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Health Equity �& Disparities

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What are some things that �stress you out?

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What are some healthy ways �to cope with stress?

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What are some BIG stressors �that teens might experience?

1^st discussion prompt: We’ve talked about some everyday stressors. What are some BIG things that can cause stress for teens?

Framing this question so it is clear that the youth aren’t expected to give personal examples, but instead general examples, will help everyone feel safe and included in the conversation. Give the youth some time to share some examples. Whether or not they mention bullying, use bullying and harassment as the example for the next discussion prompt.

2^nd discussion prompt: How about bullying? Bullying and harassment can be a significant source of ongoing, chronic stress that can be very challenging to cope with. ��

Presenter note: If a youth brings up an traumatic experience (abuse, neglect, substance use in home, etc.) that they or a friend are experiencing, be ready to talk to that youth after the presentation and refer them to a helpful resource (school counselor, community resource, etc.).

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Toxic Stress

Concept introduction: Bullying, harassment and a lot of the other significant stressors that you mentioned, are examples of toxic stress. �

Explain that throughout our lifetimes we’re all building up our coping skills and figuring out healthy ways that work for us to deal with stress. So, when toxic stress happens while a young person is still learning healthy ways to cope, in combination with being overwhelmed by chronic stressors, it can be especially difficult to find a healthy way to cope. Experiencing toxic stress such as harassment makes it more likely that a young person will try an unhealthy way to cope before they’ve built up healthy coping habits.

Discussion prompt: What are some unhealthy ways that a person might try to cope with toxic stress, such as harassment?

If they need help getting started, prompt them with a couple of examples:

Examples of unhealthy coping behaviors:

Tobacco use
Alcohol use
Drug use
Detaching from friends, family or responsibilities
Sedentary activities
Eating junk food, overeating
Self harm or suicidal ideation
Harming others
Not eating
Risky sexual behaviors

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Unhealthy Coping & Health

Image Credit: Robert Wood Johnson Foundation

Explain that toxic stress can increase the likelihood of trying unhealthy coping behaviors, which can become habits or addictions that last a lifetime. Harmful addictions, like tobacco use, can cause significant health problems that decrease quality of life and shorten the lifespan. All of the unhealthy behaviors that we’ve talked about can cause serious physical and mental health problems like you see in this image.

Youth tobacco prevention efforts like FACT are especially important because nicotine is highly addictive and tobacco damages virtually every organ in the body. Of all of these unhealthy behaviors, tobacco use is the leading cause of preventable death in Wisconsin, the U.S. and worldwide.

Discussion prompt: What are some health problems that tobacco can cause?

Examples of health issues caused by tobacco:

Cancers
Heart Disease, cardiovascular disease, stroke
COPD, chronic bronchitis, emphysema, pneumonia
Blindness, cataracts
Diabetes
Bone and joint problems

Presenter note: If this presentation will be given in 2 segments, this is a good midway stopping point.

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Targeted Tobacco Marketing

A

B

C

D

Explain that the tobacco industry has targeted many populations that were already experiencing health disparities with predatory marketing tactics. This is an additional layer that adds to the development of health disparities.

Ad Examples:

A: Targets LGBTQ community (placed in magazines popular with this community, uses “pride” message and rainbow image)

B: Targets Racial/Ethnic groups (marketed to targeted groups, uses imagery and music popular among targeted groups)

- Example B also targets youth

C: Targets low-socioeconomic status (various price promotions, occurs more often in low-income neighborhoods vs. middle/high income neighborhoods, making tobacco more affordable)

D: Targets persons with behavioral health issues (portrays smoking as a “recess” break and emphasizes relaxation, smokers appear happy and confident, implies smoking curbs anxiety of social interactions, etc.)��The tobacco industry has attempted to maintain a positive image among disparate populations by:

Developing culturally tailored images and messages
Sponsoring cultural events
Advertising more heavily in their neighborhoods
Providing free samples at cultural events and in targeted neighborhoods
Using price promotions and coupons to make tobacco more affordable and easier to access

Discussion prompt: If a person is in more than one population that has been targeted by tobacco marketing (for example, a member of the LGBTQ community who is also black), what impact might that have?

Image sources:�A: Trinkets & Trash, https://trinketsandtrash.org/detail.php?item_number=213662

B: Trinkets & Trash, https://trinketsandtrash.org/detail.php?artifactid=3645&page=5 (cropped)

C: New York Times, http://www.nytimes.com/2014/03/17/business/states-urge-retail-giants-with-pharmacies-to-stop-selling-tobacco-products.html (cropped)

D: Trinkets & Trash, https://trinketsandtrash.org/detail.php?artifactid=9775&page=4

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Populations of Focus

LGBTQ�Acronym for lesbian, gay, bisexual, transgender, and queer or questioning people.

�Race and/or Ethnicity�Race: Used to describe a group of people with similar physical traits (skin color, hair type, bone structure, etc.).�Ethnicity: Used to describe a group of people with shared language and cultural identity (foods they eat, religion they practice, music and dances unique to them, etc.).

Explain that addressing all tobacco-related health disparities is important. However, because resources are limited, Wisconsin has prioritized populations of focus where the need and potential impact of tobacco are greatest.

Introduce these populations of focus; a brief video is available to describe tobacco-related health disparities within each population. Remind youth that though these videos feature adults, it’s important to remember that most of them started smoking as teens. If you only have time to show one video, the video on socioeconomic status on the next slide covers a variety of factors that have impacted populations experiencing health disparities

Internet access will be needed; videos should begin playing when clicked on the slide. If internet access is not available, describing each population of focus is still valuable.

Discussion Points:�

LGBTQ Video (3 minutes, 33 seconds)

People in the LGBTQ community may begin smoking as a way to cope with the stress of coming out, stigma, isolation, discrimination, etc.
“It looks like they [the tobacco industry] care about us” because they sponsor LGBTQ events and have ads in LGBTQ magazines
LGBTQ youth smoke up to 2x as much as heterosexual youth

Video credit: Truth Initiative, Tobacco Control in LGBT Communities, https://youtu.be/m8d9LwPnGzg

Race and/or Ethnicity Video (5 minutes, 23 seconds)

People within racial and ethnic minority groups may begin smoking as a way to cope with the stress of discrimination and marginalization and/or because it has been normalized by the predatory marketing tactics of tobacco companies.
In Wisconsin from 2012-2014, African Americans smoked at much higher rates (32%) than the general population (19%) and smoking related disease mortality is significantly higher in African Americans than other racial/ethnic groups.
Nationally, Native American high school students have the highest smoking prevalence of all racial/ethnic groups, at 25%. In comparison, 16% of high school students smoke overall.
Hispanic/Latino adults in Wisconsin smoke at slightly higher rates (22%) than the general population (19%), according to 2012-2014 survey data.
Research on tobacco prevalence within vulnerable populations is limited. A vulnerable population is a group of people who are marginalized in some way. They typically have less power than the majority of their peers, language and/or cultural differences, and limited access to resources and health care. One example is Asian Americans; although there isn’t much data on their tobacco use rates there is a need for this population to be supported by tobacco prevention resources.

Video credit: BlackLives / BlackLungs, Introducing: Black Lives / Black Lungs, https://youtu.be/DmaWcSj5rhk

Presenter note: If you are aware of additional videos or visual aids that would help illustrate these concepts please utilize them and share them with FACT Staff so we can add them to our library of resources.

Data Source: Tobacco-Related Disparities Stat Shot (2015), http://tobwis.org/files/download_file/47a3866bd556827�

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Populations of Focus

Behavioral Health�Our emotional, psychological, and social well-being, as well as prevention and intervention efforts for substance abuse or addiction. ��Socioeconomic Status�Used to describe the level of education a person has achieved, how much money their family earns and the type of work that they do.

Introduce these populations of focus; a brief video is available to describe tobacco-related health disparities within each population. Remind youth that though these videos feature adults, it’s important to remember that most of them started smoking as teens. If you only have time to show one video, the video on socioeconomic status covers a variety of factors that have impacted populations experiencing health disparities

Internet access will be needed; videos should begin playing when clicked on the slide. If internet access is not available, describing each population of focus is still valuable.

Discussion Points:�

Behavioral Health Video (1 minute, 19 seconds)

People with behavioral health issues may begin smoking to self medicate hoping it will help them feel more relaxed or happy
1 out of every 3 people with behavioral health issues smoke
Nearly 1/3 of all cigarettes smoked are smoked by adults with behavioral health issues

Video credit: CDC Tips From Former Smokers, https://youtu.be/XCibiAnJ6Ts��Socioeconomic Status Video (4 minutes, 33 seconds)

Although this video is from California, is it relevant to Wisconsin, too? How so?�(Yes, different communities and populations in Wisconsin also have different resources available to them)
What sorts of things effect the resources and opportunities that people have available to them?�(The neighborhood you live in, access to healthy options, job opportunities, community safety, education inequalities, discrimination, local policies, etc…)
People of low SES may begin smoking to help them cope with the stress of limited resources (money, food, shelter, etc.)
About 18% of adults above the poverty line smoke, while 29% below the poverty line do in comparison
Only 5% of college graduates smoke compared to 33% of people who haven’t graduated high school
70% to 80% of homeless adults in the U.S. smoke

Video credit: The California Endowment, http://www.calendow.org/huffington-post-building-healthy-communities-to-change-the-odds/

Presenter note: If you are aware of additional videos or visual aids that would help illustrate these concepts please utilize them and share them with FACT Staff so we can add them to our library of resources.

Data Source: Tobacco-Related Disparities Stat Shot (2015), http://tobwis.org/files/download_file/47a3866bd556827�

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Equality vs. Equity

Health Equality�When all people receive the same amount of support to help them become healthy�

Health Equity�When all people become healthy no matter how much support they need to get there

Image Credit: Saskatoon Health Region Advancing Health Equity

Transition: We’ve talked about how toxic stress can increase the likelihood that a person will try unhealthy ways to cope. We’ve learned that this can lead to lifelong health problems. Now we’re going to talk about a broader range of factors that can influence the health of our community.��Concept introduction: Introduce the concepts of health equity and health equality.

Optional: Write the definitions on a white board or provide them on a handout so the youth can refer to them later. �

Discussion questions:

How does this image illustrate these two concepts? �(Apples symbolize health, boxes symbolize support, people started out with different levels of health, additional support when needed can help create equity)
Does equity mean the same thing as equality?�(No, equality is illustrated by everyone having the same amount of boxes/support)
How might this be relevant to tobacco prevention?�(Not everyone is impacted by tobacco the same way; some sub-groups of the population are impacted more than others)

Example: If one person has a scratch and another has a broken arm, a Band-Aid wouldn't be the right amount of support for both of them. The Band-Aid will be enough for the person with the scratch, but the person with a broken arm will need to see a doctor, get an x-ray and have a cast put on their arm to receive the right amount of support to get healthy again. Every person’s circumstances are different.

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What could we do to decrease �tobacco-related disparities?

This is a big, open-ended question. Youth may need some additional guidance from the Advisor to frame possibilities based on community needs, resources available and potential partnerships.

If they need help getting started, prompt them with examples:

Meeting with key school staff members to tell them about FACT’s role in addressing tobacco-related health disparities and hearing the staff member’s insights regarding how to better reach the focus populations within their school
Partnering with local organizations that serve the focus populations
Increasing the accessibility of this group’s FACT meetings so that more youth from the focus populations feel comfortable joining and are able to participate

The “Recommendations for Increasing Health Equity” resource will provide more details about options like these, but if the youth come up with a totally new idea that could work, that’s awesome! FACT Staff should be included in the development of any custom ideas.