Review informs design for smoking cessation interventions for LGBT people

November 18, 2014

Tobacco use among lesbian, gay, bisexual and transgender (LGBT) people in the U.S. is 68 percent higher than among heterosexuals. Little published work has addressed how to best promote smoking-cessation efforts targeting LGBT people, but unpublished community-led programs have important lessons for designing interventions. Clinical treatments such as counseling and nicotine replacement therapies work similarly for LGBT and heterosexual smokers, but there are likely unique barriers to accessing cessation services for LGBT smokers.

Joseph Lee

Such are the findings of Joseph G.L. Lee, MPH, health behavior doctoral candidate in the UNC Gillings School of Global Public Health. His paper, “Promoting tobacco use cessation for LGBT people: A systematic review,” was published online Nov. 18 in the American Journal of Preventive Medicine.

Lee was joined in the study by Alicia K. Matthews, PhD, associate professor in the College of Nursing at the University of Illinois-Chicago; Cramer A. McCullen, medical student in the UNC School of Medicine; and Cathy L. Melvin, PhD, associate professor in the department of public health sciences in the College of Medicine at the Medical University of South Carolina.

Lee and his colleagues reviewed literature that was not generally accessible, such as grant progress reports, along with peer-reviewed literature describing clinical, community and policy interventions, as well as knowledge, attitudes and behaviors regarding tobacco use cessation among LGBT people.

Lee and his team found interventions developed by and for LGBT communities that brought smoking cessation groups to LGBT community organizations were feasible and effective. Yet, the researchers noted these group interventions only reach small numbers of LGBT smokers. Clinical treatments such as counseling, nicotine replacement therapy, and standard drugs used to help quit smoking worked as well for LGBT people as for heterosexual people.

Higher cigarette prices and smoke-free policies help people quit and can reach more smokers than cessation groups or clinical treatment. Lee found little evidence to indicate such policy-based interventions were more or less effective for LGBT people, or whether these policies reduce or exacerbate disparities in tobacco use between LGBT and heterosexual people.

As with heterosexual smokers, many LGBT smokers have attempted to quit. While many succeed, evidence suggests LGBT people face unique barriers to accessing cessation services. It is unclear to what extent LGBT tobacco cessation is influenced by factors particular to LGBT people or experienced at greater levels by LGBT people such as stigma, discrimination and stress. Further study is needed to find ways to enhance smoking-cessation efforts and to strengthen outreach into the LGBT community.

Lee noted steps smokers can take to overcome tobacco use. First, LGBT community organizations can adopt and promote smoke-free policies and can provide links to cessation services. LGBT-serving health-care organizations should ensure they are assessing all clients for tobacco use and providing help to those who want to quit tobacco. Lastly, smokers should consult with their health-care provider and can use free phone-based coaching to quit.