Funded by the Centers for Disease Control and Prevention (CDC), the current needs assessment was led by the University of Maryland Prevention Research Center (UMD-PRC) in conjunction with the UMD Center for Health Literacy and the Maryland Department of Health to better understand tobacco use among Black and Latino/a/x lesbian, gay, bisexual, transgender, queer, and other sexual and gender diverse (LGBTQ) youth and young adults in Prince George’s and Montgomery counties. The Maryland Department of Health and the University of Maryland Institutional Review Boards approved the project. The goals of the community needs assessment were to identify health needs among Black and Latino/a/x LGBTQ communities related to tobacco use, factors associated with health and tobacco use for these communities, and the strengths and resources available to address these needs and associated factors. The degree to which existing tobacco prevention and cessation health campaigns resonate with Black and Latino/a/x young adults was also assessed.

Needs Assessment The needs assessment took place from April to September 2022 and included seven focus groups with Black and Latino/a/x LGBTQ people aged 18-30 with various histories of tobacco use, key informant interviews with community stakeholders, analysis of state-level health surveillance data, a review of county and state tobacco resources and programs, and a literature review of existing tobacco and cessation messaging focused on LGBTQ communities. The project’s Community Advisory Board (CAB) – comprised of Black, Latino/a/x, and LGBTQ-focused service providers and community members in Prince George’s and Montgomery counties – provided feedback the report. They also offered ideas regarding action items that resulted from the data. Results will inform upcoming project initiatives, including the development of a health communication campaign and community outreach programs. The assessment yielded the following findings:

State Surveillance Data • We used data from the 2018-2019 Maryland Youth Risk Behavioral Survey/Youth Tobacco Survey (YRBS/YTS, aged ~13-18) and 2018-2019 Maryland Behavioral Risk Factor Surveillance System (BRFSS, aged 18 and older). • Our sample was restricted to participants from Prince George’s and Montgomery counties and analyzed to assess tobacco use behaviors by sexual orientation and gender identity, as well as correlates of these behaviors. • Results showed greater cigarette use, e-cigarette use, cigar use, and early initiation among LGBTa residents relative to cisgender, heterosexual residents (i.e., non-LGBT). • We did not observe differences in poor physical and mental health days between adult LGBT and non-LGBT respondents. • Among youth, all tobacco use behaviors were higher among LGBT youth who reported feeling sad or hopeless and experiences of bullying when compared to LGBT youth who did not experience these feelings and interactions.

Focus Groups • Seven focus groups were conducted with residents aged 18-30 in Prince George’s and Montgomery counties (30 participants total). • Participants discussed using tobacco to cope with life stressors. • Focus group conversations highlighted the links between tobacco use, mental health, and discrimination. • Participants were unaware of most general or community-specific tobacco prevention and cessation resources.

Stakeholders Interviews • Six key informant interviews were conducted with community service professionals from organizations serving LGBTQ, Black, and/or Latino/a/x residents in Prince George’s and Montgomery counties. • One organization reported an increase in tobacco use among clients since the start of the COVID-19 pandemic. • All stakeholders were interested in receiving tobacco prevention and cessation resources and support. • Stakeholder interviewers emphasized the mental health and substance use concerns among clients.

Top Issues and Priorities Through stakeholder interviews, focus group discussions, and review of the literature and existing campaigns, the following priorities were established: • Tobacco use services do not appear to be a priority for local LGBTQ-serving organizations. • Tobacco prevention/cessation messaging and services should be paired with other topics, including mental health, stigma, coping, and peer pressure. • Our initial age range of focus (12-30 years) is too large to develop a single tailored communication health campaign; therefore, we will restrict our focus to Black and Latino/a/x youth aged 15-20. This decision was based on our literature review and focus group findings, but also to emphasize prevention and cessation early in the life course. • Communication channels for exposure to tobacco advertisements and prevention messages differed across both Black and Latino/a/x focus groups, suggesting channel preferences for our own tobacco messages. • Tobacco prevention and cessation campaign messages should be disseminated in traditional and digital formats that consider preferences and needs. • Smoking prevention and cessation messages for Black and Hispanic LGBTQ young adults must be carefully tailored to avoid stereotypes while appealing to cultural values. • The literature review shows a critical gap in existing research that tests and evaluates the effectiveness of tobacco and prevention control (TPC) messaging targeted at Black and Latino/a/x LGBTQ communities.