Improving Health and Reducing Tobacco Use of LGBT Missourians

1. Improving Health and Reducing Tobacco Use of LGBT Missourians Kevin D. Everett, PhD & Jane A. McElroy, PhD Family & Community Medicine University of Missouri August 16, 2012 NCTOH Kansas City, Missouri

2. Tobacco and Health Disparities Tobacco is a powerful and pervasive cause of health disparities. Some groups appear more vulnerable to the harm caused by tobacco use and exposure than others.

3. 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)

4. LGBT Missourians and Tobacco Use(Prior to 2008) • 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).

5. Phase1: Assessment Project • 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.’

6. 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

7. Smoking Status by Sexual and Gender Minority (SGM) Check Out Project 2008

8. Smoking Status by Sexual and Gender Minority (SGM)

9. Focus Group: Current LGBT Smokers “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…”

10. Focus Group: Former 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.” Check Out Project 2008

11. Phase I: Conclusions 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

12. Phase II: Planning Phase • 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

13. Pride Festival Surveys 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

14. Pride Festivals survey, all years 2008-2011 Pride Festivals Adult Participants MISSOURI N=3,237 N= 956 N=5919 N=727 Total=11,392 Online=553

15. Phase III: Intervention 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.

16. Cessation Initiative • 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.

17. Coming Soon:www.outproudandhealthy.org

18. Aknowledgments: • 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