Abstract A028: Implementation of a tobacco-free workplace program in a LGBTQ+ health center: A qualitative analysis

Abstract

Members of LGBTQ+ communities (e.g., lesbian, gay, bisexual, asexual, transgender, non-binary) smoke at elevated rates compared to their cisgender heterosexual counterparts, increasing risk for certain cancers. Thus, LGBTQ+ communities are a priority for tobacco control efforts to reduce tobacco-related disparities. Effective initiatives must address unique social and structural factors influencing tobacco use in LGBTQ+ communities (e.g., identity-based discrimination, sexual minority stress, identity concealment and disclosure, community belonging). Because LGBTQ+ health centers are uniquely positioned to provide culturally responsive care, understanding how to implement tobacco-free workplace programs (TFWPs) in this setting is crucial. This qualitative case study examines factors influencing implementation of a TFWP–including policy, training, and tobacco treatment delivery–within a LGBTQ+ health center located in Texas. Between December 2023–May 2026, six semi-structured individual or group interviews were conducted virtually or in-person with center leadership (n=1), staff (n=12), and clients (n=4) spanning pre-, mid and post-implementation. Rapid qualitative and matrix analysis were used to summarize transcripts by key domains drawn from interview questions and to compare findings across transcripts. Two analysts independently summarized transcripts and met to achieve consensus and develop themes. Five cross-cutting key themes emerged: 1) Ambivalence around addressing tobacco use–participants recognized the need to address tobacco use, yet ambivalence persisted about taking direct action given concerns about honoring client autonomy; 2) Bolster existing services capacity–need for dedicated tobacco treatment specialists as current staff manage multiple roles simultaneously; 3) Supporting provider dissemination of knowledge–to inform and motivate changes in client tobacco use behaviors, supporting providers in disseminating information about tobacco use’s impact on LGBTQ+ communities and specific targeting by tobacco companies; 4) Policy enforcement–longstanding tobacco-free workplace policy successfully enforced with increased awareness among staff of tobacco use harms; 5) Resource allocation–while outreach of tobacco treatment specialists led to successful TFWP adoption in other community centers, this consequently reduced capacity for managing in-house ambivalence. To reduce tobacco-related cancer disparities, findings emphasize the need for cultural adaptation of staff training and resources to expand knowledge and tailored service capacity to support LGBTQ+ clients in managing tobacco use. Further development of existing infrastructure (i.e., hiring dedicated tobacco treatment specialists to understand specific concerns and address ambivalence about treating tobacco use while honoring autonomy) and strengths may contribute to sustained change. These findings may guide tailoring of TFWP implementation in other LGBTQ+ health centers and other related settings. Abigail E. Bergey, Isabel Martinez Leal, Jacob S. Crocker, Kaixuan An, Julie Neisler, Maggie Britton, Mikal Zere, Marcy Zere, Jennifer Cofer, Lorraine R. Reitzel. Implementation of a tobacco-free workplace program in a LGBTQ+ health center: A qualitative analysis [abstract]. In: Proceedings of the 19th AACR Conference on the Science of Cancer Health Disparities; 2026 Oct 18-21; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2026;35(10 Suppl):Abstract nr A028.