Cigarette Use Linked with Substance Use Among Sexual, Gender Minority Populations

A link between cigarette smoking and frequent substance use in sexual and gender minority populations suggests a need for holistic treatment, according to researchers from the Rutgers School of Public Health.

The researchers surveyed 665 racially, ethnically and socioeconomically diverse sexual minority men and transgender women to examine the relationships between smoking, substance use, and mental, psychosocial and general health. About 70% of the survey participants reported smoking cigarettes, and of those who had smoked, 60% said they had used cigarettes within the past month.

Among the study’s findings, current smokers were more likely to be white and reported more days of marijuana use within the past month. Also, current smoking was associated with symptoms of more severe anxiety and more frequent alcohol use, and current smokers indicated lower levels of self-esteem. The researchers concluded in their study that cigarette use is “highly linked to anxiety, depression and PTSD symptomology and provide context for tobacco and other substance use as means for coping with these symptoms.”

“Evidence also tells us that smoking is associated with worse mental health and increased substance use, but we don’t know how these conditions are related to each other, exacerbating and mutually reinforcing their effects,” Perry N. Halkitis, dean of the Rutgers School of Public Health and the study’s senior author, said in a news release announcing the findings.

The researchers also noted past research that shows higher rates of smoking among LGBTQ+ individuals vs. cisgender and heterosexual individuals, suggesting that smoking is a coping mechanism to deal with a variety of social stressors, health disparities and a lack of LGBTQ-affirming healthcare providers.

“(A)n approach to tobacco use in [sexual minority men] and [transgender women] communities must not ignore how sexuality and gender identity and associated stigmas and discriminatory experiences may factor into ongoing tobacco use in the population,” the researchers wrote in the study.

“One-size-fits-all counseling models developed for heterosexual populations may be less effective if they fail to consider the social stressors of living in a homophobic and transphobic society. Though it was not the case in our sample, such stressors, which enable experiences of stigma, have been associated with numerous health disparities across the lifespan, including tobacco and alcohol use.”