LGBT Surveillance: Next Steps for the Federal Government
As tides change on the federal level, there is opportunity for our community to mobilize and discuss next steps to assist federal agencies to include LGBT communities in federal efforts. A major gap on the federal level is LGBT Surveillance, so the Network would like to host a BrownBag titled “LGBT Surveillance: Next Steps for the Federal Government.”
The goal of this BrownBag discussion is to share stories, lessons learned, strategies and successes through a discussion of the pros and cons of incorporating LGBT data as well as how these questions have been implemented in the field from state LGBT surveillance efforts.
We would love to bring together state representatives, researchers, and community folks that have implemented LGBT surveillance, or have been working on incorporating efforts in their state.
Join us on Monday, November 22nd at 4pm (EST). Please let us know if you are able to attend by completing the Registration
below. Call/log-in information will be sent out Monday morning.
About the BrownBag Series: It’s about linking people and information: The BrownBag Networking call series is designed to be an open space for, you guessed it, the Network. So pull up a chair and enjoy a virtual lunch with us to network, share, and collaborate with collogues from around the country. For descriptions of past BrownBag Webinars, see our blog.
New Policy Statement on Comprehensive Cessation Services
Many of us probably know that lo
ng ago, the federal best practice protocols for tobacco control started to call for comprehensive coverage of all cessation services by insurance companies. It’s really a no-brainer, right? I’m always a bit confused as to how the actuaries who run insurance risk profiles failed to notice the cost-benefit rewards of that one. I mean look at that new data from CA; each $5 pack of cigarettes costs the state of CA $27 in associated healthcare costs?!! (thanks Kurt for sending that out, thanks ALA for releasing that research). (see report here)
Well, nicely, we’re also seeing a growing trend of change on this point. Medicaid is now covering all cessation (read about it here) and Medicare is too (see here). Also, I’m not sure if it’s done or coming, but I know this coverage is being expanded to all federal employee insurance policies too. And 7 states currently require private insurance to cover cessation (read about it here) but more are looking to expand to this every day. So local policy change that makes a big difference could be coming to your neck of the woods soon.
And we want to help you make it happen!
So, I’m very pleased to debut the Networks’ new policy statement supporting comprehensive cessation coverage. Thanks to Gustavo for the writing. And good luck to all, may the day come soon when everyone has free and easy access to cessation!
Best,
Scout
New Fed Regulations Media Tools to Educate on “Mild” Tobacco
(From our Friends at the CDC)
CDC’s Office on Smoking and Health (OSH) and the Food and Drug Administration (FDA) are working to educate consumers, public health partners, and the general public about new tobacco regulations that took effect July 22, 2010. These regulations prohibit the tobacco industry from distributing or introducing into the U.S. market any tobacco products for which the labeling or advertising contains the descriptors “light,” “low,” “mild,” or any similar descriptor, irrespective of the date of manufacture. However, consumers may continue to see some products with these descriptors for sale in stores after July 22 because retailers are permitted to sell off their inventory.
OSH has developed several Web-based and social media materials to get the word out about these latest FDA tobacco regulations. Following are suggestions communicated to states and partners on how they can further support this communication effort.
- Post the new “Light/Low/Mild: No such thing” graphical button on your Web site. When clicked, this button will take visitors to newconsumer-focused information entitled “No More “Light,” “Low,” or “Mild” Cigarettes.” This information provides a summary of the July 22 regulations, the public health impact, and links to key resources, including a new, expanded feature article by the same title posted on CDC’s Web site.
- Encourage others to send Health-e-Cards emphasizing the value of being tobacco-free. See the new animated Health-e-Card that reiterates there’s no such thing as a safe cigarette.
- Inform others of anew widget located on FDA’s Tobacco Products Web site. A widget is an application that enables users to embed content from another Web site onto their Web site. As content gets updated on the source site, it’s automatically updated on the user’s site. This particular widget enables readers to embed regulation information from FDA’s Tobacco Products Web site, health information from OSH’s Smoking & Tobacco Web site, and quit information from NCI’s smokefree.gov Web site.
- Follow CDCTobaccoFree on Twitter and retweeting new messages related to the July 22 FDA tobacco regulations.
- Become a fan of CDC’s Facebook page and posting new“Light/Low/Mild: No such thing” status updates on your Facebook profiles.
- Tell others about our new posting on CDC’s Everyday Health Widget (coming soon).
- View OSH’s new entry on CDC’s MySpace page.
- Follow OSH on GovLoop. GovLoop is a social networking site for the government community. It currently serves about 30,000 members, including local, state, and federal government employees and contractors. Academics and students interested in government are also welcome to join.
- Subscribe to CDC’s Smoking and Tobacco Use main feed to receive updates of new and recently changed content from CDC’s Smoking & Tobacco Use Web site on your browser or desktop.
- Continue to access CDC’s Smoking & Tobacco Use Web site for helpful resources and the latest information.
We hope you find this information to be helpful as you plan your communication campaigns. If you have any questions, please contact Patti Seikus (PSeikus@cdc.gov) in OSH’s Health Communications Branch.
American Lung Association: LGBT Smoking Report
by Emilia Dunham
Network Program Associate
On June 28th, I was privileged to participate in a webinar on the American Lung Association’s LGBT Smoking Report. Since data is dramatically lacking on LGBT smoking, this national survey was extremely important, so we can expect this research will have lasing implications! Below are some major points from the webinar:
Key findings:
- Gay men 2-2.5x as straight men, women up to 2x
- Bisexuals higher than both gay men and women
- Lesbian and bisexual girls 9x higher than heterosexual girls
- Still limited data on transgender individuals
Why is this important?
- Most National and state surveys don’t ask for LGBT demographics
- LGBT are more prone to smoke for a variety of reasons:
- Stress related to homophobia/stigma
- Lacking legal protections
- Social pressure/bonding means smoking is normal in LGBT community
- LGBT smoking ignored by the greater LGBT community
- Targeting by tobacco industry
- General tobacco cessation programs are not tailored to LGBT population
- LGBT people are a perfect sample of the American population, stretching across all ethnicities, socio-economic statuses, ages, etc.
Taking Action: What’s needed and what can you do to help?
- Improve data collection and reporting on tobacco use in the LGBT community
- Direct LGBT funding to tobacco cessation
- Disseminate results of this and similar surveys to media organizations, anti-tobacco and LGBT groups
- Collaborate with other groups experiencing tobacco disparity rates; explore racial/ethnic disparity intersection
- Need for cultural competency
Population Center Presentions on LGBT Aging and Disabilities
By Emilia Dunham
Program Associate, National LGBT Tobacco Control Network
This morning I had the privilege of attending the Keynote address of Fenway Health’s Population Center‘s presentations by Brian DeVries “LGBT Persons in the Second Half of Life” followed by a Lisa Iezzoni talk on “Disabilities and Chronic Conditions.
Brian deVries
From Brian’s talk, I learned that though there are over 2 millions LGBT elderly, many are closeted largely due to their experience of discrimination and violence. It seems that stigma as well as unequal laws has dramatic effects on LGBT elderly. As a result, many LGBT people have depression and are more fearful for dying in pain alone or receiving discrimination. Unsurprisingly, they are also more likely to use alcohol and tobacco, however they are more likely to suffer from cancer perhaps due to less access to validating health care. Compared to the general population, GLBT elderly are more likely to rely on friends rather than family or spouses for end of life treatment in part because loss of familial contacts as a result of coming out.
Some of Brian’s recommendations are to include questions on age, sexual orientation and gender identity in national surveys, have more studies on LGBT elderly and ask the same questions of LGBT as the general population.
After Brian’s talk, Lisa Iezzoni led a provocative talk on “Disabilities and Chronic Conditions” where she addressed the commonly ignored Elephant-in-the-Room topic of disabilities. Most people will know of a friend of loved one who is or will have a disability, yet there is little knowledge of the subject. Even with the protective American with Disabilities Act, many bus drivers and building managers ignore persons with disabilities rather than installing a ramp.
Interestingly, the issue of disabilities have changed over time. For instance in the early part of the 20th century, the use of a stethoscope created distance and allowed physicians to become the arbiters of who was eligible for social services. Around this time, disabilities was seen as a problem of the individual much like sexual orientation, but by the 60s and 70s disability was seen as a societal human rights problem.
There are known health disparities for people with disabilities in that they are less likely to be asked by health providers about contraception, mammograms, pap smears, or smoking history (smoking is considered to help alleviate stress of their conditions). Yet, people with disabilities are 37% more likely to die from lung cancer because are less likely to be encouraged to access preventative surgeries.
Her recommendations were to correct problematic terms like “confined to a wheelchair” and “wheelchair bound” but switch to more appropriate term of “wheelchair user.” Beyond the individual level, public transportation as well as health centers should add proper equipment, which would also reduce long-term costs.
Lisa Iezzoni, Lisa Krinsky, Jennifer Potter, Brian deVries
In both presentations, I noticed experience through the generations has formulated opinions and behaviors on health. For instance, growing up in the “Baby Boomer” generation has led to a strong, independent attitude making it difficult for elderly people with disabilities to not reach out for help. Similarly, for LGBT people, living through several generations where being gay was criminal and a psychiatric condition led to increased stigma, loss of family connections. Invited Respondant Lisa Krinsky of the LGBT Again Project echoed the historical perspective’s need for including LGBT aging in current conversations and made the connection that both persons with disabilities and LGBT people are ignored and not served.
The LGBT Tobacco Policy Update You All Have Been Waiting For
Hey y’all,
A few weeks back I had the distinct pleasure of spending a few different batches of time in fluorescent lit meeting rooms in some anonymous Atlanta hotel. And you know I love that for its own sake, but also, the entertainment added some extra value. It was probably your normal cabaret show (a.k.a. CDC Office on Smoking and Health meeting and National Tobacco Disparity Networks), but in the middle, we got a few different policy updates from the good folk working on tobacco policy at a national level. So, here for your edification, is the 200% unofficial Scout-version of what might have been said, rumored, or implied. As per usual, all errors are probably someone else’s fault, and all correct information is absolutely to my credit.
They thought we were screaming mimis
So, times are a changing with tobacco. Why? Well there’s been a few bombshells recently about the potential impact of Clean Indoor Air Laws. Did you see the recent news about smoking bans cutting heart attacks by about 1/4?
IOM's Report on Secondhand Smoke Exposure and Cardiovascular Effects
Well this was a precursor to the later release of the National Institute of Health’s (NIH) Institute of Medicine (IOM) report on clean indoor air. This was rumored to be the first ever IOM report held up for release, because they couldn’t believe the strength of the findings, so they had to double check to be sure.
In that, they find smoking bans decrease heart attacks by about 1/5. Now this isn’t even considering all the associated health gains, it’s just heart attack. This is a 1-2 punch with a forthcoming Surgeon General’s report that’s staged to be released soon which continues to drive the smoking risk points home… each of these documents present conclusions that are stronger than prior claims… and as they were summarized by one guy, it’s basically such a strong negative effect between smoking and cancer that we can’t assure you that walking by a smoker once won’t be enough to give you cancer. Now in publichealthia (the land of pubic health) we rarely stumble across anything that has as big an effect as reducing 1/5 of heart attacks — so this is getting lots of notice. In the words of another, “they were dismissing our claims about clean indoor air as overestimation, now everyone realizes we were actually underestimating the risks”. This focus on policy dovetails nicely with the Obama push to move health upstream, to reclaim the dusty unfavored idea of Prevention! Remember, he also recently appointed a new bulldog to head the CDC, a guy who is rumored to work day and night and one who comes out of Bloomberg’s Tobacco-Control Land (a.k.a. New York City). So, we think tobacco control is getting more natural attention at CDC thru this move as well.
Wellness arise!
I know you all have seen the different spurts of cash coming out thru the $650M of stimulus money allocated to chronic disease prevention, the Wellness RFA, another nearly indistinguishable Wellness RFA, and some quitline $ (and yet, I’m not sure it all adds up to $650M, hmm?). So these are rumored to be Obama/CDCs shot over the prow at Wellness/prevention initiatives, with the hope they are a good testbed for smart ideas to include in bigger wellness/prevention rollouts as part of health care reform. (Or HCR for the vowel-impaired). Seems like all the states and “communities” (aka cities) are planning to submit for these awards, so it’ll be interesting to see what programs make the cut, and of course, how many of those actually include LGBT in their disparity planning. Another upshot in this wellness/prevention drift is relative lower focus on cessation, concurrent with more on policy and prevention activities. There’s an effort afoot to push cessation costs more onto employers/insurers (which only seems to be insanely logical, what mercury poisoned actuary really is advising insurance companies that it’s financially prudent not to cover nicotine replacement therapy, etc?). (Wups, will the mercury poisoning lobby dislike me for that?). Look for a large employer to take the lead in near months on showing how a smart “company” really does do comprehensive cessation benefits.
What about FDA?
It’s here! It’s vague! Get used to it! was heard being chanted outside the hotel windows, I presume they were talking about FDA. But according to the folk inside, this is a bill that is, of course you naive simpleton, not perfect, but as bills go, not dang horrid either. FDAs got some teeth, thinking is esp at a local level, where many communities have control over the laws governing advertising. Much talk of the change as we (finally) get new warning ads, but how we have a long way to progress to the ‘tombstone’ standard where tobacco companies are only able to say their cigarette name and price in a generic font at sales locations and on packages. There was some general shaming about how some lovely but not public health leading countries such as maybe Indonesia (?) are trumping our butts on having good tobacco control policies, but then, I don’t think any of us are deluded as to any US supremacy we may have on this issue, right? Anyhow, it’s power to the people here in FDA-land, where we might find lots of community action potential to keep cigarettes off our babies bodies. Of course, community level change seems a bit harder to do than one national law, but what, are we lazy? (slow yawn) No!!
Empower really always had too many vowels
So it’s the big new framework around tobacco, everything has to do with MPOWER, or as some pithy individual noted, MPOWERD. What is it? Jeez, I lost my notes… um… oh yah, it appears to be a WHO package. What? (no What’s on second) Oh, I found it, a package of 6 proven policies. M=Monitor tobacco use and prevention policies. P=Protect people from tobacco smoke. O=Offer to help people quit. W=Warn about dangers of tobacco. E=Enforce bans on tobacco ads, promotion and sponsorship. R=Raise taxes on tobacco. And of course, the silent D= eliminate Disparities!! Now isn’t that just too cute an acronym for words? Aren’t you proud of the World Health Organization (WHO) acronym generation team? I am. And mostly, if your tobacco control is working on something else, then what are you doing? Or maybe also to note, if your comprehensive tobacco control program isn’t addressing all of this, then your acronym is unspeakable. And us LGBTQIs would never ever be ok with that. Puh. (getting a feeling I should wind this up real soon)
Nu CDC combined ATS has LGBT! (vowel reduction sentence)
Oh yes, it’s true we all should be excited, the new combined Adult Tobacco Survey (ATS) coming out soon has an LGBT surveillance question!! Please contain the dancing in the streets folks, it’s just a start, but yes, we are very happy about it. Oh hey — any moment now I’m about to announce the first largescale T survey findings on tobacco, because we negotiated to get a tobacco question on the recent NGLTF national trans survey…. wanna know a preview? Yup, as expected, prevalence 50% over nat’l avg. But this is *no longer a guess*, it’s real data from 2k+ living trans folk, w00t!
In conclusion
Omigosh, I think that’s it. (and about time you’re all thinking). So from the bowels of some unremarkable hotel conference room, I remain, sincerely yours,
Dr. He’s-Just-Always-So-Professional Scout
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