Learning From LGBTQIA+ Young Adults

Learning From LGBTQIA+ Young Adults

Over the summer we produced a science communication report for a study investigating tobacco use among LGBTQIA+ young adults that we’re currently wrapping up. The study, funded by the Tobacco-Related Disease Research Program (TRDRP) of the University of California, continues our research interest in understanding tobacco-related inequities for LGBTQIA+ young adults. Building upon a study we conducted previously (funded by the National Cancer Institute), this study comprises 100 qualitative interviews that we conducted with LGBTQIA+ young adults to examine their perceptions of tobacco harm reduction.

I did.

Let me explain.

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It’s Complicated: Harm Reduction Through Nicotine & Tobacco Use

It’s Complicated: Harm Reduction Through Nicotine & Tobacco Use

Discussions among participants about the ways nicotine and tobacco (NT) products relate to the use of other substances has been a recurring topic in our recent tobacco harm reduction study. For participants this included the co-use of NT with other substances (like alcohol making cigarettes more enjoyable) and the use of NT products to alter the effects of other substances (such as smoking a cigarette after using cannabis to wake up), both well-established in tobacco use research. In a study interested in how participants reduce harm from combustible NT products, unexpectedly our participants emphasized explicitly using NT products as a substitute for other substances they considered more harmful than combustible NT products. This post will be tracing the narratives of several participants in the study who shared their experiences substituting NT products for other substances to reduce harm.

Participants are well aware of the risks associated with tobacco use, but also acknowledge that it can be a valuable tool in navigating challenges in their lives, including managing the risks posed by other substance use. There are various ways that cigarettes can be meaningful for people who use them, as documented across many studies in the tobacco field.

For example, Rob is a 19-year-old white, pansexual, nonbinary person studying to become a drug counselor. Before moving back to the Bay Area in 2020, Rob was using meth heavily and had an experience with an overdose — this and the death of a close friend greatly impacted their decision to stop using meth. About the role of cigarettes in their life and their health, Rob explai


I mean, I think, the cigarettes – it was like, it helped me so much with getting sober from that because I could chain-smoke all day instead of smoke meth. […T]he oral fixation that comes with smoking meth, and just the actual action of it is so addicting. […]I know at some point, I’ll probably have lung cancer or some form of that. I mean, I’ve smoked a lot of things that are worse than cigarettes. So, it’s definitely done some damage, and you know, smoking like, a pack a day is not healthy. And so, I definitely know that at some point down the line, my lifespan will be shorter than if I didn’t smoke. […] I’ve cut back from a pack a day to half a pack a day in the past couple months, and there’s that. But at the same time, I never really thought I would get this far in terms of living and stuff. So, it’s kind of like, whatever at this point. Like, at least I’m not smoking meth or something.

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Community, Resources

Community, Resources

Animated gif of Em Sanders at CCPH table at Pride in the Park Health and Wellness Fair
CC BY-NC-ND via Center for Critical Public Health

Recently Center for Critical Public Health got the opportunity to have a table at the Pride in the Park Health and Wellness Fair. Happy 4th Anniversary and a huge thanks to the Oakland LGBTQ Center for organizing the event and welcoming us to share space with groups like the HIV Education and Prevention Project of Alameda County (HEPPAC) doing vital work in the Bay Area! Beautiful weather and lovely people made for a day of much-needed community celebration and resource-full-ness by the lake.

At the CCPH table we focused on getting the word out about our Tobacco Harm Reduction Study and answering questions folks had about our work. Alongside getting to chat with people about the study and our research group, I also loved learning about some of the other organizations in attendance.

What resources have you found helpful or supportive? Let us know in the comments below.

I found out about ProjectQ, a non-profit founded in LA that provides affirming haircuts and other services to LGBTQIA+ young people experiencing housing insecurity. The booth across from us was run by One Degree, an online hub connecting people to all kinds of resources, social services, and local support. After the celebration we made sure to add both of these, along with HEPPAC’s harm reduction services, to the Community and Emergency Resources List we provide to participants in our studies. I feel a bit remiss for not having these orgs on my radar sooner, but, better late than never! Glad I can pass the info on now.

During set up and throughout the afternoon I also got to know our table-neighbors, who were there telling people about an online survey being conducted on experiences of inclusion, exclusion and representation in the Castro. I was excited to hear about these efforts for gathering community input because participants in our studies with LGBTQ+ folks over the past 5 years have highlighted these issues repeatedly in their narratives on identity, community, and stigma.

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Taking care

Taking care

Drawing shows newspaper with "World ending" headline together with post-it note that says "Take care"
Image by Alan Johnson @maklvane

“I hope you are taking good care during these stressful and uncertain times.”

We’ve all likely received many emails containing this phrase in the past year. What does it mean to take good care and maintain wellbeing in general? During a pandemic? During a prolonged period of civil unrest?

We began interviewing for the Tobacco Harm Reduction study two months after San Francisco’s shelter-in-place order took effect in response to the Covid-19 pandemic. One year later, with the pandemic ongoing, interviews continue to take place, online, with LGBTQ+ young adults (18-25) who smoke or used to smoke cigarettes. Each participant provides a window into their unique pandemic experience, and I became deeply interested in hearing how people talked about their mental health and personal wellbeing during this time.

There is no doubt that the pandemic has presented a number of challenges to mental health. As a society, we’ve had to navigate varying degrees of loss and grief, unprecedented stress and uncertainty, economic decline and social isolation. Uncertainty is always hard to manage, and while ideally there would be a communal or collective way to manage pandemic stress, in our society the responsibility ultimately falls on the individual to be proactive, to focus on what’s in their control, to move their body and to prioritize the “self” in self-care.

Daily life during the pandemic looks different for everyone, and as participants described shifts in daily routines, rituals and priorities, I noticed that several participants discussed the value of having time for themselves that did not exist pre-pandemic. While some were struggling with newly unstructured time, many were also engaging in healing practices. For instance, Jade, a 23-year-old, queer Chicana cis woman, is a college student whose employment ended with the pandemic, but who had some money saved. Prior to the pandemic, Jade had a busy social life and would regularly get dressed up and go out dancing with friends to unwind. She described how the pandemic shifted things for her:

One of the major things that I do to let off steam and kind of socialize with my friends, is gone. […] I’ve been really ramping up my own mental health, healing journey. So, I started therapy about a year ago now. And so, just this week actually, I joined a support group for adult survivors of child abuse. And it’s my first time ever going to a support group. It was like a really big deal. So, I guess, kind of just like focusing more on my mental health and stuff, because I finally – you know, I can’t distract myself with other people.

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Safer spaces

Safer spaces

In 2018 and 2019, we conducted 200 interviews with LGBTQ+ young adults in the San Francisco Bay Area to understand their experiences within social contexts of drinking and intoxication. The idea of “safe spaces” was a recurrent theme throughout the interviews. Participants stressed the need for safe congregation among queer people in order to prevent the harrassment and violence felt from the rest of the world.

Bars have long been considered safe spaces in queer communities, and this general sentiment was echoed again and again by our participants. For instance, when asked how an intoxicated gay man might be approached at a bar, Christine, a pansexual, genderqueer person (age 19) said:

Like if he’s at a gay bar, I think he’s probably pretty safe. I mean, personally, I don’t spend a lot of time at gay bars. But I associate queer spaces with safe— just like community and safety.

It makes sense that a study centered on queer identities and intoxication would raise points about the social significance of gay bars. Furthermore, it is unsurprising that a study centered on queer identities and intoxication based in the Bay Area would raise points specifically about San Francisco’s Castro District, one of the first gay districts in the United States.

Alongside cultural shifts related to post-war migration, social movements of the 1960s and ‘70s, and watershed moments like the 1969 Stonewall Riots, over time the Castro transformed from a working-class neighborhood into a world-class gay bar district. Some study participants exchanged fun stories that illustrate the Castro as exactly that— a fun and safe place for bar-hopping, meeting new friends and partners, and catching late-night drag shows.

However, LGBTQ+ communities are not monolithic, that is, there is diversity within diversity. Other participants, namely those who do not present as white, cisgender, or male, reported experiences in the Castro that involved discrimination and exclusion rather than fun and safety. For example, Faris, a 24-year-old gay, male-identified participant reported,

My lesbian friends don’t really like even going out to Castro… My trans friends definitely don’t like to go to Castro… People [there] would say offensive things to trans women especially, and trans men as well, and lesbians as well.

A 23-year-old queer femme participant’s experiences echoed those of Faris’s friends. She recalled facing harassment from bouncers working the door at San Francisco gay bars, saying,

Even like security guards, like not wanting to let me in, unless they see I’m with three gay men. I’m like a plus one to them… They’ll roll their eyes, or play jokes with me and be like, ‘Excuse me, ma’am. We’re not allowed to let you in.’

Ali, a 24-year-old who identifies as genderqueer and sexually queer, disclosed that even when cisgender and transgender women gain entrance to Castro bars and clubs, they are still met with prejudice.

So I think of all the times in the Castro, when I’ve had my girlfriends with me, and I’ve seen guys look at them being like, ‘I smell fish.’

This history of the Castro District is well documented, supporting these accounts of discrimination and shifting its image from a gay men’s safe haven to a cluster of prejudicial bars. Some LGBTQ+ people maintain that the solution for this intra-community dilemma is to prioritize the development of lesbian bars as an acknowledgment of patrons’ multiple intersecting identities. However, reports about a lesbian-serving bar in San Francisco’s Mission District demonstrate that discriminatory practices persist even in queer-femme centric drinking spaces.

When asked where they prefer to drink and how they navigate safety in drinking settings, participants cited drinking at home and with trusted friends as harm reduction strategies. However, all queer people should have the option to safely consume alcohol in public spheres, especially in “safe space” bars that are intended for queer people.

It was 2018 when Christine said, “I associate queer spaces with safe– just like community and safety.” I don’t think anyone (myself, the participants, the world) could have imagined how the COVID-19 pandemic would ask us to come to new relationships with health and our respective communities.

As Pride celebrations conclude and the California economy recovers, we have the unprecedented opportunity to ask ourselves: how can we ensure our spaces truly embody community and safety? Since no public drinking spaces exist entirely outside the social fabric of misogyny, racism, and heterosexism, I worry that no such safe spaces can exist. But for those exact reasons, we must work to build safer queer spaces.

Pandemic stress & tobacco harm reduction

Pandemic stress & tobacco harm reduction

Outline of person surrounded by hazard symbols
We can’t make perfect choices all the time.
Base image: Risk, CC-BY Nithinan Tatah

Candy is a queer, nonbinary Iranian person living in Oakland and working remotely as a teacher. Their former use of cigarettes was strongly associated with situations where they felt heightened anxiety. In these instances, Candy utilized cigarette smoking as a tool to take some space away from the situation and calm down. Though this was not a regular occurrence in the past, it is necessary to contextualize the role of stress in Candy’s current use:

“Like, ’cause my rent is more than half my paycheck, and my partners had to move away because they can’t afford it here… and also that we’ve been in our homes for a year because we just couldn’t get it together to do things better… But if I didn’t need to grasp at whatever I could to cope with what’s happening around me, there would be no benefit to this for me, and I would have no desire to smoke or anything else.”

Candy’s narrative reflects resource scarcity — their rent is half their paycheck and their partners can no longer afford to live in the state. The pandemic has been stressful for Candy, and this resource-related stress and isolation spurred a desire to smoke cigarettes again.

However, cigarettes are expensive — the cost per pack has increased by about $3 since the last time they bought one over a year ago. A former coworker introduced Candy to oral nicotine pouches, which are $2 per tin of about 20 pouches. In the Bay Area, that means that one nicotine pouch is about 80% cheaper than one cigarette ($.10/pouch vs $.50-.60/cigarette).

When I asked Candy, “If you had to say one reason right now to tell someone else why you use your nicotine pouches, what would it be?” they replied:

“Harm reduction. Yeah, the pandemic is hard. I’m having a time. Of all of the things I could use to cope, this feels the least destructive. It’s less expensive, and it feels like it takes less of a toll on my body than other things that I could be using. It feels more responsible than like, drinking a bunch, ’cause you know, if I’m teaching, I can do this while I do that…”

The decision to switch from cigarettes to nicotine pouches is a choice with straightforward implications of harm reduction. Candy had family members experience terminal cancer and noted that Covid-19 is a virus affecting the lungs, so switching to a non-inhaled product with less hand-to-mouth contact was a good option for them. Furthermore, the pouches weren’t a financial burden for Candy, and fit into the new rhythms of their everyday life teaching remotely and sheltering in place.

Candy commented on the nicotine effects as being useful and grounding, and specifically remarked that nicotine and tobacco use are better (for their body and for their job) than excessive drinking — a perspective shared by several other participants too.

This indicates a complex process of considerations around harm and risk when it comes to nicotine and tobacco use for many of the people we’ve spoken to in this study, revealing the breadth of harm reduction and its implications. When I asked Candy what they meant by “harm reduction,” they put it this way:

“I feel like if I tried to set the expectation of myself that I’m just not going to use any kinds of substances or not do things that I know are not good for me, like, period, full stop, that’s not a realistic expectation. And in the past, I’ve tried to make decisions like that… What happens is that it becomes all that I think about. And I don’t do it for a while, and then I give in and go way overboard, and it’s worse… I want to take care of myself. I want to make good choices. I can’t make perfect choices all the time. So, I’m going to do my best to make better ones.”

App That Converts Air Pollution Into Cigarettes

App That Converts Air Pollution Into Cigarettes

This Lifehacker post is from 2018 so perhaps y’all are already aware, but my partner just alerted me to the existence of an app entitled “Sh**t! I Smoke.”

Thought it was especially relevant to share here in the Bay Area given the current climate (literally), and even moreso considering

  1. the number of participants in the Stigma study who framed the harmfulness of cigarette smoking within the context of larger, structural health threats re: environmental pollution (most often in a “so smoking doesn’t really matter in the scheme of things” sort of way, in terms of their own health and in response to concerns/accusations that smoking is a particularly harmful and/or major source of environmental pollution)

  2. compounded concerns about population-level and individual respiratory health amid fires + COVID

  3. will be very interesting to see how the theme mentioned in point 1 shows up in our current study on Tobacco Harm Reduction given point 2!

Everything about this app is rhetorically FASCINATING.

The app icon is the shape of a poop emoji made out of a cigarette.

Cigarette twisted into the shape of a poop emoji

Everyone is a smoker within the language of this app…

Screen capture from app, point location in Oakland, CA, says "OMG! You smoke 9.3 cigarettes daily"Screen capture from app, point location in Oakland, CA, says "Dang! You smoke 64.9 cigarettes weekly"

… and it’s obvious that that is BAD.

Screen capture from app, reads "Loading... Cough... Cough"

But at the same time the positioning of personal responsibility, victimhood, innocence, and contagion are structured totally differently.

Screen capture from app says "The app was inspired by Berkeley Earth's findings about the equivalence between air pollution and cigarette smoking. The rule of thumb is... one cigarette per day is the rough equivalent of a PM2.5 level of 22"

Neat, wow, yikes, enjoy!

(All images via the Sh**t! I Smoke app)

Women of Color Being Policed

Women of Color Being Policed

Between 2017 and 2018, we conducted 49 interviews with young Black and Latina women in the San Francisco Bay Area about their perceptions and experiences of the police. This study came on the heels of nationwide outrage about countless police killings of Black men, including Philando Castile and Alton Sterling in 2016, as well as one woman, Sandra Bland, whose life was also stricken by the same violence in 2015. Now, sparked by the killing of George Floyd only a few years later, this outrage is reignited. 

To continue our #POCbeingPoliced series and further highlight the long-standing issue of racist police violence directed at women, we present the following video: “Women of Color Being Policed,” which highlights Black women’s voices, specifically.  We humbly thank the women who participated in this study, many of whom courageously shared their experiences with the sole intention of making a difference by amplifying the attention paid to women of color’s experiences with police violence. 

Findings from this study can be found here.

For more research on police violence and police use of force, see our public access bibliography.

For more information about Black women and police violence, see work from the African American Policy Forum’s #SayHerName campaign.

Voices on Police Violence

Voices on Police Violence

In recognition of the fortitude of those on the front lines; in honor of Ahmaud Arbery, Breonna Taylor, George Floyd, Tony McDade, and so many others whose lives have been cut short by police violence: Over the next few days the Center for Critical Public Health will highlight direct quotes from participants in our studies.

Since 2007, we’ve conducted interviews with people of color whose stories have included countless experiences with racial profiling, unjust stop and search, and police brutality. Though the studies they come from are not all focused on policing nor directly on violence, these quotes highlight how pervasive racist violence is. These participants and their experiences are unique, but the connecting thread of police violence is not.

Neither this violence nor the outrage it justifies are new. Immense gratitude to all of the participants who have generously shared their experiences with us. These voices, past and present, must be heard.

To follow this series, please join us on our Twitter or Facebook feeds. Since this material can be traumatic, we will use the hashtag #POCbeingPoliced consistently throughout the series so you can choose to mute it any time.

Update: Threaded quotes below

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