With the news today published by BMJ that gay youth in England are twice as likely to smoke and drink more hazardously than their heterosexual peers we speak with one of the authors of the study by UCL, Dr. Joanna Semlyen.

TGUK: Why in your opinion LGBs are more likely to smoke firstly – and secondly, perhaps more worryingly more likely to drink and to hazardous levels?

DJS: There are several reasons why LGB young people may be more likely to smoke tobacco and drink alcohol hazardously and we do not, as yet, due to lack of research, have definitive evidence as to what the reasons are, however, we suspect that the impact of homophobia and heterosexism within society, in addition to the possible experience of homophobic bullying whilst at school, may lead to what we call ‘minority stress’ or in increased low self esteem which young people then perhaps seek to alleviate with smoking and/or alcohol. We also know that LGB people tend to socialise in the places where they can be with each other, which is almost always places where alcohol and cigarettes are freely available, like bars and clubs.

This situation may be being exacerbated by a growing concern that LGB people are targeted, for example, by the tobacco industry. There may also be other reasons we do not know and a large longitudinal study (with a heterosexual control group and repeated follow-ups) might allow us to study the antecedents of smoking and drinking in young LGB people.

TGUK: Do you think this might be linked with the fact that LGBTs are more likely to suffer from mental health issues?

DS: Because no data on transgender identity was collected in this study, I can only comment on LGB participants in this study. I think that the experience of homophobia and heterosexism should not be underestimated and, along with the stress of coming out (often repeatedly throughout one’s life), may well account for why we see greater incidence of mental health issues in LGB people. The problem is, we don’t have any data yet on the causes of smoking and hazardous alcohol drinking in LGB young people, followed repeatedly over time.

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TGUK: Do you think the government or the health service is doing enough to interface with young LGBTs?

DS: As a researcher and LGBT Health Psychologist, I would like to see the routine collection of sexual orientation data within population based health and well-being studies and as part of the NHS’ own routine identity data collection.

This would allow us to accurately determine the health inequalities being experienced by this group and, by virtue of being included, would go a long way to indicate to LGBT people that their health is being considered. LGB people want to be counted in surveys. Indeed we noted the question in this study had a very low refusal rate.