LGBTQ+ People Experience a Health Burden from Commercial Tobacco

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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).2
Figures 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.4
Lgbt 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.11

More details on some of the reasons for these health disparities—and the public health measures that can improve health equity for LGBTQ+ people—are in 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 >
  1. 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].
  2. 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].
  3. 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].
  4. 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].
  5. 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].
  6. 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].
  7. 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].
  8. American Cancer Society. Cancer Facts & Figures, 2020 [accessed 2022 Mar 1].
  9. HIV.gov U.S. Statistics. U.S. Department of Health and Human Services. Updated June 2021 [accessed 2022 Mar 1].
  10. 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].
  11. 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].
  12. 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].
  13. Weinmeyer, R. The decriminalization of sodomy in the United States. AMA J Ethics, 2014;16(11): 916-922 [accessed 2022 Mar 1].
  14. 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].
  15. 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].
  16. 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].
  17. Drescher J. Out of DSM: Depathologizing Homosexuality.Behavioral Sciences, 2015;5(4): 565-575 [accessed 2022 Mar 1].
  18. Josefson D. Oregon's governor apologises for forced sterilisations. BMJ, 2002;325(7377): 1380 [accessed 2022 Mar 1].
  19. 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].
  20. Charlesworth A and Glantz SA. Smoking in the movies increases adolescent smoking: a review. Pediatrics, 2005;116(6): 1516-28 [accessed 2022 Mar 1].
  21. 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.
  22. 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].
  23. 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].
  24. 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].
  25. 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].
  26. 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].
  27. 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].
  28. 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].
  29. 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].
  30. 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].
  31. 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].
  32. 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].
  33. 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].
  34. 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].
  35. 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.
  36. 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].
  37. 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].
  38. 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].
  39. 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].
  40. 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].
  41. 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].
  42. 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].
  43. 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].
  44. 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].
  45. 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].
  46. 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].
  47. 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].
  48. 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].
  49. 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].
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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