Lesbian, Gay, Bisexual And Transgender Patients Research Articles

Experiences of Family Medicine Specialists in Providing Health Care for Lesbian, Gay, Bisexual and Transgender Patients: A Qualitative Study in East Coast Peninsular Malaysia

INTRODUCTION: Lesbian, Gay, Bisexual and Transgender (LGBT) patients continue to report discrimination in healthcare setting despite the efforts of the primary healthcare offering community friendly services in Malaysia. This qualitative study aimed to provide understanding of this current issue and to explore the challenges that family medicine specialists (FMSs) from East Coast of Peninsular Malaysia face when dealing with LGBT patients. MATERIALS AND METHODS: 30 FMSs working in East Coast Peninsular Malaysia were interviewed through a phenomenological framework using semi-structured in-depth interviews of LGBT patients. The interviews were recorded in audio format, transcribed verbatim, and subjected to Braun and Clarke’s thematic analysis. We discerned common themes that can be elucidated through the lens of Leininger’s Theory of Culture Care (TCC) and the Sunrise Enabler Model (SEM). RESULTS: Three overlapping themes of the transcriptions were developed; (1) Multidimensional understanding of LGBT described how FMSs saw the LGBT community as diverging from societal norms, yet acknowledge their vulnerability as integral members of the society, (2) obstacles to providing culturally competent care stemmed from inadequate training, an unsupportive clinic environment, and the self-stigma experienced by patients, and (3) barriers to incorporating spiritual needs for holistic care arose in situations where there was insufficient spiritual health training or a preference to concentrate on physical and emotional well-being to uphold trust. CONCLUSION: The findings on this study reflect the need for proper training of healthcare personnel to deliver a holistic, culturally competent care for LGBT patients. A collaborative effort with relevant authorities is also needed to successfully overcome those challenges.

Attitudes and knowledge of the tunisian medical staff towards LGBT patients

IntroductionSexual minorities have been coming out more than ever before. However, Tunisian laws and society are still not supportive of LGBT (lesbian, gay, bisexual and transgender) rights. To this day, Tunisian doctors are requisitioned to carry out anal tests as part of expert testimonies in cases of conviction for homosexuality.ObjectivesAssess Tunisian physicians’ attitudes and knowledge towards LGBT patients.MethodsWe conducted a cross-sectional study in October 2021, among 445 Tunisian physicians and medical students. Data were collected via an anonymous self-administered online questionnaire including sociodemographic data and the LGBT Development of Clinical Skills Scale (LGBT-DOCSS).ResultsThe overall LGBT-DOCSS score was quite good (4.47 ±0.85). The attitudes of Tunisian doctors were better than their knowledge (p=0.01; t=2.6), which was better than their clinical preparedness (p<10-3; t=25) in treating LGBT patients. Doctors who self-identify as sexual minorities and those who interacted with LGBT people in their daily lives, were less stigmatising, more able to treat them and had better knowledge of their needs. Those who had had sexology training (5%) had better LGBT-DOCSS score (p=0.013), better knowledge (p=0.045) and preparedness (p<10-3) in treating LGBT patients but did not appear to be less stigmatising than the rest of the group (p=0.9). Religiosity was associated with a more stigmatising attitude (p<10-3), but had no impact on knowledge or preparedness.ConclusionsThis study points to gaps, identified by doctors themselves when faced with an LGBT patient. A more inclusive health system requires better matching of health services to the needs of the whole population without discrimination.DisclosureNo significant relationships.

A Literature Review on the Influence of LGBT Curriculum on Medical Students’ Attitude Towards LGBT Patients

Background: Since 2014, the American Academy of Family Physicians has proposed that medical residents should gain more understanding about LGBT so that LGBT (lesbian, gay, bisexual, and transgender) patients can gain access to healthcare without bias. In order to fulfil this, appropriate educational content on LGBT is required. Methods: Ovid, PubMed, and Website of Science have been searched for literatures published in last 8 years, from 2013 to 2021. Literatures on the attitude of medical students before and after their experience of curricula with LGBT content were included, whereas those that focused on addressing the gap of LGBT content in the curricula, the bias towards LGBT medical students, and the effect of LGBT curriculum on the knowledge aspect were excluded. Results: Ninety-three articles were found, among which only six literatures were included in this review. It has been found that after LGBT education, students are more prepared and their attitude towards LGBT patients when providing healthcare is more positive. Some studies have also pointed out that medical students would change their opinion in treating LGBT patients. Conclusion: This review shows that there is evidence of the influence of LGBT education on medical students’ attitude toward LGBT patients although a wide gap still exists in this field.

‘Anything is helpful’: examining tensions and barriers towards a more LGBT-inclusive healthcare organization in the United States

ABSTRACT Semi-structured interviews (N = 34) were conducted with employees at a healthcare organization to explore their perspectives on LGBT (lesbian, gay, bisexual, and transgender) inclusion in their workplace. When lacking both comfort and a vocabulary with which to discuss issues relevant to LGBT patients and staff, employees constructed comparisons by using other groups and events as stand-ins for experiences that were unfamiliar. From employees’ reflections, three dialectic tensions emerged: (1) desire for change and uncertainty about change; (2) preserving competent appearances and knowledge gap awareness; and (3) direct and indirect appraisals. The interplaying discourses that surfaced within the organization set the stage for impending inclusion initiatives. This study contributes to theorizing on dialectical tensions by examining the interplay of order and disorder activated by indirect appraisals and resistance by omission.

Medical Students’ Attitudes Towards, and Knowledge of LGBT Persons in Guyana

ABSTRACT Evidence from industrialized countries show that discrimination and experienced and/or perceived negative encounters with healthcare workers affect frequency and type of healthcare sought by lesbian, gay, bisexual and transgender (LGBT) persons. In Guyana, and the wider English-speaking Caribbean region, there is a dearth of research on how healthcare workers and students perceive and interact with LGBT patients. This study investigated the attitudes and knowledge with regards to LGBT health among students at a medical school in Guyana by using quantitative, self-administered online surveys. We analyzed data using SPSS for descriptive and analytic calculations, and results showed that students held moderately prejudiced attitudes toward LGBT persons. Religiosity and heterosexual orientation were the main factors found to be associated with negative attitudes. Knowledge levels were also moderate with pronounced deficiencies in certain areas, and almost all students had not received LGBT-specific medical education, but most indicated a desire for such education.

LGBT Medical Education Assessment in West Virginia

BACKGROUND Lesbian, gay, bisexual and transgender (LGBT) individuals experience healthcare disparities related to their physical, mental, behavioral, and sexual health. Educating medical students about how to address this public health issue is a priority of the Association of American Medical Colleges and all medical schools across the country. Yet, the training to care for LGBT patients has been inconsistent, and it is unknown how comprehensively these competencies are being addressed at the two allopathic medical schools in West Virginia (WV). METHODS An online questionnaire was distributed to medical students at the two allopathic medical schools in WV to evaluate perceptions of the curricula with respect to care for LGBT patients. RESULTS Medical students (N-91) felt prepared to address 9 of 16 LGBT-specific subject areas. The majority of students felt prepared to discuss sexual orientation (64/91; 70.3%) and human immunodeficiency virus (60/91; 65.9%). Fewer students felt prepared to discuss sex-reassignment surgery (17/91; 18.7%) and transitioning (21/91; 23.1%). Overall, 82.4% of respondents reported feeling "comfortable" or "somewhat comfortable" with LGBT health issues. Medical school education helped 59.3% of respondents feel "more comfortable" and 65,9% of respondents feel "more prepared" to provide medical care to LGBT patients. CONCLUSION Our data suggests that medical school curricula in WV has increased student-rated comfort and preparedness in providing medical care to LGBT patients, but should be further developed and standardized to reduce the perceived knowledge gaps.

Lesbian, gay, bisexual and transgender (LGBT) inclusion in nursing services: a reflective case study from stoma care

Speaking with a female patient and her same-sex partner about their experiences of colorectal cancer and ileostomy surgery led to reflection on how specialist nursing care could be made more inclusive of the needs of lesbian, gay, bisexual and transgender (LGBT) people. The LGBT community includes people who are attracted to the same sex and/or identify as a different gender to the one they were assigned at birth. LGBT people in the UK have experienced a long history of discrimination and only begun to win legal protections over the past two decades, an experience that still affects the older generation especially. Compared with the general population, LGBT people are more likely to report poor health status, experience mental health issues and engage in risky behaviours; however, many are reluctant to attend healthcare services due to fear of discrimination. UK LGBT rights charity charity Stonewall surveys have revealed some discriminatory attitudes and widespread unconscious bias among health and social care staff. For health professionals, it can be a challenge to use the correct terminology to avoid causing offen ce, and there is a largely unmet need for inclusion training to improve their understanding and confidence to speak with patients about sexual preference and gender identity. However, confident LGBT inclusivity can be achieved with simple communication skills, such as equal treatment for same-sex partners, acknowledgement of post-transition names and pronouns and discretion in documentation, as well as awareness of verbal and non-verbal cues. Clinic environments can be made more LGBT-friendly with gender-neutral toilets, as well as wearable LGBT symbols, inclusive imagery and posters and literature that promotes LGBT rights, inclusion and support groups. Specialist nurses can act as role models and advocates for LGBT patients and colleagues in their area through small but impactful actions.

Barriers to palliative care in sexual and gender minority patients with cancer: A scoping review of the literature.

The Institute of Medicine reports lesbian, gay, bisexual and transgender (LGBT) individuals having the highest rates of tobacco, alcohol and drug use leading to elevated cancer risks. Due to fear of discrimination and lack of healthcare practitioner education, LGBT patients may be more likely to present with advanced stages of cancer resulting in suboptimal palliative care. The purpose of this scoping review is to explore what is known from the existing literature about the barriers to providing culturally competent cancer-related palliative care to LGBT patients. This review will use the five-stage framework for conducting a scoping review developed by Arksey and O'Malley. The PubMed, Scopus, PsychINFO and Cochrane electronic databases were searched resulting in 1,442 citations. Eligibility criteria consisted of all peer-reviewed journal articles in the English language between 2007 and 2020 resulting in 10 manuscripts. Barriers to palliative cancer care for the LGBT include discrimination, criminalisation, persecution, fear, distress, social isolation, disenfranchised grief, bereavement, tacit acknowledgment, homophobia and mistrust of healthcare providers. Limited healthcare-specific knowledge by both providers and patients, poor preparation of legal aspects of advanced care planning and end-of-life care were underprovided to LGBT persons. As a result of these barriers, palliative care is likely to be provided for LGBT patients with cancer in a deficient manner, perpetuating marginalisation and healthcare inequities. Minimal research investigates these barriers and healthcare curriculums do not provide practitioners skills for administering culturally sensitive palliative care to LGBT patients.

Attitudes of Future Doctors Towards LGBT Patients in Conservative Malaysian Society

One challenge which confronts the acceptance of human diversity is the stigmatisation and discrimination against Lesbian, Gay, Bisexual and Transgender (LGBT) individuals in conservative societies. These societies can be influenced by culture and belief systems, reinforced by state policies which pose health and health care provision challenges. As significant players in the health of the nation, the attitudes of medical practitioners and the decisions influenced by them impact on health outcomes. This cross-sectional study aimed to explore the associations between ethnicity, religion and gender with the attitude of clinical-year medical students toward LGBT patients. A modified 10-item Attitudes Toward LGBT Patients Scale (ATLPS-M) was used to assess attitudes towards LGBT patients. Data from 228 participants with valid responses were analysed using ANOVA for religion and ethnicity; and independent t test for gender. The mean scores of ATLPS-M was 38.5 (± 5.13). Significant differences were found between ethnicity, religions and ATLPS-M scores, with medium effect size ω2 measured at .10 and .10 respectively. Statistical differences were not found between genders and ATLPS-M score. Our findings reflect the association of ethnicity to attitudes of future doctors towards LGBT patients in the context of Malaysian society, where religion has been given great impetus with far reaching influence in shaping attitudes. Against the background of religion and ethnicity being intertwined in Malaysian society, complexities are highlighted.

Inequalities in lesbian, gay, bisexual, and transgender (LGBT) health and health care access and utilization in Wisconsin.

There are known health disparities between lesbian, gay, bisexual and transgender (LGBT) people and non-LGBT people, but only in the past couple of decades have population-based health surveys in the United States included questions on sexual and gender identity. We aimed to better understand LGBT disparities in health, health care access and utilization, and quality of care. Data are from the Survey of the Health of Wisconsin (SHOW) from 2014 to 2016 (n = 1957). The analyses focused on comparing health care access and utilization, and quality of care between LGB and non-LGB people and transgender and cisgender people. 3.8% (n = 73) identified as lesbian, gay or bisexual, and 1.3% (n = 25) were transgender. LGB adults were 2.17 (95th CI: 1.07–4.4) times more likely to delay obtaining health care. Transgender adults were 2.76 (95th CI: 1.64–4.65) times more likely to report poor quality of care and 2.78 (95th CI: 1.10–7.10) unfair treatment when receiving medical care. The results show differences in health care access and utilization and quality of care, and they add to the growing body of literature that suggest that improved health care services for LGBT patients are needed to promote health equity for LGBT populations.

Effects of LGBT Nursing Education Using Simulation.

As health care needs for Lesbian, Gay, Bisexual and Transgender (LGBT) are becoming increasingly important, it has become imperative for the nurses to be attentive towards their health problems and provide nursing care with an open-minded attitude. Due to limited opportunity to provide direct nursing care to LGBT patients, it is hypothesized that simulation would provide good opportunity for students to experience LGBT nursing care in a safe environment. This study was conducted to develop and apply simulation of LGBT nursing care to ultimately provide unbiased nursing care for LGBT population and prepare basic data for LGBT nursing education. This study was a single-group pre-post experimental design study for 57 senior nursing students based on the comparison of existing LGBT knowledge, general attitude towards LGBT, and nursing attitude towards LGBT before and after simulation. The scenario content included discussion of coming out issue, providing sexual health information, and supportive nursing care for LGBT population. Data were analyzed with descriptive statistics and Wilcoxon signed rank. Simulation education-led to a significant increase in LGBT knowledge and nursing attitude. However, there was no change in the general attitude towards LGBT. The results of this study suggest that LGBT education using simulation may be effective for nursing students and nurses from the point of concern for LGBT population. It is hypothesized that future LGBT educational programs might need more detailed information from both care recipients and nurses. Finally, LGBT education needs to be included in the nursing education curriculum.

Legal and Policy Issues for LGBT Patients with Cancer or at Elevated Risk of Cancer.

To understand the major legal and policy issues for lesbian, gay, bisexual and transgender (LGBT) cancer patients. LGBT health policy research. Major policy issues include discrimination, lack of cultural competency and clinically appropriate care, insurance coverage, family recognition, and sexual orientation and gender identity data collection. Nurses play a major role in providing affirming and competent care to LGBT cancer patients. Using correct names and pronouns with transgender patients, and collecting sexual orientation and gender identity data can send an affirming message to LGBT patients, as well as inform decision support and preventive screenings, and improve treatment outcomes.

The Personal Experience of LGBT Patients with Cancer.

To capture the perspectives from lesbian, gay, bisexual and transgender (LGBT) individuals diagnosed treated for cancer. Four LGBT individuals diagnosed and treated for cancer. Care for the LGBT patient is based on sensitivity and awareness to LGBT issues and concerns. Nurses caring for the LGBT cancer patient provide that care in a context of awareness and sensitivity. The nurse's approach to LGBT patient and family care is based on open communication, establishing trusting relationships and honoring the patient's preferences. Excellent oncology nursing care for LGBT patients is excellent oncology nursing care.

Scrambling for access: availability, accessibility, acceptability and quality of healthcare for lesbian, gay, bisexual and transgender people in South Africa

BackgroundSexual orientation and gender identity are social determinants of health for people identifying as lesbian, gay, bisexual and transgender (LGBT), and health disparities among sexual and gender minority populations are increasingly well understood. Although the South African constitution guarantees sexual and gender minority people the right to non-discrimination and the right to access to healthcare, homo- and transphobia in society abound. Little is known about LGBT people’s healthcare experiences in South Africa, but anecdotal evidence suggests significant barriers to accessing care. Using the framework of the UN International Covenant on Economic, Social and Cultural Rights General Comment 14, this study analyses the experiences of LGBT health service users using South African public sector healthcare, including access to HIV counselling, testing and treatment.MethodsA qualitative study comprised of 16 semi-structured interviews and two focus group discussions with LGBT health service users, and 14 individual interviews with representatives of LGBT organisations. Data were thematically analysed within the framework of the UN International Covenant on Economic, Social and Cultural Rights General Comment 14, focusing on availability, accessibility, acceptability and quality of care.ResultsAll interviewees reported experiences of discrimination by healthcare providers based on their sexual orientation and/or gender identity. Participants recounted violations of all four elements of the UN General Comment 14: 1) Availability: Lack of public health facilities and services, both for general and LGBT-specific concerns; 2) Accessibility: Healthcare providers' refusal to provide care to LGBT patients; 3) Acceptability: Articulation of moral judgment and disapproval of LGBT patients’ identity, and forced subjection of patients to religious practices; 4) Quality: Lack of knowledge about LGBT identities and health needs, leading to poor-quality care. Participants had delayed or avoided seeking healthcare in the past, and none had sought out accountability or complaint mechanisms within the health system.ConclusionSexual orientation and gender identity are important categories of analysis for health equity, and lead to disparities in all four dimensions of healthcare access as defined by General Comment 14. Discriminatory and prejudicial attitudes by healthcare providers, combined with a lack of competency and knowledge are key reasons for these disparities in South Africa.

Implementation of teaching on LGBT healthcare.

Lesbian, gay, bisexual and transgender (LGBT) patients represent an important proportion of the population. Despite the health inequalities and barriers to health care noted within this group, there is little evidence of LGBT-focused education within medicine, dentistry or nursing. We introduced and evaluated the effect of a half-day teaching session focused on LGBT health care, delivered to year-2 students. Initial informal discussion with year-2 and year-3 students suggested that the awareness of health inequalities other than sexual health was limited, and that students had little awareness of other issues such as gender dysphoria and heterosexism. We therefore targeted these areas when developing the material. There is little evidence of LGBT-focused education within medicine, dentistry or nursing INNOVATION: The session was divided into two sections: a lecture and a workshop. The lecture provided an introduction to issues around legislation, transgender health and health inequalities, whereas the workshops involved a role-play focused on gender dysphoria, followed by small group discussions on topics such as heterosexism and sexual identity. Volunteer peer facilitators, some of whom identified as LGBT, undertook a 2-hour training session to ensure that they were comfortable with both the material and the group facilitation. Students completed a short questionnaire before and after the session. Feedback was gathered from 350 students between 2012 and 2015. Sixty-ninepercent of students rated their competency level higher after the workshop, suggesting that they felt better prepared to consult with LGBT patients. Written comments suggested that the sessions are useful for students in terms of improving awareness of health inequalities and enabling consultation skills practice in an informal environment.

Health-care disparities stemming from sexual orientation of Italian patients with Multiple Sclerosis: A cross-sectional web-based study

Lesbian, gay, bisexual and transgender (LGBT) patients might experience unique difficulties and barriers to treatment of chronic diseases related to their sexual orientation. Thus, we investigated concerns experienced by LGBT patients with multiple sclerosis (MS). We conducted a web-based survey using a multi-choice questionnaire published in an Italian social-network (www.smsocialnetwork.com) for MS patients. The survey investigated: socio-demographic factors, lifestyle habits, MS-related health status and LGBT specific issues (e.g. friendliness to their sexual orientation and eventual homophobic behaviors in the MS Center). Among MS patients willing to use psychological services, LGBT patients were associated with a smaller number of psychological consultations, compared to heterosexuals (Coeff.=−0.449; p<0.001; 95%CI=−0.682 to −0.217). LGBT patients were more likely to change MS Center, compared to heterosexuals (OR=2.064; p=0.046; 95%CI=1.011–4.212). The number of MS Center changes was associated with MS Center friendliness (p=0.037; rho=−0.229) and with the occurrence of homophobic behaviors (p=0.036; rho=0.234). LGBT MS patients more frequently changed MS Center and had a reduced use of psychological services, compared to heterosexuals. The attitude towards LGBT MS patients might affect resource utilizations and LGBTs health status.

Advancing health equity for lesbian, gay, bisexual and transgender (LGBT) people through sexual health education and LGBT-affirming health care environments.

Lesbian, gay, bisexual and transgender (LGBT) people face pervasive health disparities and barriers to high-quality care. Adequate LGBT sexual health education for emerging health professionals is currently lacking. Clinical training programs and healthcare organisations are well poised to start addressing these disparities and affirming LGBT patients through curricula designed to cultivate core competencies in LBGT health as well as health care environments that welcome, include and protect LGBT patients, students and staff. Health education programs can emphasise mastery of basic LGBT concepts and terminology, as well as openness towards and acceptance of LGBT people. Core concepts, language and positive attitudes can be instilled alongside clinical skill in delivering inclusive sexual health care, through novel educational strategies and paradigms for clinical implementation. Caring for the health needs of LGBT patients also involves the creation of health care settings that affirm LGBT communities in a manner that is responsive to culturally specific needs, sensitivities and challenges that vary across the globe.

Psychotherapy with Lesbian, Gay, Bisexual and Transgender (LGBT) Patients

Objective: In this workshop we will address common issues in psychotherapy with LGBT patients: how it is to be in the closet, to come out of the closet -coming out, sexual identity and social stigma. Special attention is paid to self-disclosure of the therapist, yes/no or if... and to the subject of transference and countertransference. Colleagues will learn about: –– the difference between sexual orientation and sexual identity –– coping strategies of LGBTs –– dissociation as a psychological mechanism and its function in hiding a homosexual identity –– the perspective of self disclosure of the sexual identity of the therapist Design and Method: After a 15 minute oral presentation about LGBT specific issues in psychotherapy we will, in the next 60 minutes, discuss our clinical practice of working with LGBT patients. For this purpose members of the audience, our colleagues, are invited to present their clinical cases, so called vignettes. Results: Both the oral presentation about gender and sexual diversity as the clinical discussion amongst colleagues attribute to a better understanding of treating our gender- and sexual minority patients Conclusions: Gender and sexual minority patient characteristics and their health issues vary and differ from heterosexual patients. In general, training of health care professionals is not sensitive to the specific health care needs of LGBT patients. This workshop focusses on the clinical management of LGBT patients by discussing our clinical practices.

Board Editorial: LGBT equality and nursing research

This is one of the many important conclusions in the report of a large scale, representative survey of the treatment of lesbian, gay, bisexual and transgender (LGBT) people in health and social care services in Britain. The report ‘Unhealthy Attitudes’, which is mentioned in several contributions to this focus issue of the Journal of Research in Nursing (JRN), demonstrates that despite research showing that sexual orientation has an impact on both physical and mental health, services are not adequately meeting the needs of LGBT people (Somerville, 2015). While many western liberal societies have passed significant equality legislation in recent years, it is still the case that heteronormative assumptions pervade social policy, serious gaps in provider knowledge and understanding remain, and harassment and bullying of LGBT patients and staff are not uncommon. While there is then clearly a way to go in achieving equality for LGBT people in health and social care, it is good to see a growing number of nursing researchers taking on board the need systematically to explore the experiences and health outcomes of diverse communities, and make recommendations for equipping healthcare professionals to challenge prejudice and improve care. The papers in this volume present work from four countries across three continents. In the first paper, Laura Legere and Judith MacDonnell use a qualitative approach to explore the healthcare encounters and support needs of lesbian and bisexual cancer survivors in Ontario, Canada. Although based on a small sample of just seven participants, this in-depth exploratory work provides many important insights that could be usefully extended to a larger scale project. The ways in which the persistence of heteronormative assumptions can also disadvantage gay men is central to the second paper in the issue.

Smoking Cessation Awareness and Utilization Among Lesbian, Gay, Bisexual, and Transgender Adults: An Analysis of the 2009-2010 National Adult Tobacco Survey.

Each year, there are more than 480 000 deaths in the United States attributed to smoking. Lesbian, gay, bisexual and transgender (LGBT) adults are a vulnerable population that smokes at higher rates than heterosexuals. We used data collected from the National Adult Tobacco Survey 2009-2010, a large, nationally representative study using a randomized, national sample of US landline and cellular telephone listings, (N = 118 590). We compared LGBT adults to their heterosexual counterparts with regard to exposure to advertisements promoting smoking cessation, and awareness and use of tobacco treatment services, including quitlines, smoking cessation classes, health professional counseling, nicotine replacement therapy, and medications. Fewer GBT men, compared to heterosexual men, were aware of the quitline. However, LGBT individuals have similar exposure to tobacco cessation advertising, as well as similar awareness of and use of evidence based cessation methods as compared to heterosexual peers. The similarly of awareness and use of cessation support indicates a need for LGBT-specific efforts to reduce smoking disparities. Potential interventions would include: improving awareness of, access to and acceptability of current cessation methods for LGBT patients, developing tailored cessation interventions, and denormalizing smoking in LGBT community spaces.