NAMI State Conference November 16, 2013 Carole Specktor, M.P.A.

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Presentation Overview • About ClearWay Minnesota SM • Why tobacco is still a problem • Why it is important to address tobacco use?

• Smoking and persons with mental illness • QUITPLAN® Services 2

About ClearWay Minnesota • Mission: Reduce the harm tobacco causes the people of Minnesota • Grant-making, QUITPLAN stop-smoking services and statewide outreach activities 3

ClearWay Minnesota’s Work • Policy Changes • Research • Reducing Disparities • Cessation Services 4

Media Campaigns and Outreach 5

Why is Tobacco Still a Problem?

#1 Reason: The Tobacco Industry

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Tobacco Industry Adapts 7

Masterful Consumer Marketing 8

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 10

Quitting is Hard • Nicotine is highly addictive • Fundamental changes to the brain • Behavioral and psychological aspects of addiction 11

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 14

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 15

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Impact of Quitting 17

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 19

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 20

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 21

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 22

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 23

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 24

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 25

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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 28

QUITPLAN Helpline Basics • Free Services • Serves: – Uninsured – Underinsured, including Medicaid Fee-for Service – Live or work in Minnesota • Phone Counseling in English and Spanish – Partner with Asian Smokers’ Quitline – Other languages through translation service 29

QUITPLAN Helpline Program • Multi-call, one-on-one coaching program • Integrated text messages • Print materials • Nicotine Replacement Therapy • Two enrollments per year 30

QUITPLAN: Mental Health • Training for coaches – Training for individualized services – Substantial mental health training – Ongoing • Intake questions • Monitor field and adapt approach as appropriate 31

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 32

quitplan.com

• English and Spanish • NRT not available through quitplan.com

• Available to all Minnesotans, regardless of insurance status 33

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 34

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