LGBT+ youth and young adults in states with protective policies had more than 50% lower odds of smoking and vaping

Legislation that may harm the LGBT+ community – by limiting rights or reducing access to important services – is currently on the rise, and this may have a long-term impact on the physical and mental health of LGBT+ individuals. According to a study published in the American Journal of Public Health, LGBT+ individuals living in states with policies that protect LGBT+ rights had 65% lower odds of current cigarette use and 56% lower odds of current e-cigarette use compared with LGBT+ individuals in states with more restrictive or discriminatory policies.

People who identify as LGBT+ use tobacco at disproportionately higher rates compared to their heterosexual and cisgender peers, partly due to higher stress due to discrimination and harassment, as well as tobacco industry targeting. Over 15% (15.3%) of lesbian, gay, and bisexual adults and 43% of transgender or gender nonconforming adults smoke cigarettes compared with 11.4% of heterosexual adults and 19.2% of cisgender adults, respectively. 

Findings from this study suggest that state-level legislation to protect LGBT+ rights could help prevent or reduce tobacco use in the LGBT+ community and address health disparities between LGBT+ individuals and their heterosexual and cisgender peers. Furthermore, this study demonstrates the importance of considering an individual’s policy environment as a key determinant of LGBT+ health.

Anti-LGBT+ policies may be associated with higher tobacco use prevalence

Study participants aged 15 to 31 years were asked about their sexual orientation, sex assigned at birth, current gender identity, other demographic information, and cigarette and e-cigarette use. The home state of each respondent was categorized based on LGBT+ policies using data from the Movement Advancement Project, a nonprofit that tracks local LGBT+ legislation. States with predominately restrictive policies were given a negative score; states with a mix of restrictive and protective policies were given a low, medium, or fair score; and states with predominately protective policies were given a high score. Protective legislation can include laws that prevent housing and employment discrimination, laws that allow access to gender-affirming care, protection of same-sex couples’ parental rights, and state record-keeping that accounts for a person’s preferred gender identity.

The survey found that only 4.8% of LGBT+ youth and adults in high policy score states currently smoked cigarettes, compared to 11.3% in medium policy score states and 13.2% in negative policy score states. A similar pattern followed for e-cigarette use: 14.2% of LGBT+ youth and adults in high policy score states used e-cigarettes, compared to 25.5% in medium policy score states and 23.7% in negative policy score states.

When controlling for race and ethnicity, age, perceived financial situation, and state tobacco control expenditure, LGBT+ youth and adults living in states with a high policy score had significantly lower odds of current cigarette and e-cigarette use compared to those in restrictive policy states.

LGBT+ individuals living in a state with a negative policy score are potentially at higher risk for tobacco use. According to a separate study, nearly 1 in 3 LGBT+ individuals report poor mental health due to anti-LGBT+ policies and legislation, which may contribute to higher prevalence of tobacco use and overall disparities in health and wellbeing.

Protective legislation is key to addressing health disparities

In this study, higher levels of protective legislation – such as laws that prevent housing and employment discrimination and laws that allow access to gender-affirming care – was associated with the lowest levels of tobacco use compared with restrictive or discriminatory legislation.

This study is consistent with separate research finding that higher levels of discrimination are associated with poly tobacco use among a sample of lesbian, gay, and bisexual individuals. Mental health concerns are also high among the LGBT+ community - with stigma, harassment, and discrimination playing a role. Nicotine addiction can amplify the symptoms of depression and anxiety, making discrimination, mental health, and tobacco use compounding factors in overall LGBT+ health. 

Passing protective legislation could be a vital tactic in addressing LGBT+ mental health and lowering tobacco use among the LGBT+ community, closing the gap in health disparities and improving overall health and wellness.