Human papillomavirus vaccination uptake among 27-to-45-year-olds in the United States

OBJECTIVE

The human papillomavirus (HPV) vaccine prevents six types of cancer. Previously, this vaccine was only approved for 9-26-year-olds. However, in October 2018 the U.S. Food and Drug Administration approved the HPV vaccine for 27- to 45-year-olds (mid-adults). The current study aimed to assess HPV vaccination among a national sample of U.S adults aged 27-45 years. This study also assessed factors associated with HPV vaccine initiation after age 26.

METHODS

Data were analyzed using the 2019 National Health Interview Survey. The study included two samples: (1) mid-adults aged 27-45 (n = 8556), and (2) mid-adults who self-reported they had initiated HPV vaccination within the 27-45 age range and those who were unvaccinated (n = 7307). The outcome variables were HPV vaccination status and HPV vaccine initiation. The independent variables represented constructs from Andersen's Behavioral Model of Health Services Use. The odds of HPV vaccination were estimated using weighted multivariable logistic regression models.

RESULTS

Overall, 15.6% had ever received the HPV vaccine and 13.1% initiated their first dose of the vaccine after age 26. Hispanic (aOR = 0.73; 95% CI = 0.58, 0.92) and non-Hispanic Asian persons (aOR = 0.59; 95% CI = 0.41, 0.84) had lower odds of ever receiving the vaccine than non-Hispanic White persons. Females (aOR = 2.17; 95% CI = 1.42, 3.32) had higher odds of initiating the vaccine after age 26 than males.

CONCLUSIONS

The ACIP recommendation of shared clinical decision-making emphasizes the role of clinical interactions in HPV vaccine decision-making. Study findings highlight the need to further explore contextual factors that may influence HPV vaccine behavior among mid-adults.

Inoculating Black/African American and LGBTQ Communities Against the Tobacco Industry: The Role of Community Connectedness and Tobacco Denormalization Beliefs

The purpose of this study was to explore how connectedness to Black/African American or lesbian, gay, bisexual, transgender and queer (LGBTQ) communities can promote anti-tobacco industry beliefs and to examine the role of targeted anti-tobacco industry messaging (i.e., tobacco industry denormalization [TID] messages).We hypothesized that community connectedness would predict anti-tobacco industry motivation (H1) and that this effect would be mediated by community-specific anti-industry beliefs (H2). We also hypothesized that these effects would be greater (i.e., moderated) for individuals exposed to targeted TID messages (H3). This study was a secondary analysis of data from a web-based experiment focused on the effects of counter-industry messages (data collected in 2020). The sample consisted of 430 Black/African Americans and 458 LGBTQ young adults. Hypotheses were tested using structural equation modeling. In support of hypothesis 1, community connectedness was associated with anti-tobacco industry motivation for both the LGBTQ and Black/African American subsamples. Hypothesis 2 was also supported. The associations between community connectedness and anti-industry motivations were partially mediated by anti-industry beliefs. Hypothesis 3 was not supported. Exposure to counter-industry messages did not modify the structural model; however, counter-industry messages increased anti-industry beliefs in both subsamples. Fostering community connectedness may help to mobilize community-based tobacco control efforts. Furthermore, interventions targeting anti-tobacco industry beliefs may be effective at reducing tobacco-related disparities. Anti-tobacco industry beliefs can be increased using brief targeted TID messages. Collectively, these findings suggest that community-based approaches rooted in consciousness-raising action may provide a useful model for future tobacco control interventions.

The Burden of Cancer and Pre-cancerous Conditions Among Transgender Individuals in a Large Healthcare Network

The current study aimed to examine the prevalence of and risk factors for cancer and pre-cancerous conditions, comparing transgender and cisgender individuals, using 2012-2023 electronic health record data from a large healthcare system. We identified 2,745 transgender individuals using a previously validated computable phenotype and 54,900 matched cisgender individuals. We calculated the prevalence of cancer and pre-cancer related to human papillomavirus (HPV), human immunodeficiency virus (HIV), tobacco, alcohol, lung, breast, colorectum, and built multivariable logistic models to examine the association between gender identity and the presence of cancer or pre-cancer. Results indicated similar odds of developing cancer across gender identities, but transgender individuals exhibited significantly higher risks for pre-cancerous conditions, including alcohol-related, breast, and colorectal pre-cancers compared to cisgender women, and HPV-related, tobacco-related, alcohol-related, and colorectal pre-cancers compared to cisgender men. These findings underscore the need for tailored interventions and policies addressing cancer health disparities affecting the transgender population.

It takes more than rainbows: Supporting sexual and gender minority patients with trauma-informed cancer care

BACKGROUND/PURPOSE

The American Society of Clinical Oncology has called for an increased priority to improve cancer care for sexual and gender minority (SGM) populations because of heightened risk of receiving disparate treatment and having suboptimal experiences, including perceived discrimination. We demonstrate how integrating trauma-informed care (TIC) principles across the cancer continuum is a key strategy to improving care delivery and outcomes among SGM populations.

METHOD

This empirically informed perspective expands on the concepts generated through the American Society of Clinical Oncology position statement and uses the Substance Abuse and Mental Health Services Association's "Four Rs" Toward Trauma Informed Care: Realize, Recognize, Response, and Resist Traumatization.

RESULTS

Recommendations for each component of TIC include: (1) Realize: Implement SGM cultural humility training, including modules on SGM-specific trauma, discrimination, harassment, and violence; (2) Recognize: Routinely screen for emotional distress using methods to ensure privacy, and/or normalize mental health screenings to cancer patients; (3) Respond: Create and widely disseminate policies and patients' rights that prohibit discrimination and ensure access to gender-neutral clinical environments; and (4) Resist Traumatization: Establish and respond to quality metrics (e.g., standardized patients, patient satisfaction surveys) that are informed by a community advisory board with the purpose of ensuring and maintaining quality care.

CONCLUSIONS AND IMPLICATIONS

Integrating TIC principles into cancer care for SGM populations is crucial to address disparities in treatment and clinical outcomes. Our recommendations offer practical approaches for oncology teams to implement TIC care and ensure equitable and inclusive cancer care for patients and their families.

Examining Mental Health and Bullying Concerns at the Intersection of Sexuality, Gender, Race, and Ethnicity Among a National Sample of Sexual and Gender Diverse Youth

Purpose: Most extant scholarship that examines the health experiences of sexual and gender diverse youth (SGDY) is limited in the ability to apply an intersectional framework due to small sample sizes and limitations in analytic methods that only analyze the independent contribution of social identities. To address this gap, this study explored the well-being of youth at the intersection of ethnic, racial, sexual, and gender identities in relation to mental health and bullying. Methods: Data were from a U.S. national survey of SGDY aged 13-18 years, collected in 2022 (N = 12,822). Exhaustive Chi-square Automatic Interaction Detection analysis identified intersectional social positions bearing the greatest burden of negative health-related experiences (depression, anxiety, and past 30-day in-person victimization). Results: Transgender boys were among those at the highest prevalence for compromised mental health and peer-based in-person victimization. Although the primary distinguishing factor was transgender identity for depression and anxiety, there were no racial/ethnic distinctions, corroborating some previous scholarship. Asian cisgender and transgender girl SGDY shared the lowest burden of peer-based in-person victimization in school. Conclusion: Our findings suggest a need for scholars, health professionals, and other stakeholders to better understand the mechanisms that drive negative health experiences and in-person victimization experiences at the intersections of sexual, gender, racial, and ethnic identities.

Psychometric Validation of the Patient Anal Cancer Knowledge Scale (PACKS) in a Cohort of Black and Hispanic/Latino Sexual and Gender Diverse Young Adults

Lack of anal cancer information in priority populations is a major barrier to the uptake and utilization of prevention services. A validated measure of anal cancer knowledge is needed to inform patient education and shared clinical decision-making for anal cancer prevention. The purpose of this study was to validate the Patient Anal Cancer Knowledge Scale (PACKS) in a sample of GBM, namely Black and Hispanic gay, bisexual, and other men who have sex with men (GBM) and gender expansive young adults (aged 18-30 years) living in the USA (N=188). Anal cancer knowledge was hypothesized as a 3-factor scale representing (1) risk and primary prevention (9 items), (2) symptoms (5 items), and (3) screening (3 items). Confirmatory factor analysis, internal consistency, and criterion validity were assessed. The 3-factor model demonstrated adequate fit (RMSEA=0.02; CFI=0.99). All items loaded on their respective factors (p<0.01). Scale scores indicated low to moderate anal cancer knowledge and acceptable reliability: factor 1 (M=3.5; SD=2.3; range: 0-9; α=.71), factor 2 (M=2.9; SD=1.9; range: 0-5; α=.85), and factor 3 (M=2.0; SD=1.2; range: 0-3; α=.79). History of HPV vaccination (51.3%) was positively correlated with factors 1 and 2. The PACKS demonstrated good construct validity related to knowledge of anal cancer risk, prevention, symptoms, and screening. Limited anal cancer knowledge among Black and Hispanic GBM is a potential barrier to the uptake and utilization of prevention recommendations.

Sexual and Gender Minority Invisibility in Cancer Studies: A Call for Effective Recruitment Methods to Address Cancer Disparities

#LGBTQ+ people with cancer are invisibilized: A call for #intersectional cancer research (link here) #healthequity

Integrating HPV Vaccination Within PrEP care Delivery for Underserved Populations: A Mixed Methods Feasibility Study

Human Papillomavirus (HPV) vaccination is effective at preventing anal cancer, which disproportionally impacts gay/bisexual men (GBM) and transgender women (TGW). Vaccine coverage among GBM/TGW is insufficient to reduce anal cancer disparities. Federally qualified health centers (FQHCs) can increase reach and uptake of HPV vaccination by integrating and promoting HPV vaccination in ongoing HIV preventive care (e.g., Pre-exposure Prophylaxis [PrEP]). The purpose of the current study was to assess the feasibility and potential impact of integrating HPV vaccination with PrEP care. We conducted a mixed methods study of PrEP providers and staff (qualitative interviews, N = 9) and PrEP patients (quantitative survey, N = 88) at an FQHC in Philadelphia, Pennsylvania. Qualitative thematic analysis of PrEP provider/staff interviews was informed by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify and describe barriers and facilitators to HPV vaccination implementation. Quantitative analysis of PrEP patient survey was informed by the Information-Motivation-Behavioral Skills Model. Quantitative interviews resulted in 16 themes related to characteristics of the inner and outer clinic context. Barriers among providers included lack of focus on HPV in PrEP management guidelines, in metrics mandated by funding agencies, and in electronic medical record templates. Lack of anal cancer specific knowledge and motivation was identified in both PrEP patients and providers/staff. Providing HPV vaccination during routine PrEP visits was highly acceptable to both patients and providers. Based on these findings, we recommend several multi-level strategies to increase HPV vaccine uptake among PrEP patients.

Indoor Tanning among Sexual and Gender Minority Adolescents and Adults: Results from the 2020 Pennsylvania LGBT Health Needs Assessment

Sexual and gender minority (SGM) populations include individuals whose sexual orientation, gender identity, or reproductive development is characterized by nonbinary sexual constructs (e.g., lesbian, gay, bisexual, and transgender (LGBT) individuals). Previous research suggests that some SGM populations have higher rates of skin cancer. The purpose of this study was to assess the association of diverse SGM identities with indoor tanning, a risk factor for skin cancer, while exploring other relevant co-occurring risk factors. A secondary analysis was performed on the 2020 LGBT Health Needs Assessment collected by the Pennsylvania Department of Health. Measures included sexual orientation, gender identity, healthcare utilization, and cancer risk factors. Cisgender SGM men are more likely to use indoor tanning devices (adjusted odds ratio (aOR) = 1.79; 95% CI: 1.31-2.44) compared to other SGM subpopulations independent of sexual orientation. Indoor tanning was also associated with alcohol (aOR = 1.94; 95% CI: 1.50-2.51) and tobacco use (aOR = 1.64; 95% CI: 1.21-2.21). Findings suggest that targeted screening for skin cancer risk behaviors could accompany standard tobacco and alcohol screenings in clinical practice.

Clinical, psychosocial, and sociodemographic factors of sexual and gender minority groups with cancer: A systematic review

PURPOSE

Psychosocial health varies depending on demographic and clinical factors and the social context in which individuals grow and live. Sexual and gender minority (SGM) populations experience health disparities due to systemic factors that privilege cisgender and heterosexual identities. We reviewed the literature on the psychosocial, sociodemographic, and clinical factors in SGM groups with cancer and described the associations among these factors.

METHODS

We conducted a systematic review according to Fink's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines in the PubMed, PsycInfo, Cumulative Index of Nursing and Allied Health Literature, and LGBTQ+ Life databases. Quantitative articles published in English or Spanish were included. Grey literature and studies with participants in hospice care were excluded. The quality of the publications was assessed with the Joanna Briggs Institute criticalappraisal tools.

RESULTS

The review included 25 publications. In SGM groups, systemic cancer treatment was associated with worse psychosocial outcomes; and older age, employment, and higher income were associated with better psychosocial outcomes.

CONCLUSIONS

SGM groups with cancer are different from their heterosexual cisgender peers in sociodemographic, psychosocial, and clinical factors. Clinical and sociodemographic factors are associated with psychosocial outcomes among SGM individuals with cancer.

The Effects of Prostate Cancer Treatment on Role-In-Sex in Gay and Bisexual Men: Mixed Methods Results from the Restore-1 and Restore-2 Studies

Gay and bisexual men (GBM) with prostate cancer experience worse sexual and mental health outcomes following prostate cancer treatment than heterosexual men. Emerging evidence suggests that GBM may change their role-in-sex in response to treatment effects. The purpose of this study was to describe the impact of prostate cancer treatment on role-in-sex, to estimate the prevalence of such changes, and to determine the impact on quality of life and mental health. We conducted semi-structured interviews with 30 sexual minority prostate cancer patients. Then, we recruited 401 gay and bisexual prostate cancer patients into a study assessing the effects of rehabilitation. Qualitative data were analyzed using descriptive thematic analysis. Differences in quality of life and mental health outcomes were analyzed using multivariate analyses of variance. Prostate cancer treatment resulted in loss of role-in-sex for many patients. When changes in role-in-sex occurred, the shifts were predominantly from tops to bottoms. Those with a current top role-in-sex had significantly better sexual and mental health outcomes than either versatiles or bottoms. Clinical implications include the need for providers to ask about role-in-sex in order to address disparities in health outcomes by sexual orientation and to provide culturally appropriate care to sexual minority patients.

Cisheteronormativity and its influence on the psychosocial experience of LGBTQ+ people with cancer: A qualitative systematic review

OBJECTIVE

Cisheteronormativity refers to the relationship of heterosexual and cisgender privilege stemming from patriarchy. Although studies have shown that cisheteronormativity can impact health outcomes for lesbian, gay, bisexual, transgender, queer and other sexual, gender diverse, and gender nonconforming (LGBTQ+) people, the specific impact on cancer care has not been described. We synthesized the qualitative evidence on how cisheteronormativity impacts the psychosocial experience of LGBTQ+ people with cancer.

METHODS

We conducted a historic search in the CINAHL, LGBT+ Health, PsycInfo, and PubMed databases. Qualitative studies that described the psychosocial experience of LGBTQ+ people with cancer were included. After appraising the quality of the publications, 11 articles were included. Then, we conducted inductive nominal coding, taxonomic analysis, and thematic synthesis.

RESULTS

Two main themes emerged, (1) Cisheteronormativity as a social determinant of health, and (2) Cancer, sexual orientation, and gender: Associations and introjections. The themes comprise four categories and 13 subcategories that describe the impact of cisheteronormativity on the cancer experience of LGBTQ+ people.

CONCLUSION

Cisheteronormativity within the healthcare system impacts the psychosocial experience of LGBTQ+ people with cancer. Understanding how these gender biases, norms, and social expectations impact the cancer experience is necessary to transform social norms and promote health equity.

Unrecognized sexual dysfunction in gay and bisexual men after prostate cancer treatment: the antecedents and impact of anodyspareunia

BACKGROUND

Anodyspareunia may be an adverse outcome of prostate cancer (PCa) treatment for gay, bisexual, and other men who have sex with men (GBM).

AIM

The aims of this study were to (1) describe the clinical symptoms of painful receptive anal intercourse (RAI) in GBM following PCa treatment, (2) estimate the prevalence of anodyspareunia, and (3) identify clinical and psychosocial correlates.

METHODS

This was a secondary analysis of baseline and 24-month follow-up data from the Restore-2 randomized clinical trial of 401 GBM treated for PCa. The analytic sample included only those participants who attempted RAI during or since their PCa treatment (N = 195).

OUTCOMES

Anodyspareunia was operationalized as moderate to severe pain during RAI for ≥6 months that resulted in mild to severe distress. Additional quality-of-life outcomes included the Expanded Prostate Cancer Index Composite (bowel function and bother subscales), the Brief Symptom Inventory-18, and the Functional Assessment of Cancer Therapy-Prostate.

RESULTS

Overall 82 (42.1%) participants reported pain during RAI since completing PCa treatment. Of these, 45.1% experienced painful RAI sometimes or frequently, and 63.0% indicated that the pain was persistent. The pain at its worst was moderate to very severe for 79.0%. The experience of pain was at least mildly distressing for 63.5%. Painful RAI worsened for a third (33.4%) of participants after completing PCa treatment. Of the 82 GBM, 15.4% were classified as meeting criteria for anodyspareunia. Antecedents of anodyspareunia included a lifelong history of painful RAI and bowel dysfunction following PCa treatment. Those reporting symptoms of anodyspareunia were more likely to avoid RAI due to pain (adjusted odds ratio, 4.37), which was negatively associated with sexual satisfaction (mean difference, -2.77) and self-esteem (mean difference, -3.33). The model explained 37.2% of the variance in overall quality of life.

CLINICAL IMPLICATIONS

Culturally responsive PCa care should include the assessment of anodyspareunia among GBM and explore treatment options.

STRENGTHS AND LIMITATIONS

This is the largest study to date focused on anodyspareunia among GBM treated for PCa. Anodyspareunia was assessed with multiple items characterizing the intensity, duration, and distress related to painful RAI. The external validity of the findings is limited by the nonprobability sample. Furthermore, the cause-and-effect relationships between the reported associations cannot be established by the research design.

CONCLUSIONS

Anodyspareunia should be considered a sexual dysfunction in GBM and investigated as an adverse outcome of PCa treatment.

State Marijuana Laws and Marijuana Use Among Sexual and Gender Minority Youth in the United States

Purpose: The purpose of this study was to explore the association between state-level marijuana policies and marijuana use among sexual and gender minority (SGM) adolescents. Methods: A secondary analysis was conducted using a nonprobability sample, the 2017 LGBTQ National Teen Survey, based on 10,027 youth who reported their marijuana use behaviors and state of residence. Random intercept multilevel models were estimated to account for between- and within-state variability. Results: State marijuana possession laws were not associated with lifetime use; however, the odds of current marijuana use were 50% greater among youth living in states with legalized marijuana possession for recreational use (adjusted odds ratio [aOR] = 1.50; 95% confidence interval [CI]: 1.21-1.86) compared with states that prohibit any possession. Lesbian, gay, bisexual, transgender, and queer victimization was associated with greater odds of lifetime (aOR = 1.98; 95% CI: 1.78-2.20) and current (aOR = 1.99; 95% CI: 1.74-2.27) marijuana use. Conclusions: State-level policies governing recreational marijuana possession are associated with current marijuana use among SGM youth. Public health approaches to control underage access to legal marijuana and mitigate substance use-related health disparities are needed.

Discrimination of Sexual and Gender Minority Patients in Prostate Cancer Treatment: Results from the Restore-1 Study

This study is the first to quantify experiences of discrimination in treatment undertaken by sexual and gender minority prostate cancer patients. Participants were 192 gay and bisexual and one transgender prostate cancer patients living in the US recruited from North America's largest online cancer support group. In this online survey, discrimination in treatment was measured using the Everyday Discrimination Scale (EDS), adapted for medical settings. Almost half (46%) endorsed at least one item, including 43% that the provider did not listen, 25% that they were talked down to, 20% that they received poorer care than other patients, 19% that the provider acted as superior, and 10% that the provider appeared afraid of them. While most (26.3%) rated the discrimination as "rare" or "sometimes" (EDS=1-3), 20% reported it as more common (EDS≥4). Most attributed the discrimination to their sexual orientation, or to providers being arrogant or too pushed for time. Discrimination was significantly associated with poorer urinary, bowel, and hormonal (but not sexual) EPIC function and bother scores, and with poorer mental health (SF-12). Those who had systemic/combined treatment (versus either radiation only or surgery only) were more likely to report discrimination. This study provides the first evidence that discrimination in prostate cancer treatment, including micro-aggressions, appear a common experience for gay and bisexual patients, and may result in poorer health outcomes.

Predisposing, Enabling, and Need-Related Factors Associated with Human Papillomavirus Vaccination Intentions and Uptake Among Black and Hispanic Sexual and Gender Diverse Adults in the USA

The purpose of the current study was to identify predisposing, enabling, and need-based factors associated with human papillomavirus (HPV) or HPV vaccination intentions among ethnoracial minority men who have sex with men (MSM) and gender expansive natal males. This was a secondary analysis of survey data from 299 Black and Hispanic MSM and gender expansive young (aged 18-30 years) adults living in the USA. Variable selection was informed by Anderson's model of healthcare utilization. Outcomes were self-reported HPV vaccination and vaccine intentions. Less than half of the sample (45.5%) reported initiating (i.e., receiving at least 1 dose) HPV vaccination. Hierarchical multiple regression was used to identify relevant theoretical predictors. Among those who were unvaccinated, 14.2% were unlikely, 56.3% were undecided, and 29.4% likely to initiate HPV vaccination within the next 12 months. More favorable vaccine attitudes (adjusted prevalence ratio [aPR] = 1.55; 95% CI: 1.12-2.15), past year routine check-up (aPR = 1.50; 95% CI: 1.14-1.97), and ever being diagnosed with anogenital warts (aPR = 1.55; 95% CI: 1.12-2.15) were independently associated with the probability of HPV vaccination. Several enabling factors (e.g., testing for sexually transmitted infections) were not associated with HPV vaccination, suggesting routine missed opportunities. There were no associations between predictor variables and HPV vaccine intentions. Targeted efforts are needed to decrease anal cancer disparities experienced by ethnoracial minority MSM. Leveraging enabling factors already present this population (e.g., STI testing and pre-exposure prophylaxis use) are potential targets for interventions to increase the reach of HPV vaccination.

Predictors of Empirically Derived Substance Use Patterns Among Sexual and Gender Minority Populations of a Rural Midwestern State

Purpose: The study purpose was to (1) identify latent classes of substance use behaviors among a sample of sexual and gender minority (SGM) adults living in a predominantly rural midwestern state and (2) determine the association between SGM-related discrimination and the empirically derived substance use classes. Methods: We conducted a latent class analysis on 494 responses to a state-wide survey, followed by a multinomial logistic regression to test predictors of class membership, including distal experiences of discrimination and sociodemographic variables. Results: A three-class model fit best and included (1) polysubstance use, (2) binge drinking, and (3) no/low use classes. In the adjusted model, polysubstance class membership was positively associated with cisgender male identity and negatively associated with being 60 years of age or older and college educated. Binge drinking class membership was negatively associated with bisexual/pansexual identity and non-White race/ethnicity. In contrast to hypothesized outcomes guided by the Minority Stress Model, experiences of discrimination were not associated with membership in substance-using classes. Likewise, bisexual/pansexual individuals were not more likely to be members of polysubstance use or binge drinking classes, despite published reports of greater risk of substance use. Conclusion: These contradictions warrant intersectional approaches to advance substance use research, which may provide important evidence for targeted prevention/treatment interventions, particularly among polysubstance users.

Adverse Childhood Experiences and Adult Tobacco Use Among Sexual and Gender Minority Populations: Examining the Role of Mental, Social, and Community Health

Purpose: We sought to evaluate the relationship between adverse childhood experiences (ACEs) and tobacco use, to assess the intersection of sexual orientation or gender identity (SOGI), and to explore risk and protective aspects of mental, social, and community health. Methods: This was a secondary analysis of the sexual and gender minorities (SGM) subsample (n = 1102) from a 2019 Community Health Needs Assessment. Nested binary logistic regression models were created to evaluate associations between ACEs and type of tobacco use: (1) cigarette use versus no cigarette or electronic nicotine delivery systems (ENDS) use, (2) ENDS use versus no cigarette or ENDS use, and (3) dual use versus use of either cigarettes or ENDS. Results: The sample population that reported four or more ACEs and ENDS use had statistically significant adjusted odds ratios (aORs) when adjusting the models for sociodemographic variables (aOR = 2.55; 95% confidence intervals [CIs]: 1.54-4.22), SOGI (aOR = 2.44; 95% CI: 1.46-4.10), current mental health (aOR = 2.23; 95% CI: 1.32-3.75), and social and community health (aOR = 2.19; 95% CI: 1.30-3.71). The sample population that reported poor mental health had statistically significant aORs when adjusting the models for sociodemographic variables, SOGI, and mental health (aOR = 2.26; 95% CI: 1.32-3.89) and social and community health (aOR = 2.06; 95% CI: 1.17-3.54). There was no statistically significant finding related to the other tobacco use variables (tobacco use and dual use). Conclusion: We found that high-risk ACEs were positively associated with cigarette use and ENDS use. SGM populations have differing experiences when considering community and social support.

HPV vaccination and HIV preexposure prophylaxis (PrEP): Missed opportunities for anal cancer prevention among at risk populations

Gay, bisexual, and other men who have sex with men (GBM), in addition to transgender women who have sex with men (TW), are at disproportionate risk for anal cancer. Anal cancer can be prevented with HPV vaccination, but uptake among adult GBM/TW is low. Targeted HPV vaccination during the clinical management of pre-exposure prophylaxis (PrEP) is an unexplored strategy relevant to these populations. The purpose of this study was (1) to determine the need for HPV vaccination among GBM and transgender women PrEP users and (2) to identify correlates of HPV vaccination among PrEP users. Secondary analysis of the 2020 Pennsylvania LGBT Health Needs Assessment was conducted to estimate prevalence ratios of HPV vaccination among PrEP users. Overall, 43.8% of the sample had initiated HPV vaccination. Vaccine initiation was significantly lower among respondents 27 to 35 (PR = 0.64; 95% CI: 0.49-0.83) and 36 to 45 (PR = 0.38; 95% CI: 0.25-0.58). Respondents who had received Hepatitis A vaccination were significantly more likely to have had initiated HPV vaccination after adjusting for age (aPR = 2.60; 95% CI: 1.75-3.84). Overall, more than half of eligible GBM and TW engaged in PrEP care have not initiated HPV vaccination and represent potential missed opportunities for anal cancer prevention.

Pain and Loss of Pleasure in Receptive Anal Sex for Gay and Bisexual Men following Prostate Cancer Treatment: Results from the Restore-1 Study

Prostate cancer treatments disrupt receptive anal intercourse (RAI) for gay and bisexual men (GBM). Sexual dysfunction following prostate cancer treatment may include severe pain in the anorectum during RAI (i.e., anodyspareunia). The purpose of this study was to explore the impact of prostate cancer and its treatments on RAI among GBM. Data were from a cross-sectional online survey of 100 GBM prostate cancer survivors who reported pleasurable RAI prior to treatment. Approximately 47% of the sample reported recent RAI, which was more common among GBM in long-term relationships. RAI was also associated with engagement in other sexual behaviors (e.g., oral and insertive anal sex). Anodyspareunia was reported by 23% of the men who had attempted recent RAI. Anodyspareunia was negatively associated with mental health, performing oral sex on a partner, and bowel function. The overwhelming majority received no information from their healthcare providers about loss of RAI function prior to prostate cancer treatment. Culturally responsive cancer survivorship care may need to address the loss of RAI function for GBM prostate cancer survivors.

Prostate cancer disclosure and sexual orientation: Understanding outness to healthcare providers as a situational or consistent phenomenon

OBJECTIVE

In this study, we investigated if outness is more a situational or a consistent characteristic in gay, bisexual, and other men who have sex with men (GBM) treated for prostate cancer and how the disclosure of sexual orientation impacts provider discussions of sexual side effects.

METHODS

Data came from Restore, an online cross-sectional survey of 193 GBM prostate cancer survivors living in North America and were analyzed using various statistical models.

RESULTS

Disclosure of sexual orientation and of living with prostate cancer were not significantly correlated. Participants who were out regarding sexual orientation were more likely to report that their surgeons and urologists discussed the sexual side effects of treatment.

CONCLUSION

Outness appears to be a situational phenomenon. GBM prostate cancer survivors who were out regarding sexual orientation received more discussion surrounding sexual side effects of prostate cancer treatment from their providers.

PRACTICE IMPLICATIONS

It is important for healthcare providers to inquire about patient's sexual orientation to provide holistic care to these patients to address health disparities within this group.

The Development and Psychometric Evaluation of the Mid-adult Human Papillomavirus Vaccine Knowledge Scale in the United States

BACKGROUND

Previous human papillomavirus (HPV) and HPV vaccine knowledge scales have focused on young adults in the vaccination catch-up age range or parents of vaccine eligible adolescents. Previous scales are not specific to the new guidelines for HPV vaccination in mid-adults. The study aimed to develop and validate a mid-adult HPV vaccine knowledge scale informed by the latest vaccine recommendations.

METHODS

Self-reported data were collected using a cross-sectional survey of adults aged 27 to 45 years with no history of HPV vaccination (n = 706). Exploratory and confirmatory factor analyses identified latent constructs in a 13-item mid-adult HPV vaccine knowledge scale. Sociodemographic differences in the HPV vaccine knowledge were also assessed.

RESULTS

The mean of correct responses across all items was 5.9 (SD, 2.8; range, 0-13). Exploratory and confirmatory factor analyses revealed a 3-factor structure best explained the data with a good construct validity and reliability. The first factor contained 6 items about HPV infection, the second factor contained 3 items about HPV prevention through vaccination, and the third factor contained items about HPV vaccination misinformation. Analysis of variance and t test found significant group level differences in knowledge among sex, race, educational level, annual income, health insurance, and marital status.

CONCLUSIONS

Our study supports the use of a knowledge scale for US mid-adults to assess HPV and HPV vaccination knowledge because the patient requires some baseline knowledge of this recommendation to discuss the vaccine with their health care provider. The mid-adult HPV vaccine knowledge scale can measure basic HPV knowledge important to informed decision making.

Prevalence and Risk Factors for Sexually Transmitted Infections in Gay and Bisexual Prostate Cancer Survivors: Results From the Restore-2 Study

Background

Equitable cancer survivorship care for gay and bisexual male (GBM) prostate cancer survivors should be responsive to their sexual health needs. Rates of sexually transmitted infections (STIs) are higher among GBM compared to heterosexual men across the lifespan. In addition, evidence suggests that GBM will use a variety of strategies to cope with sexual dysfunction that may increase risk for STIs. The purpose of this study was to determine the prevalence of STIs following prostate cancer treatment among GBM and identify risk factors.

Methods

In 2019, 401 GBM previously treated for prostate cancer were recruited into the Restore-2 Study. They completed a baseline online questionnaire with items assessing STIs diagnosed since being treated for prostate cancer. Any STI diagnoses was regressed on demographic, clinical, and relationship related variables using binary logistic regression.

Results

Forty-five participants (11.4%) were diagnosed with an STI during or following their prostate cancer treatment. The mostly commonly diagnosed STI was syphilis (4.3%), followed by gonorrhoea (2.8%), and chlamydia (2.5%). Four participants were infected with HIV following their prostate cancer treatment. Independent risk factors for STI diagnosis included time since prostate cancer diagnosis (aOR = 1.18; 95% CI: 1.10-1.26), nonmonogamous sexual relationship (aOR = 11.23; 95% CI: 2.11-59.73), better sexual function (aOR = 1.02; 95% CI: 1.01-1.04), penile injection treatment (aOR = 3.28; 95% CI: 1.48-7.29), and multiple sex partners (aOR = 5.57; 95% CI: 1.64-18.96).

Conclusions

GBM prostate cancer survivors are at risk for STIs. Culturally responsive STI prevention should be incorporated into cancer survivorship plans, particularly as men are treated for and regain sexual function over time.

Racial/Ethnic Differences in Health-Related Quality of Life Among Gay and Bisexual Prostate Cancer Survivors

Introduction

Prostate cancer treatment has established effects on the health-related quality of life (HRQOL) of patients. While racial/ethnic differences in HRQOL have been explored in heterosexual patients, this is the first study to examine racial/ethnic differences in a cohort of sexual minority prostate cancer survivors.

Methods

We used data from the Restore-1 study, an online cross-sectional survey of sexual and gender minority (SGM) prostate cancer survivors in North America, to explore the association between race/ethnicity and HRQOL. General mental and physical HRQOL was assessed using the Short-Form Health Survey version 2 (SF-12). The frequency and distress of prostate cancer specific symptoms was assessed using the Expanded Prostate Cancer Composite (EPIC) scale. Multivariable linear regression was used to estimate mean differences in HRQOL between sexual minority men of color and their white, non-Hispanic counterparts after adjustment for pertinent demographic and medical characteristics.

Results

Among 190 participants, 23 (12%) self-identified as non-white and/or Hispanic. In unadjusted analysis, sexual minority men of color compared to their white counterparts reported worse HRQOL scores in the EPIC hormonal summary (73.8 vs. 81.8) and hormonal function (70.9 vs 80.5) domains. Clinically important differences between men of color and their white counterparts were seen in the EPIC bowel function (mean difference (MD): -4.5, 95% CI: -9.9, 0.8), hormonal summary (MD: -8.0, 95% CI: -15.6, -0.4), hormonal function (MD: -9.6, 95% CI: -17.6, -1.6), and hormonal bother (MD: -6.7, 95% CI: -14.4, 1.1) domains. After adjustment for covariates, clinically important differences persisted between men of color and white, non-Hispanic men on the hormonal summary (74.4 vs. 81.7), hormonal function (71.3 vs. 80.3), and hormonal bother (77.0 vs. 82.7) domains.

Conclusions

This exploratory study provides the first evidence that sexual minority men of color may have worse HRQOL outcomes compared to white, non-Hispanic sexual minority men following prostate cancer treatment.

Pre-exposure prophylaxis (PrEP) use, anticipated PrEP stigma, and bisexual identity among a Black and Hispanic/Latino sexual and gender diverse sample

Black and Hispanic/Latino sexual minority men and gender diverse (SMMGD) individuals are disproportionately impacted by the HIV epidemic. Uptake and adherence to pre-exposure prophylaxis (PrEP) is suboptimal among SMMGD Black and Hispanic/Latino individuals, but most research has approached this population as homogenous (e.g., a group operationalized as men who have sex with men). Bisexual men are less likely to disclose their sexual identity and report more mental health problems than their gay counterparts, but there is less attention to the impact of different sexual identities on PrEP use over time. We utilized data from three waves of a national longitudinal study (2020-2021) to characterize Black and Hispanic/Latino SMMGD participants' PrEP use including: 1) PrEP uptake during the study; 2) consistent PrEP use across the study; and 3) discontinuation of PrEP use since study baseline. We found bisexual men were significantly less likely than gay men to be consistent PrEP users and were more likely to discontinue PrEP use over the course of the study. Of the sample who reported PrEP use across surveys, 10% initiated PrEP during the study period, 0% of whom were bisexual. Additionally, bisexual participants reported statistically significantly higher anticipated PrEP stigma relative to gay participants. These findings have implications for HIV prevention interventions. Given the differences in PrEP experiences as a function of sexual identity, researchers and clinicians should consider the disruptive role of stigma (both biphobia and anticipated PrEP stigma) in PrEP care and adherence.

Recruiting an underserved, difficult to reach population into a cancer trial: Strategies from the Restore-2 Rehabilitation Trial for gay and bisexual prostate cancer patients

BACKGROUND/AIMS

Sexual minorities are small and under-researched populations that are at disproportionate risk for cancer and poor cancer outcomes. Described as a "hidden population," the principal research challenge has been to develop effective methods to identify and recruit such cancer patients into cancer studies. Online recruitment strategies, as well as targeted clinic recruitment using patient-entered sexual orientation and gender identity data from electronic medical records have potential to transform recruitment, but studies testing the effects of how to recruit using these have not been published.

METHODS

In 2019, we conducted a naturalistic, three-arm, stratified prospective study to compare three recruitment strategies: (a) clinic based recruitment of prostate cancer patients from gay health and urology clinics; (b) directly from the gay community; and (c) online recruitment (through cancer support, sex/dating, and social sites). For each strategy, we estimated time, workload, and direct costs involved. To study how recruitment strategy may affect sampling, we tested for retention rates, demographic and outcome differences across sites. Using these methods, we successfully recruited 401 gay and bisexual prostate cancer patients into a randomized, controlled, 24-month trial testing an online sexual and urinary rehabilitation curriculum tailored for this population.

RESULTS

There were seven key results. First, it is possible to recruit substantial numbers of sexual minority men into prostate cancer studies provided online recruitment methods are used. Second, we observed big differences in dropout during study onboarding by recruitment source. Third, within online recruitment, the online sex/dating application (app) was the most successful and efficient, followed by the cancer support site, and then the social networking site. Fourth, while clinics were the cheapest source of recruitment, they were time intensive and low in yield. Fifth, the cancer support site and sex/dating app recruits differed by several characteristics, with the former being more rehabilitation-focused while the latter were younger and more sexually active. Sixth, we found almost no differences in outcomes across the three online recruitment sites. Seventh, because retention in online studies has been a concern, we confirm very low attrition at 3- and 6 months into the trial.

CONCLUSION

For sexual minority cancer research, more research on how to use sexual orientation and gender identity electronic medical record data for clinic-based recruitment is needed. For other small or hard-to-reach populations, researchers should compare and publish online versus offline recruitment strategies.

Creation and Psychometric Validation of the Sexual Minorities and Prostate Cancer Scale (SMACS) in Sexual Minority Patients-The Restore-2 Study

BACKGROUND

Existing measures of sexual functioning in prostate cancer survivors focus primarily on erectile function and do not adequately measure the experiences of sexual minority men.

AIM

To develop and psychometrically evaluate a new scale to measure sexual functioning among sexual minority men with prostate cancer.

METHODS

Sexual minority prostate cancer patients (n = 401) completed an online battery of urinary and sexual functioning tests in 2019, including a new 37-item instrument about their sexual functioning post-treatment for prostate cancer.

OUTCOMES

We used confirmatory factor analysis to determine the construct validity of a new scale including five subscales: a four-factor model for all participants (n = 401) evaluated Sexual Satisfaction, Sexual Confidence, Frequency of Sexual Problems, and Urinary Incontinence in Sex. A single-factor model completed only by participants who had attempted or desired receptive anal sex (n = 255) was evaluated in the fifth subscale: Problematic Receptive Anal Sex. To evaluate criterion validity, we calculated the intercorrelations between each Sexual Minorities and Prostate Cancer Scale (SMACS) subscale and four related scales: the Expanded Prostate Cancer Index Composite-50 (EPIC), the Functional Assessment of Cancer Therapy-Prostate, the Brief Symptom Inventory-18, and the International Consultation on incontinence questionnaire. Cronbach's alphas were calculated to measure internal consistency (ie, reliability).

RESULTS

Cronbach's alpha values ranged from 0.64 to 0.89. Loadings (0.479-0.926) and model fit indices were strong (Root Mean Square Error of Approximation: 0.085, Standardized root mean squared residual: 0.063, comparative fit index: 0.927, Tucker-Lewis Index: 0.907). For criterion validity, Sexual Satisfaction, Sexual Confidence, and Frequency of Sexual Problems were moderately correlated with EPIC function and bother scores (r = 0.50-0.72) and Urinary incontinence in sex correlated moderately with EPIC Urinary Function and International Consultation on incontinence questionnaire scores (0.45-0.56).

CLINICAL IMPLICATIONS

The SMACS can be used by clinicians and researchers to comprehensively measure sexual functioning in sexual minority men, in conjunction with existing scales.

STRENGTHS AND LIMITATIONS

This new scale is validated in a large, geographically diverse cohort of sexual minority cancer survivors and fills an important gap in existing measures of sexual functioning. Limitations include a lack of a validation sample.

CONCLUSION

The SMACS is a valid and reliable new scale that measures sexual minority men's experience of urinary incontinence in sex, problematic receptive anal sex, and sexual distress. Polter EJ, Kohli N, Rosser BRS, et al. Creation and Psychometric Validation of the Sexual Minorities and Prostate Cancer Scale (SMACS) in Sexual Minority Patients-The Restore-2 Study. J Sex Med 2022;19:529-540.

Health Disparities of Sexual Minority Patients Following Prostate Cancer Treatment: Results From the Restore-2 Study

PURPOSE

The NIH has identified sexual and gender minority persons as a health disparity population but little is known about cancer outcomes in these populations. The purpose of this study was to identify disparities in sexual minority prostate cancer patient-reported outcomes, to examine within group differences, and to test for alternative explanations for identified differences.

MATERIALS AND METHODS

In 2019, we recruited 401 gay and bisexual prostate cancer patients into the Restore-2 study, a randomized controlled trial of rehabilitation program tailored for sexual minority men.

RESULTS

Compared to the normative (heterosexual) EPIC sample, participants had significantly worse urinary, bowel and hormonal function, better sexual function, and no difference on bother scores. They also had worse depression and overall mental health, and worse physical, social/family, functional, prostate specific and overall well-being quality of life outcomes. Across measures, no differences by age, gay versus bisexual orientation, race/ethnicity, and relationship status were observed. Those who had hormonal treatment had worse sexual and hormonal function than those who had radiation or surgery only. Those with a longer time since treatment had better urinary function. Differences remained when participants were matched to normative samples on cancer stage and time since treatment.

CONCLUSIONS

This, the largest study of sexual minority prostate cancer patients to date, confirms health disparities in prostate cancer quality of life outcomes. Findings appear reliable and robust. To improve the clinical care of prostate cancer, it will be important to address the health disparities experienced by sexual minority prostate cancer patients.

Decision support needs for shared clinical decision-making regarding HPV vaccination among adults 27-45 years of age

OBJECTIVE

Identify HPV information needs and shared clinical decision-making preferences among adults 27-45 and describe differences in needs and preferences among underserved and vulnerable populations.

METHODS

Participants 27-45 years old with no history of HPV vaccination completed a cross-sectional web-based survey between April-May 2020 (N = 702). Preferred role in shared clinical decision making was described across demographic groups and sociodemographic correlates of HPV vaccine information needs.

RESULTS

Most (77.6%) reported a preference to make a medical decision on their own or after consulting with a healthcare provider, while the remaining respondents preferred to make a joint decision (17.0%) or for their doctor to make the decision (5.4%). Over 80% needed more information about safety, effectiveness, personal benefit, provider recommendation, side effects, and risks. Education was the strongest demographic factors associated with higher information needs (p<0.05).

CONCLUSION

The majority of individuals across demographic groups were individually focused with regard to their healthcare decisions and wanted more information about HPV vaccine safety, side effects, and risks, in addition to personalized information about benefits from HPV vaccination.

PRACTICAL IMPLICATIONS

Patient-centered interventions are needed to engage adults in shared decision-making regarding HPV vaccination.

Disparities in Awareness of Hepatitis C Virus Among US Adults: An Analysis of the 2019 Health Information National Trends Survey

BACKGROUND

The U.S. Preventive Services Task Force updated hepatitis C virus (HCV) screening 2020 guidelines to target adults aged 18 to 79 years: a major shift from the prior focus on high-risk populations ("baby boomers" aged ≥55 years as of 2019). To inform efforts to maximize HCV screening coverage, our objective was to identify demographic groups reporting a lack of HCV awareness, particularly by race/ethnicity and age, and sources of health information.

METHODS

We used nationally representative data of adults (≥18 years) included in the 2019 Health Information National Trends Survey (n = 5438). Awareness of HCV was defined using the following question: "Have you ever heard of the hepatitis C virus (also known as Hep C or HCV)?" We estimated frequencies by demographic groups and computed risk differences (RDs) with 95% confidence intervals (CIs) to compare lack of HCV awareness by age (<55 and ≥55 years) and race/ethnicity.

RESULTS

Overall, 17% of adults never heard of HCV. Younger adults (<55 years; 21%) were more likely to have never heard of HCV compared with older adults (≥55 years; 12%; χ2P < 0.001). This observation was consistent across most demographic characteristics including, racial/ethnic categories, and residing in the Southern United States. More than one-third of adults with low English fluency had a lack of HCV awareness in both age groups (χ2P = 0.537). Non-Hispanic (NH) Asian (RD, 25%; 95% CI, 6.9%-43.3%) and Hispanic (RD, 10%; 95% CI, 0.01%-19.6%) adults younger than 55 years were significantly more likely to have never heard of HCV compared with their NH White counterparts after adjustment for sex, educational level, household income, English fluency, and having a regular provider. Adults younger than 55 years with a lack of HCV awareness commonly obtained their health information from the Internet across most sociodemographic characteristics.

CONCLUSIONS

Hispanic and NH Asian young adults should be targeted for public health messaging regarding HCV screening, potentially through social media campaigns.

Targeted Truth: An Experiment Testing the Efficacy of Counterindustry Tobacco Advertisements Targeted to Black Individuals and Sexual and Gender Minority Individuals

INTRODUCTION

Some groups disproportionately suffer from tobacco-related illnesses-in part, because the tobacco industry has strategically targeted these groups. To combat industry targeting, antitobacco media campaigns (eg, the truth campaign) have used analogous messaging strategies, describing the industry's targeted marketing practices to reach these vulnerable groups. We tested the efficacy of counterindustry tobacco advertisements targeted to vulnerable groups (Black individuals and sexual and gender minority [SGM] individuals).

AIMS AND METHODS

From March to July 2020, we recruited N = 1161 young adults in the United States, including n = 430 Black young adults and n = 452 SGM young adults (with n = 108 identifying as Black and SGM). In a web-based, between-subjects experiment, participants were randomized to watch one of four types of advertisement ("ad"): (1) ads from the truth antismoking campaign not targeted toward a specific vulnerable group, (2) Black-targeted truth ads, (3) SGM-targeted truth ads, or (4) unrelated control ads. We examined effects on support for tobacco control policies, counterindustry motivation, counterindustry beliefs, perceived effectiveness, and anger toward the industry.

RESULTS

Relative to control, non-targeted ads increased policy support, and Black-targeted ads increased motivation and beliefs. Targeted ads elicited anger regardless of the audience targeted. However, in general, neither Black identity nor SGM identity moderated the effects of the targeted ads.

CONCLUSIONS

We offer little evidence that targeted counterindustry ads are especially influential for their intended group. However, targeted counterindustry appeals may be successful at evoking industry anger regardless of the audience targeted.

IMPLICATIONS

Counterindustry advertisements from the truth campaign targeting Black individuals and SGM individuals had limited effect on tobacco control policies, counterindustry motivation, and counterindustry beliefs. However, counterindustry ads evoked anger toward the industry regardless of ingroup status, which in turn was positively associated with anti-industry outcomes. These results, considered alongside the extant literature, suggest little benefit to developing targeted counterindustry tobacco campaigns for specific groups and instead point to the utility of developing campaigns that appeal to broader audiences.

Acceptability and Feasibility of Collecting Sexual Orientation and Expanded Gender Identity Data in Urology and Oncology Clinics

Purpose: We evaluated the acceptability and feasibility of collecting sexual orientation and gender identity (SOGI) data in oncology and urology clinical settings. Methods: We surveyed 101 urology and 104 oncology clinic patients with a standardized sexual orientation question with six response options, "lesbian, gay, or homosexual;" "straight or heterosexual;" "bisexual;" "something else;" "do not know;" and "choose not to disclose." Next, we added the sexual orientation question and an expanded gender identity question to the electronic medical record (EMR) and analyzed data on the first 450 urology and 103 oncology patients. Acceptability and feasibility were assessed based on responses to the survey and patient intake forms. Results: In the acceptability survey, only 3% of urology and 4% of oncology patients selected "choose not to disclose." Over 90% of patients in both clinics assessed the sexual orientation question as understandable and easy to answer. In all, 79% of urology and 73% of oncology patients stated they would answer it in their EMR, but only 56% of urology and 54% of oncology patients described the information as important. Sexual minority patients were as likely as heterosexual patients to state they would answer the question. Only 5% of patients selected "choose not to disclose" for sexual orientation, and <1% for the expanded gender identity question. Conclusion: Adding SOGI questions to the EMR appears to be acceptable and feasible and the sexual orientation question was understandable to a large majority of urology and oncology patients. ClinicalTrials.gov ID: NCT03343093.

Acceptability and Feasibility of Collecting Sexual Orientation and Expanded Gender Identity Data in Urology and Oncology Clinics

Purpose: We evaluated the acceptability and feasibility of collecting sexual orientation and gender identity (SOGI) data in oncology and urology clinical settings. Methods: We surveyed 101 urology and 104 oncology clinic patients with a standardized sexual orientation question with six response options, "lesbian, gay, or homosexual;" "straight or heterosexual;" "bisexual;" "something else;" "do not know;" and "choose not to disclose." Next, we added the sexual orientation question and an expanded gender identity question to the electronic medical record (EMR) and analyzed data on the first 450 urology and 103 oncology patients. Acceptability and feasibility were assessed based on responses to the survey and patient intake forms. Results: In the acceptability survey, only 3% of urology and 4% of oncology patients selected "choose not to disclose." Over 90% of patients in both clinics assessed the sexual orientation question as understandable and easy to answer. In all, 79% of urology and 73% of oncology patients stated they would answer it in their EMR, but only 56% of urology and 54% of oncology patients described the information as important. Sexual minority patients were as likely as heterosexual patients to state they would answer the question. Only 5% of patients selected "choose not to disclose" for sexual orientation, and <1% for the expanded gender identity question. Conclusion: Adding SOGI questions to the EMR appears to be acceptable and feasible and the sexual orientation question was understandable to a large majority of urology and oncology patients. ClinicalTrials.gov ID: NCT03343093.

Understanding Adverse Childhood Experiences as Predictors of Cigarette and E-Cigarette Use

INTRODUCTION

Adverse childhood experiences contribute to both short- and long-term health issues and negative health behaviors that affect the individual as well as families and communities. Exposure to ≥4 of the 11 adverse childhood experiences (high adverse childhood experiences) compounds the problems in later life. This study assesses the associations among tobacco use, adverse childhood experiences, mental health, and community health.

METHODS

This study was a secondary data analysis utilizing a large 2019 data set from a Community Health Needs Assessment in Florida (N=14,056). Investigators utilized inferential statistics to determine adverse childhood experiences as a predictor of tobacco use (vaping and cigarette use). In addition, they examined whether a shorter, 2-question adverse childhood experience scale was equivalent to the full scale when predicting tobacco use.

RESULTS

The results indicated that parental divorce was the most common household stressor, followed by mental illness and alcoholism. High adverse childhood experiences were found to be most prominent in marginalized individuals. For those individuals experiencing ≥4 adverse childhood experiences, parental divorce continued to rank high, followed by mental illness. Household stressors included emotional and physical abuse as the most prevalent in the ≥4 adverse childhood experience group. High adverse childhood experiences were associated with current cigarette smoking (AOR=1.56) after controlling for individual mental health and social/community health variables. High adverse childhood experiences were also associated with E-cigarette use (AOR=1.81) but not dual cigarette/E-cigarette use. Social and community health was inversely associated with tobacco use. A 2-item adverse childhood experiences measure was sufficient in identifying tobacco users.

CONCLUSIONS

Including adverse childhood experiences in community needs assessments provides important information for tobacco control efforts and prevention of chronic disease.

Vaccine acceptability, uptake and completion amongst men who have sex with men: A systematic review, meta-analysis and theoretical framework

BACKGROUND

Due to an increased risk of sexually transmitted infections (STIs), gay, bisexual and other men who have sex with men (MSM) have been recommended to receive vaccinations against human papillomavirus, meningitis C and hepatitis A/B. This review aimed to compare the rates of vaccine acceptability, uptake and completion, and to identify determinants of vaccine outcomes specific to MSM to inform a theoretical framework.

METHODS

In January 2020 four databases were explored to identify vaccination behaviours and associated factors among MSM. A narrative systematic review and meta-analysis were performed. Data were synthesised for theoretical modelling.

RESULTS

Seventy-eight studies, mostly from the USA, were included. The average vaccine acceptability was 63% (median = 72%, range: 30%-97%), vaccine uptake 45% (median = 42%, range: 5%-100%) and vaccine completion 47% (median = 45%, range: 12%-89%). Six categories of factors associated with vaccination acceptability, uptake and completion were conceptualised: Individual (e.g., demographic and psychosocial); Interpersonal (e.g., peer education); Healthcare provider (e.g., vaccine recommendation); Organisational and practice setting (e.g., routine collection of patient sexual orientation information that is integrated into a clinical decision support system); Community environment (e.g., targeted health promotion campaigns); and National, state and local policy environment (e.g., public health guidelines targeting MSM).

CONCLUSION

Despite overall high levels of acceptability, uptake and completion rates were below targets predicted by cost-effectiveness modelling across all recommended vaccines. These parameters may need to be adjusted for more precise estimations of cost-effectiveness. Addressing the multiple levels of determinants, as outlined in our theoretical framework, will help guide interventions to increase vaccine completion among MSM.

Psychological, Normative, and Environmental Barriers to Tobacco Cessation that Disproportionally Affect Sexual Minority Tobacco Users

INTRODUCTION

Sexual minority populations-particularly gay/lesbian and bisexual women-use tobacco at higher rates than their heterosexual peers. Evidence-based biopsychosocial interventions for tobacco cessation are available; however, research is lacking on the specific barriers to tobacco cessation in these populations. The purpose of this study is to describe the psychological, normative, and environmental barriers to cessation that disproportionally affect sexual minority tobacco users.

METHODS

Data from wave 1 of the Population Assessment of Tobacco and Health were used to explore differences by sexual identity across psychosocial barriers and facilitators of tobacco cessation. The analytic sample consisted of current tobacco users (including cigarettes, e-cigarettes, cigars, cigarillos, pipes, hookah, dissolvable snus, and smokeless products). Psychosocial barriers/facilitators were modeled using logistic regression analyses, controlling for age, race/ethnicity, poverty, education, census region, and urbanicity and were stratified by sex. Models accounted for the complex study design and nonresponse.

RESULTS

Substance use and internalizing/externalizing behavioral problems were more common among gay/bisexual men. Bisexual, but not gay/lesbian, women also had higher odds of these behavioral problems. Bisexual men and women reported less normative pressure to quit than their heterosexual peers (no differences in gay/lesbian tobacco users). Gay men had more environmental barriers to quit, being more likely to receive tobacco promotion materials, and live with another tobacco user.

CONCLUSIONS

Several barriers to tobacco cessation were identified as disproportionally affecting sexual minority groups in this study; however, there were considerable differences between sexual minority men and women, as well as between gay and bisexual participants.

IMPLICATIONS

Several important psychological, normative, and environmental barriers to tobacco cessation were identified that disproportionally affect sexual minorities. There was considerable heterogeneity in the prevalence and relative difference of these barriers across sexual minority subgroups, suggesting that community-based tobacco cessation programs should be responsive to differences in gay and bisexual men and women.

An Assessment of Cancer Education Needs to Promote Mid-Adult HPV Vaccination Among Male Sexual Minorities

The purpose of this study was to assess behavioral expectations and related psychosocial factors regarding an age-expanded human papillomavirus (HPV) vaccine schedule among male sexual minorities (MSM). A measure of behavioral expectation (BE) ("How likely are you to get the HPV vaccine if the CDC recommendation was changed to include men older than 26?") was evaluated on an ethnoracially diverse sample (N = 318) of MSM. Sixty-seven percent would likely initiate vaccination if the recommendations change. Benefits of HPV vaccination were widely endorsed. Barriers/harms of vaccination were endorsed less frequently. Only 15.4% were concerned that the vaccine would not be effective. The main driver of BE was perceived physical benefits (R² = 0.34). Psychological benefits were independently associated with BE but did not improve the explanatory model. Expectation of HPV vaccination is high among MSM in the expanded age range. Prevention of anogenital warts and anal cancer is an important consideration for this population; however, promoting the benefits of vaccination must be done in accordance with realistic expectations of vaccine efficacy in older sexually active MSM.

Trust in Health Information Sources among Underserved and Vulnerable Populations in the U.S

The purpose of this study was to examine trust in health information sources among underserved and vulnerable populations. Data (N=8,759) were from the Health Information National Trends Survey. Differences were assessed across the following subgroups: ethnoracial minorities, immigrants, rural residence, people with limited English proficiency, and sexual minorities. Trust was highest for doctors, followed by government, family/friends, charities, and religious organizations. In adjusted regression models, trusting health information from charitable and religious organizations was higher in ethnoracial minorities and immigrants. Individuals with limited English proficiency also had higher trust in religious organizations compared with those fluent in English. Trusting health information from doctors was lower among individuals with limited English proficiency. There was evidence in support of additive and multiplicative intersectional frameworks for understanding trust in vulnerable and underserved populations; however, the extent to which differences in trust explain disparities in health behaviors and outcomes should be examined.

Gay and Bisexual Men in the US Lack Basic Information About Anal Cancer

OBJECTIVE

The purpose of this study was to assess knowledge of human papillomavirus (HPV) as a cause of anal cancer among at-risk gay, bisexual, and other men who have sex with men (GBM).

MATERIALS AND METHODS

Secondary analysis was conducted of cross-sectional data from 3 cycles of the Health Information National Trends Survey (2017, 2018, 2019). Results were reported for the subset of adults who identified as GBM (N = 212). Knowledge that HPV can cause anal cancer was the main outcome. Differences in knowledge were evaluated (using χ2 and multiple logistic regression) by demographic, health information factors, and access to care.

RESULTS

Sixty-eight percent of GBM were aware of HPV. Knowledge that HPV causes anal cancer was low (<20%) in the overall sample and sample of GBM (17.9%; 95% CI = 11.0-24.7). Gay, bisexual, and other men who have sex with men were no more knowledgeable that HPV causes anal cancer than heterosexual men (14.8%; 95% CI = 12.9-16.9; p = .376). College-educated GBM had higher odds (adjusted odds ratio = 3.50; 95% CI = 1.02-11.97) of knowing HPV causes anal cancer than GBM with no college degree. No other factors were associated with knowledge.

CONCLUSIONS

Gay, bisexual, and other men who have sex with men are largely unaware that HPV can cause anal cancer, despite high awareness of HPV itself. This is concerning given that GBM are at increased risk of HPV-associated anal cancer than the general population. Our findings suggest that information about anal cancer and health information about the benefits of HPV vaccination for anal cancer prevention are only reaching a small subset of college-educated GBM. Targeted anal cancer education programs are needed.

Statin Use for Atherosclerotic Cardiovascular Disease Prevention Among Sexual Minority Adults

Background

Sexual minority, or lesbian, gay, and bisexual (LGB), individuals are at increased risk for cardiovascular disease attributable to elevated rates of health risk factors. However, although there is clear evidence that statin use can prevent cardiovscular disease in certain adult populations, no studies have examined how statins are being used among the LGB population. This study aimed to examine the prevalence and predictors of statin use among LGB and non‐LGB individuals using Facebook‐delivered online surveys.

Methods and Results

We conducted a cross‐sectional online survey about statin use in adults ≥40 years of age between September and December 2019 using Facebook advertising (n=1531). We calculated the prevalence of statin use by age, sexual orientation, and statin benefit populations. We used multivariable logistic regression to examine whether statin use differed by sexual orientation, adjusting for covariates. We observed a significantly lower rate of statin use in the LGB versus non‐LGB respondents (20.8% versus 43.8%; P<0.001) in the primary prevention population. However, the prevalence of statin use was not statistically different in the LGB versus non‐LGB respondents in the secondary prevention population. Adjusting for the covariates, the LGB participants were less likely to use statins than the non‐LGB respondents in the primary prevention population (odds ratio, 0.37; 95% CI, 0.19–0.70).

Conclusions

Our results are the first to emphasize the urgent need for tailored, evidence‐based cardiovascular disease prevention programs that aim to promote statin use, and thus healthy aging, in the LGB population.

Abstract PO-257: Disparities in unawareness of hepatitis C virus among U.S. adults: An analysis of the 2019 Health Information National Trends Survey

Purpose Infection with Hepatitis C virus (HCV) is often asymptomatic and chronic infection may lead to liver cancer. In light of the 2020 USPSTF update to HCV screening guidelines to include all adults between 18-79 years old, our objective was to investigate demographic disparities in HCV unawareness with a specific interest in age and race/ethnicity. We estimated (1) HCV unawareness by demographic groups, (2) determinants of HCV unawareness, and (3) sources of health information among those with high HCV unawareness. Methods We used weighted nationally- representative data from the 2019 Health Information National Trends Survey(N=5438) to estimate frequencies of socio-demographic characteristics by HCV unawareness and determinants of HCV unawareness through multivariable logistic regression. We further estimated risk differences (RD) with 95% confidence intervals(CIs) of HCV unawareness by age and race/ethnicity compared to older non- Hispanic(NH)-Whites. Results Overall, 17.3% of adults were unaware of HCV.

Younger adults &lt;55 years (20.7%) were more likely to be unaware of HCV compared to older adults ≥55 years (11.6%, χ2 p&lt;0.001). Multivariable analyses showed that younger age, low English fluency, and Hispanic or NH-Asian ethnicity were associated with HCV unawareness. When compared to NH-Whites ≥55 years, the largest differences in HCV unawareness was observed among NH-Asians (RD:25.6%,95%CI:8.2-43.1) and Hispanics (RD:17.1,95%CI:6.3-27.9) adults &lt;55 years.

Younger adults unaware of HCV reported primarily obtaining their health information from the internet (75.5%). Conclusions Younger adults, Hispanics, and NH-Asians are more likely to be unaware of HCV. Public health messaging should be targeted to these demographic groups to improve HCV screening coverage. Social media campaigns may increase reach as most young adults unaware of HCV obtain their health information on the internet.

Citation Format: Jessica Y. Islam, Lisa Spees, Marlene Camacho-Rivera, Denise C. Vidot, Rina Yarosh, Christopher W. Wheldon. Disparities in unawareness of hepatitis C virus among U.S. adults: An analysis of the 2019 Health Information National Trends Survey [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-257.

Abstract B037: The role of HIV status in health-related quality of life in gay and bisexual prostate cancer survivors: Findings from the Restore study

Objective: Prostate cancer is the most common invasive cancer in gay and bisexual men. Despite the unique sexual and urinary concerns of this group, nearly all studies of prostate cancer rehabilitation post-treatment have focused on heterosexual men. Older gay and bisexual men, the generation most likely to experience prostate cancer, also have high prevalence of human immunodeficiency virus (HIV), which is associated with lower quality of life. Research has indicated that people with HIV may experience health disparities in cancer treatment, but to our knowledge, this is the first quantitative study of the association between HIV status and health-related quality of life (HRQOL) in gay and bisexual men with prostate cancer.

Methods: Data from the Restore study, a cross-sectional online survey of gay and bisexual men treated for prostate cancer and residing in the United States or Canada, were used to examine this association. The Expanded Prostate Cancer Index Composite (EPIC) was used to assess function and bother in four domains: urinary, sexual, bowel, and hormone. Overall physical and mental HRQOL was assessed utilizing the SF-12 Health Survey. Multivariate analysis of variance (MANOVA) was used to evaluate the association between HIV status and HRQOL scores. Models were adjusted for age, race, treatment (prostatectomy, radiation, or advanced treatment), relationship status (partnered/married versus single/dating/widowed/divorced), preferred role in sex, and number of comorbidities.

Results: Of 193 participants, 24 (12.4%) reported an HIV diagnosis, including 3 diagnosed after their prostate cancer treatment. The cohort was 89 percent white, with mean age 63.4 years. After adjustment for demographic and treatment characteristics, HIV-positive status was associated with lower scores on the EPIC urinary (RD: -10.8, 95% CI: -19.5 to -2.2) and sexual (RD: -10.3, 95% CI: -20.2 to -0.4) domains. Although there were no statistically significant associations found in the other domains, HIV-positive participants reported lower outcomes in all domains except the SF-12 mental domain (RD: 0.3, 95% CI: -5.0 to 5.6).

Conclusion: Our findings, though imprecise, provide evidence that HIV status may be associated with poorer HRQOL in gay and bisexual prostate cancer survivors.

Citation Format: Elizabeth J. Polter, Christopher W. Wheldon, Nidhi Kohli, B. R. S. Rosser. The role of HIV status in health-related quality of life in gay and bisexual prostate cancer survivors: Findings from the Restore study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B037.

Family Rejection and Cigarette Smoking Among Sexual and Gender Minority Adolescents in the USA

BACKGROUND

Sexual and gender minority (SGM) adolescents are more likely than their heterosexual and cisgender peers to smoke cigarettes. Family rejection has been associated with adverse health outcomes; however, few studies have examined whether SGM-specific family rejection is associated with cigarette smoking among SGM adolescents.

METHOD

A non-probability sample of 11,005 SGM adolescents (M = 15.58, SD = 1.27) completed an online cross-sectional survey. Bivariate and multivariable analyses were conducted to examine associations between SGM-specific family rejection, sociodemographic variables, and smoking.

RESULTS

Approximately 7% of the sample currently smoked cigarettes. Pansexual, asexual, trans boys, and non-binary assigned female at birth adolescents had the highest SGM family rejection scores. In multivariable regression analyses, SGM-specific family rejection was independently associated with smoking after adjusting for covariates (AOR = 1.15, 95% CI 1.04, 1.28). Family support (AOR = 0.80, 95% CI 0.73, 0.88) and experiencing violence (AOR = 1.64, 95% CI 1.49, 1.82) were also associated with smoking in multivariable models. Adolescents who identified as bisexual versus gay/lesbian (AOR = 1.50, 95% CI 1.21, 1.85) and trans boys versus cisgender girls (AOR = 2.05, 95% CI 1.13, 3.71) had an increased odds of smoking. Those who disclosed their sexual orientation identity to most (AOR = 1.95, 95% CI 1.45, 2.63) and all (AOR = 1.60, 95% CI 1.21, 2.11) of their family/parents had increased odds of smoking.

CONCLUSION

Our findings underscore the importance of attending to the role of SGM-specific family rejection and distinctions with SGM adolescents in tobacco prevention and smoking cessation efforts.

Evidence of Diverse Identities in a Large National Sample of Sexual and Gender Minority Adolescents

Adolescence is a time of identity exploration, and preliminary evidence indicates the ways adolescents are describing their sexual and gender identities (SOGI) are changing. A nuanced understanding of SOGI is necessary for valid assessment in developmental research. Current measures do not capture the diversity of emerging identities among young people. Our study analyzed a national sample of 17,112 sexual and gender minority adolescents (13-17 years) to better understand how identity labels are reported across sexual, gender, and ethnoracial minorities. Adolescents reported 26 distinct SOGI categories; 24% of adolescents utilized nontraditional SOGI labels, such as pansexual and nonbinary. These identifications varied significantly as a function of ethnoracial identity. Results have implications for how scholars conceptualize and measure SOGI among adolescents.

Care delivery, patient experiences, and health outcomes among sexual and gender minority patients with cancer and survivors: A scoping review

Sexual and gender minorities (SGMs) face a disproportionate burden of cancer, yet little is known about the experiences and specific needs of these underserved populations in cancer care delivery. The authors conducted a scoping review to characterize the literature on cancer care delivery, health outcomes, and health care experiences for patients with cancer and survivors identifying as SGM. In total, 1176 peer-reviewed citations were identified after a systematic search of the PubMed/Medline, PsycInfo, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Web of Sciences databases without restriction on publication date. The details captured included study aims, design, population, cancer site, and main findings. Thirty-seven studies published from 1998 to 2017 met the study criteria. Most studies were conducted in the post-treatment survivorship phase of the continuum (n = 30), and breast cancer was the most common cancer site (n = 20). There were only 2 intervention studies. The studies reviewed were classified under the following areas of focus: 1) disclosure of sexual orientation and gender identity, 2) quality of care, 3) psychosocial impact of/ adjustment to cancer, 4) social support, 5) sexual functioning, and 6) health risks/health behavior. Very little research reported an assessment of gender minority status or included a focus on gender minorities (n = 7). This review revealed substantial research gaps given a lack of population-based data and small sample sizes, likely related to the absence of systematic collection of sexual orientation and gender identity information in the cancer care context. Deficient research in this area likely perpetuates health disparities. Further research is needed to identify and remove the barriers to delivering high-quality care to SGM individuals with cancer.

Health-related quality of life by human immunodeficiency virus status in a cross-sectional survey of gay and bisexual prostate cancer survivors

OBJECTIVE

Prostate cancer is the most common invasive cancer in gay and bisexual men (GBM). Despite the unique sexual and urinary concerns of this group, studies of prostate cancer rehabilitation have primarily focused on heterosexual men. GBM also have high prevalence of human immunodeficiency virus (HIV), which may be associated with lower health-related quality of life (HRQOL). We examined the association between HIV status and HRQOL in a cohort of GBM with prostate cancer.

METHODS

Data from the Restore study, a cross-sectional online survey of GBM treated for prostate cancer, were used to examine this association. The Expanded Prostate Cancer Index Composite (EPIC) assessed function, bother, and summary measures in four domains: urinary, sexual, bowel, and hormone. Overall physical and mental HRQOL was assessed using the Short-Form Health Survey (SF-12). Multivariate analysis of variance and linear regression were used to evaluate the association between HIV status and HRQOL scores after adjustment for demographic and sexual characteristics.

RESULTS

Of 192 participants, 24 (12.4%) reported an HIV diagnosis. After adjustment for covariates, HIV-positive status was associated with lower scores on the EPIC urinary (mean difference [MD]: -13.0, 95% CI, -21.4 to -4.6), sexual (MD: -12.5, 95% CI, -21.9 to -3.2), and bowel (MD: -5.9, 95% CI, -11.7 to -0.2) domains. No significant associations were observed between HIV status and other outcomes.

CONCLUSIONS

HIV status may be associated with poorer urinary, sexual, and bowel HRQOL in GBM prostate cancer survivors.

Care delivery, patient experiences, and health outcomes among sexual and gender minority patients with cancer and survivors: A scoping review

Sexual and gender minorities (SGMs) face a disproportionate burden of cancer, yet little is known about the experiences and specific needs of these underserved populations in cancer care delivery. The authors conducted a scoping review to characterize the literature on cancer care delivery, health outcomes, and health care experiences for patients with cancer and survivors identifying as SGM. In total, 1176 peer-reviewed citations were identified after a systematic search of the PubMed/Medline, PsycInfo, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Web of Sciences databases without restriction on publication date. The details captured included study aims, design, population, cancer site, and main findings. Thirty-seven studies published from 1998 to 2017 met the study criteria. Most studies were conducted in the post-treatment survivorship phase of the continuum (n = 30), and breast cancer was the most common cancer site (n = 20). There were only 2 intervention studies. The studies reviewed were classified under the following areas of focus: 1) disclosure of sexual orientation and gender identity, 2) quality of care, 3) psychosocial impact of/ adjustment to cancer, 4) social support, 5) sexual functioning, and 6) health risks/health behavior. Very little research reported an assessment of gender minority status or included a focus on gender minorities (n = 7). This review revealed substantial research gaps given a lack of population-based data and small sample sizes, likely related to the absence of systematic collection of sexual orientation and gender identity information in the cancer care context. Deficient research in this area likely perpetuates health disparities. Further research is needed to identify and remove the barriers to delivering high-quality care to SGM individuals with cancer.

How Is Health Literacy Related to Pap Testing Among US Women?

While Pap testing has significantly reduced the burden of cervical cancer, not all women follow prevention recommendations of cervical cancer screening every 3 years. Health literacy regarding Pap testing may influence the adoption of this behavior. The objective of this study was to assess the health literacy-related factors associated with Pap testing among a nationally representative sample of women in the USA. The Health Information National Trends Survey Cycles 4.4 and 5.1 were restricted to women 21-65 years of age (N = 2992). Questions were selected using the Integrated Model of Health Literacy domains: access (i.e., seeking cancer information), understand (i.e., HPV awareness, HPV knowledge), appraise (i.e., prevention not possible, chance of getting cancer), and apply (i.e., received a Pap in last 3 years [outcome]). Survey-weighted, logistic regression models estimated how the health literacy domains were associated with Pap testing, using SAS 9.4. In the sample, 81.1% of women received a Pap test within the last 3 years. The analysis revealed women who knew HPV is an STD (aOR = 1.64, 95% CI 1.20-2.26) were more likely to have received a Pap test in the last 3 years, while controlling for sociodemographic factors. These findings indicate that knowledge about HPV may be associated with Pap testing behavior among US women. Continued research is needed to examine the impact of health literacy on Pap testing given the changes in screening guidelines, with the ultimate goal of decreasing cervical cancer.

Cigarette Smoking Among Youth at the Intersection of Sexual Orientation and Gender Identity

Purpose: The purpose of this study was to identify subgroups of sexual and gender minority (SGM) youth who are most vulnerable to tobacco use. Methods: We analyzed data from a national nonprobability sample of 11,192 SGM youth (ages 13-17). Age of cigarette initiation and current use were modeled using Cox proportional hazard and binomial regression. Sexual and gender identities were explanatory variables and the models were adjusted for ethnoracial identity and age. Results: Approximately 7% of the sample reported current smoking. Cisgender and transgender boys had higher odds of current smoking compared with cisgender and transgender girls (adjusted odds ratio [AOR] = 1.86; 95% confidence interval [CI]: 1.56-2.21). Pansexual-identified youth had higher odds of smoking (AOR = 1.33; 95% CI: 1.05-1.70) compared with gay/lesbian youth independent of gender identity. Pansexual-identified cisgender boys had the highest smoking prevalence (21.6%). Predicted probabilities were higher among transgender boys across all sexual identities, except asexual. The hazard of smoking at a younger age was greater for transgender boys compared with cisgender boys (adjusted hazard ratio [AHR] = 1.67; 95% CI: 1.43-1.94) as well as for bisexual (AHR = 1.12; 95% CI: 1.01-1.24) and pansexual (AHR = 1.17; 95% CI: 1.03-1.33) youth compared with those who identified as gay or lesbian. Conclusions: These findings suggest that transgender boys may be at higher risk for early and current cigarette use regardless of their sexual identity, whereas smoking varied more widely for youth across different sexual identities. The findings suggest that specific subgroups of SGM youth require focused attention in tobacco control research and practice.