Dr. Jennifer Slovis serves as the medical director of the Kaiser Permanente Multi-Specialty Transitions Clinic at the Oakland Medical Center, a comprehensive care specialty clinic serving gender diverse people in Northern California since 2013. She is a physician leader in LGBTQ health care at Kaiser Permanente and is an associate clinical professor in the Department of Family and Community Medicine at the University of California, San Francisco.
Tell us about smoking rates at Kaiser Permanente, among members and among LGBTQ members.
Nationally, smoking rates are at 17 percent. In California, the rate is about 11 percent. And at Kaiser Permanente in Northern California, those rates are at 7 percent. That’s huge. It’s something we’re very proud of. We look at supporting people to quit smoking as our No. 1 priority. But in the LGBTQ population the rate is higher.
Why are LGBTQ people more likely to smoke?
The CDC has identified the LGBTQ population as underserved in terms of health disparities, including access to medical care and health information. One of the most striking pieces of information from a 2016 survey is that this community is twice as likely as members of the straight community to engage in smoking. There are several reasons. One, many people say they smoke to relieve stress. Not surprising, given the LGBTQ community has a long and persistent history of discrimination and harassment, including in the health care setting. Two, historically there have been limited LGBTQ welcoming “safe spaces” where members of the LGBTQ community could socialize together. We tend to see more smoking, and exposure to second-hand smoke, in bars and clubs. And three, the LGBTQ and other vulnerable communities are, unfortunately, aggressively targeted by the tobacco industry. Tobacco companies may act as an ally to the LGBTQ community by sponsoring Pride festivals and raising money for HIV/AIDS organizations, but the friendship is not real.
What resources are available to help people quit smoking?
It’s embedded in everything we do at Kaiser Permanente. From the first visit, we ask people if they smoke, just like we take vital signs like blood pressure. If the answer is yes, we start a conversation and meet people where they are. We have web-based programs, health coaching, behavioral interventions, classes, as well as cessation aids and medication to lower cravings. We know that every person is different and it is important to have a wide range of options to help them successfully quit.
What are best practices for quitting smoking that KP has demonstrated?
We identify who smokers via several means, including member surveys and during office visits. We ask about smoking at almost every visit, in different departments all over the medical center — it is that important to us. After identification, we review and follow up with our smokers to support their efforts to quit. We ensure they aren’t left to go through the process alone. We connect them with our smoking cessation programs and interventions.
How does KP reach out to communities with health disparities to encourage people to quit smoking?
One of the main things to think about is “Who are the folks with health disparities?” We didn’t necessarily learn this in medical school. Within Kaiser Permanente, many organizations, medical providers, and employees get together regularly to determine how to deliver the best care to underserved communities, including our LGBTQ members. We educate our providers and staff how to give culturally appropriate and responsive care. We engage with the LGBTQ community and participate in Pride festivals and local LGBTQ community center events. Many of our providers have office posters stating “you are in a safe place” and demonstrate their commitment to LGBTQ patients by wearing rainbow pins or providing links to LGBTQ health resources on their provider information sites. Our efforts to engage our LGBTQ members is receiving national attention. The Human Rights Campaign has given Kaiser Permanente a perfect 100 percent for the last 13 years in its annual scorecard of LGBTQ inclusion in health care.
Can vaping help people quit smoking? Aren’t those lung injuries only from black market vaporizers?
Seven million adults and 3.6 million children in middle and high schools are vaping, according to 2019 statistics from the CDC. That is really scary. And we are not seeing that people who vape smoke less; in fact, many vapers also smoke regular cigarettes. Kaiser Permanente never endorsed vaping as a cessation technique. We didn’t fall for the tobacco industry’s slick marketing. Vaping is targeting a new and younger generation to get hooked on smoking. Lung disease is associated with all brands of vaping, not just black-market cartridges.
What are some benefits of quitting smoking that are not common knowledge?
I’d like to think the smoking-heart disease link is common knowledge. I’d also like to think that the majority of people know about the dangers of smoking and lung disease. But did you also know that smoking is linked to premature births and miscarriages? And there are also second-hand risks. Asthmatics who smoke have a greater susceptibility to respiratory infections, and this is even worse for asthmatic children who inhale second-hand smoke. The World Health Organization says that if someone stops smoking, their blood pressure goes down within 20 minutes. Coughs and shortness of breath can improve within a few weeks to months. And, if you can quit for 10 to 15 years, the health risks drop to as if you never smoked in the first place. Whether someone has just started or has smoked a long time, it’s never too late to quit.
Kaiser Permanente, kp.org