PowerPoint PresentationThursday, October 21, 2021 12:00 – 1:00 pm
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MentalWellbeingandRecovery101
• 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 individuals experiencing mental health and
substance use challenged
• 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
#BHthechange
Networking2Save: A National Network Approach to Promoting Tobacco
and Cancer-Related Health Equity in Special Populations
A consortium of eight national networks sponsored by the CDC’s
Office on Smoking and Health and Division of Cancer Prevention and
Control.
Our partnership provides leadership on and promotion of
evidence-based approaches for preventing commercial tobacco use and
cancer for priority populations on a national, state, tribal and
territorial level.
https://www.cdc.gov/cancer/ncccp/related-
programs/Networking2Save.htm
Mental wellbeing: thriving regardless of a mental health or
substance use challenge.
Commercial tobacco use/tobacco use: The use of commercial tobacco
and nicotine products (including electronic nicotine devices,
otherwise known as ENDs).*
*All references to smoking and tobacco use is referring to
commercial tobacco and not the sacred and traditional use of
tobacco by some American Indian and Alaskan Native
communities.
Learning Objectives
Learn ways in which tobacco control intersects with health
equity
Re-imagine ways to frame tobacco use in mental health, addiction
and recovery
Gain tools to enhance tobacco control and cessation efforts
Contextual Factors and the Social Determinants of Health
Determinants of Health
Tobacco & Behavioral Health: What has caused the
disparity?
The overall rate of cigarette smoking among adults has been falling
decreasing, but individuals with mental health challenges have been
neglected in prevention efforts, environmental and clinical
interventions. This disparity can be attributed in part to
predatorial practices by tobacco companies which included:
• Targeted advertisements • Providing free or cheap cigarettes to
psychiatric clinics • Blocking of smoke-free policies in behavioral
health facilities • Funding research that perpetuates the myth that
cessation
would be too stressful and negatively impact overall behavioral
health outcomes
• High rate of ACEs/Trauma • Limited access to high quality care
(delays in care,
lower quality of care, and more)
Decades later, E-CIG and VAPING companies are still taking a page
from Big Tobacco’s playbook…
Let’s Talk About Why People Start Smoking
• Targeted and Predatorial Marketing • High rate of
ACEs/Trauma
• High risk behaviors • Limited access to high quality care •
Delays in care • Lower quality of care • Anything else?
Prevalence of Trauma in Behavioral Health Treatment Settings
• Majority of adults and children in inpatient psychiatric and
substance use disorder treatment settings report a trauma history
(Lipschitz et al., 1999; Suarez, 2008; Gillece, 2010).
• 43% to 80% of individuals in psychiatric hospitals have some form
of experienced physical or sexual abuse.
• 51% to 90% “public mental health clients” are exposed to trauma
(Goodman et al., 1997; Mueser et al., 2004).
• 2/3 of adults in SUD treatment report child abuse and neglect
(SAMHSA, CSAT, 2000).
• A survey of adults in SUD treatment found that more than 70% had
a history of trauma exposure (Suarez, 2008).
13
0
5
10
15
20
25
5.5
8.7
Smoking: Age at First Use
Anda, R. F., Croft, J. B., Felitti, V. J., Nordenberg, D., Giles,
W. H., Williamson, D. F., & Giovino, G. A. (1999). Adverse
childhood experiences and smoking during adolescence and adulthood.
Journal of the American Medical Association, 282, 1652–1658.
Chart1
ACE Score
5.5
8.7
11.5
12.8
15.4
21.1
To resize chart data range, drag lower right corner of range.
ACEs and Current Smoking Prevalence
15
0
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4
6
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10
12
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16
18
Sm ok
in g
Pr ev
al en
ce (P
er ce
nt ag
Adverse Childhood Experiences vs. Current Smoking
Source: Original ACE study data American Journal of Preventative
Medicine (1988)
ACEs and Smoking Prevalence
16
Source: Austin, E. The Effect of Adverse Experiences on the Health
of Current Smoker. 2012.
What Changed in the General Population? The 1964 the U.S. Surgeon
General released the first report to examine the health
consequences of tobacco use. This report changed the American
perception, health care and public health attitudes towards tobacco
use. From this report tobacco use was found to be….
The most important cause of chronic bronchitis
A cause of lung cancer and laryngeal cancer in men
A probable cause of lung cancer in women
50 Years Later…More Findings Emerged Today we know that tobacco use
can lead to many more types of cancers and chronic conditions other
than those directly related to the lung thanks to the 2014 Report
of the Surgeon General on Smoking and Health. Key findings from
this report included:
• Smoking harms nearly every organ in the body
• Quitting smoking has both short- and long-term benefits for
health
• Exposure to secondhand smoke causes cancer, respiratory and heart
disease, and adverse health effects among children
• The list of diseases caused by smoking continues to grow
Yet for individuals with behavioral health conditions, prevention
of smoking related illnesses often takes a back seat to the
individual’s mental illness leading to delayed diagnosis.
Source: slide courtesy of CDC; Jamal A, Phillips E, Gentzke AS, et
al. Current Cigarette Smoking Among Adults — United States, 2016.
MMWR Morb Mortal Wkly Rep 2018;67:53–59.
31.8% American Indians/Alaska Natives
Poverty Status
Health Insurance
21.2% Yes
14.4% No
Examining Risk: Poverty, other disadvantages tied to higher smoking
risk
Source: Association of Cumulative Socioeconomic and Health-Related
Disadvantage With Disparities in Smoking Prevalence in the United
States, 2008 to 2017 (Leventhal, Bello, Galstyan, et al.)
20
About 14 percent of individuals without any of these forms of
adversity
smoked
increased, rising to 58 percent among individuals
with all six forms of adversity
Unemployment/poverty
Disparities in smoking are explained by disadvantaged populations
being more likely to start smoking and less likely to quit
smoking."
Source: https://www.medscape.com/
viewarticle/912195?src=wnl_edit_tpal&uac=245377DJ&impID=1948009&faf=1
Let’s Finish the Sentence…
People with mental illness die on average 5 to 25 years earlier*
than those without mental illness...
• *Depending on data source • Source: Parks, J., et al. Morbidity
and Mortality in People with Serious Mental Illness. Alexandria,
VA: National Association of State Mental Health Program Directors
Council. 2006 (25 years)
https://www.who.int/mental_health/management/info_sheet.pdf (10-15
yrs)
Let’s Finish the Sentence
People with mental illness die on average 15 to 25 years earlier
than those without mental
illness...
…due to complications from smoking- related illnesses…
The Foundations of Tobacco Disparities for Individuals with Mental
Health and Substance Use Challenges
Aggressive targeted marketing, barriers to care, the spread of
misinformation and higher than average rates of ACEs/Trauma in
individuals with mental health or substance use challenges
contribute to almost 40% of all cigarettes smoked by adults.
Source: Centers for Disease Control and Prevention
In 2018 32% of adults with any mental health challenge reported
current use of tobacco compared to 23.3% of adults with no mental
health challenge.
1 in 4 adults have some form of mental health or substance use
challenge.
THE GOOD NEWS! Overall Cigarette Smoking Is Trending Down
Source: slide courtesy of CDC; Adult cigarette smoking prevalence
data are from the National Health Interview Survey (NHIS); 2015
data based on NHIS Early Release data for January-June. High
Source: data are from the National Youth Risk Behavior
Survey.
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10
15
20
25
30
35
40
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1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
2010 2011 2012 2013 2014 2015
H ig
h sc
ho ol
s m
ok in
g pr
ev al
en ce
Ad ul
t ci
ga re
tte s
m ok
in g
pr ev
al en
ce Adults 18+ High School Students
Current Smoking among Adults (Age ≥ 18) with a Past Year Behavioral
Health (BH) Condition: NSDUH, 2015-2019
Current Smoking is defined as any cigarette use in the 30 days
prior to the interview date. Behavioral Health Condition includes
Any Mental Illness (AMI) and/or Substance Use Disorder (SUD). +
Difference between this estimate and the 2019 estimate is
statistically significant at the .05 level.
34.2+ 32.7+
Pe rc
en t
BH Condition No BH Condition
Current Smoking among Adults (Age ≥ 18) with Past Year Any Mental
Illness (AMI): NSDUH, 2008-2019
Current Smoking is defined as any cigarette use in the 30 days
prior to the interview date. Any Mental Illness is defined as
having a diagnosable mental, behavioral, or emotional disorder,
other than a developmental or substance use disorder, based on the
4th edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV). + Difference between this estimate and the 2019
estimate is statistically significant at the .05 level.
37.4+ 36.0+
20.7+ 20.1+ 18.7+ 18.4+
0
10
20
30
40
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Pe rc
en t
AMI No AMI
Current Smoking among Adults (Age ≥ 18) with Past Year Serious
Mental Illness (SMI): NSDUH, 2008-2019
Current Smoking is defined as any cigarette use in the 30 days
prior to the interview date. Serious Mental Illness is defined as
having a diagnosable mental, behavioral, or emotional disorder,
other than a developmental or substance use disorder resulting in
serious functional impairment, based on the 4th edition of the
Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). +
Difference between this estimate and the 2019 estimate is
statistically significant at the .05 level.
46.7+
18.6+ 17.7 17.3
0
10
20
30
40
50
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Pe rc
en t
SMI No SMI
Current Smoking among Adults (Age ≥ 18) with a Past Year Substance
Use Disorder (SUD): NSDUH, 2015-2019
Current Smoking is defined as any cigarette use in the 30 days
prior to the interview date. Substance Use Disorder is defined as
meeting criteria for illicit drug or alcohol dependence or abuse.
Dependence or abuse is based on definitions found in the 4th
edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV). + Difference between this estimate and the 2019
estimate is statistically significant at the .05 level.
48.3+ 46.2+ 45.5+ 45.0
0
10
20
30
40
50
60
Pe rc
en t
Sources: National Mental Health Services Survey (N-MHSS): 2018.
Data on Mental Health Treatment Facilities; National Survey of
Substance Abuse Treatment Services (N-SSATS): 2018. Data on
Substance Abuse Treatment Facilities.
Intervention Mental Health Tx Facilities
Substance Abuse Tx Facilities
Cessation Counseling 40.5% 49.8%
Non-nicotine Cessation Medications
Tobacco Cessation in Individuals with Mental Health & Substance
Use Challenges – The Facts
• The majority of persons with mental health and substance use
disorders want to quit smoking [1,2]
• Smokers are more than 2x likely to quit for good with the help of
tobacco cessation medications and counseling services.
• Persons with mental illness and substance abuse disorders can
successfully quit using tobacco at rates similar to the general
population. [3]
• Smoking cessation can enhance long-term recovery for persons with
substance use disorders. For example, if someone quit smoking at
the same time they are quitting drinking, they can have a 25%
greater chance of staying sober. [4]
Sources: [1] Acton et al. Depression and stages of change for
smoking in psychiatric outpatients. Addictive Behaviors. 2001;
26(5):621-31. [2] Prochaska et al. Return to smoking following a
smoke-free psychiatric hospitalization. Am J Addiction. 2006;
15(1):15-22. [3] Heiligenstein E, Smith SS. Smoking and mental
health problems in treatment- seeking university students. Nicotine
& Tobacco Research. 2006;8(4):519-23 [4] Prochaska, Judith J;
Delucchi, Kevin; & Hall, Sharon M. A meta-analysis of smoking
cessation interventions with individuals in substance abuse
treatment or recovery.. Journal of consulting and clinical
psychology. 2004; 72(6), 1144 - 1156. Retrieved from:
http://escholarship.org/uc/item/0r8673wv
An Overview of the Problem: Smoking Prevalence
• Lifetime smoking rates are even higher in individuals who are
diagnosed with major depression disorder (59%), bipolar disorder
(83%), or schizophrenia and other psychotic disorders (90%).
• A recent study found that adults with psychiatric disorders are
almost twice as likely as those without such disorders to smoke
(Lasser 2000)
• The interference of depression with quitting attempts has been
well documented (Anda 1990; Breslau 1993; Covey 1990)
• Depressed smokers are more likely than nondepressed smokers to
relapse (Covey 1990)
• Depression has been found to maximize withdrawal-related symptoms
and discomfort (Wetter 2000)
• Individuals who have a substance use disorder tend to be more
heavily nicotine-dependent.
• For example, individuals who use cocaine (approximately 80%) and
opioids (more than 80%) have high rates of co-morbid cigarette
smoking behavior
Source Courtesy of AAFP: Tobacco Cessation Behavioral Health Facts.
Accessed at
https://www.aafp.org/patient-care/public-health/tobacco-nicotine/office-champions/behavioral-health
An Overview of the Problem: Smoking Prevalence
• More than 80% of youth with substance use disorders report
current tobacco use, most report daily smoking, and many become
highly dependent, long-term tobacco users.
• An estimated 200,000 adults who have a mental health disorder and
comorbid substance use disorder die from tobacco-related causes
each year.
• Due to higher smoking prevalence • Disparities in access to
prevention and treatment
Source Courtesy of AAFP: Tobacco Cessation Behavioral Health Facts.
Accessed at
https://www.aafp.org/patient-care/public-health/tobacco-
Why Should We Integrate Tobacco Cessation Into Mental Heath and
Substance Use Treatment Facilities?
1. Tobacco use kills half of individuals with mental health and
substance use challenges
2. Tobacco use limits full recovery 3. Tobacco use disorder is in
the DSM
• Yet it may be the only substance use disorder that is not
routinely diagnosed and treated in mental health settings
4. Quitting tobacco promotes recovery • Quitting may increase
long-term abstinence of drug and alcohol use by as much as
25%
34
5 A’s
NRTs and P
Engage peer models
Recommendations on Addressing Tobacco Use in Behavioral Health
Populations
Source Slide Courtesy of SAMHSA: Substance Abuse and Mental Health
Services Administration.” Tobacco and Behavioral Health: The Issue
and Resources,”
https://www.samhsa.gov/sites/default/files/topics/alcohol_tobacco_drugs/tobacco-behavioral-health-issue-resources.pdf
[accessed 2018 May 11].
Emerging Trends
E-Cigarette and ENDS use among individuals with mental health/SUD
challenges
While individuals with behavioral health conditions account for
almost 40% of all traditional cigarettes smoked by adults, they are
also a significantly vulnerable group for high e-cigarette use
(Lipari & Van Horn, 2017).
Studies have shown: • people living with behavioral health
conditions, like depression and anxiety,
are twice as likely to have tried e-cigarettes and three times as
likely to be users of battery-powered electronic nicotine delivery
devices (Cummins & Zhu et al., 2014).
• individuals with mental illness often combine e-cigarettes with
concurrent use of traditional combustible cigarettes which make
them more at risk for nicotine addiction and susceptible to the
effects of traditional tobacco (Hefner & Valentine et al.,
2017).
E-Cigarette and ENDS use among individuals with mental health/SUD
challenges
• Individuals with mental health conditions are more likely to use
ENDS.
• In 2018: • Individuals with any mental health condition
were 1.8x as likely to have lifetime use of ENDS (32.6%) than those
without (17.8%).
• Individuals with any mental health condition were 2.3x as likely
to have current use of ENDS (17%) than those without (7.1%).
• Specific mental health conditions most likely to experience
disproportionally high rates of ENDS use include bipolar disorder
(42.9% lifetime use), anxiety disorder (35.9%) and depression
(34.9%).
Source: Spears, C., Jones, D., Weaver, S. et al. (2020). Use of and
perceptions about electronic nicotine delivery systems (ENDS) among
people with mental health conditions or serious psychological
distress, 2018. Elsevier B.V.
https://doi.org/10.1016/j.drugalcdep.2020.108049
Emerging Trends- Youth Use of ENDS
39
Youth, Mental Wellbeing and Nicotine Dependency • Transitional
Brain Age (13-25 years old)
• Half of all lifetime mental illness start by mid-teens and
three-fourths by mid-twenties (Kessler et al, 2007) • Strong
relationship between youth who smoke and depression, anxiety, and
stress (CDC, 2020) • More than 80% of youth with substance use
disorders report current commercial tobacco use, most report
daily smoking, and many become highly dependent, long-term
commercial tobacco users. (Hall & Prochaska, 2009)
• Electronic nicotine delivery systems (ENDS) are types of tobacco
products that contain nicotine
• Other names for ENDS include vapes, e-cigarettes, e-cigs, vape
pens, vaporizers, and e-pipes. • ENDS acts as entry nicotine
products that may lead to more nicotine products. (Truth
Initiative, 2021)
• Nicotine exposure during adolescence can: • Harm brain
development, which continues until about age 25. • Impact learning,
memory, and attention. • Increase risk for future addiction to
other drugs. (CDC, 2021)
Youth E-Cigarette Use and COVID-19 A national online survey among
those 13-24 years old was conducted in May 2020.
Findings: • COVID-19 diagnosis was
• five times more likely among ever-users of e-cigarettes only •
seven times more likely among ever-dual-users (cigarette and
e-cigarette) • and 6.8 times more likely among past 30-day
dual-users
Conclusions: COVID-19 is associated with youth use of e-cigarettes
and dual use of e-cigarettes and cigarettes, suggesting the need
for screening and education.
41
Heightened exposure to nicotine and other chemicals in e-cigarettes
adversely affects lung function, with studies showing that lung
damage caused by e-cigarettes is comparable to combustible
cigarettes
Adapting screening tools such as Screening to Brief Intervention
and Brief Scanner for Tobacco, Alcohol and Other Drugs to inquire
about ENDS use See Resource Guide for :
https://www.ysbirt.org/wp- content/uploads/2019/10/102119_NCBHSBIR
T_Final.pdf
Counseling using 5As Pharmacotherapy
NRT, patch, gum Engage in conversations about the risks of ENDS
use
with youth and their support systems Partner with key youth-serving
stakeholders to
expand reach and impact on preventing ENDS use and cessation
Recommendations on Addressing ENDS Use Among Youth
43
COVID-19 State of Smoking Poll The Foundation for a Smoke-Free
World commissioned a poll in five countries (United Kingdom, Italy,
South Africa, India, and the United States [New York and
California]) that explores the relationship between COVID-19 social
distancing and health among 6,801 tobacco and nicotine users.
Findings: • More than two thirds of the respondents rely on tobacco
and
nicotine as their main tool to manage stress and anxiety. • Nearly
40% of smokers increased use of these products in recent
weeks, which could equate to elevated use by more than 50 million
smokers in the five countries polled.
• Motivation to quit varied by country and in some countries the
desire to quit was increased due to health concerns from COVID-
19.
44
Source:
https://www.smokefreeworld.org/reports/covid-19-state-of-smoking-poll/
COVID-19 and Smoking: Evaluating the Risk 1. Smoking doubles your
risk of developing respiratory infections.
• In one study, volunteers who smoked were twice as likely as those
who did not smoke to develop an infection. • Smoking is known to
weaken the immune system and the body’s ability to fight
infections.
2. Smoking doubles your risk of getting sicker from COVID-19. • In
a review of 5 studies published to date,3 smoking is most likely
associated with getting sicker with COVID-19. • In the largest
study of people with COVID-19, people who smoke were 2.4 times more
likely to get really sick (e.g. admitted
to an intensive care unit, needing mechanical ventilation, dying)
compared to those who did not smoke. • Smoking can cause chronic
obstructive pulmonary disease (COPD) and other health problems that
may contribute to
serious illness. • Stopping smoking still helps your health if you
have COPD or heart disease.
3. Vaping increases your risk too. • Vaping harms the lungs and
diminishes the ability to respond to respiratory infection,
including COVID-19.
• Growing evidence suggests that the aerosol from vaping devices
harms lungs at the cellular and organ levels and worsens the body’s
ability to fight respiratory infections.
• The recent outbreak of e-cigarette use, predominantly affecting
young people, is associated with lung injury.
Source:
https://tobaccofreeca.com/health/covid-19-stop-smoking-and-vaping/
46
Stress, economic distress, social
isolation, motivation to quit
Recovery
It may take multiple attempts and moments of relapse for an
individual who smokes to recover. This is not an easy task in the
midst of a highly stressful pandemic, but recovery is
possible!
Quitting during the COVID-19 Pandemic
Communicate that cigarette smoking increases the severity COVID-19
illness and emphasize the following: • The adverse health effects
of smoking are well-
documented and undeniable. Now is a better time to quit than ever
and quitting is possible!
• Smoking harms nearly every organ in the body, and quitting
smoking is beneficial at any age.
• Clean air, free of secondhand smoke and aerosols, remains the
standard to protect health.
Enhance access to evidence-based cessation treatment, including
NRTs to support clients in quitting during COVID-19
Take Your Facility Tobacco-Free
• Reduce overall risk of COVID-19 among clients who use
tobacco
• Reduce overall risk of the spread of COVID-19 spread to staff and
other patients
• Enhance tobacco cessation outcomes
Adopt tobacco-free facility/grounds policies.
5 A’s
NRTs and P
Engage peer models
Recommendations on Addressing Tobacco Use in Behavioral Health
Populations
Source Slide Courtesy of SAMHSA: Substance Abuse and Mental Health
Services Administration.” Tobacco and Behavioral Health: The Issue
and Resources,”
https://www.samhsa.gov/sites/default/files/topics/alcohol_tobacco_drugs/tobacco-behavioral-health-issue-resources.pdf
[accessed 2018 May 11].
An Implementation Toolkit for Statewide Tobacco Control
Programs
Identifying and Addressing Health Disparities Related to
Tobacco Use Among Individuals with Mental
Health and Substance Use Disorders
Access the toolkit:
https://www.bhthechange.org/resources/new-nbhn-toolkit-
implementation-toolkit-for-statewide-tobacco-control-programs/
• Transitioning to a Tobacco-Free Facility: Resources & Sample
Policies [NBHN]
•
https://www.bhthechange.org/resources/prevalence-severity-and-mortality-associated-with-
copd-and-smoking-in-patients-with-covid-19-a-rapid-systematic-review-and-meta-analysis/
• Resource Digest: Impact of Coronavirus (COVID-19) on Tobacco
Consumers with Behavioral Health Conditions [NBHN]
• COVID-19 Social Media Shareables [NBHN]
• COVID-19 and Tobacco Resources [BHWP]
• COVID-19 and Tobacco Policy and Communications Toolkit
[ASH]
• Destination Tobacco-Free: A Practical Tool for Hospitals and
Health Systems, revised 2013 [Smoking Cessation Leadership
Center]
• COVID-19 and Tobacco: What You Need to Know Now
• Opportunities and Strategies for Tobacco Prevention During the
COVID-19 Pandemic
15. http://dx.doi.org/10.1136/tc.2005.011890 Retrieved from
https://escholarship.org/uc/item/73d0x34w
• Anda, R. F., Croft, J. B., Felitti, V. J., Nordenberg, D., Giles,
W. H., Williamson, D. F., & Giovino, G. A. (1999). Adverse
childhood experiences and smoking during adolescence and adulthood.
Journal of the American Medical Association, 282, 1652–1658.
• Original ACE study data American Journal of Preventative
Medicine. 1988.
• Austin, E. The Effect of Adverse Experiences on the Health of
Current Smoker. 2012.
• Anda, R. F., Croft, J. B., Felitti, V. J., Nordenberg, D., Giles,
W. H., Williamson, D. F., & Giovino, G. A. (1999). Adverse
childhood experiences and smoking during adolescence and adulthood.
Journal of the American Medical Association, 282, 1652–1658.
• Hall SM, Prochaska JJ. Treatment of smokers with co-occurring
disorders: Emphasis on integration in mental health and addiction
treatment settings. Annu Rev Clin Psychol. 2009; 5:409-31.
• Jamal A, Phillips E, Gentzke AS, et al. Current Cigarette Smoking
Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep
2018;67:53– 59.
• Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S,
Ustün TB. Age of onset of mental disorders: a review of recent
literature. Curr Opin Psychiatry. 2007;20(4):359-364.
doi:10.1097/YCO.0b013e32816ebc8c
• Centers for Disease Control and Prevention, Youth and Tobacco
Use. Office on Smoking and Health, National Center for Chronic
Disease Prevention and Health Promotion
https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm
(2020)
• Centers for Disease Control and Prevention, National Center for
Health Statistics. National Health Interview Survey (2018).
• Centers for Disease Control and Prevention. Electronic
Cigarettes.
https://www.cdc.gov/tobacco/basic_information/e-cigarettes/
(2021)
• Substance Abuse and Mental Health Services Administration, Center
for Behavioral Health Statistics and Quality. The N-MHSS Report.
November 25, 2014.
https://www.samhsa.gov/data/sites/default/files/Spot148_NMHSS_Smoking_Cessation/NMHSS-Spot148-QuitSmoking-
2014.pdf
• Kisely S, Crowe E, Lawrence D. Cancer-Related Mortality in People
With Mental Illness. JAMA Psychiatry. 2013;70(2):209–217.
doi:10.1001/jamapsychiatry.2013.278
• Substance Abuse and Mental Health Services Administration, Center
for Behavioral Health Statistics and Quality, National Survey on
Drug Use and Health (NSDUH), 2008-2015; SAMHSA, Center for
Behavioral Health Statistics and Quality. The NSDUH Report: Adults
With Mental Illness or Substance Use Disorder Account for 40
Percent of All Cigarettes Smoked [PDF–563 KB]. March 20, 2013.
Rockville, MD [accessed 2016 May 18].
• Substance Abuse and Mental Health Services Administration, Center
for Behavioral Health Statistics and Quality, National Survey on
Drug Use and Health (NSDUH), 2008-2015; SAMHSA, Center for
Behavioral Health Statistics and Quality. The NSDUH Report: Adults
With Mental Illness or Substance Use Disorder Account for 40
Percent of All Cigarettes Smoked [PDF–563 KB]. March 20, 2013.
Rockville, MD [accessed 2016 May 18].
• National Mental Health Services Survey (N-MHSS): 2018. Data on
Mental Health Treatment Facilities; National Survey of Substance
Abuse Treatment Services (N-SSATS): 2018. Data on Substance Abuse
Treatment Facilities.
• Acton et al. Depression and stages of change for smoking in
psychiatric outpatients. Addictive Behaviors. 2001;
26(5):621-31.
• Prochaska et al. Return to smoking following a smoke-free
psychiatric hospitalization. Am J Addiction. 2006;
15(1):15-22.
• Heiligenstein E, Smith SS. Smoking and mental health problems in
treatment-seeking university students. Nicotine & Tobacco
Research. 2006;8(4):519-23
• Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D,
Bor DH. (2000). Smoking and mental illness: A population-based
prevalence study. JAMA 284(20):26062–2610.
• Williams JM, Ziedonis D. (2004). Addressing tobacco among
individuals with a mental illness or an addiction. Addictive
Behaviors 29(6):1067-1083.
• Truth Initiative. Action Needed: E-Cigarettes.
https://truthinitiative.org/sites/default/files/media/files/2021/06/Truth_E-
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2021)
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characteristics of adults with selected lifetime mental illnesses:
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Sources and Citations (Cont’d)
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1521-0391 online. DOI: 10.1111/ajad.12186
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Samara Tahmid
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Slide Number 2
A Note on Language & Terminology
Learning Objectives
Determinants of Health
Slide Number 11
Slide Number 14
ACEs and Smoking Prevalence
Slide Number 19
Examining Risk:Poverty, other disadvantages tied to higher smoking
risk
Slide Number 21
Let’s Finish the Sentence…
Let’s Finish the Sentence
The Foundations of Tobacco Disparities for Individuals with Mental
Health and Substance Use Challenges
THE GOOD NEWS!Overall Cigarette Smoking Is Trending Down
Current Smoking among Adults (Age ≥ 18) with a Past Year Behavioral
Health (BH) Condition: NSDUH, 2015-2019
Current Smoking among Adults (Age ≥ 18) with Past Year Any Mental
Illness (AMI): NSDUH, 2008-2019
Current Smoking among Adults (Age ≥ 18) with Past Year Serious
Mental Illness (SMI): NSDUH, 2008-2019
Current Smoking among Adults (Age ≥ 18) with a Past Year Substance
Use Disorder (SUD): NSDUH, 2015-2019
Tobacco Interventions by Behavioral Health Facilities
Tobacco Cessation in Individuals with Mental Health & Substance
Use Challenges – The Facts
An Overview of the Problem: Smoking Prevalence
An Overview of the Problem: Smoking Prevalence
Why Should We Integrate Tobacco Cessation Into Mental Heath and
Substance Use Treatment Facilities?
Slide Number 35
E-Cigarette and ENDS use among individuals with mental health/SUD
challenges
E-Cigarette and ENDS use among individuals with mental health/SUD
challenges
Emerging Trends- Youth Use of ENDS
Youth, Mental Wellbeing and Nicotine Dependency
Youth E-Cigarette Use and COVID-19
Slide Number 42
COVID-19 and Smoking: Evaluating the Risk
Between Recovery & Relapse: The COVID-19 Challenge
Quitting during the COVID-19 Pandemic
Take Your Facility Tobacco-Free
Resources
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