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.

 

LGBT Surveillance: Next Steps for the Federal Government Summary

On Monday, November 22nd, we held a BrownBag Webinar called “LGBT Surveillance: Next Steps for the Federal Government.” The call focused on a discussion on federal opportunities for LGBT data to be considered for inclusion in national surveillance (surveys).

The crux of the conversation’s goal was to gather Lessons Learned from stories that callers shared on gathering LGBT data on the state level. In our highest attended BrownBag, participants shared their strategies for LGBT inclusion as well as barriers that have come up in that process. Scout introduced the call by requesting stories on state LGBT data implementation that can be used to help the federal government in whether/how they would include LGBT data questions on national surveys.

Among the reasons LGBT data has been left off national surveys, several myths circulate on why exclusion continues. For instance, surveyors fear higher refusal rates, break-off rates and confusion from respondents taking these surveys.

Current National Surveillance Efforts:

o       Despite failed efforts to include GLBT questions on the national Census, researchers are studying same-sex partner data gathered from the survey.

o       DHHS is including LGBT health measures on their major health survey (National Health Institute Survey : NHIS) but that is still within the works.

o       The National Adult Tobacco Survey includes multiple questions on LGBT as a singular question.

o       CDC sponsored survey on LGBT data in the United States in “Sexual behavior and selected health measures: Men and women 15–44 years of age

o       A group of researchers and advocates are working on a document for how gender identity questions can be added to national surveys (i.e. education, health.)

State Experiences

  • New York: City Health Department in NYC had a strong experience with adding sexual orientation and gender identity

o       Unexpected positive outcome: Mainstream scientists are excited about looking at LGBT data because they care about health disparities showing that LGBT data collection is not just a minority issue.

o       Positive Outcome: Multiple surveys point to LGBT data

  • California: California Health Interview Survey (CHIS) has included sexual orientation (not gender identity)

o       Barrier and Solution: When respondents are confused, the protocol is to reinforce the need for complete understanding of demographics/disparate populations and that no one is forced to answer the question.

  • Illinois – YRBS – does not include LGB, but Chicago does include a question asking folks “Which best describes you ‘gay’, ‘bisexual’, ‘lesbian’, ‘not sure”
  • New Mexico – NM has made a lot of progress in adding LGBT measure

o       Strides: “Sexual orientation” was added to both the Adult Tobacco Survey (ATS) in 2003 and the Behavioral Risk Factor Surveillance System (BRFS) in 2005.  Since 2009, both surveys added a question including “transgender”.

o       Barriers and Solutions:

  • A few participants questioned why LGB was asked, but confusion why that was added was explained.
  • In early years, there was confusion from 65+ year old individuals about LGB questions, so NM limited how many seniors received that question as many responded with “I don’t know.”
  • Lack of youth data is a major gap that needs to be filled. Since 2005, advocates and researchers have been proposing that “sexual attraction” to be added to the Youth Risk Behavior Surveillance System (YRBS) as no LGBT questions are currently asked on this major survey for youth.

o       Positive Outcome: NM APHA data paper from 2003-2009 showed refusal rates of sexual orientation question in BRFSS to only be .8- 1.8% which compares with refusal rates for other categories like 4.1-4.5% on household income.

  • Ohio – Led focus LGBT focus groups with reports on what was asked as well as transcripts for the groups. Another report is here.

o       Barrier: There weren’t enough respondents

Resources on LGBT data collection and best practices

Next Steps:

  • Please send emails or comment here with experiences of “Lessons Learned” at lgbttobacco@gmail.com.
  • We are looking for folks who have information on who has adult tobacco, YRBS, BRFFS, Quitlines
  • Another call continuing discussion will be announced.
  • A separate call on program data may be useful for folks who are looking for assistance on including LGBT data themselves.

Implementing Affordable Care Act, Section 4302: An Overview of Federal Efforts and Implications for Data Collection

by Emilia Dunham

Reporting on “The Affordable Care Act (Part II): Section 4302 and Implications for Data Collection” call earlier this afternoon

(Webinar was sponsored by the Aetna Foundation and AcademyHealth)

On the call today David Meyers of the Center for Primary Care, Agency for Healthcare Research and Quality discussed how Section 4302 of the ACA lists requirements for data collection of disparity populations affecting prevention, public health, expansion of coverage and access to care. Here were some take-aways:

  • Data from national surveillance will be available for public research, but privacy will be maintained.
  • Department of Health and Human Services Secretary Kathleen Sebelius will establish data collection standards, calling for specific language for funding.
  • Five specific standards for data collection at a minimum: Race, Ethnicity, Primary Language, Disability Status and Sex.
    • All surveys and all agencies supported by DHHS would be required to collect for these standards.
    • Secretary Sebelius has authority to require additional standards and is considering additional categories.
    • There will be listening sessions for the public to include comments on adding additional categories such as sexual orientation and gender identity. They are asking for comments on burden versus value of adding categories.
    • Next steps: Input will be incorporated, and the DHHS Secretary will either add, reject, ask for more information or more time on new categories to include.

 What to ask in listening sessions and what feedback we should provide to the DHHS?

DHHS is looking for answers on the following questions

  • What characteristic(s) do you think should be added to the current list of race, ethnicity, sex, primary language and disability status to further address health disparities?
  • How many individuals would be affected if data addressing this topic is collected?
  • Is there evidence that a health disparity exists for this characteristic?
  • Have any instruments been developed and tested to measure this demographic characteristic? If so, please provide a brief summary of the measures and evaluation results.  If not, do you have recommendations as to the questions that should be asked or how the measures should be developed?
  • Has information on this characteristic ever been collected, presented, published, or televised? If so, where has this been done?
  • Recognizing that demographic data, especially data related to disparities, may be sensitive, elicit prejudices, and affect individual’s willingness to provide information, do you have information about how collecting information on this category may affect overall data collection activities and how to maximize data quality?
  • Do you have any recommendations as to how the Secretary should decide (i.e., what criteria should be used) whether the potential for burden of adding your proposed characteristics would outweigh the need to gather additional information to address health disparities?
  • Do you have any other recommendations with respect to any other demographic data regarding health disparities that you would like the Secretary to consider?

Feedback relating to our community

One person on the call asked whether additional populations will be captured under the current 5 categories like transgender populations. Presenters stated that sex is without a doubt not just “male” or “female”, but it’s possible that options can expanded to include “other”, “transgender” or another option. HHS is needing answers on how to expand the category of sex/gender to include transgender categories.

Next Steps:

There will be additional listening sessions though many were sent by invitation only.

The Network is having a BrownBag Webinar on Monday, November 22, 2010 at 4pm to discuss what information to submit and how to respond about adding LGBT measures for federal surveillance. Please email us with thoughts or information at lgbttobacco@gmail.com or register for the call here.  See our blog post for more information.

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.

BrownBag Registration

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 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.

CDC’s National Tobacco Control Networks Support Puerto Rico LGBT Community Events & Inclusion

Sunday, June 6, 2010 was a bright sunny day and full of excitement in Puerto Rico. People from all walks of life participated in Gay Pride festivities in the capital city, San Juan. While paying respects to the families of the several transgender women murdered in the last months across the island, local LGBT groups, activists, a few government officials, and thousands from all genders and sexual orientations showed their pride and support for the LGBT community. In between vibrant shows, words of unity and calls for action, participants were thirsty for gay memorabilia, educational resources, and opportunities to support equality for all. Similar events took place in the gay-friendly setting of Boquerón on June 13 in the town of Cabo Rojo.

San Juan Pride participants complete our health-tobacco survey which is currently collecting data on the LGBT community in Puerto Rico

For these two consecutive Sundays and with much enthusiasm, a handful of volunteers led by members of the National Latino Tobacco Control Network (NLTCN) and the National LGBT Tobacco Control Network engaged over 500 people who showed interest in our “mini-gay-library” of publications on health, tobacco issues, legal rights, community surveys, a government petition, bags, pens, pins, candies, and other goodies and educational materials. Donated by Lambda Legal (www.lambdalegal.org), a national organization committed to achieving full recognition of LGBT civil rights, hundreds of “I am making the case for equality” bags were filled not only with Lambda’s materials on civil rights for HIV+ people, youth in the education system, and legal and financial planning for LGBT couples, but also with educational materials from the two Networks, the Puerto Rico Tobacco Free Coalition, the Puerto Rico Department of Health Cessation Quitline !Déjalo ya! (Leave It Now!), the Latino Commission on AIDS, and the Social Justice Sexuality Initiative from the City University of New York (CUNY). Members of these two National Tobacco Control Networks were able to pull together resources from all these organizations in order to educate the community. Some provided supplies; others purchased the tables and chairs, or paid for volunteer lunches, while allies from the University of Puerto Rico (UPR) provided staff and logistical support in preparation for the events. This collaboration was essential to provide Pride participants with health information and other educational opportunities, which seemed very limited during the festivities.

Through our participation in Pride events, we were able to collect an additional 292 NLTCN sponsored health-tobacco surveys among the LGBT community of Puerto Rico. This increases the total survey sample to 431 since distribution began in local LGBT events and activities in November 2009. We continue the search for additional venues to distribute the survey and increase the final sample. We are currently analyzing the sample with the support of our NLTCN Steering Committee Member, Dr. Elba Díaz-Toro, Associate Professor of the School of Dental Medicine, UPR.

In addition, a total of 420 signatures were collected for a Lambda sponsored petition asking the Puerto Rican Department of Justice and the local Police Department to create official links within their respective agencies with groups and individuals representing the LGBT community. Some local groups have claimed that in the last eight months seven murders of gay and transgender people have taken place around the Island, which motivated people to sign the petition. National and local groups will be taking the signatures directly to government officials and agencies. Networks’ members have been active on rallying support, sharing information, and connecting local groups and individuals with national resources in support of comprehensive approaches to address issues of health disparities, stigma, and discrimination towards the local LGBT community. Lessons learned will be shared later among other Latin@ and LGBT groups in the mainland.

Boquerón Pride participants approach our booth to fill out surveys, support a police petition, and collect educational material on tobacco control, equal rights, and other issues affecting our communities.

Just as important was the distribution of the Social Justice Sexuality Survey, a nationwide initiative that investigates the socio-political experiences of LGBT people of color, sponsored by the Sociology Department of the City University of New York (CUNY) in partnership with the Human Rights Campaign, the Gay and Lesbian Task Force, among other gay advocacy groups. During our participation at Pride events, National Network members collected a total of 115 completed surveys providing a richer set of data to create a profile of the LGBT community in Puerto Rico. The Initiative is interested in better understanding how identity enhances or inhibits the experiences of the LGBT population around accessing health, civic and social engagement, among other important issues. Folks can complete the survey online and read more about the Initiative at www.socialjusticesexuality.com

Furthermore, during the last Puerto Rico Tobacco Free Coalition meeting in June 2010, hosted by the Puerto Rico Department of Health (DOH-PR), National Networks’ members had the opportunity to bring the LGBT perspective to the agenda. We distributed valuable educational materials from NLTCN and the LGBT Tobacco Control Network and discussed the inclusion of gender and sexual orientation questions in island-wide surveillance surveys. During the exchange of ideas, Quitline staff showed interest to incorporate these questions as part of the demographic data collected during calls, but showed concern regarding LGBT cultural competency and over saturation of demographic questions. The DOH-PR is also communicating with the CDC to include these questions in the Behavioral Risk Factor Surveillance System (BRFSS) for Puerto Rico in accordance to the LGBT Surveillance and Data Collection Briefing Paper (2008) from the LGBT Tobacco Control Network and as supported in the recently released report by the American Lung Association, Smoking Out a Deadly Threat: Tobacco Use in the LGBT Community. Local tobacco Coalition members are ready to be inclusive of the LGBT community and address the need for additional research specific to the LGBT community.

Since 2009, both Networks have been overwhelmingly supportive of surveillance opportunities, outreach, and education, including the translation, edition, and adaptation of the survey instrument and by identifying (and sponsoring) national Latin@ LGBT tobacco control experts to introduce this issue at the last DOH-PR sponsored Tobacco-Obesity Summit. This was probably the first time an LGBT perspective, including preliminary local survey results, were presented to the tobacco control and public health communities of the Island.

An equally valuable opportunity took place in May 2009 at the LGBTT Health Forum: Experiences in Tobacco Control during the III Congress Against Homophobia, a week-long event sponsored by the local LGBT group, Puerto Rico Para Tod@s (Puerto Rico For All – www.prparatodos.org). The Forum was sponsored by NLTCN and the School of Dental Medicine-UPR and with support from the DOH-PR we collected more responses for the LGBT community health-tobacco survey and distributed Networks’ brochures and publications to a crowd of mostly medical students and several local Coalition members. The Forum provided a space to rally allies and educate the audience on realities of oppression and discrimination among the LGBT community and how it directly affects healthcare access and services.

Many local advocates have showed interest as we have been navigating and supporting these events in further discussing LGBT health among LGBT Puerto Ricans and their allies. Merging tobacco control efforts with other health and social justice issues (while sharing limited resources during funding cuts) will be a sensible approach to engage the LGBT community in Puerto Rico. Local advocates will seek support from the CDC National Networks and other national gay groups to move work forward in Puerto Rico.

We thank the sponsoring groups for providing unconditional support to achieving our vision and participate in these events. To all the people that have helped the work move forward, including Island volunteers (Jose Santini, Wilfredo Santana, Fernando Sosa, Thomas Bryan, Sophia Isabel Marrero, Michael Roldan, Rahul Correa, and Carmín Maldonado), NLTCN staff and members (Jeannette Noltenius, Aida McCammon, Yanira Arias, and JC Velazquez), LGBT Tobacco Control Network staff (Scout, Gustavo Torrez, and Sasha Kaufmann) and its fabulous print publications and online resources, Puerto Rico Department of Health-Tobacco Control and Prevention Division staff (Antonio Cases and Alex Cabrera), the members of the Puerto Rico Tobacco Free Coalition, the medical students and staff at the University of Puerto Rico-Medical Science Campus, and all the local Puerto Rico LGBT groups and individuals that have been supportive and excited to pursue this work.

This report was supported by CDC Cooperative Agreement Number U58/DP001515. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC. It was developed, edited, and translated into Spanish by NLTCN and LGBT Tobacco Control Network Members Juan Carlos Vega, Lissette Rodríguez, and Jean A. Leroux Guillén.

Sunday, June 6, 2010 was a bright sunny day and full of excitement in Puerto Rico. People from

all walks of life participated in Gay Pride festivities in the capital city, San Juan. While paying

respects to the families of the several transgender women murdered in the last months across

the island, local LGBT groups, activists, a few government officials, and thousands from all

genders and sexual orientations showed their pride and support for the LGBT community. In

between vibrant shows, words of unity and calls for action, participants were thirsty for gay

memorabilia, educational resources, and opportunities to support equality for all. Similar events

took place in the gay‐friendly setting of Boquerón on June 13 in the town of Cabo Rojo.

For these two consecutive Sundays and with much

enthusiasm, a handful of volunteers led by members of

the National Latino Tobacco Control Network (NLTCN)

and the National LGBT Tobacco Control Network

engaged over 500 people who showed interest in our

“mini‐gay‐library” of publications on health, tobacco

issues, legal rights, community surveys, a government

petition, bags, pens, pins, candies, and other goodies and

educational materials. Donated by Lambda Legal

(http://www.lambdalegal.org), a national organization

committed to achieving full recognition of LGBT civil

rights, hundreds of “I am making the case for equality” bags were filled not only with Lambda’s

materials on civil rights for HIV+ people, youth in the education system, and legal and financial

planning for LGBT couples, but also with educational materials from the two Networks, the

Puerto Rico Tobacco Free Coalition, the Puerto Rico Department of Health Cessation Quitline

!Déjalo ya! (Leave It Now!), the Latino Commission on AIDS, and the Social Justice Sexuality

Initiative from the City University of New York (CUNY). Members of these two National Tobacco

Control Networks were able to pull together resources from all these organizations in order to

educate the community. Some provided supplies; others

purchased the tables and chairs, or paid for volunteer

lunches, while allies from the University of Puerto Rico

(UPR) provided staff and logistical support in preparation

for the events. This collaboration was essential to

provide Pride participants with health information and

other educational opportunities, which seemed very

limited during the festivities.

Through our participation in Pride events, we were able

to collect an additional 292 NLTCN sponsored healthtobacco

surveys among the LGBT community of Puerto

Rico. This increases the total survey sample to 431 since

distribution began in local LGBT events and activities in

November 2009. We continue the search for additional

venues to distribute the survey and increase the final

sample. We are currently analyzing the sample with the

support of our NLTCN Steering Committee Member, Dr.

Elba Díaz‐Toro, Associate Professor of the School of

Dental Medicine, UPR.

In addition, a total of 420 signatures were collected for a Lambda sponsored petition asking the

Puerto Rican Department of Justice and the local Police Department to create official links within

their respective agencies with groups and individuals representing the LGBT community. Some

local groups have claimed that in the last eight months seven murders of gay and transgender

people have taken place around the Island, which motivated people to sign the petition. National

and local groups will be taking the signatures directly to government officials and agencies.

Networks’ members have been active on rallying support, sharing information, and connecting

local groups and individuals with national resources in support of comprehensive approaches to

address issues of health disparities, stigma, and discrimination towards the local LGBT

community. Lessons learned will be shared later among other Latin@ and LGBT groups in the

mainland.

Just as important was the distribution of the Social Justice Sexuality Survey, a nationwide

initiative that investigates the socio‐political experiences of LGBT people of color, sponsored by

the Sociology Department of the City University of New York (CUNY) in partnership with the

Human Rights Campaign, the Gay and Lesbian Task Force, among other gay advocacy groups.

During our participation at Pride events, National Network members collected a total of 115

completed surveys providing a richer set of data to create a profile of the LGBT community in

Puerto Rico. The Initiative is interested in better understanding how identity enhances or

inhibits the experiences of the LGBT population around accessing health, civic and social

engagement, among other important issues. Folks can complete the survey online and read more

about the Initiative at http://www.socialjusticesexuality.com

Furthermore, during the last Puerto Rico Tobacco Free Coalition meeting in June 2010, hosted by

the Puerto Rico Department of Health (DOH‐PR), National Networks’ members had the

opportunity to bring the LGBT perspective to the agenda. We distributed valuable educational

materials from NLTCN and the LGBT Tobacco Control Network and discussed the inclusion of

gender and sexual orientation questions in island‐wide surveillance surveys. During the

exchange of ideas, Quitline staff showed interest to incorporate these questions as part of the

demographic data collected during calls, but showed concern regarding LGBT cultural

competency and over saturation of demographic questions. The DOH‐PR is also communicating

with the CDC to include these questions in

the Behavioral Risk Factor Surveillance

System (BRFSS) for Puerto Rico in

accordance to the LGBT Surveillance and Data

Collection Briefing Paper (2008) from the

LGBT Tobacco Control Network and as

supported in the recently released report by

the American Lung Association, Smoking Out

a Deadly Threat: Tobacco Use in the LGBT

Community. Local tobacco Coalition

members are ready to be inclusive of the

LGBT community and address the need for

additional research specific to the LGBT

community.

Since 2009, both Networks have been overwhelmingly supportive of surveillance opportunities,

outreach, and education, including the translation, edition, and adaptation of the survey

instrument and by identifying (and sponsoring) national Latin@ LGBT tobacco control experts to

introduce this issue at the last DOH‐PR sponsored Tobacco‐Obesity Summit. This was probably

the first time an LGBT perspective, including preliminary local survey results, were presented to

the tobacco control and public health communities of the Island.

An equally valuable opportunity took place in May 2009 at the LGBTT Health Forum: Experiences

in Tobacco Control during the III Congress Against Homophobia, a week‐long event sponsored by

the local LGBT group, Puerto Rico Para Tod@s (Puerto Rico For All ‐ http://www.prparatodos.org). The

Forum was sponsored by NLTCN and the School of Dental Medicine‐UPR and with support from

the DOH‐PR we collected more responses for the LGBT community health‐tobacco survey and

distributed Networks’ brochures and publications to a crowd of mostly medical students and

several local Coalition members. The Forum provided a space to rally allies and educate the

audience on realities of oppression and discrimination among the LGBT community and how it

directly affects healthcare access and services.

Many local advocates have showed interest as we have been navigating and supporting these

events in further discussing LGBT health among LGBT Puerto Ricans and their allies. Merging

tobacco control efforts with other health and social justice issues (while sharing limited

resources during funding cuts) will be a sensible approach to engage the LGBT community in

Puerto Rico. Local advocates will seek support from the CDC National Networks and other

national gay groups to move work forward in Puerto Rico.

We thank the sponsoring groups for providing unconditional support to achieving our vision and

participate in these events. To all the people that have helped the work move forward, including

Island volunteers (Jose Santini, Wilfredo Santana, Fernando Sosa, Thomas Bryan, Sophia Isabel

Marrero, Michael Roldan, Rahul Correa, and Carmín Maldonado), NLTCN staff and members

(Jeannette Noltenius, Aida McCammon, Yanira Arias, and JC Velazquez), LGBT Tobacco Control

Network staff (Scout, Gustavo Torrez, and Sasha Kaufmann) and its fabulous print publications

and online resources, Puerto Rico Department of Health‐Tobacco Control and Prevention

Division staff (Antonio Cases and Alex Cabrera), the members of the Puerto Rico Tobacco Free

Coalition, the medical students and staff at the University of Puerto Rico‐Medical Science

Campus, and all the local Puerto Rico LGBT groups and individuals that have been supportive

and excited to pursue this work.

This report was supported by CDC Cooperative Agreement Number U58/DP001515. Its contents are solely the

responsibility of the authors and do not necessarily represent the official views of the CDC. It was developed, edited, and

translated into Spanish by NLTCN and LGBT Tobacco Control Network Members:

Juan Carlos Vega, MLS

Activist Librarian &

Information Consultant

Lissette Rodríguez, MA, BSEd

Health Educator

Jean

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