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LGBT Population Research Center Mtg on Intersectionality – part 1

Scout, Network Director
Reporting from the Intersectionality Working Group Meeting
of the LGBT Population Center at The Fenway Institute
Boston, MA

Meeting Background

The Fenway Institute has another really cool project (in addition to ours), the LGBT Population Research Center. This is the first federally funded population research center that focuses on us. It’s a really fascinating concept where the Center works to help convene and support LGBT population researchers to share information and grow new collaborative research projects. I’m lucky enough to be a faculty member, so I get to go to those cool meetings that bring the researchers together to confab and plan. I’ll tell you, they’re always valuable, there’s nothing like an occasional face to face to really jump ideas forward. So now, how does that lead us to today? Well, at a recent population center meeting Ilan Meyer and our own Steering Committee member, Phoenix Matthews, both started talking about the issues related to LGBT research on race and ethnicity. This germ of an idea has now grown into a specially convened meeting on Intersectionality. So now we’re here in the room with about 25 LGBT researchers who’ve specialized in research on LGBT race, ethnicity, or other facets of intersectionality. You know we’re all about sharing information here at the Network, so let me see if I can speedtype and try to give you a birdseye view of the meeting. Excuse these longer than usual posts, but there’s an amazing amount of expertise in the room and this is a too rare type of gathering to let the discussion float off into the ether.

Just a note, within the first twenty minutes alone it was clear the meeting was exceptional, the excitement was palpable. In the words of one researcher “I’m literally choking up because I’m so happy I’m not the only Black researcher in the room.”

Caution High Gobblygook Ahead: While we tried to translate into plain language, there’s no escaping this was a dense scientific meeting.

Lisa Bowleg, PhD

Margaret Rosario, PhD

Panel 1: Theoretical Conceptual Issues for Intersectionality

Panelists: Lisa Bowleg, Hector Carrillo, David Chae, Margaret Rosario, Bianca Wilson

Hector Carrillo, DrPH

Bianca Wilson, PhD

The day kicks off with a rapidfire panel asking “What is Intersectionality?” “Who should be involved?” “How does it help us think about LGBT health?” Perfect for me, because I think I’m a bit weak on question 1, what is intersectionality? David Chae gives the definition below. He notes that it’s traditionally been interpreted as being the study of the intersections of race and gender.

Intersectionality: Traditionally used to describe a structure of interlocking oppressive systems.

Lisa Bowleg frames it up fast, “We’re not interested in identities alone, we’re interested in social justice and power.” “And so often, data we get doesn’t help us. I’m looking at the Census tables and I’m looking for intersections, and I just get the table on Blacks or on women. That doesn’t help me.” As David says, intersectionality is really about disentangling that “Matrix of Oppression”, in some cases social identities may be more important than others and intersectionality between them may be more or less relevant.

David points out that identity is both internally adopted and externally ascribed. There’s some evidence that the externally ascribed identity might impact people more than internally ascribed for both race and sexuality. (In plain talk: what folk think you are might affect you more than what you think you are.) “Disease emergence is a socially produced phenomena” -Paul Farmer. David has some great graphics showing how socially oppressive systems, group identity and discrimination all feed into health outcomes.

Margaret Rosario uses an interesting term, she asks “How are identities arranged? Does this give us information about their health?” Some people arrange their identities hierarchically. They are usually ranked in importance by a few factors: “salience or likelihood of being activated by others”, individuals own subjective basis, or temporal grounds. What are temporal grounds? That might be something that is designated in certain contexts, like a researchers deciding “you may not identify as ____, but I think you belong in that group.” Now we can consider identities as intersecting, like in a venn diagram, but we could also consider them as nesting, so we need to explore intersectionality as one possible model.

Bianca Wilson talks about how she sees intersectionality as potentially three different constructs. She’s done a lot of work exploring these contexts with black lesbians. First, it’s the Matrix of Domination (I want to get that slide). Where the “holy trinity” of oppressive factors (race, sex, class) interact with other factors like fat-based sizeism, and heterosexism. All stand alone, plus potentially interact with each other, each independent unit or interaction flowing into the total health of a person. There where some interesting discussions here about a threshold effect in discrimination. There have been studies showing white people react more poorly to adverse incidents than people of color, the hypothesis is that experiencing something more routinely raises your threshold of tolerance. But what other effects does it have? Second, intersectionality represents interlocking sources of socialization. You are both socialized and trained by the different communities you’re affiliated with, that socialization often builds resiliency and sets standards for what is “routine”. Third, intersectionality represents multiple community affiliations, the different current social experiences you have continue to build your health context all throughout your life.

Hector Carrillo talks a bit about the potential pitfalls of intersectionality. According to him, as we explore this we run the risk of essentializing the sexuality of the people we’re studying. He worries that essentializing the sexual culture within these communities is the same phenomena that has led to the ‘othering’ of LGBT people of color too often. (cripes he talks fast) He also says, when we study the multiple lines of oppression, we run the risk of exaggerating their overall impact. We know people display amazing resiliency, that’s hard to measure. He cautions that to use intersectionality as a frame, we need to not only look at oppression, we need to really look at the different contextual factors. He’d like to suggest that we can approach research and programming not by directly asking about identities, that we instead ask about their lives, and look at the emphasis areas, then do the analytical work to see what is relevant to them in different contexts. Juan Battle heartily agrees “I really like the idea of adding intersectionality on the back end, because otherwise, it’s kinda like asking a fish to describe water. You can’t do it because you’ve never been out of it.” Lisa Bowleg also concurs, “The onus is really, really on the analyst for intersectionality. Data do not stand on their own, they have to be interpreted. The analyst has to have a voice in this work.”

Margaret really sums it up, “The body and the mind remember, we may forget the many insults to us, but the body and mind remember, and those memories can be activated when they get to a certain threshold.

Whew, and that’s it, time for a break. Back with more later!

March 25, 2011 Posted by | Uncategorized | , , , , | Leave a comment

CDC Releases Historic Disparities Report: News on LGBT Health? No Data.

Scout
Director, Network for LGBT Health Equity

CDC Releases First of New Reports on Health Disparities

I have to confess, back in college when I worked at a health library, there was one publication that I would regularly mock, the Morbidity and Mortality Weekly Report. Yup, nothing seemed to quite encapsulate “scintillating” as much as that title. Sigh, which is why I guess it’s now my lot to actually list that as one of my most used resources in my adult life. Can’t even remember what was funny about it now because it’s just the highly esteemed MMWR in my mind, source of all of CDC’s breaking news and information on population health trends of every stripe. Well almost every stripe.

So, Friday CDC used the MMWR to release the first in a regular series of reports on health disparities. We had a heads up midyear this report might exclude LGBT folk altogether, so we did a little work a ways back to confirm that it would not make that big omission, and Friday we were happy to see that yes, LGBT people were in the report. But, the news is … barely.

LGBT Inclusion?

First flip was to the chapter on tobacco. Now we know that CDC included an LGBT measure on their recent National Tobacco Survey, but unsure if these data could make it into this report. And the verdict is? The chapter notes increased LGBT tobacco prevalence (great!), but “Although multiple tobacco-related disparities exist, this report highlights only racial/ethnic and socioeconomic disparities because of limited data for other demographic groups.” Sigh, ok.

What about the chapter on suicide? Sadly news just came across my desk earlier this morning about yet another gay youth who allegedly committed suicide after experiencing bullying at school. So what does CDC say about LGBT suicide rates? That they are nearing epidemic proportions? Not exactly. Eighth paragraph or so of that chapter includes this line: “Because the variables included in U.S. mortality data are limited, the results cannot be used to determine potential factors related to such disparities as mental or physical disability, sexual orientation, or income.”

In desperation, I flip to the chapter on HIV, sure enough there I can at least find some data for MSM (Men who have Sex with Men) health disparities. But even then, I scratch my head, has the flaw of categorizing transgender women as men been fixed yet? Despite shockingly high rates of infection reported by some transgender needs assessments, this information remains hidden with the current HIV reporting methods.

No LGBT Data Now But CDC Calls For Change!

Well, many of us already know one of the biggest problems with federal health systems is they don’t collect any LGBT data, therefor unwittingly hiding all our health disparities. So the gaps in this report are distressing, but aren’t really news. So, does CDC address this at all? I’m happy to say yes they do. In the introductory Rationale For Regular Reporting on Health Disparities and Inequalities chapter their longest paragraph is titled Gaps in Data Regarding Sexual Orientation. The paragraph reviews how Health People 2010 highlighted population disparities by measures including sexual orientation (Healthy People 2020 includes gender identity in this lineup) but briefly reviews how this goal wasn’t matched with supporting data collection. They review the few federal surveys that have any data at all and strongly conclude:

“To fill this notable data gap, national and state surveys should begin consistently and routinely measuring sexual identity, orientation, and behavior. Data collection should be expanded to include not only age, sex, education, income, and race/ethnicity, but also disability, geographic location, and sexual identity or sexual orientation. Only then can health disparities be measured thoroughly and accurately nationwide.”

Excellent! Hear hear! How wonderful that CDC is calling for an end to this data desert that is holding back so much work on LGBT health disparities! (And let’s hope the gender identity inclusion gets carried over from HP2020 as well.)

Change Starts At Home: CDC Funds Major Data Collection

CDC controls many of the pursestrings for major health data collection systems. Looking at Grants.gov I see that as we speak states are finalizing their proposals to CDC for $45M they are offering for state health data collection through the BRFSS (Behavioral Risk Factor Surveillance System), I know CDC puts out even more for the youth version of that survey, the Youth Risk Behavior Survey. But right now, $0 of that $45 million goes to LGBT data collection. (though some states take the initiative to add it themselves) While it’s hard to see how invisible we are in the newly released health disparity report, perhaps the call for data can shepherd in a new era. But until we see tested LGBT measures on every major health survey I hope we keep reminding policymakers at every opportunity: stop allowing LGBT health disparities to be hidden.

See Full Disparities Report here.

Also let me give a big shout out of thanks to all the LGBT community members and allies at CDC that helped shine this spotlight on LGBT data gaps and health issues.

January 18, 2011 Posted by | Uncategorized | , , , , | 3 Comments

New Resource: Publication on Lessons Learned from Sexual Orientation Surveillance in New Mexico

by Joseph Lee
Network Steering Committee Member
 

Is sexual orientation too controversial to ask on state surveys?

No more so than race and weight according to researchers at the New Mexico Department of Health and the University of North Carolina at Chapel Hill (UNC).

In the first look at statewide data over time and in a rural state, Nicole VanKim and James Padilla from New Mexico’s Dept. of Health and Adam Goldstein and myself from UNC compared how often people refused to answer “sensitive” questions about their identity, income, and weight in state surveys from 2003-2008. Income was, by far, the most refused question. People refused to answer questions about sexual orientation at similar levels as race and weight in the state’s Behavioral Risk Factor Surveillance System (BRFSS) survey.

Previous studies looked only at women and healthcare professionals’ willingness to answer questions on sexual orientation or focused in the Pacific Northwest or New England. New Mexico’s results show that sexual orientation questions can easily be part of routine data collection in a rural border state. The authors note that the only reasons for not including sexual orientations are likely political and call on states and the CDC to add sexual orientation questions to document and track health inequalities.

The study is published in the December issue of the American Journal of Public Health.

November 11, 2010 Posted by | Uncategorized | , , , | 1 Comment

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

November 11, 2010 Posted by | Uncategorized | , , , , , , | Leave a comment

Eldin the Cabbie: Wellness Policy Savant

by Scout

Stay tuned, Institute over but more posts to come

It’s been a busy week with posting to the blog, but stay tuned, it’s not done. We still have a few more posts to finalize about lessons from the Tobacco & Diabetes Training Institute 2010, and today our team splits forces to head into 2 more meetings, I’ll be up in DC meeting with Secretary Sebelius and members of the new HHS Task Force on LGBT Health, while Gustavo and Emilia stay in Atlanta to attend the all-day tobacco disparity network planning day. So stay tuned for blogs on all.

Eldin the amazing

How did it start? I jumped into the cab to race to the airport and I think my cabbie warned me about his New York style driving but next thing you know he’s launching on a world class high volume rant about how we’re messing up health in this country. Crazy part was, he’s like a policy savant, nailing every single problem us fancy wellness folk are trying to prioritize.

Eldin on city planning for health

“Now New York has it right, in NY you can walk everywhere. Now look at Atlanta downtown, go down after dark, do you see anything? No! And it’s dangerous. They need to build more stores in those big buildings, so people can have something to walk to at night.” Right on Eldin. “And look at it here.” We’re zipping through Atlanta sprawl-lands. “Those people can’t go anywhere without their car. They can’t even walk anywhere at all. Now in New York, you can walk for hours. And do you wanna know how many different juristictions we just went through? Four. All of those places have to agree to do anything new.”

Eldin on exercise

“And what about bicycles? We’re driving through a park right now, you see any people biking or even walking? You used to use your bicycle to go places, but now you have to put it in your car before you can get anywhere safe to bike, and then we don’t, we just don’t even use our parks. Now think if you were in New York City now, how many joggers would you see in Central Park?” I admit, plenty. “Yah, we don’t even use our parks here, it’s such a shame.”

Eldin on diet

“And look around you, have we passed any grocery stores at all?” No sir. “You see, where are you supposed to even get vegetables. Yet you wanna know what’s one block that way? Lines of fast food restaurants all the way into Atlanta. What is that stuff? It’s all fried. There’s no vegetables in it. People don’t even know to eat them any more. That’s why we’re all fat. Now back in Haiti when I was a boy, whenever my mama was pregnant, my grandma would be cooking spinach and greens for months because that made your blood strong. But here, where do you even find them?”

Eldin on tobacco

I tell Eldin one of the tidbits I learned at the training, that part of the aid we sent to Haita after the quake included cigarettes.  He’s incensed, “Like they can eat that? I mean people are going to do what they’re going to do, but we’re growing enough tobacco there already. We used to grow lots of our own food, now other countries keep teaching us how to get rid of our farms and buy things from companies instead. But none of it is healthier!”

“This country is messed up!”

“And it’s going to take a long time to fix!” Eldin finishes with a flourish. He’s gotten all worked up and I sigh thinking, yup, it’s going to take a lot of time to make it simpler for people stuck in the car wilds of Atlanta sprawl to have easy access to routine exercise. Back in my doctoral program I remember wondering why the World Health Organization had Transportation as one of their top 10 social determinants of health, now that link is becoming crystal clear. (I’m not even counting how naïve me thought their listing of Food as another major determinant of health was mostly about famine, not feasting. Ha!)

New health care reform prevention council

But change is afoot from top to bottom here. The passing of health care reform, also known as ACA or Affordable Care Act is setting some big pieces in motion to focus on wellness and prevention nationally. A large step is the creation of a new Prevention Council filled with cabinet members from all over government. And no, it’s not just filled with people from Health and Human Services, but with the head of the EPA, Dept of Transportation, Dept of Agriculture, etc. Folk realize we need changes at all these levels to clear the path to make it easy to be healthy in our country. Nicely, in the first report of this council, they are also naming sexual orientation (crossing fingers for gender identity soon) as a disparity population! So, I’m looking forward to this new top level coordination to change systems and the from-the-getgo inclusion of LGBTs. I know they’re putting together an attached community advisory council, I sure hope we have LGBT health experts on it. And I think we should have Eldin too!

October 7, 2010 Posted by | Uncategorized | , , , , , | 1 Comment

Institute 2010: Tobacco Policy & Health Systems Change

by Scout

While some of this workshop was deep talk from state viewpoint about changing systems, they did do a great review of best strategies for how to get a health care agency to integrate routine cessation interventions. Considering I bet every community has a few LGBT friendly docs with large natural LGBT patient populations, focusing on getting these community-friendly offices to change can probably have a big impact on LGBT smoking status community-wide.

Background: Multi-state Collaborative for Health Systems Change

Who is this? It’s a group of 20 states that have partnered with national groups to pioneer better integration of cessation services into routine health care. See lots of great case studies and tools about this on their website.

How do we integrate better cessation into health care systems? Most current leading edge work is still focused on the basics: getting medical providers to do the AAR, or Ask, Advise, Refer model from the Public Health Guidelines. Referrals these days are often through fax forms to quitline, which allow nice followup contact between quitline & doc.

Entree: Best tips and tricks for getting health care providers to integrate cessation?

Note: This is a real time of change for providers, healthcare reform is going to usher in conversion to electronic health records for all soon, so it’s a great time to address tobacco use well. See some bullets on this at end.

  • Assess current tobacco intervention process (multi state collab has assessment tools on their website)
  • ID clinical and administrative champion (make sure clinical champion is high enough up ladder)
  • See if they have electronic health records for at least 2 yrs (so they’ve worked out bugs) (you can change systems without this but much harder to track change)
  • The newer AAR (Ask, Assist, Refer) intervention is good & takes less time than the old intervention (aka “5As” from the old guidelines).
  • Try to advocate for smoking assessment to be part of vital signs (taken at each visit) versus other medical info (not looked at too often). And it should be required vital sign, not optional.
  • Might not be doc taking vital signs, could be nurses, make sure you have champion there!
  • American Acad of Family Physicians and Amer Acad of Pediatrics have full Ask and Act toolkit for providers to integrate this work into their routine. Lots of templates and resources there, esp for elec health record integration.
  • Have info technology (IT) person at table from start, esp to plan to routinely circulate performance info reports (# smokers identified, # brief interventions, # referrals, by provider). Docs are competitive & like to do well!
  • Train staff, test changes (revise if needed), implement the feedback reports (see sample reports on web)
  • There is new money under healthcare reform to assist many medical practices to convert to electronic health records, I hear $44k per doc.
  • Eventually, healthcare reform changes means docs will get lower medicare and medicaid payments if they don’t have electronic health records that collect key info, like tobacco use.
  • See Federal Health IT website for details on how new electronic records need to meet “meaningful use” guidelines and for local tech support for conversions.

Bonus Tidbit: Best Tobacco Healthcare Reform Briefing Sheet

University of Wisconsin has boiled down the several thousand page Affordable Healthcare Act to 7 pages of what changes for tobacco and when those changes roll out. These folk say it’s the best summary they’ve seen, download it here.

October 5, 2010 Posted by | Uncategorized | , , , | 1 Comment

The Tobacco & Diabetes Training Institute Reports

by Scout, Network Director

This week the whole Network staff team and reps from each state are all down in Atlanta, attending The Institute 2010, a training event for people in tobacco and diabetes. We’ve been to one of these a few years ago, but this is the first time it’s combined with diabetes folk too, so this time it’s a joint production of the Tobacco Technical Assistance Consortium (TTAC) and the Diabetes Training and Technical Assistance Center (DTTAC).

So, since we’re all about linking people and information, watch this week as we keep posting info about what we’ve learned in our courses down here.

Just to start us off, we had an introduction by Dr. Ursula Bauer, the head of CDC’s Chronic Disease Center. As we know from some prior meetings, Dr. Friedan, the new head of CDC, is really taking a strong hand in shaping CDC direction now. Dr. Bauer reviewed the 6 “winnable battles” Dr. Friedan has identified as agency priorities:

  1. tobacco use
  2. nutrition/physical activity
  3. teen pregnancy
  4. iatragenic infections (caused by healthcare)
  5. motorvehicle injury
  6. HIV

Dr. Bauer says, chronic diseases account for nearly 3/4 of the $2 trillion dollars we spend on health care every year. Plus we know nearly every chronic disease is influenced by the 3 pillars of what’s now known informally as “wellness”, that’s tobacco, physical activity, and nutrition. So, right now there’s an increasing emphasis on changing these upstream factors to save some of that cash downstream. That’s right, run that balance sheet and show everyone how doing tobacco control work offers a great return on the healthcare dollar.

As I know we’ve reported before, Dr. Bauer continued to echo the new big emphasis on environmental policy change as a smart strategy for changing the arena. As she aptly noted, an investment in policy change lasts long after the original money is gone. Some of the ones she brought up as smart continue to echo some of the strategies we saw before at the big wellness conference, namely: banning transfats, taxing sugar sweetened beverages, increasing tobacco taxes, bolstering clean air laws, building better walking/biking options. She talked a lot about building structures that support health. As Dr. Bauer says, “Right now our communities are designed for disease. It’s unreasonable to expect people will change behaviors when so many social and cultural factors conspire against them.” (I believe part of that was a quote of B. Smedley).

I know I’m not alone in loving this larger persepective on structures to support health. Every time I’m at a conference on health, I struggle as a vegetarian to even get reasonable food to eat. And last time I was down here at the CDC wellness conference, I was biking on some of the overcongested streets to the local health store and a driver leaned out their window and yelled, “See you in the emergency room!”. Which, considering the 18″ rut that was my bike lane, I thought wasn’t terribly far fetched. So, again, loving this bigger perspective on real health and I for one can’t wait until we all do enough work to see more of those ground level changes. Just even 12 more inches of them!

Watch for more reports from the team about other things we learn at the Institute in the next few days.

Best,
Scout
Director, Network for LGBT Tobacco Control

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October 5, 2010 Posted by | Uncategorized | , , , | Leave a comment

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

July 19, 2010 Posted by | Resources, Uncategorized | , , | Leave a comment

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.

July 8, 2010 Posted by | Presentations, Uncategorized | , , | Leave a comment

Tobacco Trends in Next Five Years

by Scout
Director, National LGBT Tobacco Control Network

Examples of the 17% of cigs that don't have appropriate tax labels.

Hey y’all, we’re at the closing plenary of the CDC tobacco conference listening to Dr. Andrew Highland give an update of tobacco trends over the next five years. Let me try to match this guys speedtalking with some speednotetaking, ok? (and mucho gracias to him for the visuals in this post).

Tobacco Trends in Next Five Years

  1. More taxes! Currently my tiny home state, lil Rhody, leads the country in cig taxes with a lovely $3.46/pack tax. But… seems like we’re behind the world on average and sincethey’ve found this is one of themost effective tools to help motivate folk to quit, we’re gonna see more and more. Now if they’d just also use the money for cessation, or even just public health bans.
  2. More tax evasion and illegal cigarette commerce. Interesting concept, eh? The speaker gave the example that if he took the rear seats out of his minivan then loaded it with cigarettes from a tax free state then took them to NY, he’d clear about $25k in one run. And as he noted, the penalties are relatively minor. In fact, in a recent study they found that 17% of a representative sample of submitted cigarette packs didn’t have their appropriate tax stamps.
  3. More clean indoor air policies – again to reiterate the main point of the recent Institute of Medicine report, passing a good clean indoor air policy alone can disappear 1/5 of the heart attacks in the region. This is big, and how big it is is relatively new news to the health arena, so look for more work to get these strong policies passed everywhere.
  4. More comprehensive tobacco programs. We know they work, one example was in the 1st 15 yrs of CA tobacco control (ack, he changed the slide, what were those numbers??),

    Example of a store before and after retail ad ban.

    it cost oh (trying ot remember) about $11B and saved about $86B. (<- don’t quote me on that, but the proportions are close, and were those really Bs? Not Ms? I think so.)

  5. Quitting? Quitlines are cost effective, but most folk quit unaided. We should encourage quit attempts, reduce social acceptability of smoking, and focus on clean air policies. Pricing and clean indoor air policies are by far the most cost effective of all cessation activities.
  6. Youth smoking? Little evidence that school based education alone is effective. Little evidence that youth restrictions alone are effective. Policy changes affect youth too, in fact youth are more price sensitive than adults so we should really focus on this tool.
  7. FDA? Light and mild being banned this month. New labels coming in this month. They will also be ramping up enforcement all across the country. But… states can and still should be doing old-fashioned tobacco control. Limiting tobacco outlets and tobacco advertising is still a wide field of opportunity.
  8. What does this all mean for state tobacco control programs? Each state should have clean air, high prices, and a comprehensive program. But after that, there’s a lot of room to get creative. States can limit number of tobacco outlets; limit where ads are placed in a retail setting; and eliminate buy-one-get-one-free offers – these steps may really curb smoking. But, get your warchest in order because there will be legal challenges from you know who.

    Example of how the tobacco companies will convey "Light" cigs without using the newly banned word.

    (<-maybe some of the taxes should be set aside for the legal challenges.) What does the industry think of retail ad bans? Precedent from out of the U.S. shows they will counter with “research” showing ad bans promote organized crime and black market sales. (ask me for the link to the website they’ve created about this “research”, I’d prefer not to put it here.)

Some odd notes

  • On the coming ban on “Light” and “Mild” labeling. The industry is likely to replace the wording with things like “Ultra Smooth” or, in something that’s been shown to be effective, change their box colors so the lighter colors indicate the former “Light” cigarettes.
  • Check out “Urban Wave” on youtube or FB to see some examples of how the industry is creating ‘stealth’ marketing opportunities.

Conclusion

  • We’ve gotta think BIG! We still have 430k tobacco deaths/yr. We know lots of what works; high prices, clean air, and comprehensive programs all work! If you’ve got all that, explore the creative options beyond that. Look at this as an investment in your future, the payoff can be very large in terms of lives and cost-savings, and the faster you do it, the faster the payoff begins.

June 10, 2010 Posted by | CPPW | , , | 1 Comment

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