Nicotine/tobacco use disparities among transgender and gender diverse adults: Findings from wave 4 PATH data

Canadian Cardiovascular Society Clinical Practice Update on Contemporary Approaches to Smoking Cessation

Smoking tobacco is the leading cause of preventable disease and death in Canada. Life expectancy of those who smoke is on average 10 years shorter than those who do not smoke. It is the most important modifiable risk factor for cardiovascular disease (CVD), doubling the risk of abdominal aortic aneurysm, coronary artery disease, ischemic stroke, and peripheral arterial disease. Smoking cessation is the single most powerful preventative intervention in clinical practice. Within 1 year of smoking cessation, the risk of CVD events decreases by 50%; after 15 years, the risk is the same as that of someone who has never smoked. Those who quit by age 40 have a life expectancy similar to that of people who have never smoked. Smoking cessation is a fundamental responsibility of every health care provider and must be a priority in all clinical settings. All patients must be systematically identified, treated, and have sufficient follow-up arranged. Advice should be brief, clear, and unambiguous to inform people who smoke about the harms of smoking and the benefits of cessation, in a personalized and nonjudgemental manner. It should be combined with pharmacotherapy because this can increase the likelihood of success by almost threefold. Health care practitioners should be as comfortable managing smoking cessation and initiating pharmacotherapy as they would be managing other CVD risk factors like hypertension or dyslipidemia.

A Multistakeholder Qualitative Study to Inform Sexual Orientation and Gender Identity Data Collection in the Cancer Care Setting

Purpose: Sexual and gender minoritized (SGM) populations face health disparities along the cancer care continuum, although attempts to define these disparities are limited by a lack of comprehensive sexual orientation and gender identity (SOGI) data collection. The objective of this study was to interview a diverse group of stakeholders to understand attitudes, barriers, and facilitators to inform data collection approaches in a cancer care setting. Methods: This was a qualitative study conducted from March to July 2023 with paired surveys of stakeholders including patients, caregivers, providers, and cancer registry staff. Twenty participants across these categories, including half who identified as SGM, completed surveys and interviews. Qualitative data were reduced to themes with exemplar quotations using rapid qualitative analysis methods and compared to survey data. Results: Themes revealed general support for SOGI data collection as part of holistic cancer care, and all participants acknowledged that specific SOGI-related information, particularly correct pronoun usage, was essential to inform patient-centered care. Themes revealed tensions around optimal SOGI data collection methods, mixed opinions on the relevance of sexual orientation, experiences of discrimination and discomfort related to SOGI, and limited acknowledgment of population benefits of SOGI data collection. Conclusion: Themes demonstrated overall support for SOGI data collection but also revealed several barriers, such as a lack of recognition of population benefits and experiences of discrimination and discomfort, that will need to be addressed to comprehensively collect these data. Based on diverse preferences and limitations of all methods of collection, a multimodal approach may be needed to optimize completion.

Barriers and Solutions to Cancer Screening in Gender Minority Populations

Gender minority groups, comprising individuals whose gender identity and/or expression differ from their sex assigned at birth, experience significant health disparities in the United States and abroad. Members of this popula.

Examining general, physical, and mental health disparities between transgender and cisgender adults in the U.S

BACKGROUND

With the proliferation of anti-transgender policies in some U.S. jurisdictions, this study examines the general, mental, and physical health of transgender and cisgender populations.

METHODS

Data from the 2020-2023 Behavioral Risk Factor Surveillance System were analyzed to examine associations between gender identity and health outcomes. Propensity score weighting was used to address potential imbalances among group characteristics. We conducted logistic regression for the binary outcome of self-rated health and quasi-Poisson regression for the number of days reporting poor mental and physical health.

RESULTS

Results reveal significant disparities in health outcomes, with transgender individuals reporting lower proportions of good general health and more days of poor mental and physical health compared to cisgender individuals. In the adjusted analyses, transgender individuals were significantly less likely to report good general health compared to cisgender peers (OR = 0.60, 95% CI = 0.52-0.69). Gender nonconforming (GNC), male-to-female (MTF), and female-to-male (FTM) individuals had lower odds of reporting good general health compared to cisgender individuals (GNC, OR = 0.46, 95% CI = 0.35-0.61; MTF, OR = 0.67, 95% CI = 0.53-0.85; FTM, OR = 0.71, 95% CI = 0.57-0.87). GNC individuals had an 86% higher frequency of poor mental health days (IRR = 1.86, 95% CI = 1.57-2.21) and a 37% higher frequency of poor physical health days (IRR = 1.37, 95% CI = 1.15-1.63) compared to cisgender counterparts. Similarly, MTF and FTM individuals had significantly higher frequencies of poor mental and physical health days.

CONCLUSIONS

The study highlights significant health disparities faced by transgender individuals, who report poorer general, mental, and physical health. These findings underscore the need to address the unique challenges and improve health outcomes within the transgender community.

E-cigarette, tobacco, and cannabis vaping among diverse sexual and gender identities in U.S. high school students

OBJECTIVES

This study investigated the associations between diverse sexual and gender identities and adolescent use of e-cigarettes, tobacco products, and cannabis vaping.

STUDY DESIGN

Cross-sectional study.

METHODS

Data were collected from a nationally representative sample of high school students in 2023. Multivariable logistic regression analyses were employed to examine the relationships between sexual orientation, gender identity, and transgender status with e-cigarette, tobacco, and cannabis vaping.

RESULTS

Bisexual, pansexual, or queer students had the highest prevalence of e-cigarette use at 16.12 %, followed by gay or lesbian students at 14.46 %. Asexual students were more likely to vape cannabis (aOR = 2.22, 95 % CI = 1.08-4.56) compared to heterosexual students. Nonbinary, genderfluid, or genderqueer students had higher odds of e-cigarette use (aOR = 2.10, 95 % CI = 1.16-3.80) compared to boys. Bisexual, pansexual, or queer students were also more likely to use e-cigarettes (aOR = 2.47, 95 % CI = 1.59-3.83) and vape cannabis (aOR = 1.87, 95 % CI = 1.17-2.98) compared to heterosexual students. Transgender or questioning students had higher odds of e-cigarette use (aOR = 2.35, 95 % CI = 1.11-5.00) and other tobacco product use (aOR = 3.51, 95 % CI = 1.38-8.96) compared to non-transgender students.

CONCLUSIONS

Findings reveal significant disparities in substance use behaviors among sexual and gender minority (SGM) youth compared to their heterosexual and cisgender peers. These results highlight the need for tailored prevention and intervention strategies to address the unique needs of SGM youth.

Do Smartphone Apps Impact Long-Term Smoking Cessation for Sexual and Gender Minority Adults? Exploratory Results from a 2-Arm Randomized Trial Comparing Acceptance and Commitment Therapy with Standard US Clinical Practice Guidelines

Sexual and gender minority (SGM) adults face unique challenges in accessing smoking cessation care due to stigma tied to their identities and smoking. While cessation apps show promise in the general population, their efficacy for SGM adults is unclear. This study utilized data from a randomized trial to compare two cessation apps, iCanQuit (Acceptance and Commitment Therapy-based) and QuitGuide (US Clinical Practice Guidelines-based) among 403 SGM adults. The primary outcome was self-reported complete-case 30-day abstinence from cigarette smoking at 12 months. Mediation analyses explored whether interventions operated through acceptance of cues to smoke and app engagement. At 12 months, quit rates did not differ between arms (26% iCanQuit vs. 22% QuitGuide, OR = 1.22; 95% CI: 0.74 to 2.00, p = .43). iCanQuit positively impacted cessation via acceptance of cues to smoke (indirect effect = 0.23; 95% CI: 0.06 to 0.50, p < .001) and demonstrated higher engagement (no. logins, 28.4 vs. 12.1; p < .001) and satisfaction (91% vs. 75%, OR = 4.18; 95% CI: 2.12 to 8.25, p < .001) than QuitGuide. Although quit rates did not differ between arms, acceptance of cues to smoke seemed to play a crucial role in helping SGM adults quit smoking. Future interventions should consider promoting acceptance of cues to smoke in this population.

Considerations in the Care of Transgender and Gender-Diverse Patients Requiring Invasive Cardiac Catheterization

Transgender and gender diverse patients undergoing cardiac procedures require unique considerations to ensure the delivery of respectful, safe, and high-value health care. There are several issues for which practicing clinicians may have limited experience managing, including the potential interactions between gender-affirming medical and surgical interventions and cardiovascular conditions; using correct patient name and pronouns and additional strategies to increase comfort and safety of medical interventions; and nuances of cardiac clearance before gender-affirming surgeries. This article provides a primer on these topics and sets cardiologists up to learn more about the needs of transgender and gender diverse patient populations.

Measuring cigarette and e-cigarette use over time among LGBT+ youth and young adults using a repeat cross-sectional survey, 2022-2024

INTRODUCTION

LGBT+ individuals in the U.S. use tobacco products more than their heterosexual and cisgender peers. Although existing literature identifies this trend, more research using recent, national data from a large sample is needed to better examine trends over time.

METHODS

A repeat cross-sectional survey of approximately n=300 youth and young adults aged 15-24 was fielded weekly from October of 2022 to June of 2024, resulting in a total sample of N=25,675. This sample was used to examine cigarette and e-cigarette use over time among LGBT+ and non-LGBT+ youth and young adults. Cigarette and e-cigarette use was also examined by specific sexual orientation and gender identity, using the aggregated sample.

RESULTS

From October 2022 - June 2024, cigarette and e-cigarette use were consistently higher among LGBT+ youth and young adults, compared to their cisgender and heterosexual peers. Compared to heterosexual young people, gay/lesbian and bisexual young people reported higher cigarette and e-cigarette use. Male-identifying individuals reported the highest cigarette use while, female young people reported the highest e-cigarette use. Transgender and gender diverse individuals reported lower cigarette and e-cigarette use than cisgender young people.

CONCLUSIONS

Tobacco use disparities persist among LGBT+ youth and young adults. Sexual minority respondents showed elevated risk of tobacco use, while gender minority youth saw lower rates of tobacco use, although prevalence remains high. Future research should continue to investigate LGBT+ tobacco use using national surveillance methods. Effective programs for tobacco prevention and cessation are necessary to advance health equity among LGBT+ youth and young adults.

IMPLICATIONS

This study finds persistently elevated tobacco use among LGBT+ youth and young adults over a two-year period, highlighting the importance of continued tobacco use surveillance, as well as the development of programmatic interventions to reduce LGBT+ tobacco use. These analyses also inform future work further investigating differences in tobacco use by sexual orientation and gender identity among young people. This work provides a call to action to focus efforts on reducing tobacco use among LGBT+ youth, improving the long-term health of this population and increasing health equity.

"Do all bisexuals have this power?": An exploratory study of "crippling nicotine addiction," identity, and other emergent themes in vaping messages on QueerTok

Nicotine and tobacco use disproportionally affects sexual and gender minority (SGM) populations in the United States. Social media narratives may contribute to these disparities. This qualitative study delineated perceptions and experiences depicted in SGM-related videos about nicotine vaping on TikTok. Young adult researchers engaged in every step of the research process, adding an insider perspective. Using four TikTok accounts, we used vaping and SGM-related search terms to sample videos in March-April 2022. Three TikTok accounts collected SGM-specific videos; a fourth provided non-SGM specific videos for comparison. We iteratively sorted 303 unique videos into 32 a priori and emergent codes and identified themes in SGM videos and comparison videos. In their videos, creators displayed awareness of and ambivalence toward vaping and nicotine dependence. SGM videos reflected vaping as a salient feature of identity and a consideration in romantic partnership. Studying video-based social media platforms, like TikTok, using an insider-engaged qualitative lens promotes rich interpretation of content to identify prevalent and emerging messages, which can inform appropriate interventions for SGM young people.

Improving dissemination products and practices for community-based organisations serving LGBTQ+ communities in the USA: a thematic analysis

Background

In the USA, lesbian, gay, bisexual, transgender and queer (LGBTQ+) people report higher rates of tobacco use than non-LGBTQ+ people due to diverse factors, from anti-LGBTQ stigma to targeted marketing by the tobacco industry. There is an opportunity to support behavioural changes by delivering evidence-based health communication campaigns through community-based organisations (CBOs), but an insufficient evidence base and organisational resource restrictions limit this potential. Our previous research with CBO staff and leaders serving LGBTQ+ communities identified gaps in evidence-based campaigns, such as insufficient centering of LGBTQ+ communities in campaign development and execution. This qualitative study explores opportunities to improve the products and services supporting the dissemination of evidence-based health communication campaigns for LGBTQ+ audiences.

Methods

We conducted key informant interviews between January and June 2021 with individuals who direct or run health promotion programmes in CBOs serving LGBTQ+ populations in the USA (n=26 individuals from 22 organisations). Using critical and constructivist perspectives, we leveraged the analysis team and advisory committee's diverse research, lived and practice expertise related to LGBTQ+ health. We employed a team-based, reflexive thematic analysis approach.

Results

We identified two key opportunities. Theme 1-show us your work: participants requested (a) details about the evidence-based campaigns, including underlying values and extent of community engagement, and (b) information about campaign mechanisms and impact. Theme 2-support us in our work: participants suggested that evidence-based campaigns should (a) be designed for flexibility and adaptation, (b) offer tools and guidance for adaptation and (c) share granular data and relevant resources. Participants nominated dissemination products and processes to address gaps, including supports to integrate campaigns into multi-level action, data collection tools for adaptation and engagement with campaign developers.

Conclusions

The findings highlight the potential for CBOs to be integral partners in the development and dissemination of evidence-based health communication campaigns that address tobacco-related inequities among LGBTQ+ communities.

'Authentic' or 'corny': LGBTQ+ young adults respond to visual, thematic and semantic elements of culturally targeted tobacco public education advertisements

BACKGROUND

Lesbian, gay, bisexual, transgender and queer (LGBTQ+) young adults (YA) experience disparities in nicotine and tobacco use. Mass-reach health communications can prevent nicotine and tobacco initiation and progression, but LGBTQ+adults report low engagement. Although cultural targeting (CT) could reach LGBTQ+YA, we know little about the strategies that resonate with this population. We probed how LGBTQ+YA perceived CT content to inform tobacco public education campaigns on strategies to engage this population.

METHODS

We conducted six focus groups with N=20 LGBTQ+YA (18-35) who had ever used vapes, cigarettes or both. We showed participants examples of CT tobacco public education campaigns, probed their opinions and perceptions and coded transcripts using a data-driven inductive approach.

RESULTS

Participants were more inclined to view an ad as effective when they felt it was authentically created for the LGBTQ+community. Avoiding stereotyping, including diversity, using 'subtle' LGBTQ+iconography (ie, rainbows), and including personal experiences all contributed to the authenticity of the ad. Participants discussed the importance of visual appeal; bright colours made ads appear too corporate or like an ad for a tobacco product. Lastly, participants responded well to gain-framed messages rather than traditional risk messaging.

CONCLUSION

Tobacco public education ads featuring 'every-day' LGBTQ+people in candid or unposed shots, personal stories with gain-framed messaging, and subtle Pride iconography and colours may increase acceptability among LGBTQ+YA. Researchers should focus on cultivating authenticity in ads and avoid outdated trends by consulting with the community and moving with speed from development to implementation.

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

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.

Reporting Sex and Gender Differences in Cardiovascular Research

Incorporating sexual orientation, gender identity, and expression (SOGIE) data into cardiovascular research design is necessary to reduce cardiovascular healthcare disparities among sexual and gender minority (SGM) people. To achieve this, researchers should not only understand appropriate terminology, but also implement inclusive survey tools that respect privacy and cultural nuances, as the benefit of obtaining SOGIE information is critical to tailoring cardiovascular interventions and ensuring equitable healthcare outcomes. In order to address potential concerns related to disclosing SOGIE information, we must prioritize sensitivity training for healthcare professionals to foster an inclusive environment for data collection, ethical considerations, and confidentiality safeguards. This review aims to develop and inform critical thinking about sex and gender and to identify strategic mechanisms to include SOGIE data in cardiovascular research, thus improving cardiovascular health outcomes for SGM individuals. By embracing a more comprehensive and inclusive approach to data collection, cardiovascular research can contribute significantly to advancing personalized and inclusive healthcare practices and medical education, and ultimately promote better health outcomes for all SGM individuals.

Sociodemographic profile, health-related behaviours and experiences of healthcare access in Italian transgender and gender diverse adult population

PURPOSE

Information on the general health of transgender and gender diverse (TGD) individuals continues to be lacking. To bridge this gap, the National Institute of Health in Italy together with the National Office against Racial Discriminations, clinical centres, and TGD organizations carried out a cross-sectional study to define the sociodemographic profile, health-related behaviours, and experiences of healthcare access in Italian TGD adult population.

METHODS

A national survey was conducted by Computer-Assisted Web Interviewing (CAWI) technique. Collected data were compared within the TGD subgroups and between TGD people and the Italian general population (IGP).

RESULTS

TGD respondents were 959: 65% assigned female at birth (AFAB) and 35% assigned male at birth (AMAB). 91.8% and 8.2% were binary and non-binary TGD respondents, respectively. More than 20% of the TGD population reported to be unemployed with the highest rate detectable in AMAB and non-binary people. Cigarette smoking and binge drinking were higher in the TGD population compared with IGP (p < 0.05), affecting TGD subgroups differently. A significant lower percentage of AFAB TGD people reported having had screening for cervical and breast cancer in comparison with AFAB IGP (p < 0.0001, in both cases). Over 40% was the percentage of AFAB and non-binary TGD people accessing healthcare who felt discriminated against because of their gender identity.

CONCLUSIONS

Our results are a first step towards a better understanding of the health needs of TGD people in Italy in order to plan the best policy choices for a more inclusive public health.

Do US quitsites present information related to providing services for LGBTQ individuals? An audit study

INTRODUCTION

Most US quitlines have quitsites and websites designated to promote their services. Quitsites have the potential to encourage LGBTQ individuals to utilize quitline services by explicitly mentioning the provision of LGBTQ-competent services. The present study audited quitsites to determine the presence of information regarding services for LGBTQ individuals.

METHODS

Using a checklist consisting of nine criteria, a cross-sectional audit of the US quitsites was conducted between 16 October and 8 November 2023. The audit was divided into two phases: 1) auditors coded all quitsites separately, and 2) auditors met with the first author to compare their coding and reach a consensus. The inter-rater agreement was calculated. Frequencies and percentages were calculated for each criterion.

RESULTS

Auditors evaluated a total of 46 quitsites. Inter-rater agreement was 96.85%. Seven quitsites (15.2%) met 0 of the nine criteria, and 36.9% of the quitsites (17/46) met more than six criteria. Only one quitsite met 8 of 9. No individual website met all nine criteria. While 84.8% of quitsites had at least a singular mention of the LGBTQ community somewhere on their website, only 4.3% of the quitsites mentioned the LGBTQ community on their landing page.

CONCLUSIONS

Most quitsites mentioned the LGBTQ community somewhere on their website (84.8%). However, only 4.3% of the quitsites mentioned the LGBTQ community on their landing page. Results suggest that quitsites explicitly mention the provision of services for LGBTQ individuals on their landing page, which has the potential to engage LGBTQ individuals into quitline services and reduce tobacco-related disparities.

Minority stressors and tobacco use among a US sample of sexual and gender minority young adults

INTRODUCTION

Young adults who are sexual and gender minorities (SGM) are at the highest risk for tobacco initiation in young adulthood. Minority stress theory suggests that sexual orientation and gender identity (SOGI)-based discrimination may contribute to nicotine and tobacco use disparities. Our study aimed to quantify the association between SOGI-based distal minority stressors and current tobacco use among SGM young adults living in the United States (US).

METHODS

Eligible participants-including young adults (aged 18-35 years old), who identified as SGM, and were currently residing in the US (N=1116) -were recruited via Prolific into an online survey. We applied stepwise binary regressions with backward selection to model the association between average past 30-day distal minority stress and current tobacco use (i.e., combustible cigarettes or e-cigarettes), controlling for perceived stress and sociodemographic covariates. We also tested interactions between minority stress and SGM status. Exploratory analyses assessed associations between minority stress and current tobacco use among YA, stratified by SGM subgroup.

RESULTS

A 1-unit increase in experiencing minority stress in the past 30-days was associated with 1.02 greater odds of current tobacco use among SGM young adults. No difference between SGM subgroups in this association was found. Examining stratified SGM subgroups, a 1-unit increase in minority stress was associated with 1.11 greater odds of current tobacco among transgender adults only.

CONCLUSION

Distal minority stress is differentially associated with current tobacco use for transgender young adults, which suggests that tobacco prevention and cessation interventions may need tailoring for subgroups.

IMPLICATIONS

This study details the influence of minority stress on current tobacco use among sexual and gender minority (SGM) young adults. Findings underscore the need for targeted and tailored approaches to tobacco control, wherein SGM young adults most at-risk are engaged in cessation interventions that address minority stress as a contributing factor to tobacco use and which support their resilience. To promote health equity, tobacco control must address the contexts that engender minority stress. Assessment of policy impacts on SGM tobacco use and the effectiveness of interventions disseminated within SGM-supportive and discriminatory policy environments are important next steps.

A Scoping Review of Trends in the Size of Lesbian, Gay, and Bisexual Tobacco Use Disparities, 1996-2020, United States and Canada

Purpose: Tobacco use is a major health disparity for lesbian, gay, bisexual, and transgender (LGBT) populations compared with heterosexual/cisgender populations. In this scoping review, we aimed to determine if LGBT tobacco use disparities are improving or worsening over time and if trends in disparities differed across subgroups. Methods: We included articles that longitudinally explored youth and adult LGB tobacco use in the United States and Canada after searching four databases and capturing records through July 2022. Two reviewers independently screened the title/abstract and full text of 2326 and 45 articles, respectively. Eleven articles from 18 larger assessments met inclusion criteria, spanning data collection from 1996 to 2020. Results: All studies consistently demonstrated tobacco disparities for LGB populations. No articles examined longitudinal transgender tobacco disparities. Most studies focused on smoking combustible cigarettes. Disparities in heavy or daily use for all LGB youth subgroups compared with heterosexual samples appear to be shrinking longitudinally. Results for early-onset, current, and lifetime smoking were less consistent. Adult evidence was relatively sparse; however, after 2010, studies show diminishing disparities over time, except for current smoking by bisexual women. Conclusions: Large tobacco use disparities persist for LGB populations, although the size of disparities may be decreasing for some groups. Initiatives for lesbian and bisexual women and girls should be prioritized, in addition to interventions addressing LGB smoking broadly. Surveillance instruments should uniformly and consistently assess LGBT identities and tobacco use behaviors.

LGBTQ Utilization of a Statewide Tobacco Quitline: Engagement and Quitting Behavior, 2010-2022

INTRODUCTION

Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) individuals use tobacco at disproportionately high rates but are as likely as straight tobacco users to want to quit and to use quitlines. Little is known about the demographics and geographic distribution of LGBTQ quitline participants, their engagement with services, or their long-term outcomes.

AIMS AND METHODS

Californians (N = 333 429) who enrolled in a statewide quitline 2010-2022 were asked about their sexual and gender minority (SGM) status and other baseline characteristics. All were offered telephone counseling. A subset (n = 19 431) was followed up at seven months. Data were analyzed in 2023 by SGM status (LGBTQ vs. straight) and county type (rural vs. urban).

RESULTS

Overall, 7.0% of participants were LGBTQ, including 7.4% and 5.4% of urban and rural participants, respectively. LGBTQ participants were younger than straight participants but had similar cigarette consumption. Fewer LGBTQ participants reported a physical health condition (42.1% vs. 48.4%) but more reported a behavioral health condition (71.1% vs. 54.5%; both p's < .001). Among both LGBTQ and straight participants, nearly 9 in 10 chose counseling and both groups completed nearly three sessions on average. The groups had equivalent 30-day abstinence rates (24.5% vs. 23.2%; p = .263). Similar patterns were seen in urban and rural subgroups.

CONCLUSIONS

LGBTQ tobacco users engaged with and appeared to benefit from a statewide quitline even though it was not LGBTQ community-based. A quitline with staff trained in LGBTQ cultural competence can help address the high prevalence of tobacco use in the LGBTQ community and reach members wherever they live.

IMPLICATIONS

This study describes how participants of a statewide tobacco quitline broke down by sexual orientation and gender. It compares participants both by SGM status and by type of county to provide a more complete picture of quitline participation both in urban areas where LGBTQ community-based cessation programs may exist and in rural areas where they generally do not. To our knowledge, it is the first study to compare LGBTQ and straight participants on their use of quitline services and quitting aids, satisfaction with services received, and rates of attempting quitting and achieving prolonged abstinence from smoking.

Cannabis Use Among Adults in Cigarette Smoking Cessation Treatment in Ontario, Canada: Prevalence and Association With Tobacco Cessation Outcome, 2015-2021

Objectives. To examine cannabis use prevalence and its association with tobacco cessation among adults enrolled in cigarette smoking cessation treatment before and after Canada legalized recreational cannabis in October 2018. Methods. The sample comprised 83 206 adults enrolled in primary care-based cigarette smoking cessation treatment between 2015 and 2021 in Ontario, Canada. Past-30-day cannabis use was self-reported at enrollment and cigarette smoking abstinence at 6-month follow-up. Results. Past-30-day prevalence of cannabis use increased from 20.2% in 2015 to 37.7% in 2021. The prevalence increased linearly both before and after legalization. Cannabis and tobacco co-use was associated with lower odds of self-reported cigarette smoking abstinence at 6-month follow-up than tobacco use only (24.4% vs 29.3%; odds ratio [OR] = 0.78; 95% confidence interval [CI] = 0.75, 0.81). This association was attenuated after adjustment for covariates (OR = 0.93; 95% CI = 0.89, 0.97) and weakened slightly over time. Conclusions. Cannabis use prevalence almost doubled from 2015 to 2021 among primary care patients in Ontario seeking treatment to quit cigarettes and was associated with poorer quit outcomes. Further research into the impact of cannabis policy on cannabis and tobacco co-use is warranted to mitigate harm. (Am J Public Health. 2024;114(1):98-107. https://doi.org/10.2105/AJPH.2023.307445).

Tobacco Use and Tobacco Dependence Management

Tobacco use is a major public health problem and the leading cause of preventable deaths in the United States and worldwide. Tobacco dependence determines tobacco use and is largely due to nicotine addiction. Such dependence is a disease resulting in a strong desire or compulsion to take tobacco, with difficulty in cessation of tobacco, along with persistent use despite overtly harmful consequences.

"We're always an afterthought"- Designing tobacco control campaigns for dissemination with and to LGBTQ +-serving community organizations: a thematic analysis

PURPOSE

Evidence-based health communication campaigns can support tobacco control and address tobacco-related inequities among lesbian, gay, bisexual, transgender, and queer (LGBTQ +) populations. Community organizations focused on LGBTQ + health (e.g., nonprofits, community centers, and community health centers) can be prime channels for delivering evidence-based health communication campaigns. However, it is unclear how to balance the goals of a) designing campaigns to support broad adoption/uptake and b) adaptation addressing the needs of diverse communities and contexts. As part of an effort to support "designing for dissemination," we explored the key challenges and opportunities staff and leaders of LGBTQ + -serving community organizations encounter when adopting or adapting evidence-based health communication campaigns.

METHODS

A team of researchers and advisory committee members conducted this study, many of whom have lived, research, and/or practice experience with LGBTQ + health. We interviewed 22 staff members and leaders of community organizations serving LGBTQ + populations in the US in early 2021. We used a team-based, reflexive thematic analysis approach.

RESULTS

The findings highlight the challenges of attempting to use health communication campaigns misaligned with the assets and needs of organizations and community members. The three major themes identified were as follows: (1) available evidence-based health communication campaigns typically do not sufficiently center LGBTQ + communities, (2) negotiation regarding campaign utilization places additional burden on practitioners who have to act as "gatekeepers," and (3) processes of using health communication campaigns often conflict with organizational efforts to engage community members in adoption and adaptation activities.

CONCLUSIONS

We offer a set of considerations to support collaborative design and dissemination of health communication campaigns to organizations serving LGBTQ + communities: (1) develop campaigns with and for LGBTQ + populations, (2) attend to the broader structural forces impacting campaign recipients, (3) support in-house testing and adaptations, and (4) increase access to granular data for community organizations.

Prevalence of cancer risk factors among transgender and gender diverse individuals: a cross-sectional analysis using UK primary care data

BACKGROUND

Transgender and gender diverse (TGD) individuals experience an incongruence between their assigned birth sex and gender identity. They may have a higher prevalence of health conditions associated with cancer risk than cisgender people.

AIM

To examine the prevalence of several cancer risk factors among TGD individuals compared with cisgender individuals.

DESIGN AND SETTING

A cross-sectional analysis was conducted using data from the UK's Clinical Practice Research Datalink to identify TGD individuals between 1988-2020, matched to 20 cisgender men and 20 cisgender women on index date (date of diagnosis with gender incongruence), practice, and index age (age at index date). Assigned birth sex was determined from gender-affirming hormone use and procedures, and sex-specific diagnoses documented in the medical record.

METHOD

The prevalence of each cancer risk factor was calculated and the prevalence ratio by gender identity was estimated using log binomial or Poisson regression models adjusted for age and year at study entry, and obesity where appropriate.

RESULTS

There were 3474 transfeminine (assigned male at birth) individuals, 3591 transmasculine (assigned female at birth) individuals, 131 747 cisgender men, and 131 827 cisgender women. Transmasculine people had the highest prevalence of obesity (27.5%) and 'ever smoking' (60.2%). Transfeminine people had the highest prevalence of dyslipidaemia (15.1%), diabetes (5.4%), hepatitis C infection (0.7%), hepatitis B infection (0.4%), and HIV infection (0.8%). These prevalence estimates remained elevated in the TGD populations compared with cisgender persons in the multivariable models.

CONCLUSION

Multiple cancer risk factors are more prevalent among TGD individuals compared with cisgender individuals. Future research should examine how minority stress contributes to the increased prevalence of cancer risk factors in this population.

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

INTRODUCTION

Sexual and gender minority (SGM) nicotine and tobacco use disparities are well-documented among youth and young adults (YYA), and despite decades of prevention efforts, these disparities stubbornly persist. To better understand tobacco use disparities and craft tailored interventions, tobacco use patterns must be assessed in a contemporary sample of YYA across lines of sexual and gender identity, sex assigned at birth, and tobacco product types.

AIMS AND METHODS

Data were from an online survey of a diverse sample of emerging adult tobacco users (ages 18-29; N = 1491) in California, United States (2020-2021). Participants were recruited from various online and in-person locations. Bivariate and adjusted models assessed differences in four nicotine and tobacco use outcomes (past 30-day use of cigarettes, e-cigarettes, other tobacco products, and multiple tobacco product types) across six groups: Cisgender heterosexual males, cisgender heterosexual females, cisgender sexual minority (SM) males, cisgender SM females, transfeminine participants, and transmasculine participants.

RESULTS

Compared to cisgender heterosexual males, both transfeminine (OR = 2.25, 95% confidence intervals (CI) = 1.29 to 4.05) and transmasculine (OR = 1.85, 95% CI = 1.32 to 2.80) participants had higher odds of using cigarettes. Few differences were noted between groups in use of e-cigarettes. Cisgender heterosexual males had higher odds of other tobacco product use, compared to most other groups (eg, cisgender SM males: OR = 0.57, 95% CI = 0.37 to 0.87). Transmasculine participants had higher odds of multiple product use, compared to cisgender heterosexual females. Among multiple product users, transfeminine participants had the highest prevalence of using all three individual product types (35.6%).

CONCLUSIONS

Results highlight the need for different tobacco control approaches across sexual and gender identities, sex assigned at birth, and nicotine and tobacco products.

IMPLICATIONS

SGM nicotine and tobacco use disparities remain entrenched, despite concerted efforts to reduce them. The SGM population is heterogeneous and different SGM subgroups may have different needs. This study assessed, among young adult nicotine and tobacco users in California, U.S. patterns of tobacco use across sexual and gender identities, sex assigned at birth, as well as specific tobacco products used-a necessity to craft tailored tobacco control measures. We found patterns of nicotine and tobacco product use across several of these characteristics, highlighting how different prevention and cessation interventions may be needed to meaningfully address SGM nicotine and tobacco use disparities.

Epidemiology of non-communicable diseases among transgender population residing in Chennai district, Tamil Nadu

Introduction

There is a paucity of research on non-communicable diseases (NCDs) like diabetes, hypertension and coronary heart diseases among transgenders, with more importance given to diseases like HIV. The study was undertaken to determine the prevalence of NCDs, their risk factors and the associated factors among transgenders residing in Chennai district, Tamil Nadu.

Methodology

This is a descriptive cross-sectional study done among 145 transgenders residing in the Chennai district, Tamil Nadu, selected by snowball sampling method. Data were collected by a pre-tested semi-structured questionnaire, anthropometric data were measured, and blood pressure was measured by a mercury sphygmomanometer using standard protocols. Data were entered in Excel software and analysed by using SPSS version 25.

Results

The mean age of the study participants was 36 ± 4.2 years. Nearly 91% had only up to school education. Around 26.7% suffered from type 2 diabetes mellitus, 15.1% had a history of hypertension, 36.3% were newly diagnosed hypertensives, and 13.9% were overweight/obese. Almost 40% were either current tobacco or alcohol consumers. There was a statistically significant association found between overweight/obesity and education, work, and income of study participants.

Conclusion

The high prevalence of NCDs among the study participants warrants health education among transgenders to get screened for common NCDs. Further research is needed to understand the risks of NCDs among transgenders.

"I liked just that it was a communal thing": Feasibility and acceptability of engaging with transgender and gender-diverse persons in a digital photovoice research study on commercial cigarette smoking risk and protective factors

Background

Commercial cigarette smoking is the leading modifiable risk factor for more than 16 types of cancer. Over one-third (35.5%) of transgender and gender-diverse (TGD) adults smoke cigarettes compared to 14.9% of cisgender adults. The objective of this paper is to describe the feasibility of enrolling and engaging with TGD persons in a digital photovoice study to examine smoking risk and protective factors through real-world experiences (Project SPRING).

Methods

The study comprised a purposeful sample of 47 TGD adults aged ≥18 years who currently smoke and live in the United States (March 2019-April 2020). They participated in three weeks of digital photovoice data collection using Facebook and Instagram closed groups. A subsample participated in focus groups to explore smoking risks and protective factors in greater depth. We summarized the enrollment strategies and accrual rates, participant engagement (posts, comments, and reactions) during the photovoice data collection to assess study feasibility, and respondent feedback on acceptability and likability during and after the study.

Results

Participants were recruited via Facebook/Instagram advertising (n = 33) and via Craigslist/word-of-mouth (n = 14). Costs ranged from $29 via Craigslist/word-of-mouth to $68 per recruited participant via Facebook/Instagram advertising. On average, participants posted 17 pictures of smoking risks/protective factors, commented 15 times on others' posts, and had 30 reactions within their group over 21 days. Participants' rating of the acceptability and likability of the study were positive based on closed- and open-ended feedback.

Conclusion

The findings of this report will inform future research to engage with TGD community-engaged research to develop culturally tailored interventions to reduce smoking prevalence among TGD individuals.

Cannabis Practices Among a Gender-Diverse Sample of Young Adults

Background

Gender is an important factor in understanding cannabis patterns, yet few studies have explored cannabis patterns among gender minority (GM) individuals - particularly among high-risk age groups including young adults. The evolving cannabis market is reshaping typical patterns of cannabis use in the U.S. The combination of these factors warrants increased efforts to examine cannabis practices in gender-diverse samples.

Methods

Online survey participants between 18-34 years (N=2377) from the U.S. provided information on cannabis practices from May - July 2021. Gender differences across several cannabis outcomes (onset, methods of consumption, product potency, frequency, and quantity) were assessed. Bivariate tests and multiple regression models examined associations between gender (cisgender men: n=1020; cisgender women: n=1178; and GM: n=179) and cannabis outcomes adjusting for sociodemographic characteristics.

Results

In regression models adjusted for sociodemographic characteristics, GM identity was associated with later age of onset and lower likelihood of daily use compared to cisgender men and women. Identifying as GM or cisgender woman was associated with fewer lifetime methods of consumption and lower plant and concentrate potency usage.

Conclusions

Findings provide initial insights into potential gender differences in cannabis practices from a sample of heavy cannabis users. GM young adults report use patterns indicative of lower risk compared to cisgender men and women in our sample. Future investigations of gender differences in cannabis use that explore specific gender minority categories and that include alternative sampling strategies are needed to better understand differential risks associated with gender.