Skills Building to
Reach & Serve LGBT
Disparity Populations
North Dakota Alcohol and
Substance Abuse Summit
Thursday, September 9
By Gustavo Torrez
Training Outline
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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 LGBT
Tobacco 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 LGBT
Tobacco Control Network
Because …
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Lesbians, gays, bisexuals, and transgenders have been
targeted by the tobacco industry.
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Interventions to counter tobacco use are rarely culturally
tailored for LGBTs.
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Smoking kills more people than HIV, illegal drug use,
alcohol use, motor vehicle injuries, suicides, and murders
combined.
National LGBT
Tobacco Control Network
The 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 samegender 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.
TERMS
Categories
Descriptors
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SEX
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GENDER/GENDER ROLE
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SEXUAL ORIENTATION
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GENDER IDENTITY
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Lesbian
Gay
Bisexual
Transgender
Transsexual
Heterosexual
Queer
Male
Female
Masculine
Feminine
Genderqueer
TERMS
Categories & 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 Tips
DO
DON’T
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Use Lesbian, gay, bisexual, or
transgender
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Try to use the words they identify
with (unless they make you
uncomfortable)
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Use queer or fag or dyke unless
someone indicates they want it (and
then only if you are comfortable)
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Forget queer started as a pejorative,
but is changing for some younger
people into an affirmation statement of
identity.
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Forget to ask if you are unsure of
anything.
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Get paralyzed with fear, jumping in
with good intentions is a very powerful
action!
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
LGBTQ 101
Question
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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.
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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?
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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 Disparities
Alcohol * 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
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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 us
http://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 from
the American Community Survey
North Dakota Excerpt
Same sex couples 2005 = 1,070
Estimated LGB population = 11,003
% of total ND population = 2.3%
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 Sheet
Advocacy Organizations
Equality North Dakota
Equality North Dakota (END) is a statewide gay, lesbian, bisexual and transgender
rights organization
P.O. Box 5222
Fargo, ND 58105
Phone: 701-388-9227
E-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 1961
Fargo, ND 58107-1961
Phone: 701-239-9323
Fax: 701-478-4452
Email: info@ndhrc.org
http://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.
2.
3.
4.
5.
Include LGBT community members in planning steps
Monitor impact of tobacco on LGBTs
Establish cultural competency standards for statewide
programs
Fund community based programs
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
LGBTs
Example
 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 welcoming
2. 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 larger
wellness/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
LGBTTOBACCO.ORG
Key content of interest:
• Library of LGBT
resources
Including literature,
reports, ads, etc.
• Online directory of
people and
projects
• Factsheets + more
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 culturallycompetent and tailored cessation
quitline services for LGBTQ
Minnesotans
Available from the Network for LGBT
Tobacco Control
Resources
Tobacco Education Clearinghouse of
California has a variety of promotional
items for purchase.
http://www.tobaccofreecatalog.org
Other Network Resources
Surveillance 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 stake
Facebook: 1160 friends
Twitter: 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
lgbttobacco.org
1. Join DISCUSSION listserv.
Ask questions of 200+ pros
and get monthly newsletters.
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