Tobacco Cessation and Prevention Interventions for Sexual and/or Gender Minority-Identified People and the Theories That Underpin Them: A Scoping Review

Abstract

Introduction This scoping review takes stock of the social and behavior change theories that have underpinned tobacco interventions tailored to sexual and/or gender minority (SGM) people and reflects on the need to target contextually-based drivers of SGM tobacco use inequities. Methods Data sources were Medline (Ovid), Scopus, PubMed, Google Scholar (01/01/1946 – 10/27/2022). Peer-reviewed publications in English from anywhere in the world describing SGM-tailored tobacco cessation and/or prevention interventions were independently identified by a librarian and screened by the first and third authors. 367 articles were extracted; an additional 2 were found by hand searching. 369 articles were assessed for eligibility. Exclusion criteria were: not an intervention, review article, not SGM-tailored or tobacco-focused. We documented intervention name, intervention components, theoretical frameworks cited in reference to intervention design and/or implementation, and evaluation outcomes. All authors provided input on theoretical framework categorization. Results We identified 22 publications corresponding to 15 unique interventions. Individual-level behavior change theories (i.e., those focusing on within-person behavior change processes) were the most prominent. Among these, the Transtheoretical Model was the most frequently utilized, while Social Inoculation Theory, Theory of Reasoned Action, and Theory of Psychological Reactance were also employed. A minority of interventions referenced frameworks that more explicitly engaged with SGM people’s social contexts, namely, Theory of Diffusion of Innovations and Minority Stress Model. Conclusions Future SGM-tailored tobacco interventions should leverage both the strengths of individual-level behavior change theories and those of frameworks that understand tobacco use inequities as indivisible from place, context, and policy. Implications This scoping review describes the theoretical underpinnings of sexual and/or gender minority (SGM)-tailored tobacco interventions published in the peer-review literature in English. It reflects on the need for greater utilization of social and behavior change theoretical frameworks that can engage with unique drivers of SGM tobacco use and barriers to cessation.

Effects of cannabis use on cigarette smoking cessation in LGBTQ+ individuals.

“…While this study cannot determine the reason for cannabis use as a barrier to smoking cessation in SGM individuals, there are several potential reasons this may occur. For example, research in SGM populations highlight socioecological factors (e.g., depression symptoms, minority stress, tobacco norms) as contributors of tobacco use and cigarette cessation outcomes (McQuoid et al, 2023; Wheldon & Wiseman, 2021). It is possible that couse of cannabis and cigarettes may signify socioecological differences (e.g., greater depression symptoms, more frequent discrimination, greater coping motives; Buckner et al, 2023; Foster et al, 2016; Mattingly et al, 2023; McKelvey et al, 2021; Romm et al, 2022), which may serve as a barrier to smoking cessation.…”

“…Additionally, gender minority individuals (i.e., transgender, nonbinary, genderqueer) have the highest tobacco and cannabis use prevalence among the California SGM population (Tan, 2022). These disparities between SGM and heterosexual/gender-conforming individuals are attributed to a variety of factors, including social norms around smoking and complex and interacting experiences of minority stressors (e.g., discrimination, family rejection) that can instill or amplify substance use (Lee et al, 2020; McQuoid et al, 2023; Wheldon & Wiseman, 2021). As cigarette and cannabis couse is prevalent in sexual minority and gender minority populations, a better understanding of how cannabis use impacts cigarette smoking during a cigarette quit attempt in SGM individuals is warranted to develop and test interventions.…”

Trust in Tobacco Control

“…Resisting and coping with discrimination (Antin et al 2018, Budenz et al 2022, McCabe et al 2017, Sanders et al 2020b, economic and housing precarity (Gerend et al 2017, Wheldon & Wiseman 2019, mental health (Drescher et al 2018, Hinds et al 2022, industry targeting (Brock 2018, Emory et al 2019, and subcultural norms and aesthetics (Tinkler 2006, Youatt et al 2015 have been identified as important factors related to NT inequities in SGM populations. This growing body of research underscores the need for more SGM-inclusive and structurally-competent tobacco control efforts to better address persistent NT-related inequities (Antin et al 2023, Baskerville et al 2017, Hinds et al 2021, McQuoid et al 2023. A crucial step in this process requires an examination of how tobacco control strategies can lead to unintended consequences for certain groups more than others, and how those consequences might be mitigated (Antin et al 2015a, Bell & Dennis 2013, Evans-Polce et al 2015, Frohlich et al 2012, Graham 2012, Reuter 2013, Sanders et al 2020a, 2020b.…”

Cigarette Smoking Motives and Stages of Change in Smoking Cessation Among Veterans: Differences by Gender and Sexual Orientation

“…Evidence-based interventions for smoking cessation reduce cigarette use, and several tailored interventions have been developed for Veterans 12 and LGB individuals. 13,14 For example, SmokefreeVET is a text messaging cessation program that provides Veterans with daily encouragement and advice, and strategies for coping with Veteran identified smoking triggers. 15,16 Vet Flexiquit is a web-based and text messaging program that uses an avatar who represents a supportive peer that shares their personal quitting journey.…”