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Affirmation improves outcomes for Trans people

There is an overwhelming & growing evidence trans lives are improved via affirmation, access to medical care, and freedom from discrimination



Pictured are Elijah, a Black transgender model, advocate, & LA Blade columnist Rose Montoya (Photo by Rosalynne Montoya)

By Brynn Tannehill | FAIRFAX COUNTY, Va. – There is an overwhelming and still growing body of evidence that trans lives are improved via affirmation, access to medical care, and freedom from discrimination. The latest piece of which came from a large sample study (n = 11,914) of trans people between the ages of 11 and 24 using data collected by The Trevor Project and published in the Journal of Adolescent Health

This study found that almost half of the cohort wanted access to Gender Affirming Hormone Therapy (GAHT) but were unable to access it. It also found that the depression was significantly lower among those with access to GAHT. Most importantly, GAHT was also correlated with a 40% reduction in reported suicide attempts by youth under 18. Other recent studies, including one with an even larger sample (n = 20,619), found that access to GAHT in trans youth significantly improved mental wellbeing. Other qualitative studies have shown that deliberately withholding GAHT can cause intense distress

Similarly, there is a body of evidence that access to surgical care reduces distress and improves outcomes, both for trans masculine and trans feminine individuals. In 2018, Cornell University conducted a comprehensive lit review of studies from 1991 to 2017 on the effects of transition on well-being. They showed that 93% found positive results, 7% had mixed or null outcomes, and none found a negative effect. 

Similarly, a comprehensive review of studies on surgical regret rates found that only 1% of trans people regretted gender affirming surgery. This meta-study also found that the most common reasons for regret were being mistreated after transition, followed by poor surgical outcomes. Overall, this 1% figure is extremely low compared to the 14% regret rate among the general population for all surgeries (based on a meta-study of 889 prior studies on general surgical regret).   

Another key component of reducing risk for trans people (and trans youth in particular) is affirmation and support. One 2016 study showed that mental health among pre-pubertal trans youth who were supported by their parents was statistically no different than their cisgender peers. Another study of young trans feminine adults found that having supportive mothers reduced the probability of having suicidal ideation by 63%.  Another study of young trans people in Ontario found that having affirming parents dramatically improved mental health and reduced suicidal thoughts.

Conversely, lack of support by parents is associated with greater risk of suicide attempts, low self-esteem, and homelessness. Putting trans people in conversion therapy is particularly deadly. A 2020 study of trans adults who had been subjected to conversion therapy as youth found that the victims had double the lifetime risk of suicide attempts, regardless of whether the conversion therapy was religious or secular. 

No reputable organizations, articles, Journals, doctors, or medical health professionals provide evidence for the efficacy of conversion therapy on trans people. Major professional organizations such as the American Medical Association, American Psychiatric Association, American Academy of Pediatrics, and the American Psychological Association universally oppose conversion therapy efforts on transgender people because there’s no evidence for their efficacy, and there’s clear evidence of harm.

Trans people suffer from poorer mental health outcomes in great part due to stigma, discrimination, violence, shame, negative media portrayals, and a cluster of other factors collectively known as minority stress. There is clear evidence to suggest that affirmation by friends and family greatly reduces these factors. So does access to medical care, which allows trans people to both “pass” as cisgender (and stop being treated in public as transgender), and for their mental self-image to more closely match their physical body. 

The counter arguments to this are politically, ideologically, and religiously driven based on cherry-picked evidence, deliberate misinterpretation of studies, false appeals to authority, glaring omissions of counterfactual information, and false assumptions. No better recent example of this can be found than a recent Washington Times article by Tim Constantine. He makes the claim that because trans people have worse mental outcomes than the public, they should be shamed, discriminated against, and denied health care until they get some unspecified conversion therapy and go back into the closet.

Among the many errors, falsehoods, and omissions used in support of this conclusion:

  • He claims that transgender people are trans because they have greater psychological comorbidities (depression, anxiety, etc…). However, this ignores that the evidence shows that shame, stigma and discrimination result in transgender people being mistreated, and suffering high rates of PTSD. Constantine ignores the rule that correlation is not causation. The same logic would lead to a belief that John McCain was a POW because he had PTSD, and not the other way around. This is an example of the questionable cause logical fallacy.
  • He cites Paul McHugh as an “expert” on trans issues, without noting that he’s 90 years old, retired, has never written a journal article on trans people, has not worked clinically in decades, and is a radical Catholic anti-abortion and anti-LGBT activist who promotes conversion therapy. Nor does Constantine mention that McHugh’s own university has repudiated his work years ago. This is the logical fallacy known as an appeal to false authority.
  • He cites the Diagnostic and Statistical Manual (DSM) to claim that Gender Dysphoria is a mental illness, to imply that all transgender people are mentally ill. Constantine deliberately omitted several things that counter this conclusion, including the American Psychiatric Association’s (the body responsible for writing the DSM) own admonition in the DSM that, “Gender nonconformity is not in itself a mental disorder. The critical element of gender dysphoria is the presence of clinically significant distress associated with the condition.” In other words, a trans person who has transitioned and isn’t in distress over it anymore, isn’t de facto mentally ill, or even have a diagnosable condition. The article also ignores that the ICD-11 (International Classification of Diseases 11th Revision, published by the World Health Organization) removed gender identity disorder from its list of mental illnesses in 2019, and placed “gender incongruence” under sexual health. All in all, these are lies of omission.
  • Constantine cites the American College of Pediatrics as an authority on transgender health. First, he wrongly attributes their hate group designation to the defunct ThinkProgress (the Southern Poverty Law Center designated ACP as an anti-LGBT hate group in 2015). The article omits the fact that ACP is not an actual medical organization (like the American Academy of Pediatrics), but a small group of religiously conservative individuals masquerading as a medical organization to promote conversion therapy, oppose LGBTQ people adopting children, and attempting to link homosexuality with pedophilia. Again, Constantine has made an appeal to a false authority, while omitting crucial information about the authority he cites.
  • He refences the “Swedish study” to cast doubt on the efficacy of treatment and acceptance. Constantine omits many things about this, the most important of which is that it literally says in the study itself that, “It does not, however, address whether sex reassignment is an effective treatment or not,” because there was no control group. The Times article also omits the fact that the lead author of the study (Dr. Cecilia Dhejne) has gone on record stating her article can’t be used in exactly the way Constantine used it. He also omitted the fact that the 2011 study found no statistical difference in suicide rates between the public and people who transitioned after 1989.
  • Constantine implies that 70-80% of all transgender youth spontaneously stop being transgender. This is a misrepresentation of the literature, which in and of itself is flawed. “Desistance” as a theory was only meant to apply to pre-pubertal children, and it was developed in a period where a child who had any gender atypical interests or behaviors was regarded as trans under the old DSM-IV. Even the man who developed the desistance theory in the 1990’s (Kenneth Zucker) supported puberty blockers for trans youth who were still dysphoric at puberty, because he recognized they were highly unlikely to desist. 
  • He implies that conversion therapy is the best option, without a shred of evidence that it works (because there isn’t any), while ignoring the science showing that it does great harm. The government of Canada came to the same conclusion, and voted unanimously in Parliament and the House of Lords to ban the practice on LGBT people, virtually without exception.

The entire thesis of this article is that transgender people should only be marginally tolerated, and definitely-not accepted.  This lack of acceptance is for their own good of course. He provides no actual evidence that simply conversion therapy and stigmatizing trans people into the closet is what’s best for them based on the false assumption that closeted trans people have better outcomes than people that come out. Of course, we don’t collect data on completely closeted people.

Opposition to trans people is based on multiple burden of proof fallacies, also known as Russell’s Teapot. The burden of proof person making empirically unfalsifiable claims, rather than shifting the burden of disproof to others. Anti-trans campaigners claim that people who stay closeted are better off, and it can’t be falsified because they’re in the closet. They claim that conversion therapy is better, but don’t have any actual data to support this. 

They claim that the best thing for trans people and society is to not treat them as the gender with which they identify but can provide no evidence that making people miserable enough to go back in the closet improves their mental health. This is a bit like the 19th Century idea that if you simply threw enough buckets of cold water on people in a tiny cell, they would eventually regain their sanity. 

The evidence they do provide is based on cherry picking, gaping omissions, unfalsifiable assumptions, appeals to false authority, deliberately confusing cause and effect, and conclusions that violate Occam’s Razor (which postulates that of two competing theories, the simpler explanation of an entity is to be preferred.)

So, which hypothesis seems more likely to be the correct one:

a) Accepting and affirming trans people leads to better outcomes, based the advice of all the major medical and mental health professional organizations and decades of peer reviewed evidence? Or 

b) Conversion therapy and stigma to push trans people into the closet makes them happier, based the beliefs of religious individuals with no real qualifications using no direct evidence whatsoever.


Brynn Tannehill is a senior analyst at a Washington D.C. area think-tank, and is the author of “American Fascism: How the GOP is Subverting Democracy.”

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Where’s the LGBTQ+ outrage over Sen. Kyrsten Sinema?

LGBTQ people are still official second-class citizens without full equal rights & figured out long ago that there is no “both sides” fairness



Arizona Democratic U.S. Senator Krysten Sinema, speaking at the HRC National Dinner 2018 (Screenshot via HRC YouTube)

By Karen Ocamb | WEST HOLLYWOOD – I’ve been waiting and waiting but nothing. What the hell, Human Rights Campaign? Are we really OK with letting this hyper-flirty, bisexual nouveau conservative Democrat from Arizona continue to say she’s representing us while holding hands with Sen. Joe Manchin in crushing democracy?

Last October, when Arizona Democratic U.S. Senator Krysten Sinema found super infamy by fighting President Biden’s infrastructure spending bill and much of her Democratic Party’s call to end the procedural Senate filibuster, The Advocate cited criticism from Black gay New York Rep. Ritchie Torres.

There is a sense in which we no longer live in a democracy; we live under the tyranny of Kyrsten Sinema,” Torres told CNN. “I welcome the ideological diversity of the party. I can live with dissent. My colleagues and I have trouble living with what we perceive to be erraticism. The perception of erraticism is brought on by a lack of communication and clarity for where she stands.”

Last Thursday, Sinema gave a soap opera-choked up speech saying she would not vote to change the filibuster because “eliminating the 60-vote threshold will simply guarantee that we lose a critical tool that we need to safeguard our democracy from threats in the years to come.” First of all, the threat is here and now and the fact that she doesn’t get that makes her inept and craven. The ramifications are huge: without democracy, there is no access to justice. 

Secondly, as House Majority Whip James Clyburn told CNN on Sunday, Democrats are seeking a carveout to the filibuster to enable a simple majority to vote on fundamental principles like voting rights. 

When it comes to the Constitution of the United States of America, no one person sitting downtown in a spa ought to be able to pick up the telephone and say you are going to put a hold on my ability to vote. And that’s what’s going on here,” Clyburn told Jake Tapper. “So I would wish they would stop that foolishness because if we do not protect the vote with everything that we’ve got, we will not have a country to protect going forward.”

After Thursday’s speech – which she insultingly delivered as Biden was on his way to talk to lawmakers about the critical need to pass the Freedom to Vote Act and the John Lewis Voting Rights Advancement Act – MSNBC’s Joy Reid noted that Sinema’s rationale for defending the filibuster “is as inconsistent as it is immoral.” Sinema supported bypassing the filibuster just over a month ago “in order to raise the debt ceiling on a party-line vote. She doesn’t think Republicans should be allowed to damage America’s credit, but she thinks allowing them to damage American democracy is a virtue.” 

Reid noted that Sen. Raphael Warnock called out the contradiction last month after the debt limit vote. 

Be very clear, last week we changed the rules of the Senate to address another important issue, the economy. This is a step, a change in the Senate rules we haven’t been willing to take to save our broken democracy, but one that a bipartisan majority of this chamber thought was necessary in order to keep our economy strong. We changed the rules to protect the full faith and credit of the United States government. We’ve decided we must do it for the economy, but not for the democracy,” Warnock said.

Audacity, thy name is Sinema:

With Sinema’s obstinate obstructionism flaring up days before Martin Luther King Day and before a Senate vote on the John Lewis Act – named for the late civil rights icon she claims to have loved – more and more critics are noting how the filibuster was created to further lynching and racist Jim Crow laws. “There’s nothing partisan about saying the filibuster has mostly been used for racist reasons, I think everybody would agree that that’s true,” Harvard Law professor Michael Klarman told the Associated Press. 

On Saturday, MSNBC’s Tiffany Cross said the subtext out loud. “Sinema is a Democrat, but she is in many ways upholding white supremacy,” Cross said on “The Cross Connection” after showing a clip of Sinema’s Thursday speech. “I don’t think I can roll my eyes hard enough and you kind of just want to say, ‘Girl, bye.’” 

It’s not like we didn’t notice that Sinema – who used her story of childhood poverty to get elected – has courted infamy. In March 2021, Christine Linnell made an important point in an Advocate commentary. 

Arizona’s Sen. Kyrsten Sinema may have taught us a valuable lesson in the past week: when it comes to politics, visibility and representation will only take you so far,” she wrote. “Sinema, the first openly bisexual person to be elected to Congress, went viral for the wrong reasons on Friday when she voted against a provision in the coronavirus relief package that would have increased the minimum wage to $15 an hour. And she didn’t just vote against it, but went out of her way to get Minority Leader Mitch McConnell’s attention before giving a sassy thumbs-down on the floor of the Senate.

Linnell cited journalist Ryan Grim’s March 5, 2021 tweet, re-tweeting a C-Span video clip: “Here’s @SenatorSinema walking on to the floor, patting Mitch McConnell on the back, looking back to make sure he sees her, then giving the thumbs down to a $15 minimum wage.”

But Sinema is no John McCain and then, like now, it’s hard to see what principle she was upholding. 

I interviewed Sinema in 2018 for the Los Angeles Blade when she was running for the Senate and noted a tracking report from Nate Silver’s FiveThirtyEight indicating that Sinema voted in line with Trump’s position 54.7% of the time.

“This isn’t a matter of one party being right and the other being wrong,” Sinema said. “If we allow our basic values to become just another political football, we’ll all lose. If President Trump is willing to work together to stand up for Arizonans, I’ll work with him….I learned early on that you get more things done when you’re willing to work together…The problem with Washington is that people don’t listen to those who have different points of view so they never find the common ground needed to really solve problems. When you actually talk with people and work across the aisle, it’s amazing how much you can accomplish.”

The problem is that Trump’s Republican Party is subsumed by white supremacists for whom lying and treachery is a convenient, amoral means to an authoritarian end. There is no negotiating in good faith here.  There is no bipartisanship when one partisan side is angling for white straight male supremacy. 

And the thing is, we LGBTQ people — who are still official second-class citizens without our full equal rights – figured out long ago that there is no “both sides” fairness when you’re talking about the far right. Ask Joan Garry of GLAAD. CNN used to pit Joan against some religious right nut until finally she (standing in for all of us) said we would not acknowledge the religious right or white supremacists as the equivalent of our movement for equality and social justice. 

Yet here we are as Sinema – who claims to represent LGBTQ people – acts as if Trump’s white supremacy is equivalent to Biden/Pelosi/Schumer and GLAAD ’ agenda to restore Constitutional voting rights.

But where are WE? Do we not remember Silence = Death? 

“At consequential moments in history, they present a choice,” Biden said in his speech from Atlanta on Jan. 11. “Do you want to be the side of Dr. King or George Wallace? Do you want to be on the side of John Lewis or Bull Connor? Do you want to be on the side of Abraham Lincoln or Jefferson Davis?”

What side do you want to stand on, LGBTQ people? 

Ironically, Sinema foreshadowed this moment in her speech before the Human Rights Campaign on March 10, 2018. “It’s up to us now to make certain that being gay, lesbian, bisexual or transgender will never again be an impediment to success. These battles will take place on many fronts. Under our new President, that’s unfortunately meant returning to some of the fights we thought were behind us,” she said, noting that she was running for the Senate “to stand up for the values that unite us as Americans,” including “the right to define our own destinies. The belief that no one should be different in the eyes of the law, the freedom to reach for every opportunity and fulfill our greatest potential. We here, we together, we have a moral obligation to continue this work. And standing together, I know we can win.” 

Standing together? From Jan. 1, 2021, Krysten Sinema tweeted about LGBTQ people/issues only FIVE (5) times – three of which were during June Pride Month.

I reject any assertion that Krysten Sinema represents me as an LGBTQ person. What about you?

Arizona Representative Kyrsten Sinema Speaks at HRC Los Angeles Dinner:


Karen Ocamb an award winning veteran journalist and former editor of the Los Angeles Blade has chronicled the lives of LGBTQ+ people in Southern California for over 30 plus years.

She lives in West Hollywood with her two beloved furry ‘kids’ and writes occasional commentary on issues of concern for the greater LGBTQ+ community.

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National LGBTQ Task Force Action Fund; ‘On voting rights under attack’

LGBTQ Task Force Action Fund urges the U.S. Senate to pass the Freedom to Vote Act & the John Lewis Voting Rights Advancement Act



Los Angeles Blade graphic

By Kierra Johnson | WASHINGTON – Voting rights are a cornerstone of our democratic process and have been under attack by conservative political extremists. These extremists have tried everything from partisan gerrymandering to mass purges of voter rolls in attempts to undermine the work of election officials, sow false doubt in legitimate election results and curb access to registering and casting votes. 

There are many things to be divided over but right now there is an opportunity to be aligned in eradicating barriers to voting. We have an opportunity to restore faith in the American people that there are still foundational values and inalienable rights that can hold us together. The right to vote is a baseline. It is an essential part to exercise our power and participate in our democracy.

George Washington was quoted as saying, “The power of the constitution will always be in the people. It is entrusted for certain defined purposes and for a certain limited period, to representatives of their choosing: and whenever it is executed contrary to their interest, or not agreeable to their wishes, their servants can and undoubtedly will be recalled.”

This is the plainest argument for eradicating barriers to voting for any and all of our people. However, it also explicitly explains why attacks on voting rights and access have increased as the demographics of this country have changed.

When LGBTQ+ Americans, People of Color and other marginalized populations vote in high numbers, elections are greatly impacted and it can make the difference in local, state and federal elections. The fear of losing power and the threat of losing an elected seat is not justification for our leaders to carve out LGBTQ+ folks, People of Color, women, poor people and so many other already marginalized groups from the political process. 

Members of congress often have the hard job of making decisions that require them to weigh numerous nuances and complex decision points with varying intended and unintended consequences on communities. However, on the question whether to eradicate barriers to voting – the answer is clear. Our beloved people deserve access to our democracy. We have a right to it and therefore the right to vote – regardless of our political views. Any member of congress who is advocating for anything less than ensuring and protecting the right to vote for all of the people in their districts and states is in fact advocating to take away the power of the people to elect and hold accountable those who should be legislating on their behalf.

The choice is simple: are you on the side of all voters or are you willing to allow restricting of the vote for political ends?  Will you advocate for all of the people that you claim to represent or will your sacrifice and abandon us community by community? Every decision will firmly place our elected officials on either the right or wrong side of history.

Instead of leaning into tactics that alienate and distance people from our democracy and each other, what if instead our elected Officials were inspired to  get back to the real work of getting more of our people to more actively and consistently participate in civic engagement. What if they were willing to commit to learning more about the fears and dreams of those in the community that they know the least about and invest in meeting their needs and creating opportunities from them to thrive! 

Our Democracy is broken and further restricting access to the political process will not heal the fractures that have only grown deeper and wider over these last years. Senators must take leadership and pass legislation that will protect and ensure free and fair elections. The strength of our Democracy and of our people depend on it.

Ongoing state legislative attacks in 2021 and 2022 on voting rights, many of which are barely disguised plans to suppress votes of Black people, as well as people from other historically marginalized communities such as the LGBTQ community, are undemocratic, racist and just plain wrong.

Some new and proposed state voting laws qualify as inhumane, for example, making it illegal to provide water and food to voters standing in hours-long lines. 

Some of these attacks ignore the reality of people’s daily lives, outlawing assistance to voters with disabilities so they can cast ballots by mail from home,  limiting voting hours, limiting, or ending ballot drop-box accessibility for people working several jobs to support minor children and elderly parents, and requiring identity documents to counter supposed voter fraud that research shows is practically nonexistent.

Identity document requirements pose specific challenges for many transgender and gender non-binary people due to some outdated state laws and financial and other barriers to updating documents like legal fees, a lack of access to inclusive health insurance and an inability to afford or overcome discriminatory policies and practices to receive gender-affirming care.

The path forward is clear – we need our federal elected officials to take leadership, take action, and protect voting rights NOW in order to rebuild and strengthen our democracy. This country belongs to all of us. This is our democracy, and we demand our rightful place in it. Pass the Freedom to Vote Act and the John Lewis Voting Rights Advancement Act now!


Executive Director, Kierra Johnson, joined the Task Force in 2018 as Deputy Executive Director and previously served on the board of directors.

As a bisexual Black woman, Johnson is one of a few out queer-identified women of color at the helm of a national LGBTQ organization.

She is recognized as a national expert on queer and reproductive rights issues and has testified in front of the U.S. House of Representatives.


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COVID-19, Isolation, Tobacco and the LGBTQ + BIPOC Community

Research shows that intense amounts of discrimination is linked to increased risk of tobacco use. This is no coincidence



Courtesy of Equality California Institute’s OUT Against Big Tobacco Program

By Ryan Oda | SANTA MONICA – While smoking rates have declined nationally in the past 20 years, this decline has not been shared equally among Black, Indigenous and people of color (BIPOC) communities or the LGBTQ+ community – and especially among those with intersecting identities.

Tobacco is one of many harmful coping mechanisms that are adopted disproportionately by the LGBTQ+ community due to discrimination. Research shows that intense amounts of discrimination is linked to increased risk of tobacco use. This is no coincidence.

The LGBTQ+ community is unique because people of all ages, races, and religions can identify as LGBTQ+. Issues that affect one community, such as the increased risk of tobacco use for Black communities, also impacts Black LGBTQ+ folks at even higher rates. In fact, research has shown that Black lesbian, gay and bisexual youth are 225% more likely to smoke than heterosexual Black youth. 

While many cisgender heterosexual BIPOC folks can rely on their tight knit communities as a support system, LGBTQ+ BIPOC people are often disowned by their biological family and wider community because of their LGBTQ+ identities. These added stressors caused by the lived experiences of LGBTQ+ people are associated with a higher risk of tobacco.

Big Tobacco has used flavors, like menthol, to cover up the harsh taste of tobacco which makes it easier to get hooked and harder to quit. Candy, fruit, and dessert flavors are attractive to young people, getting them hooked on nicotine from a dangerously young age. Big Tobacco’s marketing strategy has targeted LGBTQ+ people resulting in an overwhelming presence of tobacco products in LGBTQ+ spaces, clubs, bars, Pride events, etc. 

OUT Against Big Tobacco Los Angeles, a coalition supported by Equality California Institute, is working in Santa Monica to educate the community and policymakers on the impacts of flavored tobacco and coupons and discounts on tobacco purchases on the LGBTQ+ community. Santa Monica, which has a history of passing tobacco control policies, has the unique opportunity to create a healthy and safe environment for its residents, including youth. 

Research has shown that flavored tobacco increases people’s risk of becoming addicted to nicotine; because youth are most likely to begin smoking with flavored tobacco, youth can especially be at risk for becoming addicted due to these products. The City of Santa Monica passed an outdoor smoking ordinance at the Pier, citing its danger and risk of secondhand smoke exposure to youth and tourists.

As the pandemic has continued, so have stressors for the LGBTQ+ community, and BIPOC youth. More now than ever, community action based on research is needed to prevent more people from becoming addicted to nicotine. 

To add to the many stressors LGBTQ+ folks deal with, the past year has resulted in many LGBTQ+ people facing increased risk of social isolation and depression. Due to COVID-19, various support groups that the community often relied on outside of their biological family such as school, Gender and Sexuality Alliances (GSAs) or Pride clubs, were no longer available to gather in-person.

This lack of in-person support has created room for online influences to now hold even more weight than they previously did. As we reopen, the long-term effects of isolation on youth remain to be seen.     

Further research is needed to fully understand the impacts that the pandemic and subsequent social isolation has had on smoking rates for LGBTQ+ youth, especially those of color. It’s likely that more LGBTQ+ young people will come out of this pandemic addicted to tobacco.      

The onus is on institutions to ensure equitable access to resources to quit. Big Tobacco must be prevented, once and for all, from targeting our youth.

To find out more about how to get involved in tobacco control work in Santa Monica, please check out OUT Against Big Tobacco’s Twitter: @outtobacco and Facebook: @OUTAgainstBigTobaccoCoalition


Ryan Oda (he/him) is a Program Associate for Equality California Institute’s OUT Against Big Tobacco Program, where he is working to reduce LGBTQ+ tobacco use throughout Los Angeles County.

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