Smoking & Behavioral Health. Nearly 1 in 5 adults (or 45.7 million adults) have some form of mental illness

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1 VULNERABLE ADULTS

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3 Smoking & Behavioral Health Nearly 1 in 5 adults (or 45.7 million adults) have some form of mental illness

4 Smoking & Behavioral Health Adults with mental illness, substance abuse disorders or both Make up 24.8 % of adults in U.S. Consumed nearly 40% of all cigarettes in U.S.

5 Smoking & Behavioral Health 1 out of 3 adults with mental illness smoke cigarettes twice as much as the general population Adults w/ mental illness smoke more than 1/3 of all cigs produced YET are only 1/2 as likely to quit

6 Smoking & Behavioral Health Approximately 1 in 4 mental health centers offer cessation services (24.2%) Less than half of substance abuse treatment centers offer cessation services. Smoking Cessation Leadership Center (2015)

7 Smoking & Behavioral Health Roughly half of all annual U.S. tobaccorelated deaths (200,000) are among people with mental illness

8 Smoking & Behavioral Health Up to 75 percent of individuals with serious mental illness &/or substance use disorders smoke. 30 to 35 percent of treatment staff smoke.

9 Common Myths People with mental illness or other cognitive disabilities are less motivated and able to quit than others. Tobacco is a way for people with mental illness to selfmedicate. It s a coping strategy. Tobacco addiction is a less urgent substance abuse issue than more problematic alcohol and drug addictions. Tobacco cessation treatment dangerously interferes with other medical treatments & jeopardizes / compromises recovery or stability.

10 Realities People with mental illness or disorders are as motivated as the general population to quit smoking. Tobacco is INEFFECTIVE as a treatment for mental disorders. Psychiatric disease makes the brain more susceptible to addiction.

11 Realities Smoking cessation does NOT exacerbate depression or PTSD symptoms or lead to psychiatric hospitalization or increased use of alcohol or illicit drugs People with mental illness are far more likely to die from tobacco-related diseases than from mental illness.

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13 Adult foster care... Huh? A licensed living arrangement that provides mentally or physically impaired or ailing adults around the clock support, including food, lodging, supervision and household services.

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15 Research Goals Explore barriers to reducing tobacco use & secondhand smoke exposure in assisted living residences. Identify effective strategies for ensuring a tobaccofree environment in assisted living residences.

16 National Advisory Panel Experts in elder law / smoke-free housing law Experts in tobacco use among vulnerable groups Adult foster care experts / social service administrators

17 Legal Analysis & Research Collected & analyzed data 50-state survey of all state laws, rules & policies regulating smoking in assisted living residences Reviewed and categorized requirements

18 Legal Analysis & Research Interviewed key informants in 6 states Obstacles in adopting, implementing & enforcing smoke-free measures in assisted living settings Lessons learned

19 Key Informants

20 Wrangling with Terms Adult family homes Comprehensive living facilities Family care homes Supportive care homes Long-term services and support Homes plus Family respite care

21 Assisted Living Residences Residential arrangements (including adult foster care) that provide impaired, elderly or ailing adults 24-hour support, including food, lodging, supervision and household services.

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23 Current Landscape Will insert screen grab of our 50-state survey online map & directory

24 HUD s Pending Smoke-free Rule Rule requires more than 3,100 public housing agencies across the U.S. to prohibit lit tobacco products in all living units, indoor common areas, administrative offices, and all outdoor areas within 25 feet of housing and administrative office buildings.

25 Public Health Issue Tobacco use & secondhand smoke exposure can have a disproportionately adverse health effect on assisted living residents Tobacco-free environment denormalizes smoking & promotes cessation

26 Public Health & Safety Issue Tobacco-free environments reduce the risk of fire, particularly when cognitively impaired or disabled adults smoke surreptitiously.

27 Social Justice Issue Tobacco industry targets vulnerable populations with Predatory marketing tactics Price discounting practices

28 Social Justice Issue Tobacco use stigmatizes groups already marginalized, resulting in Limited employment opportunities Restricted housing options

29 Barriers & Unintended Consequences Cultural Norm High number of staff smoke (attendants, personal caregivers, administrators) Smoking is a socialization activity of residents an emotional coping mechanism

30 Tale of the 2 Kens Developmentally disabled; mid-50s; life-long heavy smokers Started smoking to fit in with their peers Purchased cigarettes with weekly paychecks Allotted 3 to 4 cigarettes each morning to take to work In evenings, were given pack & could smoke outdoors Would run around yard and pick up butts to smoke

31 Barriers & Unintended Consequences Burden on Providers Limited resources & staff make it hard to monitor residents (fear of elopements ) Need to accommodate special challenges for life-long smokers in quitting

32 Barriers & Unintended Consequences Burden on Providers Concern that enabling nonambulatory or infirm residents to smoke outside, etc. will increase likelihood of accidents & legal liability Concern about adverse impact on recruitment & retention of staff or residents

33 New Regulatory Challenges Use of e-cigarettes or similar devices by residents and staff

34 New Regulatory Challenges Smoking of marijuana in assisted living residences in states where medical or recreational use has been legalized

35 Toolkit Policy brief Fact sheets and resources 50-state survey of smoke-free adult foster care laws, policies & regulations (online/print) Mini podcast

36 Recommendations - State/Community Leaders Promote comprehensive state smokefree laws Encourage mental health, substance use & primary care providers to integrate tobacco cessation services w/ their services

37 Recommendations - State/Community Leaders Encourage social service workers to work with tobacco control professionals. Support comprehensive insurance coverage for tobacco cessation treatment

38 Minnesota State Leadership & Policy Academy Summit and Strategy Session for Tobacco-Free Recovery

39 Recommendations Assisted Living Providers Develop a careful implementation plan Allow sufficient time to educate the staff, residents, family members/caretakers, and community, and to establish procedures before policy takes place

40 Recommendations Assisted Living Providers Disclose & discuss policy in resident preadmission screening, house rules & regulations, employee interviews & staff policy manuals. Place signage in conspicuous areas on the premises

41 Policy Implementation & Enforcement Educate staff, residents, and visitors Enforce policy fairly and consistently

42 Recommendations Assisted Living Providers Ensure that all staff, residents & visitors comply w/ tobacco-free policies and that they re enforced fairly. Give staff & residents tobacco cessation & quitline referral information & (if possible) easy access to NRT products or resources

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44 Kerry Cork, J.D. Public Health Law Center (651) Pat McKone, Director Tobacco Control Programs & Policy American Lung Association of the Upper Midwest (