computer does not like my slides. I will say that I have such envy giving a presentation after someone who talked and had such rich data because in the United States we do not collect data on the LGBTQI plus community in most of our spaces so I will not be presenting numbers to go along with any of the things that I'm talking about. I am Shannon Kozlovich, she, her, hers pronouns and I'm from the National LGBTQI plus Cancer Network to talk about LGBTQI plus communities and lung cancer. So what our network does is we arrange what we do and how we impact communities and change by educating our own populations on the need for screenings and getting involved in their own care, to advocate for inclusion of LGBTQI plus people in mainstream cancer organizations, the media, and our research because when we are not included in research we cannot be included in bedside care. And also training. I stand up in rooms like this and talk to a lot of people all the time about the existence of LGBTQI plus people, how important it is to approach folks with a culturally competent attitude and to understand that LGBTQI plus folks exist in every population. We are a part of every religion, every organization, every sex, every gender, every race. We are in your care whether or not you are asking about us, counting us, or recognizing that we're there. So when we look at health disparities among LGBTQI plus communities we're really looking at the fact that we do exist and not only and we don't only exist as lesbian, gay, bisexual, transgender, queer, or intersex folks. We also exist at different education levels, different races, different socioeconomic classes. We speak different languages, we come from different cultures, we have different ethnicities, and we come in all age groups. And so this really means that we're looking at how to retreating all of our communities and all of the people that we come in contact and serve and research in a way that is recognizing the whole person that they are when they are coming into our space and how to treat them appropriately. When we look at folks who live at these intersections of marginalized identities you're really looking at what minority stress does to health care and health care disparities. And minority stress is defined as the mental and emotional strain that marginalized groups experience due to prejudice, discrimination, or racism. This includes how we internally feel and stigmatize ourselves because of what culture has placed on us. This includes social stressors that our culture puts on us as well, and also a lot of the political landscape which in this country is not going in the right direction for LGBTQI plus equity, and also just discrimination. And this can be anything from implicit bias or explicit bias, anything from direct discrimination that is thrown at you in your face purposefully, to the microaggressions that a lot of us face all day and in a lot of circumstances. When we're looking at minority stress and how communities deal with stress, they tend to reach for substances, they reach for something that will help them feel a little bit better, calm that anxiety. And so a lot of marginalized communities, the LGBTQI plus community included here in the United States, tend to have a higher rate of tobacco use. This also means that we have a higher rate of lung cancer because, you know, tobacco causes cancer. It's bad for you. I feel like we all know that, and we establish that. It's also an addiction. So the folks that are current users of tobacco products are there because organizations have targeted that marketing directly to them. It's because of life circumstances. It is because of stress that is in their life that leads to the increased risk of lung cancer. And an increased risk of lung cancer or an increase of reaching for substances that help us deal with stressors in life, this causes disparities across the entire cancer care continuum. From primary prevention, because we tend to be in spaces and lower socioeconomic status groups, we tend to have higher use of tobacco. To detection and diagnosis, treatment, and survivorship, because we don't trust medical institutions because of how we're so often treated and approached in doctor's offices. Because of the things that we face in society and the social pressure that is placed upon us for a lot of things. And here in the United States, also because LGBTQI plus communities are overrepresented in low socioeconomic status groups or low income groups, which means that we have less health care coverage and less health care coverage that can cover the entire cost of any treatments or screenings or preventative care that's needed. So really when we look at how do we solve and address these issues, short of solving racism, solving transphobia, solving homophobia, getting rid of sexism, and doing all of that, because that would definitely solve the issue, removing tobacco from the face of the planet would probably also help to decrease tobacco rates too. Short of that though, because I feel like that's a really big ask from individuals in this room, instead we can examine the cancer spaces that we work in and that we exist in or that we advocate to change. We can look at the ways that our cancer centers are naming different programs inside of them. Why are we talking about women's cancer when we're talking about lung cancer? Because this particular place says that they're bringing specialists focused on all forms of women's cancer. Did you know that women get lung cancer? This center is not a lung cancer treatment center though. And the way that it is named is increasing marginalization. It is telling transgender men and non-binary folks who have a cervix, who can get cervical cancer, that they are not welcome in that space and that space is not for them. Which means that if you work in a health system that has names like this, your transgender patients are less likely to trust you or to trust the care that they will receive at your institution or trust recommendations for screenings and ways to interact with your care. So we really need to look at broad systems change in how we use language and terminology in our cancer care spaces. And then we also need to look at how we talk about lung cancer screening. So LGBTQI plus communities tend to have a culture that they develop all on their own because we are excluded from so many social spaces so we come together and we create our own communities. We create our own communities that are local. We create in the United States our communities are full of pride and joy and color and also a concept called chosen family where we are kicked out of our families of origin a lot of times and so we don't have access to those same spaces that a lot of folks do. So you need to find ways to explain lung cancer screening to folks who aren't going to know their family history, who don't have access to go ask their families of origin or their genetic families what is your cancer history in your family and also have higher rates of lung cancer and also have higher rates of medical mistrust. So how do you meet these communities where they're at? How do you use their own languages of needing more time with each other, of joy, of power, of pride, of years on this earth, on years of joy that they missed out on for all of the times that they were in the closet or hiding who they were or not able to express who they were? How do you think about the campaigns that you're putting out there and who it is that you're bringing in and then give them ways to demystify what lung cancer screening is? The QR code here is to a landing page on a website that we created called Breathe Out and this campaign really like walks people through what is lung cancer screening? What can you expect in that office visit? Because so often medical professionals in the U.S. don't have time and LGBT communities need you to have time but if they're not going to be explained it in the doctor's office we provided a way to explain this to communities and for them to access the information themselves putting the power back in their hands. And a lot of this also comes down to how through cancer prevention programs or cancer screenings or cancer diagnosis you talk to folks about tobacco cessation and also where do we lean on tobacco prevention? And tobacco cessation isn't any different when you need to meet communities where they are. In the United States we have a quitline structure that is places where you can call in and get talk therapy or like peer-to-peer talk support for going through tobacco cessation. But a lot of those places will misgender folks when they call in. They won't, they'll assume if you're married you're married to someone of the opposite gender that they assume that you are and there's a lot of things that make it really uncomfortable to access. So we created a campaign that really looks at quitting as an act of self-love and community love, a way to live in community together. And it's because quitting smoking really is one of the hardest things you can do and it needs cessation needs to be handled in a non-judgmental way. Thank you.

LGBTQI+ lung cancer

minority stress

inclusive healthcare

tobacco cessation

culturally competent care