Cedars-Sinai’s Quit Alliance Helps LGBTQIA+ Community Stop Using Tobacco

Quitting tobacco can be difficult, especially when people face barriers to healthcare or lack support that reflects their experiences. Through The Quit Alliance, Cedars-Sinai Cancer's Community Outreach and Engagement office works with community organizations to help LGBTQ+ community members take steps toward quitting.

The initiative brings together community organizations, healthcare providers and tobacco cessation specialists to help identify tobacco use, connect people with evidence-based support and address the barriers that can make quitting difficult.

"The Quit Alliance is really a network of community organizations that we work with-an alliance that is affirming to different populations," said Zul Surani, associate director of Community Outreach and Engagement and of the Cancer Research Center for Health Equity at Cedars-Sinai. "We're focused on LGBTQ+ communities because we found that they have higher tobacco use rates, while there was very little in terms of providing affirming support and services to help people quit."

Individual cessation support is one part of the Cancer Community Outreach and Engagement office's broader tobacco-control approach. The office also trains communities about the harmful effects of tobacco use so they can advocate for smoke-free environments in shared spaces, including workplaces, healthcare facilities, housing common areas, restaurants and other public places.

These policies help protect people from secondhand smoke while supporting cessation by changing social norms and reducing opportunities to use tobacco. For LGBTQ+ communities, smoke-free policies are paired with affirming, accessible cessation services so people who are ready to quit can receive the support they need.

The initiative is funded by the Los Angeles County Department of Public Health Tobacco Prevention Program and the California Tobacco Control Program. The Quit Alliance trains staff at community-based organizations and Federally Qualified Health Centers to lead cessation workshops and connect community members with resources.

Victor Crisanto, MPH, a certified tobacco cessation specialist at Cedars-Sinai, leads trainings for nurses, medical assistants, case managers, health educators and outreach staff members who regularly interact with patients and community members.

The trainings cover the science of nicotine addiction, the health effects of tobacco use and the challenges LGBTQ+ people may face when trying to quit.

One approach Crisanto emphasizes is "ask, advise, refer." Staff members learn how to ask about tobacco and nicotine use, advise people that support is available and refer them to appropriate resources.

The process can be incorporated into an organization's existing workflow. For example, a community organization might add a tobacco-use question to its intake form or train outreach staff to bring up tobacco use during conversations with clients.

Crisanto also uses role-playing to help participants practice responding to common concerns. Someone may say they have tried quitting before, experienced side effects from nicotine replacement therapy or are not ready to quit. The goal is to help staff respond with information and support rather than pressure.

"It's learning how to assess someone based on where they're at," Crisanto said. "Some people are just not ready. They don't want to hear about quitting. Advising them can be as simple as saying, 'Whenever you're ready, we have information for you.'"

The Quit Alliance also offers workshops for community members. These sessions cover topics such as setting a quit date, reducing tobacco use, managing cravings and withdrawal, navigating social situations, and building a support system.

Participants learn about one-on-one counseling, group counseling, support groups, nicotine replacement therapies and cessation medications. The program also connects people with resources such as Kick It California and community partners that can help address other barriers to health.

For someone who is unstably housed, does not have a healthcare provider or is managing a mental health condition, quitting tobacco may not be an immediate priority. The program works with community organizations to help address those challenges while connecting people with cessation support.

"Everybody has a different quit journey," Crisanto said.

The program uses follow-up surveys to learn how participants are progressing. Some report making a quit attempt or going several days without tobacco. Crisanto said those steps represent meaningful progress, even when someone has not given up tobacco for good.

"It takes multiple attempts before someone successfully quits," he said. "But the fact that they're actually trying-that's something."

Crisanto said culturally tailored approaches are essential to effective tobacco cessation work. Tobacco use can be influenced by social networks, stress, discrimination, access to healthcare and other social factors.

"Tailored approaches, including for LGBTQ+ communities, are important and needed," Crisanto said. "It's important to listen and to see what the community you're working with needs, because that's the only way you're going to increase or achieve health equity for all."

Tobacco use is a major risk factor for cancer and other serious health conditions. By helping community organizations identify tobacco use, start supportive conversations and connect people with evidence-based services, The Quit Alliance aims to make cessation support more accessible and affirming.

"Even if people attend one session, that sets them on that pathway," Surani said. "We help them start the journey."

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