LGBT health may be compromised by underreporting of tobacco use, study finds

October 02, 2012
Research by a health behavior doctoral student at the UNC Gillings School of Global Public Health demonstrates that an influential 2011 report on lesbian, gay, bisexual and transgender health under-reported evidence of tobacco disparities for LGBT people compared to heterosexuals.
Joseph Lee

Joseph Lee

According to a new report co-authored by Joseph G.L. Lee and published online in September by the American Journal of Public Health (PDF), an Institute of Medicine (IOM) report on LGBT health underestimated evidence of that population’s tobacco use because it omitted numerous references to studies on LGBT tobacco use.

Lee and co-authors John R. Blosnich, PhD, and Cathy L. Melvin, PhD, used systemic reviews of tobacco literature to identify 71 articles on LGBT tobacco use, the majority of which the institute omitted in its 2011 study.
“Certainly, the IOM cannot be expected to cite all studies on any subject,” Lee and his colleagues wrote, “but as a foundational report, the evidentiary building blocks of that foundation may have cracks relating to one of the largest — and clearest — causes of death and disability among the LGBT population: tobacco use.”
The IOM report, which was the first major federal report on LGBT health, is used by federal agencies and funding entities to set public health policy and priorities.
“We didn’t want people to underestimate or forget about the toll of tobacco use and the important work still to be done to prevent and treat tobacco addiction,” Lee said.
According to data from the 2009-2010 National Adult Tobacco Survey published in the American Journal of Public Health (PDF), 32.8 percent of LGBT people nationally smoke cigarettes, compared to 19.5 percent of straight people.
Since the likelihood of smoking within the LGBT community is roughly double that of the general population, members of the LGBT community are at greatly increased risk of cancer and other tobacco-related health threats such as heart attacks and strokes, according to the American Lung Association.
Lee identified 63 unduplicated studies from two systematic reviews and eight key articles published between May 2007 and January 2011, for a total of 71 unduplicated studies. The report cited only 15 of the 71 studies for their tobacco content, and of these, only eight studies used more rigorous population-based samples. At least 18 population-based studies of sexual minority tobacco use were not included in the institute’s tobacco evidence.
Co-author Blosnich is with the psychiatry department at the University of Rochester Medical Center, and co-author Melvin, formerly with the UNC public health school’s department of maternal and child health, is now at the Medical University of South Carolina.
Lee’s study was partially supported by the UNC Lineberger Comprehensive Cancer Center’s University Cancer Research Fund and by a postdoctoral fellowship in an Institutional National Research Award from the National Institute of Mental Health to Blosnich.


UNC Gillings School of Global Public Health contact: Linda Kastleman, communications editor, (919) 966-8317 or