Tobacco use is causally linked to ~17 different cancers and a variety of other diseases. Although tobacco use rates have declined in the population overall, this has not been the case within sexual and gender minority groups, which are a rapidly rising demographic in the US. High tobacco use rates, up to 37.7% in some subgroups (individuals identifying as transgender), have led to recognition of LGBTQ+ individuals as a priority population for tobacco control and intervention. Despite their focus on unique stressors and health risk factors for LGBTQ+ patients/clients, LGBTQ+ centers (which provide support services, ranging from social support groups to comprehensive medical care, to pri...

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Tobacco use is causally linked to ~17 different cancers and a variety of other diseases. Although tobacco use rates have declined in the population overall, this has not been the case within sexual and gender minority groups, which are a rapidly rising demographic in the US. High tobacco use rates, up to 37.7% in some subgroups (individuals identifying as transgender), have led to recognition of LGBTQ+ individuals as a priority population for tobacco control and intervention. Despite their focus on unique stressors and health risk factors for LGBTQ+ patients/clients, LGBTQ+ centers (which provide support services, ranging from social support groups to comprehensive medical care, to primarily LGBTQ+ persons) rarely provide tobacco use disorder care. In PP230003, we propose to disseminate and implement Taking Texas Tobacco Free (TTTF)-a successful, evidence-based tobacco control intervention for cancer prevention that provides tobacco-free workplace policy guidance to de-normalize tobacco use, education and specialized training to care providers, and resources-to LGBTQ+ centers to bolster their ability to provide cessation and relapse prevention interventions to their patients/clients. TTTF has evolved across 6 CPRIT funded awards in behavioral health care and community agency settings and is currently being implemented in medical settings (FQHCs) and homeless-serving centers. Responsiveness to CPRIT priorities include that it: 1) prioritizes populations disproportionately affected by cancer; 2) is an interdisciplinary project; 3) is a collaborative project between nonprofit entities; 4) is a project to eliminate tobacco use to reduce new cases and deaths from tobacco-related cancers; and 5) develops or strengthens the infrastructure supporting the delivery of the most appropriate cancer prevention services. Overall Project Strategy. The previously implemented program, TTTF, will be fully scaled-out for application in centers serving the LGBTQ+ community. TTTF implementation in >/=3 LGBTQ+ centers (final # as time/budget allows) will include the: 1) initiation (or refreshing) of tobacco-free workplace policies; 2) provision of education and specialized training with a focus on how to facilitate trauma-informed, community-tailored (e.g., for individuals undergoing gender-affirming hormone replacement therapy; salient stressors for tobacco use, such as discrimination and internalized stigma), tobacco use cessation and relapse prevention with patients via behavioral intervention and medicinal aids while enabling capacity for a sustainable center-led training program; 3) provision of resources to educate and motivate patients and providers for tobacco use disorder care provision; and 4) engagement and education of the community around these topics. A mixed methods evaluative process will guide program adaptation and implementation, with an emphasis on capacity building for sustainability beyond the project period. Active and passive dissemination strategies will include a step-by-step implementation/replication guide and toolkit with training materials, tailored materials for passive dissemination, web-based and social media program promotion, and hands-on technical assistance. TTTF implementation will include exploration through formative evaluation, organizational preparation, active program implementation, and sustainment/maintenance. Iterative stakeholder feedback will guide implementation. The project team has an extensive record of collaboration, is firmly grounded in implementation science and health equity interventions and has generated letters of support from sources with extensive reach into the LGBTQ+ community. Specific Goals. PP230003 has 3 primary goals: 1) adapt TTTF for dissemination and implementation in centers serving individuals identifying as LGBTQ+; 2) execute and evaluate an active implementation within >/=3 centers primarily serving the LGBTQ+ community to fully inform the dissemination products (e.g., step-by-step implementation/replication guide) to reflect setting-specific considerations, barriers, and solutions; and 3) passively and actively disseminate the adapted TTTF program to LGBTQ+ serving centers statewide (providing technical assistance for center-led implementation), the community-at-large, and academic audiences. Significance and Impact. PP230003 will increase the capacity for, and the provision of, evidence-based practices for tobacco use disorder intervention in centers serving the LGBTQ+ community and thereby help to reduce tobacco use rates and prevent tobacco-related cancers. Moreover, the dissemination materials and the technical assistance we provide will facilitate center-led program adoption statewide. Consequently, it will have a significant impact on tobacco-related cancer prevention among a historically marginalized group of Texans who disproportionately use tobacco products.

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