Associations of Sexual Orientation and Sexual Orientation-Related State Policy Environments With Smoking and Lung Cancer Screening Outcomes Among US Adults

Abstract Introduction Cigarette smoking remains disproportionately higher among sexual minority (SM; lesbian, gay, or bisexual) adults relative to straight/heterosexual adults, making SM adults an important sub-population for lung cancer screening. Policies can influence the health of stigmatized and non-stigmatized populations. We examined associations of sexual orientation-related state policy environments (i.e., laws that protect or harm SM populations, with harmful laws representing structural-level sexual stigma) with cigarette smoking and low-dose computed tomography (LDCT) lung cancer screening disparities among SM and straight adults. Methods We combined 2017–2023 data from the Behavioral Risk Factor Surveillance System (n = 560 833 adults aged ≥18 years) and the Movement Advancement Project. We used multivariable logistic regression models to examine associations of sexual orientation and sexual orientation-related state policy environment with current cigarette smoking, smoking history, eligibility for, and utilization of LDCT lung screening, adjusting for potential confounders. Results SM adults had increased odds of current cigarette smoking (aOR range = 1.32–1.33, p < .001), lifetime smoking ≥100 cigarettes (aOR range = 1.28–1.33, p < .001), and LDCT lung screening eligibility (aOR range = 1.28–1.58, p < .05) compared to straight adults. Living in a state with lower policy protections increased the odds of current cigarette smoking (aOR range = 1.16–1.32, p < .001), lifetime smoking ≥100 cigarettes (aOR range = 1.10–1.11, p < .01), ≥20 smoking pack years (aOR range = 1.15–1.40, p < .01), and LDCT screening eligibility (aOR range = 1.15–1.26, p < .05) compared to living in a state with high policy protections. Conclusion SM adults have increased odds for smoking and LDCT lung screening eligibility relative to straight adults. Structural-level sexual stigma negatively influences smoking and lung health among SM and straight adults. Implications Despite the overall decline in cigarette smoking in the United States, it remains disproportionately higher among sexual minority (SM) populations, making them an important sub-population for lung cancer screening. We examined the relationships between sexual orientation and sexual orientation-related state policy environments with cigarette smoking and low-dose computed tomography (LDCT) lung cancer screening outcomes among SM and straight adults. We found that SM adults have increased odds of smoking and LDCT lung cancer screening eligibility relative to straight adults. Structural stigma negatively influences smoking behavior and lung health among SM and straight adults. Preventive interventions to mitigate structural stigma are needed.