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Taking Charge:
Understanding Tobacco Control’s
Impact on Communities
Christine Cheng, Partner Relations Director,
Smoking Cessation Leadership Center
Shelina D. Foderingham, Director Practice Improvement,
The National Council
Kansas Health Foundation, Fellows Program
Friday, November 14, 2014 – Wichita, KS
Today’s Topics
• Overview: National Landscape
• SCLC Partnerships: State and Local Community
• Tobacco Control: Leading Preventable Cause of
Death
• Health Systems Changes
• Barriers and Myths
• Group Exercise
© 2012 BHWP2
National Council for Behavioral Health
National Landscape
SAMHSA-HRSA CIHS, 2014
National Landscape
SAMHSA-HRSA CIHS, 2014
National Landscape
Cancer and Behavioral Health
 More than 50% of people with terminal cancer have at least one
psychiatric disorder.
 Individuals with a mental illness may develop cancer at a 2.6 times
higher due to late stage diagnosis because of inadequate screenings.
 Individuals with a mental illness have a higher rate of fatality due to
cancer.
What is the National Council doing?
SAMHSA-HRSA CIHS, 2014
Practice Improvement & Workforce Development
• Learning Collaborative and Communities – SUD,
FQHC
• SAMHSA-HRSA Center for Integrated Health
Solutions
• NY State Geriatric Technical Assistance Center
• Ohio Training & Technical Assistance Center
• CDC Capacity Building and National Behavioral
Health Network for Tobacco & Cancer Control
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Jointly funded by CDC’s Office on Smoking &
Health & Division of Cancer Prevention &
Control
Provides resources and tools to help
organizations reduce tobacco use and
cancer among people with mental illness
and addictions
Visit www.BHtheChange.org and
Join Today!
Free Access to…
Toolkits, training opportunities, virtual
communities and other resources
Webinars & Presentations
State Strategy Sessions
1 of 8 CDC National Networks to eliminate
cancer and tobacco disparities in priority
populations
#BHtheChange
© 2012 BHWP
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Smoking Cessation Leadership Center
• Began in 2003 as a Robert Wood Johnson
Foundation National Program Office
• Subsequent grants from Legacy Foundation to
address behavioral health, ARRA grant, CDC/CTG
grants, SAMHSA for pioneers and state summits
• Aims to increase smoking cessation rates and
increase the number of health professionals who
help smokers quit.
© 2012 BHWP
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How We Work
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Identify champions
Create partnerships
Help create action plans
Do not reinvent the wheel
Low cost, no cost resources
Promote message through health journals,
publications and social media
© 2012 BHWP
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SCLC and Behavioral Health
• Convened leaders in BH for a summit in 2007
• Meeting at SAMSHA with the then administrator
Terry Cline in 2008, which lead to …
• SAMHSA 100 pioneers initiative in 2009
• SAMHSA leadership academy for wellness and
smoking cessation with 8 states from 2010-13
• SAMHSA policy academy held in June 2014
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SAMHSA
In-Service
Training Poster
July 7, 2008
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100 Pioneers for Smoking Cessation
• Grantees from all 3 SAMHSA centers:
o CMHS, CSAT, CSAP
• Wide range of interventionists
o Consumer groups
o Health care providers
o Community centers
o Treatment centers
o Youth
o Rehabilitation centers
• 2nd phase of initiative with 25 Pioneers
© 2012 BHWP
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SAMHSA Pioneers Map
Represent 38 states
Blue = Phase I Pioneers
Yellow = Phase II Pioneers
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Performance Partnership Model
• Used in all 8 SAMHSA leadership academy states
• Partnership organized around a specific,
measurable result, asking 4 questions:
1. Where are we now? (baseline) % intervene
with patient who smoke or current prevalence
2. Where do we want to be? (target) increase to
% in xx years or decrease prevalence by xx%
3. How will we get there? (multiple strategies)
4. How will we know we are getting there?
(evaluation/measures)
© 2012 BHWP
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Leadership Academies for Wellness
and Smoking Cessation
• 2010-2013 Leadership Academies for Wellness and
Smoking Cessation
o Purpose: To launch statewide partnerships among
behavioral health providers, consumers, public
health groups, and other stakeholders to create
and implement an action plan to reduce smoking
prevalence among behavioral health consumers
and staff.
o Eight states selected to participate in 1-2 day
planning summits
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8 State Leadership Academies
8
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Leadership Academy Participants
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State mental health department
State substance abuse department
State tobacco control department/state Medicaid department
Consumer organizations
Hospitals
Federal agency representatives from SAMHSA, HRSA, CDC, VA
Academic medical centers
State branches of national advocacy groups such as NAMI or MHA
Patient advocacy groups
Community advocacy groups
Youth organizations
Insurance companies
SCLC Leadership and staff
Results-based facilitator
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2012 Progress Report:
Common Strategy Groups
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Consumers and Community: 6 out of 7 states
Provider Education: 6 out of 7 states
Data Development: 5 out of 7 states
State Level Policy: 5 out of 7 states
Behavioral Health Facilities: 4 out of 7 states
Quitline: 4 out of 7 states
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2013: Impact: Awareness of Tobacco
Intervention among BH Providers
71% or 5 out of 7
states strongly agree
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State Leadership Academies Strongly
Interested in Partnering with Others
100% or all 7 states strongly interested in
partnering with other states
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Tobacco: Leading Preventable
Cause of Death
1. How many annual deaths are caused by
smoking?
1. What was the national prevalence in 1964 when
the first Surgeon General’s report on smoking
and health was released?
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Tobacco’s Deadly Toll
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480,000 deaths in the U.S. each year
4.8 million deaths world wide each year
10 million deaths estimated by year 2030
50,000 deaths in the U.S. due to second-hand smoke
exposure
• 8.6 million disabled from tobacco in the U.S. alone
• 46.6 million smokers in U.S. (78% daily smokers)
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Behavioral Causes of Annual Deaths
in the United States
450
435
400
365
350
300
250
*
200
150
85
100
50
43
20
29
17
0
Sexual
Behavior
Alcohol
Motor
Vehicle
Guns
Drug
Obesity/ Smoking
Induced Inactivity
suffer from mental
* Also
illness and/or substance
Mokdad et al, JAMA 2004; 291:1238-1245. Mokdad et al; JAMA. 2005; 293:293
abuse
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2008 Tobacco Dependence Clinical
Practice Guideline
“All smokers with psychiatric disorders, including
substance use disorders, should be offered
tobacco dependence treatment, and clinicians
must overcome their reluctance to treat this
population” (Fiore et al., 2008, p. 154).
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© 2012 BHWP
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Health Consequences of Smoking
 Cancers:
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 Cardiovascular diseases
Acute myeloid leukemia
Bladder and kidney
Cervical
Colon, liver, pancreas
Esophageal
Gastric
Laryngeal
Lung
Oral cavity and pharyngeal
Prostate (↓survival)
 Pulmonary diseases:
– Acute (e.g., pneumonia)
– Chronic (e.g., COPD)
– Tuberculosis
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–
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Abdominal aortic aneurysm
Coronary heart disease
Cerebrovascular disease
Peripheral arterial disease
Type 2 diabetes mellitus
 Reproductive effects
– Reduced fertility in women
– Poor pregnancy outcomes (ectopic
pregnancy, congenital anomalies, low
birth weight, preterm delivery)
– Infant mortality; childhood obesity
 Other effects: cataract; osteoporosis;
Crohn’s; periodontitis,; poor surgical
outcomes; Alzheimer's; rheumatoid
arthritis; less sleep
U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General, 2014.
© 2012 BHWP
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Causal Associations with Second-hand Smoke
•
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Developmental
•
– Low birth weight
– Sudden infant death
syndrome (SIDS)
– Pre-term delivery
-- Childhood depression
Respiratory
•
– Asthma induction and
exacerbation
– Eye and nasal irritation
– Bronchitis, pneumonia, otitis
media, bruxism in children
– Decreased hearing in teens
Carcinogenic
– Lung cancer
– Nasal sinus cancer
– Breast cancer (younger,
premenopausal women)
Cardiovascular
– Heart disease mortality
– Acute and chronic coronary
heart disease morbidity
– Altered vascular properties
There is no safe level of
second-hand smoke.
USDHHS. (2006). The Health Consequences of Involuntary Exposure to Tobacco Smoke: Report of the Surgeon General.
© 2012 BHWP
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Medications that Smoking
Decreases Blood Levels
Brand Name
Elavil*
Anafranil*
Aventyl/Pamelor*
Tofranil*
Luvox*
Thorazine*
Prolixin*
Haldol*
Clorizaril*
Zyprexa*
Tylenol
Inderal
Slo-bid, Slo-Phyllin,
Theo-24, Theo-Dur,
Theobid, Theovent
Generic Name
Amitriptyline
Clomipramine
Nortiptyline
Imipramine
Fluvoxamine
Chlorpromazine
Fluphenazine
Haloperidol
Clozapine
Olanzapine
Acetominophen
Propanolol
Theophylline
Caffeine
*Psychoactive medications
© 2012 BHWP
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Youth Smoking
• 1,000 American adolescents become regular tobacco
users every day
• Early teen smokers with low nicotine exposure
already show brain activation
patterns of heavy adult smokers
• Youth smoking is associated with
mental and addiction disorders
later in life
© 2012 BHWP
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Never Too Late to Quit*
Age of quitting smoking
25-34
35-44
45-54
55-64
Years of life saved
10
9
8
4
* Jha, NEJM Jan 24, 2013
© 2012 BHWP
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Systems Changes: We Know
What Works
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Raising tobacco taxes and price
Tobacco-free indoor air laws and workplace
tobacco bans
State prevention and cessation initiatives (e.g. quit
line)
Combination of NRT and counseling
Restriction of tobacco sales to minors
Anti-tobacco counter-marketing efforts
Contact: [email protected]
|
202.684.7457
www.TheNationalCouncil.org
Going Tobacco-Free
Contact: [email protected]
|
202.684.7457
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Barriers and Myths Poll
1. Should you do concurrent tobacco cessation &
addiction treatment and/or MH treatment?
© 2012 BHWP
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Smoking & Behavioral Health:
A Health Disparity Issue
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Elevated prevalence of use
Targeted marketing by the tobacco industry
Serious health consequences
Significant costs & social isolation
Enabling environments
Lower access to treatment
Inadequate research base
© 2012 BHWP
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Major Target Market
• 44% to 46% of cigarettes consumed in the U.S. by
smokers with psychiatric or addictive disorders
(Lasser, 2000; Grant, 2002)
• 175 billion cigarettes and $39 billion in annual
tobacco sales (USDA, 2004)
© 2012 BHWP
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Smoking Prevalence by MH Diagnosis
2007 NHIS data
• Schizophrenia
• Bipolar disorder
• ADD/ADHD
59.1%
46.4%
37.2%
Current smoking:
• 1 MH
• 2 MH
• 3+ MH
31.9%
41.8%
61.4%
Grant et al., 2004, Lasser et al., 2000
• Major depression
45-50%
• Bipolar disorder
50-70%
• Schizophrenia
70-90%
© 2012 BHWP
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Unintended Consequences of
Addictions Treatment
Usually if a person has not started smoking
by age 20, it is unlikely they will ever smoke.
However, a significant number of adults start
smoking while in treatment/recovery,
suggesting the treatment climate is
conducive to smoking.*
* Friend & Pagano, 2004
© 2012 BHWP
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Myths
• Individuals with mental illness don’t want to quit
• Individuals with mental illness can’t quit
o False – can and do quit at a rate slightly lower
than the general population
• Treating tobacco use concurrent is detrimental
to recovery and/or mental illness
o False – increase sobriety by 25%*
*Prochaska, et. al., 2006
© 2012 BHWP
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Just as Ready to Quit Smoking as the
General Population
© 2012 BHWP
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Smokers with Bipolar Disorder:
Online Survey (N=685)
• Few reported a psychiatrist (27%), therapist
(18%), or case manager (6%) ever advised them
to quit smoking (Prochaska, Reyes, Schroeder, et
al. (2011). Bipolar Disorders)
Several reported discouragement to quit
from mental health providers
© 2012 BHWP
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Need for Smoking Intervention
• Tobacco treatment needs to be a higher priority
for behavioral health.
• While focusing on addictions and mental health,
clinicians sometimes miss this more deadly
condition.
• Addressing tobacco use can improve health, ease
pain, and save lives.
© 2012 BHWP
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Leadership Activity
• If we’re moving towards integrated care, within your
sphere of influence, how will you incorporate
tobacco control & prevention efforts targeting people
with SMI?
• How will you address the specific needs of
priority populations (i.e., racial/ethnic minorities,
low SES, rural/frontier, and LGBT)?
Leadership Activity
• How are you incorporating tobacco cessation
activities as part of your KHF implementation plan?
Leadership Activity
• Would you push for tobacco cessation & what is your
role as a leader within your organization?
• Who’s responsible for ensuring that tobacco control
efforts meet the needs of SMI populations? In
treatment settings? In public health? In
communities? And How do we implement this?
• Would you push for tobacco cessation efforts for
SMI populations…
Report Out from Leadership Activity
• Name 1 thing you learned from this exercise.
• Name 1 thing that you will do when you go
home to improve tobacco control efforts.
Questions and Answers
© 2012 BHWP
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Contact US!
Shelina Foderingham
[email protected]
202-684-7457, ext. 272
Christine Cheng
[email protected]
415-476-0216 or toll free, 877-509-3786
© 2012 BHWP
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Indoor Smoking Room
Kinston Psychiatric Hospital, NJ
© 2012 BHWP
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