Background: Although studies have found that cigarette smoking is more prevalent among persons who identify as lesbian, gay, bisexual, transgender, or queer (LGBTQ) compared to persons who identify as heterosexual, limited research has examined tobacco use among LGBTQ individuals of different racial and ethnic backgrounds.
Methods: During summer 2016, the AHA-Tobacco Regulation and Addiction Center (A-TRAC) Project 3 conducted 27 focus groups and 196 surveys in Chicago, New York City and San Diego with smokers and non-smokers. Study inclusion criteria were self-identifying as LGBTQ and White Non-Hispanic (WNH), African American (AA), or Hispanic/Latino (H/L). Our study aim is to examine potential differences in tobacco use by race/ethnicity and factors that may be associated with such differences. Chi-square tests were used for group comparisons using SAS version 9.4. Atlas ti.v 7.5 software was used for qualitative analyses.
Results: Study participants were: 23% WNH, 16% AA, and 57% H/L; 60% identified as gay/lesbian, 20% as bisexual, and 20% as members of other groups. Socioeconomic status (SES) of the participants varied by smoking status. More smokers than nonsmokers lived in households with incomes under $20,000/year (50% of smokers vs. 39% of nonsmokers (p.001)) or were unemployed (34% vs. 19% (p.003)). Many participants suggested that easy access to tobacco products (e.g., cigarettes are “cheaper,” “you find single cigarettes sold everywhere") contributed to smoking initiation. Continued tobacco use was often mentioned as a way to deal with stress, such as the stress related to “coming out.” For racial minorities (AAs and H/Ls) compared to NHWs, sources of social stress included discrimination based on race, class, and sexual orientation as well as pressures to respond to community and cultural norms and expectations, such as gender roles (e.g., machismo). AAs and H/Ls also reported more heavy marketing of tobacco in their communities and indicated less knowledge about the risks associated with tobacco use. Racial minorities also expressed preferences for different tobacco products (e.g., cigarettes with menthol) than NHWs.
Conclusion: Differences in knowledge, attitudes and perceptions related to tobacco use were found among LGBTQ individuals of diverse racial/ethnic backgrounds. These findings have implications for culturally tailoring health communication campaigns and educational programs for LGBTQs, as well as for low SES groups. The findings also suggest the need for additional tobacco regulatory efforts in populations most vulnerable to tobacco marketing.