Smoking and Cancer-Related Health Disparities among Sexual and Gender Minority Adults

PROJECT SUMMARY/ABSTRACT In response to PAR-22-072: Measures and Methods to Advance Research on Minority Health and Health Disparities-Related Constructs, this project “Smoking and Cancer-Related Health Disparities among Sexual and Gender Minority Adults” proposes to integrate multiple independent national data sets to

estimate the prevalence of smoking behaviors, low dose computed tomography (LDCT) lung cancer screening eligibility and use, and other smoking-related outcomes among sexual orientation and gender identity (SOGI) minority (e.g., lesbian, gay, bisexual, transgender) adults. While a growing body of literature documents large

disparities in tobacco use for SOGI minority populations, past research focusing on SOGI minority adults to determine smoking-related health disparities has been severely hampered by geography and by inadequate sample sizes, particularly to examine heterogeneity within SOGI minority subgroups. Thus, there is a lack of

research that examines the prevalence and unique risk factors (i.e., state-level SOGI-specific policies) associated with cigarette smoking, LDCT lung cancer screening, and smoking-related health outcomes among SOGI minority adults using nationally representative data. The absence of adequate explanatory frameworks

further hinders the ability to effectively screen, prevent, or treat lung cancer-related health behaviors in at-risk populations such as SOGI minority adults. The overall five-year survival rate for lung cancer is only 17-19%, but survival substantially improves with early detection. To this end, the proposed project will integrate four

national data sets that include adults aged 18-years and older in the U.S. The integration of these data sets, which have common measures of SOGI, cigarette use, and smoking-related health outcomes, will provide adequate sample sizes to examine the prevalence and risk factors of smoking behaviors that cannot be

adequately addressed with one data set alone. This study aims to: (1) evaluate alternative state-of-the-art techniques for combining estimates from four different surveys with a specific focus on SOGI minority populations and cigarette use, smoking-related health outcomes, and LDCT eligibility and use; (2) using the

harmonized data based on the four different surveys, assess the self-reported cigarette use, smoking pack- years, smoking-related health outcomes, and eligibility and use of LDCT lung cancer screening among adults by sexual orientation (SO) and gender identity (GI); and (3) examine how state-level policy enactment and

implementation related to SO and GI are associated with smoking, LDCT lung screening eligibility and use, and smoking-related health outcomes, while controlling for the state-level tobacco environment. We will capitalize on the unique opportunities afforded by the integration of these data sets: large samples of SOGI

minorities; heterosexual and cisgender comparison groups; innovative methodological approaches for combining estimates; and multilevel analyses with state-level policies related to SO and GI.