Carole Specktor - NAMI Minnesota

Report
NAMI State Conference
November 16, 2013
Carole Specktor, M.P.A.
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Presentation Overview
• About ClearWay MinnesotaSM
• Why tobacco is still a problem
• Why it is important to address tobacco
use?
• Smoking and persons with mental
illness
• QUITPLAN® Services
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About ClearWay Minnesota
• Mission: Reduce the harm
tobacco causes the people of
Minnesota
• Grant-making, QUITPLAN
stop-smoking services and
statewide outreach activities
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ClearWay Minnesota’s Work
• Policy Changes
• Research
• Reducing Disparities
• Cessation Services
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Media Campaigns and Outreach
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Why is Tobacco Still a Problem?
#1 Reason:
The Tobacco Industry
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Tobacco Industry Adapts
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Masterful Consumer Marketing
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Targeted Marketing
• Tobacco industry has
targeted populations to
increase usage and loyalty
• Examples:
– African Americans
– American Indians
– Latinos
– Persons with mental
illness
– LGBT community
– Low-SES
– Youth
E-Cigarettes
• Untested and unregulated
• Not proven as safe
alternative to smoking
• Not an approved
cessation aid
• Often candy-flavored
• CDC study: use of e-cigarettes among
middle- and high-school students more than
doubled between 2011 and 2012
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Quitting is Hard
• Nicotine is highly
addictive
• Fundamental
changes to the
brain
• Behavioral and
psychological
aspects of
addiction
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Why Address Tobacco?
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Tobacco is a Killer Problem
• Smoking is the number one
cause of preventable disease
and death
• 443,000 tobacco-related
deaths per year nationally
• On average, smokers die 13
to 14 years earlier than
nonsmokers
Smoking in Minnesota
• 625,000
Minnesota adults
smoke (16%)
• Secondhand smoke exposure (2010):
‒ Nearly 46% of adults exposed
‒ 282,000 Minnesota children exposed
• Majority of Minnesota smokers want to quit
Minnesota Adult Tobacco Survey Tobacco Use in Minnesota: 1999-2010
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4000 Chemicals in Cigarettes
Examples and where these
chemicals are found:
– Acetone: nail polish remover
– Acetic Acid: hair dye
– Ammonia: household cleaner
– Arsenic: rat poison
– Butane: lighter fluid
– Cadmium: battery acid
– Carbon Monoxide: car exhaust
– Nicotine: insecticide
– Tar: pavement
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Impact of Quitting
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Smoking and Mental Illness
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High Prevalence
• Higher prevalence imposes
heavy morbidity and mortality
burden
• Thirty-one percent of all
cigarettes are smoked by
adults with mental illness
• Why higher prevalence?
− Targeted by tobacco industry
− Biological, psychological and social factors
− To date, not commonly addressed by providers
Vital Signs: Current Cigarette Smoking Among Adults Aged >18 Years with Mental Illness – United States, 2009-2011
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•
•
•
•
Quitting and Persons with Mental
Illness
Can quit
Want to quit
Want information to help them quit
Some factors may make it harder to quit,
but . . .
• Evidence shows cessation strategies work
• Studies show that quitting smoking does
not worsen psychiatric symptoms
Vital Signs: Current Cigarette Smoking Among Adults Aged >18 Years with Mental Illness – United States, 2009-2011; Tobacco
Cessation for Persons with Mental Illness or Substance Use Disorders, Center for Tobacco Cessation
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Understanding Higher
Prevalence: Biological Factors
Persons with mental illness have
unique neurobiological features
that may:
– Increase tendency to use nicotine
– Make it more difficult to quit; and
– Complicate withdrawal symptoms
Smoking Cessation for Persons with Mental Illnesses: A Toolkit for Mental Health Providers
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Understanding Higher Prevalence:
Psychological and Social Factors
• Psychological
considerations:
– Smoking relieves tension,
anxiety and stress
– Daily routine
• Social considerations:
– Smoke to relieve boredom
– Smoke to feel part of a group
Smoking Cessation for Persons with Mental Illnesses: A Toolkit for Mental Health Providers
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Understanding Higher Prevalence: Myths
and Barriers within Behavioral Health Care
Commonly stated reasons why mental health
providers have not addressed smoking with clients:
•
•
•
•
•
•
They can’t or don’t want to quit
More pressing issues
Concerns about worsening symptoms
Lack of training
Don’t want to take away one of patients’ few pleasures
Shared smoke breaks build strong relationships
Triggering a Paradigm Shift in Treating Patients with Mental Health and Addictive Disorders, Wisconsin Nicotine Treatment Integration
Project (presentation, July 28 2011); Vital Signs: Current Cigarette Smoking Among Adults Aged >18 Years with Mental Illness –
United States, 2009-2011; Building the Case to support Tobacco Cessation, National Council for Behavior Health, June 28, 2013
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Training
• Recent study found psychiatrists:
– Address tobacco less frequently than other
physicians
– Reported receiving no or inadequate training on
tobacco-related interventions
• Survey of Wisconsin mental health providers:
– The majority (72%) support adding nicotine
dependence treatment skills to credentials
– With training, the majority (66%) are willing to
provide treatment
Physician Behavior and Practice Patterns Related to Smoking Cessation, Association of American Medical Colleges ; Wisconsin Nicotine
Treatment Integration Project
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Strategies to Reduce Smoking for
Persons with Mental Illness
• Reframe expectations of
success
• Integrate tobacco as part of
an approach to mental health
treatment and overall
wellness
• Provide mental health providers the training and
tools they need to address tobacco with patients
• Utilize existing resources such as quitlines
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QUITPLAN® Services
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The Good News: Treatment Helps
• Evidence-based treatment can double
or triple success
• Evidence-based treatment:
– Counseling
– FDA-approved medications
– Both
• Best outcomes with both
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QUITPLAN Helpline Basics
• Free Services
• Serves:
– Uninsured
– Underinsured, including Medicaid Fee-forService
– Live or work in Minnesota
• Phone Counseling in English and Spanish
– Partner with Asian Smokers’ Quitline
– Other languages through translation service
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QUITPLAN Helpline Program
• Multi-call, one-on-one
coaching program
• Integrated text messages
• Print materials
• Nicotine Replacement
Therapy
• Two enrollments per year
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QUITPLAN: Mental Health
• Training for coaches
– Training for individualized services
– Substantial mental health training
– Ongoing
• Intake questions
• Monitor field and adapt approach
as appropriate
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Nicotine Replacement Therapy
• Patches, gum or lozenge
• Uninsured and underinsured
• Four weeks per enrollment*
(eight weeks per Medicaid enrollment)
• Medical screening
• Age 18 and older
• Live or work in Minnesota
*twice every12-months
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quitplan.com
• English and
Spanish
• NRT not available
through
quitplan.com
• Available to all
Minnesotans,
regardless of
insurance status
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Materials
• Order QUITPLAN Materials at:
www.clearwaymn.org (click “about”)
– Brochures in English and Spanish
– Smokeless tobacco brochure
– Palm card
• Mailed to you free of charge
• E-cigarette fact sheet available on
website
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