LGBT health needs rendered invisible- AGAIN!

Up in Smoke, Again….

On March 29th, the Surgeon General’s office released its latest and long awaited report on youth and smoking
” Preventing Tobacco use Among Youth and Young Adults” “an eagerly awaited and much heralded 920 page document replete with meta- analyses of national and state tobacco surveillance data, recommendations, and documentation of disparities among sub-populations . The report is intended to provide irrefutable and science-based evidence that there is a significant relationship between anti-smoking interventions, non-initiation of smoking by young people and health promotion. The report is also intended to insure the ongoing allocation of government and private resources, including funding, to prevent initiation of smoking among youth and to target prevention efforts to address significant youth population disparities.

As a staunch and dedicated smoking cessation advocate and practitioner for more than two decades, I welcomed the rigor of this report in providing the best and most reliable evidence possible to thwart the still powerful resources of the pro-tobacco lobby. The report is formidable in this regard but it also broke my heart; with all that we do now know about the disproportionate disparities in tobacco use among LGBT persons and in particular, among our most vulnerable LGBT youth, in 968 pages there was only one small line that mentioned LGBT affected communities: Limited, if any, surveillance data exists for other demographic subgroups known to have higher rates of tobacco use (e.g., the lesbian, gay, bisexual, and trans¬gender community; Lee et al. 2009), so are not explored.

Not even explored? Once again, in the name of science or evidence, in a major and most influential government report, LGBT needs were rendered invisible, despite that we now know more, have more evidence, than ever before, to document and support the higher prevalence of smoking among LGBT youth and young adults.

Despite that the report itself, cites a thorough and stellar systematic review of LGBT tobacco data from 42 studies, wherein 119 measures of tobacco prevalence or association were reported and from which , the “available evidence points to disparities in smoking among sexual minorities that are significantly higher than among the general population” .

Despite the availability of smoking data from the 20 states that now collect sexual orientation information and smoking prevalence on the Youth Risk Behavior Survey, a source used extensively in this report.

Despite the evidence in this report for the efficacy of anti-smoking media and messaging that has high emotional resonance for youth, for community specific, community level interventions that reach youth populations in their own communities, for the need for further studies of prevention approaches that will continue to be effective in smoking prevention for disparity populations.

Despite the call to action throughout this report to stay vigilant on tobacco control and smoking prevention for the next generations, or as Dr. Thomas Freidan, Director of the CDC and nationally renowned tobacco control expert and advocate says in his foreword: Reducing tobacco use is a winnable battle. We have the science and, with additional effort and support for evidence-based, cost-effective strategies that we can implement now, we will improve on our nation’s health and our children’s future.

For those of us who continue to work for a healthier and smoke free future for our LGBT young people, the lack of inclusion in this report is more than disappointing; it is unconscionable. We call upon the Surgeon General and all of those concerned for the future health and well-being of all of our children not to let the dreams and aspirations of our LGBT youth yet again, go up in smoke.

Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review.
Lee JG, Griffin GK, Melvin CL. Tob Control. 2009 Aug;18(4):275-82. Epub 2009 Feb 10.

Barbara E. Warren, Psy.D. is a longtime advocate for LGBT health equity. She was recently appointed to the New York State Department of Health’s Tobacco Use Prevention and Control Advisory Board and serves as Director for LGBT Health Services at Beth Israel Medical Center in New York City.