Abstract
Background: Studies have found that cigarette smoking is higher among lesbian, gay, bisexual, transgender and queer (LGBTQ) groups compared to heterosexual individuals. However, limited research is available about factors related to tobacco initiation or continuation among transgender adults. Methods: During summer 2016, the AHA-Tobacco Regulatory and Addiction Center (A-TRAC) conducted 27 focus groups and 196 surveys among smokers and non-smokers (ages 18-64) who self-identified as lesbian, gay, bisexual, transgender, or queer (LGBTQ). Study participants were of diverse racial and ethnic backgrounds and were recruited in Chicago, New York City and San Diego. Using qualitative data analyses, we analyzed a subsample of the LGBTQ data to examine the views and experiences of transgender individuals and identified themes related to psychosocial stressors linked to tobacco use. Atlas ti.v 7.5 qualitative software was used for analysis. Results: A total of 26 participants were identified as transgender, representing 13.9% of the total LGBTQ sample. Psychosocial stressors that were often mentioned by study participants and were associated with initial and continuing tobacco use included: childhood and adulthood trauma due to family, peer and community rejection and/or exposure to partner and/or community violence; surgery and the side effects of medication; use of hormones and/or other experiences related to the process of transitioning. Structural discrimination associated with low income, housing, and employment was also mentioned. These psychosocial stressors were also associated with depression and the use of intoxicating substances (i.e., alcohol and drugs). Tobacco use was felt to provide relief from these stressors. Conclusion: Transgender individuals perceived tobacco use as a relief from everyday chronic psychosocial stressors and appears to be associated with tobacco initiation and continued use. Health communication messages stressing healthy lifestyle practices and encouraging drawing on professional and informal support systems may prevent tobacco use.
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