It’s not enough to give her a pamphlet, to tell her to stop, that it’s affecting her heart and lungs.
Katie Shay, 39, knows all this. She thinks about giving up all the time, but it’s become a ritual, a reliable relaxant in a complicated world.
“I think what would be worse, not getting rid of this stress in the way that I know will help me get rid of it, or just holding on to it because I can’t figure it out any other way way?’
Interventions must be deeper. They have to be versatile, said Shay, who lives in Ann Arbor. She is bisexual and has smoked, with decreasing frequency, since she was a teenager, when she finally found her peers as “weird” as she felt, smoking outside punk shows in the 1990s.
Research shows that Shay is right.
Results of a study funded by a grant from the Michigan Department of Health and Human Services and released in November found that societal issues such as discrimination, violence and suicidality should be addressed as major issues leading to excessive tobacco use among LGBTQ people who struggle with anxiety and depression, oppression and, as one person said, less access to culturally competent mental health services.
“Smoking cessation programs should teach participants new strategies for coping with stress and meeting needs that are currently met through tobacco use,” reads one of the top recommendations derived from the study, completed by DataWise Consulting, formerly Calvin University’s Center for Social Research, which contracted with the Grand Rapids Pride Center to interview 348 people, most of whom identified as LGBTQ.
The majority said they would be most comfortable participating in a smoking cessation program through an LGBTQ organization. However, about 40% felt slightly or not at all comfortable doing so. Overall, responses to the interventions were negative.
“(Tobacco use) came about because of social environment or social stress or “I just need a coping mechanism. So I went for it. And then opt-out messages, to be honest with you, suck. No one said, “Oh yeah, those opt-out messages telling me to opt out were helpful,” said DataWise’s Jax Hale, who runs Zoom focus groups.
The Pride Center, in response, is starting a monthly workshop focused not directly on smoking, but on overall health. It will provide fellowship, discussions and alternative activities such as dance, yoga and hula hooping.
“What’s the purpose? Everyone’s goal may not be to be healthy, as much as we think, but we’re talking about what is your well-being?” said Butterfly Mitchell, a former smoking cessation specialist who has worked with HIV/AIDS patients and involved in planning.
A mother of two LGBTQ people, now adults, she helps out at a pride center staffed by leaders who encourage her to be herself, embrace her preferred name, wear her hair however she wants and dress in a pinstripe suit with cylinder – or not.
CONNECTED: LGBTQ people don’t see tobacco use as the most immediate threat, but it’s a simmering problem
The state health department, along with the pride center and other groups, is working to break down barriers to treatment and make their quitline, recently rebranded through an LGBTQ committee as the MI Tobacco Quitlink, more inclusive and welcoming.
“We are committed to helping people who have been targeted by the tobacco industry in the past … who suffer more adverse consequences,” department spokeswoman Chelsea Voot said in an emailed statement.
Tobacco companies have singled out gender or sexual minorities for decades. In the 1990s, the business named a strategy the Subcultural Urban Marketing Project. Companies have used LGBTQ symbolism to push flavored tobacco products, according to the CDC.
They identified a potentially lucrative and vulnerable market early and won.
About one in five LGBTQ people smoke cigarettes. By comparison, about one in six heterosexual individuals smoke, according to the US Centers for Disease Control and Prevention. In Michigan, one in 10 LGBT people report that it started before age 15. Of the study participants, 39% started smoking cigarettes when they were 15-18 years old.
In some groups, the problem is even more widespread. Transgender and non-binary individuals are more likely to suffer from smoking-related diseases, including cancer and lung and heart disease, and often lack access to health care, reports a summer 2022 police memo published by the Tobacco Research Network of the University of Michigan. They don’t always feel safe and established in traditional medical settings, experts said.
“We all know horror stories from people we are close to, about people who have been rejected or people who have suffered in healthcare. And it multiplies when there are other marginalized identities involved,” said Leslie Boker, health outreach coordinator for the Grand Rapids Pride Center. Non-binary, they understand the challenges well.
According to the study, the biggest barriers to smoking treatment are the cost of accessing resources, lack of social support and lack of health insurance coverage.
LGBTQ people may not want to go to the state that offers primary smoking cessation services. “We’re a group of people who are distrustful of government programming for good reason,” said Scout, executive director of the Rhode Island-based National LGBT Cancer Network. (He’s transgender and legally has one name.)
While in some ways society has become more tolerant of sexual and gender diversity, hostility remains. In Michigan, for example, lawmakers have taken steps to try to ensure that high school athletes only compete against those of the same biological sex and ban school drag shows.
Over the past few years, hundreds of anti-LGBTQ bills have been filed across the country. They would limit LGBTQ issues in school curricula and limit transgender people from receiving gender-affirming health care.
“We just couldn’t get smoking cessation to be our focus because it seemed like things were coming from all over the place,” Boecker said of the organization’s more holistic work.
Scout said Michigan is doing better than other states. They said it was extremely important to include the LGBTQ community. “Because one size does not fit all.”
The state health department funds three leading LGBT organizations that partner with other centers. Outcome strategies include: Training of LGBT center staff for smoking treatment specialists; engaging in community education and promoting culturally affirming activities such as prides and balls; and engaging LGBTQ youth in tobacco education and advocacy.
State Quitlink employs non-judgmental coaches required to complete continuing education, including LGBTQ sensitivity. “Our caring and supportive smoking cessation coaches are among the most experienced in the country,” the state health department said in a statement.
The Michigan Tobacco Control Program recognizes that everyone is different and experiences different life challenges, according to the state health department. “Continued quality improvement is a priority, and the Tobacco Sector and Quitlink continue to communicate with LGBTQ+ agencies and enrollees to stay current on terminology, coaching needs and reception to make the coaching experience positive and inclusive.”
According to experts and survey results, negative messages are not helpful.
“One thing I definitely didn’t appreciate, especially while I was smoking, was … being told to quit like it was easy. Quitting smoking is the hardest thing I’ve ever done; hands down,” said one focus group participant.
One commented: “I just feel that devaluing people is never a good option – dehumanizing, devaluing. A lot of times these messages (to opt out) I think border on that.”
The proportion of people who reported feeling “very” comfortable receiving any resources, including text or internet advice or information from a GP, was low – never more than 15%.
Shay, the Ann Arbor woman, said a “terrible” diagnosis would convince her to quit smoking. “But everything else? It’s like they keep raising the prices of cigarettes and I’m like, “I can’t afford it,” but I find the money.
She turned to marijuana. She believes this is a better option. But still she smokes when she drinks. This has been a ritual for many years.
As a young woman, she felt isolated in her hometown of Portage, near Kalamazoo. “In the late ’90s, there weren’t any queer people around,” Shay said as he stood on the sidewalk smoking a cigarette with his longtime partner.
Part of smoking back then was teenage angst. “Also just a reaction of like, ‘Oh, the world is messed up and I don’t feel like I fit in.'”
She wishes she had never started.
How do we stop others?
All-encompassing solutions seem daunting. Social exclusion, health disparities and discrimination are big problems.
But there are small ways to target problems.
Ask for and use the correct pronouns. Sport rainbow bumper sticker.
“Don’t underestimate how much being a kind and welcoming person to any queer person in your life can actually help a community that faces this level of discrimination,” Scout said.
“Put that rainbow flag in front of your house… It doesn’t mean you’re weird. It just means you have your back.”
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