
- Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2015-2019 [PDF - 2.6MB]. HIV Surveillance Supplemental Report 2021; 26(No. 1) [accessed 2022 Mar 1].
- Helleberg M, Afzal S, Kronborg G, Larsen CS, Pedersen G, et al. Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study. Clin Infect Dis, 2013;56(5): 727-34 [accessed 2022 Mar 1].
- McCabe SE, Hughes TL, Matthews AK, et al. Sexual Orientation Discrimination and Tobacco Use Disparities in the United States. Nicotine Tob Res. 2019;21(4):523-531 [accessed 2022 Mar 1].
- Weinmeyer, R. The decriminalization of sodomy in the United States. AMA J Ethics, 2014;16(11): 916-922 [accessed 2022 Mar 1].
- Perone AK. Health Implications of the Supreme Court's Obergefell vs. Hodges Marriage Equality Decision. LGBT Health, 2015;2(3): 196-9 [accessed 2022 Mar 1].
- Herek GM. Hate crimes and stigma-related experiences among sexual minority adults in the United States: prevalence estimates from a national probability sample. J Interpers Violence, 2009;24(1): 54-74 [accessed 2022 Mar 1].
- Bostwick WB, Boyd CJ, Hughes TL, West BT, McCabe SE. Discrimination and mental health among lesbian, gay, and bisexual adults in the United States. Am J Orthopsychiatry, 2014;84(1): 35-45 [accessed 2022 Mar 1].
- Drescher J. Out of DSM: Depathologizing Homosexuality.Behavioral Sciences, 2015;5(4): 565-575 [accessed 2022 Mar 1].
- Josefson D. Oregon's governor apologises for forced sterilisations. BMJ, 2002;325(7377): 1380 [accessed 2022 Mar 1].
- Carson NJ, Rodriguez D, Audrain-McGovern J. Investigation of mechanisms linking media exposure to smoking in high school students. Prev Med, 2005;41(2): 511-20[accessed 2022 Mar 1].
- Charlesworth A and Glantz SA. Smoking in the movies increases adolescent smoking: a review. Pediatrics, 2005;116(6): 1516-28 [accessed 2022 Mar 1].
- National Cancer Institute. The Role of the Media in Promoting and Reducing Tobacco Use. Tobacco Control Monograph No. 19. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. NIH Pub. No. 07-6242, June 2008.
- 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 Promot Pract 2004;5(Suppl):129S–34S [accessed 2022 Mar 1].
- Smith EA, Malone RE. The Outing of Philip Morris: Advertising Tobacco to Gay Men. American Journal of Public Health. 2003;93(6):988-993. [accessed 2022 Mar 1].
- Ryan H, Wortley PM, Easton A, Pederson L, Greenwood G. Smoking among lesbians, gays, and bisexuals: a review of the literature. Am J Preventive Med, 2001;21(2):141-9 [accessed 2022 Mar 1].
- U.S. Department of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012 [accessed 2022 Mar 1].
- U.S. Department of Health and Human Services. E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2016 [accessed 2022 Mar 1].
- Trinkets & Trash: Artifacts of the Tobacco Epidemic. Smokeless Tobacco [PDF - 491KB]. Rutgers Center for Tobacco Studies. Rutgers University School of Public Health. [accessed 2022 Mar 1].
- Fallin A, Goodin AJ, & King BA. Menthol cigarette smoking among lesbian, gay, bisexual, and transgender adults. Am J Preventive Med, 2015 48(1): 93–97 [accessed 2022 Mar 1].
- Robertson L, McGee R, Marsh L, and Hoek J. A systematic review on the impact of point-of-sale tobacco promotion on smoking. Nic Tob Res, 2015;17(1): 2-17 [accessed 2022 Mar 1].
- Fallin A, Neilands TB, Jordan JW, Ling PM. Secondhand smoke exposure among young adult sexual minority bar and nightclub patrons. Am J Public Health. 2014;104(2):e148-e153[accessed 2022 Mar 1].
- Slopen N, Kontos EZ, Ryff CD, Ayanian JZ, Albert MA, Williams DR. Psychosocial stress and cigarette smoking persistence, cessation, and relapse over 9-10 years: a prospective study of middle-aged adults in the United States. Cancer Causes Control. 2013;24(10):1849-1863 [accessed 2022 Mar 1].
- Slopen N, Dutra LM, Williams DR, et al. Psychosocial stressors and cigarette smoking among African American adults in midlife. Nicotine Tob Res. 2012;14(10):1161-1169 [accessed 2022 Apr 28].
- Purnell JQ, Peppone LJ, Alcaraz K, et al. Perceived discrimination, psychological distress, and current smoking status: results from the Behavioral Risk Factor Surveillance System Reactions to Race module, 2004-2008. Am J Public Health. 2012;102(5):844-851 [accessed 2022 Apr 28].
- Discrimination in America: Experiences and Views of LGBTQ Americans. Robert Wood Johnson Foundation, National Public Radio, Harvard T.H. Chan School of Public Health, 2017 [accessed 2022 Mar 1].
- Parent MC, Arriaga AS, Gobble T, Wille L. Stress and substance use among sexual and gender minority individuals across the lifespan. Neurobiol Stress. 2018;10:100146. Published 2018 Dec 27. [accessed 2022 Mar 1.
- Cochran SD, Bandiera FC, Mays VM. Sexual Orientation-Related Differences in Tobacco Use and Secondhand Smoke Exposure among US Adults Aged 20-59 Years: 2003-2010 National Health and Nutrition Examination Surveys [PDF - 585KB]. Am J Public Health 2013;103(10): 1837-44 [accessed 2022 Mar 1].
- Shires DA and Jaffee KD. Structural discrimination is associated with smoking status among a national sample of transgender individuals. Nic Tob Res, 2016;18(6): 1502-08 [accessed 2022 Mar 1].
- Eisenberg ME, Erickson DJ, Gower AL, Kne L, Watson RJ, et al. Supportive community resources are associated with lower risk of substance use among lesbian, gay, bisexual, and questioning adolescents in Minnesota. J Youth Adolesc, 2020;49(4): 836-48 [accessed 2022 Mar 1].
- Juster RP, McEwen BS, & Lupien SJ. Allostatic load biomarkers of chronic stress and impact on health and cognition. Neuroscience & Biobehavioral Reviews, 2010;35(1): 2-16 [accessed 2022 Mar 1].
- Guyll M, Matthews KA, Bromberger JT. Discrimination and unfair treatment: relationship to cardiovascular reactivity among African American and European American women. Health Psychology, 2001;20(5): 315 [accessed 2022 Mar 1].
- Fallin A, Lee YO, Bennett K, Goodin A. Smoking Cessation Awareness and Utilization Among Lesbian, Gay, Bisexual, and Transgender Adults: An Analysis of the 2009-2010 National Adult Tobacco Survey. Nic Tob Res, 2015:1-5 [accessed 2022 Mar 1].
- Burns EK, Deaton EA, Levinson AH. Rates and Reasons: Disparities in Low Intentions to Use a State Smoking Cessation Quitline. Am J Health Promotion, 2011;25(sp5): S59-65 [accessed 2022 Mar 1].
- Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quitting Smoking Among Adults—United States, 2000-2015. Morbidity and Mortality Weekly Report 2017;65(52):1457-64 [accessed 2022 Mar 1].
- James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). Executive Summary of the Report of the 2015 U.S. Transgender Survey [PDF - 205KB]. Washington, DC: National Center for Transgender Equality. [accessed 2022 Mar 1].
- Boynton MH, Gilbert J, Shook-Sa BE, Lee JGL. Perceived Importance of Health Concerns Among Lesbian, Gay, Bisexual, and Transgender Adults in a National, Probability-Based Phone Survey, 2017. Health Promotion Practice, 2020 [accessed 2022 Mar 1].
- DiGiulio A, Jump Z, Babb S, et al. State Medicaid Coverage for Tobacco Cessation Treatments and Barriers to Accessing Treatments — United States, 2008–2018. MMWR Morb Mortal Wkly Rep 2020;69:155–160 [accessed 2022 Mar 1].
- Lee JG, Matthews AK, McCullen CA, & Melvin CL. Promotion of tobacco use cessation for lesbian, gay, bisexual, and transgender people: a systematic review. Am J Preventive Med, 2014;47(6): 823-31 [accessed 2022 Mar 1].
- Matthews PA, Blok AC, Lee J, Hitsman B, Sanchez-Johnsen L, et al. SBM recommends policy support to reduce smoking disparities for sexual and gender minorities. Translational Behavioral Medicine, 2018;8(5): 692–695 [accessed 2022 Mar 1].
- U.S. Department of Health and Human Services. Smoking Cessation: A Report of the Surgeon General [PDF - 9.8MB]. Centers for Disease Control and Prevention, 2020 [accessed 2022 Mar 1].