Intention to quit smoking among lesbian, gay, bisexual, and transgender smokers

Jack E Burkhalter, Barbara Warren, Elyse Shuk, Louis Primavera, Jamie S Ostroff, Jack E Burkhalter, Barbara Warren, Elyse Shuk, Louis Primavera, Jamie S Ostroff

Abstract

Introduction: Smoking is highly prevalent among lesbian, gay men, bisexual, and transgender (LGBT) persons and contributes to health disparities. Guided by the theory of planned behavior (TPB), we identified beliefs related to attitudes, perceived behavioral control, and subjective norms, as well as LGBT-specific variables, to explain variance in intention to quit smoking in the next 6 months in LGBT smokers.

Methods: Individual interviews (n = 19) identified beliefs about quitting smoking and LGBT-salient variables and aided in survey development. Surveys were sent to a random sample from an LGBT community center's mailing list and center attendees, with a 25.4% response rate. Bivariate and multivariate analyses were conducted with the final sample of 101 smokers.

Results: No sociodemographic or LGBT-specific variables beyond the TPB constructs were related to intention to quit smoking. A multivariate TPB model explained 33.9% of the variance in quitting intention. More positive attitudes and specific beliefs that cessation would make smokers feel more like their ideal selves and improve health and longevity were related to greater intention to quit (p values < .05). Subjective norm and perceived behavioral control were marginally significant, with perceived approval of partners and others and beliefs that life goal achievement would make it easier to quit positively related to intention. Depression and stress levels were high.

Discussion: This is among the first studies to examine theoretically grounded variables related to intention to quit smoking in LGBT smokers. We identified specific behavioral, normative, and control beliefs that can serve as intervention targets to reduce smoking in the LGBT community.

Figures

Figure 1.
Figure 1.
Theory of planned behavior.

References

    1. Ajzen I. From intentions to actions: A theory of planned behavior. In: Kuhl J, Beckmann J, editors. Action-control: From cognition to behavior. Heidelberg, Germany: Springer; 1985. pp. 11–39.
    1. Ajzen I. Attitudes, personality, and behavior. Chicago: Dorsey Press; 1988.
    1. Ajzen I. The theory of planned behavior. Organizational Behavior and Human Decision Processes. 1991;50:179–211.
    1. Ajzen I. Perceived behavioral control, self-efficacy, locus of control, and the theory of planned behavior. Journal of Applied Social Psychology. 2002;32:665–683.
    1. Ajzen I. Behavioral interventions based on the theory of planned behavior. 2008. Retrieved 15 May 2008, from .
    1. Anda RF, Williamson DF, Escobedo LG, Mast EE, Giovino GA, Remington PL. Depression and the dynamics of smoking. A national perspective. Journal of the American Medical Association. 1990;264:1541–1545.
    1. Armitage CJ. Efficacy of a brief worksite intervention to reduce smoking: The roles of behavioral and implementation intentions. Journal of Occupational Health Psychology. 2007;12:376–390.
    1. Armitage CJ, Conner M. Efficacy of the theory of planned behaviour: A meta-analytic review. British Journal of Social Psychology. 2001;40(Pt. 4):471–499.
    1. Behavioral Risk Factor Surveillance System. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Behavioral Risk Factor Surveillance System. 2004. Retrieved 19 July 2009, from .
    1. Bennet P, Clatworthy J. Smoking cessation during pregnancy: Testing a psycho-biological model. Psychology, Health & Medicine. 1999;4:319–327.
    1. Borland R, Owen N, Hill D, Schofield P. Predicting attempts and sustained cessation of smoking after the introduction of workplace smoking bans. Health Psychology. 1991;10:336–342.
    1. Bradford J, Barrett K, Honnold J. The 2000 census and same-sex households: A user’s guide. New York: The National Gay and lesbian Task Force Policy Institute, the Survey and Evaluation Research Laboratory, and The Fenway Institute; 2002. Retrieved 8 September 2009, from .
    1. Burgard SA, Cochran SD, Mays VM. Alcohol and tobacco use patterns among heterosexually and homosexually experienced California women. Drug and Alcohol Dependence. 2005;77:61–70.
    1. Burkhalter JE, Shuk E, Warren B, Rowland K, Ostroff JS. Intention to quit smoking among lesbian, gay, bisexual and transgender smokers. Prague, Czech Republic: 2005, March. Paper presented at the Society for Research on Nicotine and Tobacco.
    1. Burkhalter JE, Springer CM, Chhabra R, Ostroff JS, Rapkin BD. Tobacco use and readiness to quit smoking in low-income HIV-infected persons. Nicotine & Tobacco Research. 2005;7:511–522.
    1. Centers for Disease Control and Prevention. Cigarette smoking in 99 metropolitan areas–United States, 2000. MMWR Morbidity and Mortality Weekly Report. 2001;50:1107–1113.
    1. Centers for Disease Control and Prevention. HIV/AIDS Surveillance Report, 2005. Vol. 17. Atlanta, GA: U.S. Department of Health and Human Services; 2007. pp. 1–46. Rev. ed. Retrieved 28 June 2007, from .
    1. Clements-Nolle K, Marx R, Guzman R, Katz M. HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: Implications for public health intervention. American Journal of Public Health. 2001;91:915–921.
    1. Cochran SD, Mays VM, Sullivan JG. Prevalence of mental disorders, psychological distress, and mental health services use among lesbian, gay, and bisexual adults in the United States. Journal of Consulting and Clinical Psychology. 2003;71:53–61.
    1. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. Journal of Health and Social Behavior. 1983;24:385–396.
    1. Collins RL, Kanouse DE, Gifford AL, Senterfitt JW, Schuster MA, McCaffrey DF, et al. Changes in health-promoting behavior following diagnosis with HIV: Prevalence and correlates in a national probability sample. Health Psychology. 2001;20:351–360.
    1. Comstock GW, Helsing KJ. Symptoms of depression in two communities. Psychological Medicine. 1976;6:551–563.
    1. Curry SJ, Grothaus L, McBride C. Reasons for quitting: Intrinsic and extrinsic motivation for smoking cessation in a population-based sample of smokers. Addictive Behaviors. 1997;22:727–739.
    1. Diefenbach MA, Weinstein ND, O'Reilly J. Scales for assessing perceptions of health hazard susceptibility. Health Education Research. 1993;8:181–192.
    1. Droomers M, Schrijvers CT, Mackenbach JP. Why do lower educated people continue smoking? Explanations from the longitudinal GLOBE study. Health Psychology. 2002;21:263–272.
    1. Frable DE, Wortman C, Joseph J. Predicting self-esteem, well-being, and distress in a cohort of gay men: The importance of cultural stigma, personal visibility, community networks, and positive identity. Journal of Personality. 1997;65:599–624.
    1. Francis JJ, Eccles MP, Johnston M, Walker A, Grimshaw J, Foy R, et al. Constructing questionnaires based on the theory of planned behaviour: A manual for health services researchers. 2004. Retrieved 21 December 2007, from .
    1. Godin G, Valois P, Lepage L, Desharnais R. Predictors of smoking behaviour: An application of Ajzen's theory of planned behaviour. British Journal of Addiction. 1992;87:1335–1343.
    1. Greenwood GL, Paul JP, Pollack LM, Binson D, Catania JA, Chang J, et al. Tobacco use and cessation among a household-based sample of US urban men who have sex with men. American Journal of Public Health. 2005;95:145–151.
    1. Gritz ER, Vidrine DJ, Lazev AB, Amick BC, III, Arduino RC. Smoking behavior in a low-income multiethnic HIV/AIDS population. Nicotine & Tobacco Research. 2004;6:71–77.
    1. Gruskin EP, Greenwood GL, Matevia M, Pollack LM, Bye LL. Disparities in smoking between the lesbian, gay, and bisexual population and the general population in California. American Journal of Public Health. 2007;97:1496–1502.
    1. Hanson MJ. The theory of planned behavior applied to cigarette smoking in African-American, Puerto Rican, and non-Hispanic white teenage females. Nursing Research. 1997;46:155–162.
    1. Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO. The Fagerstrom Test for Nicotine Dependence: A revision of the Fagerstrom Tolerance Questionnaire. British Journal of Addiction. 1991;86:1119–1127.
    1. Herek GM, Cogan JC, Gillis JR. Washington, DC: American Psychological Association; 2000. Psychological well-being and commitment to lesbian, gay, and bisexual identities. Paper presented in G. M. Herek (chair), Identity, community, and well-being among lesbians, gay men, and bisexuals.
    1. Hu SC, Lanese RR. The applicability of the theory of planned behavior to the intention to quit smoking across workplaces in southern Taiwan. Addictive Behaviors. 1998;23:225–237.
    1. Hyland A, Borland R, Li Q, Yong HH, McNeill A, Fong GT, et al. Individual-level predictors of cessation behaviours among participants in the International Tobacco Control (ITC) Four Country Survey. Tobacco Control. 2006;15(Suppl. 3):iii83–iii94.
    1. Johnston DW, Johnston M, Pollard B, Kinmonth AL, Mant D. Motivation is not enough: Prediction of risk behavior following diagnosis of coronary heart disease from the theory of planned behavior. Health Psychology. 2004;23:533–538.
    1. Jorm AF, Rodgers B, Jacomb PA, Christensen H, Henderson S, Korten AE. Smoking and mental health: Results from a community survey. Medical Journal of Australia. 1999;170:74–77.
    1. Luhtanen R, Crocker J. Self-esteem and intergroup comparisons: Toward a theory of collective self-esteem. In: Suls J, Willis TA, editors. Social comparison: Contemporary theory and research. Hillsdale, NJ: Erlbaum; 1991. pp. 211–234.
    1. Luhtanen R, Crocker J. A collective self-esteem scale: Self-evaluation of one's social identity. Personality and Social Psychology Bulletin. 1992;18:302–318.
    1. Maher RA, Rickwood D. The theory of planned behavior, domain specific self-efficacy and adolescent smoking. Journal of Child & Adolescent Substance Abuse. 1997;6:57–76.
    1. Meyer I. Minority stress and mental health in gay men. In: Garnets L Di, Kimmel D., editors. Psychological perspectives on lesbian, gay, and bisexual experiences. 2nd ed. New York: Columbia University Press; 2003. pp. 699–731.
    1. National Cancer Institute. Population based smoking cessation: Proceedings of a conference on what works to influence cessation in the general population. Bethesda, MD: National Institutes of Health; 2000. (Vol. Pub. No. 00-4892)
    1. National Cancer Institute. Theory at a glance: A guide for health promotion practice. 2005. (NIH Publication No. 05-3896). Bethesda, MD: Author.
    1. Ng DM, Jeffery RW. Relationships between perceived stress and health behaviors in a sample of working adults. Health Psychology. 2003;22:638–642.
    1. Nguyet NM, Beland F, Otis J. Is the intention to quit smoking influenced by other heart-healthy lifestyle habits in 30 to 60 year old men? Addictive Behaviors. 1998;23:23–30.
    1. Norman P, Conner M, Bell R. The theory of planned behavior and smoking cessation. Health Psychology. 1999;18:89–94.
    1. Pederson LL, Ahluwalia JS, Harris KJ, McGrady GA. Smoking cessation among African Americans: What we know and do not know about interventions and self-quitting. Preventive Medicine. 2000;31:23–38.
    1. Rise J, Kovac V, Kraft P, Moan IS. Predicting the intention to quit smoking and quitting behaviour: Extending the theory of planned behaviour. British Journal of Health Psychology. 2008;13(Pt. 2):291–310.
    1. Stall R, Paul JP, Greenwood G, Pollack LM, Bein E, Crosby GM, et al. Alcohol use, drug use and alcohol-related problems among men who have sex with men: The urban men's health study. Addiction. 2001;96:1589–1601.
    1. Stall RD, Greenwood GL, Acree M, Paul J, Coates TJ. Cigarette smoking among gay and bisexual men. American Journal of Public Health. 1999;89:1875–1878.
    1. Tang H, Greenwood GL, Cowling DW, Lloyd JC, Roeseler AG, Bal DG. Cigarette smoking among lesbians, gays, and bisexuals: How serious a problem? (United States) Cancer Causes Control. 2004;15:797–803.
    1. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and improving health. 2nd ed. Washington, DC: U.S. Government Printing Office; 2000.
    1. U.S. Department of Health and Human Services. A provider's introduction to substance abuse treatment for lesbian, gay, bisexual and transgender individuals. Rockville, MD: Author; 2001. (Publication No. (SMA) 01-3498)
    1. U.S. Department of Health and Human Services. Centers for Disease Control and Prevention National Center for Health Statistics, National Health Interview Survey Questionnaires. 2005. Retrieved May 2008, from .
    1. Vollrath M. Smoking, coping and health behavior among university students. Psychology and Health. 1998;13:431–441.
    1. Weissman M, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ. Assessing depressive symptoms in five psychiatric populations: A validation study. American Journal of Epidemiology. 1977;106:203–214.
    1. West R, McEwen A, Bolling K, Owen L. Smoking cessation and smoking patterns in the general population: A 1-year follow-up. Addiction. 2001;96:891–902.

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