1. Francisco O. Buchting, Ph.D. Research Administrator Epidemiology, Policy & Economic Sciences Tobacco-Related Disease Research Program LGBT Communities and Tobacco: History, Knowledge Gaps, and Challenges

2. Overview Research and Policy Research and Policy In the beginning... In the beginning... Key milestones and Knowledge gaps Key milestones and Knowledge gaps Working with LGBT (of color) Working with LGBT (of color)

3. Semantics LGBT vs. GLBT Queer or Queer Youth

4. Research and Policy

5. Research findings are a cornerstone to making or justifying policy – health, education, employment, housing, etc … Research findings are a cornerstone to making or justifying policy – health, education, employment, housing, etc … LGBT communities are growing and increasingly becoming complex LGBT communities are growing and increasingly becoming complex Coming out – Queer Youth Coming out – Queer Youth Families Families Diversity – race/ethnicity, gender, religion, immigration Diversity – race/ethnicity, gender, religion, immigration SES SES Technology Technology

6. Research and Policy Making federal, state, and local policy for allocating resources targeted at specific communities/groups is a combination of available resources, politics, group mobilization, data, etc. Making federal, state, and local policy for allocating resources targeted at specific communities/groups is a combination of available resources, politics, group mobilization, data, etc. Research data has been used to justify the increase or decrease in allocation of dedicated or targeted resources Research data has been used to justify the increase or decrease in allocation of dedicated or targeted resources

7. Tobacco Control A Comprehensive Approach Research Education & Intervention Public Policy

8. LGBT Communities and Tobacco “Running Down the Way Up”

9. “In the beginning there was nothing. God said, 'Let there be light!' And there was light. There was still nothing, but you could see it a whole lot better.” Ellen DeGeneres In the Beginning...

10. Community knowledge vs. scientific knowledge Community knowledge vs. scientific knowledge Research enterprise and the studying of LGBT communities Research enterprise and the studying of LGBT communities Findings: Findings: LGBs smoke at higher rates LGBs smoke at higher rates T rates - community knowledge T rates - community knowledge Queer youth smoke at higher rates Queer youth smoke at higher rates LGBTs of color – community knowledge LGBTs of color – community knowledge HEALTH DISPARITIES HEALTH DISPARITIES

11. Research Key Milestones Prevalence/epidemiology Prevalence/epidemiology Queer youth Queer youth Remafedi – (1987), N=29 Remafedi – (1987), N=29 Faulkner (1998) & Garofalo (1998), Faulkner (1998) & Garofalo (1998), MA Youth Risk Behavior Survey MA Youth Risk Behavior Survey Paul (study ended 2004), qualitative Paul (study ended 2004), qualitative Youth Risk Behavior Surveillance, 2003; MMWR 2004, 53:SS2 Youth Risk Behavior Surveillance, 2003; MMWR 2004, 53:SS2 Higher smoking rates

12. Research Key Milestones Prevalence/epidemiology Prevalence/epidemiology Adults Adults Bradford (1994) publication, L & B women, N=1925 Bradford (1994) publication, L & B women, N=1925 Stall/Greenwood (1999), G & B men, N=2593 Stall/Greenwood (1999), G & B men, N=2593 Skinner & Otis (1996) – L & G, N=1067 Skinner & Otis (1996) – L & G, N=1067 CHIS (2003) CHIS (2003) Bye/Gruskin (2005) – TCS, TRDRP – Population base statewide RDD study in CA Bye/Gruskin (2005) – TCS, TRDRP – Population base statewide RDD study in CA Higher smoking rates Ryan et al (2001) – Lit review Ryan et al (2001) – Lit review

13. Research Key Milestones Cessation Cessation Humfleet – NIDA (funded 2004), TRDRP (funded 2006) LGBT internet cessation study Humfleet – NIDA (funded 2004), TRDRP (funded 2006) LGBT internet cessation study Tobacco Documents Tobacco Documents Malone – TRDRP, NCI, (2005 - Smith, Offen, Malone) Malone – TRDRP, NCI, (2005 - Smith, Offen, Malone) Bar Study Bar Study Moore - TRDRP - LGBT Bars (2004, 2006) Moore - TRDRP - LGBT Bars (2004, 2006) HIV/AIDS – Higher smoking rates HIV/AIDS – Higher smoking rates www.gaydata.org www.gaydata.org www.gaydata.org Sell - Columbia U., Kellogg’s Foundation Sell - Columbia U., Kellogg’s Foundation

14. Knowledge Gap National LGBT Communities Tobacco Action Plan (2003) National LGBT Communities Tobacco Action Plan (2003) www.ttac.org/lgbt/index.html www.ttac.org/lgbt/index.html www.ttac.org/lgbt/index.html Report sections on LGBT research, cessation, policy Report sections on LGBT research, cessation, policy LGBT of Color Sampling Methodology Meeting (to be published in 2007) LGBT of Color Sampling Methodology Meeting (to be published in 2007)

15. Knowledge Gap Social Epidemiology Social Epidemiology Disease Epidemiology Disease Epidemiology Cessation Research/ Cessation Research/ Neuroscience Neuroscience Prevention Prevention Policy Policy Economic Economic Tobacco industry documents Tobacco industry documents Ethnographic/ Ethnographic/ Anthropology Anthropology International Studies International Studies Understudied areas Understudied areas Other Other Research Areas

16. Research Areas with Little or No Research

17. LGBT and Tobacco Research Areas With Hardly Any Ongoing Work LGBTs of color LGBTs of color Transgender Transgender Impact of homophobia – individual and system levels Impact of homophobia – individual and system levels Queer youth Queer youth Tobacco’s health burden on LGBT communities / health disparities Tobacco’s health burden on LGBT communities / health disparities SHS impact on LGBT communities SHS impact on LGBT communities Low SES LGBTs Low SES LGBTs

18. Tobacco Control in LGBT Communities

19. Highlights 1990 – Mautner Project, first Lesbian smoking cessation group 1990 – Mautner Project, first Lesbian smoking cessation group 1991 – CLASH founded in SF 1991 – CLASH founded in SF Last Drag – community cessation groups Last Drag – community cessation groups 1993 - Home for Little Wanderers’ TEGLY (first queer youth cessation program) 1993 - Home for Little Wanderers’ TEGLY (first queer youth cessation program) 1994 – Increase TI activity in the LGBT communities 1994 – Increase TI activity in the LGBT communities 1995 – PM launches “gay vague ad” in gay publication 1995 – PM launches “gay vague ad” in gay publication

20. Parliament ad in Details, Cosmopolitan, Madamoiselle, Penthouse, 1995 Parliament ad in Out magazine, 1995 Parliament advertismen t

23. Highlights 1998 - CLASH commissions guide on Ethical Funding for LGBT & HIV Community Based Organization 1998 - CLASH commissions guide on Ethical Funding for LGBT & HIV Community Based Organization 2000 - “we the people of PM” ads 2000 - “we the people of PM” ads 2002 – 1 st LGBT Tobacco Control and Research Summit 2002 – 1 st LGBT Tobacco Control and Research Summit 2003 American Legacy funds a number of LGBT projects 2003 American Legacy funds a number of LGBT projects 2004 – four states add sexual orientation question to Quitline intake 2004 – four states add sexual orientation question to Quitline intake 2006 – 1 st smoke free Pride - Santa Cruz, CA 2006 – 1 st smoke free Pride - Santa Cruz, CA

24. Key Milestones Meetings Meetings “Alive With Pleasure!”, CLASH/CDC, 1996 “Alive With Pleasure!”, CLASH/CDC, 1996 American Legacy Foundation, DC, 2000 American Legacy Foundation, DC, 2000 LGBT Tobacco Summit, SF/CA, 2002 (Boston, 2003; Chicago, 2005; DC, 2006) LGBT Tobacco Summit, SF/CA, 2002 (Boston, 2003; Chicago, 2005; DC, 2006) CDC – LGBT/ATS, GA, 2003 CDC – LGBT/ATS, GA, 2003 LGBT National Action Plan, DC, 2003 LGBT National Action Plan, DC, 2003 LGBT of Color Sampling Methodology Meeting, DC, 2006 LGBT of Color Sampling Methodology Meeting, DC, 2006 Next summit in Oct. 2007 before NCTOH Next summit in Oct. 2007 before NCTOH

25. Research Challenges

26. Challenges The question or questions The question or questions Depends on purpose Depends on purpose No agreement yet No agreement yet www.gaydata.org www.gaydata.org www.gaydata.org Tips on working with LGBT communities – (LGBT of Color Sampling Methodology Meeting, Ayala presentation and group discussion) Tips on working with LGBT communities – (LGBT of Color Sampling Methodology Meeting, Ayala presentation and group discussion)

27. Resources National LGBT Tobacco Control Network National LGBT Tobacco Control Network LGBT Directory – by TRDRP, Network, CLASH LGBT Directory – by TRDRP, Network, CLASH Individuals Individuals CBO CBO Programs Programs

28. Resource Allocation Research Education & Intervention Policy

29. Questions are never indiscreet, answers sometimes are. Oscar Wilde Oscar Wilde