The LGBT Tobacco Policy Update You All Have Been Waiting For


Hey y’all,
A few weeks back I had the distinct pleasure of spending a few different batches of time in fluorescent lit meeting rooms in some anonymous Atlanta hotel. And you know I love that for its own sake, but also, the entertainment added some extra value. It was probably your normal cabaret show (a.k.a. CDC Office on Smoking and Health meeting and National Tobacco Disparity Networks), but in the middle, we got a few different policy updates from the good folk working on tobacco policy at a national level. So, here for your edification, is the 200% unofficial Scout-version of what might have been said, rumored, or implied. As per usual, all errors are probably someone else’s fault, and all correct information is absolutely to my credit.

They thought we were screaming mimis
So, times are a changing with tobacco. Why? Well there’s been a few bombshells recently about the potential impact of Clean Indoor Air Laws. Did you see the recent news about smoking bans cutting heart attacks by about 1/4?

iom_report_sml

IOM's Report on Secondhand Smoke Exposure and Cardiovascular Effects

Well this was a precursor to the later release of the National Institute of Health’s (NIH) Institute of Medicine (IOM) report on clean indoor air. This was rumored to be the first ever IOM report held up for release, because they couldn’t believe the strength of the findings, so they had to double check to be sure.

In that, they find smoking bans decrease heart attacks by about 1/5. Now this isn’t even considering all the associated health gains, it’s just heart attack. This is a 1-2 punch with a forthcoming Surgeon General’s report that’s staged to be released soon which continues to drive the smoking risk points home… each of these documents present conclusions that are stronger than prior claims… and as they were summarized by one guy, it’s basically such a strong negative effect between smoking and cancer that we can’t assure you that walking by a smoker once won’t be enough to give you cancer. Now in publichealthia (the land of pubic health) we rarely stumble across anything that has as big an effect as reducing 1/5 of heart attacks — so this is getting lots of notice. In the words of another, “they were dismissing our claims about clean indoor air as overestimation, now everyone realizes we were actually underestimating the risks”. This focus on policy dovetails nicely with the Obama push to move health upstream, to reclaim the dusty unfavored idea of Prevention! Remember, he also recently appointed a new bulldog to head the CDC, a guy who is rumored to work day and night and one who comes out of Bloomberg’s Tobacco-Control Land (a.k.a. New York City). So, we think tobacco control is getting more natural attention at CDC thru this move as well.

Wellness arise!
I know you all have seen the different spurts of cash coming out thru the $650M of stimulus money allocated to chronic disease prevention, the Wellness RFA, another nearly indistinguishable Wellness RFA, and some quitline $ (and yet, I’m not sure it all adds up to $650M, hmm?). So these are rumored to be Obama/CDCs shot over the prow at Wellness/prevention initiatives, with the hope they are a good testbed for smart ideas to include in bigger wellness/prevention rollouts as part of health care reform. (Or HCR for the vowel-impaired). Seems like all the states and “communities” (aka cities) are planning to submit for these awards, so it’ll be interesting to see what programs make the cut, and of course, how many of those actually include LGBT in their disparity planning. Another upshot in this wellness/prevention drift is relative lower focus on cessation, concurrent with more on policy and prevention activities. There’s an effort afoot to push cessation costs more onto employers/insurers (which only seems to be insanely logical, what mercury poisoned actuary really is advising insurance companies that it’s financially prudent not to cover nicotine replacement therapy, etc?). (Wups, will the mercury poisoning lobby dislike me for that?). Look for a large employer to take the lead in near months on showing how a smart “company” really does do comprehensive cessation benefits.

What about FDA?
It’s here! It’s vague! Get used to it! was heard being chanted outside the hotel windows, I presume they were talking about FDA. But according to the folk inside, this is a bill that is, of course you naive simpleton, not perfect, but as bills go, not dang horrid either. FDAs got some teeth, thinking is esp at a local level, where many communities have control over the laws governing advertising. Much talk of the change as we (finally) get new warning ads, but how we have a long way to progress to the ‘tombstone’ standard where tobacco companies are only able to say their cigarette name and price in a generic font at sales locations and on packages. There was some general shaming about how some lovely but not public health leading countries such as maybe Indonesia (?) are trumping our butts on having good tobacco control policies, but then, I don’t think any of us are deluded as to any US supremacy we may have on this issue, right? Anyhow, it’s power to the people here in FDA-land, where we might find lots of community action potential to keep cigarettes off our babies bodies. Of course, community level change seems a bit harder to do than one national law, but what, are we lazy? (slow yawn) No!!

Empower really always had too many vowels
So it’s the big new framework around tobacco, everything has to do with MPOWER, or as some pithy individual noted, MPOWERD. What is it? Jeez, I lost my notes… um… oh yah, it appears to be a WHO package. What? (no What’s on second) Oh, I found it, a package of 6 proven policies. M=Monitor tobacco use and prevention policies. P=Protect people from tobacco smoke. O=Offer to help people quit. W=Warn about dangers of tobacco. E=Enforce bans on tobacco ads, promotion and sponsorship. R=Raise taxes on tobacco. And of course, the silent D= eliminate Disparities!! Now isn’t that just too cute an acronym for words? Aren’t you proud of the World Health Organization (WHO) acronym generation team? I am. And mostly, if your tobacco control is working on something else, then what are you doing? Or maybe also to note, if your comprehensive tobacco control program isn’t addressing all of this, then your acronym is unspeakable. And us LGBTQIs would never ever be ok with that. Puh. (getting a feeling I should wind this up real soon)

Nu CDC combined ATS has LGBT! (vowel reduction sentence)
Oh yes, it’s true we all should be excited, the new combined Adult Tobacco Survey (ATS) coming out soon has an LGBT surveillance question!! Please contain the dancing in the streets folks, it’s just a start, but yes, we are very happy about it. Oh hey — any moment now I’m about to announce the first largescale T survey findings on tobacco, because we negotiated to get a tobacco question on the recent NGLTF national trans survey…. wanna know a preview? Yup, as expected, prevalence 50% over nat’l avg. But this is *no longer a guess*, it’s real data from 2k+ living trans folk, w00t!

In conclusion
Omigosh, I think that’s it. (and about time you’re all thinking). So from the bowels of some unremarkable hotel conference room, I remain, sincerely yours,

Dr. He’s-Just-Always-So-Professional Scout

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