Submission by Faculty of Health Sciences, School of Public Health, Curtin University
Faculty of Health Sciences
School of Public Health
GPO Box U1987
Perth Western Australia 6845
Telephone +61 8 9266 2365
Facsimile + 61 8 9266 2958
Email : Jude Comfort at Curtin University
Web Department of Health, Curtin University
29 June 2012
National Tobacco Strategy 2012 submission
Healthcare Management Advisors
PO Box 1311
Fitzroy North VICTORIA 3068
Email to: Draftnts2012 at Healthcare Management Advisors
As a researcher in the area of tobacco control and someone who has worked in tobacco control and public health for over twenty years, I would like to make the following submission on the draft National Tobacco Strategy 2012‐2018 (the Strategy). I acknowledge that this submission is slightly outside the submission deadline however in view of the short submission time I hope that it will be considered.
As noted by many sources including the draft Strategy, Australia’s Health 2010, the National Preventive Health Taskforce, Chapman et al and others 1‐3, Australia has an enviable and well earned reputation of being at the forefront of tobacco control as demonstrated by a falling smoking prevalence. In 2010 smoking prevalence was estimated to be 15.1% (females 13.9%, males 16.4%) 4.
Over the last forty years smoking in Australia has moved from being a mainstream, social accepted activity to one that has largely become denormalised and is now largely concentrated in marginalised groups, including people in lower socioeconomic groups, culturally and linguistically diverse communities and the Indigenous community 5, 6.
While I support most of the approach outlined in the Strategy, I wish to comment primarily on the omission of LGBTI (lesbian, gay, bisexual, trans and intersex)1 people as a priority group. This group carries a disproportionate poorer health burden on many measures 7 and high smoking prevalence is a significant concern. My comments are based on my work as a public health practitioner and an academic. My PhD was on explaining the higher prevalence of smoking among lesbian and bisexual women.
LGBTI smoking rates are consistently reported as being considerably higher than the broader community in most developed countries 8‐12. Ryan et al concluded from their review of 12 studies that smoking rates for LGB ranged from 11% (respondents from a lesbian health conference), 38% to 59% among youth (28% to 35% comparative national figures) and 50% among LGB adults (28% comparative national figures) 12. Although they acknowledge methodological limitations and urge caution in interpreting these results, they none the less conclusively show higher prevalence in this group. A later review which considered 42 studies confirmed that smoking rates in LGBT populations was higher than the broader community, reporting for example that lesbians had between 1.2 and 2.0 the odds of smoking compared to heterosexual women 11.
The 2010 National Drug Strategy Household Survey reported smoking prevalence in Australia’s LGBTI population at 34%, nearly double the heterosexual population 4. Although there were limitations in how this information was reported i.e. no gender or inclusive definitions of LGBTI; for the first time we have smoking prevalence data reported at a national level.
While it is difficult to estimate the size of the LGBTI population in Australia due to both research challenges and a lack of research in this area, it is a sizeable minority group. An Australian Medical Association (AMA) position paper quoting Hillier puts the proportion of the population that is not exclusively heterosexual between 8‐11% 13, making it one of the largest minority groups.
I would therefore urge that LGBTI people be considered a priority population that requires specific targeting and action within the National Tobacco Strategy. This is required if there is to be a decrease in smoking prevalence in this group which will ultimately contribute to achieving a lower national smoking prevalence.
I make the following recommendations for consideration and integration in the Strategy:
- All smoking prevalence data to include measures of sexual orientation and gender identity. While the AIHW has made a start with this, more sophisticated and regular monitoring is required.
- That the LGBTI population is named as a high priority group for smoking control due to smoking rates that are approximately twice that of national prevalence data.
- That smoking within the LGBTI population is recognised to be the result of a complex interplay of factors including the long standing and continuing social, political and legal marginalisation of this group.
- That smoking control agencies engage with LGBTI community organisations to facilitate meaningful exchange to raise awareness of this issue.
- That there is a recognition that smoking control agencies have expertise in this area and that LGBTI community organisations have expertise in accessing this population and hence they should work together to provide culturally sensitive interventions.
- That smoking control work with LGBTI populations receives dedicated funding to promote smoking control and that such funding includes adequate evaluation funding.
- That lesson in working with this population group can be learned from other countries in particular the USA.
Lecturer Department of Health Promotion
Research Associate WA Centre for Health Promotion Research
1 The acronym LGBTI is used here although it is acknowledged there is much debate on terminology and other terms are also in use including gay, GLBTI (gay, lesbian, bisexual, trans, intersex), sexual minority groups, and sexual and gender diverse. LGBTI is used here as a general term to include people who are not exclusively heterosexual in identity, attraction and/or behaviour both male and female.
References1. Australian Institute of Health and Welfare. Australia’s health 2010. Canberra: AIHW; 2010. Available from: AIHW website.
2. Chapman S. Falling prevalence of smoking: how low can we go? Tobacco Control. 2007; 16:145‐147.
3. National Preventative Health Taskforce. Tobacco Control in Australia: making smoking history. Canberra: Australian Government; 2008. Available from: Tobacco Control in Australia: making smoking history.
4. Australian Institute of Health and Welfare. 2010 National Drug Strategy Household Survey report. Canberra: AIHW; 2011.
5. Poland B, Frahlich K, Haines R, Maykhalovskiy E, Rock M, Sparks R. The social context of smoking: the next frontier in tobacco control? Tobacco Control. 2006; 15:59‐63.
6. Chapman S, Freeman B. Markers of the denormalisation of smoking and the tobacco industry. Tobacco Control. 2008 [cited 14 February 2008]; 17:25‐31.
7. Pitts M, Smith A, Mitchell A, Patel S. Private Lives: a report on the health and wellbeing of GLBTI Australians. Melbourne: Gay and Lesbian Health Victoria and Australian Research Centre in Sex, Health and Society, La Trobe University; 2006. Report No.: Monograph Series Number 57.
8. Bye L, Gruskin E, Greenwood G, Albright V, Krotki K. California Lesbians, Gays, Bisexuals, and Transgender (LGBT) Tobacco Use Survey – 2004. Sacramento, CA: California Department of Health Services; 2005. Available from: www.cdph.ca.gov/programs/tobacco/Documents/CTCP‐ LGBTTobaccoStudy.pdf (This website link was valid at the time of submission).
9. Austin S, Ziyadeh N, Fisher L, Kahn J, Colditz G, Frazier L. Sexual orientation and tobacco use in a cohort study of US adolescent girls and boys. Archives of Pediatric Adolescent Medicine. 2004; 158:317‐322.
10. Gruskin E, Hart S, Gordon N, Ackerson L. Patterns of cigarette smoking and alcohol use among lesbians and bisexual women enrolled in a large health maintenance organization. American Journal of Public Health. 2001; 91(6):976‐979.
11. Lee J, Griffin G, Melvin C. Tobacco use among sexual minorities in the USA, 1987 to May 2007: a systematic review. Tobacco Control. 2009; 18:275‐282.
12. Ryan H, Wortley PM, Easton A, Pederson L, Greenwood G. Smoking among lesbians, gays, and bisexuals ‐ A review of the literature. American Journal of Preventive Medicine. 2001; 21(2):142‐149.
13. Australian Medical Association. AMA Position Statement: Sexual Diversity and Gender Identity, 2002 AMA;
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