Lesbian, gay, bi, and trans (LGBT) communities smoke at much higher rates than the general population. Smoking rates in the general Canadian population have gone down significantly in the last 40 years to about 18%, while research suggests that smoking rates within LGBT communities remain at between 24% and 55%.
In a 2006 study 36% of LGBT people were smokers compared to just 15% of Toronto adults.
LGBT communities are subject to the same factors that result in smoking within the general population, as well as additional factors, such as higher levels of stress due to homophobia, biphobia, and transphobia, a culture of socializing in bars and clubs, lower health access and greater vulnerability of LGBT people to depression and alcohol use.
Why Are Smoking Rates Higher in LGBT Communities?
The answer to why smoking rates are two to three times higher in LGBT communities is complicated and there is a lack of evidence.
There are many factors that work together that lead to a greater tendency to start smoking and also to keep smoking and to not use prevention and treatment resources.
The usual identified factors of smoking among youth and adults like lower education and income levels likely interplay with LGBT vulnerability to smoke since we know that school drop-out and homelessness rates are higher among LGBT youth. Higher risk to smoke may also interact and be multiplied in effect by other minority statuses – ethno-cultural, gender, or disability – which add layers of experience of oppression.
With these complexities noted, we can say that there is some evidence pointing to four key factors that increase LGBT individuals’ likelihood of smoking:
- stigma, discrimination and oppression;
- community norms;
- targeted marketing by tobacco companies and
- reduced access to health services
Stigma, Discrimination and Oppression
Despite the increasing social acceptance of LGBT identified people, there continues to be significant, persistent stigma and discrimination and homophobia, biphobia and transphobia – at the individual, family, community and societal levels. This prevents full participation in society by LGBT individuals and communities and that makes them vulnerable to a variety of health risks including smoking. This stigma, discrimination and oppression create stress and can result in reduced social supports and social exclusion including bullying – two strong indicators of smoking behaviour. The process of coming out can be met with actual or perceived rejection from family and/or peers. Self-esteem and self-confidence can suffer. These factors may also have impacts on increased rates of school leaving and homelessness – additional risk factors for smoking. Social exclusion resulting from these factors can also mean that LGBT people have fewer opportunities to develop positive coping skills to be resilient to the risks of smoking.
LGBT Communities’ Social Norms
Social norms in LGBT communities have been found in some research to be more accepting of smoking. Modeling of smoking behaviour in (or, now, outside of) LGBT bars as a common site of initiation for people to LGBT culture has been identified as a possible contributing factor supporting smoking behaviour. Also, smoking may be perceived as a way to belong and as a way to initiate conversation as an icebreaker or a social bonding opportunity in these sites.
Tobacco Industry Targeted marketing
Targeted marketing by the tobacco industry is a also a contributing factor tohigher smoking rates among LGBT populations. Tobacco companies aim to normalize smoking through advertising and promotion that appeal specifically to LGBT communities. The industry has targeted the LGBT communities for decades.
Access to and Adequacy of Health Services
LGBT people are less likely to access health services due to barriers in access, availability or acceptability, past negative experiences/discrimination, and/or a lack of culturally competent healthcare providers. Yet, support of health services and a family physician increases the likelihood of quitting smoking. Health service providers can inform smokers of the health risks of smoking and refer people to smoking cessation programs and supports.