A Community-Engaged Research Study to Inform Tailored Programming for Smoking Cessation and Lung Cancer Screening Among At-Risk LGBTQ+ Elders

Abstract

Purpose. Lung cancer is the leading cause of cancer death, with most cases attributable to cigarette smoking. Many communities within the lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ+) umbrella have high rates of smoking, but focused lung cancer prevention is limited. Our objective was to utilize a community-based participatory research (CBPR) approach to guide the development of a program focused on lung cancer prevention in LGBTQ+ elders. Methods. Through community partnerships, we recruited participants who self-identified as LGBTQ+ and were eligible for lung cancer screening (LCS) to participate in semi-structured qualitative discussions with complementary surveys. Qualitative guides were developed to collect data on determinants of smoking cessation and LCS and to elicit feedback on interventions to support lung cancer prevention through a tailored approach to patient navigation. Qualitative data were analyzed using rapid templated analysis to elucidate themes. Results. The 21 enrolled participants had diverse sexual and gender identities and 57% were of minoritized race/ethnicity. Most (81%) had experience with smoking cessation but few (10%) had undergone LCS. Overall themes suggest interest in personalized (to individuals), tailored (to the LGBTQ+ community) and integrated longitudinal programs to support lung cancer prevention. Themes suggest strong endorsement of focused messaging to LGBTQ+ persons and reducing stigma related to LGBTQ+ identity and smoking. Conclusions. Themes highlight the need for integrated tobacco and LCS programming which can provide longitudinal support, and ideally, center community settings and peer support. This formative work will be utilized to adapt a patient navigation program to assist screen-eligible LGBTQ+ elders.

Keywords

tobacco use cigarette smoking sexual and gender minority (SGM)cancer screening lung cancer navigation

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References

Acosta-Deprez

Jou

London

Chu

Cermak

Kozlovich

(2021). Tobacco control as an LGBTQ+ issue: Knowledge, attitudes, and recommendations from LGBTQ+ community leaders. International Journal of Environmental Research and Public Health, 18(11), Article 5546. https://doi.org/10.3390/ijerph18115546

Baggett

T. P.

Barbosa Teixeira

Rodriguez

E. C.

Anandakugan

Sporn

Chang

Percac-Lima

Park

E. R.

Rigotti

N. A.

(2022). Patient navigation to promote lung cancer screening in a community health center for people experiencing homelessness: Protocol for a pragmatic randomized controlled trial. Contemporary Clinical Trials, 113, Article 106666. https://doi.org/10.1016/j.cct.2021.106666

Berger

Mooney-Somers

(2017). Smoking cessation programs for lesbian, gay, bisexual, transgender, and intersex people: A content-based systematic review. Nicotine & Tobacco Research, 19(12), 1408–1417. https://doi.org/10.1093/ntr/ntw216

Bergström

Ehrenberg

Eldh

A. C.

Graham

I. D.

Gustafsson

Harvey

Hunter

Kitson

Rycroft-Malone

Wallin

(2020). The use of the PARIHS framework in implementation research and practice: A citation analysis of the literature. Implementation Science, 15(1), Article 68. https://doi.org/10.1186/s13012-020-01003-0

Boyd

C. J.

Veliz

P. T.

Stephenson

Hughes

T. L.

McCabe

S. E.

(2019). Severity of alcohol, tobacco, and drug use disorders among sexual minority individuals and their “not sure” counterparts. LGBT Health, 6(1), 15–22. https://doi.org/10.1089/lgbt.2018.0122

Bryant

Damarin

A. K.

Marshall

(2014). Tobacco control recommendations identified by LGBT Atlantans in a community-based participatory research project. Progress in Community Health Partnerships, 8(3), 269–279. https://doi.org/10.1353/cpr.2014.0041

Burns

E. K.

Deaton

E. A.

Levinson

A. H.

(2011). Rates and reasons: Disparities in low intentions to use a state smoking cessation quitline. American Journal of Health Promotion, 25(5 Suppl.), S59–S65. https://doi.org/10.4278/ajhp.100611-QUAN-183

Chapman

A. L.

Hadfield

Chapman

C. J.

(2015). Qualitative research in healthcare: An introduction to grounded theory using thematic analysis. Journal of the Royal College of Physicians of Edinburgh, 45(3), 201–205. https://doi.org/10.4997/jrcpe.2015.305

Chew

L. D.

Griffin

J. M.

Partin

M. R.

Noorbaloochi

Grill

J. P.

Snyder

Bradley

K. A.

Nugent

S. M.

Baines

A. D.

Vanryn

(2008). Validation of screening questions for limited health literacy in a large VA outpatient population. Journal of General Internal Medicine, 23(5), 561–566. https://doi.org/10.1007/s11606-008-0520-5

10.

Cornelius

M. E.

Wang

T. W.

Jamal

Loretan

C. G.

Neff

L. J.

(2020). Tobacco product use among adults: United States, 2019. Morbidity and Mortality Weekly Report, 69(46), 1736–1742. https://doi.org/10.15585/mmwr.mm6946a4

11.

Creamer

M. R.

Wang

T. W.

Babb

Cullen

K. A.

Day

Willis

Jamal

Neff

(2019). Tobacco product use and cessation indicators among adults: United States, 2018. Morbidity and Mortality Weekly Report, 68(45), 1013–1019. https://doi.org/10.15585/mmwr.mm6845a2

12.

de Koning

H. J.

van der Aalst

C. M.

de Jong

P. A.

Scholten

E. T.

Nackaerts

Heuvelmans

M. A.

Lammers

J. J.

Weenink

Yousaf-Khan

Horeweg

van’t Westeinde

Prokop

Mali

W. P.

Mohamed Hoesein

F. A. A.

van Ooijen

P. M. A.

Aerts

den Bakker

M. A.

Thunnissen

Verschakelen

Oudkerk

. (2020). Reduced lung-cancer mortality with volume CT screening in a randomized trial. New England Journal of Medicine, 382(6), 503–513. https://doi.org/10.1056/NEJMoa1911793

13.

Fallin

Goodin

Lee

Y. O.

Bennett

(2015). Smoking characteristics among lesbian, gay, and bisexual adults. Preventive Medicine, 74, 123–130. https://doi.org/10.1016/j.ypmed.2014.11.026

14.

Gerber

D. E.

Hamann

H. A.

Santini

N. O.

Abbara

Chiu

McGuire

Quirk

Zhu

Lee

S. J. C.

(2017). Patient navigation for lung cancer screening in an urban safety-net system: Protocol for a pragmatic randomized clinical trial. Contemporary Clinical Trials, 60, 78–85. https://doi.org/10.1016/j.cct.2017.07.003

15.

Gruskin

E. P.

Byrne

K. M.

Altschuler

Dibble

S. L.

(2008). Smoking it all away: Influences of stress, negative emotions, and stigma on lesbian tobacco use. Journal of LGBT Health Research, 4(4), 167–179. https://doi.org/10.1080/15574090903141104

16.

Hamilton

A. B.

Finley

E. P.

(2019). Qualitative methods in implementation research: An introduction. Psychiatry Research, 280, Article 112516. https://doi.org/10.1016/j.psychres.2019.112516

17.

Hoffman

Delahanty

Johnson

S. E.

Zhao

(2018). Sexual and gender minority cigarette smoking disparities: An analysis of 2016 behavioral risk factor surveillance system data. Preventive Medicine, 113, 109–115. https://doi.org/10.1016/j.ypmed.2018.05.014

18.

Israel

B. A.

Schulz

A. J.

Parker

E. A.

Becker

A. B.

Allen

A. J. I. I. I.

Guzman

J. R.

(2003). Critical issues in developing and following community-based participatory research principles. In Minkler

Wallerstein

(Eds.), Community-based participatory research for health (pp. 53–76). Jossey-Bass.

19.

Johnson

S. E.

Holder-Hayes

Tessman

G. K.

King

B. A.

Alexander

Zhao

(2016). Tobacco product use among sexual minority adults: Findings from the 2012–2013 national adult tobacco survey. American Journal of Preventive Medicine, 50(4), e91–e100. https://doi.org/10.1016/j.amepre.2015.07.041

20.

Kilbourne

A. M.

Switzer

Hyman

Crowley-Matoka

Fine

M. J.

(2006). Advancing health disparities research within the health care system: A conceptual framework. American Journal of Public Health, 96(12), 2113–2121.

21.

Kolb

S. M.

(2012). Grounded theory and the constant comparative method: Valid research strategies for educators. Journal of Emerging Trends in Educational Research and Policy Studies, 3(1), 83–86. https://doi.org/10.10520/EJC135409

22.

Krist

A. H.

Davidson

K. W.

Mangione

C. M.

Barry

M. J.

Cabana

Caughey

A. B.

Davis

E. M.

Donahue

K. E.

Doubeni

C. A.

Kubik

Landefeld

C. S.

Ogedegbe

Owens

D. K.

Pbert

Silverstein

Stevermer

Tseng

C. W.

Wong

J. B.

(2021). Screening for lung cancer: U.S. Preventive Services Task Force recommendation statement. Journal of the American Medical Association, 325(10), 962–970. https://doi.org/10.1001/jama.2021.1117

23.

Krueger

E. A.

Hong

Cunningham

N. J.

Berteau

L. K.

Cordero

E. S. C.

Holloway

I. W.

(2023, June 9). Prevalence of nicotine and tobacco product use by sexual identity, gender identity, and sex assigned at birth among emerging adult tobacco users in California, United States. Nicotine & Tobacco Research, 25(7), 1378–1385. https://doi.org/10.1093/ntr/ntad048

24.

Lee

J. G.

Matthews

A. K.

McCullen

C. A.

Melvin

C. L.

(2014). Promotion of tobacco use cessation for lesbian, gay, bisexual, and transgender people: A systematic review. American Journal of Preventive Medicine, 47(6), 823–831. https://doi.org/10.1016/j.amepre.2014.07.051

25.

Lee

J. G. L.

DeMarco

M. E.

Beymer

M. R.

Shover

C. L.

Bolan

R. K.

(2018). Tobacco-free policies and tobacco cessation systems at health centers serving lesbian, gay, bisexual, and transgender clients. LGBT Health, 5(4), 264–269. https://doi.org/10.1089/lgbt.2017.0208

26.

Lopez-Olivo

M. A.

Maki

K. G.

Choi

N. J.

Hoffman

R. M.

Shih

Y. T.

Lowenstein

L. M.

Hicklen

R. S.

Volk

R. J.

(2020). Patient adherence to screening for lung cancer in the US: A systematic review and meta-analysis. Journal of the American Medical Association Network Open, 3(11), Article e2025102. https://doi.org/10.1001/jamanetworkopen.2020.25102

27.

Matthews

A. K.

Breen

Veluz-Wilkins

Ciecierski

Simon

Burrell

Hitsman

(2019). Adaptation of a proactive smoking cessation intervention to increase tobacco quitline use by LGBT smokers. Progress in Community Health Partnerships, 13(5), 71–84. https://doi.org/10.1353/cpr.2019.0040

28.

Matthews

A. K.

McCabe

S. E.

Lee

J. G. L.

Veliz

(2018). Differences in smoking prevalence and eligibility for low-dose computed tomography (LDCT) lung cancer screening among older U.S. adults: Role of sexual orientation. Cancer Causes & Control, 29(8), 769–774. https://doi.org/10.1007/s10552-018-1044-x

29.

National Academies of Sciences, Engineering, and Medicine. (2022). Measuring sex, gender identity, and sexual orientation. The National Academies Press.

30.

National Lung Screening Trial Research

Aberle

D. R.

Adams

A. M.

Berg

C. D.

Black

W. C.

Clapp

J. D.

Fagerstrom

R. M.

Gareen

I. F.

Gatsonis

Marcus

P. M.

Sicks

J. D

. (2011). Reduced lung-cancer mortality with low-dose computed tomographic screening. New England Journal of Medicine, 365(5), 395–409. https://doi.org/10.1056/NEJMoa1102873

31.

O’Cleirigh

Elsesser

S. A.

King

Ehlinger

P. P.

Bradford

J. B.

Grasso

Mayer

K. H.

(2018). Characteristics and correlates of tobacco use in a community sample of sexual minority men and women: Implications for smoking cessation program development. LGBT Health, 5(3), 197–202. https://doi.org/10.1089/lgbt.2016.0157

32.

Palinkas

L. A.

Mendon

S. J.

Hamilton

A. B.

(2019). Innovations in mixed methods evaluations. Annual Review of Public Health, 40, 423–442. https://doi.org/10.1146/annurev-publhealth-040218-044215

33.

Paskett

E. D.

Harrop

J. P.

Wells

K. J.

(2011). Patient navigation: An update on the state of the science. CA: A Cancer Journal for Clinicians, 61(4), 237–249. https://doi.org/10.3322/caac.20111

34.

Pelster

A. D.

Fisher

C. M.

Irwin

J. A.

Coleman

J. D.

McCarthy

M. A.

(2015). Tobacco use and its relationship to social determinants of health in LGBT populations of a Midwestern state. LGBT Health, 2(1), 71–76. https://doi.org/10.1089/lgbt.2014.0012

35.

Percac-Lima

Ashburner

J. M.

Rigotti

N. A.

Park

E. R.

Chang

Kuchukhidze

Atlas

S. J.

(2018). Patient navigation for lung cancer screening among current smokers in community health centers a randomized controlled trial. Cancer Medicine, 7(3), 894–902. https://doi.org/10.1002/cam4.1297

36.

Philip Morris USA. (1997). CEM’s gay and lesbian marketing efforts.

37.

Sawyer

A. N.

Bono

R. S.

Kaplan

Breland

A. B.

(2022). Nicotine/tobacco use disparities among transgender and gender diverse adults: Findings from wave 4 PATH data. Drug and Alcohol Dependence, 232, Article 109268. https://doi.org/10.1016/j.drugalcdep.2022.109268

38.

Shusted

C. S.

Barta

J. A.

Lake

Brawer

Ruane

Giamboy

T. E.

Sundaram

Evans

N. R.

Myers

R. E.

Kane

G. C.

(2018). The case for patient navigation in lung cancer screening in vulnerable populations: A systematic review. Population Health Management, 22, Article e0128. https://doi.org/10.1089/pop.2018.0128

39.

Siegel

R. L.

Miller

K. D.

Fuchs

H. E.

Jemal

(2022). Cancer statistics, 2022. CA: A Cancer Journal for Clinicians, 72(1), 7–33. https://doi.org/10.3322/caac.21708

40.

Stowell

J. T.

Parikh

Tilson

Narayan

A. K.

(2020). Lung cancer screening eligibility and utilization among transgender patients: An analysis of the 2017–2018 United States behavioral risk factor surveillance system survey. Nicotine & Tobacco Research, 22(12), 2164–2169. https://doi.org/10.1093/ntr/ntaa127

41.

Sun

C. J.

Doran

K. M.

Sevelius

J. M.

Bailey

S. R.

(2023). A qualitative examination of tobacco use and smoking cessation among gender minority adults. Annals of Behavioral Medicine, 57(7), 530–540. https://doi.org/10.1093/abm/kaac072

42.

Tailor

T. D.

Tong

B. C.

Gao

Henderson

L. M.

Choudhury

K. R.

Rubin

G. D.

(2020). Utilization of lung cancer screening in the Medicare fee-for-service population. Chest, 158(5), 2200–2210. https://doi.org/10.1016/j.chest.2020.05.592

43.

Tan

A. S. L.

Potter

(2021). How the expansion of the U.S. Preventive Services Task Force lung cancer screening eligibility may improve health equity among diverse sexual and gender minority populations. LGBT Health, 8(8), 503–506. https://doi.org/10.1089/lgbt.2021.0188

44.

Tanner

N. T.

Kanodra

N. M.

Gebregziabher

Payne

Halbert

C. H.

Warren

G. W.

Egede

L. E.

Silvestri

G. A.

(2016). The association between smoking abstinence and mortality in the National Lung Screening Trial. American Journal of Respiratory and Critical Care Medicine, 193(5), 534–541. https://doi.org/10.1164/rccm.201507-1420OC

45.

Triplette

Thayer

J. H.

Pipavath

S. N.

Crothers

(2019). Poor uptake of lung cancer screening: Opportunities for improvement. Journal of the American College of Radiology, 16(4 Pt. A), 446–450. https://doi.org/10.1016/j.jacr.2018.12.018

46.

Veliz

Matthews

A. K.

Arslanian-Engoren

Evans-Polce

R. J.

Lee

J. G. L.

Boyd

C. J.

Hughes

McCabe

V. V.

McCabe

S. E.

(2019). LDCT lung cancer screening eligibility and use of CT scans for lung cancer among sexual minorities. Cancer Epidemiology, 60, 51–54. https://doi.org/10.1016/j.canep.2019.03.009

47.

Wallerstein

N. B.

Duran

(2006). Using community-based participatory research to address health disparities. Health Promotion Practice, 7(3), 312–323. https://doi.org/10.1177/1524839906289376

48.

Ward

Schulz

A. J.

Israel

B. A.

Rice

Martenies

S. E.

Markarian

(2018). A conceptual framework for evaluating health equity promotion within community-based participatory research partnerships. Evaluation and Program Planning, 70, 25–34. https://doi.org/10.1016/j.evalprogplan.2018.04.014

49.

Wheldon

C. W.

Kaufman

A. R.

Kasza

K. A.

Moser

R. P.

(2018). Tobacco use among adults by sexual orientation: Findings from the population assessment of tobacco and health study. LGBT Health, 5(1), 33–44. https://doi.org/10.1089/lgbt.2017.0175

50.

Williams

D. R.

Yan

Jackson

J. S.

Anderson

N. B.

(1997). Racial differences in physical and mental health: Socio-economic status, stress and discrimination. Journal of Health Psychology, 2(3), 335–351. https://doi.org/10.1177/135910539700200305

51.

Woodward

E. N.

Matthieu

M. M.

Uchendu

U. S.

Rogal

Kirchner

J. E.

(2019). The health equity implementation framework: Proposal and preliminary study of hepatitis C virus treatment. Implementation Science, 14(1), Article 26. https://doi.org/10.1186/s13012-019-0861-y

52.

Youlden

D. R.

Cramb

S. M.

Baade

P. D.

(2008). The International Epidemiology of Lung Cancer: Geographical distribution and secular trends. Journal of Thoracic Oncology, 3(8), 819–831. https://doi.org/10.1097/JTO.0b013e31818020eb

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