Background
Methods
Design and recruitment
Focus group procedures
Scenarios | Questions asked by facilitator |
---|---|
Group Cessation Counselling | - How do you feel about a group cessation program for people your own age who are LGBTQ, who smoke, and who want to quit smoking? - Can you imagine yourself attending such a program to help you quit smoking? Why or why not? - What are some things that you like about a group program? - What are some things that you don’t like about it? |
Imagine that every week you could meet with other LGBTQ youth and young adults who want to quit smoking. A LGBTQ counsellor would run the meetings in a safe and accepting space. The counsellor would share trusted information on how to quit and stay smoke-free, but would leave time for group members to talk about personal experiences with smoking and quitting. Examples of information that might be shared include isolation, loneliness, body image, lifestyle changes, the need for positive support, stressors like the coming-out process, triggers and self-esteem. These groups could be a way to connect with others your age with similar experiences, and promote LGBTQ people supporting LGBTQ people to overcome smoking. The group would also encourage participants to buddy-up with other members so that during the week, people would be able to support each other to stay smoke-free. The group sessions would be 6–8 weeks and have 8–15 people. | |
Social Marketing Campaigns | - How do you feel about media campaigns that can help with encouraging quitting or not-smoking? - Of the 4 ideas above, which one did you like the most? Why? - Which one did you like the least? Why? - For the one that you liked the most, is there anything that you would change? |
General Population Campaign (A) | |
Rather than a campaign that focuses on the LGBTQ community, maybe it’s time to educate the general population about some of the challenges faced by LGBTQ people. Many LGBTQ people experience homophobia, transphobia, heterosexism and are unfairly treated by society. What about a campaign that shows, in first person, some of these hardships? The advertisements would show how challenges such as family stress, peer rejection, victimization, and social anxiety can lead to smoking. For example, in one scenario a young gay male is sitting with his parents and telling them that he is gay; his parents are clearly upset. Another scenario shows a same sex couple going on a date and hearing derogatory comments being murmured and being stared at. After each scene, the individuals are shown reaching for cigarettes to help them cope. | |
Tobacco Industry Campaign (B) | |
Did you know that tobacco companies zero-in on the LGBTQ community because they think members of the LGBTQ community are an easy target? In fact, one of the biggest tobacco companies created a plan called Project SCUM to manipulate LGBTQ people into buying their cigarettes. Big Tobacco uses manipulative strategies, like sponsoring LGBTQ events and putting glamourized LGBTQ imagery in their advertisements to make it seem like they are allies. The truth is that these tactics are designed to exploit the community. | |
Perks of Not Smoking Campaign (C) | |
What do you think about a campaign that would show the immediate benefits of not smoking, and the freedom non-smokers feel because they’re smoke-free? For example, ads may show LGBTQ individuals being active. There could be ads that show two young men running, or a young woman lifting weights. The slogan might say “I can run fast and free” or “Nothing can stop me.” Other immediate perks of not smoking that might be part of this campaign could be having more money, sex appeal, and smelling good. | |
Awareness and Fact Campaign (D) | |
Did you know that for every straight non-trans smoker there are at least 3 LGBTQ smokers and smoking-related illness and death is also much higher for LGBTQ people? Not many people do. What do you think of a campaign that would raise awareness about smoking in the LGBTQ community? This campaign may also feature ads that talk about the challenges that LGBTQ persons have overcome, including smoking. For example, an ad may say: “I overcame the victimization; and the coming out process; I’m not going to let tobacco take me down.” | |
Mobile Phone App with Social Media | - How do you feel about a smartphone app and social media campaign for people your own age that are also LGBTQ, who smoke, and who want to quit smoking? - If a smoke-free app was customized to LGBTQ youth and young adults would you use it? Why or why not? - What are some things that you like about a smartphone app and social media program? - What are some things that you don’t like about it? |
Do you own a smartphone? Ever play Candy Crush or use Instagram? What if there was an app that could help you quit smoking designed specifically for LGBTQ youth and young adults? For example, this quit smoking app would allow you to create an individualized quit plan where you can set a quit date, it would provide feedback on how you’re doing, record what triggers you to smoke, and give you tips on how to remain smoke-free, as well as links to counselling services. One of the advantages of the app would be access to a peer support network which would connect you to other LGBTQ peers who are also trying to quit or who have already stopped smoking. The app would be part of a bigger social media campaign that would include a webpage, Facebook page, YouTube videos, and Twitter feed with access to more detailed educational resources about smoking and quitting [e.g., nicotine replacement therapy, like gum or the patch]. LGBTQ role models would promote the campaign. |
Data analysis
Results
Participants
CHARACTERISTIC | NUMBER (%) | CHARACTERISTIC | NUMBER (%) |
---|---|---|---|
Age | Have you smoked 100 cigarettes? | ||
16-17 | 18 (8.8) | Yes | 186 (91.2) |
18-29 | 186 (91.2) | No | 16 (7.8) |
Total | 204 (100.0) | Missing | 2 (1.0) |
Mean Age | 23 | Total | 204 (100.0) |
Gender | Ethnicity | ||
Female | 85 (39.0) | Aboriginal | 25 (10.4) |
Male | 58 (26.6) | Black/African/Caribbean | 46 (19.1) |
Trans Female | 8 (3.7) | Central Asian | 1 (0.4) |
Trans Male | 15 (6.9) | East/South East Asian | 16 (6.6) |
Two-Spirit | 9 (4.1) | Latin America | 12 (5.0) |
Gender-Queer | 32 (14.7) | Middle Eastern | 7 (2.9) |
Intersex | 1 (0.5) | South Asian | 11 (4.6) |
Othera | 10 (4.6) | White | 115 (47.7) |
Totalb | 218 (100.0) | Other | 8 (3.3) |
Totalb | 241 (100.0) | ||
Sexual orientation | Education | ||
Lesbian | 27 (12.9) | Some high school (currently enrolled) | 25 (12.3) |
Gay | 54 (25.8) | Some high school (not currently enrolled/not completed) | 21 (10.3) |
Bisexual | 57 (27.4) | Completed high school with diploma | 78 (38.2) |
Queer | 51 (24.5) | College degreed | 35 (17.2) |
Transgendered Heterosexual | 5 (2.4) | University degreed | 40 (19.6) |
Pansexual | 10 (4.8) | Graduate degree (Masters or PhD) | 4 (2.0) |
Otherc | 4 (1.9) | Missing | 1 (0.5) |
Totalb | 208 (100.0) | Total | 204 (100.0) |
How soon after waking do you smoke? | Housing | ||
<5 minutes | 25 (12.3) | Living with parent | 59 (25.2) |
6-30 minutes | 50 (24.5) | Rented or owned | 118 (50.4) |
31-60 minutes | 31 (15.2) | Homeless | 12 (5.1) |
>60 minutes | 64 (31.4) | Social Housing | 17 (7.3) |
I don’t smoke | 17 (8.3) | Couch-Surfing | 25 (10.7) |
Missing | 17 (8.3) | University/College Residence | 3 (1.3) |
Total | 204 (100.0) | Totalb | 234 (100.0) |
Currently smoke? | Years lived in Canada | ||
Daily | 113 (55.4) | 0-1 years | 12 (5.9) |
Occasionally | 58 (28.4) | 2-5 years | 17 (8.3) |
Recent quitter | 30 (14.7) | 6-10 years | 12 (5.9) |
Missing | 3 (1.5) | Over 10 years | 163 (79.9) |
Total | 204 (100.0) | Total | 204 (100.0) |
Intend to quit in the next 30 days | City | ||
Yes | 53 (26.0) | Toronto | 156 (76.5) |
No | 32 (15.7) | Ottawa | 43 (21.1) |
Don’t know | 89 (43.6) | Other | 2 (1.0) |
N/A | 13 (6.4) | Missing | 3 (1.5) |
Missing | 17 (8.3) | Total | 204 (100.0) |
Total | 204 (100.0) |
Key elements of prevention and cessation interventions for LGBTQ+ YYA
Participants also articulated the desire for LGBTQ+ SM campaigns to be tailored to LGBTQ+ audiences and believed that would be a positive attribute:If I was in a group with just trans people, I feel like there would be so many different things to do together and talk about together and support each other. I think it would be a great idea.[Trans group participant]
“I think it would be interesting to be watching television or YouTube and see an ad that directly speaks to me as a member of the LGBTQ community and as someone who currently smokes. I would really relate to it and I think that even the general population seeing some of them would also bring awareness to the fact that it's an issue in the first place.”[Trans group participant]
“ You meet at a place where you already feel comfortable and you're with people who, hopefully, you feel a sense of community or shared identity with.”[Queer group participant]
“Assuming that it’s customised to LGBTQ, that it would incorporate the kind of struggles that...we’ve lived through, it wouldn’t be any ... average … quit smoking kind of app.”[Mixed group participant]
“I think it’s good to have it geared towards the LGBTQ because that would be more incentive to be, like, ‘oh, well, I can connect with other queer youth…or I can connect with a counsellor who is queer-friendly.’”[Bisexual group participant]
“I like the virtual idea just because it seems like something that doesn’t seem like a lot of effort. I find that going somewhere can stress me out more and then I’ll smoke more, but if it [were] virtual I could sit at home and just hang out there. That would be cool.”[Mixed group participant]
“My schedule is so packed that I wouldn’t be able to attend anything. If it was online, maybe.”[Bisexual group participant]
“I don’t think, honestly, that it [GCC] would do anything for me. I think it’s not really geared toward convenience at all. So, when you’re sitting there thinking about trying to have a cigarette, it’s not like two more days and then I can go to this thing and talk about it. It’s happening right now. I want something more readily available and something that can be comfortably used in your home. Something a little more accessible than usual.”[Mixed group participant]
“It’s always available. It’s always in your hand. Everywhere you go you have access to it unlike weekly group meetings. If you’re feeling like you need to smoke and you’re actively trying to quit, you’ve got that resource that you can refer to… give you inspiration or encouragement… instead of your willpower alone. .”[Mixed group participant]
“I feel like there would need to be a website equivalent… [for] people who don’t have access to smartphones but do have access to public libraries. A lot of smokers are LGBTQ and a lot of LGBTQ are in poverty and homeless. The people that you want to access [the program] might not be able to access the program.”[Lesbian group participant]
“I feel that social marketing doesn’t just reach the LGBTQ community, but it reaches everybody … within our generation. We have a lot of access through it and I think that it can touch not only youth but parents and institutions, and all these places where… they need to get this information.”[Mixed group participant].
“The really important thing about this is that it would have to be free. You could not make… an app that you pay for because that would create a really high barrier for a lot of people.”[Queer group participant].
“I love the idea as long as it’s inclusive, which would be cool … Make sure it includes trans folk and people of colour… ”[Mixed group participant]
“If you had real LGBTQ people, not actors but real people, then that would be a lot better. And then you can relate to them and think, that could be me.”[Mixed group participant]
“I don’t want to see young gay males, and… same sex couples. I want to see people who don’t have representation. I want to see a black trans woman… or I want to see something different. People have been desensitized to these images, and I think that the correct way to shift your perspective in order to make that new, and something that people are interested in engaging in, is to change who you’re representing.”[Mixed group participant]
“I like the idea [of] the social media campaign with the web page, Facebook page, YouTube videos, Twitter feed, as long as it was created by LGBTQ youth, I think that has potential.”[Trans group participant]
“I think the idea of having a group is really good because it’s such a social thing, smoking…If it were a group of people that you grew closer with or saw regularly then it would make sense to support each other.”[Mixed group participant]
“I like the idea of a peer support network and some sort of moderated chat room …and I do like getting access to counselling services because it’s so hard to get those resources, maybe there could even be a counsellor linked up in the app.”[Mixed group participant]
“I like the stark reality that’s been portrayed by those commercials that talk about what LGBTQ face because I think that [it] does raise awareness and compassion and maybe people will be kinder [and] maybe they will make someone [feel] better and make them less wanting to reach for a smoke.”[Mixed group participant].
“I like strength; it’s something that’s really important and highlighting our strength as the LGBTQ community because we are warriors. We’ve been through a lot. We fight [things] that cis-hetero people don’t even have to think about and so I think focusing on our strength and showing that we can come together and overcome tobacco, that’s great.”[Mixed group participant].
“It’s [smoking] not something I’d want to talk about, but I can imagine coming to a group where there was something else that we were doing together as a group. I don’t know, a cycling group so you’d talk about cycling, if there was something we were doing together while also quitting smoking I can imagine it being something that I’d be interested in doing.”[Mixed group participant]
“You look at all these good things, look how fast you could run if you wanted, look how much breathing you can do. I would be much more responsive to that and I know that a lot of other people would be as well.”[Mixed group participant]
“I like it being positive, but also showing other activities – not like I can play basketball or anything like that – but that I can focus on having a family now because I’m not putting my child at risk.”[Mixed group participant]
“Another idea is making it a health focus thing because if it’s also encouraging you to go for a run or go to the gym then you are not going to want to smoke because you will be coughing and not being able to breathe, and that is a part of that healthy lifestyle thing so it could be more integrated.”[Mixed group participant]
“I liked the idea about [the app] motivating you… [M]aybe you could do a daily task, like going for a bike ride or going for a walk, and each day it's like ‘day two, why don't you go [for] a 20 minutes walk around the block’.”[Mixed group participant]
“I like C, anything positive I think is a go. So, yes, I think showing what the benefits are of you not smoking and how you would feel if you weren’t a smoker would be more positive than having people with holes in their neck on your cigarette packs.”[Mixed group participant]
“It actually sounds pretty dope to be in a positive space where there’s someone there… who has methods and stuff and having other support and making friends and being in a positive space, that seems pretty chill.”[Youth group participant].
“You can’t just tell someone to quit and then, what are they going to do?... So [giving] alternatives or different things [they can do] and if they’re receptive and they want to quit, then it could help them.”[Mixed group participant]
“I can see this working but you’d have to add options for smoking cessation, like the patch, gum, or nicotine inhalers. Or incorporate harm reduction because you’re either addicted to the nicotine, the hand-to-mouth habit or the social aspect of it. So having avenues to help reduce the harms of those and being able to talk about the things that trigger you to smoke.”[Trans group participant]
“[When people say] quit drinking, or quit smoking, they don’t say how it leaves a hole in your routine. It’s like…when you were asking about the group [counselling], and people were saying it would be good if there were outings or...like, physical activity. There needs to be some kind of routine thing that can replace [smoking].”[Bisexual group participant]
“…it [app] gives you ideas of what’s going to happen once you quit smoking, maybe something to occupy your time when you would normally go out for a smoke. So maybe something that would find local, free things to do or other ways to spend your money or your time.”[Mixed group participant]
“Maybe [social marketing campaigns] were advertising positive ways to cope with your anxiety or your social anxiety whatever you’re coping with.”[Mixed group participant]
“If there was a bunch of games on the app that were there to distract you from smoking, [you could] go play five minutes of a quick game instead of smoking.”[Mixed group participant]
“Having some type of reward for quitting after a month or something, it doesn't have to be monetary, but rewards might help with that mindset of ‘I quit and I'm being rewarded for it,’ like a [one]-month incentive, two-month, whatever interval of time.”[Trans group participant]
“I like… the campaign that tells all the benefits of not smoking, especially the money one. Like, oh, you’ll have 1,000 extra dollars a year by quitting.”[Trans group participant]