Features
Queer For Nicotine
by Ann Watson Bongiorno, RN, MS
Alarming numbers of gay men and lesbian women struggle to combat their nicotine addiction, innocently begun as a way to combat daily stress. Only limited help is available that specifically addresses the unique needs of the addicted smoker who is part of the Queer community. There are no support groups and few learning activities about devastating effects nicotine delivers to gay and lesbian smokers.
The facts are staggering, says Healthy People 2010: Companion Document for LGBT Health. According to that document, 41.5 percent of gay men in a household sample identified themselves as smokers – far exceeding the 28 percent rate reported among men in the general population. However, youth and adults grossly under or overestimated the prevalence of smoking in the queer community. “ I think that 90 percent smoke,” said one young woman. “No,” said another, “it is about 20 percent.” One gay man said, “I do not think that the smoking rates in gay men are any different than in heterosexual men, being queer has nothing to do with it.”
Reasons given for starting smoking ranged from wanting to fit in, to relieving stress, to rebelling and weight loss. “After I started smoking my weight went down and my self-esteem went up – nobody likes a fat gay man,” said ‘John Jones’ (pseudonym). “It just helped to relieve all that stress, I used it as a weapon. To deal with me being gay at the time,” Jones said.
According to the Healthy People report, twice as many lesbians as heterosexual women reported being “heavy” smokers (6.8 to 7.4% vs. 3.5%) and although almost 50 percent of the heterosexual women reported never smoking, only 25 to 33 percent of lesbian women reported never smoking. Lesbian women report smoking at rates almost double that of straight women.
“When you smoke, it’s a good pick up line, it’s easier to talk to people if they’re smoking a cigarette,” said ‘Sally.’ “There’s something extra, something that just bonds us together.” Other lesbians reported that it was all about rebellion and imitation. “Sneaking cigarettes was cool, and when I first started I got this really nifty little brain rush, and get kind of dizzy. It was fun. I don’t get that anymore,” said one woman in a focus group. Another focus group member said, “It is security, a replacement for a man, strength, it holds our desires, it calms you and it’s a momentary break.”
Due to high smoking rates, the LGBT community bears a heavy burden of tobacco-related health problems. This burden includes the risks of lung cancer, chronic obstructive pulmonary disease, and esophageal cancer, according to Healthy People 2010-Companion Document for LGBT Health.
In 2001, Fresh Attitudes: A Coalition for Healthy Choice in the Queer Community was formed to begin the hard work of developing tobacco prevention and cessation in the queer community. The initial work of the Fresh Attitudes planning grant, which included survey groups and a process video, highlighted the barriers to smoking cessation in the GLBTQ community.
“When I think of the word cigarette,” said focus group members, “it’s sexy, smelly, my friend, the endless supply of mothers milk, I love it, I hate it, and I am addicted to it.” Group members had widely varying perceptions of the effects of advertising on the Queer community. “I think of Mr. Marlboro, making tons and tons of money. It really pisses me off,” said ‘Sarah.’ Others insisted it was at least one thing in their lives they could control. “I came from a family that threw me away because I was gay,” said ‘David,’ “and it was a way to get back, an in-your-face thing without them knowing about it – and advertising had nothing to do with it.”
‘Jan’ said, “I had not come out yet, it [smoking] was definitely about something I could control when everything was out of control – and the media clearly target our vulnerability.” ‘Chris’ noted, “I started smoking to lose weight but I keep smoking because I am addicted, but the ads do make it look like the people who smoke are the fun people – and the thin people.”
Every smoker interviewed in these LGBTQ focus groups started smoking before age 18. In Vermont, eighth to twelfth grade students who had had sex with someone of their own gender were significantly more likely than those who had had sex only with people of the other gender to have smoked cigarettes in the past 30 days. The finding holds true in three years of surveys: in 1997(73% vs. 58%); in 1998 (64% vs. 55%); in 1999 (73% vs. 54%), according to the The Vermont Youth Risk Behavior Survey.
All Queer smokers who were interviewed were addicted. “One day I was just experimenting – I was at a vulnerable awkward stage, and then all of a sudden I could not stop,” said one. Another gay man commented, “I’ve quit for a week at a time, a month at a time, an hour Ö but I still go back.” ‘Mike’ said, “I quit a month ago, but I had a cigarette 2 days ago, it was the exception, just one night, and it was really bad, so I think I’m done with it.”
Adults felt that those who wanted to quit had specific needs that were unique to queers, such as the stress of being targeted because of sexual orientation and the ability to discuss triggers and relationships, but that they did not necessarily need a GBLT specific group. “I am not sure if we need specific groups for the gay community, but we need gay-friendly groups,” said ‘John.’ Another person in the focus group commented, “If you are trying to quit and want to talk about sex, kissing your partner ... the loss of those smoky, sensual moments, it helps to be where you are accepted.”
The themes that came out of the youth interviews made it clear that it is critical for adult role models to step up and provide leadership and mentoring for queer youth. “As pathetic as it sounds, it was a pact between those of us who felt alienated by the mainstream,” said one youth. “I thought I was really cool, smoking.”
Leadership seems to be an issue in the community,” one man said, “There is a cultural problem in our community, not a lot of guidance between the generations – because if you try to do the cross-generational stuff, people think you are a pedophile, so folks aren’t really available to mentor kids.” Another commented, “There is a pretty sharp class division with smoking and pretty exclusively the working class kids – they all smoke.”
It is critical to build self-efficacy in youth and provide them with the tools to make wise decisions about their health and smoking. To that end, the American Cancer Society and Fresh Attitudes have submitted a grant to create statewide programs in smoking prevention and cessation. CCTV and Health Communication Resources are creating a video, using a specifically tailored approach to raise awareness in the Queer community about the issues of tobacco use in the GBLTQ population and to help current smokers quit.
Anne Watson Bongiorno, RN, MS, is president of Health Communication Resources, a consultant to the Healthy Living Foster Families Program, and a faculty member at the University of Vermont School of Nursing. In her spare time, she’s pursuing doctoral studies at Duquesne University. She lives in Stowe