Assessing Tobacco Harm Perceptions among Transgender and Nonbinary Adults: Results from a Community

DeAtley T, Baker A, Denlinger-Apte R, Ogunbajo A, Martinez U, Ceballos R, Wetter DW, Operario D, Kershaw T, Gamarel KE, Restar A. 
Assessing Tobacco Harm Perceptions among Transgender and Nonbinary Adults: Results from a Community Informed State-wide Survey
Nicotine Tob Res. 2025 Mar 10:ntaf050. doi: 10.1093/ntr/ntaf050. Epub ahead of print. PMID: 40059718.

Introduction: Epidemiologic data has documented elevated levels of smoking and vaping among transgender and nonbinary (trans) adults. Yet, knowledge about nicotine and tobacco harm perceptions are not well understood within this population.
Methods: Utilizing data from a community-informed study conducted among transgender adults in Washington state from March-April 2023, we explored gender differences in the distribution of tobacco harm perceptions (knowledge, addiction, and harm perceptions). Using logistic and multinomial regression models, we tested predictors and correlates of accurate and inaccurate harm perceptions controlling for age, race, income, health care information trust, current cigarette use, e-cigarette use, and depression and anxiety symptoms.
Results: A total of 770 trans individuals completed the survey. Overall, 83.6% identified as a woman, 8.7% as a man, and 7.7% as nonbinary, gender nonconforming, or genderqueer. Almost half (43.64%) identified as cigarette users and 14.55% as e-cigarette users. The vast majority of study participants (93.25%) incorrectly believed that nicotine causes cancer and that cigarettes with lower levels of nicotine were less harmful to a person's health than regular cigarettes (69.87%). Experiencing elevated symptoms of depression, and having lower income were associated with more inaccurate perceptions about tobacco-related harms and addiction potential.
Conclusions: Direct messaging is needed to inform transgender individuals that nicotine is not the primary chemical in cigarettes that causes cancer and that nicotine is the primary chemical responsible for addiction. Trans women and nonbinary individuals may need specific messaging regarding the perceived risks and harms of tobacco use.
Implications: Very little research has focused on exploring tobacco-related harm perceptions among gender diverse identities. Among the studies that exist, gender identity is combined with sexual identity. Our study aims to address this gap by reporting harm perceptions in a trans only sample, focusing on two distinct harm perception domains.