How The Tobacco Industry Exploits LGBTQ People
By Casey Quinlan
The health risks of smoking are well-documented. We know that smoking not only causes nine out of 10 lung cancer deaths, but can also cause blood cancer, pancreatic cancer, liver cancer, and various other cancers in the body.
But we rarely talk about the specific harm to the LGBTQ community. More than 30,000 LGBT people’s lives are lost to tobacco-related diseases each year, which is higher than the number of Americans with AIDS in the U.S.
In some cases, LGBTQ people can be especially susceptible to adverse health effects from smoking. Smokers who are HIV-positive, for instance, are more likely to get infections like thrush and pneumonia. Bob Gordon, Project Director for the California LGBT Tobacco Education Partnership, explained that when many gay men were dying of AIDS in the 1980s, no one wanted to quit smoking, since they knew they were close to death. Now, with enormous improvements in treating people with HIV, it’s important for those with HIV or AIDS to preserve their health by quitting.
Trans people who decide they want to take hormones also face numerous health risks from smoking. Sixty-two percent of those who took the 2010 survey by the National Transgender Discrimination Survey Report on Health and Health Care had hormone therapy. Those who identified as women assigned male at birth, rather than men assigned female at birth, were also much more likely to access hormone therapy, making this a particularly pressing issue for trans women. Smoking while taking hormones can put trans people at greater risk for heart and lung disease, according to GLMA: Health Professionals Advancing LGBT Equality, an association of LGBTQ health care professionals.
“For women who are taking estrogen and smoking as well, as for men who are taking testosterone and smoking, trans or not, it is a serious risk,” Gordon said. “We have done focus group work for trans-serving agencies in the Bay area and we know that people are saying. ‘I have heard from my doctor that when I’m taking testosterone for example, that I’m really careful and my doctor would really love me to quit.”
Gordon also noted that doctors urge people to quit smoking before any kind of surgery, to improve outcomes and recovery times. Of trans women surveyed in the 2010 report, 72% either had or wanted to have chest surgery. The percentages of trans women who had or wanted vaginoplasties and orchiectomies were very similar. Smoking complicates any of these.
And yet, despite their particular vulnerabilities to the well-known health risks of smoking, LGBTQ people still smoke at higher rates than the straight and cisgender population. According to the Centers for Disease Control and Prevention, 23.9% of lesbian, gay, or bi people smoke cigarettes compared to 16.6% of straight people. Unfortunately, there is less information on transgender people’s smoking rates, but the 2010 National Transgender Discrimination Survey, which received thousands of surveys from all over the country, found that 30% of its sample of respondents said they smoked daily or occasionally.
This may be tied to the particular stressors facing the LGBTQ community. Substance use or dependence, poverty, discrimination, and mental illness all relate to and feed off of each other. To explain further, several large studies have shown that lesbian and gay youth have higher rates of substance use or dependence, according to the American Psychological Association. Americans with mental illnesses have a 70% greater likelihood of smoking according to a 2013 CDC report.
Experts on tobacco use have also tied lack of mental health treatment to smoking. Chad Morris, PhD., told the American Psychological Association that people with mental health issues may use tobacco as a form of self-medication, especially if they are poor and lack access to resources that could help them quit. People who are below the poverty level are also more likely to smoke, and those in the LGBTQ community — especially LGBTQ people of color — are more likely to be poor.
Several large studies have shown that lesbian and gay youth have higher rates of substance use or dependence, according to the American Psychological Association. Trans women, and especially trans women of color, are dealing with greater stressors than many other groups under the LGBTQ umbrella. A study examining substance use and mental health in nearly 300 young trans women in Chicago and Boston, most of whom were women of color, found than more than a third of the women had depression at one time and that one in five considered suicide in the past month. In addition, many of the women were unemployed and lived in extreme poverty. Fifteen percent were dependent on non-alcohol psychoactive substance use.
Americans with mental illnesses have a 70% greater likelihood of smoking according to a 2013 CDC report. Experts on tobacco use have also tied lack of mental health treatment to smoking. Chad Morris, PhD., told the American Psychological Association that people with mental health issues may use tobacco as a form of self-medication, especially if they are poor and lack access to resources that could help them quit. People who are below the poverty level are also more likely to smoke, and those in the LGBTQ community — especially LGBTQ people of color — are more likely to be poor.
LGBTQ people don’t just smoke more because of stress and pain. Tobacco companies have also been taking advantage of that pain for decades.
The weight of discrimination on the lives of LGBTQ people also partly explain the mental health struggles that may drive LGBTQ people to smoke. Researchers at the University of California, Los Angeles, studied whether there is a possible link between discrimination against LGB people and mental health and found strong evidence of a relationship between the two, although the findings did not prove that discrimination causes mental health problems.
But LGBTQ people don’t just smoke more because of stress and pain. Tobacco companies have also been taking advantage of that pain for decades by targeting advertising to these communities.
“I know when I came out, by going inside to a smoky environment” — an underground bar he frequented — ”that’s when I knew what it was to be a gay man,” Gordon said. His experience is not at all unusual. Smoking has long been framed as being part of many countercultures, including queer and trans-friendly spaces, and tobacco companies have been selling that message of freedom through smoking. The most obvious example is American Spirit’s simple black and white advertisement with the words, “Freedom. To speak. To choose. To marry. To participate. To be. To disagree. To inhale. To believe. To love. To live. It’s all good.”
Lucky Strike and Virginia Slims ads also targeted the gay community, with ads of two women kissing and an ad of a woman walking beside a man on the beach and turning her head to gaze at female passersby. When RJ Reynolds’ advertising project, named Project SCUM (for SubCulture Urban Marketing), was publicized in the media in 2000, the tobacco behemoth drew negative attention from the LGBTQ community, but the company’s efforts continued to find success with LGBTQ customers.
But the danger of smoking in the LGBTQ community was largely ignored by many LGBTQ advocacy groups, Gordon said, and in some cases is still being ignored. Tobacco companies used to make donations to powerful LGBTQ groups and many smaller LGBTQ-centered or LGBTQ-friendly magazines were reliant on the support of the tobacco industry through advertisements.
In a 2008 University of California, San Francisco study, researchers interviewed leaders of 74 LGBTQ organizations and publications and found that most leaders did not see tobacco as relevant to LGBTQ identity and as an individual right rather than a national health problem. Of these organizations and publications, 22% said they received tobacco industry funding. In the 1990s, tobacco companies used donations to AIDS to improve its image while marketing their products to LGBTQ people, researchers point out. In the late 1990s, AIDS organizations began to push back and refuse donations from big tobacco companies. Pride parade organizers have also allowed companies to give out free cigarettes to parade goers.
“There have been a number of tactics throughout these 25 years that we’ve seen through advertising in LGBT publications,” Gordon said. “There was a phase where the tobacco companies were giving philanthropic donations to LGBT organizations to buy silence from those organizations that they would never speak out against tobacco. Certainly when money is coming into your organization, it’s a lot harder to talk about the health that’s related to tobacco-related illness.”
A 2002 article in the American Journal of Public Health gave some examples of how the media has actually framed the tobacco industry’s targeting of LGBTQ people as a sign of progress. Joe Landry, publisher of Out and The Advocate was quoted in The Boston Globe in 2001 as saying, “Lots of companies are adding diversity marketing to their budgets, which used to mean money for advertising mainly to blacks and Hispanics, but now it’s meant largely, and sometimes mainly, for gay and lesbian customers.”
It will take a lot of time for health advocates to undo the damage done by the tobacco companies that have targeted LGBTQ people over the past 20 plus years, but smoking rates among LGBTQ people are perceived as a large enough health problem for the Food and Drug Administration to get involved. It launched a $35.7 million anti-tobacco campaign targeted toward LGBTQ youth — but its efforts have come under fire by experts. The campaign, whose freedom-based advertising calls to mind the American Spirit ad, focuses on tobacco’s effect on one’s appearance rather than serious health problems, according to NBC News. Critics argue that this strange choice of focus plays on societal assumptions that LGBTQ people are more superficial and vain than, or on stereotypes about young people. Experts have also questioned the FDA’s focus on prevention rather helping people quit smoking. The campaign targets 18 to 24 year olds, but many LGBTQ youth who smoke have already started before age 18.
Some state-level government anti-smoking campaigns are also LGBTQ-inclusive — but not nearly enough. LGBT Health Link, a network of health care experts concerned with health disparities in the LGBTQ community, created a Smoking Report Card for each state in 2014. The report cards judge how well they include LGBTQ people in their smoking prevention and cessation efforts. Nevada and Idaho were the only two states to receive As. Nevada included LGBT community members in policy and planning for tobacco control, monitored the impact of tobacco on the LGBT population, and regularly integrated LGBT tailored efforts info larger tobacco control campaigns, for example. Kentucky, Montana, South Dakota and Tennessee all received a failing grade.
The answer may lie with organizations that specifically serve the LGBTQ community. There are numerous efforts on the part of local organizations in urban areas to spread information on the particular risks facing LGBTQ people and offer help to those who want to quit. The NYC LGBT Smoke-Free Initiative raises awareness of higher smoking rates in the LGBTQ community and targets their message to both LGBTQ people and city decison-makers. The DC Center for the LGBT Community offers information on the risks of smoking and smoking cessation support. In San Francisco, Bob Gordon helps LGBTQ people quit smoking for free through a program in San Francisco called The Last Drag. He takes a judgment-free approach to the classes and acknowledges that quitting smoking is a gradual process.
“What we want people to know is that this is a nicotine is really extremely powerful right up there with heroin and crystal meth for example, and if they want to they can free themselves from the nicotine and tobacco,” Gordon said. “There is a lot of negativity out there and we don’t want people to feel that. The idea is that if you keep trying to get support and resources, we can help people free themselves from tobacco.”