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

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

2. Presentation Overview • About ClearWayMinnesotaSM • Why tobacco is still a problem • Why it is important to address tobacco use? • Smoking and persons with mental illness • QUITPLAN® Services

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

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

5. Media Campaigns and Outreach

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

7. Tobacco Industry Adapts

8. Masterful Consumer Marketing

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

12. Why Address Tobacco?

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%) • 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

17. Impact of Quitting

18. Smoking and Mental Illness

19. 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

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

27. QUITPLAN® Services

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

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

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

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

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 *twice every12-months

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

34. 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