Abstract
BackgroundSexual and gender minority young adults have a high prevalence of smoking and unique barriers to accessing tobacco treatment.ObjectiveTo address these challenges as well as their preferences for sexual and gender minority–targeted interventions and digital programs, we developed and evaluated the acceptability, preliminary efficacy, and impact on theory-based change processes of an acceptance and commitment therapy–based digital program called Empowered, Queer, Quitting, and Living (EQQUAL).MethodsParticipants (n=22) of a single-arm trial conducted to evaluate the program were young adults, age 18 to 30 years, who self-identified as sexual and gender minority individuals and smoked at least one cigarette per day. All participants received access to the EQQUAL program. Participants completed web-based surveys at baseline and at a follow-up 2 months after enrollment. We verified self-reported smoking abstinence with biochemical testing; missing data were counted as smoking or using tobacco.ResultsFor young adults who logged in at least once (n=18), the mean number of log-ins was 5.5 (SD 3.6), mean number of sessions completed was 3.1 (SD 2.6), and 39% (7/18) completed all 6 sessions. Overall, 93% of participants (14/15) were satisfied with the EQQUAL program, 100% (15/15) found it easy to use, and 100% (15/15) said it helped them be clearer about how to quit. Abstinence from smoking or using tobacco was confirmed with biochemical testing for 23% of participants (5/22). Both quantitative and qualitative results suggested a positive overall response to the avatar guide, with areas for future improvement largely centered on the avatar’s appearance and movements.ConclusionsTreatment acceptability of EQQUAL was very promising. The rate of abstinence, which was biochemically confirmed, was 3 times higher than that of the only other digital program to date that has targeted sexual and gender minority young adults and 6 to 13 times higher than those of nontargeted digital smoking interventions among sexual and gender minority young adults. Planned improvements for the next iteration of the program include making the avatar’s movements more natural; offering multiple avatar guides with different on characteristics such as race, ethnicity, and gender identity from which to choose; and providing a support forum for users to connect anonymously with peers.
Highlights
The prevalence of tobacco use among sexual and gender minority young adults is twice as high as that among non–sexual and gender minority young adults across all tobacco products: 29% vs 15% for cigarettes and 8% vs 4% for both electronic nicotine delivery systems and noncigarette tobacco, respectively [1]
Almost half of sexual and gender minority young adults lack health insurance to pay for traditional treatments such as counseling and pharmacotherapy [2], and there is substantial underuse of existing public health interventions such as tobacco quitlines among this group [3]
Only one study [5], published recently, tested a targeted digital intervention—a professionally moderated intervention delivered via Facebook—that was for sexual and gender minority young adults
Summary
The prevalence of tobacco use among sexual and gender minority young adults is twice as high as that among non–sexual and gender minority young adults across all tobacco products: 29% vs 15% for cigarettes and 8% vs 4% for both electronic nicotine delivery systems and noncigarette tobacco, respectively [1]. Compounding their risk for tobacco-related diseases, sexual and gender minority young adults encounter unique barriers to accessing treatment. Sexual and gender minority young adults have a high prevalence of smoking and unique barriers to accessing tobacco treatment
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