Last MPOWERED Best Practices Community Review Now Thru Monday

Scout, Ph.D.

Director, The Fenway Institute’s Network for LGBT Health Equity

 

Community-Verified Best Practices

This is IT folks, after nearly a year of assembling and reviewing best and promising practices the Best Practices Committee is very close to finalizing the document. From now until Monday is your last chance to provide community input. Please take the time to scan, read, or pore over the draft practices below to make sure the near-final document reflects all our collected field wisdom and effective strategies.

Please email comments to lgbthealthequity@gmail.com by end of day Monday July 30th.

Below you will find the letter by letter breakout, matching the MPOWER national model.

M: Monitor is a critical for LGBT tobacco control

If we are not counted, we don’t exist!

Effective tobacco control starts with high quality data.  Effective monitoring of the tobacco pandemic must include diverse and marginalized populations such as LGBT communities.  LGBT communities are disproportionately affected by the tobacco epidemic yet are consistently left out of critical surveillance at the national, state, and local levels.  Until sexual orientation and gender identity are systematically measured in health surveys, LGBT deaths from tobacco related causes will remain in the closet.

Monitoring is a critical for LGBT tobacco control at the local, state, national level – Myths about the difficulties of collecting LGBT data on surveys continue to hinder the inclusion of LGBT questions on health monitoring surveys.   Until measurement of sexual orientation and gender identity becomes a routine part of the core demographic sections of health surveys tobacco disparities will persist.

• LGBT questions should be routinely included in the demographic sections of health monitoring and evaluation surveys.
• Routine state and national surveillance should be augmented by community level data on tobacco use among subpopulations.
  • Examples include: attitudes about tobacco use; attitudes about targeting; awareness of community smoking disparity; awareness of cessation services; use of quitlines; attitudes about wellness policies; awareness of wellness policies; frequency of social smoking; and concomitant stress related health markers, such as addictions or mental health variables.

Monitoring must be scientifically valid – There are a number of considerations for developing surveillance systems to capture tobacco use in LGBT communities including measurement, sampling, and ensuring the validity of data.  A mix of full probability and non-probability methodology is needed to effectively monitor the population health status.

• State and national surveys (e.g., full probability surveys) should:
  • Use standardized sexual orientation and gender identity measures that are cognitively and field tested
  • Be sure to consistently collect both sexual orientation and gender identity
  • Non probability survey methods
    • A first step in creating valid surveillance of smaller groups within the LGBT communities may first call for community needs assessment and/or ethnographic study.
      • Need to ensure that the sampling plan to be implemented will yield a representative sample of the community. For example, recruiting exclusively from bars does not yield a representative sample of the LGBT community.
        • Example: LGBT of Color Report
        • Additional monitoring strategies
          • Look for other opportunities for surveillance, such as research studies, quitline intakes, and any other place where tobacco control knowledge is being amassed.

More research is needed to fully understand LGBT tobacco use disparities and potential points of intervention – Understanding the complicated profile of LGBT tobacco disparities requires measuring factors beyond prevalence.

• Additional studies should be considered to address gaps in the areas of LGBT tobacco-related.  The following list is not a comprehensive but provides a few examples:
  • Uptake
  • Outcomes
  • Attitudes, norms, and beliefs
  • Quitline utilization
  • Impact for LGBT  of color, bisexuals, and
  • Transgender people

Publicize findings — In the absence of routine inclusion in state and federal surveillance, local studies take on particular importance. Current justification of LGBT tobacco projects often relies on local study data from other jurisdictions. It is particularly important to collect data and routinely publish findings.

• Report LGBT breakout data in all routine surveillance and disparity monitoring reports
• Report community-based study data broadly

P: Protect LGBT People from Tobacco Smoke

All people deserve equal protection from the dangers of secondhand smoke

Secondhand smoke (SHS) is a known carcinogen with no safe level of exposure. Comprehensive clean air policies are effective in protecting LGBT communities from the dangers of SHS and changing community norms around tobacco use. LGBT communities are overwhelmingly supportive of clean air policies. Yet, the tobacco industry has aggressively worked to undermine policies to protect communities from secondhand smoke. Tobacco-free policies where people work, play, and live are key to protecting LGBT communities.

Protect LGBT people where they Work

• Engage the LGBT community in comprehensive clean indoor air policy adoption – Engaging LGBT community to support comprehensive clean indoor air policies has been quite effective. With strong history of tobacco industry co-opting LGBT leadership to institute exemptions it is important to gain support from the LGBT communities.
• Protect employees from tobacco exposure in the workplace – Smoke-free policies do not hurt businesses and protect the health of patrons and staff from tobacco-related illnesses.

Protect LGBT people where they Play

• Make LGBT community events smoke-free – Smoke-free policies at community events are effective at protecting LGBT communities from the dangers of secondhand smoke and changing community norms around tobacco use. Some gains have been made in certain venues, but further work is needed:

• Make restaurants and bars smoke-free— Supporting smoke-free policies not only protect the staff but the patrons alike. Smoke-free establishments are welcomed by LGBT people and have had no negative impact on business revenue. Some gains have been made in certain venues, but further work is needed to expand the types of smoke-free spaces and increase compliance with existing policies:

Protect LGBT people where they Live

• Make LGBT living environments smoke-free – Smoke-free homes protect residents and increase quit attempts.  It is important that LGBT homes are included in smoke-free and multi-unit housing campaigns.  There is significant opportunity for coalitions working on smoke-free homes and multi-unit housing to partner with LGBT communities.

O: Offer help to quit

LGBT smokers want to quit and they welcome help that is culturally appropriate

The majority of LGBT smokers are interested in quitting.  Effective smoking cessation treatments are available including stop smoking medications, counseling approaches, and self-help methods. However, LGBT smokers experience multiple barriers to accessing effective and culturally appropriate treatments.  Multi-dimensional approaches to treatment are needed to increase LGBT smoking cessation rates.

All smoking cessation awareness campaigns and treatment services should include LGBT targeted and/or tailored programs to ensure equal access – Public health approaches are relatively cost-effective strategies for raising awareness, increasing knowledge, and improving access to smoking cessation services. Tobacco prevention and smoking cessation messages that are targeted to specific communities may be effective in reducing smoking related health disparities. Targeted messaging for disparity populations should also include LGBT communities.

• Public health campaigns should highlight LGBT disparities in smoking prevalence rates
• Outreach and awareness campaigns for LGBT smokers should include information about the availability and effectiveness of stop smoking treatments
• All media campaigns targeted toward disparity populations should include LGBT specific elements
• Traditional and social media approaches should be used
• When possible, use messaging that has been tested with LGBT people

Increase Quitline utilization and efficacy for LGBT communities – Few smokers get the help they need to quit smoking.  Telephone coaching services are now available in all 50 states and US territories. State supported quit-lines serve as a cost effective treatment strategy that overcomes traditional barriers to treatment including ability to pay, geographical location, and transportation.  Cultural competency training and targeted outreach can increase utilization of state quitlines among LGBT smokers.

• Require cultural competency trainings for all state quitline staff.
• Ask sexual orientation and gender identity as part of standard demographic questions to tailor information and resource dissemination.
• Increase the saliency of coaching by providing LGBT specific information.
• Ensure quit coaches are trained to answer questions about the health implications of smoking for people living with HIV and AIDS and transgender people using hormones.
• Offer supplemental LGBT-specific written materials that can be mailed to callers.
• Provide callers with additional referrals to any locally available LGBT specific cessation resources.
• Target outreach efforts specifically to LGBT communities (e.g., targeted billboards, advertisements in LGBT media outlets) in order to increase utilization.
• Conduct more research on LGBT utilization of quitlines and evaluate smoking cessation outcomes based on sexual orientation.

Provide culturally competent quit advice and smoking cessation services – Research among racial and ethnic minority communities demonstrates the benefits of culturally targeted smoking cessation interventions. Culturally competent and targeted smoking cessation services reduce barriers to treatment and improve cessation outcomes.

• Smoking cessation services for LGBT smokers should be guided by current best practices (e.g., the “Culturally competent smoking cessation for LGBT smokers”).
• Smoking cessation treatment programs should be offered at locations that are safe and affirming to LGBT individuals.
• Treatment providers (individual therapists, group facilitators, peer counselors) should be culturally competent and knowledgeable about community–level barriers to smoking cessation (e.g., minority stress, higher rates of depression and substance use, bars as a social venue).
• When possible, provide LGBT specific treatment groups to increase comfort, trust, and mutual support.
• Several examples of culturally targeted smoking cessation curriculums are currently available (e.g., “The last drag”, “Bitch to quit”, and “Out to quit”)
• Online cessation methods should also be considered to increase access to LGBT persons living in non-urban areas (e.g., iQuit)

Clinical Practice Guidelines that address health care systems and providers should be consistently implemented – Implementation of CPG improves quit rates.  Yet, these guidelines are infrequently adhered to.  Providers and health care systems serving patients should adhere to clinical practice guidelines.   Integrating tobacco intervention into the delivery of health care represents an opportunity to increase rates of accessing tobacco dependence treatments, quit attempts, and successful smoking cessation.

• Best practices for providers:
  • All health care providers should ASK about and document smoking status, ADVISE smokers to quit, and ASSIST patients with accessing cessation services (3A’s).
  • LGBT smokers should also be provided with information about local cessation services (including LGBT specific services if available)
  • Best practices for healthcare systems:
    • LGBT health care centers should implement a systematic method for identifying tobacco users in the medical record (e.g., make smoking assessment a “vital sign” at intake)
    • Ensure that assessment and delivery of smoking cessation treatment is included in staff performance evaluations
    • LGBT health centers should provide training and resources on cessation for all of their health care providers

Funding for treatment should address LGBT tobacco users – Despite elevated smoking prevalence rates, LGBT populations are not consistently included as a disparity population in efforts to reduce tobacco-use disparities.  All general and disparity population cessation services should include LGBT specific programs to ensure equal access.

• Funding should be provided to offer and evaluate culturally tailored programs such as “the last drag”, “Bitch to quit”, and “Out to Quit”.

W:  Warn About the Impact of Tobacco Use on the LGBT Community

Media campaigns that are part of comprehensive tobacco control are effective.  LGBT people are 40% to 70% more likely to smoke than non-LGBT – one of the highest smoking rates among disproportionally affected populations. There has not been tobacco control media campaign that matches the toll of the tobacco epidemic in LGBT communities. This is in spite of the clear evidence of extensive tobacco industry media and marketing campaigns that target LGBT communities.  As a result, it is critical to develop and implement well-tested and targeted LGBT-specific media campaigns to counter the tobacco epidemic.

Create media campaigns that effectively reach and impact LGBT communities – A well-designed public education campaign that is integrated with community programs, strong enforcement efforts and help for smokers who want to quit has been documented to successfully counter tobacco industry marketing.  Effective warning labels, anti-tobacco advertising and the proactive use of earned media are three key ways to communicate health risks of tobacco. LGBT media may be particularly cost effective yielding a solid return on investment. LGBT media placements can shape dialogue within the community and encourage action by community leaders.

• Include an authentic representation of the diversity of LGBT people during campaign development and advertising message testing; utilize community groups for recruitment/outreach in testing
• Recognize that differences exist within the LGBT community:  develop tailored messages and approaches as appropriate based on geography, culture, background etc. [include transgender, HIV]
• Make tobacco use salient by linking the issue with existing community priorities (e.g., combine messages about tobacco and HIV, violence, CIVIL RIGHTS, obesity, etc.)
• Engage the LGBT community – via community promotion and leadership engagement —  to increase awareness about LGBT smoking disparities
• Seek dedicated funding for campaigns that include and target LGBT communities [i.e., imagery, ad buys]
• Consider how existing ads can be easily modified to tailor for LGBT communities (look at tobacco industry examples)
• Share campaigns with partners widely (i.e. submit advertisements to clearinghouses, post information online) in order to allow for broader use
• Negotiate rights upfront that allow for use by other organizations over time and permit easy adaptation by partners

Use LGBT media outlets and social media channels for earned, paid and online media campaigns – LGBT media outlets provide a concentrated, qualified LGBT audience and are highly trusted by LGBT people. “Earned media” and social media can be an inexpensive way to effectively reach LGBT communities.  Surveys show that the LGBT communities are more active on social networks than heterosexuals.  Aside from being more active on Facebook and Twitter, they are also more likely to read blogs – and as a result most likely to be receptive to social media marketing.  Social media strategies can be particularly effective for rural, youth populations.

• Seek dedicated and sustained funding for advertising placement in LGBT media outlets
• Proactively support LGBT events such as film festivals with advertising, sponsorships to counter tobacco industry support and to reach LGBT people
• Utilize best practice earned media approaches (e.g., localize messages; identify media-worthy issues to capture attention) and tactics (e.g., press releases and PSAs) and media advocacy (e.g., letters to the editor/publisher) targeted to LGBT-focused media outlets
• Supplement traditional paid and earned media campaigns with social media tactics and low-cost social media advertising placement
• Develop social media campaigns to take advantage of viral marketing
• Build relationships with LGBT bloggers
• Consider creating and maintaining your own blog

Partner with mainstream organizations to leverage LGBT inclusion in tobacco prevention and control campaigns – Working with partners to incorporate LGBT messages and media venues can leverage others’ investments in media campaigns and extend reach to LGBT communities.

• Advocate for LGBT representation in mainstream media campaigns and inclusion in efficacy testing of media campaigns and warning labels
• Work with other organizations (e.g. ACS, ALA) to seek inclusion of LGBT messages/issues into mainstream campaigns
• Maximize instances when other organizations include LGBT messages/issues in their campaigns via LGBT earned media, social media and wide dissemination
• Seek funding from mainstream organizations to support the development of campaigns to LGBT people

E: Enforce bans on tobacco industry promotions and sponsorships

Tobacco companies have targeted LGBT populations for decades both through product advertising and philanthropic support.  Through these efforts, tobacco companies have sought to attract LGBT smokers and curry support with and blunt criticism from LGBT community leaders. Tobacco industry advertisements are filled with subtle and not-so-subtle LGBT imagery and messaging. In addition, tobacco companies offer an unknown amount of financial support to LGBT festivals, bars, media, and local organizations.  Sometimes this money comes with conditions such as prohibiting gay bars from allowing anti-tobacco promotion onsite.  As early supporters of LGBT causes, the tobacco companies garnered positive community responses, since many other organizations avoided LGBT organizations.  This tobacco industry funding sometimes compromised anti-tobacco activities by LGBT community organizations.

Counter tobacco industry influence in the LGBT community – Tobacco industry documents reveal a long history of manipulative marketing tactics. The industry has spent billions to strategically market its products to targeted populations, including LGBT people. Other strategies include funding LGBT organizations and making campaign contributions to LGBT politicians. These “corporate social responsibility” tactics serve to cultivate positive perceptions of the industry and undermine tobacco prevention efforts. Public health and community groups have had success exposing tobacco industry tactics.

• Best and Promising Practices in Monitoring
  • Monitor the tobacco industry’s non-media tactics (CSR, recruitment, etc.)
  • Monitor the tobacco industry’s media buys and promotions, including point of sale, that target LGBT communities
  • Monitor the tobacco industry’s campaign contributions to political candidates
  • Encourage use of tobacco industry documents to expose tobacco industry efforts aimed at the LGBT community

• Best and Promising Practices in Education
  • Challenge the tobacco industry’s co-opting of LGBT community imagery and messaging in their targeted advertising
  • Educate the LGBT community on the history of tobacco industry attempts to market to and infiltrate LGBT communities, including supporting LGBT elected officials
  • Build awareness about tobacco industry marketing and ad buys focused on the LGBT community
  • Expose tobacco industry sponsorship of LGBT organizations, programs and events and juxtapose with the deadly impact of using their products
  • Speak out against any depictions of smoking in gay-oriented media.
  • Publicly challenge the tobacco industry when its tactics are found to be counter to public health, societal ethics, etc.

Eliminate tobacco industry marketing in venues that serve the LGBT community – Bars and nightclubs have traditionally been a safe social space for the LGBT communities. The tobacco industry utilizes these spaces to market tobacco products through venue-based promotions (giveaways, events, name recruitment) and provision of functional items (coasters, napkins, signage) that include tobacco brands and pro-tobacco imagery. The tobacco industry contracting with establishments may present barriers to implement tobacco control work in those venues.

• Adopt policies that reject tobacco industry advertising, event sponsorships and other promotions
• Hold LGBT media outlets and partner organizations accountable to ensure they refuse offers of tobacco industry advertising buys or other support
• Engage local organizations and coalitions to ban point of sale tobacco product advertising and promotions; when possible partner with mainstream organizations working on restrictions/bans and enforcement
• Include LGBT leaders/communities in policy advocacy, policy change efforts

R: Raise taxes on tobacco products

Tobacco taxation is one of the most effective strategies for lowering tobacco use consumption and prevalence, especially for youth. Similar to the general population, increasing tobacco taxation may have a positive influence on lowering initiation rates among LGBT youth and increasing cessation rates among regular adult LGBT smokers.

Engage LGBT communities in mainstream policy change campaigns – LGBT people are disproportionately affected by tobacco use and thus stand to greatly benefit from comprehensive tobacco control policies, especially those that fund LGBT specific tobacco control programs. LGBT organizations are well equipped with advocacy skills and experience to mobilize the community in favor of tobacco tax increases.

• Engage local LGBT organizations and communities in tobacco control to increase awareness of and support for tobacco tax campaigns
• Include LGBT organizations and leadership in tobacco control coalitions
• Fund community-based organizations to engage and activate LGBT communities on tobacco tax and media counter-advertising campaigns
• Leverage existing relationships with LGBT-friendly policy makers to promote tobacco control aims
  • Example: Clash, Mark Leno, No Tobacco Pledge
  • Avoid inclusion of anti-LGBT organizations in coalitions
  • Provide resources that will sustain the capacity of LGBT groups involved in tobacco control efforts

Use Tobacco taxes to fund local tobacco control programs and initiatives, especially those serving disparity populations, inclusive of LGBT communities – Historically, tobacco taxes have rarely been invested in comprehensive tobacco control efforts. Unfortunately when funds are made available for tobacco control, less than recommended funds are dedicated to priority populations inclusive of LGBT communities. Funding to support prevention and cessation in LGBT communities is needed.

• Engage community leadership to increase support for funding for tobacco control efforts
• Include community-based funding for priority populations to build support for tax increases on tobacco products
• Allocate tobacco tax revenue towards community-based tobacco control programs and initiatives among priority populations

Counter potential tobacco industry manipulation of the LGBT community in tobacco tax campaigns – The tobacco industry has a long history of influencing the LGBT community through targeted campaigns and funding opportunities and has previously manipulated the community in specific tobacco tax campaigns. Countering the tobacco industry’s influence around tax increases presents an opportunity to expose the industry’s exploitation of the LGBT community while working towards reduced smoking within the population.

E: Evaluate programs and disseminate findings

How we do it matters as well /how we do it counts

Innovative programs to address the tobacco epidemic in LGBT communities exist; however, few of these programs have been evaluated. Thus, is it unclear which of these programs work best and where resources should be targeted.  Evaluation can build the evidence base for developing better ways of preventing and treating tobacco addiction.

Programs and funders should give clear guidelines for evaluation outcomes and provide adequate funding to ensure that rigorous evaluation practices are followed – Evidence-based programs are needed to guide the best uses of limited resources in LGBT tobacco control.  Investment in well-designed and well-implemented evaluation can strengthen efforts to address the tobacco epidemic.

• Treatment groups should follow standard best practices documented in Howard Brown’s “How to run tailored LGBT culturally competent cessation treatment groups”
  • http://www.howardbrown.org/uploadedFiles/SmokingTreatmentGroup.pdf
  • Funders should ensure that at least 10% of budgets are devoted to program monitoring and evaluation.
  • See: http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm
  • Evaluators should be incorporated into program planning and design.
  • Organizations and state agencies should ensure that evaluation approaches are relevant to programs, improve quality, and are actionable.  Principles of utilization-focused or empowerment evaluation may be a particularly good fit.
  • Funding streams are more effective when evaluation is incorporated into the funding stream

State tobacco control evaluators should include measures of LGBT reach, access and impact in comprehensive program and media campaign evaluations – LGBT indicators should be part of the core reporting requirements.

• Specific care should be taken with the measurement of quit attempts and their duration. See: http://www.howardbrown.org/uploadedFiles/SmokingTreatmentGroup.pdf
• Standardized questions should be used whenever possible –
  • Standard optional Quitline intake questions: http://www.naquitline.org/resource/resmgr/mdsta2010/jan12mdsiq12-30-09final.pdf
  • Surveillance questions: http://www.lgbttobacco.org/files/09FCH_DataCollection.pdf

There is a compelling need for better sharing of evaluation results and lessons learned by LGBT community organizations, evaluators, and funders—disseminate findings – In an environment of limited resources and local community efforts, there is considerable value in sharing lessons learned and innovations between programs.  Innovations developed in one state need to be available for other states.

• Results from evaluations should be submitted to the Network for LGBT Health Equity’s resources page for sharing.
  • Funders should require that projects reports and lesson learned be submitted to such a clearinghouse.
  • Funders should examine their reporting requirements and develop reports in a format that lends itself to wider dissemination.
  • Partnerships between academic organizations and community organizations can result in academic publication of findings
  • Whenever possible, evaluation results should be shared back to communities for further discussion, development of next steps, and build advocacy campaigns.

D: Diversify to be inclusive of race, ethnicity, youth, sexual orientation & gender identity

The mainstream tobacco control movement is committed to reducing smoking disparities but has often neglected to engage the LGBT community in tobacco control efforts. Additionally, LGBT organizations have not consistently been inclusive of the diversity of subpopulations harmed by tobacco. Tobacco control efforts are stronger with the involvement of coalitions across populations and can more effectively address tobacco disparities. Marginalized groups that are especially affected and targeted by tobacco are valuable stakeholders in tobacco control initiatives.

Tobacco policy must be created with LGBT community input at all levels – LGBT organizations bring considerable community-organizing and advocacy expertise and experience to tobacco control campaigns. Tobacco control programs and policies benefit from LGBT engagement at the local, state, and federal levels and also at all stages of program planning, implementation and evaluation.

• Enlist the expertise of LGBT organizations on community advisory bodies, especially those determining funding
• Ensure representation of the diversity within the LGBT community
• Ensure constructive engagement by identifying LGBT representatives who are recognized community leaders with access to other LGBT and Allied leadership and organizations
• Avoid bringing politicized, anti-LGBT organizations into policy change coalitions

LGBT-community based activities are strengthened through collaboration with nontraditional partners and allied organizations – Partnerships with non-LGBT organizations represent a missed opportunity in strengthening LGBT tobacco control efforts. Tobacco control aims can be achieved by building collaborations and developing relationships with potential allies.

• Require cross-training between priority population organizations
• Build linkages and collaboration with relevant organizations including racial and ethnic minority groups and professional and health-related networks
• Encourage LGBT community-based organizations to support the initiatives of allied organizations

Engage LGBT youth to build current and future capacity for tobacco control – LGBT youth smoke at higher rates likely due to tobacco industry targeting, as well as a coping mechanism against isolation and systemic homophobia. Fostering LGBT youth leadership around tobacco control is a sustainable and effective strategy to change cultural norms, involve an at-risk population, and develop capacity for the future.

• Foster tobacco control programs within existing LGBT-relevant youth organizations
• Involve LGBT youth in tobacco control-related activities and policy campaigns
• Promote inclusion of LGBT youth in tobacco control youth leadership programs
• Use successful youth-led leadership programs as a model for tobacco control
• Utilize messaging shown to resonate with youth
• Consult and include youth in the development of traditional and social media campaigns around tobacco issues
• Developing youth leadership includes accommodating the practical needs of youth through provision of training, ongoing mentorship, resources, transportation, and appropriate reimbursement

Engage LGBT communities of color in tobacco control initiatives — Tobacco industry targeting of communities of color and LGBT people increases risks for those at the intersection of these communities. Tobacco control efforts at all levels are more effective when programs demonstrate cultural competence and utilize the networks and leadership within LGBT communities of color.

• Highlight and acknowledge issues of multiple identities, including issues of competing priorities across organizations.
• Provide culturally competent and targeted outreach, interventions, and materials.
• Establish relationships with LGBT communities of color-specific organizations.
  • YouthPride Services with support from the National Youth Advocacy Coalition and the American Legacy Foundation conducted youth-led focus groups centered around tobacco use among LGBT youth of color. Black, MSM and LGBT youth of color were given decision-making power in the formation of the focus group, the group’s activities and participation in events relevant to tobacco control. These focus groups were engaged in discussions around tobacco use in the community and participants interviewed peers on tobacco-related behavior and perceptions of smoking.

Engage Transgender communities in tobacco control initiatives – The transgender community has been especially marginalized relative to other affected populations. Tailoring programs to meet the specific needs of the transgender community will improve the reach and success of tobacco control efforts for this population.

• Ensure cultural competency training is mandated for all staff and volunteers.
• Ensure cultural competency around pronoun and preferred name usage as well as access to services and facilities such as gender neutral restrooms.
• Address different capacity needs in order to effectively target Transgender community in tobacco control
• Understand that being “out”/perceived as Trans and/or “passing” as one’s preferred gender affects and elevates smoking rates in this population
• Build awareness among providers about the relationship between smoking and transgender specific healthcare needs, e.g. the risk associated with smoking and hormone replacement therapy
• Smoking cessation should be a standard part of clinical models of care for transgendered individuals
  • The New Mexico Community Planning and Action Group (CPAG) engaged the transgender community in tobacco control by creating The Transgender Taskforce Established as a partnership between the New Mexico Department of Health and the local transgender community, the Taskforce seeks to address HIV, substance abuse (including alcohol and tobacco), and other health disparities in the local transgender community. The CPAG and the Transgender Taskforce has since collaborated with community-based LGBT health organization, Fierce Pride, in tobacco control initiatives.

Engage Bisexual communities in tobacco control initiatives – Evidence suggests higher rates of smoking among bisexual individuals compared to lesbian and gay populations. Further research and intervention are needed in order to better understand and serve this community.

• Ensure that studies of LGBT tobacco use and other tobacco-related research involve bisexual populations in addition to other disparate groups
• Include bisexual community leaders, representatives and organizations in LGBT community based tobacco programs