health issue

larming 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 avail-

_ able 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

\

went up — nobody likes a fat gay

, man,” said ‘John Jones’ (pseudo-

nym). “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%)

Queer For

Nicotine

,TobaccoWreaks Havoc
on GLBTQ Health

“When I

think of the
word ‘cigarette’
it’s sexy, smeily,
my friend,

the endless
supply of
mothers milk,

I love it, I hate it,
and I am
addicted to it.”

 
   

immediate h

by anne watson bongiorno, RN, MS

about devastating effects nicotine
delivers to gay and lesbian smok-
ers.

The facts are staggering,
says Healthy People 2010:
Companion Document for LGBT
Health. According to that docu-
ment, 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 gener-
al population. However, youth
and adults grossly under or over-
estimated 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 per-
cent.” 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 start-
ing 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

 

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.” pther les-
bians reported that it was all
about rebellion and imitation.
“Sneaking cigarettes was cool,
and when I first started I got this
really nifiy 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
calmsxyou 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 com-
munity. 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,

i and I am addicted to it.” Group

members had widely varying per-
ceptions of the effects of advertis-
ing 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 advertis-
ing had nothing to do with it.” A
‘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 vulnera-
bility.” ‘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 inter-

viewed 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 cig-
arettes 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 experiment-
ing — I was at a vulnerable awk-
ward stage, and then all of a sud-
den 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  but I
still go back.” ‘Mike’ said, ‘‘I

 

quit a month ago, but I had a cig-
arette 2 days ago, it was the
exception, just one night, and it
was really bad, so I think I’m
done with it.” 7

Adults felt that those
who wanted to quit had specific
needs that were unique to queers,
such as the stress of being target-
ed 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 pro-
vide 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,” saidyone youth.‘ J
‘‘I thought I was really ‘asesig """"“‘

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 gen-
erations — 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 comment-
ed, “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 pro-
grams in smoking prevention and
cessation. CCTV and Health
Communication Resources are
creating a video, using a specifi-

‘ cally tailored approach to raise

awareness in the Queer commu-
nity about the issues of tobacco
use in the GBLTQ population and
to help current smokers quit. V

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