Stigma and targeted marketing by the tobacco industry have contributed to a smoking rate among the gay and lesbian population that’s twice as high as for other Americans, according to a new report from the American Lung Association.

“Although social conditions and public acceptance of the LGBT community have been slowly improving, it appears that they still face high levels of health disparities in a number of areas, tobacco use included,” the report said. “Reasons for this disparity may include the stresses of social stigma, peer pressure, aggressive targeting by the tobacco industry, and limited access to effective tobacco treatment.”

The report, “Smoking Out a Deadly Threat: Tobacco Use in the LGBT Community,” said that smoking prevalence rates among the lesbian, gay, bisexual and transgender (LGBT) community are hard to determine because many health surveys don’t ask participants about their sexual orientation.

Still, enough evidence of high rates of tobacco use among this population exists to justify making the LGBT community a high priority for prevention, the Lung Association said.

“The American Lung Association calls on states and the federal government to expand and improve data collection and reporting to provide an accurate picture of health conditions and behaviors, especially tobacco use, in the U.S. LGBT population,” according to the report “In addition, local and state tobacco control programs should engage with the LGBT community to ensure that they are included in programs to both prevent youth from starting to smoke and to help smokers quit. Finally, LGBT organizations should recognize tobacco use as a public health priority in their community, and should include tobacco control advocacy and programs in their scope of activities.”