Abstract A154: Trends and predictors of cigarette smoking in Guam: Analysis of 2011–2023 BRFSS data

Abstract Background Cigarette smoking remains a major public health concern in Guam, contributing to the island’s high burden of smoking-related cancers. Although breast cancer is the most diagnosed cancer, lung cancer accounts for the highest number of cancer deaths. Guam is home to diverse communities, including Indigenous CHamoru, and other Pacific Islanders, many of whom historically face structural inequities impacting health outcomes. Persistent disparities in lung cancer outcomes highlight ongoing barriers to achieving health equity. This study examines the association between smoking status and sociodemographic characteristics (sex, age, ethnicity, income, education, employment, insurance status) and analyzes smoking trends in Guam from 2011 to 2023. Methods This cross-sectional study used data from the Guam Behavioral Risk Factor Surveillance System (BRFSS, 2011–2023) to estimate weighted smoking prevalence and assess trends in current smoking by sex and ethnicity. Logistic regression was used to evaluate associations between socioeconomic status (SES) and current smoking. Joinpoint regression was applied to estimate the average annual percent change (AAPC) in smoking prevalence over time. Results The sample included 24,825 adults, primarily CHamoru (41.1%) and Filipino (29.1%), followed by White (12.5%), Micronesian/Pacific Islander (8.7%), and Asian (5.1%) participants. Micronesians/Pacific Islanders had the lowest socioeconomic status, with over 70% having a high school education or less and 58.3% earning under $25,000 annually. Whites and Asians had the highest employment and insurance coverage. CHamorus had the highest smoking prevalence (54.5%), while Filipinos and Asians were most likely to have never smoked. From 2011 to 2023, Guam’s overall smoking prevalence decreased from 30.2% to 16.8%, yet CHamoru individuals consistently showed the highest prevalence and smallest significant decline (AAPC = -3.58; from 42.8% to 23.3%). Logistic regression showed significantly higher odds of current smoking among males (OR=1.72), CHamorus (OR=3.20), those with low income (OR=1.84), less than high school education (OR=2.98), the unemployed (OR=2.39), and the uninsured (OR=1.20). Conclusions Despite reductions in smoking prevalence, Guam's rates remain substantially higher than the U.S. national average (16.8% vs. 11.0% in 2023). Persistent differences in smoking patterns across groups suggest the need for focused prevention and cessation strategies. Future research should inform targeted policy and outreach efforts to reduce smoking-related health inequities. Funding Source: This research was, in part, funded by the National Institutes of Health (NIH) Agreement NO. 1OT2OD032581. The views and conclusions contained in this document are those of the authors and should not be interpreted as representing the official policies, either expressed or implied, of the NIH. Citation Format: Angelika Argao, Cabrini Aguon, Grace Garces. Bordallo, Lakshman Tamil, Grazyna Badowski. Trends and predictors of cigarette smoking in Guam: Analysis of 2011–2023 BRFSS data [abstract]. In: Proceedings of the 18th AACR Conference on the Science of Cancer Health Disparities; 2025 Sep 18-21; Baltimore, MD. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2025;34(9 Suppl):Abstract nr A154.