A Peer Intervention Program to Reduce Smoking Rates Among LGBTQ

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Abstract

Tobacco smoking in South Eastern Sydney Local Health District (SESLHD) produces a high number of deaths and illnesses. At the same time, a specific segment of the population smokes more often than others. That is, young lesbians, gays, bisexuals, and transgender people are at high risk for cancer, respiratory disease, and vascular disease. Thus, the project aims to decrease the number of smokers, further supporting maintaining their health. Accordingly, based on the research of the reasons for smoking and methods of influencing part of society, the project’s expected outcome is creating an adapted plan to reduce smoking.

Introduction

Investigations explain that smoking among peer lesbian, gay, bisexual, transgender, queer (LGBTQ) is higher than the average among the population. The reasons are biological, psychological, social, environmental risk factors. The project aims to create a smoking reduction plan in South Eastern Sydney Local Health District. Thus, the study of physiological and economic circumstances of smoking will create a holistic view of methods of resisting adolescent smoking. Therefore, the presumed results of the project are its introduction into the health care system, which will promote a healthy lifestyle and diminish the level of smoking among LGBTQ people in the SESLHD.

Problem Statement

It is known that there are differences in the vulnerabilities of individuals and groups, in their health beliefs, risks, and wellbeing outcomes. Right across communities, those with higher social status are healthier than those below them (Johns, et al., 2013). Groups that most likely experience inequities in health and wellbeing include: people from low socioeconomic backgrounds, Aboriginal people, disengaged, homeless, and especially LGBTQ.

The reason for that is numerous biological and psychological factors that motivate them to take actions that seem to reduce stress levels, such as smoking (Deacon & Mooney‐Somers, 2017) and (Comfort, 2012). These dissimilarities are unfair and have direct and tangible consequences for the body, so it is required to explore the possibility of reducing differences among specific population groups. That is why the topic of the project is Developing a peer intervention program to reduce smoking rates among LGBTQ people in South Eastern Sydney Local Health District.

Context

The project will be implemented among the LGBTQ community as in addition to everyday life difficulties, it experiences unique stressors. Due to their sexuality, they are daily oppressed, and such social pressure leads to mental and physical health problems (Greenhalgh, et al., 2020). According to recent researches of tobacco prevalence heterosexuals smoke half as much as LGBTQ people. ‘Almost one in four among the minorities smokes in comparison to one in six for heterosexuals’ (Poynten, 2015). They start smoking at an earlier age and with greater intensity. The reason for such indicators is primarily the emotions they feel, such as bad mood, loneliness, irritability. In order to reduce such negative indicators, it is essential to assess all biological and psychological factors that are the leading reason for smoking. Moreover, the project is essential because it aims to offer possible solutions to this problem and improve the level of health among this group of people.

Critical Review of Evidence

A systematic review of World Health Organization articles explains that diseases caused by smoking are one of the most significant state health threats the globe has ever suffered. At the same time, statistics show that specific categories of the population are more likely to smoke for several motives (The World Health Organization, n.d.). Therefore, the project is relevant as LGBTQ community is especially at risk. Australians Institute of Health and Welfare (AIHW’s) Drug Strategy Household Survey (NDSHS) is the national data source that specifically disaggregates by sexual identity and provides comprehensive estimates (Australians institute of health and welfare, n.d.).

Survey results confirm that members of the rainbow communities face higher levels of smoking than their heterogeneous counterparts. Although, surveys from the 2019 NDSHS indicate that daily smoking among people who identify as homosexual or bisexual has steadily declined from 28% in 2010 to 16.0% in 2019. However, people who classify as homosexual or bisexual (16.7%) were still 1.5 times as likely to smoke daily as people who identify as heterosexual (10.8%) (Australians institute of health and welfare, n.d.). Grounds for the discrepancy between heterosexual and LGBT people are complex.

Nevertheless, the Australian National Drug Strategy Household Survey discovered that consumption of alcohol and smoking were experienced at higher rates, and internalized homophobia and responses to the exposure of orientation, unique to LGBTQ people, could be defining factors. It is also important to say that there are available statistics from SWASH (formerly the Sydney Women and Sexual Health survey), the study of LBQ women’s health initiated in 1996 and runs every two years since (Mooney-Somers, et al., 2018).

While it has consistently reported high levels of smoking, this comprehensive dataset has never been systematically analyzed to take measures and increase mental and physical health among the community in the District. This highlights the need for the project, which aims to reduce rates of smoking, increase awareness, access, and acceptability of existing interventions. It additionally concentrates on the factors of smoking for LGBTQ community members, involving minority pressure, contributes responses to separation, and strengthens the community’s ability to preserve those parts which end smoking.

During the project’s development, a research question was stated on reducing the statistics of smokers among the LGBTQ community in the SESLHD. After that, a strategy of exploring for information by keywords was applied, which enabled studying a particular group of society and a specific region (Davies, et al., 2020). The research results were articles that contained reports about the reasons for smoking among LGBTQs and the economic benefits that cigarette sellers received.

Moreover, it was possible to find information about different age categories of the population, which was provided to analyze data about peers. Information retrieval research methods have also offered a wealth of statistical knowledge (Praeger, et al., 2019). However, not many studies have focused on problem-solving methods. Therefore, authoritative sources were used to create the project, based on which approaches were introduced to reduce the number of smokers.

Investigations of smoking problems among LGBTQ people have shown that they subconsciously protect themselves from stress and discrimination. However, the primary motivation for the higher smoking rate among the minority is rejecting their identity, resulting in low self-esteem. Although the study reveals the main reasons, it does not explain how to improve the attitude of minorities in the community but only predicts the reduction of health (Greenhalgh, et al., 2020), (Deacon & Mooney‐Somers, 2017) and (Comfort, 2012). As for smoking rates in other regions, the sample only embraces the central areas of Australia, which does not provide complete information on different regions (Praeger, et al., 2019), (Davies, et al., 2020) and (Kreps, et al., 2014).

The foremost outcomes in the literature concerning the detection of cancer and HIV infection in the LGBT community are that statistically, they are more likely to be infected. However, since sexual identity is not entered in the patient’s medical paper, it is difficult to track in the patient register (Drysdale, et al., 2020) and (Poynten, 2015). Research has also been conducted on reducing smoking among young people (Berger & Mooney-Somers, 2017), (Office on Smoking, 2012) and (Hefler & Chapman, 2015). However, they applied to the United States or the whole of Australia. Therefore, it is not easy to assess the possibility of functioning of the developed project in the SESLHD.

The Solution

The main gap in the way in which the issue is addressed in the literature is the lack of information about the outcomes of this smoking disparity. They include inevitable cancer, heart disease, lung disease, and other burdens that naturally follow higher smoking rates. This drives the lack of tailored intervention for the LGBTQ communities in these health areas (Hefler & Chapman, 2015). There is also practically no research on the interventions specific to tobacco dependence treatment or prevention among LGBTQ populations, and the research literature is inconclusive.

The methodology used in the project is to apply an information approach that allows investigating the level of influence of external factors that create smoking among LGBTQ people. This approach also includes studying the social, economic, psychological, and biological effects of smoking among the community in SESLHD. Surveys and qualitative studies were also included if they were relevant to the study objectives (Kreps, et al., 2014). The statistical data is also analyzed to predict probable solutions to the problem and evaluate their effectiveness.

First of all, it is important to identify the most common causes of smoking among young people for the implementation of the plan. The project proposes to create courses for psychological support of the minority community, where professional psychologists will provide assistance. Concerning the prevention of already acquired diseases, the project intends to introduce available periodic examinations in the health care system (Office on Smoking, 2012). Thus, it will encourage minorities not to hide the acquired disease but to perform efforts for treatment.

The principal condition of the project is the desire among peers to start the fight against the dangerous habit. Therefore, it is possible to place an office with individual doctor consultations and free drugs, such as nicotine tablets and pills. Moreover, the smoking reduction plan proposes to create a sample of people who participated in the project and to assess their health in three months. Thus, it is an opportunity to examine the effectiveness of prevention and treatment. Accordingly, in order to implement the plan, stakeholders need to organize research and coordinate the provision of psychological assistance to minorities (Berger & Mooney-Somers, 2017).

At the same time, it is required to allocate funding for available treatment and encourage specialists to cooperate. The product for solving the problems is a completed application to the global human rights education and training center. That is, the idea of the project is to gather information about the problem and prepare solutions. Thus, applying will be the first step to reduce the reasons for smoking by preparing training programs.

Expected Outcomes

First of all, outcomes include the protection of LGBTQ communities from the dangers of smoking and changing community norms around tobacco use. After implementing the project, it is expected to raise awareness, increase knowledge and improve access to smoking cessation services. Moreover, the new methods and recommendations that will consider the specifics of LGBTQ in Sydney will be developed. Tobacco prevention and smoking cessation measures targeted to specific communities effectively reduce smoking-related health disparities. Some gains have been made in specific venues, but smoking rates are still high, and that is why further work is needed.

Lessons Learned

The effectiveness of the project can be affected by various factors, beginning with its perception among the heterosexual population and the LGBTQ community in SESLHD. However, in order to conduct full-scale health programs to prevent cancer and other diseases, it is essential to accurately assess current statistics. As mentioned earlier, patients’ medical records do not provide information about their sexual orientation (Drysdale, et al., 2020).

Therefore, the lack of initial information about the health of the LGBQ community needs to be addressed through people surveys. Accordingly, it is possible that the examination participants will agree to become the first patients of the program and critically evaluate its effectiveness. Ways to address the limitations of the project can be public initiatives that will inform the citizens about the significance of the problem. At the same time, such a measure will assist to find sponsorship for the practical implementation of the plan.

Conclusion

The report highlights the leading causes of smoking among LGBTQ people in the District. The background information is described, and a deep analysis of information concerning this subject is carried out. Moreover, the disparity in smoking prevalence among LGBTQ young people compared to their non-LGBTQ peers is given, and effective intervention strategies for this population are provided. Specific solutions tailored to the interests of the LGBTQ groups are needed to successfully engage community members in advocating for policy change to reduce the rates of tobacco use and promote long-term health.

References

Australian Institute of health and welfare (n.d.). Web.

Berger, I., & Mooney-Somers, J. (2017). Smoking cessation programs for lesbian, gay, bisexual, transgender, and intersex people: A content-based systematic review. Nicotine & Tobacco Research, 19(12), 1408-1417.

Comfort, J. A. (2012). Understanding the higher rates of smoking among lesbian and bisexual women [Doctoral dissertation, Curtin University]. Curtin University.

Davies, M., Moon, G., & Lewis, N. M. (2020). Trends in smoking prevalence over time and space: A comparison between sexual minority and heterosexual populations. Health & Place, 65, 102421.

Deacon, R. M., & Mooney‐Somers, J. (2017). Smoking prevalence among lesbian, bisexual and queer women in Sydney remains high: analysis of trends and correlates. Drug and alcohol review, 36(4), 546-554.

Drysdale, K., Cama, E., Botfield, J., Bear, B., Cerio, R., & Newman, C. E. (2020). Targeting cancer prevention and screening interventions to LGBTQ communities: A scoping review. Health & Social Care in the Community, 1-16. Web.

Greenhalgh, E.M., Scollo, M.M., & Winstanley, M.H. (2020).Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria.

Hefler, M., & Chapman, S. (2015). Disadvantaged youth and smoking in mature tobacco control contexts: a systematic review and synthesis of qualitative research. Tobacco control, 24(5), 429-435.

Johns, M. M., Pingel, E. S., Youatt, E. J., Soler, J. H., McClelland, S. I., & Bauermeister, J. A. (2013). LGBT community, social network characteristics, and smoking behaviors in young sexual minority women. American Journal of Community Psychology, 52(1-2), 141-154.

Kreps, G. L., Peterkin, A. D., Willes, K., Allen, M., Manning, J., Ross, K., & Moltz, R. (2014). Health Care Disparities and the LGBT Population. Lexington Books.

Mooney-Somers, J., Deacon, R.M, Scott, P., Price, K., & Parkhill, N. (2018). Women in contact with the Sydney LGBTQ communities: Report of the SWASH Lesbian, Bisexual and Queer Women’s Health Survey 2014, 2016, 2018 Sydney.Sydney Health Ethics, University of Sydney.

Poynten, I. (2015). Current Policy and Research on Cancer in LGBT Communities Internationally. In U. Boehmer & R. Elk (Eds.), Cancer and the LGBT Community (pp. 293-311). Springer.

Praeger, R., Roxburgh, A., Passey, M., & Mooney-Somers, J. (2019). The prevalence and factors associated with smoking among lesbian and bisexual women: Analysis of the Australian National Drug Strategy Household Survey. International Journal of Drug Policy, 70, 54-60.

The World Health Organization (n.d.). Web.

United States. Public Health Service. Office of the Surgeon General, National Center for Chronic Disease Prevention, & Health Promotion (US). Office on Smoking. (2012). Preventing tobacco use among youth and young adults: a report of the surgeon general. US Government Printing Office.

Appendix A

Peer Education Program: Smoking Rates in LGBTQ community

To design, plan, facilitate and successfully implement an intervention, a peer education program is required. The program would focus on the sociological and demographic reasons behind the increased smoking rates among the target group. It would furthermore address the risks associated with such rates and the way they overlap with the consequences of marginalization experienced by LGBTQ people in other spheres of life. This knowledge would be further supported by the introduction of appropriate methods of addiction prevention and addiction management to the target demographic.

Since the research problem is focused on the smoking rates among specifically LGBT youth, the impact of the peer influence could be considered even higher than normally for such initiatives. As an overall marginalized community, LGBT people’s predisposition to display greater levels of trust to those who also belong to this group is even higher. Despite the fact that young people who identify as trans, queer, or a sexual minority have much higher rates of smoking than young people who identify as cisgender with a heterosexual orientation, very few treatments have been created and assessed for the LGBTQ+ population.

The main goal of this study was to get LGBTQ+ young people involved in identifying essential components of tobacco use prevention and cessation treatments for their group. This paper examines the components of tobacco prevention and cessation interventions that may influence tobacco uptake, use, and, ultimately, support behavior change in LGBTQ+.

When it comes to conveying health promotion messages, peer-led approaches have a lot to offer. According to available studies, there is a link between peer influence and young smoking habits. There are also opportunities for the peer supporter to develop as a person (i.e. increased knowledge, communication skills, confidence and self-esteem). Peer educators can also engage in a less formal manner than teacher-led, classroom-based programs because they are generally of the same age. Peer-led health promotion is also more acceptable and trustworthy among young people, according to evidence.

The program utilizes the supportive and transformational elements of the active social network. The inadequate assessment of social network interventions’ application to health behavior modification interventions has been criticized, implying that little is known about their health-promoting qualities. The program is an example of a network intervention based on champions that has been extensively assessed and is based on diffusion theory.

Opinion leaders (‘peer supporters’) are discovered in this product using a process known as ‘peer nomination,’ in which the whole school year fills out a questionnaire to identify important students who are then invited to become peer supporters. Peer supporters are taught how to discuss the dangers of smoking and the advantages of quitting in ordinary discussions with their peers, using language and concepts that they believe would resonate with the individuals they are speaking with. The curriculum consists of seven sessions provided by professional trainers over a 14-week period.

In terms of the peer education classification, the program is to follow the combination of the outreach model and the formal model. The outreach model relies on reaching out to the target demographic in places and settings where they are the most comfortable. The formal model involves structured arrangements, such as a tutor or a selected peer supporter working with a group on a timetable basis. The combinatory approach could help in reducing the risks of the program operating as a formal and restrictive initiative, while at the same time keeping it focused and effective.

A peer education program, whether administered or staffed by professionals or volunteers, requires a framework to function properly. A person or group should be in charge of coordinating and administering the program, as well as overseeing or doing the following tasks:

Enlisting the help of peer educators and students;
Creating, improving, and delivering tutoring programs Matching students with suitable peer educators or programs;
Scheduling;
Managing peer educators;
Managing conflicts amongst peer educators, students, supervisors, and the program as a whole;
Evaluation and continuous improvement of the recordkeeping program.

A communication system is also required for the program, so that peer educators and learners can be readily notified about special events, cancellations, and scheduling, among other things. It requires a spokesman who can be trusted to speak on behalf of the program, often without the benefit of consulting others (for example, in a crisis). It also requires someone to contact and report to donors if it is financed by any official sources — public money, foundations, etc. The existence, or lack thereof, of a coordinating structure can have a significant impact on the success or failure of a peer education program.

Program Structure

Orientation and Training

Orientation, which helps individuals understand the program and its challenges, can be seen as the start of the training, but it can also be used as an introduction to assist potential peer educators determine whether or not they want to participate. An orientation might take place before the start of training, or even before a training is scheduled, to enable individuals to determine whether or not they want to be tutors. The following are some topics you might wish to discuss during orientation:

Peer education training is designed to educate peer educators to work effectively with students. It should be lengthy enough, both in terms of total training hours and total training time, to provide educators with not just the background and expertise they require, but also time to process and assimilate the information and concepts given. A training group’s size should be small enough for everyone to get individual attention, yet large enough for good discussion and role-playing possibilities. A group of eight to 10 people is typically good, with 15 being roughly the maximum size.

Supervision and Support

Continuous monitoring, like training, is essential for a successful peer education program. Each peer educator within the program will be assigned with a more experienced supervisor: the coordinator, a paid or volunteer staff member, a more experienced peer educator, or if appropriate and in a mutual arrangement, another peer educator with similar experience. Peer educators require continual assistance in addition to monitoring. The supervisor can give some of this in the form of guidance, encouragement, problem-solving assistance, and so on. Peer educators should, in the ideal world, have regular chances to meet with one another, with or without a supervisor, to address shared difficulties and concerns. The sense of shared experience and peer support, as well as the knowledge that others are having similar problems at work, may be a huge help to everyone involved.

Program Evaluation

A peer education program, like any other, must be able to analyze what it is doing, identify how effectively it is functioning, improve or rework those elements of the program that aren’t working, and adapt to meet the changing needs of the target audience. In order to analyze itself, a program must decide what to look at – what information it will collect, how it will interpret it once it has it – and how to look at it – how it will obtain that information. The most appropriate scenario for this research subject is focused on the peer satisfaction evaluation with the workshops and the discussion sessions provided.

Summary and Conclusion

Overall, the efficacy of smoking cessation treatments was higher among LGBT individuals than in the overall population. In programs for stopping drugs other than cigarettes, LGBT individuals frequently do as well as or better than non-LGBT ones. This observation is important as it occurs in spite of the predisposition to addiction mentioned in the main body of the project. This could be because people looking for population-specific programs have put more thought into the smoking cessation process than people who are recruited into general population interventions, or it could be because participants feel an automatic sense of commonality, reinforcement of existing social circles, direct applicability to one’s life, or even that people looking for population-specific programs have put more thought into the smoking cessation process than people who are recruited into general population interventions.

The key elements of a well-designed program may operate as KPIs and are as follows:

Involvement of the community in the program’s conception and implementation.
A strong sense of purpose and knowledge of the target demographic.
A coordinating framework that ensures that the program runs smoothly.
Recruitment of peer educators and students that takes into consideration their cultures, needs, and concerns.
A well-planned peer education training procedure that matches the program’s philosophy, methodology, and objectives.
Peer educators have access to ongoing supervision, support, and in-service training.
Volunteer and learner personnel policies that spell out expectations, rights, and responsibilities.
A structure for program assessment and improvement, as well as a regular timetable.

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