LGBTQ Tobacco and Nicotine Cessation

Tobacco and Nicotine Cessation Resources
Your Life Iowa
Truth Initiative: Ex Program
Quitline Iowa
SmokeFree.gov
BreathOut: A Stop-smoking program for Transgender and Gender Diverse Folks (self-guided)

Tobacco and Nicotine use in the LGBTQ+ Community
15.3% of lesbian, gay, and bisexual adults smoke, compared to 11.4% of straight adults
43% of transgender and gender-nonconforming adults smoke, compared to 19.2% of cisgender adults (1)

These higher rates are reflective of the unique stressors that affect the LGBTQ+ community such as discrimination, stigma, social isolation, and many other factors. These issues also cause LGBTQ+ folks to have higher rates of anxiety and depression. The LGBTQ+ community is also underserved in healthcare, leading people to find other ways to manage their mental and physical health. There is also a long history of the LGBTQ+ community being targeted by tobacco marketing.

Quitting can be difficult, but it is not impossible. Quitting tobacco and nicotine has many benefits for your physical and mental health. Set yourself up for success by utilizing resources and educating yourself.

Tobacco and Nicotine
Sometimes used interchangeably, tobacco and nicotine are different. They have different effects on the body and are used in different products. Both are harmful and have various health risks when used as directed by companies that use them in their products.

Tobacco is a plant that contains high levels of nicotine. It can be smoked in products such as cigarettes, cigars, and hookah or through smokeless methods such as dipping and chewing tobacco, or snuff. While nicotine is what makes tobacco addictive, it is other toxic chemicals found in tobacco that cause serious health effects. These chemicals are also found in some e-cigarettes/vapes.

Nicotine is a highly addictive chemical and stimulant drug found naturally in the tobacco plant or created synthetically in various products such as vapes, e-cigarettes, or nicotine pouches.

There is no such thing as a safe tobacco or nicotine product. While tobacco-free nicotine products may seem like a lower risk choice, many products come with their own unique risks.
Dual use of cigarettes and vaping causes more harm than exclusively using one or the other. (2)

Nicotine can also be used to help folks quit smoking when used for Nicotine Replacement Therapy (NRT). These products are available both over the counter and by prescription. Using NRT helps to manage withdrawal symptoms and cravings. Using NRT in combination with other strategies such as coaching or counseling can improve your chances of quitting and is more effective than doing just one method on its own. (3)

Over the counter options include patches, gum, and lozenges. Products that require a prescription are inhalers and nasal spray. There are other prescription medications that do not contain nicotine that can also be used to help you quit, they are Bupropion and Varenicline. These methods can also be used in combination with each other. Some cessation programs also help people access NRT either by providing discounts or providing the products for free. Some insurance plans may also offer incentives and assistance when quitting.

Effects of Tobacco and Nicotine on…
Mental Health:
While many folks use tobacco and nicotine to control their stress, smoking is not an effective way to cope with stress. While there may be some initial stress relief when someone starts smoking, long-term use can affect your brain in ways that worsen anxiety and affect mood overtime. (4)
Why does it feel like smoking helps our stress? When you begin smoking, your brain starts to crave nicotine, and that craving can cause irritability and anxiety. Those feelings are then temporarily relieved when you smoke again. (5)
Nicotine withdrawal can cause many unwanted symptoms and can be the reason why folks are not successful in quitting. Knowing what to expect and having ways to manage symptoms can help you be more successful in your quit attempt.

Physical Health
Tobacco is the leading preventable cause of disease and death in the United States. Smoking causes 20% of all cancers and 30% of cancer deaths.
Damage to your lungs begins soon after you start smoking and gets worse the longer you smoke. Lung conditions include pneumonia, COPD, chronic bronchitis, emphysema, and can worsen existing conditions such as asthma.
Smoking also damages your heart and blood vessels and increases your risk of heart disease and stroke.
Your sexual and reproductive health can also be affected by tobacco use. Tobacco can affect fertility and can make it harder for someone to get pregnant or get someone else pregnant. It also increases the risk of ectopic pregnancy.
Once pregnant, tobacco use can create issues with the pregnancy that puts both the pregnant person and fetus at risk before, during, and after birth.
Smoking’s effect on blood vessels means that it can lead to sexual dysfunction and erectile dysfunction.
Tobacco use is also linked to gum disease and tooth loss, lower immune system functions, increased risk of type 2 diabetes, and many others. (6)

Transitioning:
Folks looking to begin their medical transition journey should be aware of the effects tobacco and nicotine have on the process. We know accessing these life-saving services can already be difficult and expensive. Make sure to give yourself the best chance at reaching your transition goals by learning about how smoking impacts HRT and gender-affirming surgery.
For those using HRT, nicotine can slow the effectiveness of expected physical changes. Smoking while on HRT can also increase the risk of developing blood clots, cause heart disease, and stroke. (7)
For those taking estrogen, you will already experience an increase in cardiovascular risk which only worsen when smoking.Smoking can reduce or completely cancel the effectiveness of estrogens taken orally. (8)
For those taking testosterone, your risk for heart attacks also increases when smoking. (9)
Smoking also greatly impacts not only your ability to receive gender-affirming surgery, but can affect the healing process post-surgery. Many surgeons will require that you quit smoking for a period of time before and after top surgery. The earlier you quit the better but even stopping a day before surgery can lower the risk of complications. (9)
Smoking narrows your blood vessels and reduces blood flow which will impact your healing. It increases your chance of scarring, increases chances of infection, and can cause skin tissue death.

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