Background : Mainly because of gender minority stress, many trans and gender non-binary (TGNB) people use substances but little is known about psychosocial correlates of their tobacco use. The study aimed to describe correlates of cigarette smoking among TGNB in the San Francisco Bay area.
Methods : A total of 118 participants (18 years and over; self-identified transwoman, transman, or non-binary person) were recruited based on stratified sampling and completed a survey questionnaire that included questions about drug and tobacco use, hormone use (prescribed/non-prescribed hormone use), and psychosocial factors (e.g., self-esteem, depression, trauma, and transphobia).
Results : Participants’ characteristics were: mean age of 37 years (SD=12.2); 65% transwoman, 23% transman, and 13% non-binary; 30% African American, 8% Latina/o, 13% API, 30% Caucasian, 2% Native American, 19% multiracial; 64% single and 8% married/domestic partner. Half of the participants were currently using tobacco products, among them 89% smoked cigarettes, 24% e-cigarettes, and 27% other tobacco products, and smoked 9 cigarettes a day, on average. The participants started smoking at 16.8 years old, on average. Current smokers showed higher levels of transphobia than non-smokers (p < .05). More than half (60 %) of the participants were depressed based on CES-D scores and those who showed higher levels of depression were more likely to show symptoms of trauma and lower levels of self-esteem (p < .01). The participants who were living with HIV were more likely to currently smoke cigarettes (70%) than HIV-negative participants (30%) (p < .05). The prevalence of smoking was higher among the participants who had used non-prescribed hormones (62%) than those who had not (42%) (p < .05).
Conclusions : Smoking was associated with transphobia but not with depression, trauma, and self-esteem. Transphobia needs to be addressed in cessation and prevention programs for smoking through individual and group counseling programs, as well as support groups. The high prevalence of depression and symptoms of trauma among TGNC populations must be addressed by strengthening self-esteem. In addition, future intervention programs must focus on specific risk groups, such as those who are living with HIV or using non-prescribed hormones.