Grant Number:	5R01CA276500-02 Interpret this number
Primary Investigator:	Veliz, Philip
Organization:	University Of Michigan At Ann Arbor
Project Title:	Smoking and Cancer-Related Health Disparities Among Sexual and Gender Minority Adults
Fiscal Year:	2025

In response to PAR-22-072: “Smoking and Cancer-Related Health Problems among Demographic Groups that Face Unique Challenges” proposes to integrate multiple independent national data sets to estimate the prevalence of smoking behaviors, low dose computed tomography (LDCT) lung cancer screening eligibility and use, and other smoking-related outcomes (e.g., lung cancer) among demographic groups that face unique challenges (DGtFUC) in the U.S. While a growing body of literature documents excessive risk in tobacco use for DGtFUC, past research focusing on these adults to determine smoking-related health problems has been severely hampered by geography and by inadequate sample sizes, particularly to examine heterogeneity within specific subgroups. Thus, there is a lack of research that examines the prevalence and unique risk factors (i.e., state-level tobacco policies) associated with cigarette smoking, LDCT lung cancer screening, and smoking-related health outcomes among DGtFUC using nationally representative data. The absence of adequate explanatory frameworks further hinders the ability to effectively screen, prevent, or treat lung cancer-related health behaviors in various populations within the U.S. The overall five-year survival rate for lung cancer is only 17-19%, but survival substantially improves with early detection. To this end, the proposed project will integrate four national data sets that include adults aged 18 years and older in the U.S. The integration of these data sets, which have common measures of demographic characteristics, cigarette use, and smoking-related health outcomes, will provide adequate sample sizes to examine the prevalence and risk factors of smoking behaviors that cannot be adequately addressed with one data set alone. This study aims to: (1) evaluate alternative state-of-the-art techniques for combining estimates from four different surveys with a specific focus on DGtFUC and cigarette use, smoking-related health outcomes, and LDCT eligibility and use; (2) using the harmonized data based on the four different surveys, assess the self-reported cigarette use, smoking pack-years, smoking-related health outcomes, and eligibility and use of LDCT lung cancer screening among DGtFUC; and (3) examine how state-level policy enactment and implementation related to unique demographic characteristics are associated with smoking, LDCT lung screening eligibility and use, and smoking-related health outcomes, while controlling for the state-level tobacco environment. We will capitalize on the unique opportunities afforded by the integration of these data sets: large samples of subgroups in the U.S; traditional comparison groups within the U.S. population; innovative methodological approaches for combining estimates; and multilevel analyses with state-level policies related to tobacco.