Healthy Chicago 2.0: Addressing Disparities in Vulnerable Populations

To transform the health of its city, the Chicago Department of Public Health (CDPH) in 2011 created a 4-year public health agenda known as Healthy Chicago aimed at improving health and addressing disparities. The agenda focuses on 12 key priorities, including tobacco use, obesity prevention, HIV prevention, access to care, healthy mothers and babies, and violence prevention, all of which reflect areas represented by the Healthy People 2020 Leading Health Indicators.¹ As a result of Healthy Chicago, key indicators have moved in a positive direction; however, health disparities persist. To reduce these remaining disparities and build greater health equity, CDPH recently completed a citywide community health assessment and is now developing a new, updated health improvement plan, known as Healthy Chicago 2.0.² In addition, CDPH has implemented the Healthy Chicago Survey to gather information from Chicagoans to estimate health behaviors, disease prevalence, and access to and utilization of health care services to monitor progress of the Healthy Chicago strategic plan.³ These activities will assist CDPH as it works to improve the health of Chicago residents. 

Healthy Chicago 2.0 focuses on health equity to address disparities and inequities among vulnerable populations. One vulnerable population identified in the health assessment encompasses the lesbian, gay, bisexual, and transgender (LGBT) communities. As a supplement to Healthy Chicago, CDPH created the LGBT Community Action Plan, which identifies ways to address increased rates of tobacco use, obesity, HIV, and other health concerns within Chicago’s LGBT communities. The plan outlines 22 strategies to improve the overall health of LGBT communities.⁴

Based on data for 2009–2010, LGBT adult tobacco use in the U.S. was 40% higher than that of heterosexuals.⁵ While data are limited globally, similar disparities appear to be present in population-based surveys in some other countries (e.g., England⁶ and Mexico⁷). Although data on the reasons for these disparities continue to emerge,⁸ researchers have proposed several explanations: historic exposure to community spaces^9,10 and media^11–13 where smoking was normative; targeted marketing by the tobacco industry;^14–16 pro-tobacco community norms;^17,18 and the impacts of stigma, discrimination, and stress.^8,19

Given these disparities in tobacco use, CDPH has implemented a number of activities aimed at reducing tobacco use among LGBT communities in Chicago. As part of these efforts, CDPH implemented a targeted advertising campaign aimed at the LGBT community—specifically targeting queer women of color ages 20 to 50. The term “queer” was selected over “LGBT” for the campaign design and implementation process to indicate a more inclusive group. In 2013, CDPH engaged an advertising agency with experience marketing in LGBT, queer, and African American communities. Members of the LGBT Health Advisory Council, a council that provides input to CDPH on implementation of the LGBT Community Action Plan, identified organizations to host focus groups and encouraged residents to participate. Based on focus group findings, the campaign was revised. Census data determined locations where the ad campaign would have the greatest impact in the targeted population.  

In addition to designing this campaign, CDPH hosted a series of town halls focused on menthol cigarettes and youth. Local LGBT organizations were invited to participate in the town halls, one of which was hosted by the local LGBT Community Center. The launch of the campaign coincided with the release of CDPH’s report on the outcome of the town hall meetings [PDF – 2.4 MB], which included recommendations to help increase tobacco cessation and prevention efforts. The campaign and the report release built momentum toward adopting a series of tobacco control interventions—including increasing the city’s taxes on cigarettes (resulting in Chicago having the highest tax rate in the nation), banning the sale of menthol and other flavored tobacco products within 500 feet of schools, and including electronic cigarettes in Chicago’s local Clean Indoor Air Act.

Though data on smoking rates since these interventions, including the ad campaign, were implemented are not yet available, the city has seen a dramatic decline in overall cigarette smoking since Healthy Chicago was first implemented in 2011. According to the Youth Risk Behavior Surveillance System, 10.7% of Chicago students in grades 9–12 smoked cigarettes in 2014—a historic low for the City and 32% below the national average. Additionally, 17.7% of Chicago adults reported smoking in 2013—another historic low.  

There is still work to be done. CDPH is working on making data on LGBT youth health available, showing disparities continuing to challenge these communities. Specific to smoking, the data will show that although youth overall have seen a steep decline in smoking rates, LGBT youth rates remain relatively stable, resulting in a growing disparity. These data will be used as part of CDPH’s Healthy Chicago 2.0 planning process, determining additional steps for the department and partners to take to address LGBT smoking.