Strengthening Psychology s Role in Reducing Tobacco Health Disparities Who Smokes Today and What Kind of Cessation Assistance do They Need?

Transcription

1 Strengthening Psychology s Role in Reducing Tobacco Health Disparities Who Smokes Today and What Kind of Cessation Assistance do They Need? Dee Burton, Ph.D. SUNY Downstate School of Public Health

2 What kind of cessation assistance have we been providing?

3 What Kind of Assistance Has Been Provided? Interventions USA Smoking Prevalence 1960s Information 42.4%1965 Counter-Advertising 1970s 1980s 1990s In-Person Treatment Groups Habit Addiction Physician Involvement Stages of Smoking Cessation NRT & Psychopharmacology Proactive phone counseling Quit Lines 2000 on Quit Lines NRT 18.3%* %** % 2012*** *BRFSS; **NHIS ***First half of 2012

4 What kind of cessation assistance are we providing today?

5 Cessation Assistance Provided Today Gold Standard: NRT and Quit Line Plus All previous methods still available

6 Available Assistance Varenicline NRT Proactive phone counseling Individual counseling Bupropion Group counseling Quitline counseling

7 Caveat Most smokers do not use or try any of those methods.

8 Of all those in USA who quit smoking > 75-90% quit unaided.

9 Only about 50% of those who smoke ever succeed in quitting.

10 65-90% of those who smoke want to quit.

11 What type of assistance is needed?

12 Who Smokes Today

13 Lower Incomes & Lower Education Legacy Foundation 2010 report

14 Sources of Stress Inability to support one s family Inability to support oneself Inability to support one s self

15 Smoking by Occupation 44.7% Food preparation & serving 36.9% Installation, maintenance & repair 31.6% Farming, fishing, forestry 12.3% Education, training, library SAMHSA national survey aggregate data

16 Sources of Stress Job strain from high job demand with low job control

17 45.4% of unemployed smoke. SAMHSA national survey aggregate data

18 Sources of Stress Loss of esteem Lack of hope Lack of shelter and food

19 Smoking among Newer Male Immigrants Masked by gender and region. Smoking Prevalence Male Female Chinese 33.0% 2.8% Vietnamese 25.0% < 1.0% Asian: 9.2%

20 Sources of Stress Alienation from family Downward occupational mobility Intergenerational conflicts Inability to access mainstream society

21 Race & Smoking Cessation African Americans: less likely to start smoking Less likely to stop smoking Smoking Prevalence AfAm 21.5% 20.6% White 21.9% 21.0% NHIS.

22 Sources of Stress Chronic pervasive racial discrimination

23 Figure 1. LGBT vs. Heterosexual Smoking Prevalence in Six States. Source: American Lung Association. Smoking Out a Deadly Threat: Tobacco Use in the LGBT Community.. Published Accessed October 15, 2012.

24 Sources of Stress Stigma Blocked expression of identity

25 Smoking and Mental Illness 41% mental illness overall 58-90% schizophrenia Those with a diagnosable psychiatric condition smoke 34-44% of all cigarettes smoked in the USA. Grant et al, 2004; Lasser et al, 20000

26 Sources of Stress Experiences of the disease itself Stigma

27 Smoking & HIV Smoking prevalence among HIV-infected men and women: 2-3 x greater than general population. Reported smoking prevalence: 40-75%.

28 Sources of Stress Anxiety re: mortality Fatigue from associated illnesses Stigma

29 In sum: Who Smokes Today Highly stressed individuals

30 What kind of cessation assistance do they need? Cessation assistance that: 1. Comes to them 2. Provides long-term support 3. Is tailored to the whole person s experience

31 Example from Chinese Restaurant Workers Study Door-to-door outreach for engagement Longer term proactive phone counseling With open-slate counseling that focuses on the whole person s experience Burton, Zeng et al, 2010

32 Individuals Who Smoke Today Need Cessation assistance that: 1. Comes to them 2. Stays with them to provide long-term support 3. Is tailored to the whole person s experience

33 Psychology s Role in Reducing Tobacco Health Disparities can be to Provide Cessation assistance that: 1. Comes to them 2. Stays with them to provide long-term support 3. Is tailored to the whole person s experience

34 Thank you.