Skills Building to Reach & Serve LGBT Disparity Populations

North Dakota Alcohol and Substance Abuse Summit

Thursday, September 9By Gustavo Torrez

Training Outline

• Intro to the Network for LGBT Tobacco Control, LGBT’s• LGBT Cultural Competency 101• LGBT Health Disparities• Reaching LGBTs – Part 1: LGBTs in my state,

community access points & structures• Reaching LGBTs – Part 2: Local Community

Perspective, Sherri Paxon• Serving LGBTs – Part 1: State Best Practices• Serving LGBTs – Part 2: Enhancing LGBT access for

your agency & Strategies for your work• ACTION PLANNING• Network Resources, Linking People & Information• Evaluation

National LGBTTobacco Control Network

Funded as one of six tobacco

disparity networks by the

Centers for Disease Control

and Prevention.

We are a project of The Fenway Institute, one of the largest LGBT healthcare organizations in the country.

Network Steering Committee

National LGBTTobacco Control NetworkBecause …• Lesbians, gays, bisexuals, and transgenders have been

targeted by the tobacco industry. • Interventions to counter tobacco use are rarely culturally

tailored for LGBTs.• Smoking kills more people than HIV, illegal drug use,

alcohol use, motor vehicle injuries, suicides, and murders combined.

National LGBTTobacco Control NetworkThe National LGBT Tobacco Control Network links people and

information to help eliminate LGBT tobacco and wellness disparities.

Evaluation excerpt showing how we network people.

LGBT Cultural Competency 101

Language 101 * LGBTQ 101 *

Language 101

Excerpted from: A providers Introduction to Substance Abuse Treatment for LGBT Individuals, training curriculum.

What is LGBT?

LGBT is shorthand for the lesbian, gay, bisexual and transgender

population. This population includes a diverse spectrum of people

grouped together because they either choose to partner with same-

gender people (LGBs) or they do not identify as the gender they were

assigned at birth (Ts).

SGM is another common phrase referring to the same population, it

stands for sexual and gender minorities.

Additional information on definitions and terms will be provided later in the training.

Definitions

Gender: femaleness or femininity and maleness or masculinity

Gender Role: masculine or feminine behaviors

Gender Identity: inner sense of oneself, a person’s self-concept, in terms of gender

Sexual Orientation: distinct from gender identity, describes one's attraction to, sexual desire for, lust for, romantic attachments to others; lesbian, gay, bisexual, heterosexual.

TERMSCategories

• SEX

• GENDER/GENDER ROLE

• SEXUAL ORIENTATION

• GENDER IDENTITY

Descriptors

• Lesbian• Gay• Bisexual• Transgender• Transsexual• Heterosexual• Queer• Male • Female • Masculine• Feminine• Genderqueer

TERMSCategories & Descriptors

SEX• Male• Female

SEXUAL ORIENTATION• Lesbian• Gay• Bisexual• Hetrosexual• Queer

GENDER/GENDER ROLE• Male• Female• Masculine• Feminine

GENDER IDENTITY• Transgender• Transsexual• Male• Female• Queer or Genderqueer

Language TipsDO• Use Lesbian, gay, bisexual, or

transgender

• Try to use the words they identify with (unless they make you uncomfortable)

• Use the same pronoun someone refers to themselves with

• If you mess that up, apologize quickly and move on

• Ask if you don’t know which pronoun someone prefers

DON’T• Use queer or fag or dyke unless

someone indicates they want it (and then only if you are comfortable)

• Forget queer started as a pejorative, but is changing for some younger people into an affirmation statement of identity.

• Forget to ask if you are unsure of anything.

• Get paralyzed with fear, jumping in with good intentions is a very powerful action!

LGBTQ 101

Question

• Is it legal to fire someone for being gay?

Current State Nondiscrimination Laws

Courtesy of the National Gay and Lesbian Task Force, as of July 1, 2009

Blue = States banning discrimination based on sexual orientation and gender identity

Pink=Laws banning discrimination based on sexual orientation

In most of the country, yes it is.

• Is it legal to fire someone for being gay? On the last chart, in every white state it is legal to fire someone, kick them out of their house, or a restaurant for being LGBT.

• The pink states protect LGB only.• In the blue states it is illegal to do these things to all LGBT

people.

How many people does this affect?• There are an estimated 8.8 million gay, lesbian, and

bisexual (GLB) persons in the U.S.• This is roughly equivalent to the population of the

state of North Carolina• The Census does not count LGBTs, but does count

same sex couples, if we use these couples as a proxy for all LGBTs, we then know:

• LGBTs are found in all Congressional districts in the U.S.

• The number of LGBTs generally even across racial and ethnic groups.

LGBT Health DisparitiesAlcohol * Substance Abuse * Access to Care * Tobacco

Alcohol

• Lesbian Women are 3.6 times more likely to have alcohol dependence, compared to their heterosexual counterparts.

• Bisexual women and gay men were 2.9 times more likely to have alcohol dependence, compared to their heterosexual counterparts

• Bisexual Men are 4.2 times more likely to have alcohol dependence, compared to their heterosexual counterparts.

Substance Abuse• Lesbian Women are 11.3 times more likely to have

Marijuana dependence, and 12.4 times more likely to have other drug dependence compared to their heterosexual counterparts.

• Gay men are 4.2 times more likely to have other drug dependence, while bisexual men where 6.3 times more likely to have other drug dependence compared to their heterosexual counterparts.

Sexual orientation, substance use behaviors and

substance dependence in the United States, Addiction Research Report

Sean Esteban McCabe1, Tonda L. Hughes2, Wendy B. Bostwick3, Brady T. West4 & Carol J. Boyd5

Access to care

• 25% of respondents on recently released TG needs assessment report being denied healthcare as a result of being transgender.

• Movie “Southern Comfort” from 2001 documented a trans smoker who was turned down for care by 19 providers before dying of cancer without treatment.

• Studies of LGBTs report varied access to care barriers: from negative reception by providers, to hiding LGBT status, up to avoiding care for fear of discrimination.

Tobacco

LGBT tobacco disparities have been established

by a series of studies over the last decade.

The studies consistently show LGBT smoking prevalence

is 35% to almost 200% higher than the general population.

This prevalence disparity is among the largest among

different population subgroups.

Why LGBTQs smoke more

#1: Homophobia, racism, and sexism• LGBT people live in a world where most are routinely

discriminated against, denied civil rights, and harassed on the streets and workplaces

• Such homophobia, along with racism and sexism, likely contributes to higher levels of substance abuse as a coping strategy, especially in LGBT communities of color.

#2: Where are my people?

Often, a primary social outlet for GLBT folks are bars and

clubs, where drinking and smoking are prevalent and

used as tools for socializing and meeting people.

#3: Youth coming out

LGBT youth most often come out in their late childhood

through teen years. The stressors of coming out occur

just when the youth is at greatest risk for smoking uptake.

#4: Tobacco companies love to target us.

• Big Tobacco has successfully targeted our communities• They have invested a LOT of money• They are good at twisting our civil rights messages to look

like pro-tobacco messages

Targeting

How they target ushttp://www.youtube.com/watch?v=F5-6eH18E4U

• Direct advertising

• Indirect advertising

• Event sponsorship

• Outreach efforts and community promotions

Reaching LGBTs – Part 1

LGBTs in my State * Community Access Points

LGBTs in my state?

This presentation is excerpted from…

Total population

• There are an estimated 8.8 million gay, lesbian, and bisexual (GLB) persons in the U.S.

• Same-sex couples are found in all Congressional districts in the U.S.

Is it an epidemic?

• From 2000 – 2005, the number of same sex couples in the U.S. increased by 30%.

No it’s probably not

Those increases are most likely due to a combination of factors:

• People do feel increasingly safe to come out

• People feel increasingly safe to disclose this on surveys

• LGBTs have run campaigns encouraging people to disclose on surveys.

Same-sex Couples and the Gay, Lesbian,Bisexual Population: New Estimates fromthe American Community Survey

Same sex couples 2005 = 1,070

Estimated LGB population = 11,003

% of total ND population = 2.3%

North Dakota Excerpt

For the full report

http://www.law.ucla.edu/williamsinstitute/publications/

SameSexCouplesandGLBpopACS.pdf

Thank you to Gary Gates and the other demographers

at the Williams Institute for this ongoing work.

Community Access Points

National

The Human Rights Campaign• As the largest national lesbian, gay, bisexual and transgender civil

rights organization, HRC envisions an America where LGBT people are ensured of their basic equal rights, and can be open, honest and safe at home, at work and in the community.

www.hrc.org

The National Gay and Lesbian Task Force• The mission of the National Gay and Lesbian Task Force is to

build the political power of the lesbian, gay, bisexual and transgender (LGBT) community from the ground up.

www.thetaskforce.org

North Dakota Briefing SheetAdvocacy Organizations

Equality North DakotaEquality North Dakota (END) is a statewide gay, lesbian, bisexual and transgender rights organizationP.O. Box 5222Fargo, ND 58105Phone: 701-388-9227E-mail: info@equalitynd.org

The North Dakota Human Rights Coalition (NDHRC)Is a broad-based coalition of individuals and organizations with an interest in the furtherance of human rights in North Dakota. We work toward the enhancement of human rights in North Dakota through information, education and legislative action.P.O. Box 1961Fargo, ND 58107-1961Phone: 701-239-9323Fax: 701-478-4452Email: info@ndhrc.orghttp://www.ndhrc.org/wp-publish/contact-us

Reaching LGBTs – Part 2

Local Community Perspective

Sherri Paxion Sherri Paxon, MSPH, MT(ASCP)BB

QPax Unlimited

705 23rd St SE

Mandan, ND 58554

701-663-7598

701-400-7598 cell

spaxon@bis.midco.net

Serving LGBTs – Part 1: State Best Practices & Examples

State Best Practices

1. Initiated by the community members from advanced states

2. Wisdom-based document, community signors

3. Compiles common best practices of the most advanced states

4. A template for states and communities to use for their local work

5. Available online at www.lgbttobacco.org

Preamble

“It is the opinion of the undersigned that these strategies represent the current best practices available to address LGBT tobacco disparities, and as such, we strongly encourage states to adopt as many of these best practices as possible.”

Simple and powerful

1. Include LGBT community members in planning steps2. Monitor impact of tobacco on LGBTs3. Establish cultural competency standards for statewide

programs4. Fund community based programs5. Disseminate findings and lessons learned

1. Include LGBT community members in planning steps

Example Many states are putting LGBT community

members on their tobacco disparity planning groups. Many are putting LGBT reps on their statewide tobacco planning bodies.

In Washington, the LGBTs join other disparity populations to do cross leadership development, planning and training.

2. Monitor impact of tobacco on LGBTsExample MN just tested new question to enable them to add good

LGBT data collection question to their quitline and ATS. No adverse response during testing and many other

states report negligible issues in this area. (In general straight people are pretty comfortable declaring that they’re straight.)

But brace yourself for potential opposition, the Network has a briefing paper to help overcome common myths about LGBT data collection.

3. Establish cultural competency standards

Example WV, KS, IA, DC, TX, and others are training their

state staff/grantees in LGBT cultural competency MN, IA, CA have also trained their quitlines Key elements of training

1. How to make your services welcoming2. Having best resources to refer to LGBTQ community

resources when desired Update training regularly

4. Fund community based programs

Example 5 states have statewide networks of LGBT grantees Often uses main LGBT group as access point, sometimes

subgrants from there. Want impact? This funding builds great community

energy on tobacco issue.

5. Routinely integrate LGBT tailored efforts into largerwellness/tobacco campaigns.

Example MN has expanded mission of tobacco control

program to incorporate “wellness”. GA program launched to be “wellness-ready”,

collecting data on diet/exercise in tobacco assessment.

6. Disseminate findings and lessons learned

Example OR got local community press on their pride

tobacco survey CO did case study of their lessons learned in

creating statewide network We have “Lessons Learned” newsletter, let us

help you share yours!

Serving LGBTs – Part 2: Enhancing LGBT Access for Your

Agency

Enhancing LGBTQ access at your agency

&Strategies for your

work

So, how do you make your work responsive to the needs of the LGBT community?

2 Main Strategies

Take basic steps to make your programs

welcoming to LGBTs.

Have updated information about LGBT focused

resources if they want a referral.

LGBT cultural competency strategies

1. Adopt and post a non-discrimination statement.

LGBT cultural competency strategies

1. Adopt and post a non-discrimination statement.

2. Include LGBT advisors on planning groups,

community advisory groups.

LGBT cultural competency strategies

1. Adopt and post a non-discrimination statement.

2. Include LGBT advisors on planning groups, community advisory groups.

3. Make sure staff are trained in LGBT cultural competency, esp. frontline staff.

LGBT cultural competency strategies

1. Adopt and post a non-discrimination statement.

2. Include LGBT advisors on planning groups, community advisory groups.

3. Make sure staff are trained in LGBT cultural competency, esp. frontline staff.

4. Promote LGBT welcoming materials.

LGBT cultural competency strategies

5. Co-brand or partner with LGBT groups.

LGBT cultural competency strategies

5. Co-brand or partner with LGBT groups.

6. Consistently use preferred pronouns and names.

LGBT cultural competency strategies

5. Co-brand or partner with LGBT groups.

6. Consistently use preferred pronouns and names.

7. Don’t make assumptions (gender on phone, sexual behavior, etc.)

LGBT cultural competency strategies

5. Co-brand or partner with LGBT groups.

6. Consistently use preferred pronouns and names.

7. Don’t make assumptions (gender on phone, sexual behavior, etc.)

8. Examine program materials for alienating language/processes.

We all can feel it when folk are well meaning

We all can feel it when folk are well meaning

And we all can feel it when it’s a cold or hostile

environment

We all can feel it when folk are well meaning

And we all can feel it when it’s a cold or hostile

environment

Which is your program?

Action Planning

Resources

The Network for LGBT Tobacco Control

Online Resources

Key content of interest: • Library of LGBT

resources Including literature, reports, ads, etc.

• Online directory of people and projects

• Factsheets + more

LGBTTOBACCO.ORG

Resources

Quitline LGBT targeted poster

Space for co-branding with your organization name at bottom.

Available from the Network for LGBT Tobacco Control

Resources

LGBTQ motivational quitguide pamphlet.

Intended to be used in conjunction with professional counseling.

Available from the Network for LGBT Tobacco Control

Resources

Sharing Our Lessons Series

This issue highlights the successful implementation of culturally-competent and tailored cessation quitline services for LGBTQ Minnesotans

Available from the Network for LGBT Tobacco Control

Tobacco Education Clearinghouse of California has a variety of promotional items for purchase.

http://www.tobaccofreecatalog.org

Resources

Other Network ResourcesSurveillance Briefing Paper

• Facts about why LGBT data collection is feasible• Which instruments to collect data on• Examples of tested questions

Other Network Resources

State Best Practices 2007•Consensus document from community about the best current strategies to eliminate LGBT tobacco disparities

Other Network Resources

Resources- New Pride Ad

The Network on Social Media

• Twitter @lgbttobacco

• Facebook www.facebook.com/lgbt.tobaccocontrol

• Blog lgbttobacco.wordpress.org

Other Resources

• Business Inside Out – Bob Witeck

• GLMA, www.glma.org

• Gay Yellow Pages

• LGBTQ Tobacco Control Summit

Linking People

1. DISCUSSION listserv: 300+ pros who ask questions and

talk to each other.

2. Online directory of 100+ pros by expertise area:

available for direct contact.

3. Social networking stakeFacebook: 1160 friendsTwitter: 869 followers

And information…

4. NEWS listserv: 800 people who get bimonthly newsletter

5. Direct mailings to list of 1200+ policymakers and

community advocates

6. Online resource library with hundreds of local and national

items.

7. Blog (4000+ views)

Our aim?

TC communities

TC communities

LGBT communities

LGBT communities

TC communities

TC communities

LGBT communities

LGBT communities

1. Join DISCUSSION listserv. Ask questions of 200+ pros

and get monthly newsletters.

lgbttobacco.org

1a. Want newsletters only? Join NEWS listserv

2. Search online resource library for hundreds of

relevant docs.

3. Find contact info for 100+ pros by expertise area. Ask

questions directly.

THANK YOU!The Network for LGBT Tobacco Control looks forward to working with you to

collaboratively address LGBT tobacco health disparities.

Additional questions…

Feel free to contact us whenever needed lgbttobacco@gmail.com

 

Gustavo Torrez | Program Manager

National LGBT Tobacco Control Network

The Fenway Institute | Fenway Health

Ansin Building, 8th Floor

1340 Boylston Street | Boston, MA 02215

voice: 617.927.6451 | fax: 617.267.0764

www.lgbttobacco.org