Smoking within Scotland’s LGBT
community, and the impact on HIV
Linda Bates, PATH
21st October 2010:
GayCon, Edinburgh
Outline of today’s presentation
1. PATH report on smoking and the LGBT
community in Scotland
2. Rationale/method for report
3. Findings and recommendations
4. Other info relevant for smoking and BBV
5. Your chance to contribute – focus groups
1. PATH report: Smoking and LGBT
people in Scotland
• PATH: Partnership Action on Tobacco and Health
• established in 2002, PATH is a joint initiative between
ASH Scotland, NHS Health Scotland and the Scottish
Government to reduce the prevalence of tobacco use in
Scotland
• work includes youth work, projects and inequalities,
developing/providing training
• LGBT report published July 2010, available online at
www.ashscotland.org.uk/ash/8248.1939.html
2.
Rationale/method
• PATH has a particular focus on addressing health
inequalities, which includes issues affecting LGBT
people – including access to and equity of services
• literature review (search terms L/G/B/T, smok*/tobacco)
• mapping exercise (existing services and tobacco control
plans within Scotland)
• data collection (online survey) – 106 responses
• interviews – 7 (one-to-one)
Smoking and health inequalities:
the wider picture
• irrespective of other health factors (inc. HIV and other
BBV), half of the world’s life-long smokers will die from
their habit (Jha, P., Chaloupka, F.J., 1999)
• 24% of all deaths in Scotland can be attributed to
smoking-related causes (Health Scotland, ISD Scotland and ASH Scotland, 2007)
• on average, middle-aged (35-69) smokers in Scotland
will die 22 years before their non-smoking counterparts
(Health Scotland, ISD Scotland and ASH Scotland, 2007)
• it’s not only about dying; it’s about poorer quality of life
(and not just for the smoker)
3. Report findings: general
Smoking in the LGBT community
• nationally, very little data and/or targeted work
• evidence suggests that lesbians, gay men and
bisexual people have a higher rate of smoking
than the population as a whole (NHS Health Scotland/
ScotPHO, 2010)
• little clear evidence exists for transgender
people on smoking (or many other health-related
issues) (NHS Health Scotland/ScotPHO, 2010)
Recommendation:
Scottish Government
• that research is undertaken to provide a
more accurate picture of the LGBT
community within Scotland, and to
identify smoking prevalence rates within
it. Such research should take into account
all relevant socioeconomic factors and
broader equality and diversity strands
Report findings (cont’d): general
links between sexual orientation and health
• higher smoking rates, alcohol
consumption and misuse of drugs by
lesbians, bisexual women and gay men
than the general population (Department of Health,
2007)
• young lesbian, gay and bisexual people
have poorer mental health and
wellbeing than the wider population (NHS
Health Scotland/ScotPHO, 2010)
Recommendations (cont’d):
Health Boards and NHS services
• that NHS services (including stop-smoking initiatives)
undertake equality and diversity training to ensure
that the health needs of LGBT people are appropriately
met, and to ensure delivery of a non-judgmental and
inclusive service. This could link in with Equality
Impact Assessments (EQIAs), to evidence that NHS
boards are addressing the health needs of the whole
community
• that local health plans and tobacco control strategies
(where they exist) include and reflect the identified
health needs of the LGBT community (once known),
including those relating to tobacco use and stopping
smoking
Report findings (cont’d): general
links between orientation and sexual health
• lesbians, bisexual people and gay men are
reportedly more likely to display risky
sexual behaviours than heterosexuals
(NHS Health Scotland/ScotPHO, 2010)
• in Scotland, gay and bisexual men are
more likely than their heterosexual
peers to be HIV+ (ISD Scotland, 2009)
Report findings (cont’d): general
links between smoking and HIV
• Gay Men Fighting AIDS (London-based charity)
estimate that 48% of HIV+ gay men smoke or
use tobacco (http://www.gmfa.org.uk/quitsmoking/#_ftnref1)
• a higher risk of smoking-related illnesses
[such as lung or oral cancers; chest infections;
cardiovascular events and brain degenerative
disorders] developing in HIV-positive smokers
in the first instance, compared to HIV-negative
smokers (Shiels, M.S. et al, 2009)
Recommendations (cont’d):
Health Boards and NHS services
• that services for people living with HIV
(including, but not limited to, sexual health
settings) are encouraged to raise the
issue of smoking and tobacco use with
their clients, and signpost them on to
stop-smoking services where appropriate
Recommendations (cont’d):
Health Boards and NHS services
• that through relevant community
groups, NHS boards specifically
engage with and encourage their local
LGBT population to access stopsmoking services, which may also help
boards meet their HEAT target relating to
smoking prevalence
Report findings (cont’d): specific
LGBT people asked about smoking
• most respondees (65%) had been
asked about their smoking by an NHS
health professional (e.g. doctor, nurse,
dentist)
• most respondees (89%) had NOT been
asked about their smoking by an LGBT
service (e.g. specialist health org.)
• most respondees (86%) had tried to
stop smoking at least once
Report findings (cont’d): specific
future quit attempts
• no clear preference for method of
future quit attempt(s): 44% on their own;
30% with help; 16% no preference; 10%
‘other’
• for those who would consider using a stopsmoking service (1:1 or group), 53% said
it was ‘unimportant’ that it be
specifically LGBT
Report findings (cont’d): specific
example of good practice
• Gay Men’s Health, in partnership with NHS Lothian and
the LGBT Centre for Health & Wellbeing, have run an
LGBT stop-smoking group
• numbers are modest, but results are encouraging 9% of service users were still stopped after one year
(NHS Lothian generic services average was 4%)
• provides choice for LGBT people in the Lothians as to
where they can go for stop-smoking support
Recommendations (cont’d):
research
• that the Gay Men’s Health/LGBT Centre
for Health & Wellbeing model, which
shows some promise, be examined more
closely to determine whether there are
aspects of its delivery which could be
reproduced in other settings (NHS
and/or LGBT community-based)
Recommendations (cont’d):
PATH and ASH Scotland
• that PATH conducts needs assessments with
LGBT community organisations, to explore
what issues should be addressed (including, but
not limited to, training) in order to raise the issue
of smoking and tobacco use with their service
users
• that PATH and ASH Scotland’s tobaccorelated work links in with LGBT community
organisations (including those for young
people), to widen its reach amongst the
voluntary sector
4.
Links between smoking and
other blood-borne viruses
• 2002 report suggested that smoking can
aggravate the risks of further liver damage
for those living with conditions such as
Hep B and Hep C (Wang, C-S et al, 2002)
• 2010 report provides evidence of the link
between smoking, a Hep B/C diagnosis
and developing liver cancer (Chuang, S.C. et al, 2010)
5. Focus groups: volunteers sought!
• held in late 2010/early 2011
• to explore what barriers may exist within
LGBT and/or sexual health services for
raising the issue of smoking with clients
• possibility of training being developed to
help staff/volunteers raise the issue and
signpost on to appropriate services
Any final questions?
References 1
Chuang, S.C., Lee, Y.C., Hashibe, M., Dai, M., Zheng, T., Boffetta, P. 2010. Interaction between
cigarette smoking and hepatitis B and C virus infection on the risk of liver cancer: a meta-analysis.
Cancer Epidimiol. Biomarkers Prev. 19(5):1261-8. Available online at:
http://www.ncbi.nlm.nih.gov/pubmed/20447919 [accessed 13.10.10]
Department of Health. 2007. Healthy lifestyles for lesbian, gay, bisexual and trans (LGBT) people.
London: Department of Health. Available online at:
http://www.dh.gov.uk/dr_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_07
8345.pdf [accessed 25.08.10]
Gay Men Fighting AIDS (date unknown). Quit smoking [online]. Available at:
http://www.gmfa.org.uk/quitsmoking/index [accessed 01.09.10]
Health Scotland, ISD Scotland and ASH Scotland. 2007. An atlas of tobacco smoking in Scotland:
A report presenting estimated smoking prevalence and smoking-attributable deaths within Scotland.
Edinburgh: NHS Scotland/Scottish Public Health Observatory.
ISD Scotland. 2009. Scotland’s Sexual Health Information Report 2009. Edinburgh: ISD Scotland.
Available online at: http://isd.scot.nhs.uk/isd/5717.html [accessed 25.08.10]
References 2
Jha P., Chaloupka F.J. 1999. Curbing the Epidemic: Governments and the Economics of Tobacco
Control. Washington, DC: The World Bank.
NHS Health Scotland/ScotPHO. 2010. Dimensions of diversity: population differences and
health improvement opportunities. Edinburgh: NHS Health Scotland. Available online at:
http://www.scotpho.org.uk/home/Publications/scotphoreports/pub_diversityreport.asp
[accessed 26.02.10]
Partnership Action on Tobacco and Health. 2010. Stop-smoking service provision for
LGBT communities in Scotland [online]. Available from:
http://www.ashscotland.org.uk/ash/8248.1939.html
Shiels, M.S. et al. 2009. A meta-analysis of the incidence of non-AIDS cancers in HIVinfected individuals. J Acquir Immun Defic Syndr. 52(5): 611-22 [online].
Available at: http://www.ncbi.nlm.nih.gov/pubmed/19770804 [accessed 01.09.10]
Wang, C-S., Wang, S-T., Chang, T-T., Yao, W-J., Chou, P. 2002. Smoking and alanine
aminotransferase levels in Hepatitis C virus infection: implications for prevention of Hepatitis C virus
progression. Arch Intern Med. 162:811-815.
Available online at: http://archinte.ama-assn.org/cgi/content/full/162/7/811 [accessed 13.10.10]
Linda Bates, PATH
email: lbates@ashscotland.org.uk
tel: 0131 220 9481