Los Angeles County Peer-to-Peer Quit Smoking Program

1. Los Angeles County Peer-to-Peer Quit Smoking Program Addressing Tobacco Use in Mental Health and Alcohol and Drug Treatment Centers Rachel A. Tyree, MPH Los Angeles County Department of Public Health Tobacco Control and Prevention Program September 15, 2010

2. To assist individuals to lead meaningful lives, we need to promote behaviors that lead to health. -University of Colorado, Denver, Behavioral Health and Wellness Program

3. Peer-to-Peer Program Overview • Persons with serious mental illnesses and substance use disorders represent 7.1% of the total U.S. population, but consume 30-44% of all cigarettes smoked (Lasser K et al: JAMA 284:2606-10, 2000). • Persons with serious mental illness live 25 years less than the general population – much of this increased mortality is due to smoking (NASMHPD, 2006). • People with mental health illnesses want to quit smoking and want information about cessation services and resources (Morris et al., 2006). • People with mental health illnesses can successfully quit using tobacco (Evans et al., 2005; George et al., 2002).

4. Peer-to-Peer Program Overview Persons with Addictions & Mental Illnesses are: • Nicotine dependent at rates 2-3 times higher • Represent over 44% of the U.S. tobacco market • Consume over 34% of all cigarettes smoked -Lasser K et al: JAMA 284:2606-10, 2000)

5. Peer-to-Peer Program Overview • People with mental health and substance use disorders do have choices when it comes to their health. • What do persons with mental illness need to quit smoking? • “…a peer advocate maybe somebody that’s smoked and quit smoking and they have ideas of how they dealt with stress at that time and how they deal with it now…” -Mental Health Consumer Focus Group Participant, Colorado, 2006.

6. Peer-to-Peer Interventions • Peer-to-Peer Interventions have become a central part of the substance abuse and mental health recovery movement. The Recovery Movement suggests that “adjuncts and alternatives to formal treatment, involvement in self-help groups, and social opportunities at local drop-in centers foster empowerment and provide opportunities for a more meaningful life” (Forquer & Knight, 2001, p. 25). • Peer-run services can provide a sense of empowerment, and mutual benefit for the peer provider, as well as the recipient.

7. CHOICES Program Consumers Helping Others Improve their Condition by Ending Smoking • Started in New Jersey, June 2005 • Wellness and Recovery Philosophy • Consumer Tobacco Advocates • Mental health consumer trained on tobacco • Deliver message to smokers with mental illness that quitting smoking is important • Advocate for increased tobacco treatment services for mental health consumers • Williams, 2007; www.njchoices.org

8. CHOICES Program “Since I’ve started working for CHOICES, it has strengthened my resolve to stay off of tobacco and live a healthy, well-informed lifestyle. CHOICES not only motivates me to live healthier, but also made me realize that I can live up to my full potential and help others in the process.” – CHOICES Consumer Tobacco Advocate, New Jersey 2008

9. CHOICES Program • Of the consumers who met with an Advocate for a brief peer-to-peer intervention, 22% reported trying to quit one month after the intervention. • 70% of consumers who had not tried to quit significantly reduced their smoking after receiving the peer-to-peer intervention. • 70% of consumers surveyed reported that is was “a lot easier” to talk with an Advocate about their smoking compared to talking with their psychiatrist or mental health provider.

10. LA County Peer-to-Peer Quit Smoking Program • Peer-to-Peer “Embedded” Model • Created by the University of Colorado, Denver Behavioral Health and Wellness Program • Raise awareness through center in-services, “lunch and learn”, trainings • Conduct one-on-one motivational interviews • Provide cessation service referrals • Conduct an on-site peer support group Behavioral Health & Wellness Program

11. Role of the Tobacco Peer Specialist • Runs onsite support groups, conducts one-on-one motivational interviews with consumers, and provides cessation service referrals. • Works at a Wellness Center or AOD Treatment Center. • Joins network of other peer advocates and counselors in sharing lessons learned, ideas for recruitment, and participates in monthly TA calls, other workshops, site visits with the LA County Tobacco Control & Prevention Program. Behavioral Health & Wellness Program

12. Peer-to-Peer Program Veterans Affairs Homeless/ Transitional Living Shelters Community Health Clinics Other Resources Behavioral Health & Wellness Program

13. Peer-to-Peer Program Spring 2009 – Spring 2010: 5 two-day trainings Nearly 200 peer advocates and substance use counselors trained 30 programs currently implementing program Behavioral Health & Wellness Program

14. Embedded Program Behavioral Health & Wellness Program

15. Motivational Intervention • 30-minute session • Motivate smokers with mental health/substance use disorders to seek tobacco dependence treatment • Provides brief, personalized feedback about the impact of tobacco use • Carbon Monoxide (CO) • Money spent on tobacco Behavioral Health & Wellness Program

16. 30-Minute Session Objectives: • Interact one-on-one with smoker • Educate smoker on health risks of CO • Give feedback about smoker’s own CO level • Give feedback on average daily, weekly, monthly, and yearly amount spent on cigarettes • Consider how money could be spent Behavioral Health & Wellness Program

17. 30-Minute Session Afterward, smokers should be able to: • Know what CO is and why it is dangerous • Know their own CO level • Understand that quitting smoking will reduce CO to a safe level • Know that a pack/day smoker spends $2,000 per year on cigarettes • Know how much $ they will save if they quit Behavioral Health & Wellness Program

18. CO Handout What is Carbon Monoxide? • Deadly chemical found in cigarette, cigar and pipe smoke • Odorless and colorless gas • Found in air pollution (small amounts) • Takes the place of oxygen in your blood • Increases risk for heart attacks Behavioral Health & Wellness Program

19. CO Reading Peer advocates have the smoker breathe through a carbon monoxide monitor to assess CO levels in the lungs • Great motivational tool • Peers use it to assess lung health as they cut down on cigarettes • Draws attention to the smoking cessation efforts Behavioral Health & Wellness Program

20. Cost of Smoking Handout Behavioral Health & Wellness Program

21. Peer Support Group Behavioral Health & Wellness Program

22. Peer Support Group • Weekly, 1 hour group • Can be closed or drop-in • Participants may join at any time • Participants may attend as many sessions as needed • Session topics will cycle over a 6-week period Behavioral Health & Wellness Program

23. Peer Support Group • Session A: Healthy Behaviors • Session B: The Truth About Tobacco • Session C: Changing Behaviors • Session D: Coping with Cravings • Session E: Managing Stress • Session F: Planning Ahead Behavioral Health & Wellness Program

24. Session A: Healthy Behaviors • Objectives: • To learn about living a healthy lifestyle • To discover ways to make healthier choices • To learn about the health effects of smoking and of quitting • 5 handouts Behavioral Health & Wellness Program

25. Session B: Truth About Tobacco • Objectives: • To learn about chemicals in cigarette smoke • To review common myths about smoking • To review reasons to keep smoking and reasons to quit smoking • To determine “top 5 reasons to quit” • 3 Handouts Behavioral Health & Wellness Program

26. What is in Cigarette Smoke?

27. Session C: Changing Behaviors Objectives: • To recognize smoking patterns • To discover new behaviors to change current patterns • To discuss activities that do not involve smoking • 1 handout Behavioral Health & Wellness Program

28. Session D: Coping with Cravings Objectives • To learn about cravings and determine current “craving score” • To discover new ways to cope with cravings • To learn about medications that are helpful when quitting smoking • 4 handouts Behavioral Health & Wellness Program

30. Session E: Managing Stress Objectives: • To learn about stress • To discuss current stress management habits • To discover new ways to cope with stress • 3 handouts Behavioral Health & Wellness Program

31. Session F: Planning Ahead Objectives: • To visualize life as a non-smoker • To discuss potential relapse situations • To practice preventing relapse and saying “no” Behavioral Health & Wellness Program

32. Peer-to-Peer Program • 116 peer advocates and substance use counselors trained • Nearly 100 providers and clinicians trained with the “Ask, Advise, Refer” intervention • Program up-and-running in 29 centers/clinics • Partners: Smoking Cessation Leadership Center, Veterans Affairs, Coalition to End Hunger and Homelessness • Currently conducting impact evaluation study Behavioral Health & Wellness Program

33. LA County Programs • Pacific Clinics • Action Rehabilitation Center • Chabad Residential Treatment Center • BACUP Life Center • Exodus Recovery, Inc. • Harbor UCLA MH Wellness Center • Hollywood Wellness Center • Northeast MH Wellness Center • South Bay Wellness Center • West Central Mental Health Center • S.H.A.R.E.! Self Help • Divine Healthcare Services • Veterans Affairs – West LA, Downtown LA & East LA • WB Community Learning Center • ClinicaMonsenor Oscar Romero • Divine Healthcare Services, Inc. • Trinity Plus Healthcare • National Council on Alcoholism & Drug Dependence: Pomona • B.R.I.D.G.E.S. Project Independence Wellness Center • Long Beach MH Wellness Center • Rio Hondo MH Wellness Center • San Fernando MH Wellness Center • ENKI Health Services • Phoenix House • Social Model Recovery Systems

34. Interventions for Tobacco Use University of Colorado, Denver, Behavioral Health and Wellness Program: http://www.bhwellness.org/?page_id=73

35. California Smokers’ Helpline1-800-NO-BUTTS • Free statewide tobacco cessation program • Scientifically proven to be effective • All services available by telephone • In operation since 1992 • Adults, teens, pregnant women and proxy • Multiple languages

36. California Smoker’s Helpline • English1-800-NO-BUTTS (1-800-662-8887) • Cantonese1-800-838-8917 • Korean1-800-556-5564 • Mandarin1-800-838-8917 • Spanish1-800-45-NO-FUME (1-800-456-6386) • Vietnamese1-800-778-8440

37. Elearning - Online CME • Online CME (1 credit) • Ask, Advise, Refer intervention • Nicotine replacement therapies • www.publichealth.lacounty.gov “Rx for Prevention” under • “Publications and Reports • Upcoming: • Online CME for mental health providers and clinicians with the Center for Tobacco Cessation

38. Project TRUST • LA County Tobacco Control & Prevention Program received $16 million in economic stimulus dollars for policy, environment, and systems-level change • Mini-Grant Program • Up to $5,000 for social services agencies • 100% smoke-free environment policies • Implement smoking cessation programs for staff and consumers/clients • First wave of recipients: September 2010

39. LA Pioneers in Tobacco Control • The Alcoholism Center for Women • United American Indian Involvement, Inc. • Veterans Health Association, LA Ambulatory Care Center • Cri-Help, Inc. • WB Community Learning Center • Phoenix House of Los Angeles • Phoenix House of California • The Walls Las MemoriasProject • The Lavelle Center • Epidarurus Amity Foundation • Chabad Residential Treatment Center • Asian Youth Center • Mission City Community Network • BRIDGES • Gateways Hospital and Mental Health Center • The Saban Free Clinic • Valley Community Clinic • Pathways to Your Future • Tarzana Treatment Center • NCADD – South Bay • Northeast Valley Health Corporation • House of Hope Foundation • AIDS Project Los Angeles • LA Biomedical Research Institute • Rainbow Bridge Community Services • Divine Healthcare Services • Harbor-UCLA Wellness Center • Trinity Plus Healthcare Services • Penny Lane Centers • Pasadena Council on Alcoholism & Drug Dependence • Child Care Resource Center • South Central LA Regional Center for Developmentally Disabled Persons

40. Resources Quitting Time LA! www.laquits.com Become An Ex http://www.becomeanex.org/ ConvierteteEnUnEx http://es.becomeanex.org/

41. Additional Resources • Behavioral Health and Wellness Program, Mental Health Provider Toolkit http://www.bhwellness.org/?page_id=73 • The Smoking Cessation Leadership Center http://smokingcessationleadership.ucsf.edu/ • Centers for Disease Control and Prevention www.cdc.gov/tobacco • U.S. Surgeon General www.surgeongeneral.gov/tobacco/ • Partnership to Help Pregnant Smokers Quit www.helppregnantsmokersquit.org/ • Tobacco Cessation Leadership Network www.tcln.org

42. Thank you! Contact Information: Rachel A. Tyree, MPH Project Director, Tobacco Cessation Initiatives LA County Tobacco Control & Prevention Program (213) 427-4466 rtyree@ph.lacounty.gov www.publichealth.lacounty.gov/tobacco www.laquits.com