Making Sure Smoking Cessation Works for Everybody

Making Sure Smoking Cessation Works for Everybody

By Mira Krishnan

For the past couple of years, I have had the privilege of partnering with a broad array of non-profit agencies and the Michigan Department of Health and Human Services (MDHHS) to reduce smoking among people living with HIV/AIDS and the Lesbian, Gay, Bisexual, and Transgender (LGBT) community.

Above you will see disparities in tobacco consumption rates among Michigan populations.

As part of this, I learned that tobacco kills way more LGBT people than hate crimes. In Michigan, LGBT people smoke at a significantly higher rate than the general population – about 30% vs. 20% of the general population (based on data from the 2013 BRFSS). This mirrors national trends. Many experts believe the biggest driver of increased smoking rates is something psychologists call minority stress. Members of minority communities, like the LGBT community, face a toxic milieu of hate crimes, laws designed to disenfranchise them or limit their rights, and fear-mongering, alongside a much more constant stream of subtle, daily messages that their lives are valued less than the lives of the majority. This leads to higher levels of anxiety and depression, as well as higher rates across a number of mental and medical health problems. And it leads to higher rates of unhealthy behaviors as ways to help to cope with stress, such as smoking. Supporting this view, it turns out that many other minority communities, including Black/African-American, Arab-American, and Native American Michiganders, those with disabilities, and the HIV+ community, all smoke at higher rates, as well, as can be seen in the graph, above.

And so, although I’ve been an advocate for public health for some time, smoking cessation hadn’t been one of my core issues, until the last couple of years, when MDHHS and this project helped me realize how important it is. I’ve also been thinking about how all the work I do on public health topics – on helping Michiganders be healthier and helping Michigan communities be more inclusive — intersect with my own desire to start a family. Mother’s Day came and went recently, and alongside thankfulness for my own mother, it is a time for me to renew my commitment to seeing a world where all people can choose to have or not have healthy, loving families, on their own terms, just as I wish to be able to do.

And smoking and family planning are related.

Smoking carries big risks if you’re pregnant or trying to conceive. Smoking is a risk factor for miscarriage, premature birth and low birth weight, lung disease and other birth defects, and even sudden infant death syndrome (SIDS). If an expectant mother is exposed to secondhand smoke, this also increases the risk of congenital heart disease. Just one more reason to make sure that Michigan restaurants stay smoke free! Even if you’re not pregnant or seeking to start a family right now, smoking has negative effects on multiple components of your reproductive system. Even if you never experience pregnancy, this puts you at risk for health complications including reproductive cancers.

Dads, we already knew you make a big difference, too. Did you know that lifestyle factors for you, prior to conception, affect your child’s health? One example is that obesity for dad, prior to conception, reduces the likelihood of conception, and increases the likelihood of slowed fetal and placental development. The children of fathers who smoked prior to conception also have been estimated to have a risk of developing leukemia, lymphoma, or brain tumor up to 80% higher than their peers.

Not to mention, if your mom smokes – if any of your parents smoke, helping them quit could mean that you get a few more years of help and advice. As much as we hate to admit it, we still need our parents! I know I do!

Although we don’t have great Michigan data stratifying smoking rates among people who fall in multiple minority categories, it’s likely those rates are even higher than the ones in the graph above, and this emphasizes, as well, the need for intersectional thinking in smoking cessation.

Finally, depending on how LGBT people choose to have families, as we are increasingly doing (and isn’t that wonderful!), all of this may apply to us, too. Even if you’re adopting, like my fiancé and I hope to do in the future, advocating for a healthier Michigan can still make a difference in the health and wellness of your family, as well as all Michigan families, in the future.

So, if you’re thinking about quitting, or if you want to get involved in advocacy in this area, please reach out, and I would be happy to connect you to resources. You should also know that Michigan offers a free, evidence-based support for quitting, the Michigan Quit Line (800-QUIT-NOW), and its staff have been trained to be LGBTQIA+ and minority friendly, as well as to work with clients who are pregnant.


Mira Krishnan is a neuropsychologist and consultant to the Grand Rapids Pride Center, one of two Grand Rapids non-profit agencies involved in this project. She is a proud reproductive justice advocate and past speaker at Lady Parts Justice MI. 

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