# Alcohol and tobacco use among sexual and gender minority cancer survivors in relation to urbanicity/rurality

## TL;DR

This study found that where sexual and gender minority cancer survivors live affects their alcohol use, with suburban residents drinking less than urban ones.

## Contribution

The study reveals how urbanicity and social factors influence alcohol and tobacco use in SGM cancer survivors.

## Key findings

- Suburban SGM cancer survivors had lower odds of drinking ≥2 alcoholic drinks/day compared to urban residents.
- Black/African American SGM cancer survivors had higher odds of both alcohol and tobacco use.
- Education and health insurance were linked to lower tobacco use among SGM cancer survivors.

## Abstract

Understanding how place of residence affects cancer-related health risks is paramount to addressing health disparities in sexual and gender minority (SGM) cancer survivors. This study examined the associations between urbanicity and other social drivers of health on current tobacco and alcohol use in SGM cancer survivors.

The OUT: National Cancer Survey Study was a cross-sectional, online survey created by the National LGBT Cancer Network (NLCN) from September 2020 to March 2021, targeting U.S. adults identifying as SGM and previously diagnosed with cancer. We examined associations between self-described residential area (urban, suburban, and rural) and other social drivers of health and tobacco and alcohol use.

Of n = 2,371 participants, n = 350 reported tobacco use and n = 359 reported ≥ 2 alcoholic drinks/day. The odds of consuming ≥ 2 alcoholic drinks/day were lower among those living in suburban (vs urban) areas (adjusted odds ratio [AOR] = 0.74; 95% CI: 0.56–0.96) and those reporting a disability (AOR = 0.62; 95% CI: 0.46–0.83) and were higher among Black/African American (versus White) cancer survivors (AOR = 2.36; 95% CI: 1.32–4.22). The odds of current tobacco use did not differ significantly based on place of residence, but decreased with increasing age (AOR = 0.97; 95% CI = 0.96–0.98), were lower for those with graduate school education (AOR = 0.29; 95% CI = 0.16–0.54), and health insurance (AOR = 0.30; 95% CI = 0.16–0.59), and were greater among Black/African American (versus White) (AOR = 2.55; 95% CI: 1.36–4.80) and Hispanic (versus non-Hispanic) (AOR = 1.77; 95% CI = 1.04–3.00) SGM cancer survivors.

Urbanicity/Rurality was significantly associated with alcohol use among SGM cancer survivors. Social drivers of health are crucial factors for researchers and clinicians intervening to improve the health of SGM cancer survivors.

The online version contains supplementary material available at 10.1007/s10552-025-02065-5.