Defense Date


Document Type


Degree Name

Doctor of Philosophy


Social and Behavioral Health

First Advisor

Richard Brown


Background: Each year in the United States there are roughly 2 million new cancer diagnoses, with over 600,000 deaths due to cancer. The National Cancer Institute developed a six-stage cancer control continuum framework ranging from etiology to survivorship to organize the cancer experience. Sexual and gender minorities (SGM) are comprised of multiple communities representing ~23.6 million adults in the US, SGM face disparities at each stage of the cancer control continuum. This study emphasizes three stages, prevention, detection, and treatment. Engagement in prevention can prevent or prolong cancer, early detection through engagement in cancer screening improves cancer trajectories and compliance with time-to-treatment recommendations based on stage of detection (early or late) and cancer type improves cancer prognosis. A gap in literature is determining unique barriers and facilitates to SGM prevention, detection, and time-to-treatment. The minority stress model has described disparities in SGM prevention and detection but to date has not explored disparities in time-to-treatment. The minority strengths model has described health promotion for SGM including cancer screening but has not explored prevention or time-to-treatment.

Objective: The objective of this study was to examine the barriers and facilitators to cancer prevention and detection for SGM and understand how SGM cancer survivors’ experiences, across the cancer control continuum, may have been impacted by both stressors and strengths. Through the utilization of a sequential explanatory mixed methods approach: Aim 1 (Quantitative, comparison of 120 non-SGM and 60 SGM crowd-sourced survey data, on prevention engagement, cancer screening compliance with guideline recommendations, cancer detection, and compliance with time-to-treatment recommendations), Aim 2 (Qualitative, in-depth interviews among SGM on the cancer control continuum and Minority stress and strength constructs), Aim 3 (Triangulation, 60 SGM cancer survivor quantitative surveys and 10 SGM in-depth interviews describing and quantifying engagement in prevention, cancer screening compliance, and experiences of self-advocacy throughout their experiences with cancer).


Aim 1: There were no significant differences between SGM and non-SGM on prevention engagement, compliance with cancer screening recommendations, cancer detection rates, and compliance with time-to-treatment recommendations.

Aim 2: SGM survivors endorsed four cancer control continuum stages, four of the six original minority stress constructs, also identifying two additional stressors co-morbid psychological distress and self-doubt in the ability to full embrace their SGM identities for survivors < 45 years old. Finally, the SGM survivors endorsed all six minority strength constructs and two additional strengths, self-acceptance for survivors > 45 years old and self-advocacy.

Aim 3: The most engaged in prevention behaviors for SGM both in the survey and interviews were smoking cessation and physical activity. There were significant differences between SGM who engaged in colonoscopies, HPV pap smears, mammograms, and PSA tests compared to SGM who were recommended to screened. Survivors also used self-advocacy to gain access to many of these cancer screeners.

Discussion: This study indicates calls-to-action, to improve prevention related to safe-sex and HPV-vaccine uptake as these were not highly endorsed by SGM cancer survivors. As well as to reduce the need for SGM to self-advocate for cancer screeners.


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Available for download on Tuesday, July 16, 2024