Tobacco consumption among LGBTQIA+ in Switzerland

General population surveys

In the specific analyses conducted by HSLU on the 2012 and 2017 data from the Swiss Health Survey (Krüger et al., 2022[3]), clear differences were observed in terms of smoking (at least occasional consumption and level of consumption) between LGB people – for whom the prevalence of smoking varied between 36% and 50%, depending on gender and specific sexual orientation – and the rest of the population (Figure 1). Adjusted statistical analyses confirmed the close link between sexual behaviour, or sexual identity, and smoking, in terms of both the prevalence and level of consumption. Compared to heterosexual women, lesbian and bisexual women were more than twice as likely to smoke at least occasionally. Compared to heterosexual men, bisexual men were one-and-a-half times more likely to smoke. These same analyses also highlighted that gay men were significantly overrepresented among people smoking a minimum of 10 cigarettes per day. Incidentally, this latter subgroup revealed more often than the rest of the population that they had tried to quit smoking during the 12 months preceding the survey (conversely, lesbian women were less likely than heterosexual people to have tried to quit smoking during this period of time).

Other data sources are available that provide information on smoking issues in the LGBTQIA+ population.

Data from the “LGBT Health” survey (a national survey on the health of LGBT people and their access to care, conducted online in 2021; Pfister et al., 2023[5]) detailed by the HSLU confirm the observations made in the context of analyses on the cumulative data of the ESS (Krüger et al., 2022[6]). According to this survey, the share of smoking reached 31.7% among respondents in 2021. Among smokers, almost two-thirds (63%) smoked daily. However, of all respondents, cislesbian women were the least likely to smoke (28.5%); among all the other profile groups considered, around a third of people used tobacco (between 30.3% and 34.7%; the highest prevalence being recorded for trans/non-binary people).

Other studies, regional and/or older (reasons for which they are not detailed here) have also highlighted in recent decades that gay and bisexual men consume more tobacco and other substances than heterosexual men (e.g. Wang et al., 2007[7]); trends largely corroborated by various international studies (for reviews, see e.g. Marshal et al., 2008[8], or Berger and Mooney-Somers, 2017[9]).

It should also be noted that a recent Zurich study (Vock et al., 2023[10]) highlighted the high propensity for the consumption of psychoactive substances among young people from sexual minorities in Switzerland. With prevalences of tobacco consumption of around 45 to 50%, depending on the age considered (17 and 20 years), and adjusted probabilities of being smokers more than twice those of their heterosexual counterparts, young women from sexual minorities appeared to be particularly affected by smoking.

While in Switzerland the data currently available on LGBTQIA+ people are generally limited to the question of tobacco use in the form of cigarettes, international studies suggest that disparities in this area are reinforced by the significant penetration of e-cigarettes and other electronic nicotine delivery systems (e.g. Truth Initiative, 2022[11]). A large American cohort study including young people ages 15 to 21, the Truth Longitudinal Cohort study[12], has documented this phenomenon (Truth Initiative, 2024[13]). In this cohort, in 2021, the prevalence of vaping was higher among LGBT+ youth than among their non-LGBT+ peers, both in terms of experimentation (lifetime use) and current use. Disparities were identified both in terms of sexual orientation (i.e. among young people who do not identify as heterosexual) and gender identity. For example, compared with their heterosexual peers, bisexual youth were more likely to report ever using e-cigarettes (57% vs. 39%) and to be currently using them (22% vs. 13%). Lesbian and gay youth also reported a higher prevalence of e-cigarette use (48%) than their heterosexual peers (39%).

Associated risk factors

The international literature highlights a multitude of specific risk factors contributing to the increased prevalence of smoking and nicotine use in LGBTQIA+ populations. These range from the experience of social stigma, discrimination, and family rejection, which can lead to high levels of stress (with smoking frequently being used as a coping mechanism to manage this stress), to mental health (co-)morbidities (such as anxiety, depression, and post-traumatic stress disorder) that increase the propensity to smoke, or to environmental factors such as frequenting environments in which smoking is often more accepted and widespread, as well as the tobacco industry’s significant efforts to target LGBTQIA+ populations with specific marketing campaigns.

Note: The different terminology used in this text, such as LGBTQIA+, LGB, LGBT+ or similar terms, is due to the fact that the underlying studies were conducted at different times and focussed on different aspects of sexual and gender minorities, or are older in some cases.

AT Switzerland, October 2024