April 22-24, 2021
Promoting Equity in Health Communication Research
Promoting Equity in Health Communication Research
Abstract: Health Belief Model Variables Predict Tobacco-Related Behavioral Intentions Differently Between LGBTQ and Heterosexual Individuals
Background. Tobacco-related health disparities among the LGBTQ community are growing. About 21% of LGB adults and 36% of transgender adults smoke cigarettes, compared to 15% of heterosexual adults. Nearly 1 in 3 sexual minorities have ever used e-cigarettes, compared to 1 in 5 heterosexual people. As tobacco use has direct adverse health consequences, reducing tobacco-related health disparities among LGBTQ people is critical. Health Belief Model (HBM) is an instrumental theory to design anti-tobacco campaign messages. Messages addressing HBM constructs are more likely to encourage behavioral change. However, less is known whether HBM constructs predict tobacco-related intentions differently among heterosexual and LGBTQ adults. We explored this issue in the context of smoking (study 1) and vaping (study 2).
Method. Participants were a national sample of 1,808 current adult smokers (study 1) and 2,801 adults (study 2), recruited by a market research company. Participants in both studies were randomly assigned either to view an anti-smoking message (study 1) or an e-cigarette risk message (study 2) that were designed to evoke thoughts about HBM constructs. After message exposure, participants reported HBM constructs and quit intentions or intentions to stay away from vaping. Message effects were not a major focus of this study; thus, message conditions were controlled for in both studies.
Results. In study 1, hierarchical regression showed that LGBTQ identity interacted with perceived health threat and perceived barriers to quitting to predict quit intentions. Specifically, perceived health threat positively predicted quit intentions among heterosexual, but not among LGBTQ smokers. Perceived barriers to quitting more strongly negatively predicted quit intentions among LGBTQ than heterosexual smokers. In study 2, LGBTQ identity interacted with perceived health threat and perceived benefits of not vaping to predict intentions to stay away from vaping. Specifically, perceived health threat positively predicted intentions to stay away from vaping only among heterosexual, but not LGBTQ people. Perceived benefits of not vaping more strongly positively predicted intentions among LGBTQ than heterosexual people.
Discussion & Conclusion. Our study demonstrated that HBM constructs predicted tobacco cessation or prevention intentions differently among heterosexual and LGBTQ adults. Perceived benefits and perceived barriers were more important in predicting LGBTQ people’s behavioral intentions. Yet, perceived health threat of tobacco use did not predict intentions among LGBTQ people. LGBTQ people may strongly believe that smoking and vaping are inextricably linked to being sexual and gender minority, and thus they may overlook the risks of tobacco use. The limited availability of LGBTQ friendly social gathering locations may also normalize smokey bar culture amongst this marginalized group. Moreover, LGBTQ people’s decisions to stay away from tobacco products might be determined by other reasons more important to them than risk, such as the belief that tobacco use may compromise HIV/AIDS prognoses and hormone therapy. Many anti-tobacco messages are focused on communicating risks of smoking. Our finding suggested that these messages might not work among LGBTQ people. Anti-tobacco campaign message designers using HBM should consider that different HBM constructs might be differently related to intentions or behaviors among LGBTQ and heterosexual people.
Method. Participants were a national sample of 1,808 current adult smokers (study 1) and 2,801 adults (study 2), recruited by a market research company. Participants in both studies were randomly assigned either to view an anti-smoking message (study 1) or an e-cigarette risk message (study 2) that were designed to evoke thoughts about HBM constructs. After message exposure, participants reported HBM constructs and quit intentions or intentions to stay away from vaping. Message effects were not a major focus of this study; thus, message conditions were controlled for in both studies.
Results. In study 1, hierarchical regression showed that LGBTQ identity interacted with perceived health threat and perceived barriers to quitting to predict quit intentions. Specifically, perceived health threat positively predicted quit intentions among heterosexual, but not among LGBTQ smokers. Perceived barriers to quitting more strongly negatively predicted quit intentions among LGBTQ than heterosexual smokers. In study 2, LGBTQ identity interacted with perceived health threat and perceived benefits of not vaping to predict intentions to stay away from vaping. Specifically, perceived health threat positively predicted intentions to stay away from vaping only among heterosexual, but not LGBTQ people. Perceived benefits of not vaping more strongly positively predicted intentions among LGBTQ than heterosexual people.
Discussion & Conclusion. Our study demonstrated that HBM constructs predicted tobacco cessation or prevention intentions differently among heterosexual and LGBTQ adults. Perceived benefits and perceived barriers were more important in predicting LGBTQ people’s behavioral intentions. Yet, perceived health threat of tobacco use did not predict intentions among LGBTQ people. LGBTQ people may strongly believe that smoking and vaping are inextricably linked to being sexual and gender minority, and thus they may overlook the risks of tobacco use. The limited availability of LGBTQ friendly social gathering locations may also normalize smokey bar culture amongst this marginalized group. Moreover, LGBTQ people’s decisions to stay away from tobacco products might be determined by other reasons more important to them than risk, such as the belief that tobacco use may compromise HIV/AIDS prognoses and hormone therapy. Many anti-tobacco messages are focused on communicating risks of smoking. Our finding suggested that these messages might not work among LGBTQ people. Anti-tobacco campaign message designers using HBM should consider that different HBM constructs might be differently related to intentions or behaviors among LGBTQ and heterosexual people.