1 Q.U.I.T. Queers United to Interrupt Tobacco A Lesbian, Gay, Bisexual, Transgender, Questioning and Intersex Youth Smoking Cessation Project Based on the ALA’s Not On Tobacco (N-O-T) Program Evelyn Castillo, Catherine Saiki, Joe Ereñeta, Bob Gordon A Project by the American Lung Association of San Francisco & San Mateo Counties and the San Francisco Tobacco Free Project

2 ABSTRACT DESCRIPTION: A quit smoking program, Queers United to Interrupt Tobacco (Q.U.I.T.), was offered in San Francisco Bay Area to LGBTQI youth smokers ages 23 and under in March of The goals of the program were to help them a) quit smoking or b) cut-down number of cigarettes smoked. METHODS: Two tobacco control advocates were recruited and trained on the ALA’s tobacco cessation facilitation curriculum, Not On Tobacco (N-O-T). Fifteen youth participated in this voluntary smoking cessation program. The N-O-T curriculum sessions were used to provide the smoking cessation sessions. Pre and post tests were conducted to measure smoking status, beliefs and attitudes about smoking and quitting. Handouts were revised to reflect LGBT youth specific issues. RESULTS: End-of- program results indicated a 54.5% quit rate among the participants and a 66.7% weekday reduction along with a 81.8% weekend reduction in cigarettes smoked among participants who did not quit. Using the Stages of Change continuum based on a 5-point scale, beginning with 1 “I do not plan to quit in the next 6 months” and ending with 5 “I quit less than 6 months ago”, Q.U.I.T. participants progressed significantly along the continuum, from 3.28 to 4.09 moving towards “action” (p=.025). A 6-month follow-up is due this month. Discussion: This demonstration project has disconfirmed a generally accepted idea that LGBTQI youth are not responsive to joining quit smoking groups voluntarily. Although limited by the paradigms of a case study methodology, the lessons learned from this project provided the team with a much better understanding of LGBT youth’s attitudes about smoking and quitting. The project is currently seeking funding to recreate, expand, and continue quit smoking services for LGBTQI youth in San Francisco.

3 PROBLEM LGBT youth face tremendous challenges growing up physically and mentally healthy in a culture that is often unaccepting (Pediatrics, 1991). Research shows greater than 30 health risk behaviors positively associated with self-reported LGBT orientation (Pediatrics, 1998).

4 PROBLEM The research adds that among 30 health risk behaviors, cigarette smoking was higher in the LGBT youth (59.3%) than in their heterosexual counterparts (35.2%). The research also shows that smoking rates in the LGBT community overall are nearly double that of the general population (American Journal of Public Health, 1994).

5 PROBLEM San Francisco has a sizeable LGBT community who smokes. Many LGBTQI youth programs are not specific to smoking cessation and the impact on this lack of services can represent a significant health problem for San Francisco.

6 METHODS Two LGBT tobacco control advocates were recruited, trained, and certified on smoking cessation facilitation using the ALA’s Not On Tobacco (N-O-T) training protocol. Trained tobacco control advocates recruited 15 LGBTQI youth ages 23 and under to participate in a smoking cessation program based on N-O-T. Youth participated in a series of 9 voluntary sessions. Smoking status, beliefs and attitudes were assessed at baseline and at the end of the program.

7 METHODS What worked: Location : an LGBT youth-serving agency (SF- LGBT Center) Incentives : Food at every meeting; $100 on Quit Day (fifth session) and $100 on graduation day (ninth session); movie passes; music gift certificates Inter-agency collaboration : ALA – Tobacco Free Project – LGBT SF Center Previously conducted needs assessment : LGBT Youth Survey conducted by Queer-Tip Methodology : youth-led, behavior change model Funding available (SF Tobacco Free Project)

8 Recruitment & Outreach Tools Flyer Event palm cards Project account –Under “men seeking men” and “women seeking women”

9 Recruitment & Outreach Plan WhatWhereWhen Flyers & Palm Card Distribution School District (sexual minority liaison); OHMY Conference; cafés/shops bulletin boards; Bars/Clubs; FAITH (LGBT youth dance club); SFSU; LGBT youth serving medical clinics. 4 weeks in advance Media CoverageBay Area Reporter article2 weeks in advance Lists/MailingsGay Straight Alliance Network2 weeks in advance Follow-up callsTo all youth who expressed interest in class1 week in advance account for class: Established to answer class questions/follow- up Throughout project Waiting ListThe initially expected 10 youth maximum enrollment was extended to 15. An additional 15 youth were asked to wait in case someone cancelled – nobody did. Up to the 2 nd session.

10 Description of Participants AgeN% 17 and under and over00

11 Description of Participants Sexual OrientationN% Bisexual533.3 Gay640.1 Lesbian213.3 Queer213.3

12 Description of Participants Gender IdentityN% Female640.0 Intersex16.7 Transgender00 Male853.3

13 Description of Participants EthnicityN% African American213.3 Caucasian746.7 Asian/Pacific Islander320.0 Other -includes mixed ethnicity 320.0

14 RESULTS End of program results showed: -a 54.5% quit rate (with matched pre and post tests) -a 40% quit rate (unmatched pre and post tests) -a 66.7% weekday reduced consumption -a 81.8% weekend reduced consumption Six month follow-up results will be posted on December, 2002:

15 RESULTS Using the Stages of Change continuum based on a 5-point scale: “I do not plan to quit in the next 6 months” for 1 and “I quit less than 6 months ago” for 5, Q.U.I.T. participants progressed significantly* along the continuum, from 3.28 to 4.09 moving towards “action.” * (p=.025)

16 CONCLUSIONS 1.Demonstration project has disconfirmed a generally accepted idea that LGBTQI youth are not responsive to joining quit smoking groups voluntarily.

17 CONCLUSIONS 2.Although limited by the paradigms of a case study methodology, the lessons learned from this project provided the team with a much better understanding of LGBTQI youth’s attitudes about smoking and quitting.

18 Lessons Learned There is interest among LGBT youth in quitting smoking. A waiting list of youth was kept. About 15 youth were turned away. It is preferable for facilitators to be LGBT for group bonding to occur. Understanding individual differences about quitting and their stages of change helps facilitate change. The use of incentives is a crucial element in health behavior change among youth. Session handouts need to be culturally competent. Further revision required for different LGBT youth communities.

19 Next Steps Seeking funding to recreate Program will be expanded to more than one group per year Session length will be increased from 1 hour to hour and a half Session handouts will be bound in booklet form Conduct 6-month follow-up by end of this month (November)