Purpose Using evidence-based health communication campaigns (EBHCC) is critical for addressing disparities in tobacco-related health outcomes among LGBTQ+ populations; therefore, this study aimed to examine processes and supports for community-based organizations (CBOs) to integrate evidence-based solutions into practice using a design-for-dissemination framework. Approach Qualitative interviews were conducted. Setting CBOs serving LGBTQ+ populations. Participants 22 staff from U.S.-based CBOs participated in video interviews. Method We used reflexive thematic analysis to generate themes. Results 3 key themes included: (1) leaders perceived storytelling as a desirable and effective way to operationalize hyperlocal adaptation of content, particularly when in-group stories came from the community and included video content (which was perceived to maximize reach); (2) researcher participation in content production/delivery was seen as a compelling implementation strategy; and (3) these requested components were seen as adding value rather than as substitutions for text- and image-based EBHCC content. Adaptations envisioned by participants are associated with increased demand for limited resources (ie, requiring more time or financial resources), on the part of CBOs, the research team, or both. Researcher strategies were identified to support meeting CBOs’ needs given these contextual constraints. Conclusion This research explores supports and processes requested by CBOs serving LGBTQ+ populations as part of the adaptations envisioned in implementing EBHCCs and highlights possible avenues to better meet CBOs’ needs in effectively utilizing interventions.

Background In the USA, lesbian, gay, bisexual, transgender and queer (LGBTQ+) people report higher rates of tobacco use than non-LGBTQ+ people due to diverse factors, from anti-LGBTQ stigma to targeted marketing by the tobacco industry. There is an opportunity to support behavioural changes by delivering evidence-based health communication campaigns through community-based organisations (CBOs), but an insufficient evidence base and organisational resource restrictions limit this potential. Our previous research with CBO staff and leaders serving LGBTQ+ communities identified gaps in evidence-based campaigns, such as insufficient centering of LGBTQ+ communities in campaign development and execution. This qualitative study explores opportunities to improve the products and services supporting the dissemination of evidence-based health communication campaigns for LGBTQ+ audiences.Methods We conducted key informant interviews between January and June 2021 with individuals who direct or run health promotion programmes in CBOs serving LGBTQ+ populations in the USA (n=26 individuals from 22 organisations). Using critical and constructivist perspectives, we leveraged the analysis team and advisory committee’s diverse research, lived and practice expertise related to LGBTQ+ health. We employed a team-based, reflexive thematic analysis approach.Results We identified two key opportunities. Theme 1—show us your work: participants requested (a) details about the evidence-based campaigns, including underlying values and extent of community engagement, and (b) information about campaign mechanisms and impact. Theme 2—support us in our work: participants suggested that evidence-based campaigns should (a) be designed for flexibility and adaptation, (b) offer tools and guidance for adaptation and (c) share granular data and relevant resources. Participants nominated dissemination products and processes to address gaps, including supports to integrate campaigns into multi-level action, data collection tools for adaptation and engagement with campaign developers.Conclusions The findings highlight the potential for CBOs to be integral partners in the development and dissemination of evidence-based health communication campaigns that address tobacco-related inequities among LGBTQ+ communities.

Abstract We conducted a longitudinal randomized controlled experiment between September 2021 and May 2022 to evaluate whether anti-tobacco industry beliefs and attitudes mediate the effect of culturally tailored anti-smoking messages on quit intentions among US young adult sexual minority women (SMW) ages 18–30 who smoke. Participants were randomized to view up to a total of 20 tailored versus non-tailored messages over one month. Outcomes were assessed at baseline and one-month follow-up. We fit a structural equation model testing the effect of LGBTQ + community-tailored, anti-smoking messages on quit intentions and mediating roles of anti-industry attitudes and beliefs (n = 966). Anti-industry beliefs (indirect effect size = 0.024, 95% confidence interval [CI] = [0.040, 0.056]) and attitudes (indirect effect size = 0.034, 95% CI = [0.006, 0.077]) significantly mediated the effect of the tailored condition on quit intentions. These findings suggest that LGBTQ + -tailored cues in anti-smoking messaging may promote quit intentions indirectly through influencing young adult SMW’s beliefs and attitudes about the tobacco industry. Future campaigns to promote quitting among young adult SMW who smoke should consider incorporating themes to change their beliefs and attitudes about the tobacco industry. Trial registration This study was registered in ClinicalTrials.gov (NCT04812795) on 24/03/2021.

We conducted a longitudinal randomized controlled experiment between September 2021 and May 2022 to evaluate whether anti-tobacco industry beliefs and attitudes mediate the effect of culturally tailored anti-smoking messages on quit intentions among US young adult sexual minority women (SMW) ages 18-30 who smoke. Participants were randomized to view up to a total of 20 tailored versus non-tailored messages over one month. Outcomes were assessed at baseline and one month follow-up. We fit a structural equation model testing the effect of LGBTQ+ community-tailored, anti-smoking messages on quit intentions and mediating roles of anti-industry attitudes and beliefs (n=966). Anti-industry beliefs (indirect effect size = 0.024, 95% confidence interval [CI] = [0.040, 0.056]) and attitudes (indirect effect size = 0.034, 95% CI = [0.006, 0.077]) significantly mediated the effect of the tailored condition on quit intentions. These findings suggest that LGBTQ+ tailored cues in anti-smoking messaging may promote quit intentions indirectly through influencing young adult SMW’s beliefs and attitudes about the tobacco industry. Future campaigns to promote quitting among young adult SMW who smoke should consider incorporating themes to change their beliefs and attitudes about the tobacco industry.

The number of individuals identifying as lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ+) has doubled over the past 10 years, and this figure continues to rise. The LGBTQ+ community is diverse, encompassing a vast array of differences in gender identity and sexual orientation. Additionally, it is inclusive of people from all races, ethnicities, religions, and socioeconomic backgrounds. This intersectionality of identities and experiences impacts both access to health care and its delivery. Barriers to care for this population are multifactorial and include stigma, discrimination, bias, limited role models, issues with insurance coverage, lack of education and training for health care providers, and lack of research on LGBTQ+ health-related issues. Specific to breast cancer, the screening recommendations for this group are influenced not only by risk but also by gender-affirming hormonal and surgical therapies. This article will provide an overview of the LGBTQ+ population, review breast cancer screening compliance and recommendations, summarize the multitude of health disparities, and offer potential interventions to improve care delivery at the individual, facility, organizational, and health policy levels.

Introduction: This study explored the impact of health care (HC) bias and discrimination on lesbian, gay, bisexual, transgender, and queer (LGBTQ) parents and their children with developmental disabilities. Method: We conducted a national online survey of LGBTQ parents of children with developmental disabilities using social media and professional networks. Descriptive statistics were compiled. Open-ended responses were coded using inductive and deductive approaches.Results: Thirty-seven parents completed the survey. Most partici-pants identified as highly educated, White, lesbian or queer, cisgen-der women and reported positive experiences. Some reported bias and discrimination, including heterosexist forms, LGBTQ disclo-sure challenges, and, because of their LGBTQ identity, feeling mis-treated by their children's providers or being refused needed HC for their child.Discussion: This study advances knowledge around LGBTQ parents' experiences of bias and discrimination while accessing children's HC. Findings highlight the need for additional research, policy change, and workforce development to improve HC for LGBTQ families.

INTRODUCTION:This study evaluated effects of exposure to culturally tailored anti-smoking ads versus control ads on quitting intentions, cigarette purchase intentions, and tobacco industry perceptions among young adult, cisgender and transgender, sexual minority women (SMW). STUDY DESIGN:An online randomized controlled experiment with 1-month longitudinal follow-up was conducted. SETTING AND PARTICIPANTS:About 2,214 U.S. SMW ages 18-30 were recruited via online survey panels (The PRIDE Study and Prolific), social media ads and posts, and HER dating app ads. Data were collected in 2021-2022. INTERVENTION:Participants were randomly assigned to receive up to 20 tailored ads containing LGBTQ+ branding versus 20 control ads without LGBTQ+ branding over 4 weeks. Both conditions used identical anti-smoking statements and photographs (including several photographs of individuals who self-identified as SMW). MAIN OUTCOME MEASURES:One-month follow-up intention to purchase cigarettes, intention to quit, marketing receptivity, pro-industry attitudes, and pro-industry beliefs were measured. Analyses were conducted in 2022-2023. Linear regression models predicted outcomes at 1-month follow-up with the randomized arm, adjusted for baseline measures of each outcome and stratified by smoking status (those who currently smoked and those who did not smoke). RESULTS:Among those who smoked, follow-up intention to quit increased and intention to purchase cigarettes, marketing receptivity, pro-industry attitudes, and pro-industry beliefs decreased versus baseline in both arms. Follow-up pro-industry beliefs were significantly lower (B=-0.331, 95% CI -0.652, -0.010, p=0.043) in the tailored versus control arm, adjusted for baseline beliefs. Among those who did not smoke, marketing receptivity, pro-industry attitudes, and pro-industry beliefs decreased versus baseline in both arms. Follow-up outcomes did not differ significantly between arms. CONCLUSIONS:These findings can inform future anti-smoking campaign development to reduce cigarette smoking-related disparities among young adult, cisgender and transgender, sexual minority women and serve as the basis for developing similar ads for other LGBTQ+ audiences. TRIAL REGISTRATION:This study was registered in ClinicalTrials.gov (NCT04812795).

Purpose Evidence-based health communication campaigns can support tobacco control and address tobacco-related inequities among lesbian, gay, bisexual, transgender, and queer (LGBTQ +) populations. Community organizations focused on LGBTQ + health (e.g., nonprofits, community centers, and community health centers) can be prime channels for delivering evidence-based health communication campaigns. However, it is unclear how to balance the goals of a) designing campaigns to support broad adoption/uptake and b) adaptation addressing the needs of diverse communities and contexts. As part of an effort to support “designing for dissemination,” we explored the key challenges and opportunities staff and leaders of LGBTQ + -serving community organizations encounter when adopting or adapting evidence-based health communication campaigns. Methods A team of researchers and advisory committee members conducted this study, many of whom have lived, research, and/or practice experience with LGBTQ + health. We interviewed 22 staff members and leaders of community organizations serving LGBTQ + populations in the US in early 2021. We used a team-based, reflexive thematic analysis approach. Results The findings highlight the challenges of attempting to use health communication campaigns misaligned with the assets and needs of organizations and community members. The three major themes identified were as follows: (1) available evidence-based health communication campaigns typically do not sufficiently center LGBTQ + communities, (2) negotiation regarding campaign utilization places additional burden on practitioners who have to act as “gatekeepers,” and (3) processes of using health communication campaigns often conflict with organizational efforts to engage community members in adoption and adaptation activities. Conclusions We offer a set of considerations to support collaborative design and dissemination of health communication campaigns to organizations serving LGBTQ + communities: (1) develop campaigns with and for LGBTQ + populations, (2) attend to the broader structural forces impacting campaign recipients, (3) support in-house testing and adaptations, and (4) increase access to granular data for community organizations.

Introduction: This study explored the impact of health care (HC) bias and discrimination on lesbian, gay, bisexual, transgender, and queer (LGBTQ) parents and their children with disabilities in the United States, including the timing of developmental screening and diagnosis. Method: We conducted semistructured interviews with 16 LGBTQ parents of children with developmental concerns or disabilities recruited through a prior national survey. Interviews were transcribed and analyzed using a combined inductive and deductive approach. Results: Discrimination types reported included noninclusive forms, disclosure challenges, and providers dismissing nongestational parents and diverse families. Few parents reported screening and diagnosis delays. Parents' recommendations included: avoiding assumptions, honoring family diversity, increasing LGBTQ family support, improving HC forms, increasing antibias training, and convening a learning community. Discussion: Our study advances the knowledge around HC bias and discrimination among LGBTQ parents of children with disabilities. Findings highlight the need for increased LGBTQ-affirming family support and research representing LGBTQ family diversity in U.S. health care.