Smoking Cessation Programs for LGBTI People: A Systematic Review of Content and Effect

Abstract

Despite widespread evidence of smoking’s harms to health, rising costs of tobacco products, and the visibility of public health interventions aimed at tobacco users, tobacco use remains high among lesbian women, gay men, bisexual people and transgender people (LGBT ) internationally, with US data showing at least double the smoking rates of the general population. [1-5] Although anecdotal evidence suggests similar rates internationally, no formal smoking data exist for intersex people, representing an important area for research.[6] There are many reasons why LGBT people may begin or continue smoking. Commonly cited reasons include minority stress due to the effects of discrimination, harassment, and violence; lack of social support; and fear of weight gain.[7,8] The NSW Tobacco Strategy 2012-17 stresses the importance of promoting smoking cessation and assistance to priority groups, i.e. those with high smoking prevalence.[9] Similarly to LGBT communities internationally, 30% of Australia’s LGB people smoke compared to 16% of the general population.[10-13] While smoking rates have declined among heterosexual people, the 2013 National Drug Strategy Household Survey shows no significant change among LGB people since 2010.[10] There is little specific Australian data regarding smoking rates amongst trans people, but one study in 2006 reported smoking rates of 44% of trans men and 35% of trans women.[14] Applying existing public health interventions to marginalised populations without modifying, piloting, and evaluating them may lead to further inequalities. In 2014, ACON received a Cancer Institute NSW Evidence to Practice Grant to develop a smoking cessation intervention to address the high and stable smoking rate among sexual minority women in Australia. The current review is intended to guide development of that intervention and promote future research on smoking cessation interventions for LGBT people.