1. NAMI State Conference November 16, 2013 Carole Specktor, M.P.A. 1

2. 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

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

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

5. Media Campaigns and Outreach 5

6. Why is Tobacco Still a Problem? #1 Reason: The Tobacco Industry 6

7. Tobacco Industry Adapts 7

8. Masterful Consumer Marketing 8

9. 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

10. E-Cigarettes 10 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

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

12. Why Address Tobacco? 12

13. 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

14. Smoking in Minnesota 625,000 Minnesota adults smoke (16%) 14 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

15. 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

16. 16

17. Impact of Quitting 17

18. Smoking and Mental Illness 18

19. High Prevalence Higher prevalence imposes heavy morbidity and mortality burden Thirty-one percent of all cigarettes are smoked by adults with mental illness 19 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

20. 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 20 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

21. 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 21 Smoking Cessation for Persons with Mental Illnesses: A Toolkit for Mental Health Providers

22. 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 22 Smoking Cessation for Persons with Mental Illnesses: A Toolkit for Mental Health Providers

23. 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 23 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

24. 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 24 Physician Behavior and Practice Patterns Related to Smoking Cessation, Association of American Medical Colleges ; Wisconsin Nicotine Treatment Integration Project

25. 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 25 Provide mental health providers the training and tools they need to address tobacco with patients Utilize existing resources such as quitlines

26. 26

27. QUITPLAN® Services 27

28. 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

29. 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

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

31. 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

32. 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 32 *twice every12-months

33. quitplan.com English and Spanish NRT not available through quitplan.com Available to all Minnesotans, regardless of insurance status 33

34. Materials Order QUITPLAN Materials at: www.clearwaymn.org (click “about”) www.clearwaymn.org –Brochures in English and Spanish –Smokeless tobacco brochure –Palm card Mailed to you free of charge E-cigarette fact sheet available on website 34

35. For More Information www.clearwaymn.org www.quitplan.com www.stillaproblem.org http://www.mnadulttobaccosurvey.org/ www.cdc.gov http://smokingcessationleadership.ucsf.edu Carole Specktor: cspecktor@clearwaymn.org (952) 767-1418 35

36. 36

37. 37