Promotion of Tobacco Use Cessation for Lesbian, Gay, Bisexual, and Transgender People

A Systematic Review


      Lesbian, gay, bisexual, and transgender (LGBT) people are at increased risk for the adverse effects of tobacco use, given their high prevalence of use, especially smoking. Evidence regarding cessation is limited. To determine if efficacious interventions are available and to aid the development of interventions, a systematic review was conducted of grey and peer-reviewed literature describing clinical, community, and policy interventions, as well as knowledge, attitudes, and behaviors regarding tobacco use cessation among LGBT people.

      Evidence acquisition

      Eight databases for articles from 1987 to April 23, 2014, were searched. In February−November 2013, authors and researchers were contacted to identify grey literature.

      Evidence synthesis

      The search identified 57 records, of which 51 were included and 22 were from the grey literature; these were abstracted into evidence tables, and a narrative synthesis was conducted in October 2013−May 2014. Group cessation curricula tailored for LGBT populations were found feasible to implement and show evidence of effectiveness. Community interventions have been implemented by and for LGBT communities, although these interventions showed feasibility, no rigorous outcome evaluations exist. Clinical interventions show little difference between LGBT and heterosexual people. Focus groups suggest that care is needed in selecting the messaging used in media campaigns.


      LGBT-serving organizations should implement existing evidence-based tobacco-dependence treatment and clinical systems to support treatment of tobacco use. A clear commitment from government and funders is needed to investigate whether sexual orientation and gender identity moderate the impacts of policy interventions, media campaigns, and clinical interventions.
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        • Lee J.G.
        • Griffin G.K.
        • Melvin C.L.
        Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review.
        Tob Control. 2009; 18: 275-282
        • King B.A.
        • Dube S.R.
        • Tynan M.A.
        Current tobacco use among adults in the United States: findings from the National Adult Tobacco Survey.
        Am J Public Health. 2012; 102: e93-e100
        • Hagger-Johnson G.
        • Taibjee R.
        • Semlyen J.
        • et al.
        Sexual orientation identity in relation to smoking history and alcohol use at age 18/19: cross-sectional associations from the Longitudinal Study of Young People in England (LSYPE).
        BMJ Open. 2013; 3: e002810
        • Ortiz-Hernandez L.
        • Tello B.L.
        • Valdes J.
        The association of sexual orientation with self-rated health, and cigarette and alcohol use in Mexican adolescents and youths.
        Soc Sci Med. 2009; 69: 85-93
        • Blosnich J.
        • Lee J.G.
        • Horn K.
        A systematic review of the aetiology of tobacco disparities for sexual minorities.
        Tob Control. 2013; 22: 66-73
        • Leibel K.
        • Lee J.G.
        • Goldstein A.O.
        • Ranney L.M.
        Barring intervention? Lesbian and gay bars as an underutilized venue for tobacco interventions.
        Nicotine Tob Res. 2011; 13: 507-511
        • Gruskin E.
        • Byrne K.
        • Kools S.
        • Altschuler A.
        Consequences of frequenting the lesbian bar.
        Women Health. 2006; 44: 103-120
        • Smith E.A.
        • Offen N.
        • Malone R.E.
        What makes an ad a cigarette ad? Commercial tobacco imagery in the lesbian, gay, and bisexual press.
        J Epidemiol Community Health. 2005; 59: 1086-1091
        • Smith E.A.
        • Offen N.
        • Malone R.E.
        Pictures worth a thousand words: noncommercial tobacco content in the lesbian, gay, and bisexual press.
        J Health Commun. 2006; 11: 635-649
        • Lee J.G.
        • Agnew-Brune C.B.
        • Clapp J.A.
        • Blosnich J.R.
        Out smoking on the big screen: tobacco use in LGBT movies, 2000−2011.
        Tob Control. 2013 Nov 25; ( [Epub ahead of print])
        • Washington H.A.
        Burning love: big tobacco takes aim at LGBT youths.
        Am J Public Health. 2002; 92: 1086-1095
        • Stevens P.
        • Carlson L.M.
        • Hinman J.M.
        An analysis of tobacco industry marketing to lesbian, gay, bisexual, and transgender (LGBT) populations: strategies for mainstream tobacco control and prevention.
        Health Promot Pract. 2004; 5: 129S-134S
        • Offen N.
        • Smith E.A.
        • Malone R.E.
        From adversary to target market: the ACT-UP boycott of Philip Morris.
        Tob Control. 2003; 12: 203-207
        • Offen N.
        • Smith E.A.
        • Malone R.E.
        Is tobacco a gay issue? Interviews with leaders of the lesbian, gay, bisexual and transgender community.
        Cult Health Sex. 2008; 10: 143-157
        • Smith E.A.
        • Thomson K.
        • Offen N.
        • Malone R.E.
        “If you know you exist, it’s just marketing poison”: meanings of tobacco industry targeting in the lesbian, gay, bisexual, and transgender community.
        Am J Public Health. 2008; 98: 996-1003
        • Hatzenbuehler M.L.
        • Wieringa N.F.
        • Keyes K.M.
        Community-level determinants of tobacco use disparities in lesbian, gay, and bisexual youth: results from a population-based study.
        Arch Pediatr Adolesc Med. 2011; 165: 527-532
        • Burns E.K.
        • Deaton E.A.
        • Levinson A.H.
        Rates and reasons: disparities in low intentions to use a state smoking cessation quitline.
        Am J Health Promot. 2011; 25: S59-S65
        • Schwappach D.L.
        Queer quit: gay smokers’ perspectives on a culturally specific smoking cessation service.
        Health Expect. 2009; 12: 383-395
        • San Francisco Lesbian and Gay History Project
        “She even chewed tobacco”: a pictoral narrative of passing women in America.
        in: Duberman M.B. Vicinus M. Chauncey G. Hidden from history: reclaiming the gay & lesbian past. New American Library, New York NY1989
        • Gruskin E.P.
        • Byrne K.M.
        • Altschuler A.
        • Dibble S.L.
        Smoking it all away: influences of stress, negative emotions, and stigma on lesbian tobacco use.
        J LGBT Health Res. 2008; 4: 167-179
        • Hatzenbuehler M.L.
        • Keyes K.M.
        • Hamilton A.
        • Hasin D.S.
        State-level tobacco environments and sexual orientation disparities in tobacco use and dependence in the USA.
        Tob Control. 2014 Feb 25; ( [Epub ahead of print])
        • Frohlich K.L.
        • Potvin L.
        Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations.
        Am J Public Health. 2008; 98: 216-221
        • Hill S.
        • Amos A.
        • Clifford D.
        • Platt S.
        Impact of tobacco control interventions on socioeconomic inequalities in smoking: review of the evidence.
        Tob Control. 2013 Sep 17; ( [Epub ahead of print])
        • Niederdeppe J.
        • Bigman C.A.
        • Gonzales A.L.
        • Gollust S.E.
        Communication about health disparities in the mass media.
        J Commun. 2013; 63: 8-30
        • Lorenc T.
        • Petticrew M.
        • Welch V.
        • Tugwell P.
        What types of interventions generate inequalities? Evidence from systematic reviews.
        J Epidemiol Community Health. 2013; 67: 190-193
        • Greaves L.
        • Johnson J.
        • Bottorff J.
        • et al.
        What are the effects of tobacco policies on vulnerable populations? A better practices review.
        Can J Public Health. 2006; 97: 310-315
        • Main C.
        • Thomas S.
        • Ogilvie D.
        • et al.
        Population tobacco control interventions and their effects on social inequalities in smoking: placing an equity lens on existing systematic reviews.
        BMC Public Health. 2008; 8: 178
        • Green L.W.
        Making research relevant: if it is an evidence-based practice, where’s the practice-based evidence?.
        Fam Pract. 2008; 25: i20-i24
        • Fiore M.C.
        • Jaen C.R.
        • Baker T.B.
        Treating tobacco use and dependence: 2008 update.
        U.S. Department of Health and Human Services, Rockville MD2008
        • IOM
        The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding.
        National Academies Press, Washington DC2011
        • Lee J.G.
        • Blosnich J.R.
        • Melvin C.L.
        Up in smoke: vanishing evidence of tobacco disparities in the Institute of Medicine’s report on sexual and gender minority health.
        Am J Public Health. 2012; 102: 2041-2043
        • Doolan D.M.
        • Froelicher E.S.
        Efficacy of smoking cessation intervention among special populations: review of the literature from 2000 to 2005.
        Nurs Res. 2006; 55: S29-S37
        • Network for LGBT Health Equity
        MPOWERED: best and promising practices for LGBT tobacco prevention and control.
        Fenway Institute, Boston MA2012
        • Dickersin K.
        • Min Y.I.
        Publication bias: the problem that won’t go away.
        Ann N Y Acad Sci. 1993; 703: 135-146
        • Leviton L.C.
        • Gutman M.A.
        Overview and rationale for the systematic screening and assessment method.
        New Direct Eval. 2010; 124: 7-31
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • PRISMA Group
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS Med. 2009; 6: e1000097
        • Grady E.S.
        • Humfleet G.L.
        • Delucchi K.L.
        • Reus V.I.
        • Munoz R.F.
        • Hall S.M.
        Smoking cessation outcomes among sexual and gender minority and nonminority smokers in extended smoking treatments.
        Nic Tob Res. 2014; 16: 1207-1215
        • Eliason M.J.
        • Dibble S.L.
        • Gordon R.
        • Soliz G.B.
        The last drag: an evaluation of an LGBT-specific smoking intervention.
        J Homosex. 2012; 59: 864-878
        • Harding R.
        • Bensley J.
        • Corrigan N.
        Targeting smoking cessation to high prevalence communities: outcomes from a pilot intervention for gay men.
        BMC Public Health. 2004; 4: 43
        • Miele A.M.
        • Scout N.
        • Bradford J.B.
        • Perry D.
        Priority populations initiative: the LGBT incubation project, final report 3/1/03– 8/31/05.
        The Fenway Institute, Boston MA2005
        • Covey L.S.
        • Weissman J.
        • LoDuca C.
        • Duan N.
        A comparison of abstinence outcomes among gay/bisexual and heterosexual male smokers in an intensive, non-tailored smoking cessation study.
        Nicotine Tob Res. 2009; 11: 1374-1377
      1. Warren B. Positively smokefree: helping HIV+ smokers to quit. Boston MA: National LGBT Tobacco Control Network, 2010.

        • Walls N.E.
        • Wisneski H.
        Evaluation of smoking cessation classes for the lesbian, gay, bisexual, and transgender community.
        J Soc Serv Res. 2011; 37: 99-111
        • Matthews A.K.
        • Conrad M.
        • Kuhns L.
        • Vargas M.
        • King A.C.
        Project Exhale: preliminary evaluation of a tailored smoking cessation treatment for HIV+ African American smokers.
        AIDS Patient Care STDS. 2013; 27: 22-32
        • Matthews A.K.
        • Li C.C.
        • Kuhns L.M.
        • Tasker T.B.
        • Cesario J.A.
        Results from a community-based smoking cessation treatment program for LGBT smokers.
        J Environ Public Health. 2013; 2013 ( 984508
        • Dickson-Spillmann M.
        • Sullivan R.
        • Zahno B.
        • Schaub M.P.
        Queer quit: a pilot study of a smoking cessation programme tailored to gay men.
        BMC Public Health. 2014; 14: 126
      2. Senseman S.E. Making Minnesota’s quitlines accessible to LGBTQ communities: lessons learned. [Conference Presentation.] Bridging the Gap: 8th National LGBTQ Health Equity Summit, August 14, 2012, Kansas City MO.

      3. National LGBT Tobacco Control Network. Making Minnesota’s quitlines accessible to LGBTs. 2008.

        • Huber M.
        • Ledergerber B.
        • Sauter R.
        • et al.
        Outcome of smoking cessation counselling of HIV-positive persons by HIV care physicians.
        HIV Med. 2012; 13: 387-397
        • King B.A.
        • Dube S.R.
        • Babb S.D.
        • McAfee T.A.
        Patient-reported recall of smoking cessation interventions from a health professional.
        Prev Med. 2013; 57: 715-717
      4. Chicago Tobacco Prevention Project (CTPP) Close Out Summary Questions. [Grant reporting document to Respiratory Health Association (of Chicago)]. Chicago, IL: Howard Brown Health Center; March 5, 2012

      5. Aragon L.M., Le Veque M. The Last Drag Campaign: countering the tobacco industry’s targeting of the gay and lesbian community. [Conference poster.] Presented at 2006 World Conference on Tobacco or Health, Washington, DC, July 14, 2006.

        • Peretti-Watel P.
        • Villes V.
        • Duval X.
        • et al.
        How do HIV-infected smokers react to cigarette price increases? Evidence from the Aproco-Copilote-ANRS CO8 Cohort.
        Curr HIV Res. 2009; 7: 462-467
      6. Vincent M. LGBT engagement paradigm: West Virginia case study. [Conference presentation.] LGBT Health Equity Summit, August 14, 2012; Kansas City MO.

      7. Priority Populations Initiative: "Queer and Healthy in the Bronx: Smoking Cessation for Lesbians and Their Families". [Grant reporting document to American Legacy Foundation]. Bronx, NY: Bronx Lesbian & Gay Health Resource Consortium; July 22, 2003

      8. Priority Populations Initiative Grant: "Queer and Healthy in the Bronx". [Grant reporting document to American Legacy Foundation]. NY: Bronx Lesbian & Gay Health Resource Consortium; June 29, 2006

      9. Priority Populations Initiative: Queer Tobacco Elimination and Control Collaborative (Q-TECC). [Grant reporting document to American Legacy Foundation]. Chicago, IL: Howard Brown Health Center; March 1, 2006

      10. American Legacy Foundation Priority Populations Initiative II Final Report: LGBT Lifestyle Project. [Grant reporting document to American Legacy Foundation]. Las Vegas, NV: Southern Nevada Health District; June 2, 2010

      11. Priority Populations Initiative: Smoking Cessation Media Campaign for Lesbians Over 40. [Grant reporting document to American Legacy Foundation]. Washington, DC: Mautner Project; November 30, 2005

        • Shields M.
        • Zapert K.
        • Ackermann S.
        Mautner Project / Witeck-Combs LBT anti-smoking qualitative research summary report. Witeck-Combs Communications, accessed through Schlesinger Library (collection: MC 683).
        Radcliffe Institute, Harvard University, 2003
        • Bye L.L.
        • Gruskin E.P.
        • Greenwood G.
        • Albright V.
        • Krotki K.
        California lesbians, gays, bisexuals, and transgender (LGBT) tobacco use survey−2004.
        California Department of Health Services, Sacramento CA2005
        • Greenwood G.L.
        • Paul J.P.
        • Pollack L.M.
        • et al.
        Tobacco use and cessation among a household-based sample of US urban men who have sex with men.
        Am J Public Health. 2005; 95: 145-151
        • Remafedi G.
        • Carol H.
        Preventing tobacco use among lesbian, gay, bisexual, and transgender youths.
        Nicotine Tob Res. 2005; 7: 249-256
        • Sánchez J.P.
        • Meacher P.
        • Beil R.
        Cigarette smoking and lesbian and bisexual women in the Bronx.
        J Community Health. 2005; 30: 23-37
        • Dibble S.L.
        • Sato N.
        • Haller E.
        Asians and native Hawaiian or other Pacific Islanders midlife lesbians’ health.
        Women Ther. 2007; 30: 129-143
        • Schwappach D.L.
        Smoking behavior, intention to quit, and preferences toward cessation programs among gay men in Zurich, Switzerland.
        Nicotine Tob Res. 2008; 10: 1783-1787
        • Tobacco Program Evaluation Group
        Cessation barriers, attitudes and preferences among Colorado GLBT smokers.
        University of Colorado Denver, Denver CO2008
        • Aholt E.C.
        Cognitive processing themes for smoking among lesbians [dissertation].
        Department of Special Education, Rehabilitation and Counseling, Auburn University, Auburn AL2009
        • Burkhalter J.E.
        • Warren B.
        • Shuk E.
        • Primavera L.
        • Ostroff J.S.
        Intention to quit smoking among lesbian, gay, bisexual, and transgender smokers.
        Nicotine Tob Res. 2009; 11: 1312-1320
        • Pizacani B.A.
        • Rohde K.
        • Bushore C.
        • et al.
        Smoking-related knowledge, attitudes and behaviors in the lesbian, gay and bisexual community: a population-based study from the U.S. Pacific Northwest..
        Prev Med. 2009; 48: 555-561
        • Rose J.
        • Adams E.
        Focus groups with selected priority populations: evaluation of the Florida Tobacco Prevention and Control Program.
        RTI International, Research Triangle Park NC2009
        • Bryant L.
        • Bowman L.
        • Damarin A.K.
        Assessment for a better understanding of tobacco use by LGBT Atlantans.
        Respir Care Educ Annu. 2011; 20 ( 63-73
        • Burkhalter J.E.
        • Hay J.L.
        • Coups E.
        • Warren B.
        • Li Y.
        • Ostroff J.S.
        Perceived risk for cancer in an urban sexual minority.
        J Behav Med. 2011; 34: 157-169
        • McElroy J.A.
        • Everett K.D.
        • Zaniletti I.
        An examination of smoking behavior and opinions about smoke-free environments in a large sample of sexual and gender minority community members.
        Nicotine Tob Res. 2011; 13: 440-448
        • Levinson A.H.
        • Hood N.
        • Mahajan R.
        • Russ R.
        Smoking cessation treatment preferences, intentions, and behaviors among a large sample of Colorado gay, lesbian, bisexual, and transgendered smokers.
        Nicotine Tob Res. 2012; 14: 910-918
      12. Farmer GW, Bowen DJ, Bucholz KK. A population-based comparison of smoking cessation among sexual minority and heterosexual adults. [Conference presentation.] Society for Research on Nicotine & Tobacco Annual Meeting, 2013; Boston MA.

        • Matthews A.K.
        • Vargas M.
        • Kuhns L.
        • Shappiva N.
        • King A.
        A qualitative examination of barriers and motivators to smoking cessation among HIV positive African American MSM smokers.
        J Health Disparities Res Pract. 2014; 7: 50-76
        • Robinson W.T.
        • Brown M.C.
        • Moody-Thomas S.
        Smoking and experiences with tobacco cessation among men who have sex with men: New Orleans, 2011.
        AIDS Behav. 2014; 18: 324-332
        • Matthews A.K.
        • Hotton A.
        • DuBois S.
        • Fingerhut D.
        • Kuhns L.M.
        Demographic, psychosocial, and contextual correlates of tobacco use in sexual minority women.
        Res Nurs Health. 2011; 34: 141-152
        • Berg C.J.
        • Nehl E.J.
        • Wang X.
        • et al.
        Healthcare provider intervention on smoking and quit attempts among HIV-positive versus HIV-negative MSM smokers in Chengdu, China.
        AIDS Care. 2014; 26: 1201-1207
        • Matthews A.K.
        • Riley B.B.
        • Everett B.
        • Hughes T.L.
        • Aranda F.
        • Johnson T.
        A longitudinal study of the correlates of persistent smoking among sexual minority women.
        Nicotine Tob Res. 2014 Apr 11; ([Epub ahead of print])
      13. Lesbian, Gay, Bisexual and Transgender Young Adult Tobacco Use in Salt Lake City, UT. [Research report to Utah State Department of Health]. San Diego, CA: Rescue Social Change Group; 2011

        • McCullough A.
        • Fisher M.
        • Goldstein A.O.
        • Kramer K.D.
        • Ripley-Moffitt C.
        Smoking as a vital sign: prompts to ask and assess increase cessation counseling.
        J Am Board Fam Med. 2009; 22: 625-632
        • Lee J.G.
        • Goldstein A.O.
        • Ranney L.M.
        • Crist J.
        • McCullough A.
        High tobacco use among lesbian, gay, and bisexual populations in West Virginian bars and community festivals.
        Int J Environ Res Public Health. 2011; 8: 2758-2769
        • Christakis N.A.
        • Fowler J.H.
        The collective dynamics of smoking in a large social network.
        N Engl J Med. 2008; 358: 2249-2258
        • Scout N.
        • Miele A.M.
        • Bradford J.B.
        • Perry D.
        Running an LGBT smoking treatment group.
        Fenway Institute, Boston MA2006
        • Runyan C.W.
        • Freire K.E.
        Developing interventions when there is little science.
        in: Doll L.S. Bonzo S.E. Mercy J.A. Sleet D.A. Handbook of injury and violence prevention. Springer, New York NY2007
        • Task Force on Community Preventive Services
        Recommendations regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke.
        Am J Prev Med. 2001; 20: 10-15
        • Tynan M.A.
        • Ribisl K.M.
        • Loomis B.R.
        Impact of cigarette minimum price laws on the retail price of cigarettes in the USA.
        Tob Control. 2013; 22: e78-e85
        • Chapman S.
        • Freeman B.
        Regulating the tobacco retail environment: beyond reducing sales to minors.
        Tob Control. 2009; 18: 496-501
        • Niederdeppe J.
        • Kuang X.
        • Crock B.
        • Skelton A.
        Media campaigns to promote smoking cessation among socioeconomically disadvantaged populations: what do we know, what do we need to learn, and what should we do now?.
        Soc Sci Med. 2008; 67: 1343-1355
        • Nicholson R.A.
        • Kreuter M.W.
        • Lapka C.
        • et al.
        Unintended effects of emphasizing disparities in cancer communication to African-Americans.
        Cancer Epidemiol Biomarkers Prev. 2008; 17: 2946-2953
        • Thrasher J.F.
        • Niederdeppe J.
        • Farrelly M.C.
        • Davis K.C.
        • Ribisl K.M.
        • Haviland M.L.
        The impact of anti-tobacco industry prevention messages in tobacco producing regions: evidence from the US truth campaign.
        Tob Control. 2004; 13: 283-288
        • Chapman S.
        • MacKenzie R.
        The global research neglect of unassisted smoking cessation: causes and consequences.
        PLoS Med. 2010; 7: e1000216
        • Coulter R.W.
        • Kenst K.S.
        • Bowen D.J.
        Scout. Research funded by the National Institutes of Health on the health of lesbian, gay, bisexual, and transgender populations.
        Am J Public Health. 2014; 104: e105-e112
        • Badgett L.
        • Goldberg N.
        Best practices for asking questions about sexual orientation on surveys. Williams Institute Sexual Minority Assessment Research Team, Los Angeles CA2009 (