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1 THE WEBINAR WILL BE STARTING SHORTLY. Please do the following prior to the webcast: 1. To listen to audio by phone, dial Conference Room Check your system requirements by clicking the? on your GoToWebcast platform Still need help? Call

2 National Behavioral Health Network for Tobacco & Cancer Control:. State/Tribal Agency Community of Practice Tobacco Control, Systems-Level August 18 th, 2016

3 WELCOME! Krystle Canare Project & Logistics Coordinator, NBHN Project Coordinator, National Council for Behavioral Health

4 Housekeeping Dial-In Conference Room Audio/Video Trouble? Check your system requirements by clicking the? on your GoToWebcast platform.. Technical Difficulties? Call The best way to ask a question is to type it into the Questions box in your WebCast window.

5 CoP Faculty Catherine Saucedo Deputy Director, Smoking Cessation Leadership Center, University of California, San Francisco

6 State/Tribal CoP Webinar: Tobacco Control, Systems-Level August 18, 2016 Catherine Saucedo Deputy Director, Smoking Cessation Leadership Center University of California, San Francisco

7 It s a New Era

8 50 th Anniversary of the Surgeon General s First Report on Smoking and Health Smoking is still the leading cause of preventable disease and death in the United States; it is responsible for over 480,000 deaths per year. Between 1964 and 2014: Over 20 million Americans died because of smoking, including 2.5 million nonsmokers More than 100,000 babies The cigarette is the deadliest artifact in the history of human civilization. Robert Proctor, Stanford University

9 Tobacco s Deadly Toll 540,000 deaths in the U.S. each year* 4.8 million deaths world wide each year --Current trends show >8 million deaths annually by ,000 deaths in the U.S. due to second-hand smoke exposure 14 million in U.S. with smoking related diseases (60% with COPD) 42.1 million smokers in U.S. (76.9% daily smokers, averaging 14.2 cigarettes/day, 2013) Source: * Carter et al, NEJM, Feb 12, 2015

10 Health Consequences of Smoking 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 Source: U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General, Cardiovascular diseases > Abdominal aortic aneurysm > Coronary heart disease > Cerebro-vascular 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; Crohns; periodontitis,; poor surgical outcomes; Alzheimers; rheumatoid arthritis; less sleep

11 Current Smokers Population Smoking Rate Persons with MI or SU disorder 38.3% The poor Medicaid: 29.1% Least educated GED: 41.4%; Less than H.S.: 24.2% LGBT 26.6% Chronically homeless 80% Incarcerated persons 70% - 83% Sources: Tsai & Rosenheck, Psychiatric Services, 2012; Parker et al., Addict Med, 2014.

12 About 25% of population... is smoking nearly 40% of all cigarettes Figure 1. Any Mental Illness (AMI) or Substance Use Disorder (SUD) in the Past Year among Adults Aged 18 or Older: 2009 to 2011 Figure 2. Percentage of Cigarettes Smoked in the Past Month among Adults 18 or Older, by Any Mental Illness (AMI) or Substance Use Disorder (SUD) in the Past Year: 2009 to 2011 AMI Only 16.1% AMI Only 21.4% No AMI or SUD 75.2% SUD Only 4.9% AMI and SUD 3.8% No AMI or SUD 60.4% SUD Only 8.7% AMI and SUD 9.5% Source: The NSDUH Report (SAMHSA), March 20,

13 Smoking, Drug, and Alcohol Use Current Illicit Drug Use Past month Alcohol Use Past month Binge Drinking Past month Heavy Drinking Past month Smokers Non Smokers 20.1% 4.1% 66.9% 46.1% 45% 16.4% 16.4% 3.8% Adults in this survey are age 12+ Source: Substance Abuse and Mental Health Services Administration, Office of Applied Studies (2008). Results from the 2007 National Survey on Drug Use and Health: National Findings (NSDUH Series H-34, DHHS Publication No. SMA ). Rockville, MD. 1 3

14 Smoking Prevalence and Substance Use 34 and 80% - alcohol abusers 49 and 98% - other drug addictions 53-91% of people in addiction treatment settings use tobacco (Source: Guydish et al, Nicotine and Tobacco Research, June 2011, p 401) Tobacco use causes more deaths than the alcohol or drug use bringing clients to treatment: death rates among tobacco users is nearly 1.5 times the rate of death from other addiction-related causes (Source: SAMHSA N-SSATS Report September 2013)

15 Mental Health Treatment Facilities Offering Services to Quit Smoking, by Treatment Setting: 2010 NOTE Inpatient settings include 24- hour psychiatric care in a hospital setting. Outpatient settings also include day treatment or partial hospitalization. Residential settings include 24-hour, overnight, psychiatric care in a residential nonhospital setting. Percentage Source: 2010 Substance Abuse and Mental Health Services Administration (SAMHSA) National Mental Health Services Survey (N-MHSS). N-MHSS is an annual survey of all mental health treatment facilities in the United States, both public and private, that are known to SAMHSA. N-MHSS is one component of the Behavioral Health Services Information System (BHSIS), an integrated data system maintained by the Center for Behavioral Health Statistics and Quality (CBHSQ), SAMHSA. Information and data for this report are based on data reported to N-MHSS for the survey reference date April 30, For more information on N-MHSS, see

16 Percentage Substance Abuse Treatment Facilities Offering Services to Quit Tobacco Use: 2012 Source: 2012 Substance Abuse and Mental Health Services Administration (SAMHSA) National Survey of Substance Abuse Treatment Services (N-SSATS). N-SSATS is an annual survey of all substance abuse treatment facilities in the United States, both public and private, that are known to SAMHSA. N-SSATS is one component of the Behavioral Health Services Information System (BHSIS), an integrated data system maintained by the Center for Behavioral Health Statistics and Quality, SAMHSA. Information and data for this report are based on data reported to N-SSATS for the survey reference date March 30, For more information on N-SSATS, see

17 Myths: Smoking and Behavioral Health Tobacco is necessary self-medication (industry has supported this myth) They are not interested in quitting (same % wish to quit as general population) They can t quit (quit rates same or slightly lower than general population) Quitting worsens recovery from the mental illness (not so; associated with decreased episodes of depression, anxiety, etc. and increase in positive moods) Quitting worsens recovery from addictions (not so; and quitting increases long-term abstinence from alcohol/other drug addictions) It is a low priority problem (smoking is the biggest killer for those with mental or substance use disorders) Source: Prochaska, NEJM, July 21, 2011.

18 SAMHSA s Flagship Effort to Reduce Tobacco Use in Behavioral Health State Efforts Beginning in 2010 In partnership with the Smoking Cessation Leadership Center State Leadership Academies Multi-state Policy Academies (2014 & 2015) Academies provide an opportunity for each state to bring together policymakers and stakeholders to develop a collaborative action plan for reducing tobacco use among persons with mental or substance use disorders.

19 Academy & State Strategy Sessions on Tobacco Control in Behavioral Health OR MT WY MN MI IN OH WV NY MD MA KY NC AZ OK AR MS TX LA HI Pre-SAMHSA Initiative Leadership Academy on Smoking Cessation Alaska Hawaii 2014 Policy Academy on Tobacco Control in BH 2015 Policy Academy on Tobacco Control in BH Both Policy and Leadership Academies

20 The Five Questions 1. Where are we now? Baseline 2. Where do we want to be? Target 3. How will we get there? Multiple strategies 4. How will we know we are getting there? Evaluation 5. Who will do what by when? Commitment to implementation

21 SAMHSA-SCLC Leadership Academy Summits and NBHN State Strategy Sessions Photo of the Mississippi Leadership Academy for Wellness and Smoking Cessation Summit

22 Data Driven

23 Percentage of Smoking Prevalence Trend Over Time Data 80.0% 70.0% North Carolina Leadership Academy BASELINE General Population, Adult Mental Health, and Substance Abuse Smoking Rates (Initial) 74% 72% 73% 63% 63% 60.0% 50.0% 48% 47% 50% 47% 49% 40.0% General Population Mental Health (initial) 30.0% 22.1% 22.90% 20.90% 20.30% 19.80% Substance Abuse (initial) 20.0% 10.0% 0.0% Year

24 Sample Target

25 Best Practices Adopting & implementing a tobacco-free facility/grounds policy BH providers routinely asking clients about tobacco use & providing evidence-based cessation treatment Effectiveness of tobacco cessation treatment significantly increases when integrating cessation services/initiatives into the behavioral health treatment settings Many may benefit from additional counseling & longer use of cessation medications Peer-driven approaches such as peer specialists trained in smoking cessation

26 Action Plan - Implementation Plan is fluid Includes baseline, target, multiple strategies and measurement strategy Timeline and volunteers assigned to each strategy Quickly produced and shared to sustain momentum

27 Common Strategy Groups Data Development, Analysis, Dissemination Legislation and Policy Media and Messaging Medicaid Outreach and Consumer Education Provider Education Youth Cessation

28 Quitlines and Behavioral Health Do quitlines work for people with MI and/or SUD? Are they able to meet the demand?

29 % Smoking Self-Reported Mental Health Issues Among Helpline Callers Depression (Zhu,et al, Unpublished data) Anxiety Bipolar Schizophrenia Drug/Alcohol Any

30 Power of Peers Peer-led support groups, community referrals, etc. Train peers to integrate tobacco cessation & wellness services into existing roles and responsibilities. Embedded model uses programs that have peer specialists on staff or as volunteers

31 2016 Tips Campaign

32 National Campaigns

33 Mississippi

34 Maryland

35 Outcomes New York 22 out of 24 behavioral health campuses are tobacco-free; this policy is expected to become system-wide soon for all state-operated campus. Preliminary findings from its Patient Characteristic Survey: Smoking rates for both SMI and non-smi adults decreased Treatment (both counseling and medication) increased

36 Outcomes North Carolina As of July 1, 2014, the use of tobacco products, including e-cigarettes, was prohibited anywhere on the grounds of state-operated healthcare facilities Breathe Easy, North Carolina s state-wide conference and training focused on tobacco and behavioral health

37 Outcomes - Texas 18 local mental health authorities have adopted a 100% tobacco-free campus policy Taking Texas Tobacco Free, 3-year grant funded through Cancer Prevention Research Institute of Texas Through a partnership with UT Austin, the Tobacco Prevention and Control Branch is funding CTTS training in June 2016 for up to 50 community, medical and behavioral health providers

38 Outcomes - Smoking Prevalence Maryland Smoking prevalence for addiction treatment consumers dropped from 71.8% in 2010 to 56.5% in Oklahoma >Smoking prevalence for addiction treatment consumers served by the ODMHSAS provider system dropped from 74% in 2009 to 47% in 2014 (self-report data). 38

39 Final Thoughts The gap between the magnitude of the problem of tobacco use and the amount of attention it deserves is huge Often in behavioral health, nonsmokers live in housing with smokers and are exposed to SHS If we push harder, we can accelerate the decline in smoking prevalence. This means policy advocacy for taxes, clean indoor air, counter-marketing, and cessation Failure to do so will cost millions of lives

40 Toll-free: (877)

41 Guest Speaker #2 Annie Rechlin Tobacco Cessation Specialist, Montana Tobacco Use Prevention Program

42 MTUPP Media Campaign & Materials Creation/Development Production Dissemination 42

43 Targeted Media Campaign & Materials: Behavioral Health Media Gallery: 43

44 Targeted Media Campaign & Materials: Behavioral Health 2 Media Gallery: 44

45 Montana Leadership Academy for Tobacco-Free Recovery March 21-22,

46 MT Leadership Academy for Tobacco-Free Recovery Planning considerations Process Outcomes Action Plan Action Plan available here: 46

47 From then to now... Update on outcomes Challenges Renewed focus 47

48 Questions? To ask a question, type it into the Questions box in your WebCast window.

49 Next Steps Week of Aug. 29 th : Topic-based Conference Calls Please complete this Doodle poll indicating your date/time preference: Sept. 8 th : Pre-Assignment #2 DUE (Cancer Control & Prevention) Sept. 22 2:00pm ET: Webinar #3: Cancer Control, Provider-Level 49

50 Thank you for joining us! As you exit the webinar, please do not forget to complete the evaluation survey. Questions? Please contact Margaret Jaco at