The Greater Cleveland LGBTQ+ Community Needs Assessment surveyed 1,592 LGBTQ+ adults across Cuyahoga, Geauga, Lake, and Lorain counties, revealing that 21.9 percent currently use tobacco products. Combustible cigarettes and e-cigarettes dominate the product landscape, followed by cigars. E-cigarettes uniquely showed frequent heavy use, with some users reporting more than 30 times daily.
High-risk populations
Two statistically significant patterns emerged. Young adults aged 18-26 comprise 44.1 percent of current tobacco users, with usage rates declining significantly with age. Notably, individuals earning between $35,000-$50,000 annually showed elevated tobacco use rates, demonstrating higher odds of current use than even the lowest income bracket—a finding that challenges assumptions about tobacco use clustering solely among the lowest earners.
Mental health co-occurrence
Tobacco use is deeply intertwined with mental health challenges. Among current users, 53.6 percent experience depression and 45.8 percent have anxiety disorders. Approximately one-quarter report post-traumatic stress disorder or suicidal ideation. These findings underscore that tobacco use rarely exists in isolation but occurs alongside broader emotional and psychological health needs.
Cessation readiness
Most current users are not planning to quit immediately. Only 22 percent indicated plans to quit within 30 days, while another 20 percent planned to quit within six months. However, 42 percent expressed openness to cessation within the next one to six months, suggesting a window of opportunity for intervention.
Root causes
Higher tobacco use among LGBTQ+ populations stems from three interconnected factors: minority stress from stigma and discrimination, targeted marketing campaigns that normalize tobacco use in LGBTQ+ communities, and structural stigma embedded in policies and social environments. These upstream factors manifest as elevated use among younger adults, low cessation readiness, and strong overlap with mental health conditions.
Recommendations for Northeast Ohio
Integrated Care Models: Develop "Quit + Care" approaches that co-locate cessation counseling with mental health screening and treatment in LGBTQ+-affirming settings such as community centers, federally qualified health centers, and campus clinics. Train clinicians in trauma-informed care and embed peer navigators from the community.
Strategic Targeting: Focus resources on the 18-26 age cohort and those earning $35,000-$50,000 annually. Partner with colleges, universities, trade programs, and early-career workplaces to provide on-site services, text-based coaching, and combination therapy coverage.
Affirming Messaging: Design campaigns featuring trusted local messengers that elevate community pride rather than employing stigma-based tactics, reflecting the diversity of Northeast Ohio's LGBTQ+ identities.
Policy Action: Implement comprehensive non-discrimination protections, include LGBTQ+ communities in public health funding streams, and enforce equitable health benefits in employer and campus plans.
Sustained Assessment: Continue the community-based participatory research approach to maintain trust, expand regional reach, and enable partners to monitor progress and refine interventions.
Addressing tobacco use in LGBTQ+ communities requires tackling both individual behavior and structural context simultaneously, recognizing that cessation efforts must account for the sociocultural conditions in which people live, learn, and work.
