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barrier to accessing care, including financial (such as lack The National LGBT Cancer Network and “Quality
of insurance coverage or costs for appointments) as well Healthcare for Lesbian, Gay, Bisexual & Transgender
as negative interactions with providers and clinical staff. People”* hosted by GLMA Health Professionals
1
Examples include: Advancing LGBTQ Equality (previously known as the
Gay and Lesbian Medical Association).
“Bad health insurance, fear of outright discrimination, feeling the Additionally, qualifying health systems may work
need to closet myself and being uncomfortable.” towards Healthcare Equality Index (HEI) designation.
2
“Awkward ‘no it’s not possible I’m pregnant’ conversations.” HEI is a tool developed by the Human Rights Campaign
(HRC)* that ensures clinical systems are more equipped
“Worried about homophobia and transphobia. Previous negative/ to meet the diverse needs of their LGBTQ2IA+
traumatic experiences of physical health services.” patients, as well as protect and affirm their experiences
When people experience barriers to accessing when they seek health services. As more qualifying
competent, inclusive care, they may be less likely to health systems earn HEI designation, all community
seek care from medical professionals who can provide members will have more options for where they can
health education and tobacco prevention and cessation receive quality, affirming health care.
resources. These barriers may further explain tobacco The HEI evaluates and scores healthcare facilities on
use and cessation rate disparities amongst LGBTQ2IA+ criteria from four central pillars:
communities. Additionally, multiply marginalized groups 1. Foundational Policies and Training of LGBTQ+
– for example, members of LGBTQ2IA+ communities
who are people of color – may experience more stigma Patient-Centered Care;
and discrimination than those with a single marginalized 2. LGBTQ+ Patient Services and Support;
identity. 3. Employee Benefits and Policies; and 4
4. Patient and Community Engagement
“Given minority stress theory’s emphasis on the detrimental impact
of cumulative stress on wellbeing, researchers have posited that Brief Tobacco Intervention and Electronic Health Record Protocol
these multiple experiences of minority stress may leave LGBT (EHR)
People of Color (POC) especially vulnerable to adverse health It has been reported that 68% of adult smokers
outcomes.” 3 want to quit, but most will make multiple attempts
5
Although more research is needed on how multiple before successfully quitting. A brief intervention during
minority stress impacts health and wellbeing, practitioners every visit to a health setting, including public health
should be prepared to support patients with these intersections. clinics, can make a vast impact for patients looking to
Health Systems Strategies to Improve Cultural start their tobacco cessation journey. The “Ask, Advise,
Refer” model guides providers to ask patients about
Competency and Reduce Tobacco Use Among their tobacco use, advise them to quit, and refer them to
LGBTQ2IA+ Communities cessation resources.
Trainings and Designations Austin Public Health has implemented the eTobacco
It is important for health care providers to strengthen protocol, which incorporates the “Ask, Advise, Refer”
their capacity to meet the needs of LGBTQ2IA+ model into the EHR system. Patients interested in
community members. Improving cultural competency quitting tobacco are referred to several free cessation
for working with LGBTQ2IA+ communities can greatly resources, including SmokefreeTXT and the Texas
impact the ways in which these populations receive Tobacco Quit Line (TTQL). If a patient is interested in
healthcare and engage with tobacco cessation education quitting with the TTQL, the EHR asks a few additional
and resources. questions to allow quit coaches to contact the patient
Feedback from community members helps us gain directly, and an electronic referral is sent through EHR
a better understanding of some of the things that are to the TTQL. One benefit of the TTQL is that patients
important to LGBTQ2IA+ patients and ways providers can talk to a quit coach and find out if they qualify for
can improve trust, comfort, safety, and quality of care two weeks of free NRT.
for this community. Here is one powerful example of an This systems-level change increases knowledge and
affirming experience that a community member shared access to prevention and cessation resources. Health
with Austin Public Health (APH) staff: systems that are interested in adopting eTobacco protocol
“[My primary care doctor] uses your preferred name and can reach out to the Tobacco Research and Evaluation
pronouns, has no problem talking about LGBTQ+ sexual Team at University of Texas at Austin* for assistance
health, encourages PrEP and helps you with getting access to with EHR implementation.
low-cost or free PrEP, and is just easy to talk to and be around. I Community-Based Strategies to Reduce Tobacco
have never felt judged by her, she makes me feel welcomed, and Use Among LGBTQ2IA+ Communities
I feel safe to speak on my intersecting identities.” In addition to health systems interventions, community-
Many virtual programs exist to help train clinical based programs are essential to reducing tobacco use
staff on cultural competency for LGBTQ2IA+
communities, such as “Welcoming Spaces”* hosted by Continue on page 25

TCMS 2023 January • February 23