Creating a Health Equity Movement for the LGBT Community: Effective Health Messaging In Puerto Rico

Background:  There have been no studies on the prevalence of smoking in the lesbian, gay, bisexual, transgender, and transsexual (LGBTT) community in Puerto Rico.  The National Latino Tobacco Control Network conducted a survey to gain insights into the prevalence and the motivators for smoking.  The research served as a vehicle for a larger national dialogue about health equity within LGBTT communities.  Local health activists disseminated the survey results to educate health officials and empower the LGBTT community through strategic social media platforms.  Health advocates and professionals have been successful in initiating and implementing policy changes.  One significant win for the movement has been the inclusion of sexual and gender identity questions on the BRFFS which will provide Puerto Rico an invaluable data set to justify targeted health interventions and marketing campaigns to address a broader health equity movement.    

Program background:  NLTCN and a research team from the University of Puerto Rico developed a survey to assess the prevalence of smoking within the LGBTT community.  A convenience sample was secured in the metropolitan area of San Juan and other urban centers.  Questions on the survey assessed motivators for smoking initiation and cessation and touched upon other health disparities.  The data clearly show a need for targeted cessation programs; restrictions to exposure to second-hand smoke; a strong prevalence of depression and identified homophobia as a barrier to health services and information.  The results were shared widely at community forums and through social media outlets to educate the LGBTT community and health officials about the need to eliminate LGBTT health disparities.

Evaluation Methods and Results:  Results from the survey indicate that 50% of the respondents had tried to stop smoking; 56.8% had suffered from depression; and 27.3% from asthma.  Eighty two percent of the respondents had graduated from college which is significantly above the norm but their annual income was below the medium range.  The majority of the respondents were not out to their doctors (60%) but a significant percentage reported that they would like for doctors to know more about LGBTT health. Social media platforms were used to share content on LGBT health and to advocate for policy changes.  In addition, media advocacy efforts have been executed to shift public opinion on civil rights and health equity.

Conclusions:  The results from the data, traffic on social media platforms, and a national dialogue on health equity have generated a movement that demonstrates a need for cultural competency; access to care; and prevention interventions for smoking and other health disparities within the LGBTT communities in Puerto Rico. 

Implications for research and/or practice:  Homophobia is a cultural and institutional barrier for health within Puerto Rican LGBTT communities. The collaborative strategies that were established with national and local organizations in conjunction with communications experts are demonstrative of the effectiveness of grassroots organizing for systems change to eliminate health disparities and achieve health equity.  Ongoing research is warranted as additional policy changes and marketing campaigns are implemented to address behavioral change and health outcomes within the LGBTT community.