“I Can’t Make Perfect Choices All the Time”: Perspectives on Tobacco Harm Reduction Among Young Adults Who Identify as Sexual and Gender Minorities

Abstract Introduction Cigarette smoking is among the most harmful ways to consume nicotine and tends to be concentrated among socially marginalized groups of people, including sexual and gender minorities (SGM). Though some approaches to tobacco control in the United States are harm reduction strategies (eg, smoke-free environments), often abstinence is an explicitly stated goal and discussions of tobacco harm reduction (THR) are controversial, particularly for young people. Despite this controversy in the tobacco field, emerging research suggests that THR may be gaining momentum as a “community-led” rather than “public health-led” health practice. To date, little is known about how SGM young adults negotiate their use of tobacco products, particularly in terms of minimizing the harms associated with smoking. Aims and Methods We conducted 100 in-depth interviews with SGM young adults ages 18–25 years living in the San Francisco Bay Area, to better understand participant perceptions and everyday practices related to THR. Results A thematic analysis of interview narratives revealed the ways in which participants relied upon various THR strategies while balancing their well-being within the context of broader socio-structural harms. Participants’ narratives also underscored beliefs about the importance of pragmatic, nonjudgmental, and person-centered approaches to preventing inequities in tobacco-related illnesses. Conclusions Findings represent a significant departure from the mainstream discourse in the U. S. surrounding THR, by revealing how understanding the practice of THR among SGM young adults who use nicotine and tobacco can be instrumental in shaping approaches to tobacco control policy and prevention that may ultimately help to reduce inequities in tobacco-related illnesses. Implications Findings from this study present the perspectives and practices of THR among sexual and gender minority young adults and emphasize the importance of integrating this approach in tobacco control to better achieve tobacco-related equity. Results can be used to better design tobacco prevention, treatment, and policy strategies that are compassionate and responsive to the needs of these important priority populations.