Unfair and Unjust Practices Harm LGBTQ+ People and Drive Health Disparities

At a glance

  • The tobacco industry targets the LGBTQ+ community with marketing and advertising.
  • Stress can increase commercial tobacco use and can make health problems worse.
A gay couple smiling at the camera

Overview

Sexual minority groups have experienced harassment, discrimination, and been exposed to forms of violence related to unfair and unjust practices, policies, and conditions.1 Experiences of discrimination and stressful socioenvironmental conditions are associated with commercial tobacco product and other substance use and, in turn, can contribute to poor health outcomes.A2 Some examples of historical policies and practices in the United States (U.S.) that have led to mental and physical health risks and challenges, and related long-term outcomes, for LGBTQ+ people include:

  • Laws targeting LGBTQ+ people by making same-sex relationships illegal. These laws were in place from the time the nation was founded until 2003. In 1960, all fifty states had laws against same-sex sexual activity. Before the 2003 Supreme Court ruling in Lawrence v. Texas, sexual activity between people of the same sex was illegal in 14 U.S. states, Puerto Rico, and the U.S. military. Making same-sex relationships a crime led to unjust practices that harmed LGBTQ+ people, including discrimination in finding housing and jobs and children being removed from their parents' care.3
  • Marriage bans prevented many LGBTQ+ people from having the same rights as straight married couples, such as job protection while caring for a sick spouse and the ability to add spouses to employer-sponsored health insurance plans.4 Until the 2015 U.S. Supreme Court ruling (Obergefell vs. Hodges), states were not required to recognize marriages between same-sex couples and many states denied same-sex couples the right to marry. Marriage bans caused stigma and made same-sex couples less equal in the eyes of the law, adding to chronic stress.2
  • Some LGBTQ+ people have experienced harm and distress caused by people expressing anti-LGBTQ+ views using hate crimes: threats, verbal abuse, vandalism, and violence. 56As of 2017, fewer than half of U.S. states offered legal protection from discrimination based on sexual orientation.7
Lesbian couple sitting on couch with infant
LGBTQ+ people face challenges that may make them more likely to use commercial tobacco.

LGBTQ+ people have also experienced discrimination and harm from health care systems and medical science. For example:

  • Organized medicine in the United States has often made stigma around same-sex attraction worse by using supposedly scientific reasons for this discrimination. For instance, the American Psychiatric Association’s official diagnostic book (the Diagnostic & Statistical Manual) stated that homosexuality was a mental disorder until 1973.8
  • Between 1923 and 1981, the state of Oregon had people who committed “crimes against nature” (a way it described same-sex sexual activity) sterilized without their consent.9

There are also current reasons—like the ones explored below—that help explain why commercial tobacco affects the health of LGBTQ+ people.

Justice Building
Until 2015, states were not required to recognize marriages between same-sex couples.

The tobacco industry targets the LGBTQ+ community with marketing and advertising.

Marketing plays a big role in whether people try or use commercial tobacco products. Being around commercial tobacco ads makes smoking appear more appealing and increases the chance that someone will try smoking for the first time or start using commercial tobacco products regularly.10111213

Tobacco companies spend billions of dollars each year to aggressively market their products. They also target specific populations, including the LGBTQ+ population, and flood them with commercial tobacco advertising.

  • Donations and Sponsorships. In the early 1990s, tobacco companies were among the first large corporations to advertise in magazines and newspapers targeted at LGBTQ+ readers, sponsor Pride parades, and give donations to organizations serving LGBTQ+ people.11 Tobacco companies said in documents not shown to the public that these sponsorships and ads were marketing tactics designed to attract LGBTQ+ people to their products. In the 1990s, they gave one LGBT+ marketing strategy the code name “Project SCUM (Sub-Culture Urban Marketing).” Tobacco companies still advertise at festivals and other community events held by and for LGBTQ+ people and give to local and national groups serving LGBTQ+ people and people living with HIV.
  • Targeted advertising. Tobacco companies advertise heavily in publications with gay and lesbian readership, often using images that show LGBTQ+ people using tobacco as a “normal” part of life.14
  • Nightlife Marketing: Bars and clubs have traditionally been one of the few spaces in which LGBTQ+ people have felt safe to meet and socialize openly.15 Tobacco companies work to promote their brands in these spaces and sponsor nightclub after-parties in bars and clubs.
  • Marketing flavored tobacco products to LGBTQ+ people using symbolism. Adding flavors (like menthol) to commercial tobacco products can mask the harshness of tobacco, promote youth initiation, lead to establishment of product use, and can contribute to lifelong tobacco use.71617 Ads for flavored tobacco products have used LGBTQ+ symbolism, including phrases like “Take pride in your flavor” or images of colored packages arranged like a rainbow.18 Tobacco companies have also heavily marketed menthol cigarettes to LGBTQ+ people. This can help to explain why about 36% of LGBTQ+ people who smoke use menthol cigarettes compared to 29% of straight people who smoke.14
e-cigarettes' in rainbow LGBT colors
Tobacco companies market their products using LGBTQ+ symbolism.

Public health strategies can help reduce the pressure to buy that comes with heavy advertising and discounts. To help protect LGBTQ+ people from tobacco price promotions and discourage tobacco product use, states and communities could consider increasing prices and prohibiting price discounts, prohibiting the sale of flavored tobacco products, and either allowing fewer stores in a neighborhood to sell commercial tobacco products or prohibiting tobacco product sales altogether.19

Another step that states and communities can take include making all workplaces smokefree—with no exceptions. Many workplaces are now covered by a smokefree law—but gaps in smokefree protections often leave out bars and nightclubs. In places that do not have comprehensive smokefree laws bartenders and servers in LGBT nightclubs can be harmed by exposure to secondhand smoke.20

Stress can increase commercial tobacco use and make health problems worse

When people face many forms of stress—like financial problems, discrimination, or unsafe neighborhoods—they can be more likely to smoke.212223 Most LGBTQ+ people say they have experienced some form of harassment or discrimination. More than half have had slurs used against them, and 57% report that they or a close friend have been threatened with violence.24

The link between discrimination, stress, and commercial tobacco helps to explain why:

  • Gay college students are more likely to smoke when they have to hide their orientation.25
  • LGBTQ+ youth who attend schools with LGBT-friendly policies and student groups are less likely to begin smoking.26

When people have severe or long-lasting stress, their bodies respond by raising stress hormones and keeping them raised. When this goes on for a long time, they may develop health problems like high blood pressure or a faster heart rate.2728 Smoking cigarettes also leads to disease and disability and harms nearly every organ in the body.10

Couple sitting at the bottom of stairs with LGBT colors.
Stress can make people more likely to smoke.
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Content Source:
National Center for Chronic Disease Prevention and Health Promotion; Office on Smoking and Health
  1. "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.
  1. McCabe SE, Hughes TL, Matthews AK, et al. . Nicotine Tob Res. 2019;21(4):523–531.
  2. Helleberg M, Afzal S, Kronborg G, et al. . Clin Infect Dis. 2013;56(5): 727–734.
  3. Weinmeyer, R. . AMA J Ethics. 2014;16(11):916–922.
  4. Perone AK. . LGBT Health. 2015;2(3):196–199.
  5. Herek GM. . J Interpers Violence. 2009;24(1): 54–74.
  6. Bostwick WB, Boyd CJ, Hughes TL, West BT, McCabe SE. . Am J Orthopsychiatry. 2014;84(1):35–45.
  7. Caceres BA, Brody A, Luscombe RE, et al. . Am J Public Health. 2017;107(4):e13–e21.
  8. Drescher J. Behav Sci. 2015;5(4): 565–575.
  9. Josefson D. . BMJ. 2002;325(7377):1380.
  10. U.S. Dept of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. U.S. Dept of Health and Human Services, 2014. Accessed March 1, 2022.
  11. Carson NJ, Rodriguez D, Audrain-McGovern J. . Prev Med. 2005;41(2):511–520.
  12. Charlesworth A, Glantz SA. . Pediatrics. 2005;116(6):1516–1528.
  13. National Cancer Institute. . U.S. Dept of Health and Human Services, 2008.
  14. Smith EA, Malone RE. . Am J Public Health. 2003;93(6):988–993.
  15. Ryan H, Wortley PM, Easton A, Pederson L, Greenwood G. . Am J Prev Med. 2001;21(2):142–149.
  16. U.S. Dept of Health and Human Services. Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General. U.S. Dept of Health and Human Services, 2012. Accessed March 1, 2022.
  17. U.S. Dept of Health and Human Services. E-Cigarette Use Among Youth and Young Adults. A Report of the Surgeon General. U.S. Dept of Health and Human Services, 2016. Accessed March 1, 2022.
  18. Trinkets & Trash: Artifacts of the Tobacco Epidemic. . University of Medicine & Dentistry of New Jersey.
  19. Robertson L, McGee R, Marsh L, Hoek J. . Nicotine Tob Res. 2015;17(1):2–17.
  20. Fallin A, Neilands TB, Jordan JW, Ling PM. . Am J Public Health. 2014;104(2):e148–e153.
  21. Slopen N, Kontos EZ, Ryff CD, Ayanian JZ, Albert MA, Williams DR. . Cancer Causes Control. 2013;24(10):1849–1863.
  22. Slopen N, Dutra LM, Williams DR, et al. . Nicotine Tob Res. 2012;14(10):1161–1169.
  23. Purnell JQ, Peppone LJ, Alcaraz K, et al. . Am J Public Health. 2012;102(5):844–851.
  24. Robert Wood Johnson Foundation. 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 March 1, 2022.
  25. Cochran SD, Bandiera FC, Mays VM. . Am J Public Health. 2013;103(10):1837–1844.
  26. Eisenberg ME, Erickson DJ, Gower AL, et al. . J Youth Adolesc. 2020;49(4):836–848.
  27. Juster RP, McEwen BS, Lupien SJ. . Neurosci Biobehav Rev. 2010;35(1):2–16.
  28. Guyll M, Matthews KA, Bromberger JT. . Health Psychol. 2001;20(5):315–325.