Gays Have Higher Rate Of Smoking Than Other Groups

At a smoke-friendly bar in the Castro on a hazy afternoon, Robert, 24, sits at a table by the window with a pack of cigarettes at his side and talks about when, and why, he first lit up.
"I was 16, and I'd just come out, and my family rejected me for being gay," said Robert, who asked that his last name not be used. "It was stress. I started smoking, and I was hooked."
Stress, many health care experts believe, is one of the main reasons why the smoking rate among gays and lesbians is at least twice the average in California. More than a decade of advertising targeted at gays and lesbians is also to blame, they say.
It's only in the past year or two that researchers were able to confirm what they'd suspected all along about the high smoking rate in the gay community. Now, at least one new survey, the results of which are expected next year, seeks to explain why.
About 14 percent of Californians smoke, according to a 2005 Department of Health Services survey released in April. But in a 2004 state survey, more than 30 percent of gay, lesbian, bisexual and transgender people were smokers.
Lesbians smoked at an even higher rate, 32.5 percent -- nearly three times the average -- for women in California. And among young lesbians between the ages of 18 and 24, a staggering 47 percent were smokers, compared with the average rate of 18 percent for that age group overall.
Gay smokers have their own theories on why they smoke: the club and bar scene, trouble finding dates and falling in love, high alcohol- and drug-abuse rates in the community. Sometimes, smoking is related to a lack of family connections, which can cause stress and also remove pressure to stop smoking once someone has started.
"Gay people probably smoke longer because we're not as family- oriented. If you don't have kids and raise a family, you don't need to stop," said John Daly, 41, who has smoked for 25 years. "We don't have the same responsibilities. We can be reckless a little longer."
Dr. Elizabeth Gruskin, a Kaiser Permanente researcher who studies tobacco and substance abuse among gays and lesbians, conducted a survey last year on why smoking is prevalent in the community. She hopes to publish the results sometime next year.
"It doesn't seem like the issues are different than with straight people, so maybe they're just more intense," Gruskin said. "If you said you smoke because of job stress, well, for an LGBT person, stresses can include 'Do I come out at the office?' and 'Am I going to get fired if they find out I'm gay?' There's sort of an added layer for LGBT people."
New anti-smoking campaigns helped spur a recent decrease in smoking nationwide after rates held steady through much of the 1990s. In 1999, 1 in 4 adult Americans, or 25 percent, reported smoking. In 2004, when the most recent national survey was conducted by the Centers for Disease Control and Prevention, that number had dropped to 21 percent.
That's still a long way from the CDC's goal of only 12 percent of Americans smoking by 2010. But the results vary heavily by state -- California has the second-lowest rate, behind Utah -- and by social or ethnic group.
American Indians, have the highest smoking rate, at 33.4 percent, followed by white Americans and black Americans, at 22.2 percent and 20.2 percent, respectively. Hispanics and Asians have the lowest smoking rates, at 15 percent and 11.3 percent, respectively, according to the national survey.
In last year's California study, researchers broke down the demographics even further. Behind gays and lesbians, the biggest smokers were U.S. Marines and Korean men. Among immigrants, smoking rates decrease for men as they spend more time in the United States, and increase for women.
Gruskin and other health care experts who have studied smoking among gays and lesbians have plenty of theories on why they smoke more -- but no hard evidence.
There's the influence of the club and bar scene, and the idea that smoking tends to go hand-in-hand with alcohol and other drug use. As far as sources of stress, it's hard to beat coming out to family and friends. And even in liberal, open-minded San Francisco, being gay can carry its own weight, smokers said.
"There's a theory that smoking truly is a part of gay identity, whether that be a prop for a drag queen or a cigar for a woman who's part of the Women's Motorcycle Contingent," said Bob Gordon, director of the California LGBT Tobacco Education Partnership in San Francisco. "Perhaps smoking signals 'queer,' that I'm different from the mainstream."
The media influence also is an important factor, said Ruth Malone, a UCSF medical sociologist who has studied tobacco-industry advertising targeted at gays and lesbians. She said it's worrisome how embedded cigarettes are in gay media.
"What we found was that the images of smoking were just ubiquitous in the gay press. They appeared in illustrations with articles that had nothing to do with tobacco. Tobacco appeared in ads that had nothing to do with tobacco products," Malone said.
"We also did some focus groups with LGBTs, and this just does not seem to be on the radar screen as a health issue in the community, which is kind of striking," she said. "Given the smoking rates, it's really a big health issue for the community, but the community does not see it as an issue."
Aside from the obvious health risks associated with smoking, health care experts said smoking among gays is worrisome given that other potential health problems, such as AIDS, are exacerbated by smoking. Transgender men and women face even further risks from smoking when combined with hormone therapy, said Gruskin.
Gloria Soliz, who runs The Last Drag in San Francisco, one of several smoking-cessation programs for gays and lesbians, said she's surprised at the high rate of smoking among people in those groups. In the 1990s, gay men were focused on healthy living in the face of AIDS, and today there is a focus on working out and maintaining an attractive, healthy lifestyle, she said.
Still, incongruous as it seems, smoking often becomes part of that picture.
"When it comes to family and friends in the lesbian and gay community, smoking seems to be one of those ways of bonding and rebelling and finding identity. I think that's unfortunately still part of it," Soliz said. "There are other things you can do. You can bowl, you can play on volleyball teams ... but society is pretty ambivalent. Both alcohol and tobacco are legal, and yet they're killers in our society."
from The San Francisco Chronicle