“I Can’t Make Perfect Choices All the Time”: Perspectives on Tobacco Harm Reduction Among Young Adults Who Identify as Sexual and Gender Minorities

Abstract

Introduction Cigarette smoking is among the most harmful ways to consume nicotine and tends to be concentrated among socially marginalized groups of people, including sexual and gender minorities (SGM). Though some approaches to tobacco control in the U.S. are harm reduction strategies (e.g. smoke-free environments), often abstinence is an explicitly-stated goal and discussions of tobacco harm reduction (THR) are controversial, particularly for young people. Despite this controversy in the tobacco field, emerging research suggests that THR may be gaining momentum as a “community-led” rather than ‘public health-led’ health practice. To date, little is known about how SGM young adults negotiate their use of tobacco products, particularly in terms of minimizing the harms associated with smoking. Methods We conducted 100 in-depth interviews with SGM young adults ages 18-25 living in the San Francisco Bay Area, to better understand participant perceptions and everyday practices related to THR. Results A thematic analysis of interview narratives revealed the ways in which participants relied upon various THR strategies while balancing their wellbeing within the context of broader socio-structural harms. Participants’ narratives also underscored beliefs about the importance of pragmatic, nonjudgmental, and person-centered approaches to preventing inequities in tobacco-related illnesses. Conclusions Findings represent a significant departure from the mainstream discourse in the United States surrounding THR, by revealing how understanding the practice of THR among SGM young adults who use nicotine and tobacco can be instrumental in shaping approaches to tobacco control policy and prevention that may ultimately help to reduce inequities in tobacco-related illnesses. Implications Findings from this study present the perspectives and practices of tobacco harm reduction among sexual and gender minority young adults and emphasize the importance of integrating this approach in tobacco control to better achieve tobacco-related equity. Results can be used to better design tobacco prevention, treatment, and policy strategies that are compassionate and responsive to the needs of these important priority populations.

Harm perceptions of vaping nicotine relative to cigarette smoking among sexual and gender minority young adults

“…Using ATLAS.ti to facilitate analysis of the qualitative data, we first grouped participants' interview transcripts by relative risk perceptions to set up a comparative qualitative, pattern‐level analysis, which focuses on linking together related ideas into superordinate patterns across participants and within groups defined by relative risk perceptions [29]. Working with interview data already coded with a preliminary code list (for details, see [9]), TA created code reports based on the codes ‘NT’ and ‘Health Ideologies’, the former including any reference to NT and the latter being broadly applied to quotations where participants reference either ideas, norms, assumptions and/or discourses surrounding what is healthy or not or the ideological meanings of substance use practices or risks. EP, ES and TA then conducted an independent pattern‐level analysis of these code reports, followed by meetings to arrive at a shared consensus of identified patterns across risk perception groups.…”

“…We limited the number of referrals from any one participant to three to minimise selection bias. Additional details about recruitment, eligibility and procedures can be found elsewhere [9,27].…”

“…THR strategies are defined by the substitution of less toxic forms of NT (e.g., e-cigarettes, snus, nicotine replacement therapies) for extremely toxic combustible products (e.g., cigarettes) [16,17]. Our recent research noted the ways in which SGMYA perceive and practices THR while they consider the personal risks and benefits of using nicotine [9]. Notably, despite practising THR, it was unclear whether participants confidently understood the relative risk of various NT products, an important precondition for effectively implementing THR strategies for risk reduction.…”

“…Moreover, other research has shown that SGM adults are aware of the risks associated with NT use, but also of the important role NT use plays in their everyday lives and stigma‐related experiences [8]. In a further examination of the role of NT in the lives of SGM young adults (SGMYA), a recent study noted the ways in which SGMYAs perceive and practice tobacco harm reduction (THR) as a way to balance their awareness of risks of NT use with the personal perceived benefits of using nicotine [9]. However, despite practising THR, it was unclear whether participants confidently understood the relative risk of various NT products, an important precondition for effectively implementing THR strategies for risk reduction.…”

Knowledge, Perception, and Willingness of Emerging Public Health Advocates to Effectively Communicate about Smoking Cessation and Tobacco Harm Reduction in Africa

“…Of the 450 interested participants in the training, 415 consented to the survey. Open-ended questions were included because studies have established that such questions assessing perspectives of THR among young people can contribute to the design of tobacco use and prevention strategies speci c to the population (Antin et al, 2022).…”