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    The New Old Gay Epidemic

    naomiHere’s a little known fact about me: I used to smoke two packs of cigarettes, Camel filter or Export A, daily during my college years in Canada. It was pretty hard-core. I quit over 30 years ago, and have not taken a puff since. I’ll share more about that later…

    Despite how passé smoking is in the general community, it is not so in our community. It is well known that LGBTQI  folks are more likely to be smokers compared to straight folks. The Huffington Post recently called cigarette smoking the “New Gay Epidemic.” Although it’s actually an old epidemic, the current facts are shocking.

    Nationally, one third of LGBTQI people smoke. This is 68% higher than the general population. Even in California, where it is super uncool to smoke, a lot more of us smoke (nearly 30%) compared to straight people (18%). Most individuals start smoking as teenagers. Among our youth (when surveys include sexuality questions), smoking is two times higher among our teen boys and four times higher among our girls.

    Everyone knows it’s ‘bad’ to smoke. But did you know that smoking is even a bigger health problem for gay men than HIV-AIDS? Here are the numbers: Close to 500,000 LGBTQI Americans are HIV positive and 2.3 million are smokers. Those who smoke and are HIV-positive lose 12.3 years off their life’s expectancy compared to 5.1 years for anyone else who merely smokes. As a community, we spend nearly 8 billion dollars a year on tobacco. Surely we have better ways to spend our money and time here on Earth.

    There are unique factors that contribute to this problem, including the bar culture (not that anyone can smoke in bars anymore), stress, social stigma and discrimination. These latter factors are responsible for increased levels of mental health issues such as depression and PTSD, all of which contribute to higher levels of smoking in general. However, I would postulate that an additional factor is that our culture tolerates smoking. So many of us do it that it’s perceived as not uncool; it’s inevitable.

    There are many ways to quit smoking. Numerous programs—online, at home, or in classes—are available. Pharmaceuticals and over-the-counter items like nicotine gum, lozenges and vapors are possibilities too. Some smokers transition to electronic cigarettes, known as e-cigarettes. You can also just do it alone and go cold turkey. Just remember that nicotine is the smallest part of the cigarette addiction. It’s out of your system in just 2 or 3 days.

    The biggest part of the addiction is the habit. I therefore am not a fan of the pharmaceutical methods. They usually just keep you addicted to the nicotine. Instead of spending your money on cigarettes, you wind up shelling it out to a pharmacy company.

    And get this: Guess who is buying out the newest nicotine replacement fad, e-cigarettes? Yes, our friendly tobacco companies are, like Reynolds and Philip Morris. We have no idea if e-cigarettes are safe. The best method for overcoming the “habit” addiction is through behavior modification, whether via an in-person course (The Last Drag, for example, in SF) or an online program, such as It’s important to learn how to be a non-smoker, and that’s what behavior modification does.

    I used a behavior modification program to quit smoking 34 years ago, and it definitely worked for me. It can do so for you or your loved ones as well. Don’t wait for the Great American Smokeout, which was created by the American Cancer Society and happens on Thursday, November 20. Commit to quitting, or to help a friend or family member do so, today.

    Dr. Naomi Jay is a nurse practitioner in the department of Infectious Disease at UCSF.