Abstract
BackgroundTransgender and gender-expansive (TGE) adults are twice as likely to smoke cigarettes than cisgender individuals. There is a critical gap in research on effective and culturally sensitive approaches to reduce smoking prevalence among TGE adults.ObjectiveThis study aims to qualitatively examine the risk and protective factors of cigarette smoking among TGE adults through real-world exemplars.MethodsWe conducted a digital photovoice study among a purposeful sample of 47 TGE adults aged ≥18 years and currently smoking in the United States (March 2019-April 2020). Participants uploaded photos daily that depicted smoking risk and protective factors they experienced over 21 days on either private Facebook or Instagram groups. Next, we conducted separate focus group discussions to explore the experiences of these factors among a subset of participants from each group. We analyzed participants’ photos, captions, and focus group transcripts and generated themes associated with smoking risk and protective factors.ResultsWe identified 6 major themes of risk and protective factors of smoking among TGE individuals: experience of stress, gender affirmation, health consciousness, social influences, routine behaviors, and environmental cues. We describe and illustrate each theme using exemplar photos and quotes.ConclusionsThe findings of this study will inform future community-engaged research to develop culturally tailored interventions to reduce smoking prevalence among TGE individuals.
Highlights
BackgroundCigarette smoking is the leading cause of preventable cancer, cardiovascular, respiratory, and other smoking-related illnesses and deaths in the United States [1]
Transgender and gender-expansive (TGE) adults—individuals who have a gender identity, behavior, or self-expression that is different from their sex assigned at birth—are twice as likely to smoke cigarettes than cisgender individuals [3]
An estimated 1 million TGE adults live in the United States [4], which means that approximately 350,000 TGE individuals are at increased risk of developing smoking-related cancers
Summary
BackgroundCigarette smoking is the leading cause of preventable cancer, cardiovascular, respiratory, and other smoking-related illnesses and deaths in the United States [1]. An estimated 1 million TGE adults live in the United States [4], which means that approximately 350,000 TGE individuals are at increased risk of developing smoking-related cancers. The tobacco industry targets its product marketing and advertising among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities [7,8] Compounding these risk factors, TGE individuals lack equitable access to health care and, face barriers in receiving smoking cessation interventions [9]. Transgender and gender-expansive (TGE) adults are twice as likely to smoke cigarettes than cisgender individuals. Results: We identified 6 major themes of risk and protective factors of smoking among TGE individuals: experience of stress, gender affirmation, health consciousness, social influences, routine behaviors, and environmental cues. Conclusions: The findings of this study will inform future community-engaged research to develop culturally tailored interventions to reduce smoking prevalence among TGE individuals
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