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Access, engagement, and tobacco treatment by telephone quitlines among lesbian, gay, bisexual, and transgender adults

Ylioja, Thomas (2018) Access, engagement, and tobacco treatment by telephone quitlines among lesbian, gay, bisexual, and transgender adults. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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Tobacco smoking is the primary cause of early death and disability in U.S. adults, and the prevalence of tobacco use is disproportionate among socially disadvantaged populations, including people who identify as lesbian, gay, bisexual, or transgender (LGBT). Stigma stress associated with an LGBT identity is theorized to underlie this disparity, and may present barriers to tobacco use treatment. Evidence-based tobacco treatment includes telephonic cessation counseling by quitlines, however this mode of treatment has not been systematically evaluated for LGBT populations with regards to access, engagement, and treatment outcomes. In this study, access to quitlines was investigated as 1) differences in rates of quitline referrals between cisgender heterosexual (CH) and LGBT hospitalized patients, 2) willingness to accept a referral among patients attending an LGBT-tailored primary care clinic, and 3) calls to the quitline by LGBT identified adults during mass media campaigns. Quitline engagement in counseling calls and nicotine replacement, and 30-day self-reported cessation treatment outcomes seven months after intake was compared between CH and LGBT callers, using propensity score matching to estimate the average treatment effects.

Nearly one-third of LGBT inpatients were referred to the quitline by a tobacco treatment specialist, a higher rate compared to CH but not statistically significant, and 40% of patients in the LGBT-tailored clinic would accept a quitline referral at the time of their visit. Mass media campaigns were effective at proportionally increasing quitline intakes with LGBT callers from the pre-campaign to the campaign duration over six campaigns. LGBT females were significantly less engaged in treatment than CH, and had a trend (p = .081) towards lower cessation rates. There were no differences in engagement or cessation outcomes between LGBT and CH males.

The research conducted for this study was limited by convenience sampling methodology, social desirability bias, reliance on self-report measures of identity and cessation, as well as modeling outcomes with observational data. Implications for social work practice and tobacco control efforts are discussed within the context of these research findings. Future research should examine factors associated with successful treatment for LGBT quitline callers, with special emphasis on females.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Ylioja, Thomasthy5@pitt.eduthy5
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairNewhill, Christina
Committee MemberShook, Jeff
Committee MemberCochran, Gerald
Committee MemberTindle, Hilary
Date: 26 June 2018
Date Type: Publication
Defense Date: 12 June 2018
Approval Date: 26 June 2018
Submission Date: 26 June 2018
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 151
Institution: University of Pittsburgh
Schools and Programs: School of Social Work > Social Work
Degree: PhD - Doctor of Philosophy
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: smoking cessation; lesbian, gay, bisexual; telephone quitlines; tobacco; stigma; minority stress
Date Deposited: 26 Jun 2018 13:33
Last Modified: 26 Jun 2018 13:33


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