Voices of Health: Seeing LGBTQ health in Minnesota

Headshot_Color
 
 
Sheila Nezhad
Research & Education Manager
Rainbow Health Initiative
Voices of Health: Seeing LGBTQ health in Minnesota

 

In March, 2013, Rainbow Health Initiative released a landmark report that outlined the results of a health survey of 1,144 LGBTQ people in Minnesota.  The results made it clear that we need to take immediate action to advance health equity for Minnesota’s LGBTQ population.

wrfwefsLGBTQ people in Minnesota are smoking at significantly higher rates. 30.8% of respondents were smokers, compared to 16.1% of the general population in Minnesota.[1] Tobacco can be a tricky issue to address because, too often, it is attributed to an individual lack of willpower, rather than systematic targeting and discrimination by tobacco manufacturers. However, I want the members of my community to lead long and healthy lives. This means we need to support the 61% of respondents who said they want to quit, and prevent the tobacco industry from recruiting new LGBTQ smokers.

The survey identified some structural barriers to LGBTQ health. 32.7% of transgender LGBTQ respondents reported that not having a safe and convenient place to exercise was a barrier to physical activity—three times the rate of cisgender LGBTQ respondents (11.3%). LGBTQ people of color were less likely to have good quality fruits and vegetables available where they usually shop for food (24.4%) than their white counterparts (15.8%), suggesting they are more likely to live in food deserts.  We must utilize our knowledge of structural barriers to health in order to design systems that are accessible to everyone.

The survey revealed that LGBTQ people in Minnesota are being severely underserved by our healthcare system. One in four LGBTQ respondents reported receiving poor quality healthcare because of their sexual orientation or gender identity.  One respondent wrote,

“Every time I go to the doctor I end up wasting time having to justify my gender and the changes I’ve made to my body to the doctor, even if I am seeing a doctor for something unrelated to my gender.”

More than one in every six LGBTQ respondents reported being discriminated against by a healthcare provider because of their identity.  A respondent recounted their experience:

“Doctors are so confused by me and afraid at urgent cares that sometimes they won’t touch me or often prescribe three times the antibiotic I may need.”

wwer

This disservice disproportionately affected the transgender population. Trans people were nearly twice as likely to have received poor quality care (44%) than cisgender

people (24.5%) and more than twice as likely to have experienced discriminatory care (38.2%) than cisgender people (15.2%).  Healthcare professionals need to make an explicit commitment to improving LGBTQ cultural competency to address this disparity.

In order to design culturally competent policies and programs, we need to understand the needs of our LGBTQ communities. Part of that understanding means improving data collection. Universities, healthcare providers, and policy makers need to follow the example of leaders like the National Health Interview Survey and the Williams Institute and adapt their techniques to local contexts, as Minnesota’s Hennepin County SHAPE survey has done. Better data collection also means that LGBTQ people need to remain engaged with research efforts. The more people who participate, the more we can break analysis by identity to understand the needs of all members of our communities.

Download the full report here: http://www.rainbowhealth.org/files/1013/6318/9525/VoicesofHealth_Rainbow_Health_Initiative.pdf

check out this cool infographic of their findings!

Learn more about Rainbow Health Initiative: www.rainbowhealth.org

adafas


[1] Cigarette Smoking and Secondhand Smoke Exposure Among Adult Minnesotans Continues to Decline. Retrieved from http://www.mnadulttobaccosurvey.org/

March Updates from the Network

March has been yet another busy month for the Network. We are pleased to announce the launch of two major projects from the Network. First, Joseph Lee of our Steering Committee is helping us launch MPOWERED best and promising 

practices review, an effort to collect lessons learned in the field of LGBT Tobacco Control. The final document will be launched at our Summit, the 8th National LGBT Health Equity Summit, in Kansas City this August. Second, at long last the Network is pleased to announce the launch of our new website www.lgbthealthequity.org. Although we are still working on the last small details, we are very pleased to have this new resource up and running for the field.

Our staff was active this month in a few different events. First, Scout attended the FDA Research Summit. At it we got one win from a prior action alert – FDA agreed to collect at least LGB (not yet T) data on their new historic NIH tobacco research project. He recaps the important aspects of the summit here: FDA Tobacco Research Meeting – Upshot & Action Needed Now!

Pakou, Sarah, and Ditra giving us the inside line

He also attended the TAPP-INTO convening of state disparity networks in Minnesota (we have a long term contract to provide tech assist to these networks). See one of the key lessons from their sustainability training here: What do funders want? Gustavo was also out training, he presented on making practices welcoming to LGBT patients at the first ever Sharing Best Practices in GLBT Health training sponsored by the Sylvie Ratelle Prevention and Training Center of Massachusetts Department of Public Health. Most recently, staff attended the FDA Tobacco Policy Center disparities listening session hosted by our friends at Legacy, with the sister tobacco control networks and partners across the country. The next day, Legacy convened the disparity groups to strategize together. Watch to see us roll out more coordinated menthol advocacy in the near future, and read about the other policy priorities here: Disparity Networks Plus.

There have been some major events this month that the Network has been promoting. First, partnering with our friends at Shift MN, we celebrated Kick Butts Day. We had two great posts from MN Youth from Shift MN showcased posts on our blog; Dangerous Swagger and Breathe… Standing Up Against Corporate Tobacco. The Network has also helped promote the Coalition’s Health Awareness Week. Most notably, we have helped spread the news on two major tobacco events: the rollout of the first national tobacco education campaign and the release of the Surgeon General’s Report on youth smoking. Also this month, the Network campaigned to help one of our bloggers, e.shor, run for and ultimately win a scholarship to Netroots Nation. The network also highlighted some world tobacco news, as Brazil announced the ban of flavored cigarettes including menthol. According to a report from the National LGBTQ Youth Adult Tobacco Project, 71%33.9% of current smokers smoke menthols and an astonishing 82.6% of African American smokers smoke menthols. In addition, a disproportionate number of Hawaiian/Pacific Islander, Hispanic/Latino, Asian, American Indian/Alaskan Native, and multiracial smokers smoke menthols compared to white smokers.
of LGBT youth who smoke cigarettes smoke mentholated cigarettes. If FDA stepped up and also banned menthol in the U.S. it is likely the single most important action that could be taken to deter youth smoking. Also, we continue to highlight local projects, like this one on David Mariner’s tobacco and HIV project, and provide policy insight on our blog, like with our post on LGBT funding announcements and our heads up on things we expect to see soon from HHS.

We are very pleased to report that one of the requests we made with our Puerto Rico allies in January’s Department of Justice meetings has already come about, FBI and DOJ officials have been deployed to Puerto Rico to conduct additional listening sessions with community members with a promise of official trainings to follow. Read more about it here.

In other notes, we also got the news our PCORI application submitted a few months ago did not get funded and we are currently seeking nominations for two new Steering Committee members. Also catch our nice rundown of last year’s accomplishments here: Highlights of Network Accomplishments Over Past Year.

Finally, you know we blog a lot, and perhaps you’ve noticed we’re also trying to get more media attention to LGBT tobacco and wellness issues. We’re happy to announce a great outgrowth of both of those efforts; Scout has become an official Huffington Post blogger! Read his first two pieces New ‘Additional Feature’ for Health Insurance Finder: Same-Sex Coverage & White House Creates a Watershed Moment for LGBT Health and be sure to watch for more.

They’re Still Talking Bout YOU

Hay Network Hay,

Last week I went to a training by La Tanisha Wright, former trade marketing manager for Brown and Williamson Co (now a part of RJ Reynolds), currently a fierce anti-tobacco/tobacco control activist. This was some of the most interesting information that I have heard to date about how the tobacco corporations screw over marginalized communities because it was an inside perspective on all of those little things that are put in place to target our communities to become life long addicts. Let me extrapolate…

Let’s talk about language. Corporate tobacco knows we are watching them, so they have crafted a linguistic system to keep litigation and keen tobacco control activists always guessing what their intentions are. For example, corp-tobaco doesn’t want you to think that they target minors (cuz that’s ILLEGAL) so they use the language ASU 30 (adult smoker under 30…insert any age) and ASO 21 (adult smoke over 21). Now, this might not seem that deceptive to you, but there are distinct differences between the demographics of ASU 30 and ASO 30, and corp-tobacco incorporates marketing campaigns that appeal to MSU 18 (minor smoker under 18, an e.shor creation) into these campaigns. Check out this picture of the Kool MIXX campaign if you don’t believe me…

 

Another language lesson that La Tanisha taught me was about “focus” communities and “non-focus” communities. Instead of saying let’s target African American people or LGBTQ people or Native American and American Indian communities, now corp-tobacco says “focus” and “non-focus.” Focus is the term corp-tobacco literally uses to refer to “low socio-economic status communities with urban characteristics with high economic insecurity and risk of poverty, lower education, and less access to health insurance.” Corp-tobacco, RJ Reynolds and Lorillard (they have the biggest market share in focus communities) put more marketing in focus communities, provide more coupons in focus communities, and give more discounts of tobacco products in focus communities. So who are they targeting?

“We don’t smoke that shit, we just reserve the right to sell it to the young, the poor, the black, and the stupid.”

–as quoted in a New York Times editorial by Bob Hebert, 1993

The inspiring part of La Tanisha’s story is that she identified the ruthless and manipulative marketing ways of corp-tobacco through the branding of the Kool MIXX campaign (see pic above) and is now teaching tobacco control folks about how the company she worked for silenced her, silenced her community, and has sneakily coerced millions of people into becoming slaves to their poisonous products. La Tanisha painted an earnest history of African American people emerging from slavery in the tobacco fields to the slavery of addiction of corp-tobacco due to the intensive marketing in African American communities. This is not an accident. Corp-tobacco knows your history and they will use your pain and weaknesses to make you believe whatever you want…as long as you use their products.

I have so much more to say here, but I understand the attention span of most readers is longer than mine and I am…mmmmm pretty colors.

Whoa…I’m back.

I know this blog is about LGBTQ tobacco control, but unfortunately, one of the things I am learning on my journey in this field is that LGBTQ folks are targeted by corporate tobacco alongside the African American communities, Native communities, Latino communities, Southeast Asian communities, people in poverty, homeless people, and so many others. In my work, I need to constantly acknowledge that we are all working in solidarity with one another.

Hope you have a wonderful holiday time,

e.shor

Great American SmokeOUT with SHIFT Minnesota!

Hay Network Hay,

e.shor here on this day called the Great American SmokeOUT!

In case you are looking for a bit more information on the Great American SmokeOut here is a bitty synopsis: “The Great American Smokeout has helped to spotlight the dangers of tobacco use and the challenges of quitting, but more importantly, it has set the stage for the cultural revolution in tobacco control that has occurred over this period [since 1977] (American Cancer Society).”

To address the Great American SmokeOUT, my colleagues and I from SHIFT Minnesota are going to be sharing some of our thoughts with you throughout the day! SHIFT Minnesota is a brand-new, young-adult-run tobacco control campaign in Minneapolis! We know from the many resources like The Network for LGBT Health Equity and The National LGBT Tobacco Control Network (and many others too!) that there is an increased rate of smoking and tobacco consumption in LGBTQ communities, as well as direct targeting from tobacco corporations to get LGBTQ folks to be life-long addicts. So, SHIFT’s mission is:

SHIFT  charge forth to mold healthier LGBTQ communities by severing ties with corporate tobacco…using education, advocacy, and power-punching policy, we fight against the ruthless, manipulative corporate tobacco agenda. 

Hope ya’ll are having a great day!

e.shor

 

American Public Health Association (APHA) Conference Reflections

 

 

 

 

Hay Network Hay,

It’s me, e.shor, sitting on a plush leather couch in the lobby of the Washington DC Convention Center at the American Public Health Association (APHA) Annual Meeting. This place is a whirlwind for a first timer, filled with fast moving sessions, lots of talk about methods, odds ratios, and limitations of research studies. Public health is growing so fast that this conference is now spread over three buildings in downtown DC with over 13,000 attendees and thousands of sessions and posters on hundreds of public health topics. One of the opening speakers was from the National Parks and talked about the positive health benefits from being active in the natural world…pretty cool huh?

There is so much good work being done by such a diverse group of public health practitioners at this conference. It really is impressive the strides and research people are doing in tobacco control, alcohol, nutrition, physical activity, cardio-vascular disease, diabetes and how different populations experience and face different health disparities. However, it was really tough to walk into the LGBT Caucus meeting to find that there were only 6 session on LGBTQ health, most of which focused on MSM (men who have sex with men) and HIV. Out of the thousands (not an exaggeration) of sessions and posters presented  only SIX sessions and about 12 posters were directly related to LGBTQ health.

This shows me exactly our place in this whole thing…

I went to a session about “Lesbian and Bisexual Women’s Health” where we covered studies dealing with mental health, substance abuse, sexual health and sexually transmitted infections (STIs). Most of the data that the researchers presented was fascinating and illuminated risk factors that are tied to sexual minority status (now that is the jargon) and that health disparities really do exist for LBQ women! At the end of this session a person asked whether data in these studies account for transgender people and transwomen in collection and analysis…most of the presenters apologized and said that they used data from large data sets like NHANES where LGB people are sparsly represented because most large, national data sets to not over-collect in LGB communities, and trans folks are virtually invisible. I call this disparities in data collection…

Good news in: Healthy People 2020 has a new initiative to address LGBTQ health disparities! One of the issues that was identified is the complete lack of data on transgender and gender non-conforming people in our communities. Thank goodness! There were a number of states that have been awarded funding from Healthy People 2020 to start working on many different projects, including LGBTQ health initiatives…to find out more about your state click here! This is an amazing opportunity to Mobilize, Asses, Plan, Implement, and Track in local communities, with local health organizations, and to collect data and find out more about the health needs of our communities. I am from Minnesota, and there is quite a bit of scandal around the use (or lack there) of our HP2020 funding and the fact that we yet to reach out to local agencies working on health disparities. When I get home I will definitely be looking into this and holding the Minnesota Department of Health accountable to me and to my communities.

I know statistics are boring sometimes, and a lot of the stuff they say at conferences like this don’t make sense to a lot of people because they are all “log odds ratios” and “95% confidence intervals,” but having the data and knowing about LGBTQ health needs and trends is so important to figuring out how to grow healthier communities. Keeping asking for it…keeping fighting for it.

Let’s talk soon,

e.shor

PopCtr Mtg: Panel Discussion on Probability and Non-Probability Methods

Scoutby Scout
Director, Network for LGBT Health Equity
A project of The Fenway Institute in Boston, MA

SCIENCEBABBLE ALERT – This is a meeting for scientists, despite my efforts, some of this may get technical.

411 on the issue

Probability sampling = getting a group of people for your research that is statistically proven to be a random selection from the full population of interest, thus the statistics support you being able to draw conclusions for the full population based on the info from this random subgroup. (Like if 50% of your probability sample of LGBT people parachute, you can confidently say 50% of all LGBT people parachute.)

Non-probability sampling = any non-random sample of people. (Like if you do a survey at pride, it’s a non-probability sample.) Unfortunately, the statistics then do not support being able to generalize these findings to the full population, because there’s a chance bias might have snuck in. (Like, maybe pride participants aren’t as closeted as other LGBT people, so even if 50% of your sample are in LGBT parachuting clubs, you can’t say 50% of all LGBT people are in such clubs.)

Why’s this a big issue? Probability sample data is the gold-standard for drawing conclusions, but we have much less of this for LGBT people, mostly because LGBT measures aren’t included on the monster federal surveys that are the big probability studies.

Panel Members:

  • Dan Kasprzyk, Ph.D. Vice President of NORC (which I realize is so well known as one of 2 fanciest survey shops that his bio doesn’t even say what NORC stands for… so just know, NORC=surveys)
  • Melissa Clark, Ph.D. Brown University Department of Community Health
  • Margaret Rosario, Ph.D.
  • Jeffrey Parsons, PhD. Hunter University

The Panel

Dr. Kasprzyk led the panel off talking about some of his interesting experiences as part of the Institute of Medicine committee for the recent LGBT report. He emphasized that the choice of probability or non-probability might really not be as important as the reporting and impact of any well-designed study, regardless of the methods chosen. Then he moves onto talking about the federal surveys. “If the federal gov’t added LGBT measures to the American Community Survey, then allowed oversampling, that alone would allow the community to target populations, whether it’s regional, city, rural, you name it, and we’d be much better off. But we have to go beyond NHANES, you have to get on other surveys, NHIS and especially the Labor Force Survey would be very valuable.” He emphasized how important it was to get measures on these large full-probability surveys, “because otherwise you remain invisible.”

“Probability data is very important, it is the gold standard, in Washington, that’s what people are going to listen to. I think the real advancement in healthcare policy comes from really pushing hard with the federal government to have these questions on those surveys, and that point cannot be diminished. I think it’s really important that we actually stay focused on the federal government and become part of that health policy debate.” Dr. Kasprzyk

Dr. Clark followed (that’s Melissa to you and me) and led off by echoing all of Dr. Kasprzyk’s points. She says “”That’s usually how I end every talk I give about sexual minorities, I say ‘please help us get these questions added.'” She talked about her experience at Brown University and how much she’s been working to try to get the non-LGBT researchers to include LGBT measures. Through this effort, she’s managed to take one of the IOM report recommendations and institutionalize it, “Now when there’s a new study, people have to either include sexual minorities or explain why they are not.” Kudos to Melissa, let’s hope NIH follows suit!

Next up was Margaret Rosario. She warns us that while probability samples are important, most of our real explanatory data will come from non-probability samples because they are so much cheaper they have more latitude to go much deeper into issues, explore causal models, etc. For her, the bottom line is either approach can be useful, it’s often an issue of cost, if we have the chance to do the higher costs full-probability samples, excellent, if not, let’s just do excellent non-probability studies. Lastly she also weighs in on the importance of getting LGBT measures on the large surveys, “For the probability studies, please please, whatever we can do to get questions on there, do be able to identify the population as best we can, we should definitely do that.”

The panel was rounded out by Jeff Parsons. He talked about how it always seems there’s a flavor of the day at NIH for the newest rage for sampling, some of which are just never really viable in the field. “You can’t just count every 9th person who goes in the bar and pull them for the study, it doesn’t work.” Tonda Hughes from UIC echoes that sentiment, noting that the popular method, Respondent Driven Sampling, has never worked for her in samples of women.

As the discussion opens up to audience comments, there’s an interesting suggestion from Jim McNally, a director at ICPSR (the Intra-university Consortium of Political and Social Research, probably the largest data library in the country). one of the University of Michigan (ICPSR) scientists… “We recommend people work to create a small strong full probability sample and then ask the same questions you have on the federal surveys. That way you have policy strength to compare to the federal questions.”

Center for Population Research in LGBT Health Holds Annual Convening

Scoutby Scout
Director, Network for LGBT Health Equity
A project of The Fenway Institute in Boston, MA

My Non-Sampling Error Experience

Ok, I’ve fled from the very exciting Netroots Nation conference to get back to Boston because today and tomorrow mark the 3rd annual convening of one of The Fenway Institute’s other major initiatives, the Center for Population Research in LGBT Health. Not only does this mean I get to hang with some of my farflung friends for two days, not only does it mean the largest gathering of trans health researchers I’ve seen, not only does it mean I get to meet many upcoming researchers involved in the mentorship program, but right now, it’s also the biggest meeting about LGBT research that occurs each year.

I came a little late, so am jumping in as the head of one of the most prestigious survey centers in the country, Dan Kasprzyk of NORC, weighs in on issues related to LGBT sampling. (He was just talking about a non-sampling error experience.) So, I’m going to focus more on the actual content now… but just wanted to start off by giving you a little bit of context to the meeting, because this is a really cool project.

Abstract of Center for Population Research in LGBT Health Project

Previous studies have shown that sexual and gender minorities have higher prevalence of life-threatening physical and mental health conditions, experience significant barriers to health care quality and access, and face substantial threats to quality of life. Population-based research is necessary to more fully understand the causes of these disparities, so that effective responses can be developed. The proposed project’s long-term objective is to create a sustainable capacity for population studies and the translation of results into practice models for sexual and gender minorities. This 5-year effort will be conducted by the Fenway Institute, supported by the Research and Evaluation Department of Fenway Community Health (FCH), a Federally-Qualified Community Health Center. FCH provides comprehensive primary health care and mental health services annually to 11,000 neighborhood residents and students in nearby colleges and to LGBT persons, primarily from Greater Boston. Approximately 55% of patients self-identify as LGBT, reporting sexual or gender minority behavior and/or identity. The project has the following specific aims to develop the infrastructure for population research regarding the health of sexual minorities: (1) develop and support a multidisciplinary faculty to advance the study of sexual and gender minority populations, (2) create a shared research library, to include selected population-based datasets and findings from a large clinical dataset, and (3) disseminate the products of our work through the internet, a monograph, and peer-reviewed journal articles.  A team of researchers with diverse qualifications has been assembled to address these specific aims, with the assistance of a National Advisory Board of experienced population scientists and technical experts. The input and collaborative work of these researchers will lead to a common framework for multidisciplinary scholarship that advances understanding of sexual minority populations and how social, cultural, and institutional factors influence their health. This work will provide a foundation for culturally competent treatment approaches and behavior change models for sexual minorities.