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Lesbian, gay, bisexual and transgender (LGBT) individuals smoke at high rates: LGB higher than their heterosexual counterparts; transgender, higher than their cisgender counterparts.1 Historically, LGBT bars often played a central role in the lives of LGBT people in the USA, often serving as one of the only available spaces for socialising.2 Bars have historically allowed smoking and tobacco marketing,3 and there is a well-established link between drinking alcohol and smoking.4 Tobacco companies were also early contributors to HIV/AIDS organisations and the Gay and Lesbian Alliance Against Defamation (GLAAD) Media Awards Program5 ,6 and early adopters of employee non-discrimination policies covering sexual orientation.7 Recently, the tobacco companies released advertisements linking tobacco use with contemporary LGBT issues (eg, freedom to smoke likened to freedom to marry, figure 1)8 and LGBT pride.9 ,10
Although smoking is now prohibited in bars in California, tobacco promotional events still occur. In San Jose, California, advocates with the Tri-City Health Center's LGBT Tobacco Prevention Project began a campaign to expose tobacco company distribution of samples and coupons in the LGBT bar. This article describes tobacco company promotions in an LGBT bar in California's third largest city, and the advocacy efforts that led to an end to those promotions.
Advocates with the LGBT Tobacco Prevention Project obtained the schedule of tobacco representative bar visits from January 2013 to March 2015 provided by Philip Morris (PM) to the California Attorney General's Office. Of the 10 bars in San Jose listed, 1 catered to an LGBT crowd; 151 of the 575 scheduled bar visits in San Jose were to the LGBT bar (26%).
On the basis of this list, seven advocates began conducting bar observations to document tobacco company marketing practices.
Advocates observed PM representatives visiting bars in San Jose and signed up with them, providing phone numbers, email addresses and driver's licenses. Once registered, advocates received a packet which included a ‘buy one, get one free’ coupon (figure 2) and a coupon for $1 per pack redeemable only that night at the bar (figure 3). On other nights, PM representatives gave away free MarkTen electronic cigarettes and two packages of replacement cartridges to those who were signed up. PM representatives were not always present at the scheduled locations. Bar employees reported that one could “check in” with Marlboro online to receive free gifts (eg, a prepaid $10 MasterCard, a Zippo lighter) as well as obtain a bar promotional schedule.
As a result of these data, in July 2013, the advocates started the campaign “Butt Out of Our Bars” to highlight tobacco promotions in LGBT bars. Thirty-four organisations supported the effort including the Billy DeFrank LGBT Community Center and the LGBTQ Youth Space. Advocates created educational materials, documenting the tobacco influence in the LGBT bar, as well as the easy availability of electronic cigarettes. They also tabled in LGBT community spaces (eg, LGBT pride) as well as in the broader community (eg, Earth Day celebrations, health fairs and festivals) and gathered 1821 signatures of individuals demonstrating their concern about these bar-based tobacco promotional events. Finally, the group created educational materials for city council members, documenting the health risks of tobacco use and the disproportionate burden of the tobacco epidemic faced by the LGBT community. These educational materials also included specific tobacco promotions obtained in the LGBT bar in San Jose, as well as model ordinances addressing this issue in other cities. Ultimately, on June 9, 2015, the City of San Jose passed an ordinance prohibiting the distribution of free or low cost tobacco products in public places, including bars.
This case study can serve as a model for tobacco advocates across the country, as data collected in a relatively simple and cost-effective way by community advocates led to policy change. Bar promotions are concerning because they can make it easier for young adults to start smoking, as well as make smoking cessation more challenging. Prohibiting tobacco product sampling in bars can change the pro-tobacco social norm in bars, including in those serving populations with disproportionately high smoking rates such as LGBT bars.
Contributors AF contributed to the analysis and interpretation of the data, and drafting of the manuscript. BD led data collection and critically revised for content. Both the authors gave final approval on this manuscript.
Funding Tri-City Health Center's LGBT Tobacco was funded by the California Department of Health.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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