LGBTQ+ People Experience a Health Burden From Commercial Tobacco

At a glance

  • In 2020, use of any commercial tobacco product was higher among lesbian, gay, or bisexual adults, compared to heterosexual/straight adults (25.1% vs 18.8%).
  • Transgender adults are more likely to currently use a commercial tobacco product than adults who are not transgender (cisgender).
  • People living with HIV, including those who have access to freely available and well-organized HIV treatment, now lose more years of life from smoking than from HIV.
Friends talking at a coffee shop

The health burden of commercial tobacco

  • In 2020, 16.1% of lesbian, gay, or bisexual adults smoked cigarettes— compared with 12.3% of heterosexual/straight adults. Use of any commercial tobacco product was also higher among lesbian, gay, or bisexual adults compared to heterosexual/straight adults (25.1% vs 18.8%).A1
  • Transgender adults are more likely to currently use a commercial tobacco product than adults who are not transgender (cisgender). The prevalence of e-cigarette use among transgender adults is more than four times the prevalence among cisgender adults (31.3% transgender vs. 5.0% cisgender).2
  • In 2021, 17.4% of gay, lesbian, or bisexual high school students currently used any tobacco product—compared to 11.4% of heterosexual high school students.3
  • Among middle school students, any current tobacco product use was three times higher for gay, lesbian, or bisexual youth than heterosexual.3
  • About 1 in 5 lesbian, gay, or bisexual middle and high school students currently used electronic cigarettes in 2020 compared to about 1 in 8 heterosexual students.4
  • Lesbian, gay, and bisexual adults have more risk factors for cardiovascular (heart and blood vessel) disease—like high blood pressure—than straight adults.56 Cigarette smoking can cause cardiovascular disease.7
  • Cigarette smoking is the leading cause of lung cancer in all Americans and is linked to at least 11 other types of cancer.7 Given that an estimated 45,000 LGBTQ+ people die from cancer each year, it is important to understand the causes of cancer in this population.A8
  • Gay, bisexual, and other men who have sex with men (MSM) are the population group most affected by HIV in the United States, with MSM accounting for 69% of all new HIV diagnoses.910 People living with HIV, including those who have access to freely available and well-organized HIV treatment, now lose more years of life from smoking than from HIV.11

More details on some of the reasons for these health disparities—and the public health measures that can improve health equity for LGBTQ+ people—are in this website section.

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Content Source:
National Center for Chronic Disease Prevention and Health Promotion; Office on Smoking and Health
  1. The term "LGBTQ+" is used on this page to refer to people who are lesbian, gay, bisexual, or transgender, with the plus sign indicating inclusion of people who are queer, questioning, intersex, asexual, or who hold other gender/sex/romantic identities not specifically identified. Many studies cited on this page only looked at certain groups within the greater LGBTQ+ community. When single terms like "gay" or "lesbian," or acronyms like "LGB" are used on this page, this corresponds with how terms are used in the cited studies. More studies are needed to understand the ways that commercial tobacco and exposure affects other groups in the LGBTQ+ community.
  1. Cornelius ME, Loretan CG, Wang TW, Jamal A, Homa DM. Tobacco Product Use Among Adults — United States, 2020. MMWR Morb Mortal Wkly Rep. 2022;71(11):397–405.
  2. Buchting FO, Emory KT, Scout, et al. Transgender use of cigarettes, cigars, and e-cigarettes in a national study. Am J Preventive Med. 2017;53(1):e1–e7.
  3. Gentzke AS, Wang TW, Cornelius M, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students — National Youth Tobacco Survey, United States, 2021. MMWR Surveill Summ. 2022;71(5):1–29.
  4. Gentzke AS, Wang TW, Jamal A, et al. Tobacco Product Use Among Middle and High School Students — United States, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(50):1881–1888.
  5. Caceres BA, Brody A, Luscombe RE, et al. A systematic review of cardiovascular disease in sexual minorities. Am J Public Health. 2017;107(4):e13–e21.
  6. Gawlik KS, Melnyk BM, Tan A. An epidemiological study of population health reveals social smoking as a major cardiovascular risk factor. Am J Health Promot. 2018;32(5):1221–1227.
  7. U.S. Dept of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. U.S. Dept of Health and Human Services, 2014. Accessed March 1, 2022. https://pubmed.ncbi.nlm.nih.gov/24455788/
  8. American Cancer Society. Cancer Facts & Figures 2020. Accessed March 1, 2022. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2020.html
  9. HIV.gov. U.S. Statistics. Accessed March 1, 2022. https://www.hiv.gov/hiv-basics/overview/data-and-trends/statistics
  10. Centers for Disease Control and Prevention. Estimated HIV incidence and prevalence in the United States, 2015-2019. HIV Surveillance Report Supplemental Report. Accessed March 1, 2022.
  11. Helleberg M, Afzal S, Kronborg G, et al. Mortality attributable to smoking among HIV-1-infected individuals: a nationwide, population-based cohort study. Clin Infect Dis. 2013;56(5): 727–734.
  • "Commercial tobacco" means harmful products that are made and sold by tobacco companies. It does not include "traditional tobacco" used by Indigenous groups for religious or ceremonial purposes.