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It’s a Bitch to Quit: Interview with Dr. Phoenix Matthews

By: Regina Barry, Howard Brown Health Center Intern

November is Lung Cancer Awareness Month. It’s a time that makes us reflect on our lung health, and at Howard Brown Health Center, we continually strive to improve the health and wellness (including lung health) of the LGBTQ community and beyond. Statistics show that LGBTQ adults are more likely to smoke than their straight counterparts.  We all know that avoiding cigarettes is a healthy decision, and studies have shown that group-oriented programs are more effective at helping smokers quit.  But are these programs more effective for LGBTQ smokers if they are specifically tailored for people who are part of the community?  The research team at Howard Brown Health Center (HBHC) intends to find an answer to this question.  Betsy Rubinstein, the Manager of the Lesbian Community Care Project (LCCP) at HBHC sat down with Dr. Phoenix Matthews to learn more about the study she’s directing on helping LGBTQ folks kick the habit.

Betsy Rubinstein:  What is your background, and what kind of work do you do?
Dr. Phoenix Matthews:  I am a licensed clinical psychologist and Associate Professor at the University of Illinois at Chicago.  My academic appointment is in the College of Nursing.  I also serve as a principal investigator in the Department of Research at Howard Brown Health Center (HBHC).  My role at UIC is a combination of teaching, research, and administrative activities.  However, my passion and the majority of my time is spent engaged in research.  The focus of my research is on the reduction of cancer disparities among underserved populations including racial/ethnic minorities and members of the LGBTQ communities.   Currently, I am working on a large research study that aims to test the benefits of a culturally tailored smoking cessation treatment program that was specifically developed to address the needs of LGBTQ smokers.  The name of the treatment program is Bitch to Quit.

BR:  Tell me about Bitch to Quit, the smoking cessation study at HBHC. What are some of the strategies that the program uses  to help people stop smoking? Who is eligible to participate? What does it cost?
Dr. M:  Bitch to Quit is the name of the culturally tailored smoking cessation treatment program that we are testing.   This research is funded by a grant from the National Institute of Drug Abuse.  The study is a collaboration between UIC, HBHC and the University of Chicago.  The principal investigators of the study are me and Dr. Andrea King from the University of Chicago.  Currently, there are very few studies that include large numbers of LGBTQ smokers or that were specifically developed to help LGBTQ smokers quit.   As a result, we know very little about the smoking cessation needs of LGBTQ smokers – that is, what works best for smokers from our communities.  Without this information we are at a huge disadvantage in helping people quit and ensuring that members of our communities have access to the best possible strategies for helping overcome their psychological and physical addiction to cigarettes.  The purpose of this study is to answer the basic question of whether we can improve smoking quit rates by addressing issues that are unique to LGBTQ smokers in the treatment program.   So, by the end of the study we hope to learn which of two types of treatments are better for helping LGBTQ smokers quit if there are some individuals for which our treatments were more or less successful, and the ways in which we might improve our treatments in the future.   To my knowledge, this study is only the second large scale study of a smoking cessation treatment for LGBTQ smokers to be funded by the National Institute of Health.  Our research team is proud to be partnering with HBHC on this historic project.

Bitch to Quit is a group-based treatment program.  Individuals participate in 6 weekly sessions with other LGBTQ smokers and a trained and culturally competent facilitator.  In addition to the group sessions, participants receive 4 individualized telephone counseling sessions and access to free nicotine replacement in the form of the patch.  The program is based on established methods for helping smokers quit – social support, goal setting, stress reduction, nicotine replacement, knowledge building, and strengthening motivation and belief in one’s ability to quit smoking.   Since this is program is part of a research project, we follow-up with our group participants for 12 months after the completion of their group counseling sessions.   Our ability to stay in touch with our participants for the entire 12 months is critically important for understanding the long-term benefits of our treatment program.

LGBTQ smokers who are over the age of 18 are potentially eligible for our study.  Interested smokers should contact us to learn more about the study and to answer questions about their smoking history and behaviors.   If eligible for the study, participants will be randomized to either the culturally tailored or the non-tailored treatment program.    Both programs include the same key strategies known to help smokers to quit.

The cost of the treatment is absolutely free.   If eligible, participants receive free group and individual counseling, a two month supply of patches, and a small weekly stipend to cover transportation costs to HBHC.  In addition, participants receive payment for completing all follow-up interviews.  These follow-up interviews take place at 3, 6, and 12 months after completion of the treatment sessions.  Again, collecting this follow-up information – it is important to note that we want to stay in touch with participants whether they were able to quit smoking or they continued to smoke – is so very important for understanding how effective our program is in the long run.    If you consider the cost of receiving professional counseling, nicotine replacement, and the stipends, participants will receive nearly $2,000 worth of benefits for participating in the study.  However, we hope the greatest benefit of participating is quitting smoking.

BR: Has the Bitch to Quit program been successful thus far? Have you found that program participants have been able to quit smoking long-term?
Dr. M: The goal of the study is to recruit 400 LGBTQ smokers into the study and to following as many of them as possible for 12 months after the group sessions are over.  We are very early in our study.   It will be about two more years before we will fully understand how effective our program has been.  What I can say is that HBHC has been offering tailored smoking cessation treatments as a part of clinical services for about 10 years.  We recently analyzed the results of these groups and found them to be very helpful to smokers.   Some of these groups were also called Bitch to Quit; we continued using this name for our study because of the community’s familiarity with the name.   Overall, self-reported quit rates for the groups that were offered as part of clinical care at HBHC were about 35-40%.  Keep in mind that less than 5% of smokers are able to quit without any type of help and only about 10% are able to quit using self-help materials.   We anticipate that the quit rates for our program will be improve on what was seen in the non-research groups.

BR:  Why is it important to have a smoking cessation program that is specific to LGBTQ individuals?
Dr. M:  We know that culturally tailoring health promotion treatments to specific populations is helpful.  This is true for members of racial/ethnic groups, for groups of people based on gender, age, etc.   Programs that “speak” to the unique needs of individuals and communities are better received and have better outcomes.   Like other communities, we have beliefs, attitudes, and expectations that are associated with smoking that need to be addressed to overcome some of the barriers to quitting.  In addition, we face unique challenges to quitting such as higher levels of stress, less support, and more tolerance for smoking.  We are more likely to embrace a “live and let live” approach to tobacco use compared to other communities.   Each of these things create unique opportunities and challenges for quitting.  We are testing whether, like other groups, LGBTQ smokers are helped by attending to these cultural issues during smoking cessation treatment.

BR:  What are the rates of smoking in the LGBTQ community? Why are smoking  rates higher in this community?
Dr. M:  A little known fact is some of the highest rates of smoking of any group in our country are found in the LGBTQ community.  The latest figures show that the rates of smoking in the LGBTQ communities are much higher than in straight communities.  So for example, in Illinois about 19% of women currently smoke.   Most studies suggest that rates of smoking among lesbian and bisexual women are between 25-35%.    A main reason for these higher rates is that the LGBTQ communities have been directly targeted by the tobacco industry for years.   The tobacco industry spends millions of dollars each year to advertise in our papers and magazines, to sponsor events such as pride festivals, and to “help” LGBTQ organizations.  To the benefit of the industry, there is very little anti-tobacco advocacy being done by members of our communities.  In many ways, we view the tobacco industry as a “friend.”   Other reasons include higher rates of drinking and more engagement in the bar culture which is strongly associated with smoking.  Of course, stress due to discrimination based on sexual orientation and gender identify are also important factors.

BR:  Any tips that you can share with individuals trying to quit?  
Dr. M:  Quitting smoking, like stopping any form of addictive behavior, is extremely difficult.  That being said, there are a number of things that a smoker can do to improve their likelihood of quitting.  These include using what are called evidence-based treatments.   Evidence-based treatments are those that research has shown to be effective, including counseling that focuses on skill building, using some form of stop smoking medications such as the patch or other approaches, obtaining social support for quitting, working on stress reduction, and persistence.   I can’t say enough about persistence as a key to becoming a non-smoker.  It will take the majority of smokers several attempts before they are able to quit for good.  The majority of the participants who come to our groups have tried to quit before.  We believe that we can help provide the skills and support to help them quit for good or move one huge step closer to that eventual goal.

BR:  Anything else you’d like to share?
Dr. M:  I really encourage members of our communities – smokers and non-smokers – to join together to change our attitudes about tobacco use.   Participate in research aimed at helping smokers quit, insist that the leaders of our community address the high rates of smoking, and resist the efforts by the tobacco industry to make money at the expense of our lives.

For more information on Bitch to Quit call 773-388-8682 or BTQ@howardbrown.org

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