As tobacco companies market directly to the LGBTQ community, Kaiser Permanente Northern California offers measures for members to kick the habit. Pictured, Jennifer Slovis, MD, at the Kaiser Permanente Oakland Multi-Specialty Transitions Department.

Lesbian, gay, bisexual and transgender adults in the U.S. smoke at rates of up to 2.5 times higher than straight adults, according to Truth Initiative, which attributes the rise to tobacco company marketing.

“Unfortunately, the tobacco companies target vulnerable populations, including but not limited to LGBTQ people,” said Renee Fogelberg, MD, clinical lead of tobacco cessation at Kaiser Permanente Northern California.

She said that the marketing is visible everywhere this population is — from clubs to magazines — and further capitalizes on the fact that the LGBTQ community faces higher rates of depression and anxiety.

“The marketing preys on this population with messages that say smoking will relieve stress,” Dr. Fogelberg added.

“We are seeing a climbing rate of physical and social hate crimes against LGBTQ people,” added Jennifer Slovis, MD, medical director of the Kaiser Permanente Oakland Multi-Specialty Transitions Department, which serves transgender and gender non-conforming members. “In turn, it is not at all surprising there is an increase in stress-related behavior, including smoking.”

The Tidal Wave

Marcos Siqueiros, MD, is a 22-year Kaiser Permanente primary care physician in Santa Clara. He’s also that area’s lead champion for transgender health care. He said the smoking rates can be as high as 30% of LGBTQ adults, which he termed “astounding.”

“There is especially heavy marketing of e-cigarettes and vaping products,” he said. The result is tobacco popularity among peer-pressured adolescents and young adults who are vulnerable to ploys such as candy bar or fruit-flavored tobacco.

“Tactics like these further the misperception that there are few impurities in e-cigarettes and vaping products. But that is not true,” Dr. Siqueiros said. “They carry harmful chemicals that can cause long-term health repercussions and can be a gateway to long-term tobacco addiction with standard cigarettes.”

“We all know that smoking is really the tidal wave behind many of the severe illnesses that we take care of as providers,” Dr. Slovis said. “Not only cancers but also cardiovascular disease, which includes heart attacks and strokes.”

Quitting Is Free

Kaiser Permanente Northern California sets ambitious quit targets for all of its medical centers. As a result, overall tobacco usage among Northern California members is currently at 7.2 percent. “No one else in the nation has such a low prevalence,” said Dr. Fogelberg.

All members who come in for an appointment are asked if they smoke. Those who do are encouraged to quit by their provider, who can write a prescription for no-cost NRT medication and book an online or in-person appointment for cessation counseling at Kaiser Permanente.

To counteract tobacco company advertising, Dr. Siqueiros said his medical center is celebrating Pride Month with fact-based tip sheets about tobacco use as well as banners that say, “Take pride in your health by living tobacco-free.”

Dr. Slovis said part of counteracting LGBTQ tobacco use lies with culturally competent care, which at Kaiser Permanente ranges from physician and staff education to the ability for members to find LGBTQ knowledgeable providers by contacting the local Member Services Department or checking on kp.org for the LGBTQ link on individual provider home pages.

“Pride Month is when the LGBTQ community hears a lot about Kaiser Permanente because we have such a big presence in the various Bay Area Pride Parades,” Dr. Slovis said. “It’s also a time to tell people that we are their LGBTQ sensitive and knowledgeable health care provider — which includes help with smoking cessation.”

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