Reducing Tobacco-Related Cancer Risks in LGBTQ+ Communities

Sexual and gender minorities, including LGBTQ+ populations, face an elevated risk of poor health outcomes due to higher rates of tobacco use compared to their cisgender and heterosexual peers. Tobacco causes roughly 20% of all cancers and 30% of all cancer deaths in the United States.  

Lesbian, gay, and bisexual adults smoke cigarettes at rates significantly higher than heterosexual adults. For example, the highest rates of tobacco use were found in bisexual women (37.7%) and lesbians (31.7%), while heterosexual women had the lowest prevalence (16.6%). Studies have shown that transgender individuals are also more likely to be current smokers than their cisgender counterparts.  

As a scholar-activist, Phoenix Matthews, PhD, has made it part of their mission to reduce tobacco-related health disparities among sexual and gender minorities. Using a mix of traditional academic and boots-on-the-ground approaches, they develop community-based and culturally-targeted health promotion interventions — such as smoking cessation treatments — to reduce cancer risk and improve cancer outcomes in vulnerable communities. 

“I talk to members who are part of those communities, so that I can learn from their lived experiences — what is working, what hasn't been working — and figure out how can we best try to address their needs as it relates to cancer prevention and control,” says Dr. Matthews, who identifies as non-binary.  

Pioneering culturally-targeted tobacco solutions

Dr. Matthews, co-director of the Community Outreach and Engagement office at the Herbert Irving Comprehensive Cancer Center (HICCC) at New York-Presbyterian/Columbia University Irving Medical Center (CUIMC), joined Columbia University School of Nursing as a professor of behavioral sciences in August 2022. After presenting health disparities research at a series of town hall meetings while at the University of Illinois Chicago, they helped pass the city’s first-ever restrictions on menthol-flavored tobacco sales. 

In 2019, they conducted one of the first National Institutes of Health (NIH)-funded smoking cessation intervention studies that compared the effects of culturally targeted versus non-targeted programs among lesbian, gay, bisexual, and transgender smokers. Quit rates were similar between the two programs, which suggests that existing evidence-based interventions can be effective for LGBT smokers as well.  

More recently, Dr. Matthews and colleagues at Columbia found an association between past-year discrimination and smoking outcomes in sexual minority women, who have 1.5 to 2 times higher odds of smoking than heterosexual women. Lesbian and bisexual women who reported a higher count of discriminatory experiences, including gender-based discrimination, in the past year reported smoking more cigarettes now than 12 months ago.  

The findings support the minority stress model, first published in 2003 by psychiatric epidemiologist Ilan H. Meyer, which asserts that sexual orientation discrimination contributes to stress-related substance use behaviors such as cigarette smoking.

“The minority stress model has been used to explain higher rates of health risk behaviors, as well as poor physical and mental health outcomes in LGBTQ+ populations,” Dr. Matthews says. “LGBT folks have higher rates of general stressors, as well as minority-specific stressors, that other folks aren't impacted by. And they use what has been termed maladaptive coping strategies — such as drinking, smoking, and sexual risk-taking — to manage those feelings.” 

Dr. Matthews began their academic career at a time when a focus on LGBTQ+ health research was relatively uncommon and sometimes controversial. They encountered barriers to funding, publication, and finding an academic community — which is why today, they strive to create a safe and supportive academic environment for young researchers with these interests.  

“Part of my work involves trying to support, uplift, and train the next generation of LGBTQ+ health researchers, whether they are members of those populations or in general aim to reduce disparities,” they say. "We, as an academic community, need to do more to ensure the success of the next generation of researchers."