Spencer Case does good work in making the case that the LGBT community in America has to pay more attention to smoking than it does. That said, I’m a bit doubtful that many of the programs from the American Legacy Foundation, CDC and others will do that much good. Most them involve “doubling down” on efforts that don’t seem to be working now for gay Americans or anyone else.

The facts first: The first 40 or so years of stern public-health warnings about cigarettes resulted in a 50 percent decline in smoking amongst adult Americans (from over 40 percent to just about 20 percent.) But the declines have more-or-less stopped in the last 10 years. Meanwhile, smoking rates amongst LGBT Americans remain just about where they were for the population as a whole 50 years ago. Doing more anti-tobacco advertising and expanding already broad smoking bans hasn’t done much to reduce overall smoking; adding rainbow flags to the same messages probably won’t either. This makes me think that some different approaches are worth trying. Three stand out in my mind.

First, gay teenagers — and even 18-to-21 year olds who can buy cigarettes legally but can’t drink — need special public-health attention to discourage them from picking up smoking in the first place. A lot of aspects of gay culture, the bar and club scene in particular, seem to encourage smoking. Directing anti-smoking messages to this group may work even if it doesn’t for the population as a whole.

Second, the simplest and cheapest approach to quitting smoking — going cold turkey — should get more attention from gay organizations. Most gay-community health centers were founded in response to the AIDS epidemic and, for both political and medical reasons, came to rely (correctly) on complex pharmaceutical approaches as a key tool in fighting that public-health threat. They often take the same approach towards smoking. The problem is that all “quit smoking” drugs have enormous failure rates over a period of a few years. While “abrupt cessation” (as medical professionals call it) works best when a doctor is involved, it’s also simpler and cheaper than using drugs and may have a higher success rate.

Third, harm reduction approaches that encourage “switching” for those who can’t quit should get some attention, given the urgent public-health need to reduce LGBT smoking rates. Nicotine is very, very addictive and, as a stimulant, almost certainly can cause heart disease. That said, inhaling smoke does a lot more damage to one’s body and causes many more diseases than chewing tobacco or puffing on an e-cigarette. Switching should never be a first effort, but it’s worth looking at when all else fails.

The current smoking rate amongst gay Americans is a public-health crisis. Confronting it requires new approaches.

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