411 on Including LGBT Communities in CTG Proposals

Scout, Ph.D. Director, Network for LGBT Health Equity at The Fenway Institute

Debra Morris, MPH CHESDirector of Technical AssistanceTobacco Technical Assistance Consortium

Gustavo Torrez, Manager - Network for LGBT Health Equity at The Fenway Institute

Network for LGBT Health EquityThe Network for LGBT Health Equity is community-driven network of advocates and

professionals enhancing LGBT health by countering tobacco use, and enhancing diet and exercise. We are one of six CDC-funded tobacco disparity networks and a project of The Fenway Institute in Boston. We advance these issues primarily by linking people and information to advocate for policy change. We actively monitor national and state health policymakers and urge community action when there is an opportunity to enhance LGBT wellness.

We would like to thank our cosponsor for this webinar

This webinar is the 2nd in a seriesThe first webinar was for LGBT community experts/advocates, training them on how

to identify and offer assistance to their local CTG applicants.

We would like to thank our community collaborators for the LGBT engagement

Agenda• Why integrating LGBT partners strengthens your proposal• Data sources for local LGBT health information• How to identify local LGBT partners• Examples of successful LGBT policy advocacy campaigns• Models for inclusion in CTG proposals and/or action

planning• Comments from Tobacco Technical Assistance Consortium

staff

Goals of This Webinar• Educate CTG applicants on the policies urging

LGBT inclusion• Provide the information so you can successfully

integrate LGBT people into your CTG proposal and activities

• Provide linkages to local LGBT organizations• Build the number of LGBT focused/inclusive CTG

programs nationwide

Why integrating LGBT partners strengthens your proposal

LGBT Cultural Competency in 1 Slide• LGBT people have notable health disparities, for

example we smoke at rates 35-almost 200% higher than the general population.

• Due to a legacy of discrimination, LGBT people often do not trust that mainstream health interventions are welcoming to them.

• You need to demonstrate a project is welcoming to LGBT people, otherwise you will perpetuate old or build new disparities.

LGBT Wellness Disparities in 1 Slide• Smoking rates much higher• Major access to care barriers aggravate all health

issues• Some concerns of overeating (& undereating)• Lack of data defines much of knowledge: not enough

to comment on diet/exercise widely• Remember: We need to include LGBT people in all

health work, so we don’t accidentally create new disparities by only changing behavior among others.

CTG Request for Applications• There is much stronger focus on including

disparity populations routinely, sexual orientation specifically mentioned as a possible one.

• It didn’t take as much leadership as desired (see: http://lgbthealthequity.wordpress.com/2011/05/13/the-long-awaited-community-transform-grants-thumbs-down/) but other policy docs do show notable leadership on including LGBT folk.

New Changes in Federal Commitment to LGBT Disparities

A series of policy documents in the last year capture the newly enhanced commitment to LGBT inclusion in health activities.

Healthy People 2020• Overarching goal: “Achieve

health equity, eliminate disparities.”

• Disparities/inequity to be assessed by: Race/ethnicity, Gender, Socioeconomic status, Disability status, Lesbian, gay, bisexual, and transgender status, Geography

• New LGBT Topic Area

IOM Report• Historic review of LGBT

health disparities• Calls for data collection,

cultural competency, & additional research.

• Read more: Is This The Biggest 48 Hrs Ever for LGBT Health? & Why the IOM report is a healthy change for LGBTs: Op-Ed on IOM Report on LGBT Health

HHS Tobacco Action Plan• “Available evidence also reports

very high smoking rates among lesbian, gay, bisexual and transgender populations; however these populations remain underrepresented in current surveillance systems used to monitor tobacco use.”

• Read more here: HHS Tobacco Strategic Plan Launch: Eyewitness Account & LGBT Inclusion Details

National Prevention Strategy• “Pillar 4. Eliminate Health Disparities: Eliminate disparities in 

traditionally underserved populations to improve the quality of life for all Americans. Some groups are disproportionately affected by health risks including major disorders such as heart disease, obesity, diabetes, HIV/AIDS, or viral hepatitis; high rates of infant mortality; and high rates of violence. Disparities often occur under conditions of social, economic, and environmental disadvantage. All Americans should have access to opportunities for healthy living and be supported in their efforts to make choices that promote long, healthy, and productive lives, regardless of race or ethnicity; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or other characteristics.

HHS ACA LGBT Factsheet• “In addition, the Affordable Care Act is funding

preventive efforts for communities, including millions of dollars to use evidence-based interventions to address tobacco control, obesity prevention, HIV-related health disparities, and better nutrition and physical activity. The Department of Health and Human Services intends to work with community centers serving the LGBT community to ensure the deployment of proven prevention strategies.”

• Read more here: New Government Factsheet on LGBTs & Health Care Reform

SummaryIncluding the LGBT population in your CTG application & work is not only scientifically indicated, it reflects the latest policy directives from HHS.

Data sources for local LGBT health information

LGBT local needs assessments

Michigan: Breaking the Habit; Southeastern Michigan LGBT Tobacco Use Report (2006) New Mexico: New Mexico LGBT Tobacco Community Survey (2006); Adding Sexual Orientation Questions to Statewide Public Health Surveillance: New Mexico's Experience (2010) Arizona: Smoking Prevalence and Cessation among Lesbian, Gay, Bisexual, and Transgender Residents in Arizona (2008); Tobacco Use and Interventions among Arizona Lesbian, Gay, Bisexual, and Transgender People New York: A Blueprint for Meeting LGBT health and Human Services Needs in NYS (2010) Minnesota: Creating an Effective Tobacco Plan for Minnesota's Gay, Lesbian, Bisexual, and Transgender Communities (2005) Idaho: Idaho Tobacco Prevention and Control Program (2004) North Carolina: North Carolina Report- Tobacco Disparities in the LGBT Community (2004) Ohio: Ohio LGBT Report: Voices of the Lesbian, Gay, Bisexual, Transgender on: Tobacco Use, Tobacco Control, and the Effects of Tobacco Colorado: Tobacco Control Needs in Colorado

For more, check out our website for further assessments: lgbttobacco.org

* Leigh Evans, MPH, The Fenway Institute, 2011

Sexual orientation not included (19)

Sexual orientation included (22 and DC)

Information not available (7)

Sexual orientation included in specific counties (2)

States that have included LGB on BRFSS

LGBT national data sourcesFull probability• NHIS same sex household data• Pooled YRBS data (caveats)• National Survey of Family Growth• (NATS?)• Tobacco use among sexual minorities in the USA, 1987 to 

May 2007: a systematic review Tobacco Control August 2009. Joseph Lee, Gabriel Griffin, Cathy Melvin

Community based sample• National transgender survey (tobacco info in full report only,

not exec summary)

How to identify local LGBT partners

Our secret formula• Do we have members in your state?• Is there one or more community centers in

your state? • If you’re a large city, you could also have one

of the 12 health centers.• Are there members of the National Coalition

for LGBT Health in your state? • Is there an “equality federation” in your state

But let’s make it easy…• We will send each of you an email with the

names of one more key LGBT leaders/organizations in your state

Examples of successful LGBT policy advocacy campaigns

Examples 01• DC - CIA passage in Washington DC• CA – legislators refusing tobacco money• CA – assisting getting tobacco out of

pharmacies• WA – No tobacco funds pledge for pride

On the horizon• MO – created an LGBT tobacco/wellness

action plan, now moving to implementation phase

• IL, DC – CPPW subcontracts in action• GA – planning LGBT wellness campaign

heavily focused on policy changes

Our Tools/Assistance• LGBT organizational wellness policy toolkit• Online LGBT organizational environmental

scan• Online resource library: needs assessments,

sample reports, etc.• We can do LGBT cultural competency

trainings + help you find local experts + provide technical assistance to them.

Models for inclusion in CTG proposals and/or action planning

How you can include us – big picture1. Subcontract to local LGBT organization(s).– Fund a project that pushes for policy changes in

LGBT organizations. – Fund local organization to assist general coalitions

working on policy change (e.g. clean air measures)2. Require other subcontractors to demonstrate

LGBT inclusion in their work.3. Add smart LGBT measures to health surveys to

evaluate LGBT disparity changes.

Where to mention LGBT in proposal1. Needs section (10 pts) – write 1-2 paras describing LGBT

community & health disparities2. Leadership Team & Coalitions (20 pts) – a. Commit to

include LGBT leadership in the leadership team or coalition. B. Secure letter(s) of support from LGBT groups

3. Community Transformation & Implementation Plan (20 pts) – include or plan to include LGBT targeted activities in the implementation plan

4. Performance Monitoring & Evaluation (10 pts) – Commit to adding LGBT measure in eval measures. (we have resources to assist)

Comments from Tobacco Technical Assistance Consortium staff

Questions

THANK YOU!We look forward to working with you to collaboratively address LGBT wellness disparities.

Please take 2 minutes to complete an evaluation on this call: http://www.zoomerang.com/Survey/WEB22CJFN25YF9/

Additional questions?Feel free to contact us whenever needed

Network for LGBT Health Equitylgbthealthequity@gmail.com

The Fenway Institute | Fenway Health1340 Boylston Street | Boston, MA 02215voice: 401-263-5092 | fax: 401-633-6092

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Debra MorrisTobacco Technical Assistance Consortium

debra.morris@emory.edu