When Bill Gruenloh moved from Sacramento from St. Louis 10 years ago, he headed to the easiest place to meet people and make friends – the local gay bar.
Then 24 and a smoker since his teens, he hoped that a healthy West Coast lifestyle, and the state ban on smoking in many public areas, would help him shake his addiction once and for all. But when he walked into the Mercantile Saloon and other midtown haunts sporting the rainbow flag, he was quickly offered a light.
“I knew it would be kind of a different world, that there might be more of a negative connotation to smoking that there was here, but not so much in the bars in the gay community,” said Gruenloh, now 34. “You’d walk out on the street and not see smokers in public, but when you were in the bars it made no difference.”
Ashtrays on patios and heavy clouds of smoke have long been the norm at queer-friendly drinking establishments. Combined with targeted marketing from tobacco companies, that really helps explain why LGBT people smoke at double the rate of their heterosexual peers. That represents a problem which advocates and health officials are tackling with new ad campaigns, anti-smoking legislation and safe spaces for those who want to quit for good.
“Historically, trans and queer folks had very limited gathering spaces, and many of those spaces have been centered around bars,” said Ben Hudson, executive director of the Gender Health Center in Sacramento, an LGBT-focused clinic. “Folks who experience a lot of microaggressions and are living in a world that’s not necessarily accepting of who they are may use smoking to relieve that stress.”
The 2012 National Adult Tobacco Survey, which was the most recent report from the U.S. Centers for Disease Control and Prevention to consider gender identity and sexual orientation in smoking habits, found that 33 percent of lesbian, gay, bisexual and transgender respondents smoked, vs. 20 percent of the general population.
The situation was similar in California, where the LGBT smoking rate is 27 percent, compared with a heterosexual smoking rate of 13 percent, according to a 2013 report from the California Department of Public Health. More than 40 percent of lesbian, gay and bisexual respondents said they allowed smoking in their homes, vs. only 23 percent of heterosexuals.
To combat the problem, the U.S. Food and Drug Administration launched an anti-smoking campaign this May called This Free Life, specifically targeted at LGBT people ages 18-24. Social media messages and banners in 20 cities show young people smiling and holding rainbow flags.
This June, the LGBT organization Equality California became the first minority rights group to endorse the Healthcare, Research and Prevention Tobacco Tax Act of 2016, which would raise California’s cigarette tax by $2.
Rick Zbur, the group’s executive director, said his staff has been honing in on LGBT health issues following the approval of same-sex marriage and other breakthrough progress for the community. Expanding health care enrollment has been a major effort, he said, as has been training health care providers to be more sensitive to LGBT patient needs.
Tobacco is particularly dangerous for transgender women taking estrogen, as smoking increases the risk of blood clots, heart conditions and stroke. People with HIV are more likely to develop HIV-related infections such as mouth sores, pneumonia and lung infections if they smoke.
“Programs and issues affecting the health of LGBT people are a core issue for us,” Zbur said. “If this means gay married couples who are now free to be together get 10 extra years without emphysema and cancer, that’s a great thing. And that’s why we want to tackle the problem in the community. We know it’s a struggle, and we want to march forward together.”
Bringing the smoking rates down also means pushing against the tobacco companies, who often design smoking ads that appeal to LGBT youths, said Bob Gordon, a public health advocate and founder of The Last Drag, an LGBT-specific smoking cessation group in San Francisco.
In the 1990’s, Gordon reached out to editors at LGBT publications nationwide and asked them to stop running cigarette ads. Fred Palmer, CEO of Outward Media Marketing and Events, said he quickly agreed to keep them out of Sacramento’s Outward magazine.
“I didn’t lose revenue, and it wasn’t really about losing revenue,” he said. “It was about taking a stand against tobacco health issues in the LGBT community.”
Unfortunately, dropping the habit isn’t easy, and groups such as The Last Drag are few and far between, Gordon said. In Sacramento, neither the Gender Health Center nor Cares Community Health, a midtown clinic with a specialty in HIV treatment, offers programs to help people quit.
“When people would go to a regular class, they’d have to talk about something so personal and they’d strive not to use a pronoun because they didn’t want to have to come out while trying to quit smoking,” he said. “There’s a lot of isolation in our community. People feel good when they quit with support.”
Gruenloh said he didn’t seriously quit until he met his now-fiance, Garrett Wyllie. The couple visited Wyllie’s grandmother often while she struggled through the final stages of lung cancer caused by secondhand smoke – a wake-up call to the long-term health consequences of tobacco use, he said.
“It did make me feel guilty, and it did make me want to stop,” he said. “It was a reality check.”
Wyllie’s grandmother died on Feb. 8, 2015. Gruenloh and Wyllie have not had a cigarette since then, though they’re still trying to wean themselves off the vaporizing pen they sometimes use to smoke socially.
The journey was long, and physically painful at times, Gruenloh said. Now, though, the avid cyclist couldn’t be happier about the choice.
“My body feels better, my lungs feel great,” he said. “There are enough things floating around this environment anyway. Why put something in your body that’s going to hurt you?”
For more information for Native Americans to quit smoking, call the American Indian Commercial Tobacco Program at 1-855-372-0037.