{ITAL “The LGBT communities have an excellent health infrastructure, but when you ask our leaders about our top health issues, smoking is rarely even in the list. It really is time for smoking to come out of the closet as the top issue health issue affecting LGBT people today.”

– Dr. Scout.}

Both a national study and a Michigan-based survey have come to the same conclusion – smoking is a big cost to the LGBT community. According to CenterLink’s Network for Health Equity, LGBT people spend 65 times more money on cigarettes as the Funders for LGBTQ Issues report all foundations spend on LGBT funding. An estimated $7.9 million goes from the pockets of the gay community to the tobacco companies for products that are causing them harm.

The recently released The Health Consequences of Smoking–50 Years of Progress report by the Surgeon General shares the hard truth about cigarettes. It also contains data specifically collected on the gay community.

According to the report, “Significant disparities in tobacco use persist among certain racial/ethnic populations, and among groups defined by educational level, socioeconomic status, geographic region, sexual minorities (including individuals who are gay, lesbian, bisexual, and transgender, and individuals with same-sex relationships or attraction), and severe mental illness. The majority (88 percent) started smoking before 18 years of age, and in nearly all, first use of cigarettes occurs before 26 years of age.”

“It’s a brutal truth,” says the Network’s Director Dr. Scout, “We’re spending more on something that kills us than everyone else is spending to help us.”

The health risks associated with smoking are also high. More than 16 million Americans suffer from a disease caused by smoking, according to the report. In the U.S., smoking causes 87 percent of lung cancer deaths, 32 percent of coronary heart disease deaths, and 79 percent of all cases of chronic obstructive pulmonary disease (COPD). One out of three cancer deaths is caused by smoking.

LGBT smoking disparities have been documented with a series of studies over several decades, but the 2012 National Adult Tobacco Survey marked the first time a national surveillance instrument reported LGBT smoking prevalence. In that survey, 32.8 percent of LGBT respondents smoked, versus 19.5 percent of others.

“LGBT people smoke at rates that are 68 percent higher than the general population,” said Scout, “and the 50 years of Surgeon General’s reports just show us how effectively lethal tobacco is.

“The LGBT communities have an excellent health infrastructure, but when you ask our leaders about our top health issues, smoking is rarely even in the list. It really is time for smoking to come out of the closet as the top issue health issue affecting LGBT people today,” says Dr. Scout.

Because of trends like these, in spring 2013, Michigan Department of Community Health approached Affirmations to collect qualitative data on tobacco use in LGBT communities. Since Affirmations is located in southeast Michigan, Affirmations partnered with Kalamazoo Gay Lesbian Resource Center (KGLRC) in order to expand this project to include the west side of the state. The centers conducted focus groups to look at why LGBT people smoke, and what more can be done to stop it.

They learned that tobacco use creates community. “The vast majority of focus group participants stated that one of their key motivations to start and continue using tobacco was the community they found among tobacco users. Participants explained that tobacco use created a common interest that eased social anxieties and made meeting people easier. Additionally, this sense of community also created a barrier to quitting because when friends would go outside or gather to smoke cigarettes participants explained that they did not want to be left alone or left out of the activity,” the report said.

They also found that most people did not know that a Quit Line existed to provide resources to help them break the habit, and also that when they did see outreach campaigns about quitting smoking, they did not represent LGBT people positively.

Quit Lines are set up in every state to provide support for people who want to give up smoking. The phone number is 1-800-QUITNOW, and many call responders have been trained in LGBT sensitivity by CenterLink’s Network for Health Equity.

The findings in Michigan are preliminary, but during summer 2014, Affirmations will work with a University of Michigan School of Public Health intern to further analyze the data collected from the focus groups described in this report. Affirmations has had smoking cessation services and campaigns in the past, but currently none are offered. “Hopefully this survey can be the basis for funding in the future,” said Lydia Hanson, Health and Wellness Manager at the community center.

“LGBT people, people of color, the poor – tobacco preys on stigma and too often we pay with our lives,” says Dr. Phoenix Matthews, a tobacco researcher at University of Illinois at Chicago and Network member. “I hope this number shocks people enough so we start building tobacco control into all of our communities’ health programs.”

For resources and support in quitting, visit http://smokefree.gov/talk-to-an-expert. For more on CenterLink’s Network for Health Equality see http://www.lgbtcenters.org/news/553/CenterLink-Becomes-New-Organizational-Home-for-Network-for-LGBT-Health-Equity.aspx.