Amber Bullock, MPH, CHES 12/10/12

Transcription

1 CHALLENGES & EMERGING TRENDS IN TOBACCO HEALTH DISPARITIES: IMPLICATIONS FOR MENTAL HEALTH PROFESSIONALS Amber Bullock, MPH, CHES 12/10/12

2 WHAT IS LEGACY? Nonprofit public health foundation located in Washington, D.C. Established by the landmark 1998 Master Settlement Agreement between the five major tobacco companies, 46 states and five U.S. territories. Two-part mission: (1) build a world where young people reject tobacco (prevention) and (2) anyone can quit (cessation) Grants Dissemination Work 2

3 TOBACCO USE AND MENTAL ILLNESS: A HIDDEN EPIDEMIC 60% 50% 40% 30% 20% 10% 0% 59.1% 46.4% 38.1% 37.2% 35.4% 34.3% 20.6% Lifetime Mental Illnesses Schizophrenia Bipolar Disorder Serious Psychological Distress Attention Deficit Disorder Dementia Phobias or Fears General Population Smoking rates are significantly higher in people with mental illnesses than in the general population Effects are staggering: Persons with serious mental illness (SMI) die 25 years earlier than general Population Financial consequences: Reliance on fixed incomes and tobacco product expenditures Source: Annette K. McClave et al., Smoking Characteristics of Adults With Selected Lifetime Mental Illnesses: Results From the 2007 National Health Interview Survey, American Journal of Public Health 100:12 (2010). Graphic prepared by Legacy 3

4 ATTENTION NEEDED While improving tobacco control is not a priority Less than a quarter of mental health outpatients receive cessation counseling In hospitals only 1% of inpatients were assessed for smoking 4

5 CESSATION SERVICE PROVISION: COMPARISON OF PSYCHIATRISTS TO FAMILY PHYSICIANS 90% 86% 80% Psychiatrists 70% 62% 60% 50% Family Physicians 40% 30% 20% 10% 14% 19% 2% 9% 0% Ask about Smoking Status Arrange Follow-up Visits Refer to a Quit Line Source: American Association of Medical Colleges, Physician Behavior and Practice Patterns Related to Smoking Cessation, 2007 Graphic prepared by Legacy 5

6 SOME DISPARITY CHALLENGES Very limited training for mental health providers Patients have more immediate problems to address People with mental health illness can t or don t want to quit smoking Perception that smoking is a pleasure that should not be taken away Quitting smoking will exacerbate symptoms and lead to relapse of the mental health disorder 6

7 SOME DISPARITY CHALLENGES Emerging Tobacco Products - Continual evolution - Marketing - Pricing Menthol Tobacco Industry Behavior Shifting Tobacco Control Landscape Resources Policy Restrictions 7

8 COUNSELING SERVICES, INC (CSI) CASE STUDY CSI serves low-income clients with mental illness Most clients are very heavy smokers, with a range of complex backgrounds Their charge: How best to approach cessation? 8

9 CSI CASE STUDY: PROGRAM DESIGN Client-based development of strategies Client Consultants Their recommendations: Focus on larger issue of health and wellness Need for socialization and group support alternatives Groups be co-led by a client and a staff member (validation and empowerment) 9

10 CSI CASE STUDY: IMPLEMENTATION Creation of 3 mutual-aid wellness groups (cofacilitated) Focus on wellness activities as the core Cessation was integrated into the activities exercise, weight control, etc. Use of buddy support systems Swimming Club formation at a local YMCA Tai Chi classes at another site 10

11 CSI CASE STUDY: LESSONS LEARNED Results 45 group members 8 successfully quit (out of 12 that decided to quit) Model of co-facilitation created a supportive environment where clients could gain information, support one another and work to empower themselves Asking clients to name and then solve their own problems was a fundamental strategy Don t put focus exclusively on quitting smoking; integrate smoking concerns with general medical issues and health care needs 11

12 SELECTED ENDNOTES Sharon M Hall and Judith J Prochaska, Treatment of Smokers with Co-Occurring Disorders: Emphasis on Integration in Mental Health and Addiction Treatment Settings. Annual Review of Clinical Psychology 5 (2009): Karen Lasser et al., Smoking and Mental Illness: A Population-Based Prevalence Study, The Journal of the American Medical Association 284:20 (2000): National Institute of Mental Health, Expert Panel Addresses High Rates of Smoking in People with Psychiatric Disorders: Recommendations Urge Exploration of Causal Links, Treatment Research. Science Update, February 18, 2009, accessed February 14, 2011, Steven A Schroeder, A 51-year-old woman with bipolar disorder who wants to quit smoking, JAMA Clinical Crossroads 301:5 (2009): Judith J Prochaska et al., Depressed Smoke and Stage of Change: Implications for Treatment Interventions, Drug and Alcohol Dependence 76 (2004): A. Lucksted et al., Specifying Cigarette Smoking and Quitting Among People with Serious Mental Illness. American Journal of Addiction 13:2 (2004): Ranita Siru, Gary K Hulse and Robert J Tait, Assessing Motivation to Quit Smoking in People with Mental Illness: A Review, Addiction 104:5 (2009): Judith J Prochaska, Sebastien C Fromont, and Sharon M. Hall, How Prepared Are Psychiatry Residents for Treating Nicotine Dependence? Academic Psychiatry 29:3 (2005): National Association of State Mental Health Program Directors (BNASMHPD), Tobacco-Free Living in Psychiatric Settings: A Best Practices Toolkit Promoting Wellness and Recovery, (Alexandria, VA: NASMHPD, 2006),

13 THANK YOU A B U L L O C L E G A C Y F O R H E A LT H. O R G