Abstract
Problem Identification:
Hypertension affects nearly 50% of Americans and is a major risk factor for cardiovascular disease—the nation's leading cause of death. Bisexual women face 17% higher hypertension rates and are 30% less likely to use medication than heterosexual women. This population experiences disproportionately high tobacco use—a significant hypertension risk factor—while facing unique challenges including dual stigma from both heterosexual and LGBTQ communities. The San Joaquin Valley in California shows particularly high hypertension rates (32% versus 27% statewide), making it an important intervention focus.
Analysis:
Using the BARHII Framework, analysis reveals bisexual women's elevated hypertension risk stems from higher tobacco use, alcohol consumption, obesity rates, and poverty levels. These behaviors are influenced by minority stress, reduced social support, and frequent experiences of violence, compounded by healthcare barriers and targeted tobacco advertising. Limited Sexual Orientation and Gender Identity (SOGI) data collection significantly hinders addressing these disparities.
Intervention:
The Free Your Breath program employs: (1) a tailored smoking cessation program featuring Transtheoretical Model-based modules and an online support forum with successful quitter "seed users"; and (2) advocacy to amend California's AB-959 legislation to require comprehensive SOGI data collection across healthcare settings.
Implementation and Evaluation:
The program will track intervention fidelity and participant engagement through comprehensive process evaluation. Pre-test/post-test evaluation will measure changes in tobacco use, self-efficacy, social support, and blood pressure, with objectives of 30% tobacco abstinence and 50% smoking reduction among participants.