adults
Tobacco Prevention
Tobacco use remains the number one source of preventable disease and death in the United States. While United States smoking rates are around 20%, the Wisconsin state average has been about 22% according to the recent estimates. High rates of smoking mean higher health care costs for every resident of the state of Wisconsin and have an adverse effect on life span and years of productive, healthy life. Compounding the problem is the fact that smoking rates are higher among some cultural and ethnic groups. Cultural norms and socialization patterns in the lesbian, gay, bisexual, and transgender (LGBT) communities place us at risk for tobacco usage and subsequent health problems.
Over the past six years, Diverse and Resilient has conducted health disparity research among LGBT populations in Wisconsin on several health issues. In many areas, LGBT individuals matched overall statewide health statistics for the general population including self-perception of overall health, routine check-ups, high blood pressure, nutrition and diet.
This research indicates, however, that tobacco use rates are considerably higher among LGBT populations as compared to the general population in Wisconsin. Whereas 22% of Wisconsin adults are current smokers, more than 4,000 surveys conducted by Diverse and Resilient over the past six years among LGBT adults indicate rates of that are 68-100% higher than the general population in Wisconsin. In a large national study, it was found that smoking rates for lesbians, bisexual women, gay men, and bisexual men were 25%, 27%, 33% and 20%, respectively.
Other studies have shown smoking rates among gay and bisexual men to be as high as 48%. Overall, smoking levels among LGBT populations point to figures 40-70% higher than those in the general population in the US.
Several factors have been cited as possible reasons for the disparity between smoking rates in the LGBT and general populations. They include: higher levels of economic and social marginalization, stresses resulting from homophobia and discrimination, frequent patronage of bars and clubs where smoking is permitted or promoted, lack of smoke-free social venues, higher rates of alcohol and drug use, and direct targeting of LGBT consumers by the tobacco industry.
In addition to the above factors, few tobacco cessation or prevention programs are inclusive of LGBT culture. Culturally specific interventions are needed for the LGBT population to reduce tobacco use. A comprehensive review of the literature concluded that targeted and culturally competent tobacco prevention techniques, tobacco use surveillance, and data collection were necessary to combat the higher than average smoking rates in the LGBT community. Unfortunately, the number of places which provide treatment for substance abuse tailored to the LGBT community have declined. The National Survey of Substance Abuse Treatment Services (2003) collected data showing that in 2000, 15.1% of facilities reported providing special services to gays and lesbians. This number decreased to 12.8% in 2002 and just 5.5% in 2003. While we do not know how many of the facilities surveyed offered tobacco cessation services, the trend toward fewer culturally competent programs for LGBT clients is alarming.
In 2008, Diverse and Resilient launched a partnership with the University of Wisconsin School of Medicine and Public Health and LGBT community centers around Wisconsin. The result of this cooperative agreement was rm2breathe, a project that aims to change tobacco use norms in Wisconsin LGBT communities and to help current smokers quit. The multi-faceted program is described on its website, www.rm2breathe.org
To be effective, tobacco prevention and cessation programs for LGBT people in Wisconsin must take into account that while many smokers would like to quit, most have been unsuccessful. Further, for LGBT smokers, tobacco use is both a chemical addiction and a psychosocial coping process. Observing the role that minority stress has in tobacco use among LGBT people is an important part of the process. However, real facts about addiction to nicotine is critical as well. In our experience, most current programs for tobacco cessation reflect neither understanding of the role of minority stress nor a clear exploration of addiction.
