State Work

For Immediate Release- LGBT HealthLink Grades States on LGBT Tobacco Integration

December 10,  2014

For Immediate Release
Dr. Scout
(954) 765-6024

LGBT HealthLink Grades States on LGBT Tobacco Integration

Ft. Lauderdale, FL – December 10, 2014 – LGBT HealthLink today announced the first ever grades for state tobacco programs’ LGBT inclusion practices. The grades, based on a survey of best practices originally conducted in 2013 and updated this fall, represent an assessment of the overall progress each state has made in addressing inclusion, including policies, training, data collection, and community engagement. Grades span from “A” to “F”, with the average across states a “C+”.

LGBT people smoke at rates that are over 50% higher than the general population and experience profound health disparities in both cancer and smoking-related disease. The survey was developed to bring transparency to how successful states are at integrating this disproportionately affected population into their overall tobacco control work.

According to Daniella Matthews-Trigg, Administrator of LGBT HealthLink, “The results of this survey not only illustrate the work that needs to be done, but highlights the impressive efforts by many states. Our hope is that creating a system for comparison will motivate states to adopt as many best practices as possible, thereby improving acceptance and wellness in LGBTQ communities around the country”. LGBT HealthLink is offering resources to each state to improve their grades.

For several years, LGBT HealthLink (formerly the Network for LGBT Health Equity) has been circulating “Identifying and Eliminating LGBT Tobacco Disparities”, a document outlining the best practices for state programs in LGBT tobacco control, and working closely with states to implement them. These report cards are intended to gauge adoption of those best practices at a state level and create a baseline for future work.

The release of the report cards comes just after the CDC’s Office of Smoking and Health recently accepted applications from states for their next five years of tobacco funding. Dr. Scout, Director of LGBT HealthLink, noted that “In order to eliminate the LGBT smoking disparity, we need to make sure the tobacco control community targets us just like the tobacco industry already does.”

Matthews-Trigg emphasized how closely HealthLink is working with states improve their grades, “We are the people providing technical assistance to these states to do this well, so this is really a report card of our work as much as theirs. We look forward to continuing our work with the many amazing state representatives to get these grades even higher.”

View the report cards:

For more about the methodology and scoring:

 # # #

 LGBT HealthLink, a program of CenterLink, spreads LGBT wellness best practices across state and federal health departments and community organizations. LGBT HealthLink is one of eight CDC-funded tobacco and cancer disparity networks.

CenterLink: The Community of LGBT Centers was founded in 1994 as a member-based coalition to support the development of strong, sustainable LGBT community centers. Serving over 200 LGBT community centers across the country in 46 states. Puerto Rico and the District of Columbia, as well as centers in Canada, Mexico, China, Cameroon and Australia, the organization plays an important role in supporting the growth of LGBT centers and addressing the challenges they face by helping them to improve their organizational and service delivery capacity and increase access to public resources.


Yet another life lost to smoking

We are deeply saddened to report that Bill Busse, a Tips From Former Smokers ad participant, has passed away. The cause of death was heart disease, which is very common for smokers. Bill shared his story on the Tips From Former Smokers Campaign about the affects that smoking had on his health (made more severe by diabetes, which he had since childhood).

The CDC released a statement from Tim McAfee, Director, CDC’s Office on Smoking and Health on the passing of Bill Busse. The CDC asks that you please direct any questions and/or condolences to The CDC will make sure that your correspondence is forwarded to Bill’s family.

Bill’s health problems didn’t stop him from heroically coming forward towarn other smokers of some of the dangers they faced if they don’t quit smoking.  Nor did his health problems stop Bill from enjoying time with his kids.

Our thoughts and prayers go out to Bill’s wife, two children and two step-children, as well as his parents and his sister.

A tip for smokers, from the man himself; “Make a list and put the people you love at the top, put down your eyes your legs your kidneys and your heart, now cross off all the things you’re okay with losing, because you’d rather smoke.”

You can view Bill Busse’s videos here.


E-Cigarettes: Friend or Foe for the LGBT Communities?


 As published on Huffington Post’s new LGBT Wellness blog, see original at:

Working in tobacco control sometimes elicits interesting reactions from people. Some try to hide their smoking. While I certainly appreciate not being near the smoke itself, I’ve got great empathy for smokers. In fact, since most smokers have already tried to quit, they’re much more likely to be fellow fighters against tobacco than non-smokers. Sometimes they ask me how to best quit and I’m happy to tell them (hint, call 1-800-QUITNOW). These days everyone’s asking me something new: What about e-cigarettes? The shortest answer is “they could be helpful for a few, but we all worry about our youth.”

First, if you’re not familiar with e-cigs, they are battery-powered imitators of old-school cigarettes, designed to deliver nicotine, flavor and other chemicals through vapor inhaled by the user. Most of them have a swag little electronic light at the tip to make it seem more like an old-school cig. Some now have other names like e-hookah to avoid any cigarette associations. The claim is here’s a no-combustion device to get your nicotine fix, great for cessation and great to smoke in places where cigarettes are banned.

There is one study supporting the effects of e-cigs in helping people quit smoking but now another study is out contravening it. Considering how toxic cigarette smoke is, we all applaud anything that helps reduce the amount of cigarette smoke in the air. But if you’re trying to use e-cigs as a cessation device it’s a bit dicey right now because they’re unregulated, so the amount of nicotine you get in each dose varies, and sometimes does not match the advertising. It’s commonly known that it only takes about two weeks to kick the nicotine addiction of smoking, but anyone who’s quit will tell you, it’s the social habit of smoking that draws you back again and again. I’m not sure how putting a cigarette replacement in your mouth helps you kick that social habit — sounds to me like it’s just perpetuating it. Plus there is a new study showing other toxic chemicals in the vapor. To top it off, there’s no real science on the long-term effects of inhaling nicotine vapor. So while I’m willing to bet it’s better than inhaling tobacco smoke, that’s like saying I bet it’s better than inhaling truck exhaust. Nicotine is so toxic, poison control centers just issued an alert about high numbers of calls on accidental exposure. Just touching the liquid is enough to cause vomiting and ingesting as little as a teaspoon of some of the liquid nicotine concentrations can be fatal. I hope people set a higher bar for their own cessation journey.

The real problem is, as anyone who’s visited a vaporium can see, it’s not a cessation game. Vaporiums and e-cigs are all about enticing, and particularly enticing young people. Wander into your local vaporium belly up to the “bar” and you’ll be shocked to see how many vaporiums look like the lovechild of a hip coffee shop and a candy store. I’m not sure exactly which adult Marlboro user would switch to cotton candy flavored nicotine cartridges, or banana nut bread, or cherry limeade. Sounds to me more like flavors I’d find at a little league game. To make it worse, these products are easily available online and many states aren’t yet doing anything to restrict access to minors. Data show LGBT youth continue to smoke at rates much higher than their non-LGBT counterparts and the number of youth experimenting with e-cigs is rising rapidly… the very last thing we need is to have some fancy new gadgetry on the market enticing LGBT youth to start using a highly addictive drug to deal with the stress of stigma against us all.

We pass on smoking down through the LGBT generations socially. I’ve always called it an STD for us, a socially transmitted disease. So I also worry about adult e-cig use. Every time you “light up” you’re perpetuating the huge LGBT cigarette culture, all of us laughing and having fun and hanging out, with cigarettes in our mouths.

We already have cessation aids that deliver you nicotine in controlled regulated doses, you can find those on every drugstore shelf. Nicely, there’s not one gummy bear or watermelon flavored nicotine patch, spray or gum. So while e-cigs might help a few in quitting, I say the big picture on e-cigs for the LGBT communities is we need to think of our youth and “beware of the wolf in sheep’s clothing.”





 Dr. Scout, Director

 The Network for LGBT Health Equity



Follow Scout, Ph.D. on Twitter:


“If we are not counted, we don’t exist”

Kansas City View

by Alex Iantaffi, Guest Blogger

Reporting on The 8th National LGBT Health Equity Summit (Kansas City, MO)

One of the threads throughout the Summit was the importance of being visible in policy, research and practice. While introducing the MPOWERED document in the Opening Plenary, Dr. Francisco Butching highlighted why monitoring is so important by reminding us all that “if we are not counted, we don’t exist”. As someone who does not often find a box to tick on surveys or health forms, I am a believer! In fact, my own budding NIH study focusing on Deaf Men who have Sex with Men (MSM) will include trans masculine folks, and I am delighted to be able to set my own questions, separating sex assigned at birth from gender identity. But let’s get back to the Summit and the other believers who also called for increased visibility of our communities.

Juan Carlos Verga gave us some great insights into what including the T, when building an LGBTA Health Alliance, looks like. One of the take-home messages focused on the need to be aware of what issues might impact our communities’ health, such as violence stemming from stigma and discrimination. We cannot support people in making healthier choices if they are anxious about their own and their friends’ survival. However, we can monitor and record the impact of those issues on our communities’ health to increase our potential impact on institutional changes, like The Puerto Rico Citizens Alliance Pro Lesbian, Gay, Bisexual, Transsexual, Transgender, and Ally Health (PRCAPH-LGBTTA) has.

Finally, I want to touch briefly on the panel discussion facilitated by e.Shor on “Research to Practice”. For this session, Dr. Jane McElroy and Dr. Phoenix A.K. Matthews, gave two great presentations showing not only how to monitor our communities, but also how to create meaningful programs to address some of the disparities faced by our communities. Dr. Matthews in particular discussed the development, implementation, and evaluation of two smoking cessation programs: Bitch to Quit! for LGBT communities, and Project Exhale, for African American MSM smokers who are HIV+. The latter was, for me, a great example of why it is essential to integrate tobacco prevention and cessation programs into a broader vision of wellness for our communities. Many of us face multiple challenges in an environment that is often hostile, or oblivious to our identities. Those challenges, combined with invisibility and/or outright stigma and discrimination require robust, and holistic approaches to health promotion. Tobacco cessation programs cannot ignore the context in which we live, or the impact this has on our whole health.

We indeed exist, and public health professionals, organizations, and institutions need to be accountable for counting, including, and finally recognizing our existence, and the disparities our communities face. For a day, it was fantastic to be in a room with so many other people who were also believers. Thank you Network for LGBT Health Equity for bringing us together. I am already excited about next year’s Summit!


Creative Problem Solving and Arkansas

By Daniella Matthews-Trigg
Program Associate
Creative Problem-Solving and Arkansas


After Gustavo’s trip to Arkansas last week and blog post about forging national and local partnerships, I wanted to share another very cool Arkansas-related health equity resource, LGBT/HIV and Tobacco Survey Report prepared by Dathan Johnson, BS and the Tobacco Cessation and Prevention Program through the Arkansas Department of Health.

In February, the Arkansas DoH set out to better understand the high rates of tobacco use in LGBT communities, as well as which strategies would be most effective for reaching these populations with cessation and public health messages.

The survey had some very  interesting results, including that “none of the 30 participants who answered the question could correctly list the Arkansas Tobacco Quit line number”, which was of “most concern”. Additionally, 86% of the participants who smoke stated that “if given the resources and support, they would cut down or quit using tobacco”.

The conclusions that they came to after this survey were both insightful and extremely relevant;

“tobacco cessation should be strongly addressed in the LGBT community in
Arkansas through radio, TV, and the Internet (i.e., Programs that target the LGBT population need to be developed to both prevent the initiation of tobacco use and help smokers quit. ADH TPCP will establish a work group with the objective of generating targeted, effective tobacco control strategies in a small group setting for this community.”

They also not only recommend that a “concerted effort be made to heighten LGBT-focused organizations’ awareness of tobacco control as a public health priority in the community” but pledged to assist local LGBT organizations in including tobacco control advocacy and programs in their scope of activities to build healthier communities.

These results speak to the greater issue of lack of access to health resources in the LGBT community. The steps that the Arkansas Department of Health are taking to support local LGBT organizations is admirable, but sadly, rare. In the fight against tobacco it seems that the most basic strategies aren’t working. So…do we go smaller or bigger? If even the seemingly most straightforward intervention, telling people the number of the quitline, doesn’t stick, then what is the next step?

Maybe instead of recreating the wheel, maybe we improve upon the work that has already been done. I am always most inspired by creative, almost too-simple-to-be-true strategies. An example that comes to mind is the Q-drum. In places without running water, people often have to walk many miles each day to access water for bathing, cooking and drinking as well as agriculture. Water is heavy so the amount that can actually be carried is small. The Q-drum is incredibly simple but revolutionary in its success.

Lets use the Q-drum as inspiration. Lets look at the resources we have available but try to see them in a new way.

One of the Arkansas study participants wrote, “I do not think any form of media would really
grab my attention” but then went on to mention anti-smoking campaigns that they remembered, one even by name! So I guess the question is how to consciously INVOLVE people and communities in anti-tobacco work. The advertisements are out there, and they are being noticed, but maybe not in a way that STICKS. So do we push harder? Do we try something new? I guess that’s for all of us to decide…

What creative solutions do you use? What is a challenge that you have?  Lets start a dialogue and bounce around ideas until we create our own, LGBT health equity and tobacco control Q-drum.

A great first step is to join our discussion Listserve and stay informed about what others are doing and keep all of us updated about your work (to sign up, click here and fill in your email under “Join the Fight” on the right side of the page,  or shoot me an email!). Also, check out our Resource Library, which has research, articles, surveys, presentations and lots of other great resources from a whole variety of organizations and individuals around LGBT health and tobacco control. Get connected!

We are so excited about the work around LGBT health equity and tobacco that is happening in Arkansas and want to give a huge shout-out to the folks who are doing such great work. Thanks for asking the right questions and searching for the best answers.


Tobacco Stats and The Great American Smokeout

   Daniella Matthews-Trigg
  Program Associate
  Tobacco Stats and The Great American Smokeout

Today was the 36th Great American Smokeout, a day chosen by the American Cancer Society to encourage people to stop smoking.

In a very exciting move, President Obama addressed the nation in a short video, in which he highlighted a few key stats, including:

– 46 Million Americans are smokers

– Tobacco is the leading cause of preventable, early deaths in the US

(He also emphasized the difficulty of quitting and he knows from experience… the story is that when he asked Michelle if he could run for President, she said “if you quite smoking”!)

These statistics are staggering, but the figures about smoking in the LGBT Community are…what’s more shocking than staggering? Horrendous? Awful? completely horrifying? Anyways, here are a few facts to chew on:                    

– LGBT people are 35 to almost 200% more likely to smoke than non-LGBT people

– 29% of  youth smoke, but the numbers for LGBT adolescents are around 40%

– Lesbians are more likely to smoke (56%) than heterosexual women (42%) and the smoking rate among lesbians increases with age, while the rate among other groups declines with age.
-American Cancer Society estimates that over 30,000 LGBT people die each
year of tobacco-related diseases

The craziest thing to me is that, until very recently, I didn’t know any of this! I stopped to think about my own group of queer friends and 4 out of 5 of us smoke. I am frequently the one left in the kitchen to watch the food on the stove while everyone else goes outside for a smoke break. And it’s shocking to me that these smart, savvy queers don’t KNOW about these disparities in their community.

This information is not common knowledge, but it’s the kind of stuff that  EVERYONE should know.

So to honor this 36th Great American Smokeout, even if you’re not a smoker, or if today isn’t the day you quit smoking, read these statistics. Memorize one. Really think about it. Because who knows? It may come up in double jeopardy. Or, it may save your life.

Research Studies


by e.shor

After some tumultuous travel, I finally arrived in Bloomington where the queers are bustling in the Indiana Memorial Union Hotel and Conference Center among many wedding parties. Irony? Duh.

This is a small conference with lots of space for conversation and learning from discussion and questions. I like that. I had a chance to listen to what Dr. McElroy from the University of Missouri-Columbia had to say about the research that is happening in queer communities across Missouri with affect to smoking rates. The needs assessment that Dr. McElroy presented mirrored many of the assessments of smoking in LGBTQI communities because it illuminated again that LGBTQI folks are smoking at disproportionately higher rates than straight communities. There was a cool new thought they presented about the status of a smokers…not everyone is just a heavy or light smoker anymore (and even when they were, what does that mean anyway?!?!). There is a whole new lingo about “social smoking” and “occasional smoking” and other such terms that make building smoking cessation programs a whole new ballgame!

The discussion that really struck me was about how people get categorized on surveys…and this has been on my mind for a while. In general LGBTQI surveys, there are the standard sexual orientation options (LGB Straight) and then there are the GENDER questions. On most surveys that I have seen for the LGBTQI community there is Male OR Female AND Transgedner OR Transexual. I know that from a statistical perspective it is important to have mutually exclusive categories so that you can plug your numbers into SAS and run some sexy chi-square tests. However, this presents a dissonance between the true identities of people in community. I know most people I know have yet to see a survey that actually reflects their gender identity…like FTM, MTF, genderqueer, trans woman, trans man, trans masculine, trans feminine, two-spirit, third gender, and many others.  I realize that this is a difficult issue: there are clear restrictions in statistical data analysis, but queer identity is fluid and changing. How do we reconceptualize this rift between academia and community?

Tobacco Policy

New Policy Statement on Comprehensive Cessation Services

Many of us probably know that long ago, the federal best practice protocols for tobacco control started to call for comprehensive coverage of all cessation services by insurance companies. It’s really a no-brainer, right? I’m always a bit confused as to how the actuaries who run insurance risk profiles failed to notice the cost-benefit rewards of that one. I mean look at that new data from CA; each $5 pack of cigarettes costs the state of CA $27 in associated healthcare costs?!! (thanks Kurt for sending that out, thanks ALA for releasing that research). (see report here)

Well, nicely, we’re also seeing a growing trend of change on this point. Medicaid is now covering all cessation (read about it here) and Medicare is too (see here). Also, I’m not sure if it’s done or coming, but I know this coverage is being expanded to all federal employee insurance policies too. And 7 states currently require private insurance to cover cessation (read about it here) but more are looking to expand to this every day. So local policy change that makes a big difference could be coming to your neck of the woods soon.

And we want to help you make it happen!

So, I’m very pleased to debut the Networks’ new policy statement supporting comprehensive cessation coverage. Thanks to Gustavo for the writing. And good luck to all, may the day come soon when everyone has free and easy access to cessation!


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Presentations · Resources

Network hosting June 8th Webinar on HIV and Tobacco. Register today!

The Network, in conjunction with the National Youth Advocacy Coalition, will be hosting an interactive webinar on tobacco and HIV this Tuesday June 8th from 2pm-330pm EST. Please join host Shannon Murphy for a dialogue on the effects of tobacco on individuals living with HIV/AIDS and the importance of cessation within this population. There will also be ample time allotted to share stories, network, and collaborate on the call. You can register for the webinar here.

Our Sharing Our Lessons on HIV and Tobacco Cessation


  • Danielle Grospitch is a certified tobacco treatment specialist for Tobacco-Free Lake County Illinois. She recently presented at the Promising Practices: Acheiving Health and Social Equity in Tobacco Control conference in New Orleans on tobacco use in HIV populations. She will sharing her knowledge on how tobacco use affects treatment and disease progression for the  50%-70% of HIV-positive individuals who use tobacco.
  • Featured in our most recent issue of Sharing Our Lessons, Barbara Warren Psy. D., CASAC, CPP will be discussing her involvement in the groundbreaking cessation program for people living with HIV/AIDS established at the LGBT Center of New York City.

You can register here and we look forward to your participation!

Scholarship Opportunity

SRNT Update 5: The New Wave of Cessation

Scary time today.  Early this morning I received a text from back home in Hawaii about all this crazy tsunami stuff after the terrible earthquake in Chile.  Worried all morning about my family back home, it was hard to really have my head in the game.  I still managed to take in some posters and presentations, but hadn’t been able to write up anything until now because I had been glued to the TV.  Things have now been pretty much cleared, so it’s back to tobacco and nicotine!

Speaking of waves, as far as tobacco research, one of those new waves is cessation for adolescents.  That was certainly represented in the presentations here at the SRNT conference.  Let me ruin the ending for you: cessation for youth can and does work.  At least that’s according to the presentations I attended.  There are some barriers and lessons learned that the presenters did an awesome job in talking about. Here’s a quick rundown of what I got:

You might not want to call your youth cessation program a cessation program: Susan Druker from the University of Massachusetts in her presentation talked about how they called their youth cessation research project “Air It Out”.  This as a way to counter the stigma associated with youth cessation and instead capitalized on the idea that teens want to talk and air our their feelings on “stuff.”

Don’t make your cessation program just for smokers: Dr. Jeffrey Fellows from Kaiser Permanente and Dr. Arthur Peterson from the Fred Hutchinson Cancer Research designed interventions that provided services for both smokers and non-smokers.  This also helped to reduce the stigma of a teen going into a cessation program.  This also helped in recruitment and retention into the program.  Non-smokers would get some preventive information about tobacco or about other health topics.

Be Proactive: speakers pointed out that proactive recruitment and services were key to the efficacy of their interventions.  All programs not only saw significant increases in cessation rates between control and experimental group, but also saw huge retention rates.  While some recruited through well visits to pediatricians, others recruited through schools.

Build rapport: As with most programs that utilize motivational interviewing for cessation programs, rapport is very important to teen cessation.  It starts all the way at the beginning by emphasizing confidentiality, as Air It Out did, and by utilizing trained counselors in motivational interviewing.  Air It Out sent out individualized notes to each teen, which Druker believes was key to their high retention rates.

Kaiser partnered with Free & Clear to provide telephone counseling.  The Fred Hutchinson treatment center also provided phone services while Air It Out provided face to face. The topics covered in the counseling were similar to the topics that are covered in adult cessation, and the cessation rates were similar to those of adults.  One difference is that the youth were not provided with NRT, as it’s still not approved by the FDA.

I will have one more blog entry talking about the awesome posters at the conference.  Too many to share, but I will try to give a taste.