Problem/Objective: More and more data sustains the assertion that sexual minority youth and gender variant youth are among the highest impacted by tobacco use. Lesbians, gays and bisexuals (LGB) show higher smoking rates than the general population, and face unique needs that impact treatment.

Methods: Research is difficult for LGBT youth due to homophobia. It seems that those who are questioning their sexual orientation or who are engaging in same-sex attractions and behaviors without identifying as gay, lesbian, bisexual or transgender may smoke more than their peers.

Results: Youth may need support or tips for surviving oppression and bullying in order to make their quit efforts more successful. Given the many social challenges faced by these youth in general, it is important to create an environment in the school based cessation programs that provides essential support, welcomes them and helps to reinforce the attractiveness and effectiveness of treatment.

Conclusions: It is important to identify specific messages from the tobacco industry that reinforce the dominant culture's socially constructed gender norms. These messages may impact smoking behaviors of gender variant and sexual minority youth. School based treatment programs can create “ground rules” for creating a safe supportive space and more culturally competent treatment groups that are respectful of and responsive to the needs of gender variant and sexual minority youth.