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LGBTQ+ People Experience a Health Burden from Commercial Tobacco										Related Pages
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In 2020, 16.1% of lesbian, gay, or bisexual adults smoked cigarettes – compared with 12.3% of heterosexual/straight adults. Use of any commercial tobacco* product was also higher among lesbian, gay, or bisexual adults, compared to heterosexual/straight adults (25.1% vs 18.8%).1
Transgender adults are more likely to currently use a commercial tobacco product than adults who are not transgender (cisgender). The prevalence of e-cigarette use among trans adults is more than 4 times the prevalence among cis adults (21.3% transgender vs. 5.0% cisgender).2Figures of people standing next to arrow with LGTY colors pointing up
In 2021, 17.4% of gay, lesbian, or bisexual high school students currently used any tobacco product – compared to 11.4% of heterosexual high school students.3
Among middle school students, any current tobacco product use was 3 times higher for gay, lesbian, or bisexual youth than heterosexual.3
About 1 in 5 lesbian, gay, or bisexual middle and high school students currently used electronic cigarettes in 2020 compared to about 1 in 8 heterosexual students.4Lgbt drawing of a heart next to LGBT colors
Lesbian, gay, and bisexual adults have more risk factors for cardiovascular (heart and blood vessel) disease – like high blood pressure – than straight adults.5,6 Cigarette smoking can cause cardiovascular disease.7
Cigarette smoking is the leading cause of lung cancer in all Americans and is linked to at least 11 other types of cancer.7 Given that an estimated 45,000 LGBTQ+ people die from cancer each year,8 it is important to understand the causes of cancer in this population.
Gay, bisexual, and other men who have sex with men (MSM) are the population group most affected by HIV in the US, with MSM accounting for 69% of all new HIV diagnoses.9,10 People living with HIV, including those who have access to freely available and well-organized HIV treatment, now lose more years of life from smoking than from HIV.11More details on some of the reasons for these health disparities—and the public health measures that can improve health equity for LGBTQ+ people—arein this website section.
† 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.
**“Commercial tobacco” means harmful products that are made and sold by tobacco companies. It does not include “traditional tobacco” used by Indigenous groups for religious or ceremonial purposes*.Next Section: Unfair and Unjust Practices Harm LGBTQ+ People and Drive Health Disparities >ReferencesCornelius 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].
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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].
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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].
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Drescher J. Out of DSM: Depathologizing Homosexuality.Behavioral Sciences, 2015;5(4): 565-575 [accessed 2022 Mar 1].
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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].
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						Page last reviewed:  June 27, 2022					Content source: 	Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion homeHomeOffice on Smoking and Health (OSH)plus iconOSH Partners with StatesFunding Opportunity AnnouncementsInteragency Committee on Smoking and Healthplus iconMembership RosterNewsroomStay ConnectedOrganizationSmoking & Tobacco Use FeaturesQuit Smokingplus iconHow to Quitplus iconBenefits of QuittingBasic Informationplus iconHealth Effectsplus iconCancerHeart Disease and StrokeChronic Obstructive Pulmonary Disease (COPD)Smoking During PregnancyEquality in Smoking & Disease: Nobody Wins!Electronic Cigarettesplus iconAbout Electronic Cigarettes (E-Cigarettes)Quick Facts on the Risks of E-cigarettes for Kids, Teens, and Young AdultsEmpower Vape-Free Youth CampaignMenthol Tobacco Productsplus iconState Menthol Fact SheetsMenthol Tobacco Products are a Public Health ProblemMenthol Smoking and Related Health DisparitiesAddressing Menthol Tobacco ProductsHeated Tobacco ProductsYouth Tobacco PreventionCommercial Tobacco and Health Equityplus iconBlack and African American Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoAmerican Indian and Alaska Native Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoAsian, Native Hawaiian, and Pacific Islander Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsQuitting TobaccoHispanic and Latino Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoLGBTQ+ Peopleplus iconHealth BurdenUnfair and Unjust Practices and ConditionsQuitting TobaccoPeople Across Geographic Regionsplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoPeople with Behavioral Health Conditionsplus iconHealth BurdenUnfair and Unjust Practices and ConditionsCommercial Tobacco Product Use and Behavioral Health Conditions can Affect Each OtherQuitting TobaccoPeople with Low Socioeconomic Statusplus iconHealth BurdenUnfair and Unjust Practices and ConditionsSecondhand SmokeQuitting TobaccoSecondhand Smokeplus iconGeneral InformationTrends and DisparitiesHealth ProblemsSecondhand Smoke in the CommunitySecondhand Smoke in the HomeSmokefree PoliciesResourcesGoing Smokefree Mattersplus iconBars and RestaurantsCasinosIn Your HomeMultiunit HousingSurgeon General's Reports on Smoking and Tobacco Useplus icon2020 SGR—Smoking Cessation2016 SGR—E-Cigarette Use Among Youth and Young AdultsHistorical ReportsA Brief HistoryArchiveData and Statisticsplus iconFast Facts and Fact Sheetsplus icon**Smoking and Cigarettes**Diseases and DeathHealth Effects of Cigarette SmokingTobacco-Related MortalityCigarette Smoking in the U.S.Adult DataCessationCost and ExpendituresEconomics**Smokeless Tobacco**Health EffectsProducts and MarketingSmokeless Tobacco Product Use in the United States**Other Tobacco Products**CigarsHookahsLow Yield Cigarettes**Secondhand Smoke****Youth Tobacco Use**Youth DataSmoking in the MoviesTrends in Tobacco Use Among Youth**Tobacco Industry**Tobacco Brand PreferencesIndustry MarketingSurveysplus iconNational Youth Tobacco Survey (NYTS)Alaska Native Adult Tobacco Survey Guidance ManualAmerican Indian Adult Tobacco SurveyScientific Evidence BriefsSTATE SystemMorbidity and Mortality Weekly Reports (MMWR)Vital SignsPatient Careplus iconPatient Care Settings and Smoking Cessationplus iconCardiovascular Care SettingsRespiratory Care SettingsCancer Care SettingsMaternal and Infant Care SettingsClinical Interventions to Treat Tobacco Use and Dependence Among AdultsClinical Cessation ToolsPatient Cessation MaterialsQuitlines and Other Cessation Support ResourcesClinical Education and TrainingE-Cigarettes and Patient CareState and Community Workplus iconTobacco Control Programsplus iconCessation Materials for Tobacco Control ProgramsNetworking2Save: Co-op AgreementGuidelines and ResourcesProgram FundingEvidence Based Guides for StatesState Fact SheetsTobacco Ingredient and Nicotine ReportingTobacco Counter-Marketing CampaignGlobal Tobacco Controlplus iconAbout Global Tobacco Surveillance System (GTSS)GTSSDataThe Global Adult Tobacco Survey (GATS) AtlasHelp & Glossaryplus iconGlossaryData and DocumentationUsing the GTSSData HomepageUsing the GTSSData Explorer PageContact UsMultimedia & Toolsplus iconMedia Campaign Resource Center (MCRC)Publication Catalog To receive email updates about Smoking & Tobacco Use, enter your email address: Email Address			What's this				Submit
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