Description
Introduction: Adverse childhood experiences (ACEs) including abuse, neglect, and household dysfunction, have long-term health consequences extending into adulthood. In the United States (US), lesbian, gay, bisexual (LGB) adults report significantly higher rates of ACEs than their heterosexual counterparts. These early life adversities affect cancer vulnerability by increasing the likelihood of high-risk behaviors, psychological distress, chronic inflammation, and creates barriers that restrict access to preventive care. We hypothesized that as LGB adults reported a greater number of ACEs, they would be less likely to engage in cancer screening, compared to heterosexual adults with fewer ACEs reported.
Methods: We analyzed data from the 158,710 participants within 2019–2023 Behavioral Risk Factor Surveillance System (BRFSS), focusing on self-reported ACEs, sexual orientation, and cancer screening behaviors (breast, prostate, colorectal). Descriptive statistics and logistic regression models were used to examine associations across sexual orientation, ACE scores, sociodemographic covariates, and screening outcomes among adults aged ≥35 years.
Results: LGB participants were more likely to report 4+ ACEs when compared to their heterosexual counterparts (8.4% vs. 4.7%, p<.001). Differences in screening rates were observed between groups. In unadjusted models, LGB participants with 4+ ACEs were less likely to report prostate, mammography, and colorectal cancer screening when compared with heterosexual participants with 0 ACEs. When fully adjusted for age, education, income, and insurance status, LGB adults with 4+ ACEs were still less likely to report cancer screenings for prostate, breast, and colorectal cancers.
Discussion: These findings highlight the compounded disadvantage experienced by LGB adults with high levels of ACEs, who demonstrate significantly lower odds of receiving cancer screenings even after adjusting for key sociodemographic factors. Addressing behavioral, socioeconomic, and healthcare barriers in this vulnerable population is critical to reducing cancer disparities and improving preventive care equity.