LGBTQ2S+ individuals use tobacco and nicotine products at significantly higher rates than straight and cisgender people, research shows. Reasons can include stress and other health problems brought on by systemic and social prejudice, along with barriers to support for breaking the habit.
UC Merced and CalPride Valle Central have partnered with the University of Oklahoma Health Sciences and advocates from across the nation to develop a program to support efforts by LGBTQ2S+ people to quit smoking.
(The “2S” added to the commonly used adjective for gay, lesbian and transgender individuals refers to Indigenous people who embody two spirits, male and female.)
The Empowering our Community and Health Outcomes (ECHO) project is a community-academic partnership aimed at developing a 12-week intervention that combines proven nicotine-cessation support with community-based volunteer activities, all designed to empower participants to buffer stigmas that drive nicotine dependency. ECHO is supported by a $600,000 grant from the National Institute on Drug Abuse (NIDA).
While the San Joaquin Valley and the state of Oklahoma may appear dissimilar, they share key challenges and barriers that shape health outcomes for structurally marginalized communities.
The Valley is generally a more conservative region compared to coastal California, with pockets of liberal and progressive influence. Voters lean toward Republican candidates in many local and national elections. There are recent examples of Valley school boards and municipal leaders opposing inclusive policies for LGBTQAS+ individuals.
Oklahoma has a documented record of discrimination against LGBTQAS+ individuals, including numerous state government bills and a law that bans gender-affirming medical care.
These high-stigma environments play a powerful role in creating elevated rates of nicotine use. About 1 in 6 LGBTQ2S+ people in the United States smoke cigarettes, compared to 1 in 9 heterosexual adults, according to the Centers for Disease Control. In a 2024 interview with NBC News, Kristy Marynak, a CDC adviser, called tobacco a “singular health threat” to LGBTQ2S+ communities.
Also, a recent study by The Truth Initiative, a nonprofit public health organization, found that LGBTQ2S+ youth use cigarettes or e-cigarettes at higher rates than their heterosexual peers. E-cigarettes can deliver nicotine more efficiently than cigarettes, making them potentially more addictive.
People who are minoritized because of their sexual orientation or gender can live in what we call high-stigma environments that make it especially hard to quit smoking.
The NIDA award for ECHO supports a three-year project that began in December 2024. Public health Professor Arturo Durazo leads UC Merced’s part of the initiative. Durazo, director of the university's Nicotine and Cannabis Policy Center, part of the Health Sciences Research Institute, emphasized the critical need for inclusive and affirming interventions.
“People who are minoritized because of their sexual orientation or gender can live in what we call high-stigma environments that make it especially hard to quit smoking,” said Durazo, who received his doctorate in health and medical psychology at UC Merced. “This addresses a group that has been left behind in terms of tobacco control."
Durazo’s counterpart in the project, Professor Julia McQuoid of the TSET Health Promotion Research Center at University of Oklahoma Health Sciences, developed and pilot-tested this approach with Freedom Oklahoma, an LGBTQ2S+ advocacy organization.
“We are excited to partner with UC Merced and CalPride to take this project to the next level in advancing smoking cessation for and with LGBTQ2S+ communities across the country,” McQuoid said, “And we couldn’t do it without our community partners.”
The ECHO program planning process has three phases:
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Listening and learning: Listen to smokers and others in the community to learn what they are doing to try to kick the habit. Give them a phone app to record their experiences for a month. What worked? What didn’t?
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Community-academic co-design: With input from CalPride and Freedom Oklahoma, the team will design activities and programs that help people feel supported and listened to, which can bolster the success of nicotine cessation.
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Pilot intervention trial: Run a trial version of the 12-week intervention program with community-driven components to assess acceptability and feasibility.
Durazo underscored ECHO’s strong alignment with UC Merced’s mission.
“One of the flagships of UC Merced is addressing health disparities in our region,” he said. “This project touches the foundation of why our university was put here.”
The ECHO research team hopes this work will serve as a model for scalable, community-grounded interventions that support LGBTQ2S+ communities nationwide.
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