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Youth-initiated tobacco harm reduction? A qualitative study of sexual and gender minorities

Institution: Scientific Analysis Corporation
Investigator(s): Tamar Antin,
Award Cycle: 2019 (Cycle 30) Grant #: T30IR0890 Award: $1,070,979
Subject Area: Tobacco-Use Prevention and Cessation
Award Type: High Impact Research Project Award

Initial Award Abstract
Though comprehensive tobacco control efforts have been successful in reducing tobacco use in the California general population, nicotine and tobacco (NT) use remains concentrated among sexual and gender minorities (SGM), and within SGM groups, young adults may have the highest smoking prevalence. Therefore, understanding how to most effectively reduce the risk of tobacco-related disease for SGM young adults is crucial, and tobacco harm reduction (THR) approaches may serve as an important step for ultimately achieving a nicotine- and tobacco-free future for sexual and gender minorities. THR approaches emphasize the substitution of less harmful forms of nicotine (e.g. e-cigarettes) for more harmful combustible tobacco products (e.g. cigarettes) for smokers who are unable or unwilling to quit. THR is hotly debated in tobacco control and, as such, remains at the margins. Yet, as the public health community remains embroiled in heated debates about THR, some research suggests that young smokers are nevertheless engaging in a youth-initiated practice of THR to reduce their risks associated with combustible tobacco products by integrating e-cigarettes into their nicotine and tobacco use pathways and patterns. The extent to which this practice has been adopted by young SGM smokers remains unknown. This proposed 36-month qualitative study will investigate SGM young adults nicotine and tobacco use pathways and patterns to consider the extent to which THR is practiced by SGM young adults. In in-depth qualitative interviews with 100 SGM young adult smokers and former smokers, we will examine the following aims: (1) Describe whether and how SGM young adults demonstrate pathways and patterns of nicotine and tobacco use that are illustrative of tobacco harm reduction, (2) Examine whether SGM young adults describe the practice of tobacco harm reduction as a way to minimize the tension between the challenges of their everyday lives and their awareness of smoking-related harms, and (3) Develop a theory of practice of tobacco harm reduction to inform prevention and treatment interventions responsive to the unique needs of SGM young adults and grounded in their experiences.