Smoking within Scotland s LGBT community, and the impact on HIV

1. Smoking within Scotland’s LGBT community, and the impact on HIV Linda Bates, PATH 21st October 2010: GayCon, Edinburgh

2. Outline of today’s presentation PATH report on smoking and the LGBT community in Scotland Rationale/method for report Findings and recommendations Other info relevant for smoking and BBV Your chance to contribute – focus groups

3. 1. PATH report: Smoking and LGBT people in Scotland PATH: Partnership Action on Tobacco and Health established in 2002, PATH is a joint initiative between ASH Scotland, NHS Health Scotland and the Scottish Government to reduce the prevalence of tobacco use in Scotland work includes youth work, projects and inequalities, developing/providing training LGBT report published July 2010, available online at www.ashscotland.org.uk/ash/8248.1939.html

4. 2. Rationale/method PATH has a particular focus on addressing health inequalities, which includes issues affecting LGBT people – including access to and equity of services literature review (search terms L/G/B/T, smok*/tobacco) mapping exercise (existing services and tobacco control plans within Scotland) data collection (online survey) – 106 responses interviews – 7 (one-to-one)

5. Smoking and health inequalities: the wider picture irrespective of other health factors (inc. HIV and other BBV), half of the world’s life-long smokers will die from their habit (Jha, P., Chaloupka, F.J., 1999) 24% of all deaths in Scotland can be attributed to smoking-related causes (Health Scotland, ISD Scotland and ASH Scotland, 2007) on average, middle-aged (35-69) smokers in Scotland will die 22 years before their non-smoking counterparts (Health Scotland, ISD Scotland and ASH Scotland, 2007) it’s not only about dying; it’s about poorer quality of life (and not just for the smoker)

6. Report findings: generalSmoking in the LGBT community nationally, very little data and/or targeted work evidence suggests that lesbians, gay men and bisexual people have a higher rate of smoking than the population as a whole (NHS Health Scotland/ ScotPHO, 2010) little clear evidence exists for transgender people on smoking (or many other health-related issues) (NHS Health Scotland/ScotPHO, 2010)

7. Recommendation:Scottish Government that research is undertaken to provide a more accurate picture of the LGBT community within Scotland, and to identify smoking prevalence rates within it. Such research should take into account all relevant socioeconomic factors and broader equality and diversity strands  

8. Report findings (cont’d): generallinks between sexual orientation and health higher smoking rates, alcohol consumption and misuse of drugs by lesbians, bisexual women and gay men than the general population (Department of Health, 2007) young lesbian, gay and bisexual people have poorer mental health and wellbeing than the wider population (NHS Health Scotland/ScotPHO, 2010)

9. Recommendations (cont’d):Health Boards and NHS services that NHS services (including stop-smoking initiatives) undertake equality and diversity training to ensure that the health needs of LGBT people are appropriately met, and to ensure delivery of a non-judgmental and inclusive service. This could link in with Equality Impact Assessments (EQIAs), to evidence that NHS boards are addressing the health needs of the whole community that local health plans and tobacco control strategies (where they exist) include and reflect the identified health needs of the LGBT community (once known), including those relating to tobacco use and stopping smoking

10. Report findings (cont’d): generallinks between orientation and sexual health lesbians, bisexual people and gay men are reportedly more likely to display risky sexual behaviours than heterosexuals (NHS Health Scotland/ScotPHO, 2010) in Scotland, gay and bisexual men are more likely than their heterosexual peers to be HIV+ (ISD Scotland, 2009)

11. Report findings (cont’d): generallinks between smoking and HIV Gay Men Fighting AIDS (London-based charity) estimate that 48% of HIV+ gay men smoke or use tobacco (http://www.gmfa.org.uk/quitsmoking/#_ftnref1) a higher risk of smoking-related illnesses [such as lung or oral cancers; chest infections; cardiovascular events and brain degenerative disorders] developing in HIV-positive smokers in the first instance, compared to HIV-negative smokers (Shiels, M.S. et al, 2009)

12. Recommendations (cont’d):Health Boards and NHS services that services for people living with HIV (including, but not limited to, sexual health settings) are encouraged to raise the issue of smoking and tobacco use with their clients, and signpost them on to stop-smoking services where appropriate

13. Recommendations (cont’d):Health Boards and NHS services that through relevant community groups, NHS boards specifically engage with and encourage their local LGBT population to access stop-smoking services, which may also help boards meet their HEAT target relating to smoking prevalence

14. Report findings (cont’d): specificLGBT people asked about smoking most respondees (65%) had been asked about their smoking by an NHS health professional (e.g. doctor, nurse, dentist) most respondees (89%) had NOT been asked about their smoking by an LGBT service (e.g. specialist health org.) most respondees (86%) had tried to stop smoking at least once

15. Report findings (cont’d): specificfuture quit attempts no clear preference for method of future quit attempt(s): 44% on their own; 30% with help; 16% no preference; 10% ‘other’ for those who would consider using a stop-smoking service (1:1 or group), 53% said it was ‘unimportant’ that it be specifically LGBT

16. Report findings (cont’d): specificexample of good practice Gay Men’s Health, in partnership with NHS Lothian and the LGBT Centre for Health & Wellbeing, have run an LGBT stop-smoking group numbers are modest, but results are encouraging - 9% of service users were still stopped after one year (NHS Lothian generic services average was 4%) provides choice for LGBT people in the Lothians as to where they can go for stop-smoking support

17. Recommendations (cont’d):research that the Gay Men’s Health/LGBT Centre for Health & Wellbeing model, which shows some promise, be examined more closely to determine whether there are aspects of its delivery which could be reproduced in other settings (NHS and/or LGBT community-based)

18. Recommendations (cont’d):PATH and ASH Scotland that PATH conducts needs assessments with LGBT community organisations, to explore what issues should be addressed (including, but not limited to, training) in order to raise the issue of smoking and tobacco use with their service users that PATH and ASH Scotland’s tobacco-related work links in with LGBT community organisations (including those for young people), to widen its reach amongst the voluntary sector

19. 4. Links between smoking and other blood-borne viruses 2002 report suggested that smoking can aggravate the risks of further liver damage for those living with conditions such as Hep B and Hep C (Wang, C-S et al, 2002) 2010 report provides evidence of the link between smoking, a Hep B/C diagnosis and developing liver cancer (Chuang, S.C. et al, 2010)

20. 5. Focus groups: volunteers sought! held in late 2010/early 2011 to explore what barriers may exist within LGBT and/or sexual health services for raising the issue of smoking with clients possibility of training being developed to help staff/volunteers raise the issue and signpost on to appropriate services

21. Any final questions?

22. References 1 Chuang, S.C., Lee, Y.C., Hashibe, M., Dai, M., Zheng, T., Boffetta, P. 2010. Interaction between cigarette smoking and hepatitis B and C virus infection on the risk of liver cancer: a meta-analysis. Cancer Epidimiol. Biomarkers Prev. 19(5):1261-8. Available online at: http://www.ncbi.nlm.nih.gov/pubmed/20447919 [accessed 13.10.10] Department of Health. 2007. Healthy lifestyles for lesbian, gay, bisexual and trans (LGBT) people. London: Department of Health. Available online at: http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_07 8345.pdf [accessed 25.08.10] Gay Men Fighting AIDS (date unknown). Quit smoking [online]. Available at: http://www.gmfa.org.uk/quitsmoking/index [accessed 01.09.10] Health Scotland, ISD Scotland and ASH Scotland. 2007. An atlas of tobacco smoking in Scotland: A report presenting estimated smoking prevalence and smoking-attributable deaths within Scotland. Edinburgh: NHS Scotland/Scottish Public Health Observatory. ISD Scotland. 2009. Scotland’s Sexual Health Information Report 2009. Edinburgh: ISD Scotland. Available online at: http://isd.scot.nhs.uk/isd/5717.html [accessed 25.08.10]

23. References 2 Jha P., Chaloupka F.J. 1999. Curbing the Epidemic: Governments and the Economics of Tobacco Control. Washington, DC: The World Bank. NHS Health Scotland/ScotPHO. 2010. Dimensions of diversity: population differences and health improvement opportunities. Edinburgh: NHS Health Scotland. Available online at: http://www.scotpho.org.uk/home/Publications/scotphoreports/pub_diversityreport.asp [accessed 26.02.10] Partnership Action on Tobacco and Health. 2010. Stop-smoking service provision for LGBT communities in Scotland [online]. Available from: http://www.ashscotland.org.uk/ash/8248.1939.html Shiels, M.S. et al. 2009. A meta-analysis of the incidence of non-AIDS cancers in HIV- infected individuals. J Acquir Immun Defic Syndr. 52(5): 611-22 [online]. Available at: http://www.ncbi.nlm.nih.gov/pubmed/19770804 [accessed 01.09.10] Wang, C-S., Wang, S-T., Chang, T-T., Yao, W-J., Chou, P. 2002. Smoking and alanine aminotransferase levels in Hepatitis C virus infection: implications for prevention of Hepatitis C virus progression. Arch Intern Med. 162:811-815. Available online at: http://archinte.ama-assn.org/cgi/content/full/162/7/811 [accessed 13.10.10]