Abstract
To examine how the co-occurrence of behavioral and psychosocial factors (depression, cigarette smoking, heavy alcohol use, and polydrug use) is associated with lung cancer incidence, we included 3,554 sexual minority men (SMM) from the Multicenter AIDS Cohort Study (MACS), 1996-2022, with assessments every 6 months. We used Cox proportional hazards models to examine the cumulative relationships of these factors with lung cancer incidence. We identified a positive dose-response relationship between the number of these factors and lung cancer incidence. Compared to men with no factors, those with two (aHR= 3.80, 95% Cl [1.46, 9.86]) and three or more (aHR = 8.33, 95% Cl [2.20, 31.60]) had increased lungcancer risk. Men living with HIV were more affected by these factors than men without HIV. Our findings highlight the need for prevention and treatment for depression and substance use when assessing lung cancer risk among SMM, which may inform strategies to reduce lung cancer incidence.