Improving Health and Reducing Tobacco Use of LGBT Missourians

Kevin D. Everett, PhD & Jane A. McElroy, PhDKevin D. Everett, PhD & Jane A. McElroy, PhDFamily & Community MedicineFamily & Community Medicine

University of Missouri University of Missouri

August 16, 2012August 16, 2012NCTOHNCTOH

Kansas City, MissouriKansas City, Missouri

Tobacco is a powerful and pervasive causeof health disparities.

Some groups appear more vulnerable to the harm caused by tobacco use and exposure than others.

Tobacco and Health Disparities

LGBT Missourians and Tobacco Use

Funding announcement:

Address tobacco caused health disparities in Missouri.

Funding in three phases: Assessment, Planning, & Implementation

Phase I: Assessment (2008-2009)

Phase II: Planning (2010-2011)

Phase III: Implementation (2011-2013)

No statewide Missouri data on LGBT tobacco use THE PULSE (2003;2006) - a health assessment

of SGM in the Kansas City area. Both years of assessment found higher rates of smoking than general population (state and national).

LGBT Missourians and Tobacco Use

(Prior to 2008)

Reviewed published literature on LGBT tobacco issues

Project to be guided by community-based participatory research (CBPR) principles.

Selected a project advisory board Leaders in LGBT community, not necessarily tobacco

control experts . Initial task for advisory board and research team:

Discuss strategies for gathering data from this ‘hard to reach population.’

Phase1: Assessment Project

The Check-Out Project

Develop survey instrument for Pride Festivals and interview guides for focus groups

Data collection plan for Pride Festivals

Recruitment plan for focus groups

http://www.mffh.net/mm/files/LGBT2009.pdf

SGMCurrent Smoker

Former Smoker

Never Smoker

Lesbian (n=949) 38% 20% 43%

Gay (n=891) 34% 17% 49%

Bisexual (n=367) 36% 13% 52%

Transgender (n=29) 38% 14% 48%

Transsexual (n=14) 43% 21% 36%

Queer (n=70) 41% 19% 40%

SGM Total (n=2320) 36% 18% 46%

Smoking Status by Sexual and Gender Minority

(SGM)

Check Out Project 2008

Smoking Status by Sexual and Gender Minority

(SGM)SGM Groups

(2008, 2010, 2011 unique participants)

Current Smoker

Former Smoker

Never Smoker

Lesbian (n=1,713) 38% 14% 48%

Gay (n=1,890) 36% 15% 49%

Bisexual Male (n=240) 39% 10% 51%

Bisexual Female (n=608) 42% 12% 46%

Transgender/transsexual (n=284) 41% 11% 48%

Other (n=397) 35% 14% 51%

SGM Male Total (n=2165) 36% 14% 49%

SGM Female (2874) 39% 13% 48%

“There is a certain dependency that I have upon cigarettes --- to go to if something’s wrong.”

“Judgment by ex-smokers is more negative because they seem to be so grossed out now by smoking that they are more judgmental than nonsmokers.”

“If I were a nonsmoker just magically, that would be wonderful…”

Focus Group: Current LGBT Smokers

“Quitting smoking doesn’t change social life as much as one fears it will.”

“…now I don’t eat candy or drink soda. Eat lots of vegetables. Not sure if it is a result of quitting, but feel it is only possible because I quit.”

Focus Group: Former Smokers

Check Out Project 2008

High rates of smoking within the LGBT community

Lower rates of quitting smoking Lack of awareness of evidence-based

cessation methods Lower support for tobacco control best

practices Excellent project performance --- exceeded

expectation regarding survey collection

Phase I: Conclusions

Develop a plan for interventions to reduce exposure to tobacco use and increase cessation attempts of current smokers.

Approach: Advisory Board meetings Utilized facilitators to enhance Advisory Board’s

appreciation for tobacco control best practices Interviewed leaders across the country who had success

with LGBT community addressing tobacco issues Continued collecting data at Pride Festivals

Phase II: Planning Phase

2008 (n=3,138) Initial survey tobacco use and opinions about tobacco control

2009 (n= 600) – addressed preferred cessation locations

2010 (n = 3,199)– assessed preferred health information sources, use of new media, and current smokers rated strategies for quitting

2011 (n= 4038) – broader assessment of health issues

2012 (n = 5,000+)– ratings of stress and resilience

Pride Festival Surveys

Pride Festivals survey, all years

N= 956N=3,237

N=727

N=5919

Total=11,392

2008-2011 Pride Festivals Adult Participants

MISSOURI

Online=553

Launch a SGM-tailored, Missouri-grounded website that promotes a healthy and smoke-free lifestyle.

Create and disseminate effective tobacco control messaging throughout the project period.

Promote evidence-based smoking cessation treatment for the SGM community beginning January 2012.

Support leadership development of SGM young adults.

Phase III: Intervention

Three partner organizations offering evidence-based treatment cessation treatment (trained coaches, free NRT, and culturally adapted self-help materials): LGBT Center of St Louis SAGE of Metro St Louis The Spot

Missouri Tobacco Quitline – now asks sexual orientation questions (as of April 2012) at intake and promotes the three organizations if calls come from LGBT individual.

Cessation Initiative

Coming Soon:www.outproudandhealthy.or

g

Funders: Missouri Foundation for Health; St Louis County Health Department ARRA funds

Staff: Dean Andersen, MEd; Kimmie Nolte; Sue

McDaniel, PhD; Jenna Jordan, MS; Angie Bunge Our National Consultants Kitty Jerome, MEd – The Robert Wood Johnson

Foundation Dr. Scout -The Network for Health Equity,

Fenway Institute

Aknowledgments: