A Scoping Review of Theory-Based Tobacco Control Efforts for Sexual and Gender Minority Populations

Understanding which theories have been effectively applied in tobacco control efforts for sexual and gender minority (SGM) individuals will help identify constructs to incorporate into future tobacco control efforts aimed at reducing SGM tobacco disparities. This scoping review summarizes the use of theory in SGM-focused tobacco control efforts.

We searched four databases using SGM- and tobacco-focused terms in November 2023. Two trained coders independently screened each title and abstract, reviewed the full text, and extracted data about theories used and which tobacco control measures from the World Health Organization Framework Convention on Tobacco Control were included.

The final analytic sample included 86 papers. Of those, 11 (12.9%) discussed price/tax manipulations, 15 (17.7%) discussed secondhand smoke and smoke-free policies, 11 (12.9%) discussed product characteristics (e.g., flavors), 5 (5.9%) discussed product disclosures (e.g., warning labels), 7 (8.1%) discussed packaging, 23 (27.1%) discussed education, communication and public awareness, 15 (17.7%) discussed tobacco advertising and promotion, 49 (57.7%) discussed tobacco prevention/cessation interventions, and 1 discussed Tobacco 21 (1%). Under half (31 articles, 36.0%) explicitly presented theoretical models.

This review found a relative lack of theoretical models applied in tobacco control initiatives for SGM people. Of the 31 studies that did, most used theory to help clarify the etiology and associated factors of tobacco use (e.g., minority stress, increased exposure to marketing) or tailor prevention/cessation interventions focused on SGM individuals. Future studies should be grounded in theory to increase the effectiveness of these activities while preventing potential unintended consequences.

This scoping review aimed to summarize which theoretical models have been implemented in relation to tobacco control measures among SGM individuals. Most theories were integrated in helping explain disparities or tailor interventions. Large-scale tobacco control initiatives may cause unique harm to SGM samples when critical theories are not integrated into their design and implementation.