Tobacco.org

• Smoking prevention groups go after tobacco ads targeting gays  

The cigarette pitch demands a second look.

Two ripped, rakish men and one lean, pristine hound pause, inexplicably, in the cool shallows of a calm green sea.

"How gay is this ad?" R.E. Szego, a Portland tobacco-prevention specialist, asks when she sees such an image.

It's a sincere question, not a slam.

Wooed for years by tobacco companies -- who lavish free merchandise on their bars and clubs, sponsor their events and advertise heavily in their publications -- gays, lesbians and bisexuals remain hooked on cigarettes, even as the general population smokes less.

But public health specialists are optimistic that a new ban on smoking in Oregon bars will cause a decline in the smoking rates of gays and lesbians, who tend to pick up the habit as teens coming to terms with stigma surrounding their sexual identity.

"If you were coming up gay, it used to be the only place you got to meet was in a bar," says Michael Kaplan, executive director of Cascade AIDS Project and a former pack-a-day smoker. "If you wanted to fit in, you'd smoke."

About one in three gay, lesbian and bisexual Oregonians smoke . . .

Tobacco foes call the cigarette companies' marketing techniques "gay vague." It's a love-that-dare-not-speak-its-name style of advertising heavy on images of hearty women fishing in the woods and beefy bartenders leveling come-hither gazes at ... no one in particular.

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• Tobacco use among sexual minorities, USA, 1987-2007 (May): A Systematic Review 

CONCLUSION

Increased attention to smoking among sexual minority populations is warranted in clinical practice and in the creation of prevention and treatment programs. In examining the ample evidence of disparities in suicidal ideation among sexual minority adolescents, Morrison and L'Heureux noted that the “[p]revention of GLBQ [gay, lesbian, bisexual, and queer] adolescent suicide thus could entail treating the environments that interface with GLBQ youth in addition to treating the adolescents themselves.”[87] The same may well be true for elevated prevalence of smoking among sexual minorities. Moreover, there are specific evidence-based steps that can be taken to reduce the impact of smoking on sexual minority communities.

Prevalence could be assessed and monitored through Youth Risk Behaviour Surveillance Surveys, Youth Tobacco Surveys, Behavioural Risk Factor Surveillance Surveys, and Adult Tobacco Surveys. Many states, however, do not include sexual orientation, thus hindering monitoring efforts despite the fact that sampling methodology has been crucial in researchers’ understanding of gay and lesbian health and wellbeing.[88] Population-based interventions like increasing taxes on tobacco products and banning advertising should be combined with approaches that seek to reduce disparities in vulnerable populations.[9] These might include social marketing efforts, mass media campaigns in the gay and lesbian press, community recognition of tobacco as a problem,[89, 90] extra efforts for smoke-free gay and lesbian venues, targeted cessation services,[91] community rejection of tobacco industry sponsorship of events, and ongoing collaboration with the National LGBT Tobacco Control Network (http://www.lgbttobacco.org/). Given the leitmotiv of smoking as a health inequality in sexual minorities’ lives, local, state, and federal tobacco programs should target LGBT populations in tobacco prevention and cessation interventions and include priority population indicators in the evaluation of program outcomes.

. . .

WHAT THIS PAPER ADDS?

• There is compelling evidence that an elevated prevalence of tobacco use among lesbian, gay, and bisexual men and women exists.

• National and state surveillance systems should incorporate sexual minority status to monitor the elevated use of tobacco by gays and lesbians.

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• More Smokers Seek Help With Quitting Since Latest Cigarette Tax Took Effect  

"It's another vice I have to give up to survive, not only health-wise, but financially," explained Mr. Alderman, 58, who said he lives in a single-room-occupancy building in Times Square and depends on federal disability payments and food stamps.

Clients like Mr. Alderman at smoking-cessation programs around the city have been citing the $1.25 tax increase that took effect June 3 as their motivation for quitting, and several programs have seen their numbers balloon in the weeks since.

Tax increases are the most effective measure known to reduce demand for tobacco, according to reports published by the Centers for Disease Control and Prevention, and The British Medical Journal. Young people and poor people are most responsive to price changes, the research shows.

Requests to New York City's 311 line for advice on quitting tripled during the week of June 2, with 2,700 calls this year compared with 850 calls during the same period in 2007. Calls to the New York State Smokers' Quitline -- including those transferred from 311 -- quadrupled, to 9,750 from 2,295 a year ago.

"It was a huge surge," . . .

"Many people need a more sustained effort," said Barbara Warren, the director for research and planning at the Lesbian, Gay, Bisexual and Transgender Community Center in Manhattan, where she started a smoking-cessation program in 1994. "The quitline is an essential part of the continuum. But it demands a certain degree of self-direction and follow-through. Other people need more than that."

Dr. Warren said community-based group programs that meet continuously for several weeks are more successful

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• "If You Know You Exist, It's Just Marketing Poison": Meanings of Tobacco Industry Targeting in the Lesbian, Gay, Bisexual, and Transgender Community 

We conducted focus groups with LGBT individuals in 4 US cities to explore their perceptions. Our findings indicated that focus group participants often responded positively to tobacco company targeting.

Targeting connoted community visibility, legitimacy, and economic viability. Participants did not view tobacco as a gay health issue. Targeting is a key aspect of corporate-community interaction. A better understanding of targeting may aid public health efforts to counter corporate disease promotion.

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• CROI: Smoking increases cancer-associated HPV viral load 

Smoking increases the rate of viral reproduction in gay men who have anal infections with cancer-causing variants of the human papilloma virus (HPV), a German study has found.

The association between smoking and viral load was particularly strong in men who had not yet developed precancerous changes (dysplasia) in the anal or rectal epithelium (skin or mucosa), suggesting that smoking may possibly speed the development of so-called squamous cell intraepithelial lesions (SIL). High HPV viral loads have previously been shown to be associated with an increased risk of anal cancer. . . .

Reference Brockmeyer N et al. Elevated anal HPV16 DNA loads in HIV+ men who smoke. Fourteenth Conference on Retroviruses and Opportunistic Infections, Los Angeles, abstract 872, 2007.

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• Gay/Lesbian sexual orientation increases risk for cigarette smoking and heavy drinking among members of a large Northern California health plan 

In April-July of 1999 and 2002, general health surveys were mailed to independent stratified random samples of 40,000 female and male adult members of the Kaiser Permanente Medical Care Program in Northern California. . . .

Conclusion

Lesbians and gay men may be at increased risk for morbidity and mortality due to higher levels of cigarette and alcohol use. More population-based research is needed to understand the nature of substance use in these communities so that appropriate interventions can be developed.

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• ATLAS Shrugs: As the city's smoking ban approaches, Mark Lee brings 16 years of holiday-weekend parties to an end 

Mark Lee is not the bogeyman. He is not lurking around the district's many alleys handing out cigarettes to underage teens. But Lee says his opposition to Washington, D.C.'s mandatory smoking ban, which prohibits smoking in all district businesses beginning Jan. 1, 2007, makes the well-known nightlife promoter one of the most misunderstood men in Washington.

''To listen to smoking prohibition groups, you would think I was carrying dead bodies out in trash bags along with the empty beer bottles to throw away at the end of the night,'' says Lee. In reality, Lee does not disagree with health officials who promote non-smoking or healthy lifestyles. He is not an advocate for smoking. But Lee is opposed to the approach that smoking prohibition groups in Washington have taken in enforcing a mandatory smoking ban.

''There's a lot of hype around the so-called 'health and safety issue,''' he says. ''But the stockholders, business manager operators, service professionals, entertainers, musicians, DJs and the vastly overwhelming number of actual patrons in this discussion know that one size doesn't fit all, and the [inability] of [health groups] to educate and persuade more people to stop smoking does not justify forcing us to stop smoking by social engineering.''

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• Systematic review suggests smoking increases HIV infection risk 

A systematic review published online ahead of print publication in the journal Sexually Transmitted Infections suggests that smoking appears to be associated with an increased risk of acquiring HIV infection. However, although the review also suggests that smoking does not appear to be related to progression to AIDS, the authors point out several important limitations to their headline conclusions, including the fact that all of the studies examining the effects of smoking on HIV disease progression took place in the developed world prior to the widespread availability of potent antiretroviral therapy.

Smoking tobacco is known to be associated with immunological changes and an increased risk for certain infections in both HIV-negative and HIV-positive individuals, including the sexually transmitted infection (STI), human papilloma virus (HPV) , which is associated with genital and anal warts and cervical and anal cancer.

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• Is smoking tobacco an independent risk factor for HIV infection and progression to AIDS? 

Conclusions: Tobacco smoking may be an independent risk factor for HIV infection although residual confounding is another possible explanation. Smoking did not appear to be related to progression to AIDS although this finding may not be true in developing countries or with the longer life expectancies seen with Highly Active Antiretroviral Therapy.

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• Smokers may have higher risk of HIV: study 

Smoking, already linked to several illnesses, may also increase the risk of infection with HIV, the virus that causes AIDS, researchers said on Thursday.

In a review of studies that looked at the association between smoking and HIV, British doctors said five of the six studies they analysed showed smokers had a higher chance of becoming infected.

Nine of 10 other studies in the review that tracked the progression from HIV to AIDS found no link with smoking.

"The studies identified in this systematic review indicate that while smoking might be independently associated with acquiring HIV infection, it does not appear to be related to progression to AIDS," said Dr Andrew Furber, of the South East Sheffield Primary Care Trust.

Furber and his colleagues, who reported the findings in the journal Sexually Transmitted Infections, said tobacco smoke may increase susceptibility to HIV infection by modifying a variety of immune system responses.

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• Gay community has higher rate of smoking than other groups  

Stress, many health care experts believe, is one of the main reasons why the smoking rate among gays and lesbians is at least twice the average in California. More than a decade of advertising targeted at gays and lesbians is also to blame, they say.

It's only in the past year or two that researchers were able to confirm what they'd suspected all along about the high smoking rate in the gay community. Now, at least one new survey, the results of which are expected next year, seeks to explain why.

About 14 percent of Californians smoke, according to a 2005 Department of Health Services survey released in April. But in a 2004 state survey, more than 30 percent of gay, lesbian, bisexual and transgender people were smokers.

Lesbians smoked at an even higher rate, 32.5 percent -- nearly three times the average -- for women in California. And among young lesbians between the ages of 18 and 24, a staggering 47 percent were smokers, compared with the average rate of 18 percent for that age group overall.

Gay smokers have their own theories on why they smoke: the club and bar scene, trouble finding dates and falling in love, high alcohol- and drug-abuse rates in the community. Sometimes, smoking is related to a lack of family connections, which can cause stress and also remove pressure to stop smoking once someone has started.

"Gay people probably smoke longer because we're not as family- oriented. If you don't have kids and raise a family, you don't need to stop,"

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• Tobacco as an LGBT issue 

Gays and lesbians are about twice as likely to smoke as heterosexuals, according to most research. And that has to stop, said participants at the fourth National LGBTI Anti-Tobacco Summit in Washington, D.C. earlier this month. The summit took place immediately prior to a world conference on tobacco and health.

At the July 11 event, Barbara Warren, director of planning and research at the LGBT Center in New York City, believes there is a great potential in "connecting the dots between civil liberties, LGBT inclusion, justice issues, and tobacco - it can be a powerful organizing tool."

She made a comparison with HIV in that it is both an LGBT health issue "but it also brought up a lot of issues about LGBT inclusion in our society. We were able to use it as a leveraging tool and a doorway to other things."

In posing these questions to a panel of national LGBT leaders she said, "We really are hungry for and looking to our national leaders to be more involved in the tobacco work we are doing." . . .

Jeremy Bishop, executive director of Pride At Work (AFL-CIO), acknowledged that the group "hasn't done any work on anti-smoking efforts," and that should change. He sees state and local ordinances restricting smoking as "a workers' rights issue." If it is not okay for people to smoke in his office, then it is not okay for people to smoke in bars or restaurants where others must work, he said.

More controversial was his call "for the whole LGBT movement to come together as national signatories saying, we are not going to accept tobacco money, we are not going to accept alcohol money for any of our events or operations. Ultimately this is blood money. It is time to say, enough is enough, you are not going to prey on us any more."

Bishop said they would be pushing that resolution at the Pride at Work annual meeting in San Diego later this year.

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• Survey shows many complain about smoke in gay bars and restaurants 

The Mautner Project, a national lesbian health organization, says results of its nationwide survey show that many patrons and employees of bars and restaurants that cater to gay, lesbian, bisexual, and transgender clients are bothered by too much smoke in such establishments. The survey, called “LGBT Bars and Smoking Study,” shows that 86% of gay bar and restaurant owners say they've received complaints from patrons about too much smokiness. More than half of the business owners say their employees have complained about too much cigarette smoke. About 16% of bar and restaurant owners or managers reported having health conditions that are exacerbated by exposure to tobacco smoke, including chronic obstructive pulmonary disease, asthma, emphysema, and HIV, according to the survey. . . .

The survey showed that 88% of them currently sell cigarettes, that 30% advertised tobacco products, and that about 10% held tobacco-sponsored nights and distributed free cigarettes at those events. However, about 32% of the survey respondents said they wished their businesses were smoke-free.

“For many members of the LGBT community, gay and gay-friendly bars and clubs are important sources of employment as well as social outlets,” said Amari Sokoya Pearson-Fields, the Mautner Project’s director of research. “In the case of bars and restaurants, smoking bans benefit both employees and patrons.”

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• Gay clubs fear ‘devastating’ impact of D.C. smoking ban 

A gay nightlife advocate predicted a smoking ban bill approved by the D.C. Council on Dec. 6 would have a “dramatic and devastating” impact on gay bars and nightclubs.

Mark Lee, who operates the weekly gay bar event Lizard Lounge, wants the Council to reverse its action, predicting that large numbers of gay bar and nightclub patrons who smoke would likely stay away from these businesses as a result of a smoking ban.

“Gay and lesbian nightlife establishments have indicated that, if this bill were to become law, the affects on those businesses would be dramatic and devastating,” Lee said.

But members of a coalition of gay health advocates that includes the Whitman-Walker Clinic and the Mautner Project for Lesbians with Cancer disputed the prediction, saying the legislation was needed to protect the health of both gay and straight restaurant and bar patrons, including people with HIV. . . .

Gay D.C. Councilmember David Catania (I-At-Large), who chairs the Council’s Committee on Health, is credited with playing a key role in advancing the bill after Councilmember Carol Schwartz (R-At-Large) blocked similar smoking ban legislation for more than two years. . . .

Gay activist Peter Rosenstein, who is part of the gay coalition supporting the bill, said gay bars and clubs in other cities and states with smoking bans have not been harmed by such legislation. He noted that a Delaware smoking ban has not hurt bars in Rehoboth Beach

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• Smoking rates soar among state's gays 

But it's for real this time, he said, after joining a gay smoking-cessation group in Tucson. He said he feels the group will be more supportive in a comfortable setting.

It's men and women like Fournie that the Arizona Department of Health Services wants to study to find the best way to help the state's gay and lesbian community stop smoking.

About 31 to 38 percent of Arizona's gay and lesbian population smoke, according to the Health Department, compared with 21 percent of U.S. adults. Nationwide, about 41 to 45 percent of the gay and lesbian population smoke.

Dilia Loe, an Arizona Department of Health Services senior program coordinator, said the intent of the study is to find the best way to reach the gay community with anti-smoking and smoking-cessation programs. . . .

Fred McConnell, an R.J. Reynolds Tobacco Co. spokesman, said his company does not single out any ethnic or minority group for marketing purposes.

Loe said gay men or lesbians who smoke; have smoked; have a chronic disease; have had a chronic disease or risk factors for a chronic disease; and those who would like to participate in the study can call (602) 364-0824.

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