PowerPoint PresentationThursday, October 21, 2021 12:00 – 1:00 pm ET
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MentalWellbeingandRecovery101
• 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 individuals experiencing mental health and substance use challenged
• 1 of 8 CDC National Networks to eliminate cancer and tobacco disparities in priority populations
Free Access to… Toolkits, training opportunities, virtual communities and other resources
Webinars & Presentations
#BHthechange
Networking2Save: A National Network Approach to Promoting Tobacco and Cancer-Related Health Equity in Special Populations
A consortium of eight national networks sponsored by the CDC’s Office on Smoking and Health and Division of Cancer Prevention and Control.
Our partnership provides leadership on and promotion of evidence-based approaches for preventing commercial tobacco use and cancer for priority populations on a national, state, tribal and territorial level.
https://www.cdc.gov/cancer/ncccp/related- programs/Networking2Save.htm
Mental wellbeing: thriving regardless of a mental health or substance use challenge.
Commercial tobacco use/tobacco use: The use of commercial tobacco and nicotine products (including electronic nicotine devices, otherwise known as ENDs).*
*All references to smoking and tobacco use is referring to commercial tobacco and not the sacred and traditional use of tobacco by some American Indian and Alaskan Native communities.
Learning Objectives
Learn ways in which tobacco control intersects with health equity
Re-imagine ways to frame tobacco use in mental health, addiction and recovery
Gain tools to enhance tobacco control and cessation efforts
Contextual Factors and the Social Determinants of Health
Determinants of Health
Tobacco & Behavioral Health: What has caused the disparity?
The overall rate of cigarette smoking among adults has been falling decreasing, but individuals with mental health challenges have been neglected in prevention efforts, environmental and clinical interventions. This disparity can be attributed in part to predatorial practices by tobacco companies which included:
• Targeted advertisements • Providing free or cheap cigarettes to psychiatric clinics • Blocking of smoke-free policies in behavioral health facilities • Funding research that perpetuates the myth that cessation
would be too stressful and negatively impact overall behavioral health outcomes
• High rate of ACEs/Trauma • Limited access to high quality care (delays in care,
lower quality of care, and more)
Decades later, E-CIG and VAPING companies are still taking a page from Big Tobacco’s playbook…
Let’s Talk About Why People Start Smoking
• Targeted and Predatorial Marketing • High rate of ACEs/Trauma
• High risk behaviors • Limited access to high quality care • Delays in care • Lower quality of care • Anything else?
Prevalence of Trauma in Behavioral Health Treatment Settings
• Majority of adults and children in inpatient psychiatric and substance use disorder treatment settings report a trauma history (Lipschitz et al., 1999; Suarez, 2008; Gillece, 2010).
• 43% to 80% of individuals in psychiatric hospitals have some form of experienced physical or sexual abuse.
• 51% to 90% “public mental health clients” are exposed to trauma (Goodman et al., 1997; Mueser et al., 2004).
• 2/3 of adults in SUD treatment report child abuse and neglect (SAMHSA, CSAT, 2000).
• A survey of adults in SUD treatment found that more than 70% had a history of trauma exposure (Suarez, 2008).
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Smoking: Age at First Use
Anda, R. F., Croft, J. B., Felitti, V. J., Nordenberg, D., Giles, W. H., Williamson, D. F., & Giovino, G. A. (1999). Adverse childhood experiences and smoking during adolescence and adulthood. Journal of the American Medical Association, 282, 1652–1658.
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ACE Score
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ACEs and Current Smoking Prevalence
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Adverse Childhood Experiences vs. Current Smoking
Source: Original ACE study data American Journal of Preventative Medicine (1988)
ACEs and Smoking Prevalence
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Source: Austin, E. The Effect of Adverse Experiences on the Health of Current Smoker. 2012.
What Changed in the General Population? The 1964 the U.S. Surgeon General released the first report to examine the health consequences of tobacco use. This report changed the American perception, health care and public health attitudes towards tobacco use. From this report tobacco use was found to be….
The most important cause of chronic bronchitis
A cause of lung cancer and laryngeal cancer in men
A probable cause of lung cancer in women
50 Years Later…More Findings Emerged Today we know that tobacco use can lead to many more types of cancers and chronic conditions other than those directly related to the lung thanks to the 2014 Report of the Surgeon General on Smoking and Health. Key findings from this report included:
• Smoking harms nearly every organ in the body
• Quitting smoking has both short- and long-term benefits for health
• Exposure to secondhand smoke causes cancer, respiratory and heart disease, and adverse health effects among children
• The list of diseases caused by smoking continues to grow
Yet for individuals with behavioral health conditions, prevention of smoking related illnesses often takes a back seat to the individual’s mental illness leading to delayed diagnosis.
Source: slide courtesy of CDC; Jamal A, Phillips E, Gentzke AS, et al. Current Cigarette Smoking Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:53–59.
31.8% American Indians/Alaska Natives
Poverty Status
Health Insurance
21.2% Yes
14.4% No
Examining Risk: Poverty, other disadvantages tied to higher smoking risk
Source: Association of Cumulative Socioeconomic and Health-Related Disadvantage With Disparities in Smoking Prevalence in the United States, 2008 to 2017 (Leventhal, Bello, Galstyan, et al.)
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About 14 percent of individuals without any of these forms of adversity
smoked
increased, rising to 58 percent among individuals
with all six forms of adversity
Unemployment/poverty
Disparities in smoking are explained by disadvantaged populations being more likely to start smoking and less likely to quit smoking."
Source: https://www.medscape.com/ viewarticle/912195?src=wnl_edit_tpal&uac=245377DJ&impID=1948009&faf=1
Let’s Finish the Sentence…
People with mental illness die on average 5 to 25 years earlier* than those without mental illness...
• *Depending on data source • Source: Parks, J., et al. Morbidity and Mortality in People with Serious Mental Illness. Alexandria, VA: National Association of State Mental Health Program Directors Council. 2006 (25 years) https://www.who.int/mental_health/management/info_sheet.pdf (10-15 yrs)
Let’s Finish the Sentence
People with mental illness die on average 15 to 25 years earlier than those without mental
illness...
…due to complications from smoking- related illnesses…
The Foundations of Tobacco Disparities for Individuals with Mental Health and Substance Use Challenges
Aggressive targeted marketing, barriers to care, the spread of misinformation and higher than average rates of ACEs/Trauma in individuals with mental health or substance use challenges contribute to almost 40% of all cigarettes smoked by adults.
Source: Centers for Disease Control and Prevention
In 2018 32% of adults with any mental health challenge reported current use of tobacco compared to 23.3% of adults with no mental health challenge.
1 in 4 adults have some form of mental health or substance use challenge.
THE GOOD NEWS! Overall Cigarette Smoking Is Trending Down
Source: slide courtesy of CDC; Adult cigarette smoking prevalence data are from the National Health Interview Survey (NHIS); 2015 data based on NHIS Early Release data for January-June. High Source: data are from the National Youth Risk Behavior Survey.
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Current Smoking among Adults (Age ≥ 18) with a Past Year Behavioral Health (BH) Condition: NSDUH, 2015-2019
Current Smoking is defined as any cigarette use in the 30 days prior to the interview date. Behavioral Health Condition includes Any Mental Illness (AMI) and/or Substance Use Disorder (SUD). + Difference between this estimate and the 2019 estimate is statistically significant at the .05 level.
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Current Smoking among Adults (Age ≥ 18) with Past Year Any Mental Illness (AMI): NSDUH, 2008-2019
Current Smoking is defined as any cigarette use in the 30 days prior to the interview date. Any Mental Illness is defined as having a diagnosable mental, behavioral, or emotional disorder, other than a developmental or substance use disorder, based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). + Difference between this estimate and the 2019 estimate is statistically significant at the .05 level.
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Current Smoking among Adults (Age ≥ 18) with Past Year Serious Mental Illness (SMI): NSDUH, 2008-2019
Current Smoking is defined as any cigarette use in the 30 days prior to the interview date. Serious Mental Illness is defined as having a diagnosable mental, behavioral, or emotional disorder, other than a developmental or substance use disorder resulting in serious functional impairment, based on the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). + Difference between this estimate and the 2019 estimate is statistically significant at the .05 level.
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Current Smoking among Adults (Age ≥ 18) with a Past Year Substance Use Disorder (SUD): NSDUH, 2015-2019
Current Smoking is defined as any cigarette use in the 30 days prior to the interview date. Substance Use Disorder is defined as meeting criteria for illicit drug or alcohol dependence or abuse. Dependence or abuse is based on definitions found in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). + Difference between this estimate and the 2019 estimate is statistically significant at the .05 level.
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Sources: National Mental Health Services Survey (N-MHSS): 2018. Data on Mental Health Treatment Facilities; National Survey of Substance Abuse Treatment Services (N-SSATS): 2018. Data on Substance Abuse Treatment Facilities.
Intervention Mental Health Tx Facilities
Substance Abuse Tx Facilities
Cessation Counseling 40.5% 49.8%
Non-nicotine Cessation Medications
Tobacco Cessation in Individuals with Mental Health & Substance Use Challenges – The Facts
• The majority of persons with mental health and substance use disorders want to quit smoking [1,2]
• Smokers are more than 2x likely to quit for good with the help of tobacco cessation medications and counseling services.
• Persons with mental illness and substance abuse disorders can successfully quit using tobacco at rates similar to the general population. [3]
• Smoking cessation can enhance long-term recovery for persons with substance use disorders. For example, if someone quit smoking at the same time they are quitting drinking, they can have a 25% greater chance of staying sober. [4]
Sources: [1] Acton et al. Depression and stages of change for smoking in psychiatric outpatients. Addictive Behaviors. 2001; 26(5):621-31. [2] Prochaska et al. Return to smoking following a smoke-free psychiatric hospitalization. Am J Addiction. 2006; 15(1):15-22. [3] Heiligenstein E, Smith SS. Smoking and mental health problems in treatment- seeking university students. Nicotine & Tobacco Research. 2006;8(4):519-23 [4] Prochaska, Judith J; Delucchi, Kevin; & Hall, Sharon M. A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery.. Journal of consulting and clinical psychology. 2004; 72(6), 1144 - 1156. Retrieved from: http://escholarship.org/uc/item/0r8673wv
An Overview of the Problem: Smoking Prevalence
• Lifetime smoking rates are even higher in individuals who are diagnosed with major depression disorder (59%), bipolar disorder (83%), or schizophrenia and other psychotic disorders (90%).
• A recent study found that adults with psychiatric disorders are almost twice as likely as those without such disorders to smoke (Lasser 2000)
• The interference of depression with quitting attempts has been well documented (Anda 1990; Breslau 1993; Covey 1990)
• Depressed smokers are more likely than nondepressed smokers to relapse (Covey 1990)
• Depression has been found to maximize withdrawal-related symptoms and discomfort (Wetter 2000)
• Individuals who have a substance use disorder tend to be more heavily nicotine-dependent.
• For example, individuals who use cocaine (approximately 80%) and opioids (more than 80%) have high rates of co-morbid cigarette smoking behavior
Source Courtesy of AAFP: Tobacco Cessation Behavioral Health Facts. Accessed at https://www.aafp.org/patient-care/public-health/tobacco-nicotine/office-champions/behavioral-health
An Overview of the Problem: Smoking Prevalence
• More than 80% of youth with substance use disorders report current tobacco use, most report daily smoking, and many become highly dependent, long-term tobacco users.
• An estimated 200,000 adults who have a mental health disorder and comorbid substance use disorder die from tobacco-related causes each year.
• Due to higher smoking prevalence • Disparities in access to prevention and treatment
Source Courtesy of AAFP: Tobacco Cessation Behavioral Health Facts. Accessed at https://www.aafp.org/patient-care/public-health/tobacco-
Why Should We Integrate Tobacco Cessation Into Mental Heath and Substance Use Treatment Facilities?
1. Tobacco use kills half of individuals with mental health and substance use challenges
2. Tobacco use limits full recovery 3. Tobacco use disorder is in the DSM
• Yet it may be the only substance use disorder that is not routinely diagnosed and treated in mental health settings
4. Quitting tobacco promotes recovery • Quitting may increase long-term abstinence of drug and alcohol use by as much as
25%
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5 A’s
NRTs and P
Engage peer models
Recommendations on Addressing Tobacco Use in Behavioral Health Populations
Source Slide Courtesy of SAMHSA: Substance Abuse and Mental Health Services Administration.” Tobacco and Behavioral Health: The Issue and Resources,” https://www.samhsa.gov/sites/default/files/topics/alcohol_tobacco_drugs/tobacco-behavioral-health-issue-resources.pdf [accessed 2018 May 11].
Emerging Trends
E-Cigarette and ENDS use among individuals with mental health/SUD challenges
While individuals with behavioral health conditions account for almost 40% of all traditional cigarettes smoked by adults, they are also a significantly vulnerable group for high e-cigarette use (Lipari & Van Horn, 2017).
Studies have shown: • people living with behavioral health conditions, like depression and anxiety,
are twice as likely to have tried e-cigarettes and three times as likely to be users of battery-powered electronic nicotine delivery devices (Cummins & Zhu et al., 2014).
• individuals with mental illness often combine e-cigarettes with concurrent use of traditional combustible cigarettes which make them more at risk for nicotine addiction and susceptible to the effects of traditional tobacco (Hefner & Valentine et al., 2017).
E-Cigarette and ENDS use among individuals with mental health/SUD challenges
• Individuals with mental health conditions are more likely to use ENDS.
• In 2018: • Individuals with any mental health condition
were 1.8x as likely to have lifetime use of ENDS (32.6%) than those without (17.8%).
• Individuals with any mental health condition were 2.3x as likely to have current use of ENDS (17%) than those without (7.1%).
• Specific mental health conditions most likely to experience disproportionally high rates of ENDS use include bipolar disorder (42.9% lifetime use), anxiety disorder (35.9%) and depression (34.9%).
Source: Spears, C., Jones, D., Weaver, S. et al. (2020). Use of and perceptions about electronic nicotine delivery systems (ENDS) among people with mental health conditions or serious psychological distress, 2018. Elsevier B.V. https://doi.org/10.1016/j.drugalcdep.2020.108049
Emerging Trends- Youth Use of ENDS
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Youth, Mental Wellbeing and Nicotine Dependency • Transitional Brain Age (13-25 years old)
• Half of all lifetime mental illness start by mid-teens and three-fourths by mid-twenties (Kessler et al, 2007) • Strong relationship between youth who smoke and depression, anxiety, and stress (CDC, 2020) • More than 80% of youth with substance use disorders report current commercial tobacco use, most report
daily smoking, and many become highly dependent, long-term commercial tobacco users. (Hall & Prochaska, 2009)
• Electronic nicotine delivery systems (ENDS) are types of tobacco products that contain nicotine
• Other names for ENDS include vapes, e-cigarettes, e-cigs, vape pens, vaporizers, and e-pipes. • ENDS acts as entry nicotine products that may lead to more nicotine products. (Truth Initiative, 2021)
• Nicotine exposure during adolescence can: • Harm brain development, which continues until about age 25. • Impact learning, memory, and attention. • Increase risk for future addiction to other drugs. (CDC, 2021)
Youth E-Cigarette Use and COVID-19 A national online survey among those 13-24 years old was conducted in May 2020.
Findings: • COVID-19 diagnosis was
• five times more likely among ever-users of e-cigarettes only • seven times more likely among ever-dual-users (cigarette and e-cigarette) • and 6.8 times more likely among past 30-day dual-users
Conclusions: COVID-19 is associated with youth use of e-cigarettes and dual use of e-cigarettes and cigarettes, suggesting the need for screening and education.
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Heightened exposure to nicotine and other chemicals in e-cigarettes adversely affects lung function, with studies showing that lung damage caused by e-cigarettes is comparable to combustible cigarettes
Adapting screening tools such as Screening to Brief Intervention and Brief Scanner for Tobacco, Alcohol and Other Drugs to inquire about ENDS use See Resource Guide for :
https://www.ysbirt.org/wp- content/uploads/2019/10/102119_NCBHSBIR T_Final.pdf
Counseling using 5As Pharmacotherapy
NRT, patch, gum Engage in conversations about the risks of ENDS use
with youth and their support systems Partner with key youth-serving stakeholders to
expand reach and impact on preventing ENDS use and cessation
Recommendations on Addressing ENDS Use Among Youth
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COVID-19 State of Smoking Poll The Foundation for a Smoke-Free World commissioned a poll in five countries (United Kingdom, Italy, South Africa, India, and the United States [New York and California]) that explores the relationship between COVID-19 social distancing and health among 6,801 tobacco and nicotine users. Findings: • More than two thirds of the respondents rely on tobacco and
nicotine as their main tool to manage stress and anxiety. • Nearly 40% of smokers increased use of these products in recent
weeks, which could equate to elevated use by more than 50 million smokers in the five countries polled.
• Motivation to quit varied by country and in some countries the desire to quit was increased due to health concerns from COVID- 19.
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Source: https://www.smokefreeworld.org/reports/covid-19-state-of-smoking-poll/
COVID-19 and Smoking: Evaluating the Risk 1. Smoking doubles your risk of developing respiratory infections.
• In one study, volunteers who smoked were twice as likely as those who did not smoke to develop an infection. • Smoking is known to weaken the immune system and the body’s ability to fight infections.
2. Smoking doubles your risk of getting sicker from COVID-19. • In a review of 5 studies published to date,3 smoking is most likely associated with getting sicker with COVID-19. • In the largest study of people with COVID-19, people who smoke were 2.4 times more likely to get really sick (e.g. admitted
to an intensive care unit, needing mechanical ventilation, dying) compared to those who did not smoke. • Smoking can cause chronic obstructive pulmonary disease (COPD) and other health problems that may contribute to
serious illness. • Stopping smoking still helps your health if you have COPD or heart disease.
3. Vaping increases your risk too. • Vaping harms the lungs and diminishes the ability to respond to respiratory infection, including COVID-19.
• Growing evidence suggests that the aerosol from vaping devices harms lungs at the cellular and organ levels and worsens the body’s ability to fight respiratory infections.
• The recent outbreak of e-cigarette use, predominantly affecting young people, is associated with lung injury.
Source: https://tobaccofreeca.com/health/covid-19-stop-smoking-and-vaping/
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Stress, economic distress, social
isolation, motivation to quit
Recovery
It may take multiple attempts and moments of relapse for an individual who smokes to recover. This is not an easy task in the midst of a highly stressful pandemic, but recovery is possible!
Quitting during the COVID-19 Pandemic
Communicate that cigarette smoking increases the severity COVID-19 illness and emphasize the following: • The adverse health effects of smoking are well-
documented and undeniable. Now is a better time to quit than ever and quitting is possible!
• Smoking harms nearly every organ in the body, and quitting smoking is beneficial at any age.
• Clean air, free of secondhand smoke and aerosols, remains the standard to protect health.
Enhance access to evidence-based cessation treatment, including NRTs to support clients in quitting during COVID-19
Take Your Facility Tobacco-Free
• Reduce overall risk of COVID-19 among clients who use tobacco
• Reduce overall risk of the spread of COVID-19 spread to staff and other patients
• Enhance tobacco cessation outcomes
Adopt tobacco-free facility/grounds policies.
5 A’s
NRTs and P
Engage peer models
Recommendations on Addressing Tobacco Use in Behavioral Health Populations
Source Slide Courtesy of SAMHSA: Substance Abuse and Mental Health Services Administration.” Tobacco and Behavioral Health: The Issue and Resources,” https://www.samhsa.gov/sites/default/files/topics/alcohol_tobacco_drugs/tobacco-behavioral-health-issue-resources.pdf [accessed 2018 May 11].
An Implementation Toolkit for Statewide Tobacco Control Programs
Identifying and Addressing Health Disparities Related to
Tobacco Use Among Individuals with Mental
Health and Substance Use Disorders
Access the toolkit: https://www.bhthechange.org/resources/new-nbhn-toolkit- implementation-toolkit-for-statewide-tobacco-control-programs/
• Transitioning to a Tobacco-Free Facility: Resources & Sample Policies [NBHN]
• https://www.bhthechange.org/resources/prevalence-severity-and-mortality-associated-with- copd-and-smoking-in-patients-with-covid-19-a-rapid-systematic-review-and-meta-analysis/
• Resource Digest: Impact of Coronavirus (COVID-19) on Tobacco Consumers with Behavioral Health Conditions [NBHN]
• COVID-19 Social Media Shareables [NBHN]
• COVID-19 and Tobacco Resources [BHWP]
• COVID-19 and Tobacco Policy and Communications Toolkit [ASH]
• Destination Tobacco-Free: A Practical Tool for Hospitals and Health Systems, revised 2013 [Smoking Cessation Leadership Center]
• COVID-19 and Tobacco: What You Need to Know Now
• Opportunities and Strategies for Tobacco Prevention During the COVID-19 Pandemic
15. http://dx.doi.org/10.1136/tc.2005.011890 Retrieved from https://escholarship.org/uc/item/73d0x34w
• Anda, R. F., Croft, J. B., Felitti, V. J., Nordenberg, D., Giles, W. H., Williamson, D. F., & Giovino, G. A. (1999). Adverse childhood experiences and smoking during adolescence and adulthood. Journal of the American Medical Association, 282, 1652–1658.
• Original ACE study data American Journal of Preventative Medicine. 1988.
• Austin, E. The Effect of Adverse Experiences on the Health of Current Smoker. 2012.
• Anda, R. F., Croft, J. B., Felitti, V. J., Nordenberg, D., Giles, W. H., Williamson, D. F., & Giovino, G. A. (1999). Adverse childhood experiences and smoking during adolescence and adulthood. Journal of the American Medical Association, 282, 1652–1658.
• Hall SM, Prochaska JJ. Treatment of smokers with co-occurring disorders: Emphasis on integration in mental health and addiction treatment settings. Annu Rev Clin Psychol. 2009; 5:409-31.
• Jamal A, Phillips E, Gentzke AS, et al. Current Cigarette Smoking Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:53– 59.
• Kessler RC, Amminger GP, Aguilar-Gaxiola S, Alonso J, Lee S, Ustün TB. Age of onset of mental disorders: a review of recent literature. Curr Opin Psychiatry. 2007;20(4):359-364. doi:10.1097/YCO.0b013e32816ebc8c
• Centers for Disease Control and Prevention, Youth and Tobacco Use. Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion https://www.cdc.gov/tobacco/data_statistics/fact_sheets/youth_data/tobacco_use/index.htm (2020)
• Centers for Disease Control and Prevention, National Center for Health Statistics. National Health Interview Survey (2018).
• Centers for Disease Control and Prevention. Electronic Cigarettes. https://www.cdc.gov/tobacco/basic_information/e-cigarettes/ (2021)
• Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. The N-MHSS Report. November 25, 2014. https://www.samhsa.gov/data/sites/default/files/Spot148_NMHSS_Smoking_Cessation/NMHSS-Spot148-QuitSmoking- 2014.pdf
• Kisely S, Crowe E, Lawrence D. Cancer-Related Mortality in People With Mental Illness. JAMA Psychiatry. 2013;70(2):209–217. doi:10.1001/jamapsychiatry.2013.278
• Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health (NSDUH), 2008-2015; SAMHSA, Center for Behavioral Health Statistics and Quality. The NSDUH Report: Adults With Mental Illness or Substance Use Disorder Account for 40 Percent of All Cigarettes Smoked [PDF–563 KB]. March 20, 2013. Rockville, MD [accessed 2016 May 18].
• Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health (NSDUH), 2008-2015; SAMHSA, Center for Behavioral Health Statistics and Quality. The NSDUH Report: Adults With Mental Illness or Substance Use Disorder Account for 40 Percent of All Cigarettes Smoked [PDF–563 KB]. March 20, 2013. Rockville, MD [accessed 2016 May 18].
• National Mental Health Services Survey (N-MHSS): 2018. Data on Mental Health Treatment Facilities; National Survey of Substance Abuse Treatment Services (N-SSATS): 2018. Data on Substance Abuse Treatment Facilities.
• Acton et al. Depression and stages of change for smoking in psychiatric outpatients. Addictive Behaviors. 2001; 26(5):621-31.
• Prochaska et al. Return to smoking following a smoke-free psychiatric hospitalization. Am J Addiction. 2006; 15(1):15-22.
• Heiligenstein E, Smith SS. Smoking and mental health problems in treatment-seeking university students. Nicotine & Tobacco Research. 2006;8(4):519-23
• Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. (2000). Smoking and mental illness: A population-based prevalence study. JAMA 284(20):26062–2610.
• Williams JM, Ziedonis D. (2004). Addressing tobacco among individuals with a mental illness or an addiction. Addictive Behaviors 29(6):1067-1083.
• Truth Initiative. Action Needed: E-Cigarettes. https://truthinitiative.org/sites/default/files/media/files/2021/06/Truth_E- Cigarette%20Factsheet%20update%20JUNE%202021_FINAL.pdf (May 2021)
• McClave AK, McKnight-Elly LR, Davis SP, Dube SR. (2010). Smoking characteristics of adults with selected lifetime mental illnesses: Results from the 2007 National Health Interview Survey. American Journal of Public Health 100 (12) 2464-2472.
• Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and Mental Illness: A Population-based Prevalence Study. JAMA 2000; 284(20):2606-10.
• Centers for Disease Control and Prevention. National Center for Health Statistics. National Health Interview Survey 2014-2017.
• Centers for Disease Control and Prevention. National Youth Tobacco Survey, 2011-2018.
• Judith (Jodi) Prochaska. Vaping and E-cigs among Behavioral Health Populations: Research Evidence and Research Needs Wednesday, September 12, 2018
Sources & Citations (Cont.)
Sources and Citations (Cont’d)
• Dube, S.R., et al., Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics, 2003. 111(3): p. 564- 572.
• Yoon, J.H., S.D. Lane, and M.F. Weaver, Opioid analgesics and nicotine: more than blowing smoke. Journal of pain & palliative care pharmacotherapy, 2015. 29(3): p. 281-289.
• Klein, L.C., Effects of adolescent nicotine exposure on opioid consumption and neuroendocrine responses in adult male and female rats. Experimental and clinical psychopharmacology, 2001. 9(3): p. 251.
• Mannelli, P., et al., Smoking and opioid detoxification: behavioral changes and response to treatment. nicotine & tobacco research, 2013. 15(10): p. 1705-1713.
• The American Journal on Addictions, 24: 105–116, 2015 Copyright © American Academy of Addiction Psychiatry ISSN: 1055-0496 print / 1521-0391 online. DOI: 10.1111/ajad.12186
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Slide Number 2
A Note on Language & Terminology
Learning Objectives
Determinants of Health
Slide Number 11
Slide Number 14
ACEs and Smoking Prevalence
Slide Number 19
Examining Risk:Poverty, other disadvantages tied to higher smoking risk
Slide Number 21
Let’s Finish the Sentence…
Let’s Finish the Sentence
The Foundations of Tobacco Disparities for Individuals with Mental Health and Substance Use Challenges
THE GOOD NEWS!Overall Cigarette Smoking Is Trending Down
Current Smoking among Adults (Age ≥ 18) with a Past Year Behavioral Health (BH) Condition: NSDUH, 2015-2019
Current Smoking among Adults (Age ≥ 18) with Past Year Any Mental Illness (AMI): NSDUH, 2008-2019
Current Smoking among Adults (Age ≥ 18) with Past Year Serious Mental Illness (SMI): NSDUH, 2008-2019
Current Smoking among Adults (Age ≥ 18) with a Past Year Substance Use Disorder (SUD): NSDUH, 2015-2019
Tobacco Interventions by Behavioral Health Facilities
Tobacco Cessation in Individuals with Mental Health & Substance Use Challenges – The Facts
An Overview of the Problem: Smoking Prevalence
An Overview of the Problem: Smoking Prevalence
Why Should We Integrate Tobacco Cessation Into Mental Heath and Substance Use Treatment Facilities?
Slide Number 35
E-Cigarette and ENDS use among individuals with mental health/SUD challenges
E-Cigarette and ENDS use among individuals with mental health/SUD challenges
Emerging Trends- Youth Use of ENDS
Youth, Mental Wellbeing and Nicotine Dependency
Youth E-Cigarette Use and COVID-19
Slide Number 42
COVID-19 and Smoking: Evaluating the Risk
Between Recovery & Relapse: The COVID-19 Challenge
Quitting during the COVID-19 Pandemic
Take Your Facility Tobacco-Free
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