411 on Including LGBT Communities in CTG Proposals Scout, Ph.D. Director, Network for LGBT Health Equity at The Fenway Institute Debra Morris, MPH CHES Director of Technical Assistance Tobacco Technical Assistance Consortium Gustavo Torrez, Manager - Network for LGBT Health Equity at The Fenway Institute

Network for LGBT Health Equity The 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 2 nd in a series The 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: awaited-community-transform-grants-thumbs-down/ ) but other policy docs do show notable leadership on including LGBT folk. awaited-community-transform-grants-thumbs-down/

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 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 DetailsHHS 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 ReformNew Government Factsheet on LGBTs & Health Care Reform

Summary Including 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)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)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 PeopleSmoking 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)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)Creating an Effective Tobacco Plan for Minnesota's Gay, Lesbian, Bisexual, and Transgender Communities (2005) Idaho: Idaho Tobacco Prevention and Control Program (2004)Idaho Tobacco Prevention and Control Program (2004) North Carolina: North Carolina Report- Tobacco Disparities in the LGBT Community (2004)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 TobaccoOhio LGBT Report: Voices of the Lesbian, Gay, Bisexual, Transgender on: Tobacco Use, Tobacco Control, and the Effects of Tobacco Colorado: Tobacco Control Needs in ColoradoTobacco 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 sources Full probability NHIS same sex household data Pooled YRBS data (caveats) Pooled YRBS data National Survey of Family Growth (NATS?) Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review Tobacco Control August Joseph Lee, Gabriel Griffin, Cathy Melvin Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review Community based sample National transgender survey (tobacco info in full report only, not exec summary) National transgender survey

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 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 picture 1.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 proposal 1.Needs section (10 pts) – write 1-2 paras describing LGBT community & health disparities 2.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: Additional questions? Feel free to contact us whenever needed Network for LGBT Health Equity The Fenway Institute | Fenway Health 1340 Boylston Street | Boston, MA voice: | fax: Our Blog Debra Morris Tobacco Technical Assistance Consortium