Evaluating the Capacity for a Community Response to LGB Tobacco Use

Background and Purpose: Smoking tobacco and exposure to environmental tobacco smoke is significantly elevated for individuals who identify as lesbian, gay or bisexual (LGB) compared to heterosexual populations, and may be an early driver of known health disparities. LGB individuals have higher rates of smoking risk factors, such as depression, substance use, and violence victimization, but face unique risk factors related to structural stigma and identity-based discrimination. Research has also found that LGB smoking rates are sensitive to local tobacco control policy, with decreased smoking observed with more restrictive policies. LGB community socialization historically has involved attending bars and nightclubs, many of which still allow indoor smoking, to share a common identity in a safe environment but can increase smoking behavior. In contrast, LGB community leaders and service agencies have traditionally not viewed tobacco use as a health priority, and even appreciated the symbolic status associated with being a target market for tobacco advertising. The objective of this study was to examine the capacity for a community response to LGB tobacco use.                                                     

Method:This study employed a community assessment of health and social spaces frequented by LGB people in a mid-size mid-Atlantic U.S. metropolitan area to examine the capacity for the community to respond to tobacco use. Twelve state and local government resources at the state and local level with responsibility for tobacco or public health, as well as community agencies that dealt primarily with tobacco use or public health, and LGB health and social services were identified. Content on LGB health, social services, or tobacco was gathered from websites, Facebook and social media sites, and publicly available reports. Email, telephone, and in-person contact was initiated to inquire specifically about the capacity of each agency to address LGB tobacco use.

Results:The assessment revealed that the challenge of addressing tobacco for LGB people is multifaceted. At the state level, the plan to address tobacco disparities did not include LGBT populations. Contracted agencies that deliver state-funded tobacco cessation and prevention activities do not offer LGB-specific culturally competent services to address tobacco use. Health service agencies reported barriers to identifying needs in the LGB community, or did not provide tobacco prevention services. LGB-serving agencies reported that tobacco control was not part of their mission but were open to outside resources working within their spaces. Challenges reported by agencies included underfunding of tobacco by governments, lack of attention to tobacco as a problem, and difficulty initiating and sustaining partnerships between LGB and other community social service and health agencies. 

Conclusion: Despite significantly higher rates of use, exposure to environmental smoke, and being a target market for the tobacco industry, LGB community resources have not been directed towards reducing a primary driver of health problems and disparities. Capacity exists within the healthcare and LGB community to mobilize supports and resources to address tobacco use for LGBT people, however the lack of funding at multiple levels of government leaves this vulnerable community at high risk for poor health.