Tobacco Policies and Alcohol Sponsorship at Lesbian, Gay, Bisexual, and Transgender Pride Festivals: Time for Intervention

Members of lesbian, gay, bisexual, and transgender (LGBT) communities have higher rates of tobacco use and alcohol abuse than their non-LGBT counterparts.¹ Both alcohol and tobacco use represent forms of substance use with substantial costs to the US economy, to population health, and to LGBT lives. Smoking and excessive alcohol consumption cause more than half a million premature deaths each year in the United States. These substances vary considerably in their regulation by government, use, abuse, and consequences. However, disproportionate tobacco and alcohol use among LGBT people has been linked to some common factors, including experiences with stigma and discrimination on the basis of sexual orientation and gender identity.

Although the role of stigma and psychosocial stressors is important, these disparities should also be viewed in the context of industry marketing to promote the use of tobacco and alcohol products. Such marketing includes targeted advertising, corporate sponsorships (although tobacco industry sponsorship is not allowed under the Family Smoking Prevention and Tobacco Control Act of 2009), and efforts to undermine public policies that reduce consumption of these products.^2,3 Because tobacco and alcohol companies often focus on marginalized groups, LGBT people of color may be more aggressively targeted in multiple ways on the basis of their intersecting identities. Even such factors as permissive norms toward tobacco and alcohol in community spaces may themselves be driven by industry marketing.⁴ One space that serves as the nexus between LGBT identity, community, and norms is the pride parade and festival. Pride events have played an important role in LGBT efforts to gain recognition and acceptance,⁵ and in 2016 there were more than 900 such events globally.⁶

OUTING A PROBLEM WITH DATA

To assess pride event policies about tobacco and alcohol, we identified the 100 most populous cities in the 2010 decennial census and then identified pride events in those cities through systematic searching. Birmingham, Alabama, was the smallest city included (population 212 038). We then cross-referenced this list of pride events with Center for Black Equity and InterPride event directories.

Two independent coders examined each pride event’s Web site for the presence of a written policy about tobacco use, if the pride event was tobacco-free (i.e., tobacco use was not allowed anywhere on festival grounds) or smoke-free (i.e., combustible tobacco products were not allowed anywhere on the festival grounds), if sponsors were listed on the Web site, and if the sponsors included alcohol brands or companies. Alcohol brands or companies were recorded, as were notes on the policy. In the absence of clear written Web site policies, the first author contacted the pride event organizer via e-mail or Facebook to inquire about policies. We searched Web sites and contacted pride festivals between February and April 2017. We also used a December 2016 discussion on the e-mail list for LGBT HealthLink (a Centers for Disease Control and Prevention–funded tobacco and cancer disparity network) about smoke-free pride events to identify policies. We coded pride events with no mention of tobacco policies on their public Web pages and who did not respond to the query as having no policy.

In the 100 selected cities, we identified 103 pride events, but only included the 100 events that had 2016 or later Web activity (Table A, available as a supplement to the online version of this article at http://www.ajph.org). There were eight pride events with a smoke-free policy (8%). Of note, six events indicated that their smoke-free policies were because of a municipal ordinance or smoke-free park policy. There were three pride events with a tobacco-free policy (3%). Most pride Web sites listed their sponsors (71%); of those, there were 43 pride events (61%) with evidence of alcohol industry sponsorship. The two most common alcohol sponsors were E. & J. Gallo Winery (under their Barefoot Wine & Bubbly brand) and AB InBev (under their Bud Light brand).

These results indicate that festivalgoers at pride festivals have few protections from involuntary smoking. Very few events have tobacco-free or smoke-free policies, and of the events that do, the policies are largely the byproduct of municipal smoke-free park or public space ordinances. Almost half of these events show online evidence of alcohol industry marketing, and this is likely an undercount as not all pride events listed their sponsors online.

There are limitations to our inquiry. In-person data collection could provide more information about policy implementation on the ground as well as compliance with policies than Web site searches. Partial policies (e.g., a smoke-free section) are not captured in our data. Some events may have policies that do not appear online. However, we also contacted pride event staff and utilized a network of LGBT cancer and tobacco-control advocates to identify policies.

INTERVENING FOR EQUALITY

LGBT pride events have the potential to be a critical part of efforts to promote health and wellness among communities that experience substantial substance use and abuse disparities. Pride events can highlight community norms, convey messages about what is appropriate to newly out members of LGBT communities, and have played an important role in community organizing.⁵ In many cases, pride events have become family friendly with children present.⁵

Smoke-free park advocates should be proud—our findings about the limited policies in place at pride events highlight that there are unanticipated benefits from smoke-free park ordinances. Many pride events are held in public parks, and a substantial number of smoke-free policies at pride events are the result of the growing smoke-free park movement. Advocates for LGBT health should consider supporting smoke-free and tobacco-free park efforts.

Although messages about sexual health promotion are common at LGBT pride events, there are few events that have policies promoting health in other areas. There is substantial room for improvement in efforts by LGBT communities, public health practitioners, and pride festival organizers to address persistent health challenges that are marketed to LGBT communities.

Given the normative nature of alcohol use, it will be challenging to reduce and eliminate alcohol sponsorship in the near term. Nonetheless, we believe it is critical to renew a conversation about critically appraising the marketing efforts of industries that sell products that disproportionately target and harm LGBT communities and communities of color. Although targeted marketing is a standard practice, it is cause for concern when such marketing has potential to exacerbate health inequalities and undermine efforts to build policy support to improve health.^2,4 Laurie Drabble offered some of the first work on this in 2000. She called on LGBT organizations to (1) adopt written rules about accepting funds from alcohol, tobacco, and pharmaceutical companies; (2) ensure best practices in alcohol control were implemented in beverage service at affiliated events; and (3) ensure that alcohol- and tobacco-free events are available for youths.² Pride festival organizers can find technical assistance from organizations such as LGBT HealthLink and state departments of health.

As health officials seek to ensure equitable coverage of tobacco-free policies and address alcohol abuse inequalities, efforts to promote policy changes at pride events are warranted. State and local health departments should continue to reach out and engage with LGBT communities about ways to promote healthier communities. Tobacco and alcohol control programs should consider participating in pride events as well as ensuring that data on LGBT health inequalities are available to community leaders. Advocates for LGBT health should build support within LGBT communities for the role of public health policies in promoting social justice,³ including addressing normalization⁷ and marketing of cancer-causing products by for-profit industries.