Implicit Bias and Tobacco Cessation Services Increasing Impact through Understanding and Action Thursday, August 31 st, 2017, 2:00pm EDT Presented by: Nicole Mueller, BA Mary Mancuso, MA
Welcome! Margaret Jaco Manecke, MSSW Project Manager, National Behavioral Health Network for Tobacco & Cancer Control National Council for Behavioral Health MargaretM@thenationalcouncil.org 2
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 people with mental illness and addictions 1 of 8 CDC National Networks to eliminate cancer and tobacco disparities in priority populations Visit www.bhthechange.org and Join Today! Free Access to Toolkits, training opportunities, virtual communities and other resources Webinars & Presentations State Strategy Sessions Community ofpractice #BHtheChange
Implicit Bias
Housekeeping How to join the webinar? GoToWebinar INSTRUCTIONS: Join the webinar: https://attendee.gotowebinar.com/register/464 2737709838408961 Call in using your telephone: +1 (631) 992-3221 Access Code: 228-880-041 Audio PIN: Shown after joining the meeting To ask a question: type it into the Q&A pod. Technical difficulties? Call Citrix Tech Support at 888-585-9008
Today s Agenda Implicit bias and healthcare The role of bias in tobacco treatment Bias in various populations Strategies to overcome implicit bias Moderated Q&A 7
Guest Speakers Nicole Mueller, BA Community Liaison, Behavioral Health and Wellness Program (BHWP) University of Colorado Mary Mancuso, MA Clinical Associate, Behavioral Health and Wellness Program (BHWP) University of Colorado 8
Implicit Bias and Tobacco Cessation Services Increasing Impact through Understanding and Action
Objectives The concept of implicit bias in our society How implicit bias factors relate to the behavioral health population The impact of implicit bias on clients in tobacco cessation treatment Strategies for increasing awareness and counteracting implicit bias for healthcare providers
Implicit Bias Overview
Explicit Bias Our conscious attitudes and beliefs about a person or group
Our unconscious attitudes and beliefs about a person or group Implicit Bias
Implicit biases are attitudes or stereotypes that affect our understanding, actions, and decision in an unconscious manner (Kirwan Institute, 2016)
Implicit bias is activated involuntarily, outside of our conscious awareness or intentional control (Kirwan Institute, 2016)
Implicit bias can be either positive or negative (Kirwan Institute, 2016)
Everyone is susceptible to implicit bias (Kirwan Institute, 2016)
The Origins of Implicit Bias Mental associations over time from direct and indirect messaging Individuals paired with specific characteristics
Demographic Characteristics Age Geography Sex/Gender Socioeconomic Status Behavioral Health/Substance Abuse Race/Ethnicity Sexual Orientation Weight
How is Implicit Bias Measured? The Assumption Method The Implicit Association Test (IAT) Project Implicit Evaluative Priming Task (EPT) Affect Misattribution Procedure
Implicit Bias in Society Legal Healthcare Employment Housing Education
Implicit Bias & Healthcare
Implicit Bias and Health Disparities Provider implicit bias Path A Path B Judgments and decisions about patient care Communication and trust with patients Patients engagement and adherence to treatment Disparities in health Zestcott, Blair, & Stone, (2016)
Implicit Bias in Healthcare Treatment options Patient mistrust Diagnosis Communication between providers and patients
The Role of Bias in Tobacco Treatment
Explicit Bias & Tobacco Use The perception that tobacco use is an individual choice influences Provider treatment Policy Insurance coverage Social marginalization of smokers
Explicit Bias, Tobacco & Behavioral Health Tobacco cessation treatment not traditionally a priority in behavioral health Common myths Symptom management Self-medication Fulfillment
60 50 40 30 Tobacco Use and Behavioral Health Populations 61-90% Schizophrenia 51-70% Bipolar Disorder; 49-80% Other Drug Abuse 45-60% PTSD 38-42% ADHD; 36-80% Major Depression 34-80% Alcohol Abuse; 32-60% Anxiety 20 10 0 1957 1980 1998 2003 2008 2013 Men Women
Tobacco Use Affects Mental Health Care and Treatment Persons with behavioral health conditions who use tobacco: Have more psychiatric symptoms Have increased hospitalizations Require higher dosages of medications Die 25 years earlier than the general population
Quitting: It Can Be Done Persons with behavioral health conditions: 75% want to quit using 65% tried to quit in the last 12 months Are able to quit using
Implicit Bias & Tobacco Users
Factors that Influence Tobacco Users Pattern activation Implicit Attitudes The environment and other stimuli shift smoker s implicit attitudes toward tobacco Therefore, smokers experience both positive and negative implicit attitudes Smokers implicit attitudes shift based on: Tobacco use Experience of abstinence/withdrawal Cravings can increase positive associations
Effect of Implicit Attitudes Smokers implicit attitudes towards tobacco can influence smoking behavior Implicit attitudes found to be predictive of smoking onset in non-smoking adolescents Implicit attitudes about tobacco are associated with quit attempts, cessation, relapse and abstinence
Tobacco Dependence Has Two Parts Tobacco dependence is a 2-part problem Physical The addiction to nicotine Treatment Behavior The habit of using tobacco Treatment Medications for cessation Behavior change program Treatment should address both the addiction and the habit. Courtesy of the University of California, San Francisco
Patient Interventions Explicit Intervention Strategies
Patient Interventions Implicit Intervention Strategies
Implicit Bias & Providers
Patient Health
Patient Education
Patient Race
Patient Gender
Provider Tobacco Use
Patient Insurance Status
Strategies to Reduce Implicit Bias
Education
Skill Building
Reducing Implicit Bias in Healthcare Settings Healthcare education and training Bias-awareness strategies Inclusive learning environments Control strategies Perspective taking strategies Habituate egalitarian values Healthcare institutions Positive intergroup contact Commitment to the norm of treating all patients equally Reduce cognitive load Limit reliance on automatic processes (e.g., stereotypes) Standardize processes (e.g., EHR)
Project Implicit Implicit Association Tests to assess attitudes and beliefs: Gender-Career Gender-Science Race Age Disability Weapons Weight Skin-tone Sexuality Arab-Muslim Religion Native Presidents Asian https://implicit.harvard.edu/implicit/takeatest.html
Behavioral Health & Wellness Program 303.724.3713 bh.wellness@ucdenver.edu www.bhwellness.org Behavioral Health and Wellness Program BHWP_UCD
Questions? To ask a question, type it into the Q&A box in your webinar window.
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 people with mental illness and addictions 1 of 8 CDC National Networks to eliminate cancer and tobacco disparities in priority populations Visit www.bhthechange.org and Join Today! Free Access to Toolkits, training opportunities, virtual communities and other resources Webinars & Presentations State Strategy Sessions Community ofpractice #BHtheChange
Additional Opportunities Health Financing Webinar Series: Sept. 13: Cracking the (CPT) Code for Tobacco Cessation & Cancer Prevention Oct. 11: Finding New Financing for Tobacco Cessation & Cancer Prevention Efforts Cancer Control Webinar Series: Sept. 12: Promising Practices to Track, Monitor and Address Needs Across the Cancer Continuum in Behavioral Health Populations Oct. 17: Financing Cancer Control Practices for Behavioral Health Populations Other Webinars: Sept. 26: The Intersection of Tobacco, E-Cigarettes, and Marijuana Use
Thank you for joining us! As you exit the webinar, please do not forget to complete the evaluation survey. Questions? Please contact Margaret Jaco Manecke at MargaretM@thenationalcouncil.org