After Quite a Long Time: Federal Cultural Competency WIN!

by Scout, Ph.D.

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

with additional reporting from the esteemed Daniella Matthews-Trigg

 

Sometimes you really do have to wait for good things to happen. So if you didn’t catch the news earlier this week we wanted to start your weekend off by reporting on the progress of a few different action alerts we ran back in… can you believe it, 2010.

Back then the Office of Minority Health was asking for input on their Cultural and Linguistically Appropriate Services. We were happy to oblige and ran a few different action alerts urging people to write in with smart ideas on how to include LGBT people in the standards for the first time. See our action alerts below:

• ACTION ALERT: FEDERAL CULTURAL COMPETENCY STANDARDS BEING ENHANCED: OPEN COMMENT PERIOD NOW!
• ACTION ALERT: FEDERAL CULTURAL COMPETENCY STANDARDS BEING ENHANCED: OPEN TILL 12/31/10!

The National CLAS was originally published in 2000, and provides a framework for all health organizations to address diverse populations, and provide culturally and linguistically appropriate care. The standards aim to advance health equity, improve quality, and help eliminate healthcare disparities. Importantly, hospitals and healthcare groups really pay attention to these standards.

What we’re very happy to report is we now have culture! The enhanced National CLAS Standards have adopted an expanded definition of culture that now includes sexual orientation and gender identity. The implementation blueprint even urges trainings and data collection no less! Read more details in this great post from our friend Kellan on all the different changes here: New Health Services Standards Ensure Respect For LGBT Patients. Or poke around the new standards directly on the federal Think Cultural Health website.

Mostly, for all of you that wrote in back in 2010 that you wanted sexual orientation and gender identity to be included, we just wanted you to know, the long wait was worth it!

Nebraska Travelogue: How did Heartlands Pride Adopt New Tobacco Control Policy?

Scout, Ph.D.

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

Ariss on left and the whole Heartland Pride board. Beth’s flashing the Pride toolkit,

Smokefree pride festivals are a great way to showcase our communities’ investment in keeping ourselves healthy. But as many know who’ve worked on getting their local pride’s smokefree, it can be a really long process. Habits die hard and you need to do a lot of education with the local organizers to help them understand the impact of smoking and how to transition the event to a new smokefree one. Luckily there’s a great step-by-step resource out there that Bob Gordon & others in CA developed, the Smoke-Free Outdoor Pride Event Toolkit. This was our goto resource when we presented to Interpride last year.

But sometimes locals write their own recipe for change. I am so happy to report the culmination of my Tuesday in Nebraska was a meeting with the Heartland Pride board where they agreed to a new tobacco control policy at pride!

So, what’s the Nebraska recipe for success? (please do not try this at home, these are trained professionals)

1. Include dedicated staff time for LGBT outreach in state tobacco control efforts. Check.
2. Hire Ariss Mendoza — a straight woman who’s had lots of experience with LGBT friends and has absolutely boundless energy
3. Take notes (aka build relationship with policymakers by identifying something they need that you can offer) – when Ariss went to the Heartland Pride board meeting, she realized they needed a secretary, so she stepped in to take notes!
4. Take baby steps — Ariss stepped in to take notes, but she also asked the organizers to officially partner with her tobacco-free group. They warned they wouldn’t go smokefree, but were fine with having an official partnership.
5. Add food & some crazy outta town guy folk call an “expert” on LGBT health — Like I said my last meeting was a special presentation to Heartlands Pride board on smokefree prides. And of course since it was dinner time, Athena & Ariss picked a nice restaurant to have it at. As the board members arrived Ariss passed out the smokefree toolkits. And to my amusement, before dinner they were urging her to please apply to be a permanent board member. Everyone wants Ariss!
6. Educate a bit, listen lots, & offer models — eventually we got around to talking about smokefree prides. In some ways it seemed such a natural outgrowth of all our talk about eating healthier, and swapping healthy recipes before. By then the Board Chair, Beth laid it out… “We can’t go smokefree in one year, but is there a middle ground?” Sure! I talked about how prides offered smokefree areas and how they sometimes rearranged their tables to offer a “wellness area”, put kid/family services there too and keep that all smokefree.
7. Get outta the way as Pride changes their policies! — Beth and the others from Heartland Pride jumped at the ideas we laid out and ran with them. Of course Ariss agreed to organize the wellness area! We talked about maybe getting some folks from the Nebraska healthy living projects to maybe offer some exercise or healthy eating info. And the board went even further than our ideas, after discussing it they chose not to limit the smokefree space but instead limit smoking to a few designated areas! The loved how the wellness theme echoed with their pride theme, and we even figured out how to reframe their “keep hydrated” messages from the stage to larger wellness messages, so the theme will be echoed out all day. Excellent!
8. Build support for totally smokefree pride next year — Ariss & others from the local tobacco free coalition will take a page from other’s work and get signors on a petition for pride to go totally smokefree next year. These petitions can help organizers see there’s support for the next step, a fully smokefree pride.

Again, great job all! I’d like to think I helped but frankly by the time I arrived it seemed like I was just watching two groups (pride & tobacco control) just finally agree on what they always wanted to do all along… so my hat’s off to the pride board and Ariss! In a few months every LGBT Nebraskan at pride will be able to breathe the sweet smell of change!

Nebraska Travelogue: Great LGBT Research Being Done Here

Scout, Ph.D.

Director, The Fenway Institute’s Network for LGBT Health Equity
My first meeting yesterday was with the Midlands Sexual Health Research Collaborative, what an active group of folk! Loved hearing about their educational campaigns and was pretty impressed by the 700+ person survey Dr. Fisher and the others conducted a few years ago for a report on the health of LGBT Nebraskans. This survey was able to generate national coverage on the high suicide rates for local LGBT people, even some interesting information on how the suicide ideation persists into adulthood. Ugh. And not surprisingly, the other big news from it was the high smoking rates, 26% v. 20% for the rest of the state population. I also loved hearing about how they had such a large trans sample, no doubt in part because one of the researchers is openly trans, great job Dr. Irwin! I really look forward to his coming paper on the trans sample, we too rarely get information on trans people out of the biggest cities. Oh, and watch for another paper coming on tobacco use as well. I hope some of the ideas I offered on where to pursue research funding can help Drs. Fisher, Coleman, Irwin, and Jawed-Wessel and all their impressive graduate assistants keep the LGBT health research data rolling in!

L to R: Dr. Fisher, Dr. Irwin, Ms. Kneip-Pelster, Ms. Clausen, Mr. Taylor, Ms. McCarthy of the Midlands Sexual Health Research Collaborative

Nebraska Travelogue: Everyone Meet the National LGBT Expert Day

Scout, Ph.D.

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

I was up early and out late yesterday because Athena had a huge day planned for me in Nebraska, 7 meetings, 2 of them presentations. Athena is a lead on the Metro Omaha Tobacco Action Coalition, or MOTAC. MOTAC worked with local groups to sponsor this extra day in town for me, allowing them to set up a bunch of meetings with local folk working to do more in LGBT health/tobacco.

Tuesday Agenda

• 9:30 – Meet with Midlands Sexual Health Research Collaborative
• Noon – Lunch ‘N Learn Presentation at U of Nebraska College of Public Health “LGBT Tobacco Control: Lessons from a Disparity Population”
• 1 pm – informal meeting with local tobacco coalition members
• 2 pm – meeting with Dr. Su, Director of UNMC Center for Reducing Health Disparities
• 4 pm – meeting with “A la familia” trainers
• 6-8 pm – Dinner presentation with Heartland Pride on smokefree pride events

A lot of great stuff happened at these meetings, some of them are chewy enough to have their own posts, so I’ll do that. Sometimes resources we found out about in one meetings were able to be connected with ideas from the next meeting. At the Lunch N Learn presentation for the school of public health I focused on how tobacco education and linkages were used in creative ways to help advance a bunch of larger LGBT health issues at the national level – and why now I really believe the next forum for LGBT health gains is doing the same at state level. I had a great conversation with the head of the Center for Reducing Health Disparities that I hope might result in new LGBT research proposals. We had several good conversations about strategies for outreach to the LGBT Latin@ communities, because that’s a growing population here.

At the meet with the local tobacco control coalition I really respect the woman who brought up her discomfort with the plans for using drag performers to hand out awards at a coming tobacco control luncheon. That’s the kind of real honesty that helps us all grow. In this case, it was a chance for me to tell her about Rescue Social Change, the national group who’s doing so well using entertainers like this for health educational purposes, and how they even received a large award to expand their tobacco control media work.

Did you already see the Rescue Social Change Video about the recent event they did for us at the National Tobacco Conference? This is the event that gave the Nebraska folk the idea to hold their own Tobacco-Free Drag Diva contest here, it’s a must watch.

Nebraska Travelogue: Smokeless Diva Drag Pageant?

Scout, Ph.D.

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

Uh-oh met the great tobacco team over at U of Nebraska Medical Center and boy have they upped the game! Little did I know they already have an LGBT outreach person working on tobacco control, the great Ariss Rogel Mendoza. And our old friend Antonia Correa has been running a great Latinas Tabaco y Cancer group. And some of the Latina group were major drivers in organizing last weekend’s… no, I’m not lying… Smokeless Diva Drag Pageant. Wow! How many other states have community level LGBT tobacco control activities now? And the stories from it were great, the winner’s father died of lung cancer, so she went all out, even making dresses incorporating bits & pieces of tobacco marketing materials.

So if they’re already running tobacco control drag pageants here in Nebraska, my only question is… how in the world do I help move them forward?

Wow, so much glitter. The crowning of the smokeless diva drag queen!

Ariss, Antonia, & Athena – the Latina powerteam working on tobacco a U Nebraska Med Ctr – Ctr on DIsparities.

The Nebraska Travelogue: Example of Network LGBT Technical Assistance to States

Scout, Ph.D.

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

Since we’re funded by the CDC Office of Smoking & Health (OSH) to link people & information we find much of our work is naturally helping the 50 state departments of health OSH also funds connect with people and information on LGBT tobacco & health. Of course states like California or New York usually have their own resources, this means we are often traveling less beaten paths. This work is frankly some of our most exciting and fulfilling because this is where there’s huge gains to be made. Plus, after 7 years working alongside the state reps as CDC grantees, we know there are many allies in these health departments pushing hard to address LGBT health disparities and we’re more than happy to help.

Right now I’m on a jet flying out to visit Nebraska and boy have they got a full schedule for me on the trip. So, instead of the usual “we went there” report, I thought this time why not take a closer look on what happens on these state trips? So hope you’ll stay tuned over the next few days as I start a little Nebraska travelogue.

Agenda Day 1:

• Fly west! Lose an hour, forget today’s actually Patriots day in Massachusetts, where everyone is given a holiday to watch the marathon, oops.
• Arrive around 4 pm. Airport pickup (swank!) by a Nebraska superstar, Athena Ramos. (you’ll know why later)
• 4:30 – meet the tobacco outreach team to say hi
• Evening free to prepare – because the next 2 days have 6 meetings, one daylong conference & 4 different presentations! Gulp.

Until now my strongest memories of Nebraska are that gas stations swarmed with locusts and a long ago grand roadside 4th of July celebration in the wheat fields. The odds have to be against the locusts being out again now, right? Please.

OK, off I go. Hope folk stay tuned for the whole travelogue.

Best,

Dr. Traveling Scout

Update – Oh no, Twitter is full of reports there were explosions at the marathon… oh please please let everyone be ok.

New Resource to Guide Trans Inclusion on Surveys

Scout, Ph.D.

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

I’ve had the pleasure of working with some brilliant people for a few years now as part of the Williams Institute workgroup on Gender Identity in U.S. Surveillance, aka GenIUSS group! As more and more of us get pinged by feds and states about how to include trans measures in surveys and research, this is the place the researchers have come together to discuss the state of trans measurement. Many of us have conducted cognitive testing on questions, so you can imagine, the discussions get really chewy fast.

So, it’s with great pleasure that we share the release of the first GenIUSS resource reviewing the state of the arena on trans measurement for full population studies. (<- that’s important, because we’d ask different questions on community-based surveys). This is only an interim resource, because GenIUSS will be creating a full report in the near future. But there’s been such interest we all felt it was important to help provide an overview of tested options for survey developers quickly. So please spread this far and wide because people need to know there are a range of tested trans measures that can be added to surveys. And big thanks to Gary Gates and Jody Herman over at Williams Institute for making this happen!

Download the full review here: http://williamsinstitute.law.ucla.edu/wp-content/uploads/GenIUSS-Gender-related-Question-Overview.pdf

Missouri Hospital Incident Highlights Need for Awareness & Training on LGBT Health Protections

Scout, Ph.D.

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

This morning Bill Snook at Kansas City Department of Health informed us of a sad incident that occurred at one of their hospitals. According to reports, a gay man was denied access to his partner because the hospital refused to acknowledge him as family. (read more of the details in the Huffington Post piece here: http://www.huffingtonpost.com/2013/04/11/gay-man-arrested-missouri-hospital_n_3060488.html?ncid=edlinkusaolp00000009).

Unfortunately, this looks like it could be another example where new policies protecting LGBT health rights are not promoted as widely as needed. Obama’s presidential order from nearly two years ago clearly said any hospital who wanted to get Medicaid or Medicare payments must treat same-sex partners as family. Later clarifications even went further, making sure hospitals went out of their way to allow patients to designate partners who would have powers beyond simply visitation. We were also very enthusiastic when the HHS Office of Civil Rights assured us they would actively investigate any reports of LGBT health discrimination.

New Joint Commission regulations go even further in protecting the rights of LGBT patients. But sometimes it’s hard to even figure out if a hospital has adopted the new non-discrimination regulations.

It is one of our larger concerns that many of the new protections for LGBT health aren’t getting the promotion needed so everyone knows how we deserve equal treatment in health, and what to do if we don’t get equal treatment.

Luckily we’re very happy that through amazing agencies like PROMO and Sage in Missouri – this hospital will be offered free resources on how to change their policies to not just offer new protections but also share that information with patients. They will also be offered free resources for culturally competent trainings. But in our work with Sage & PROMO on their health policy project it’s already become apparent – passing protective policies is only half the battle, we need to educate LGBT people and hospitals about the protections these new policies offer before real change will come.

For today, our thoughts are with Roger Gorley and his partner as they deal with something no one in this country should have to face.

Who Has the Real Power to Stop Smoking? Hint: Not Smokers

Scout, Ph.D.

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

[Wanted to make sure my next Huffington Post tobacco post was echoed on our blog too, so please see the following post up there now, and please share it widely too!]

I used to be annoyed with smokers; now that I’m involved in tobacco control work at The Fenway Institute‘s Network for LGBT Health Equity, I realize how that thinking is seriously misguided. The epitome of my boorish behavior occurred one New Year’s Eve in New York City. I was all dressed up for the New York City Road Runners Midnight Run in Central Park. Walking back, I ran across Peter Jennings, the popular news anchor. He said “Great costume!” My reply to this star sighting? “You shouldn’t smoke.” I still cringe at the memory.

Yes, Peter Jennings shouldn’t smoke, a point that was no doubt driven home by his later death from lung cancer. I, like many others, thought smokers were the problem with smoking. They aren’t. Many non-smokers don’t realize smoking is actually a pediatric epidemic. The average age of initiation is a tender 11 years old. An addiction researcher friend of mine who’s personally experienced heroin and tobacco addiction is very clear: Tobacco is the more addictive of the two, in his opinion. Now, what if companies were legally addicting one-fifth of our kids to heroin at the age of 11? Would our reaction be to just say to all those adults, “You should stop”? Of course not. We’d offer them lots of support and tools to stop while turning back and tackling the root of the problem, as we should with tobacco.

Let’s put smoking in its larger context. How many health insurance companies pay for cessation treatment? Too few. How many even pay for nicotine replacement therapies? Again, way too few. (Remember, if you wanted heroin treatment, you can get methadone for free at government-funded clinics.) How much of the hundreds of millions in tobacco taxes are put toward cessation treatment? A recent Massachusetts study estimated 99 percent of their tobacco taxes are funneled to other issues. According to the most recent American Lung Association report, 32 states get an F on their cessation efforts, the feds get a D, and the highest scoring handful of states only get Cs.

Read the rest on their site, and do please share! http://www.huffingtonpost.com/scout-phd/quitting-smoking_b_2582247.html

December & January Updates from the Network

Scout, Ph.D.

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

 

We routinely prepare a report highlighting our recent activities for the Fenway board and we always like to copy it here as “Updates”… so hold on for a fast romp on what we’ve been up to the last two months!

December/January Updates from the Network for LGBT Health Equity

The Network started December with a flurry of travel. Scout and our Steering Committee Past President, Dr. Francisco Buchting first represented us at a small Legacy Foundation funded meeting of tobacco disparity leaders brainstorming how to move our combined impact up several notches. It’s great to work with disparity leaders outside the LGBT world. We came up with several new strategies, so look for action from that convening soon.

Directly after, Scout and Gustavo went to Atlanta to attend the National Partners Meeting and a meeting of the tobacco disparity networks. We had many constructive discussions at these meetings, including extra meetings that were set up with Dr. Ursula Bauer (about LGBT inclusion in Prevention Fund work) and with the surveillance people at CDC and National Center for Health Statistics (about reintroducing trans data collection to the adult tobacco survey). Overall – there are some very promising signs of better integration of disparity work on many levels. Dr. Buchting again joined us for the last part of this trip as Office of Smoking & Health staff helped us set up our first ever CDC-wide training on our new MPOWERED best practices document. The training was received very well!

Next week we were off again, this time to DC for the multi-part LGBT spotlight engineered by the American Legacy Foundation. They’ve got a great new video that several of us helped with, and a new report on LGBT smoking, and we were so pleased to work with HRC and other old friends at their Warner Series lecture and live webcast that evening. Be sure to catch Scout’s Huffington Post blog on it all: It’s Time for the LGBT Communities to be Such Easy Targets for the Tobacco Industry. Note also the second installment from our friend the head of Bilerico.com, Bil Browning. Not only was he in the Legacy video, but he continued posting publicly about his cessation journey, which this month took a hard twist. Overall, we’re very pleased to report the Legacy rollout heralded our most active week of LGBT media on tobacco control in our history, with at least eight articles in national and local LGBT media!

We were very pleased to see January start with the exciting news of NIH rolling out their long-awaited response to the IOM LGBT report, including notably, the news that only 1.4% of their LGBT portfolio is tobacco research. The very next week, we had our first Huffington Post piece go up about LGBT targeting in the $100M Tips from Former Smokers Campaign. This is targeting that we advocated strongly to get, and we expect this to be just the beginning. The very day that post came out, Dr. Scoutwas again down at HHS Secty. Sebelius’ office providing input on what we’d like HHS to prioritize for the coming years’ LGBT action plan. More details on what we said soon, but you know we definitely asked for more funded LGBT tobacco research! Midmonth we helped promote the joint action alert about collecting LGBT data in clinical settings. Finally, we are rounding out the month by announcing our three great blogging scholarship recipients for Creating Change this week and getting ready to head down to Atlanta for that preeminent LGBT leadership convening. Each year we roll out a big community engagement event at Creating Change (see examples here & here), so watch our blog both for live event reports from the blogging scholars and to hear what new community engagement strategy we’re rolling out this year!

(p.s. Thanks for catching the errors Naph!)