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Opinion

New York Must End the Sale of Menthol Cigarettes and Protect LGBTQ Lives


State Senator Brad Hoylman-Sigal (photo: @bradhoylman)


For decades, Big Tobacco companies like R.J. Reynolds have insidiously pushed menthol cigarettes onto our most vulnerable communities, perhaps most infamously with Black Americans. Menthol cigarettes are mint-flavored and highly addictive because they soothe the throat and mask the harshness of regular cigarettes. As a result of tenacious advertising and marketing campaigns, today 85% of all Black smokers smoke menthols compared to just 29% of whites. 

What is less known, however, is that in the 1990s Big Tobacco companies began targeting queer communities with menthol-flavored products as well. On the heels of the AIDS epidemic that took the lives of a hundred thousand LGBTQ+ men, Big Tobacco sought to take advantage of the emerging LGBTQ+ market and started directly marketing towards the communities. Masquerading as allies, Big Tobacco companies  advertised at pride festivals and other LGBTQ+ community events and even contributed financially to local and national LGBTQ+ and HIV/AIDS organizations. Internally, R.J. Reynolds’ marketing campaign was called “Project SCUM” (Sub-Culture Urban Marketing), showing us how they really feel about the queer people they’re profiting from.

As with communities of color, Big Tobacco’s advertising machine paid off. Smoking rates are generally higher in the LGBTQ+ communities: 1 in 6 LGBTQ+ adults smoke cigarettes, compared to about 1 in 8 non-LGBTQ+ adults. Even more worrisome are the smoking rates among LGBTQ+ youth. In 2021, 17.4% of LGBTQ high school students used tobacco products, compared with just 11.4% of their cis-heterosexual peers. 

Menthol-flavored products are more prevalent in our communities as well: 36 percent of LGBTQ+ smokers report smoking menthol cigarettes, compared to 29 percent of non-LGBTQ+ smokers. Much of this data comes from the 2009-2010 National Adult Tobacco Survey, the last major effort to research LGTBQ+ tobacco use. Many health experts theorize that the numbers may be even higher since many people may not have been out at the time. 

Big Tobacco is using the same playbook to kill LGBTQ+ folks as they have done for decades with the Black and Latino communities. By banning menthol-flavored products in New York State, as proposed in Governor Hocul’s executive budget and our bill S2441/A3907, we’d go a long way to stopping thousands of people from smoking and thousands more from even picking up the habit in the first place. 

Big Tobacco, of course, isn’t going down easy – while profiting off the harm of communities of color and LGBTQ+ communities, both groups with a difficult history with policing, they’ve spread misinformation about local law enforcement’s role in enforcing the proposed menthol ban. 

Let’s be clear: our bill explicitly prohibits the NYPD or any local law enforcement agency to make arrests for unregulated individual purchase, use, or possession of any kind of cigarette – just as they do now with flavored e-cigarettes. To avoid adding police presence to already overpoliced communities, we will only pass a bill that makes the lack of law enforcement crystal clear. Big Tobacco’s most recent misinformation campaign that says otherwise is just one more example of how low they will stoop to keep their profits up. 

In the last century, the government callously ignored a major health crisis in queer communities by turning a blind eye to the AIDS epidemic. But today, while 13,000 Americans die from AIDS each year, more than 700,000 die from smoking-related deaths. We must end this needless suffering. It’s time to ban menthol and protect thousands of LGBTQ+ New Yorkers from the greed of predatory tobacco companies. 

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Dr. Scout is the Executive Director of the National LGBT Cancer Network and the principal investigator of both the CDC-funded LGBTQ tobacco-related cancer disparity network and Out: The National Cancer Survey. Brad Hoylman-Sigal is a Democratic State Senator from Manhattan. On Twitter @scoutout & @cancerLGBT & @bradhoylman.

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New Yorkers Deserve Health Equity; Fully Funding Safety Net Hospitals and Expanding Health Insurance to All is How To Do It


Advocates rally for the Coverage for All bill in Albany (photo: Daniel Altschuler/@altochulo)


After the last three years, New York’s health care system continues to face an unprecedented crisis – particularly for safety net hospitals located in historically marginalized communities that primarily serve uninsured patients struggling to access care. These are the same low-income neighborhoods that bore the brunt of COVID-19 and have long suffered from the effects of New York’s two-tiered health care system. To reduce health inequities, the State must fix the structures that perpetuate them.

In many underserved communities, safety nets are the only hospitals that render care regardless of a patient’s financial situation or immigration status. These anchor institutions operate on far fewer resources than other hospitals and against the backdrop of inadequate Medicaid reimbursement rates that haven’t been updated since 2008. At the same time, our State’s undocumented community has long suffered from our unequal healthcare system, even before the pandemic. We all witnessed what the public health crisis did to our community of immigrant New Yorkers who braved the frontlines to keep New York running.

In the face of rising health care costs and uncertain economic headwinds, the State’s current reimbursement model for safety net hospitals is unsustainable, made even more so by Governor Kathy Hochul’s proposed budget, which would cut $700 million in funding. Despite near-uniform agreement that these hospitals provide vital resources and necessary care for vulnerable New Yorkers, chronic Medicaid underfunding has left them to grapple with deep negative operating margins and face hard choices about services and capacity, adversely affecting the communities they care for.

Last year, the Governor also promised to access federal funding to extend health insurance to undocumented New Yorkers but has yet to do so. The consequences of inaction for low-income and undocumented communities are dire. Denying safety net hospitals adequate funding puts millions of lives at risk because of poor health outcomes and places a significant financial burden on our already beleaguered health care system. Leaving federal funds on the table that could cover health insurance for immigrant New Yorkers is also a significant lost opportunity. Why would we turn down federal funding that could provide lifesaving coverage at no cost to the State?

New York has long been recognized as the home to some of the nation’s premier hospitals and health care facilities. We have produced groundbreaking research and treatments, and we have realized the positive impact that extending health insurance has had on patients and hospitals alike. The challenges posed by our current health care crisis present another opportunity for New York to lead the way by improving coverage and care while creating equitable outcomes.

But there are viable solutions that legislators have introduced to help New York achieve those goals.

First, the Health Equity Stabilization and Transformation Act would allow the State to leverage a larger share of federal Medicaid funds, ensuring that safety net hospitals receive adequate reimbursement rates to finally address the Medicaid gap that has plagued hospitals serving underserved communities. By shoring up the finances of safety net hospitals, we can guarantee they can continue to operate in the short term while strengthening their long-term viability.

Second, the Coverage for All legislation would extend a lifeline to an estimated 255,000 uninsured New Yorkers currently excluded from federally-funded health insurance such as Medicaid and the Essential Plan because of their immigration status. While immigrants comprise 54% of New York’s frontline workforce and are invaluable contributors to our economy, many have been deliberately denied access to New York’s health care system. If we’ve learned anything from the pandemic, it’s that our communities are stronger and healthier when everyone has equal access to lifesaving health insurance and care.

As both chambers of the Legislature have proposed, the State should include Coverage for All in the Fiscal Year 2024 budget to expand the Essential Plan to all low-income New Yorkers, regardless of immigration status, bringing us one step closer to guaranteeing health coverage for all. By amending the Federal 1332 Waiver request to include all immigrants regardless of immigration status, which would have zero cost to the state, it would enable the State to use the estimated $2 billion “passthrough” surplus to provide comprehensive coverage for all eligible low-income people through the Essential Plan. 

If enacted, these solutions would profoundly impact the health of low-income communities, advance racial equity, and better prepare us for future public health emergencies. If the pandemic has taught us anything, it’s that access to quality health care is critically linked to so many aspects of our society. Now more than ever, it is essential that Governor Hochul and State policymakers fully fund our safety net hospitals, expand health insurance to all immigrants, and guarantee everyone in need has access to quality care. Doing so would benefit our fellow New Yorkers’ health and well-being and our health care system as a whole.

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Ramon Rodriguez is the President & CEO of Wyckoff Heights Medical Center in Brooklyn and Co-Chair of the New York Safety Net Hospital Coalition. Theo Oshiro is the Co-Executive Director of Make the Road NY. On Twitter @MaketheRoadNY.

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Navigating a Better Path Forward on Mental Health


Outreach in the subways (photo: Michael Appleton/Mayor's Office)


Every day on the Lower East Side and throughout the city, teams of dedicated, trained outreach workers walk the streets, searching out folks who seem like they may need a helping hand.

Perhaps the people they meet are unhoused and would benefit from a hot meal, fresh clothes, or a medical check-up. Maybe they display signs of mental health issues but don’t know how or where to find the right services that would steer them away from harming themselves or others. Or perhaps they simply need a human connection.

Through proven methods, their own lived experiences, and endless reserves of patience and perseverance, these outreach experts help those who may be in crisis navigate the maze of social service agencies and programs. The end goal is as simple as it is essential: to connect people to voluntary services and support to help them flourish.

This “navigator” model has shown great success in the past, and represents a refreshing break from a failed status quo that has time and time again failed to provide a meaningful solution to our communities’ needs. For far too long, the default response to addressing unhoused people struggling with mental health or substance use challenges has been the criminal legal system — so much so that, in 2020, one in five people sent to Rikers was unhoused and experiencing mental health challenges.

But this isn’t a case of applying a band-aid to a gaping open wound, to use a common analogy: it's actually the equivalent of ripping open a deep laceration even wider. These individuals — so often our neighbors, our relatives, our friends — don't need jail; they need treatment, hospitals, and supportive programs. By tossing them into a carceral system that is incapable of addressing the root of these problems, their struggles and conditions will only worsen. To ignore their needs is to condemn people to an endless doom spiral between the streets, shelters, and incarceration that can – and has – resulted in catastrophic tragedy for themselves, or innocent bystanders around them.

Thankfully, there is a better way to dramatically improve — and often save — countless lives, and it's now getting a huge shot in the arm. A new program launched through the Criminal Justice Investment Initiative (CJII) will invest $6 million in a mental health initiative to immediately reach New Yorkers with deeply entrenched needs. The plan deploys networks of navigators like the ones described above who will build relationships – and trust – with people where they are. A rapport is first established by connecting people living on the streets with immediate needs, such as food. Growing the relationship leads to the next round of healthy support and engagement: connecting people to a wider range of wraparound services, like housing assistance and treatment for mental health and substance use disorders. This progression of engagement, fueled by emerging trust, ultimately makes them and their neighbors safer.

This effort, operated in a pioneering partnership between CUNY’s Institute for State and Local Governance and the Manhattan District Attorney’s Office, will build on the promising successes of similar past work. In a previous CJII program, created in partnership with the Silberman School of Social Work at Hunter College, community navigators in East Harlem were able to connect with more than 1,880 clients from late 2017 through August 2021. Navigators gave 68% of participants at least one referral, and among those people, 90% accessed one or more of these services referred to them. Since the program’s inception, 61% of participants had some or all of their immediate needs met.

Most promisingly, 39% of those who utilized services through fresh outreach had been disengaged from social services for at least six months prior to enrollment in the program — suggesting a powerful ability to connect with people who may have previously given up on seeking help. One participant noted that she “didn’t feel alone anymore” because she had a Navigator supporting her. 

This groundbreaking outreach also corrects a racial imbalance that infects our shattered criminal legal and health care systems. More than 60% of those incarcerated in New York City jails are Black, as are 56% of heads of household in city shelters (including single adults), even though Black people comprise just 25% of the city’s total population. Quite simply, a path forward to a brighter, healthy, more fulfilling future exists for people who right now are swept aside to the margins of society.

This approach is a vast improvement over the status quo. Rikers is no place for someone grappling with mental health or substance use issues; the notorious facility has descended into chaos and violence, and offers inadequate support for those in need. New York City must reduce its reliance on criminalization, and instead invest in services and programs that build safe communities and center humanity.

In addition to the moral and human value, there is an economic benefit to using community-based supports in lieu of incarceration. At a time when cities and states are experiencing budget crunches, the cost for community-based programs are exponentially lower than a bed at Rikers, ranging from $1,000 for some light-touch interventions to $50,000 for more intensive services per person, compared to more than $550,000 per year per person at Rikers.

But more importantly, there is no price tag that can be applied to turning a person’s life around — or saving it. The value of connecting people with touchpoints in their community can’t be

measured on a ledger sheet or in a budget book. Neighborhoods like the Lower East Side — and the others served by this trailblazing program—will be safer, healthier and more productive. And this is how we build a New York City that lifts up all its people, and gives everyone, no matter the challenges they face, the opportunity to live the life they deserve.

Michael P. Jacobson is Executive Director of CUNY’s Institute for State and Local Governance. City Council Member Carlina Rivera represents District 2 in Manhattan and chairs the Council’s Criminal Justice Committee. On Twitter @michaelislg & @CarlinaRivera.

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