'Big Tobacco' Companies Leave Legacy of High LGBTQ Smoking Rates

Smoking is big business in the United States. Almost 250 billion cigarettes are sold every year to smokers, totaling more than $228 billion in sales. But these figures only show one part of tobacco's economic impact as smoking-related illnesses in the U.S. cost more than $300 billion a year, including both direct medical care and lost productivity.

Not all communities are impacted equally by the harm caused by smoking. While smoking rates have fallen significantly in recent decades, disparities remain regarding the LGBTQ+ community. National Health Information Survey data shows that one in five LGB adults report being current cigarette smokers (transgender identity was not specifically recorded in the survey). Only around 14 percent of non-LGB adults were current smokers.

"The fact that we have some of the highest smoking rates of any disparity population makes us particularly concerned, not just about cancer, but actually about all the other negative effects related to smoking, like heart disease and everything all the way down to diabetes," explains Scout, executive director of the National LGBT Cancer Network. "We know that a third of cancers would just disappear out of existence if smoking stopped. According to The American Cancer Society's Cancer Facts & Figures 2021 report, 19% of cancers are caused by smoking.

LGBTQ+ adults aged 18 and 24 are nearly twice as likely to use tobacco as their heterosexual counterparts. Cigarette smoking in the United States is responsible for 480,000 deaths per year, with more than 30,000 LGBTQ+ people dying from tobacco-related diseases each year.

'A story of stigma, social exclusion and discrimination.'

No single factor can explain the disproportionately high percentage of LGBTQ+ people who smoke. According to experts, a toxic combination of stressors unique to members of the LGBTQ+ community can contribute to queer people starting to smoke, especially when it comes to younger queer people.

"This is absolutely a story of stigma, social exclusion and discrimination," explains Scout. "Many people don't realize that smoking is actually a pediatric epidemic. If you get to the age of 20, without smoking, you're not likely to ever start."

Scout points out that the average age people start smoking is about 12 or 13, which coincidentally is also the average age LGBTQ+ people come out, according to a recent youth survey from the Human Rights Campaign (HRC).

"It's the exact time we realize there's this incredible additional burden of social exclusion on us, and we're looking for ways to both cope with that stressor and also find new ways to bond with people. Guess what? Smoking fits perfectly into both of those categories," adds Scout.

While some younger people may not consider the repercussions of smoking, believing one cigarette now and again isn't a problem, numerous studies and reports have found people who start smoking younger are more likely to continue into adulthood. "It's easy to get lost in smoking without sort of realizing how addictive it can be; it's very difficult then to stop when people realize," says Scout.

Creating effective strategies to reduce smoking among LGBTQ+ people is not an easy task. One of the significant challenges facing activists working to address tobacco-related harms within the community is the acute lack of healthcare data, especially for the trans population.

For Em Sanders, project manager of the LGBTQ+ Tobacco Harm Reduction Study, data-gathering issues can present a challenge in reporting accurate statistics. "Are people being asked about their sexual and gender identity in appropriate and competent ways? And are they being asked by people who make them feel comfortable disclosing this information?" they add.

"All of those sorts of things make it really difficult for the data to reflect reality in an up-to-date way. First of all, there's not as much data on sexual and gender minority groups as there is on cisgender and heterosexual populations. Data on trans folks is even more scant – it's very, very hard to come by," Sanders adds.

One of the studies Em worked on, titled "LGBTQ+ Adults and Tobacco Stigma," sought to document the attitudes and experiences of LGBTQ+ people towards tobacco, stigma and identity. A number of the responses highlighted the unique concerns policymakers and LGBTQ+ populations need to consider when dealing with smoking-related health issues.

"There's a quote in the paper where someone's talking about the extent to which negative health outcomes from smoking might lead people to have to rely more on medical systems that may be hostile to them. This is perhaps a risk that is particularly unique for some folks in LGBTQ+ communities," Sanders says.

'Meaningful change requires more.'

LGBTQ+ rights organizations have complex relationships with tobacco firms. On the one hand, advocacy groups raise concerns about the damaging impact of tobacco and the ways tobacco companies target the community. For example, The Human Rights Campaign (HRC) has hosted webinars and conducted surveys to illustrate the impact of smoking on queer people.

Yet, at the same time as calling attention to the damage smoking causes to LGBTQ+ people, leading tobacco firms are regularly recognized by HRC as some of the "Best places to work for LGBTQ equality."

"You'll see [tobacco firms] brag every year about how they get a perfect rating on the Corporate Equality Index (CEI) from HRC. They may be great to work for, but they're still selling death to our community when their products are used directly," explains Scout.

The CEI does not measure what a business sells or the services it offers but rather analyzes the experience of LGBTQ+ workers. Policies around non-discrimination, a public commitment to LGBTQ+ equality and evidence of LGBTQ+ inclusion are several key factors that firms are measured on.

"While the CEI should continue to be a transformational tool for setting the bar for workplace inclusion for LGBTQ workers, it is also only a starting point, not the ending point for corporate stakeholders committed to advancing LGBTQ equality," adds HRC press secretary Aryn Fields.

"In other words, diversity and inclusion policies and practices advanced through tools like the CEI are critical, but meaningful change requires more. It requires breathing life into these policies and practices in real and tangible ways," Aryn adds.

The second-largest US tobacco company, R. J. Reynolds Tobacco Company (RJRT), celebrated its 100% score on HRC's 2020 Corporate Equality Index with its CEO, Ricardo Oberlander, commenting, "Within our organization, diversity and inclusion are integral to our ability to transform tobacco, innovate, and succeed."

Tobacco companies directly advertising to LGBTQ+ people through magazines, Pride Marches and 'brand ambassadors' is nothing new. Many restrictions have been placed on how tobacco products can be promoted and marketed, but many avenues remain to reach smokers, as well as potential smokers. Sporadic advertisements for cigarettes appear in countless mainstream magazines such as Rolling Stone, People and Vogue and LGBTQ+ publications.

Adverts for the Camel Snus tobacco product, with the headline "Take pride in your flavor," were published in Minneapolis-based LGBTQ magazine Lavender and North Carolina-based Q-Notes in 2011.

Perhaps one of the most infamous examples is "Project SCUM" (Sub Culture Urban Marketing). Proposed by tobacco giant R.J. Reynolds, this initiative contained plans to more effectively sell cigarettes to members of so-called "alternative lifestyles" in San Francisco, primarily gay residents of the Castro and homeless people in the Tenderloin neighborhood.

Documents that detail the targeted marketing of marginalized groups by R.J. Reynolds came to light when, as part of the State of California's litigation against tobacco companies, a court order demanded Project SCUM information to be made public. Soon after the exploitative marketing plans were released, LGBTQ community activists railed against what they perceived as an anti-gay strategy.

"This is a hate crime, plain and simple," Kathleen DeBold, director of the Washington, D.C.-based Mautner Project for Lesbians With Cancer, told SF Weekly in 2001. "What else do you call it when a group thinks of gays and lesbians as 'scum' and then targets us with something that kills?"

A major element of this plan focused on how tobacco firms were actively working to ensure young smokers become lifetime customers. "We have information going all the way back to the mid-90s, showing a series of things that the tobacco industry started to do in terms of outreach to our communities, including recruiting one of our civil rights leaders and asking him what kind of messaging would be effective in neutralizing LGBT opposition to the tobacco industry," says Scout.

For example, in 1998, author and gay rights advocacy David Mixner was hired by the Tobacco Institute, a lobbying group, to help create a strategy to "convince LGBT California voters to support the industry's position on a statewide ballot measure."

Much of the advice provided by the civil rights leader to tobacco firms mimicked key talking points found in the early gay rights movement, including slogans including 'hands-off our bodies', 'the freedom to choose' and 'don't regulate our lives.'

Dismantling 'the vector of this smoking epidemic'

Government agencies, LGBTQ+ nonprofits and anti-smoking organizations are actively working to communicate the dangers of smoking to the community. For example, the FDA's This Free Life Campaign, which ran from 2016-2020, sought to prevent and reduce tobacco use among LGBTQ+ young adults through educational digital advertisements and social media.

But sporadic initiatives are unlikely to have much of an effect when 'Big Tobacco' firms spend more than $9 billion on advertising and promoting tobacco products each year, continuing to directly target the community through a range of marketing initiatives.

Courtney Rhodes, a spokesperson for the Center for Drug Evaluation and Research (CDER), a division of the U.S. Food and Drug Administration (FDA), believes that higher rates of tobacco use among LGBTQ+ individuals can also be attributed, at least in part, to this advertising.

"Tobacco companies will often advertise at Gay Pride parties and other events specific to the LGBTQ community. In LGBTQ lifestyle publications and media, tobacco ads often portray tobacco use as normal and widely accepted behavior. This strategic marketing plays a part in the initiation and continued use of tobacco products among LGBTQ young adults," Rhodes said in an emailed statement.

Several cities across the U.S. have introduced legislation to outlaw the distribution of tobacco coupons in bars and clubs in their districts, with some of the rulings specifically mentioning the prevalence of this practice in LGBTQ+ venues.

In 2015, the San Jose city council announced a ban on tobacco sampling and coupons. In a report at the time, "scantily-clad" representatives were reported to offer bar patrons coupons for half-priced or $1 cigarette packages. This practice is completely legal unless legislators ban it in their jurisdiction.

"The tobacco industry is and always has been the vector of this smoking epidemic," says Bob Gordon, project director of the California LGBT Tobacco Education Partnership. Gordon, who has worked in LGBTQ+ tobacco control for decades, he's seen the many ways LGBTQ+ people have been targeted.

"In the past, tobacco brands like Lucky Strike pulled a lot of stunts to try to cozy up to our community. For example, they sponsored Lucky Strike-branded smoking lounges, passing out free cigarettes at LGBT fundraisers," he says.

These same tactics are in place today. An e-cigarette company called Vaporfi sponsored Miami Beach Pride in 2014, with their website advising those who are "New to Vaping" and offering e-liquid flavors like strawberry cheesecake and peanut butter and jelly.

"Big Tobacco sells our community addiction and death with appealing flavors targeting young people," he concludes.