Cancer Causes & Control

, Volume 29, Issue 8, pp 769–774 | Cite as

Differences in smoking prevalence and eligibility for low-dose computed tomography (LDCT) lung cancer screening among older U.S. adults: role of sexual orientation

  • Alicia K. MatthewsEmail author
  • Sean Esteban McCabe
  • Joseph G. L. Lee
  • Phil Veliz
Original paper


The purpose of this study was to determine the past-year prevalence estimates of cigarette smoking and eligibility for low-dose computed tomography (LDCT) lung cancer screening among older U.S. adults and examine potential variations in these estimates by sexual orientation. Data were from the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) and included in-person interviews with a nationally representative sample of non-institutionalized adults aged 18 and older. Eligibility for LDCT was based on U.S. Centers for Medicare and Medicaid Services (CMS) guidelines. Analyses included participants aged 55–77 (n = 9,635). Overall, 17.5% of older adult respondents reported past-year smoking. Overall rates of past-year cigarette smoking were influenced by sex and sexual orientation with males reporting higher rates compared to females. Among both males and females, smoking was most prevalent among bisexual individuals. Eligibility for LDCT was also higher among males compared to females and among bisexually identified adults relative to homosexual and heterosexual-identified adults. Overall, 11.2% of older U.S. adults met eligibility for LDCT lung cancer screening. Eligibility for LDCT lung screening is associated with sexual orientation; the highest rates of eligibility are among bisexual women and men (26.9 and 24.5%, respectively). The current study found variations in cigarette smoking and eligibility for LDCT lung cancer screening (a proxy for chronic high-risk smoking) among older U.S. adults based on sexual orientation. Efforts to increase screening should take into account these differences.


LDCT lung cancer screening Cigarette smoking Sexual orientation Cancer disparities Cancer screening 



Low-dose computed tomography


National Epidemiologic Survey on Alcohol and Related Conditions


Centers for Medicare and Medicaid Services


National Lung Screening Trial


United States Preventive Services Task Force


Lesbian, gay, and bisexual



This manuscript was prepared using a limited access dataset obtained from the National Institute on Alcohol Abuse and Alcoholism. The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute, National Institute on Alcohol Abuse and Alcoholism, National Institute on Drug Abuse, National Institutes of Health, or the U.S. Government. The authors would like to thank Sebastian Hoak for his assistance with variable preparation during a summer internship.


The development of this manuscript was supported by research Grants P20CA202908, R01CA212517, R01CA203809, R01DA036541, R01DA031160, and U54CA202997 from the National Cancer Institute and the National Institute on Drug Abuse, National Institutes of Health.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to report.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.College of NursingUniversity of Illinois at ChicagoChicagoUSA
  2. 2.Institute for Research on Women and GenderUniversity of MichiganAnn ArborUSA
  3. 3.Department of Health Education and Promotion, College of Health and Human PerformanceEast Carolina UniversityGreenvilleUSA

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