PRESS RELEASE: FINDINGS FROM CDC’S NATIONAL ADULT TOBACCO SURVEY SHOWS SIGNIFICANTLY HIGHER PREVALENCE OF TOBACCO USE AMONG LGBT RESPONDENTS VERSUS GENERAL POPULATION

 

FOR IMMEDIATE RELEASE                                        
September 20, 2012    

Contact:     Chris Viveiros
617.927.6342 / 617.721.7494                                                                                               cviveiros@fenwayhealth.org 

FINDINGS FROM CDC’S NATIONAL ADULT TOBACCO SURVEY SHOWS SIGNIFICANTLY HIGHER PREVALENCE OF TOBACCO USE AMONG LGBT RESPONDENTS VERSUS GENERAL POPULATION

Report Marks Historic First Release of National Surveillance Data on LGBT Tobacco Use

A CDC (United States Centers for Disease Control and Prevention) analysis of data from 2009-2010 National Adult Tobacco Survey published in the American Journal of Public Health (AJPH) showed that with the exception of pipes, tobacco use was significantly higher among LGBT respondents when compared to the general population.   The survey found that 32.8% of LGBT people nationally smoke cigarettes; 12.2% smoke cigars/cigarillos/small cigars; 6.1% and 38.5% report using any tobacco.  Among heterosexual/straight respondents, those rates fell to 19.5% for cigarettes; 6.6% for cigars/cigarillos/small cigars; and 25.2% for any tobacco use.

An abstract of the APJH report is available here, where American Public Health Association (APHA) members can download a PDF of the full report.  Members of the press who would like a copy of the report should contact the APHA at mediarelations@apha.org or 202.777.2509.

“These data provide the first national benchmark of adult LGBT tobacco use and we applaud the Office of Smoking and Health at CDC for their leadership in LGBT integration and data collection,” comments Dr. Scout, The Director of The Network for LGBT Health Equity.  “Unfortunately, these findings  confirm the bad news that LGBT people smoke cigarettes at rates 68% higher than the general population and that our overall tobacco use is 50% higher.” said Scout, PhD, Director of The Network for LGBT Health.

“It’s clearer than ever that tobacco use is one of the largest single health burdens on the LGBT community,” Scout continued. “On a daily level, this means smoking and secondhand smoke is taking our health and too often, our lives. I look forward to the day when every tobacco control program includes LGBT tailored work and every tobacco industry marketing program doesn’t.”

“The American Lung Association is happy to see that this report contains specific information on LGBT tobacco use. As we stated in our 2010 report on LGBT tobacco use, Smoking Out a Deadly Threat – Tobacco Use in the LGBT Community, it’s important that this type of data be collected among the LGBT community so we can target programs and funding appropriately to reduce the burden of tobacco use among this community and all disproportionately affected communities,” said Bill Blatt, the Director of Tobacco Control Programs at The American Lung Association.

“The LGBT communities have been advocating for health data collection for so long.” reports Terry Stone, the Executive Director of Centerlink, the national association of LGBT community centers, “It’s great to finally see some results from that work. Even if the news is bad, it’s better than being invisible.”

The 2009 – 2010 National Adult Tobacco Survey is a national landline and cell phone survey of adults aged 18 years and older, to estimate current use of any tobacco; cigarettes; cigars, cigarillos, or small cigars; chewing tobacco, snuff, or dip; water pipes; snus; and pipes. We stratified estimates by gender, age, race/ethnicity, education, income, sexual orientation, and US state.

The Network for LGBT Health Equity at The Fenway Institute is a community-driven network of advocates and professionals looking to enhance LGBT health by eliminating tobacco use, and other health disparities within our communities. We are one of six CDC-funded tobacco disparity networks.

For more than forty years, Fenway Health has been working to make life healthier for the people in our neighborhood, the LGBT community, people living with HIV/AIDS and the broader population.  The Fenway Institute at Fenway Health is an interdisciplinary center for research, training, education and policy development focusing on national and international health issues. Fenway’s Sidney Borum Jr. Health Center cares for youth and young adults ages 12 to 29 who may not feel comfortable going anywhere else, including those who are LGBT or just figuring things out; homeless or living on the streets; struggling with substance use or abuse; sex workers; or living with HIV/AIDS.

-30-

PopCtr Mtg: LGBT Data Inclusion on the Health Center Level

By Emilia Dunham

Program Associate, Reporting on the Center for Population Research in LGBT Health at The Fenway Institute on Panel presentation on possibilities and challenges working with patient data with Judy Bradford, Chris Grasso, Ken Mayer, Valerie Fein-Zachary

 

Data, data and more data. Perhaps to some it seems like we talk about data like it’s going out of style. It may seem obscure, distant and ironically abstract, something reserved for academics, researchers and federal government officials; it may seem that data comes mostly from large research studies at large institution networks or within national surveys. However, data can be collected at community health centers with meaningful impact.

Chances are your local health center collects data already through intake and

Dr. Judy Bradford

visits, and if electronic as it’s easy to collect. Chris and Judy discussed what Fenway is doing and how they are including more LGBT questions. Data from that will be available after publications, however it’s a great way to learn about the population, extract patient information and contribute to public health knowledge.

If you’re a patient, you may wonder is your personal information safe? The answer is Yes!  Fenway and other health centers adhere to strict federal regulations, provide all patients with privacy and Health Insurance Portability and Accountability Act (HIPAA) notices, and that any research is de-identified and goes through an Institutional Review Board. As someone who worked for this board for a year, I would know it’s very safe! To be able to understand the populations you serve, their health risks and potentially influence others to do the same, simple data collection can turn into a huge community gain. And you always have a right to ask how your information is being used even though there is little harm but potential broad benefit.

For instance in past studies, it was found that 48% of HIV+ clients at several facilities serving many people living with AIDS were smokers (Crane 2011 [full citation needed]). Just imagine the implications of these types of data!

So what can you do?

Challenge yourselves and others to work with local advocates in health centers in order to collect data on LGBT patients by asking questions of sexual orientation and gender identity on demographic forms. For instance, at your health center, you could advocate for your center to participate in the Healthcare Equality Index of the Human Rights Campaign to identify ways in which health centers can be more inclusive and eventually add LGBT questions. This index also includes LGBT non-discrimination measures and sensitivity, so asking for their participation in the HEI could add to your healthcare facility’s LGBT cultural competency and positive impact for the communities.

CDC Releases Historic Disparities Report: News on LGBT Health? No Data.

Scout
Director, Network for LGBT Health Equity
 

CDC Releases First of New Reports on Health Disparities

I have to confess, back in college when I worked at a health library, there was one publication that I would regularly mock, the Morbidity and Mortality Weekly Report. Yup, nothing seemed to quite encapsulate “scintillating” as much as that title. Sigh, which is why I guess it’s now my lot to actually list that as one of my most used resources in my adult life. Can’t even remember what was funny about it now because it’s just the highly esteemed MMWR in my mind, source of all of CDC’s breaking news and information on population health trends of every stripe. Well almost every stripe.

So, Friday CDC used the MMWR to release the first in a regular series of reports on health disparities. We had a heads up midyear this report might exclude LGBT folk altogether, so we did a little work a ways back to confirm that it would not make that big omission, and Friday we were happy to see that yes, LGBT people were in the report. But, the news is … barely.

LGBT Inclusion?

First flip was to the chapter on tobacco. Now we know that CDC included an LGBT measure on their recent National Tobacco Survey, but unsure if these data could make it into this report. And the verdict is? The chapter notes increased LGBT tobacco prevalence (great!), but “Although multiple tobacco-related disparities exist, this report highlights only racial/ethnic and socioeconomic disparities because of limited data for other demographic groups.” Sigh, ok.

What about the chapter on suicide? Sadly news just came across my desk earlier this morning about yet another gay youth who allegedly committed suicide after experiencing bullying at school. So what does CDC say about LGBT suicide rates? That they are nearing epidemic proportions? Not exactly. Eighth paragraph or so of that chapter includes this line: “Because the variables included in U.S. mortality data are limited, the results cannot be used to determine potential factors related to such disparities as mental or physical disability, sexual orientation, or income.”

In desperation, I flip to the chapter on HIV, sure enough there I can at least find some data for MSM (Men who have Sex with Men) health disparities. But even then, I scratch my head, has the flaw of categorizing transgender women as men been fixed yet? Despite shockingly high rates of infection reported by some transgender needs assessments, this information remains hidden with the current HIV reporting methods.

No LGBT Data Now But CDC Calls For Change!

Well, many of us already know one of the biggest problems with federal health systems is they don’t collect any LGBT data, therefor unwittingly hiding all our health disparities. So the gaps in this report are distressing, but aren’t really news. So, does CDC address this at all? I’m happy to say yes they do. In the introductory Rationale For Regular Reporting on Health Disparities and Inequalities chapter their longest paragraph is titled Gaps in Data Regarding Sexual Orientation. The paragraph reviews how Health People 2010 highlighted population disparities by measures including sexual orientation (Healthy People 2020 includes gender identity in this lineup) but briefly reviews how this goal wasn’t matched with supporting data collection. They review the few federal surveys that have any data at all and strongly conclude:

“To fill this notable data gap, national and state surveys should begin consistently and routinely measuring sexual identity, orientation, and behavior. Data collection should be expanded to include not only age, sex, education, income, and race/ethnicity, but also disability, geographic location, and sexual identity or sexual orientation. Only then can health disparities be measured thoroughly and accurately nationwide.”

Excellent! Hear hear! How wonderful that CDC is calling for an end to this data desert that is holding back so much work on LGBT health disparities! (And let’s hope the gender identity inclusion gets carried over from HP2020 as well.)

Change Starts At Home: CDC Funds Major Data Collection

CDC controls many of the pursestrings for major health data collection systems. Looking at Grants.gov I see that as we speak states are finalizing their proposals to CDC for $45M they are offering for state health data collection through the BRFSS (Behavioral Risk Factor Surveillance System), I know CDC puts out even more for the youth version of that survey, the Youth Risk Behavior Survey. But right now, $0 of that $45 million goes to LGBT data collection. (though some states take the initiative to add it themselves) While it’s hard to see how invisible we are in the newly released health disparity report, perhaps the call for data can shepherd in a new era. But until we see tested LGBT measures on every major health survey I hope we keep reminding policymakers at every opportunity: stop allowing LGBT health disparities to be hidden.

See Full Disparities Report here.

Also let me give a big shout out of thanks to all the LGBT community members and allies at CDC that helped shine this spotlight on LGBT data gaps and health issues.

 

LGBT Surveillance: Next Steps for the Federal Government Summary

On Monday, November 22nd, we held a BrownBag Webinar called “LGBT Surveillance: Next Steps for the Federal Government.” The call focused on a discussion on federal opportunities for LGBT data to be considered for inclusion in national surveillance (surveys).

The crux of the conversation’s goal was to gather Lessons Learned from stories that callers shared on gathering LGBT data on the state level. In our highest attended BrownBag, participants shared their strategies for LGBT inclusion as well as barriers that have come up in that process. Scout introduced the call by requesting stories on state LGBT data implementation that can be used to help the federal government in whether/how they would include LGBT data questions on national surveys.

Among the reasons LGBT data has been left off national surveys, several myths circulate on why exclusion continues. For instance, surveyors fear higher refusal rates, break-off rates and confusion from respondents taking these surveys.

Current National Surveillance Efforts:

o       Despite failed efforts to include GLBT questions on the national Census, researchers are studying same-sex partner data gathered from the survey.

o       DHHS is including LGBT health measures on their major health survey (National Health Institute Survey : NHIS) but that is still within the works.

o       The National Adult Tobacco Survey includes multiple questions on LGBT as a singular question.

o       CDC sponsored survey on LGBT data in the United States in “Sexual behavior and selected health measures: Men and women 15–44 years of age

o       A group of researchers and advocates are working on a document for how gender identity questions can be added to national surveys (i.e. education, health.)

State Experiences

  • New York: City Health Department in NYC had a strong experience with adding sexual orientation and gender identity

o       Unexpected positive outcome: Mainstream scientists are excited about looking at LGBT data because they care about health disparities showing that LGBT data collection is not just a minority issue.

o       Positive Outcome: Multiple surveys point to LGBT data

  • California: California Health Interview Survey (CHIS) has included sexual orientation (not gender identity)

o       Barrier and Solution: When respondents are confused, the protocol is to reinforce the need for complete understanding of demographics/disparate populations and that no one is forced to answer the question.

  • Illinois – YRBS – does not include LGB, but Chicago does include a question asking folks “Which best describes you ‘gay’, ‘bisexual’, ‘lesbian’, ‘not sure”
  • New Mexico – NM has made a lot of progress in adding LGBT measure

o       Strides: “Sexual orientation” was added to both the Adult Tobacco Survey (ATS) in 2003 and the Behavioral Risk Factor Surveillance System (BRFS) in 2005.  Since 2009, both surveys added a question including “transgender”.

o       Barriers and Solutions:

  • A few participants questioned why LGB was asked, but confusion why that was added was explained.
  • In early years, there was confusion from 65+ year old individuals about LGB questions, so NM limited how many seniors received that question as many responded with “I don’t know.”
  • Lack of youth data is a major gap that needs to be filled. Since 2005, advocates and researchers have been proposing that “sexual attraction” to be added to the Youth Risk Behavior Surveillance System (YRBS) as no LGBT questions are currently asked on this major survey for youth.

o       Positive Outcome: NM APHA data paper from 2003-2009 showed refusal rates of sexual orientation question in BRFSS to only be .8- 1.8% which compares with refusal rates for other categories like 4.1-4.5% on household income.

  • Ohio – Led focus LGBT focus groups with reports on what was asked as well as transcripts for the groups. Another report is here.

o       Barrier: There weren’t enough respondents

Resources on LGBT data collection and best practices

Next Steps:

  • Please send emails or comment here with experiences of “Lessons Learned” at lgbttobacco@gmail.com.
  • We are looking for folks who have information on who has adult tobacco, YRBS, BRFFS, Quitlines
  • Another call continuing discussion will be announced.
  • A separate call on program data may be useful for folks who are looking for assistance on including LGBT data themselves.