Development of a first intervention for tobacco cessation for sexual and gender minority individuals in Romania

Abstract Background Data on tobacco use among SGM in Romania indicate high use rates, yet tailored smoking cessation efforts do not exist. We collected data from SGM individuals in Romania on tobacco use and cessation attitudes, facilitators and barriers to quitting, and intervention components acceptability to inform the first smoking cessation intervention for SGM in Romania, adapted from a U.S.-based intervention with mobile app support. Methods SGM individuals (≥ 18 years old, current smokers) recruited through community outreach in March 2024 completed a brief assessment and participated in a focus group regarding tobacco use, attitudes, norms, risks knowledge, facilitators and barriers to quitting, and intervention acceptability. Results Focus groups were held with 36 participants characterized as 45% cis male, 40% gender-diverse, 15% cis female; 40% gay, 33% bisexual, 10% queer, 8% pansexual; 6% lesbian, 3% heterosexual; M age=27, SD = 7.62. 70% smoked daily; median age of first cigarette was 17. Participants reported smoking up to 2 packs a day, with 50%-98% of people in their circles being smokers. Common reasons for smoking included to alleviate stress and “fit in.” Most did not receive support to quit from their social circles or within healthcare. While smoking was communal, quitting was individual and siloed, suggesting a preference for a group-based intervention, along with robust strategies to replace the function of smoking with adaptive habits. The app was evaluated positively, especially for its daily smoking tracking, reminders for alternative healthy activities, positive achievements, and forum for support. Conclusions Findings provide a solid platform for creating a first smoking cessation intervention for SGM individuals in Romania. Next steps include iterative testing of the mobile app to examine comprehension, usability, and satisfaction with content and functionality, in preparation for a randomized controlled trial testing the intervention’s efficacy.