Q&A: Smoking disparities may raise COPD risk in lesbian, gay, bisexual adults

Key takeaways:

• Sexual minority individuals are a target of tobacco companies.
• LGBTQ+ affirming care is important in all medical specialties.

Lesbian, gay and bisexual adults smoked more frequently and had a heightened prevalence of COPD vs. heterosexual adults, according to research published in Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation.

Using 2020 Behavioral Risk Factor Surveillance System (BRFSS) data, Kevin P. Ferriter, MD, pulmonary and critical care fellow at Loyola University Chicago Stritch School of Medicine, and colleagues assessed 161,741 adults aged at least 45 years to find out how smoking and COPD prevalence differ between sexual minority individuals and heterosexual individuals.

Researchers also investigated how smoking impacted the relationship between sexual minority identity and self-reported COPD and found a link between smoking disparities and a raised risk for COPD in this patient population.

Healio spoke with Ferriter to learn more about sexual orientation health disparities, study findings and how pulmonologists can make sure they are providing the best care for individuals who identify as LGBTQ+.

Healio: Why is smoking more prevalent among sexual minority individuals vs. heterosexual individuals? Have there been any efforts to reduce smoking in this population? If not, do you have any suggestions on how to do this?

Ferriter: Smoking has been elevated among sexual minority individuals for decades and continues to be elevated even as rates of smoking in general fall. There appear to be two main drivers for this disparity. First, smoking represents both a way to try to cope with stress that is easily accessible and produces less short-term problems than other drugs. Second, tobacco companies have explicitly targeted sexual minorities for marketing efforts for decades, working to increase the appeal of cigarettes to that community.

Substantial efforts have been made to reduce smoking in sexual minority communities, both at the community and individual level. Those include public health campaigns, such as Austin Public Health’s Breathe with Pride program and individual smoking cessation programs designed for sexual minority individuals, such as Quit the Hit.

Healio: A recent literature review found only eight studies that reported on COPD prevalence in LGBTQ+ populations. Why are there few studies assessing pulmonary conditions in this community?

Ferriter: Studies on pulmonary conditions in LGBTQ+ populations can be difficult. We often rely on public health data to capture disorder incidence, and those data sets either may not include pulmonary conditions as part of assessments or may not include sexual orientation and gender identity in demographics.

Healio: What did you find in your analysis of 2020 BRFSS data?

Ferriter: We used data from individuals aged 45 years and older who participated in the BRFSS, a national study on health. Consistent with a large body of prior work, being a sexual minority was linked with greater odds of lifetime smoking. We also found a link between sexual orientation and chronic respiratory disorders, such that there was a disparity in the proportion of sexual minority people with those disorders and that disparity was driven substantially by smoking.

Healio: Would you characterize what the impact of the findings are for the everyday clinician?

Ferriter: Pulmonologists should be aware that they will likely see a disproportionate number of patients who are sexual minorities. Sometimes, we might think of LGBTQ+ affirming care as being more important to family medicine or general practice, but it is relevant to specialties too. We know that patients may find another provider, or even reduce their medical care help-seeking, if they encounter heterosexism or other forms of discrimination from their providers.

Healio: How can pulmonologists make sure they are providing the best care for individuals who identify as LGBTQ+?

Ferriter: A huge number of resources exist to promote affirming care. It’s especially important to note that affirming care happens across the entire care experience, from the waiting room and interactions with front desk staff to interactions with a provider. There are a large number of continuing education modules devoted to this, from LGBTQ+ care 101 to more advanced topics.

Healio: Do you have any recommendations for changes at the policy level that could improve outcomes?

Ferriter: Smoking is substantially driven by stress. Anti-LGBTQ+ legislation, in general, can exacerbate stress. The best policy changes to improve public health would be ones that promote the humanity and well-being of marginalized populations, including LGBTQ+ individuals.

Healio: How will future research on this topic be different?

Ferriter: With an increasingly aging population, we’re likely to see more and more LGBTQ+ patients presenting with many chronic conditions that arise in older age, including respiratory conditions. Unfortunately, smoking is still elevated in LGBTQ+ youth and so the disparity in chronic respiratory conditions is likely to persist. Future research may examine methods to optimize affirming care for this population.

For more information:

Kevin P. Ferriter, MD, can be reached at kevin.ferriter@luhs.org.

References:

• Ferriter KP, et al. Chronic Obstr Pulm Dis. 2024;doi:10.15326/jcopdf.2023.0467.
• Increased education, research needed to address risk of COPD among sexual and gender minorities. https://www.copdfoundation.org/About-Us/Press-Room/Press-Releases/Article/1973/Increased-Education-Research-Needed-to-Address-Risk-of-COPD-Among-Sexual-and-Ge.aspx. Published June 20, 2024. Accessed June 20, 2024.