The Network

for LGBT Tobacco Control

HHS Tobacco Strategic Plan Launch: Eyewitness Account & LGBT Inclusion Details

by Scout
Director of National LGBT Tobacco Control Network

1st ever HHS Tobacco Plan!

Reporting from George Washington University Auditorium Launch of the HHS Tobacco Strategic Plan

Houston We Have An Easy-to-Read Liftoff

As your intrepid guy about town, I zipped down to DC to attend the live launch of the first-ever HHS Tobacco Control Strategic Plan. If memories of Healthy People 2010 are leaving you waiting for the shorter movie version of the plan, let me tell you the first piece of important news – this plan is only 21 pages long! So, read away dear ones!

The Launch Party

I get to DC and sure enough, it’s a gathering of the glitterati of the tobacco control world (which of course meant I didn’t know half the folk)… there’s the head of ALA, TFK, ACS, OSH*, BLDDT, CHRK, and ZLWY. (ok, maybe I made a few of those up). And there’s big TV cameras everywhere, like maybe there’s a new all-tobacco-all-the-time set of news channels? Arrayed in the front of the room are posters of all the new tobacco warning ads FDA just announced they are considering. Plus lo, I see the head of another tobacco disparity network, Jeannette Noltenius (the Latino network). We of course bond together, because we are nearly invincible as a team. With a nod to dear ally Rosie Hinson from HHS Assistant Secretary Koh’s office (she was the one who helped make sure there were enough LGBT references in the plan before launch) I sat down and hushed up ready for the show.

Many folk were obviously listening to the actual launch via webcast… so let me just hit a few points that stuck out for me in the launch comments.

HHS Secretary Sebelius explained how tobacco is a big focus for HHS and health care reform, she mentioned the 3 bigger initiatives they’ve taken till now.

The gathered media waiting for the launch party

Big 3 Govt Tobacco Initiatives Before This Plan

  1. Passing FDA oversight of nicotine, which will especially change the warning labels. (finally!)
  2. Investing about $250M in new tobaccoprograms (presumable through Communities Putting Prevention to Work (CPPW) and REACH awards, neither had much LGBT inclusion).
  3. Healthcare reform invests $15B (over years) in new prevention healthcare fund. (This money is expected to take the best practices from 2. and replicate them to other areas.)

Shocking Facts Rattled Off

  • Tobacco costs this country $193B a year in health care and lost productivity costs! ($96B in healthcare costs alone)
  • Tobacco estimated to take 1 billion lives worldwide this century.
  • 1,000 people each day become daily smokers.

    Assist. Secty. Koh rattling off shocking facts, but what is Secty. Sebelius doing?

  • 8 million people in US have chronic diseases stemming from tobacco.
  • Every 10% increase in cigarette costs decreases local smoking rates by 4%. (<- that’s why policy changes are SO hot right now)
  • US Tobacco industry spends $12.5 billion dollars a year in marketing, or $34M a day!

4 Pillars of New Tobacco Plan

  1. Change social norms (including big media campaign to counter last point above)
  2. Improve health (supporting states and communities to continue work like was launched with CPPW awards, or supporting quitlines).
  3. HHS leading by example (such as increasing cessation coverage through medicare and medicaid, both planned rollouts)
  4. Advancing knowledge (like more data collection on priority populations and more research on best practices)

The Goal

According to Assistant Secty Koh, “The goal is to make it as easy to quit a it is to buy a pack of cigarettes.” And of course… they also talked about the other goal of making sure young folk don’t start.

New FDA Tobacco Warnings

So Miguel, the videocam fits in your pocket but the mic needs its own suitcase?

Not sure if lesbians gained control of Congress while I wasn’t looking but in what seems to government by consensus, the FDA has rolled out 36 potential new warning labels for cigarette packages and are taking comments on them until Spring. Then they will pick 9 that will be required to cover the top 50% of front and back of each cigarette pack and top 20% of every tobacco industry advertisement by Sept 2011. Like the FDA Commissioner said… “this essentially makes each pack of cigarettes into a mini billboard for tobacco control.” It’s an interesting note that while the ads are sometimes graphic… it’s not necessarily because they feel adults need to learn the dangers (research has shown most adults know the dangers well), but because they feel it’ll be a deterrent to youth to see (or carry around) something so terribly yucky looking. Interesting. Linda Bailey from North American Quitline Consortium later asked, “why don’t any of the warnings include the national quitline 1-800-QUITNOW?” Good point Linda, maybe folk can suggest that in the comment period.

Open Comments and Other Bloggers

In the comment section Jeanette and I duly stood up and mentioned something about disparity populations. I believe I mostly thanked them then asked another question about elementary school programs (which showed how many were watching online because folk started to email me resources right after I spoke) and Jeannette asked about the importance of racial and ethnic minority community-based work. But then afterwards I hooked up with old buddy Miguel Gomez from Office on HIV/AIDS (who was sporting the biggest microphone I’ve ever seen attached to his flip camera). He runs AIDS.gov and seems they are doing buckets of social media interviews and podcasting for blog.AIDS.gov, so when he finishes editing them up, I’ll be sure to link them here. And later, we’re hoping they teach us some tricks to get our Youtube channel really rolling. (until then thanks for reading the old school print version!) But I know you’re all waiting for the real news, so let me get right to…

LGBT Inclusion in Tobacco Plan

  • P. 12 CHALLENGES: THE BURDEN OF TOBACCO USE AND BARRIERS TO PROGRESS. “Members of certain racial/ethnic minority groups, individuals of low socio-economic status (SES),pregnant women, and other groups carry a disproportionate burden of risk for tobacco use and tobacco-related illness and death… [last sentence of para] Available evidence also reports very high smoking rates among lesbian, gay, bisexual and transgender populations;however these populations remain underrepresented in current surveillance systems used to monitor tobacco use.”
  • p. 23 STRATEGIC ACTIONS: 4. Advance Knowledge. [bullet 3] “Expand research and surveillance related to high-risk populations (e.g. American Indians/Alaskan Natives and other minority racial/ethnic groups; lesibn, gay, bisexual, and transgender populations; individuals with mental disorders; those of low socio-economic status) to identify effective approaches to prevention and cessation.”
  • P. 24 STRATEGIC ACTIONS: 4. Advance Knowledge. [bullet 4] Expand research andsurveillance that promote the effectiveness of both population- and individual-based cessation interventions and tobacco dependence treatments. [Descriptive subtext] … “In addition there is a need for more evidence of effective cessation interventions for populations such as youth; young adults; pregnant women; low-income smokers; racial/ethnic minorities; lesbian, gay, bisexual and transgender smokers; light or intermittent smokers; and those with comorbidities (particularly mental health and substance abuse disorders).”

That’s all I’ve got for now folk, hope you enjoyed the eyewitness account of the launch!

Best,

Scout

* ALA = American Lung Association
TFK = Campaign for Tobacco Free Kids
OSH = CDC Office on Smoking and Health
ACS = American Cancer Society
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November 11, 2010 Posted by | Uncategorized | , , , , , , | Leave a comment

HIV and Tobacco Webinar: Lessons Learned

Yesterday the Network co-hosted a great webinar with the National Youth Advocacy Coalition, examining the relationship between HIV and tobacco.  With over 50 participants, the information disseminated and discussions articulated was a fascinating opening dialogue.

Some really interesting facts I learned:

  • Smokers are contracting HIV faster than the general population: About two-to-three times faster actually, with 50-70% of HIV-positive individuals using tobacco.  HIV-positive men-who-have-sex-with men (MSM’s) are two times more likely to smoke than HIV-negative MSM’s.  This can be contributed to oral ulcerations caused by tobacco use, more minority-related stress, and the higher incidence of risky behaviors with smokers generally.
  • Smokers are developing AIDS faster than HIV-positive individuals overall:  With anti-retrovirals (ART’s) today, HIV is considered to be a chronic illness rather than a death sentence. But if you use tobacco, that notion decreases. Smoking can interfere with the processing of  anti-retrovirals (ART).  The liver processes the 4,000 chemicals ingested from cigarette smoke as well as the ART medications…and the liver always chooses the tobacco first. Tobacco also reduces immune function, increasing the susceptibility to opportunistic infections (OI’s).  One of the OI’s, Mycobacterium Avium Complex or MAC, is actually found IN the cigarette paper, active even when it burns down to the filter.
  • HIV-positive smokers are dying from tobacco-related illnesses rather than AIDSl: Consequences of smoking such as cardio-vascular disease and liver issues can kill you before AIDS can, influencing 53% of all AIDS moralities.  Studies have shown that quitting smoking does more to reduce cardiovascular attack risk in HIV-positive patients than ANYTHING else, including changes in ART regimens.  You can also be on less ART ‘s because your liver will have to digest less chemicals.  Less tobacco and less medications means you will be saving your body and a combined total of $5500 a year to be a smoker on ART’s.
  • HIV-positive smokers have a harder time quitting than tobacco users overall: Not only do HIV-positive people face increased tobacco use and effects, but their ability to quit is compromised as well. HIV-positive individuals have higher relapse rates and lower quit attempts…even though they need to quit and want to quit! Providers frequently have the perception that people living with HIV have enough on their plate as is, so why try and get them to quit if the self-medicating helps them with the stress of the disease. In turn, the provider feels uncomfortable addressing the issue. However, if patients don’t know the negative impacts of tobacco, how can they make educated decisions about whether or not they want to quit?

Helping to Quit: Lessons Learned

Barbara E. Warren, Psy.D.

Danielle Grospitch, CTTS

Danielle Grospitch, a certified tobacco treatment specialist and HIV educator, gave some great insight on how to aide HIV-positive smokers in quitting. There seems to be a success in numbers when it comes to cessation in positive communities rather than individual support.  Be careful if you use nicotine replacement therapy (NRT) in treatment. While it is covered by Medicaid in most states, cessation medications like Zyban can interact with protease inhibitors. For longer-term success, behavioral modification techniques such as cognitive behavioral therapy are more effective than NRT.

An example of a program that has all the above components is the first east-coast LGBT/HIV-positive support group to address tobacco cessation overall.  Apart of the LGBT center of New York City for 22 years, presenter and psychologist Barbara Warren helped to find all mental health and social services for the center, including the LGBT Smokefree project. The most interesting component of the case study I found was supporting the ambivalence of cessation. If your client is not ready to quit, that’s okay. Videos like the one below featuring “Mercedes Maybe”  allows individuals to explore their ambivalence about quitting, aiding them to quit when they feel its right and increasing their ability to quit successfully.

Videos are also great ways to get youth and young adults to think about quitting as well.

While incentives were found to be helpful to recruit and maintain people in the group, extrinsic motivations were replaced with intrinsic motivation by the end. 50% of the individuals who graduated from the program wanted to donate their final incentive back to the center because they were so grateful for being able to quit. Barbara found that the most important attribute for a group facilitator is  to be an ex-smoker, proclaiming that status allowed her to connect with the group members even though she was not HIV-positive or LGBT-identified.

Suggestions on what you can do to help:

  • Ask, Advise, Refer: Providers need to be asking and advising HIV-positive smokers, and feel comfortable doing so. Three simple steps will send the person in the right direction: ask if they use tobacco, advise them to quit, and refer them to the appropriate program.
  • Collaborate:  Collaborating with other local tobacco efforts can decrease costs and resources. If you are interested in funding opportunities, make sure to sign-up for our discussion listserv on our homepage, http://www.lgbttobacco.org, to learn about new tobacco RFP’s in your state.
  • Accessibility: If you are going to start a peer-led support group, providing the meeting at an easily accessible location by public transportation and in a comfortable environment like an LGBT center is helpful.
  • Following the leader: Howard Brown Health Center and the University of Chicago have just finished four focus groups examining smoking cessation in HIV-positive, African-American MSM’s. The major theme that emerged was that being an ex-smoker was the most deterimental factor for the group make-up. (Click here to request more information on the Chicago Study…) If you cannot have an ex-smoker facilitating, videos sharing success stories of HIV-positive individuals quitting can be used for motivation, like “Ready Rico.”
  • Address the whole individual: In cessation, examine the physical, mental, and emotional factors that influence a person’s tobacco use and ability to quit. Having information on nutrition is also pertinent because of the food limitations with ART medications and the use of snacking as a coping mechanism in cessation.

MORE RESOURCE INFORMATION NOW AVAILABLE FROM NYAC!

As I prepare for my departure from the Network to participate in my field internship at AIDS Action Committee, I will make sure to know my resources and to always ask if tobacco is used by my clients. Just a quick ask, suggestion, and resource referral can at least get the ball rolling and educate my clients so they can make the best decision for themselves possible!

June 9, 2010 Posted by | Presentations | , | Leave a comment

Network hosting June 8th Webinar on HIV and Tobacco. Register today!

The Network, in conjunction with the National Youth Advocacy Coalition, will be hosting an interactive webinar on tobacco and HIV this Tuesday June 8th from 2pm-330pm EST. Please join host Shannon Murphy for a dialogue on the effects of tobacco on individuals living with HIV/AIDS and the importance of cessation within this population. There will also be ample time allotted to share stories, network, and collaborate on the call. You can register for the webinar here.

Our Sharing Our Lessons on HIV and Tobacco Cessation

Speakers:

  • Danielle Grospitch is a certified tobacco treatment specialist for Tobacco-Free Lake County Illinois. She recently presented at the Promising Practices: Acheiving Health and Social Equity in Tobacco Control conference in New Orleans on tobacco use in HIV populations. She will sharing her knowledge on how tobacco use affects treatment and disease progression for the  50%-70% of HIV-positive individuals who use tobacco.
  • Featured in our most recent issue of Sharing Our Lessons, Barbara Warren Psy. D., CASAC, CPP will be discussing her involvement in the groundbreaking cessation program for people living with HIV/AIDS established at the LGBT Center of New York City.

You can register here and we look forward to your participation!

June 3, 2010 Posted by | Presentations, Resources | , , | 2 Comments

The Risks Associated with Continued Tobacco Use Among the HIV + Community

A Gyour1mainman Blog…

After lunch and the fabulous band, (which I hope you viewed the lunchtime at Hotel Monteleone blog to see the video), I attended a session presented by Danielle Grospitch from Tobacco Free Lake County. Her Presentation:  The Risks Associated with Continued Tobacco Use Among the HIV + Community was amazing. It is estimated that 50-70% of people living with HIV in the U.S. smoke. She went on to say people living with AIDS are living longer, but not if they are HIV+ and smoke.

As you may or may not know tobacco causes a reduction in the immune function, and that smoking can interfere with the metabolism of HIV medications. So as you may know and she reiterated in her presentation HIV+ individuals need to quit, and something you don’t know is that majority of HIV+ individuals want to quit. So she has been working with the HIV+ community and has implemented a cessation program to assist in a successful intervention in assisting individuals quit. She believes that in order to help people quit you need to have a comprehensive program, and look into the right NRT to assist in individuals quit attempt. For instance Bupropion (Zyban) has been fount to interfere with the efficacy of protease inhibitors used by HIV patients. She identified tasks in order to create a program and encourages everyone to become more knowledgeable and reach out to local resources if they are interested in working with the population as well as ensuring cultural diversity within your programs. She also talks about using the 5 A’s, Ask, Advise, Assess, Assist, and Arrange splashed with Motivational Interviewing. Overall this was such a great presentation and I will have to see if I can get her to do a presentation for us. I think both her and Barbra Warren have great examples of how to assist in helping HIV+ people quit. We will be sure to get them on a call together and really expand on working with this population. Stay tuned for this is the very near future.

May 11, 2010 Posted by | Break Free Alliance | | 1 Comment

SRNT Update 4: Tobacco and People Living With Cancer and HIV/AIDS

So this is day 3 for me in Baltimore and so far, aside of a little detour into food-poisoning-land, it’s been great.  Last night I got to see the touring Broadway show In The Heights and got to see it snow for the first time in my life. Both were great, in case you were wondering, although I felt like my ears were going to fall off (I mean in reference to the cold of the snow, not because of the show).  But you don’t want to hear about me, you want to hear bout the SRNT conference. 

On this update I wanted to focus on an excellent presentation give by Dr. Ellen Gritz on cancer and HIV/AIDS patients and tobacco use.  Turns out that over 20% of people living with cancer continue to smoke.  Yikes!  So obvious not only could tobacco use have contributed to the onset of cancer but there are other downsides once a person living with cancer continues to smoke.  For starters, it can worsen the side effects of treatment, however it also has adverse effects on the efficacy of treatment too.  If undergoing surgery, it can increase the complications of general anesthesia and detrimental to wound healing.  If a cancer patient is undergoing radiation, smoking can increase the toxicity of the treatment.  Nicotine itself induces resistance to chemotherapy.

After talking about the detrimental effects of tobacco on cancer, Dr. Gritz switched over to talking about the effects on people living with HIV/AIDS, and I got smarter and instead of typing on my computer I began to take pictures of slides…alright, so I copied it from someone in front of me, at least I know when to follow a good idea.

Anyway, as you can read in the picture below, smoking is a major cause of cardiovascular disease (CVD), and CVD has been rearing its ugly head more in this population as people living with HIV/AIDS have longer life expectancies.  Cancer also tends to be one of the top reasons of death for this population.  So there’s this terrible cycle that is perpetuated by continuing to smoke while living with HIV/AIDS. 

Me being smart and taking pics of the screen instead of notes

BUT, and that’s a big J.Lo BUT, the good news is that people with cancer and HIV/AIDS have shown that they want to quit just like everyone else.  Dr. Gritz ended by showing a pilot a project, conducted by Dr. Gary Humfleet from the University of California, San Francisco, which has shown that people with HIV/AIDS can quit tobacco right along with the rest of us.  Basically, follow the recommendations that are set forth in the mighty Quit Tobacco Bible (The Treating Tobacco Use and Dependence Clinical Practice Guidelines), but address barriers that are specific to people living with HIV/AIDS.  One the points that Dr. Humfleet clarified for me was that people with HIV/AIDS could be prescribed NRT.  I got to meet Dr. Humfleet during one of the posters sessions after a tip from Gustavo that he was in attendance.

Implications from all this is that we, as tobacco control advocates, should concentrate on building cessation programs that target people with caner and HIV/AIDS.  Furthermore, the old stereotype that people facing these challenges will not want to quit, because that’s a bunch of bologna.   Not only do these people want to quit just like most smokers do, they can, and they have a heightened risk of smoking interfering with their very important treatment.  Encourage clinicians to approach the subject of tobacco with their clients, and if they say “they won’t want to quit” tell them Pedro said “Si Se Puede!”

February 26, 2010 Posted by | Scholarship Opportunity | , , , | Leave a comment

   

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