Tobacco Harm Reduction & LGBTQ+ Young Adults

If you are interested in participating in this study, please visit criticalpublichealth.org/thr/

Ink and watercolor illustration of cigarette pack
Cigarettes, by Irenka Domínguez-Pareto
Compared to the general population, nicotine and tobacco (NT) use, especially smoking, is more common within LGBTQ+ communities, and within these communities, young adults may smoke the most. Given this situation, we need to understand how to best eliminate the burden of tobacco-related illnesses for LGBTQ+ young adults.

Some research, including our own previous work, suggests that young people who use nicotine and tobacco products are developing strategies to reduce their own chances of tobacco-related illnesses. Because these strategies do not necessarily involve abstinence or cessation, they may be considered tobacco harm reduction strategies. Tobacco harm reduction (THR) approaches typically emphasize the substitution of less harmful forms of nicotine for more harmful combustible tobacco products, like cigarettes, for smokers who are unable or unwilling to quit.

“Sometimes I try to take breaks from it, and then I tried to use the tea cigarettes because they don’t have any tobacco in it. And for me, it kind of confirms that I’m not as addicted to it as the rest of my family is. I rely on it to feel better throughout the day, but it’s not something I would go out of my way, like stealing money or neglecting children in order to get it. And it’s also an encouragement for whenever I do try to stop for a while. ‘Cause now, you’re like, Oh, you can do this. You might not be able to do it all the time, but you can do it.”

– Zephyr Breeze *

“Sometimes I try to take breaks from it, and then I tried to use the tea cigarettes because they don’t have any tobacco in it. And for me, it kind of confirms that I’m not as addicted to it as the rest of my family is. I rely on it to feel better throughout the day, but it’s not something I would go out of my way, like stealing money or neglecting children in order to get it. And it’s also an encouragement for whenever I do try to stop for a while. ‘Cause now, you’re like, Oh, you can do this. You might not be able to do it all the time, but you can do it.”

– Zephyr Breeze *


Ink and watercolor illustration of vape devices
Vape devices, by Irenka Domínguez-Pareto
THR is hotly debated in tobacco control and, as such, remains under-researched. Yet, as the public health community continues to debate THR, some young people may already be engaging in practices that they consider harm reduction. The extent to which this practice has been adopted by young LGBTQ+ smokers remains unknown.

The Center for Critical Public Health’s Tobacco Harm Reduction Study is a 36-month qualitative project that explores LGBTQ+ young adults’ nicotine and tobacco use practices. In doing this, we are examining the extent to which THR is practiced by LGBTQ+ young adults. We will conduct 100 in-depth qualitative online interviews with LGBTQ+ young adults who either currently or used to smoke cigarettes.

“I get motivated to take better care of myself. ‘Cause I smoke, but I don’t – I don’t fool myself. It’s not stopping any damage, and it’s not to overcompensate either. If anything, it’s like, reminding me to take care of myself in other ways. You know, if you’re going to smoke, eat vegetables. (quick laugh)[…] So, you just try to take care of yourself in other ways.”

– Dan *

“I get motivated to take better care of myself. ‘Cause I smoke, but I don’t – I don’t fool myself. It’s not stopping any damage, and it’s not to overcompensate either. If anything, it’s like, reminding me to take care of myself in other ways. You know, if you’re going to smoke, eat vegetables. (quick laugh)[…] So, you just try to take care of yourself in other ways.”

– Dan *


Narrative data from participants will respond to the following aims:

  1. Describe whether and how LGBTQ+ young adults demonstrate pathways and patterns of nicotine and tobacco use that are illustrative of tobacco harm reduction,
  2. Examine whether LGBTQ+ young adults describe the practice of tobacco harm reduction as a way to minimize the tension between the challenges of their everyday lives and their awareness of smoking-related harms, and
  3. Develop a theory of practice of tobacco harm reduction to inform prevention and treatment interventions responsive and compassionate to the unique needs of LGBTQ+ young adults and grounded in their experiences.

“That’s how I cope with all these emotions, just to kind of numb myself out… Yeah, uh, that is one of the main reasons I started smoking cigarettes again. I was doing fine for a very long time, and then I had a really dark patch in my life, and so, I started smoking again. Also because of the – I was on antidepressants and mood stabilizers. And so, it really wasn’t possible for me to start taking marijuana again, because it would affect me, and it would have side effects with the medication.”

– Steven *

“That’s how I cope with all these emotions, just to kind of numb myself out… Yeah, uh, that is one of the main reasons I started smoking cigarettes again. I was doing fine for a very long time, and then I had a really dark patch in my life, and so, I started smoking again. Also because of the – I was on antidepressants and mood stabilizers. And so, it really wasn’t possible for me to start taking marijuana again, because it would affect me, and it would have side effects with the medication.”

– Steven *

“Smoking cigarettes is one of the most unhealthy things I do. Like, I’m generally otherwise very healthy. I eat really healthy. I exercise, and I try not to like, sit too much. I’m very conscious of my health, and it’s very important to me. So – I don’t think the occasional cigarette has a huge impact on that, honestly, just … health is more holistic than just like, a couple things. So, the fact that I generally take really good care of myself … means like, I’m more okay with the occasional drug use.”

– Rocky *

“Smoking cigarettes is one of the most unhealthy things I do. Like, I’m generally otherwise very healthy. I eat really healthy. I exercise, and I try not to like, sit too much. I’m very conscious of my health, and it’s very important to me. So – I don’t think the occasional cigarette has a huge impact on that, honestly, just … health is more holistic than just like, a couple things. So, the fact that I generally take really good care of myself … means like, I’m more okay with the occasional drug use.”

– Rocky *

* To protect confidentiality, respondents are asked to choose pseudonyms.


Project Contact

Em Sanders, Project Manager

Funding

This research was supported by funds from the Tobacco-Related Disease Research Program (TRDRP) of the University of California, grant number T30IR0890 (Tamar Antin, PI). The content provided here is solely the responsibility of the authors and does not necessarily reflect the opinions of TRDRP.