Smoking Cessation Programs for Lesbian, Gay, Bisexual, Transgender, and Intersex People: A Content-Based Systematic Review.
BACKGROUND
Tobacco use among lesbian, gay, bisexual, and transgender (LGBT) people is double the general population. Limited evidence suggests high smoking rates among intersex people. Lesbian, gay, bisexual, transgender, and intersex (LGBTI) people are a priority population in Australian health policy, particularly mental health and aging. Despite associations between smoking and noncommunicable diseases relevant to aging and mental health, LGBTI-targeted smoking cessation interventions in Australia have been limited to people living with HIV. Applying existing interventions to marginalized populations without modification and evaluation may fail and exacerbate inequities.


OBJECTIVE
To assess outcomes and characterize the populations served, cultural modifications, and behavior change techniques (BCTs) of interventions to reduce LGBTI smoking.


METHODS
We searched MEDLINE, six additional databases, and contacted authors to retrieve published and unpublished program evaluations.


RESULTS
We retrieved 19 studies (3663 participants). None used control groups. Overall quit rate was 61.0% at the end of interventions and stabilized at 38.6% at 3-6 months. All studies included gay men, 13 included lesbians, 13 "LGBT," 12 bisexual people, five transgender people, and none included intersex people. Transgender people comprised 3% of participants. Of programs open to women, 27.8% of participants were women. Cultural modifications were used by 17 (89.5%) studies, commonly meeting in LGBT spaces, discussing social justice, and discussing LGBT-specific triggers. Common BCTs included providing normative information, boosting motivation/self-efficacy, relapse prevention, social support, action planning, and discussing consequences.


CONCLUSIONS
Quit rates were high; using control groups would improve evaluation. Existing programs may fail to reach groups other than gay men.


CONCLUSIONS
This review examines the evidence for LGBTI-targeted smoking cessation interventions. Populations within LGBTI are not proportionally represented in smoking cessation research, and no study addressed intersex smoking. Overall, LGBT-targeted interventions appear to be effective, and simply having an LGBT-specific group may be more effective than groups for the general population. More rigorous research is necessary to draw firm conclusions. Our study space analysis provides suggestions for areas of more targeted research on mechanisms underlying these complex interventions' success.
Centre for Values, Ethics and Law in Medicine (VELiM), Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
Israel
I
Berger
Centre for Values, Ethics and Law in Medicine (VELiM), Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
Julie
J
Mooney-Somers
D001315:Australia / Q000453:epidemiology; D001727:Bisexuality / Q000523:psychology; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000379:methods / Q000639:trends; D005260:Female; D018452:Homosexuality, Female / Q000523:psychology; D018451:Homosexuality, Male / Q000523:psychology; D006801:Humans; D008297:Male; D008603:Mental Health / Q000639:trends; D000072339:Sexual and Gender Minorities / Q000523:psychology*; D012907:Smoking / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology*; D063106:Transgender Persons / Q000523:psychology