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PowerPoint Presentation
NAMI State ConferenceNovember 16, 2013Carole Specktor, M.P.A.1
DONT FORGET TO TELL THEM I HAVE THE INFO AND WILL HAND IT OUT AFTER1Presentation OverviewAbout ClearWay MinnesotaSMWhy tobacco is still a problemWhy it is important to address tobacco use?Smoking and persons with mental illnessQUITPLAN Services
2About ClearWay MinnesotaMission: Reduce the harm tobacco causes the people of Minnesota
Grant-making, QUITPLAN stop-smoking services and statewide outreach activities3
Our vision is to eliminate the harm tobacco causes the people of Minnesota. We do this through our grant-making program, our cessation services and our statewide outreach activities.
3ClearWay Minnesotas Work Policy Changes
Research
Reducing Disparities
Cessation Services
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In addition to QUITPLAN promoition and statewise ad campaigns, ClearWay Minnesotas work includes.
Since 2001 weve contributed to passing significant policies that help people quit, protect people from secondhand smoke and prevent youth from starting to smoke.
Statewide and local
Weve provided funding to local communities to pass local smoke-free ordinances and other local policies to protect people from secondhand smoke and support quitting services.
Raising the price of tobacco products is the most effective way to reduce youth smoking rates, and it also helps smokers quit. After the health impact fee was enacted, we saw results of this in our own programs with our Helpline call volume almost double.
We worked hard on passing the Freedom to Breathe Act, which made workplaces smoke-free including bars and restaurants protecting all types of workers.
We led efforts to pass the Tobacco Modernization and Compliance Act. This bill updates the definition of tobacco products in Minnesota so new products the tobacco industry is creating will be considered tobacco products and subject to appropriate regulations (such as being behind counters at convenience stores so youth have less access to them).
Tobacco control initiatives in diverse populations that are targeted by the tobacco industry
Trained 90 Leadership Fellows since 2005
Grants to American Indian communities
Highest rates of tobacco are among american indians where rates are as much as 60%
ClearWay Minnesota is committed to reducing health disparities among populations that have higher rates of death and disease because of tobacco. We are training leaders in those communities in ways they can reduce the harm of tobacco. So far we have trained Fellows from the Chicano-Latino, African American, African Immigrant, Southeast Asian, American Indian and GLBT communities.
We have particular emphasis in the American Indian community, where smoking rates can be as high as 60 percent. We have grants to three reservations who want to work on education and advancing policies that will help people quit and protect people from secondhand smoke. All of these reservations have passed new policies since they were funded by ClearWay Minnesota.
4Media Campaigns and Outreach
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Following the Centers for Disease Control best practices, ClearWay Minnesota has conducted extensive outreach and education campaigns for the past 10 years. Most visible are our award-winning advertising campaigns, which are designed to educate Minnesotans about the dangers of tobacco use and secondhand smoke and motivate people to quit and use QUITPLAN Services.
We know our efforts have made a difference in educating the public and changing attitudes and opinions about tobacco and quitting. 5Why is Tobacco Still a Problem?#1 Reason:The Tobacco Industry6Tobacco Industry Adapts 7
Masterful Consumer Marketing8
Displayed near candyEye level for kidsThat lipstick container is actually a tobacco pipeSimilarity bw mints and orbs
8Targeted MarketingTobacco industry has targeted populations to increase usage and loyaltyExamples:African AmericansAmerican IndiansLatinosPersons with mental illnessLGBT communityLow-SESYouth
Examples of targeting to persons with mental illness are providing cigarettes to homeless shelters and mental hospitals beginning in the late 1970s.
Higher prevalence and lower quit rates make targeted marketing profitable for companies9E-Cigarettes10Untested and unregulatedNot proven as safe alternative to smokingNot an approved cessation aidOften candy-flavored
CDC study: use of e-cigarettes among middle- and high-school students more than doubled between 2011 and 2012
Promoted for use where traditional cigarettes prohibited10Quitting is Hard11
Nicotine is highly addictive
Fundamental changes to the brain
Behavioral and psychological aspects of addictionDiagram is drug delivery and impact on brainLong term effects the brain develops more nicotine receptors. When the receptors are empty they start screaming for their nicotine.
Increase nicotine receptorsReceptors demand nicotine
Biological ReasonsBoosts concentrationPositively affects moodPsychological Reasons Relieves tension and anxietyRelaxationSocial AcceptanceWeight management
11Why Address Tobacco? 12Tobacco is a Killer ProblemSmoking is the number one cause of preventable disease and death443,000 tobacco-related deaths per year nationallyOn average, smokers die 13 to 14 years earlier than nonsmokers
More than 440,000 deaths annually (including deaths from secondhand smoke)49,400 deaths per year from secondhand smoke exposureTobacco causes 1 in 5 deaths in the us annually
13Smoking in Minnesota625,000 Minnesota adults smoke (16%)
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Secondhand smoke exposure (2010):Nearly 46% of adults exposed 282,000 Minnesota children exposed
Majority of Minnesota smokers want to quitMinnesota Adult Tobacco Survey Tobacco Use in Minnesota: 1999-2010I think for many, with the passage of smokefree laws, smoking is no longer as visible and it can be a little out of sight, out of mind. But, it is still a significant problem in Minnesota as well.
Talk about disparities briefly
144000 Chemicals in CigarettesExamples and where these chemicals are found:Acetone: nail polish remover Acetic Acid: hair dye Ammonia: household cleaner Arsenic: rat poison Butane: lighter fluid Cadmium: battery acid Carbon Monoxide: car exhaustNicotine: insecticide Tar: pavement
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Impact of Quitting17
Smoking and Mental Illness 18High PrevalenceHigher prevalence imposes heavy morbidity and mortality burdenThirty-one percent of all cigarettes are smoked by adults with mental illness
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Why higher prevalence? Targeted by tobacco industryBiological, psychological and social factorsTo date, not commonly addressed by providers
Vital Signs: Current Cigarette Smoking Among Adults Aged >18 Years with Mental Illness United States, 2009-2011According to a recent report, 36% of adults with mental illness are smokers compared to 21% of adults who do not have a mental illness
31% stat from smoking among adults with mental illness cdc feature
Persons with serious mental illness are now dying 25 years earlier than the general population. In large part, the increased mortality is due to treatable medical conditions associated with modifiabel risk factors such as smoking, obesity, substance abuse and inadequate medical care.19Quitting and Persons with Mental IllnessCan quitWant to quit Want information to help them quitSome factors may make it harder to quit, but . . . Evidence shows cessation strategies workStudies show that quitting smoking does not worsen psychiatric symptoms20
Vital Signs: Current Cigarette Smoking Among Adults Aged >18 Years with Mental Illness United States, 2009-2011; Tobacco Cessation for Persons with Mental Illness or Substance Use Disorders, Center for Tobacco CessationEvidence shows that smoking cessation strategies work
20Understanding Higher Prevalence: Biological FactorsPersons with mental illness have unique neurobiological features that may:Increase tendency to use nicotineMake it more difficult to quit; andComplicate withdrawal symptoms
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Smoking Cessation for Persons with Mental Illnesses: A Toolkit for Mental Health Providers 21Understanding Higher Prevalence: Psychological and Social FactorsPsychological considerations:Smoking relieves tension, anxiety and stressDaily routineSocial considerations:Smoke to relieve boredomSmoke to feel part of a group
22Smoking Cessation for Persons with Mental Illnesses: A Toolkit for Mental Health Providers
22Understanding Higher Prevalence: Myths and Barriers within Behavioral Health Care Commonly stated reasons why mental health providers have not addressed smoking with clients:They cant or dont want to quitMore pressing issuesConcerns about worsening symptomsLack of training Dont want to take away one of patients few pleasuresShared smoke breaks build strong relationships
23Triggering a Paradigm Shift in Treating Patients with Mental Health and Addictive Disorders, Wisconsin Nicotine Treatment Integration Project (presentation, July 28 2011); Vital Signs: Current Cigarette Smoking Among Adults Aged >18 Years with Mental Illness United States, 2009-2011; Building the Case to support Tobacco Cessation, National Council for Behavior Health, June 28, 201323Training Recent study found psychiatrists:Address tobacco less frequently than other physicians Reported receiving no or inadequate training on tobacco-related interventionsSurvey of Wisconsin mental health providers: The majority (72%) support adding nicotine dependence treatment skills to credentialsWith training, the majority (66%) are willing to provide treatment24Physician Behavior and Practice Patterns Related to Smoking Cessation, Association of American Medical Colleges ; Wisconsin Nicotine Treatment Integration ProjectStrategies to Reduce Smoking for Persons with Mental IllnessReframe expectations of successIntegrate tobacco as part of an approach to mental health treatment and overall wellness25
Provide mental health providers the training and tools they need to address tobacco with patientsUtilize existing resources such as quitlines
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QUITPLAN Services 27
The Good News: Treatment HelpsEvidence-based treatment can double or triple success Evidence-based treatment:CounselingFDA-approved medicationsBothBest outcomes with both
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Medication = nrt and rx meds such as chantix
Medication addresses the physical aspects and the counsleing addresses behaviiral and social
Long term quit rate:Cold turkey = 3-5%With assistance that increases to 13-30%Depending use of medications (roughly 22%), counseling (13-17%) or both 22-28% --outlier =32%28QUITPLAN Helpline BasicsFree ServicesServes:UninsuredUnderinsured, including Medicaid Fee-for-ServiceLive or work in Minnesota Phone Counseling in English and SpanishPartner with Asian Smokers Quitline Other languages through translation service
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Underinsured individual does not have coverage for telephone counseling and/or nrt through his or her health plan
Use LanguageLine Solutions
Transfer those who speak Mandarin, Cantonese, Korean or Vietnamese to the ASQ. Receive same NRT benefit.
29QUITPLAN Helpline ProgramMulti-call, one-on-one coaching programIntegrated text messagesPrint materialsNicotine Replacement Therapy Two enrollments per year30
Explain intake versus coaching
Coaches do answer the phones and offer the ppt to go right into coaching if available.
Individualized based on based on needs, previous quit attempts, background
Text program since January 2013. 53% of enrollees choose to receive texts. They are informational, motivational and programmatic.
Hope to launch email soon.30QUITPLAN: Mental HealthTraining for coachesTraining for individualized services Substantial mental health trainingOngoingIntake questions Monitor field and adapt approach as appropriate
31Nicotine Replacement TherapyPatches, gum or lozenge Uninsured and underinsuredFour weeks per enrollment* (eight weeks per Medicaid enrollment) Medical screeningAge 18 and olderLive or work in Minnesota
32*twice every12-months
Mention which NRT is most popular (patches) = year to date (July Sept.)Patch = 76%Gum = 18%Lozenge = 6%
Here are the contraindications for NRT that would require a signed MD consent form:PregnantBreast-feedingHBP not controlled with medsHeart diseaseHeart attack or stroke in the last year
What happens if someone does not pass medical screen? explain process32quitplan.comEnglish and SpanishNRT not available through quitplan.comAvailable to all Minnesotans, regardless of insurance status 33
Talk about web-based quitting program and that this is one way to help people directly NRT is not available only through quitlineWebsite available in spanish33MaterialsOrder QUITPLAN Materials at: www.clearwaymn.org (click about)Brochures in English and SpanishSmokeless tobacco brochurePalm card Mailed to you free of chargeE-cigarette fact sheet available on website
34For More Informationwww.clearwaymn.orgwww.quitplan.com www.stillaproblem.orghttp://www.mnadulttobaccosurvey.org/www.cdc.govhttp://smokingcessationleadership.ucsf.edu
Carole Specktor:[email protected](952) 767-1418
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37Thank you for your time37
