Taking Charge: Understanding Tobacco Control’s Impact on Communities Christine Cheng, Partner...

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Taking Charge:Understanding Tobacco Control’s

Impact on CommunitiesChristine 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

National Council for Behavioral Health

82250 CBHOs

750,000 staff

Advocacy & Education

SAMHSA-HRSA CIHS, 2014

National Landscape

22.1 million Americans>12 years old

Substance Use Disorder

25-40 million AmericansIn Recovery

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?

• 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

Practice Improvement & Workforce Development

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

1 of 8 CDC National Networks to eliminate cancer and tobacco disparities in priority populations

Free Access to…Toolkits, training opportunities, virtual communities and other resources

Webinars & Presentations

State Strategy Sessions

#BHtheChange

Visit www.BHtheChange.org and Join Today!

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.

How We Work

• 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

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

SAMHSAIn-Service Training Poster

July 7, 2008

• Grantees from all 3 SAMHSA centers:o CMHS, CSAT, CSAP

• Wide range of interventionistso Consumer groupso Health care providerso Community centerso Treatment centerso Youth o Rehabilitation centers

• 2nd phase of initiative with 25 Pioneers

100 Pioneers for Smoking Cessation

SAMHSA Pioneers Map

Blue = Phase I PioneersYellow = Phase II Pioneers

Represent 38 states

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 prevalence2. 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)

Leadership Academies for Wellness and Smoking Cessation

• 2010-2013 Leadership Academies for Wellness and Smoking Cessationo 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

8 State Leadership Academies

Leadership Academy Participants• 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

2012 Progress Report:Common Strategy Groups

• 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

2013: Impact: Awareness of Tobacco Intervention among BH Providers

71% or 5 out of 7 states strongly agree

State Leadership Academies Strongly Interested in Partnering with Others

100% or all 7 states strongly interested in partnering with other states

Tobacco: Leading PreventableCause of Death

1. How many annual deaths are caused by smoking?

2. What was the national prevalence in 1964 when the first Surgeon General’s report on smoking and health was released?

Tobacco’s Deadly Toll

• 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)

Behavioral Causes of Annual Deaths in the United States

4329 17

Mokdad et al, JAMA 2004; 291:1238-1245. Mokdad et al; JAMA. 2005; 293:293

Sexual Alcohol Motor Guns Drug Obesity/ Smoking Behavior Vehicle Induced Inactivity

Also suffer from mental illness and/or substance abuse

“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).

2008 Tobacco Dependence Clinical Practice Guideline

Health Consequences of Smoking

U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General, 2014.

Cancers:– 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

Cardiovascular diseases– 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 obesityOther effects: cataract; osteoporosis;

Crohn’s; periodontitis,; poor surgical outcomes; Alzheimer's; rheumatoid arthritis; less sleep

Causal Associations with Second-hand Smoke• 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

USDHHS. (2006). The Health Consequences of Involuntary Exposure to Tobacco Smoke: Report of the Surgeon General.

There is no safe level of second-hand smoke.

Medications that SmokingDecreases Blood Levels

Brand Name Generic NameElavil* AmitriptylineAnafranil* ClomipramineAventyl/Pamelor* NortiptylineTofranil* ImipramineLuvox* FluvoxamineThorazine* ChlorpromazineProlixin* FluphenazineHaldol* HaloperidolClorizaril* ClozapineZyprexa* OlanzapineTylenol AcetominophenInderal PropanololSlo-bid, Slo-Phyllin, TheophyllineTheo-24, Theo-Dur,Theobid, Theovent

Caffeine*Psychoactive medications

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

Never Too Late to Quit*

Age of quitting smoking Years of life saved25-34 1035-44 945-54 855-64 4

* Jha, NEJM Jan 24, 2013

C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

Systems Changes: We Know What Works

• 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

C o n t a c t : C o m m u n i c a t i o n s @ T h e N a t i o n a l C o u n c i l . o r g | 2 0 2 . 6 8 4 . 7 4 5 7

www.TheNationalCouncil.org

Going Tobacco-Free

Barriers and Myths Poll

1. Should you do concurrent tobacco cessation & addiction treatment and/or MH treatment?

Smoking & Behavioral Health:A Health Disparity Issue

• 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

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)

Smoking Prevalence by MH Diagnosis2007 NHIS data• Schizophrenia 59.1%• Bipolar disorder 46.4%• ADD/ADHD 37.2%

Current smoking: • 1 MH 31.9%• 2 MH 41.8%• 3+ MH 61.4%

Grant et al., 2004, Lasser et al., 2000• Major depression 45-50%• Bipolar disorder 50-70%• Schizophrenia 70-90%

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.*

Unintended Consequences of Addictions Treatment

* Friend & Pagano, 2004

• Individuals with mental illness don’t want to quit

• Individuals with mental illness can’t quito 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 illnesso False – increase sobriety by 25%*

*Prochaska, et. al., 2006

Just as Ready to Quit Smoking as theGeneral Population

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

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.

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…

• Name 1 thing you learned from this exercise.

• Name 1 thing that you will do when you go home to improve tobacco control efforts.

Report Out from Leadership Activity

Questions and Answers

Contact US!

Shelina Foderingham ShelinaF@thenationalcouncil.org202-684-7457, ext. 272

Christine Chengccheng@medicine.ucsf.edu415-476-0216 or toll free, 877-509-3786

Indoor Smoking Room

Kinston Psychiatric Hospital, NJ

Taking Charge: Understanding Tobacco Control’s Impact on Communities Christine Cheng, Partner...

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