The Ripple Effect: - PowerPoint Presentation

Slide1

The Ripple Effect:

Smoking in Behavioral Health Populations and the Impact on the Family—Health Implications and Future Directions

Carlo

DiClemente, Ph.D. & Meagan Graydon, M.A.

NAMI Maryland

2015 Annual Conference

Saturday, October 17, 2015Slide2

The Maryland Resource Center for Quitting

Use and Initiation of Tobacco (MDQuit

)Funded by the Maryland Department of Health and Mental Hygiene (DHMH) and located on UMBC campus

Dedicated to assisting providers and programs in reducing tobacco use among citizens across the state utilizing best practices strategiesSlide3

Today’s Objectives

Overview of Tobacco Use in the U.S.Tobacco Use & Behavioral Health

Second and Third-hand SmokeBenefits of Smoke-free PoliciesWhat Can Family Members Do? Slide4

“Cigarette smoking is the chief, single, avoidable cause of death in our society and the most important public health issue of our time.”

~C. Everett Koop, M.D.

former U.S. Surgeon GeneralSlide5

In the U.S.,

42.1 million people

currently smoke cigarettes (17.8% of adults). Of these…3 out of 4 smoke DAILY (77%)

More than half of these daily smokers tried to quit in the past year (52.9%)Between 1965 and 2009 the proportion of former smokers more than doubled

In 2012, 55% of ever smokers are now former

smokers

Smoking prevalence

has dropped from 42% in 1965

to

17.8%

in

2013.

CDC,

2014

The Big Picture: U.S. Tobacco UseSlide6

Behavioral Health Populations

Behavioral Health includes individuals at risk or suffering from mental, behavioral, and/or addictive disorders.They are a special population in tobacco use research, because of their:

Higher smoking prevalence than the general population of smokers Disproportionate tobacco-related health disparities Lack of access to treatmentUnderrepresentation in prospective, longitudinal treatment trialsSlide7

Tobacco Disproportionately Impacts Substance Use

Populations

Smoking rates are estimated to be as high as 74% to 88% among individuals with substance abuse problems Estimates range between 85% to 98% for individuals in Methadone-Maintenance programs

Individuals who abuse substances…Tend to start smoking at a younger ageAre more likely to be heavy smokersAre more nicotine dependentExperience greater difficulty with quitting

Kalman

, 1998 ; Holbrook &

Kaltenbach

, 2011;

Prochaska

et al., 2004Slide8

Tobacco Disproportionately Impacts Mental Health

Populations

Tobacco use among persons with mental illness is 2 to 4 times as great as among the general U.S. population“In general, the more severe the psychiatric condition, the higher the smoking prevalence.”Prochaska et al., 2013;

Schroeder & Morris, p. 299, 2010Slide9

2010 Smoking Rates by Age Group in Maryland Addiction/Mental Health Clients

~ 70% of individuals entering Addiction Treatment and

~40% of individuals receiving Mental Health Services are Current Smokers

Percentage of SmokersSlide10

Effects of Smoking

(DHHS, 2014)Slide11

U.S. Deaths Attributable to

Smoking Annually

Average annual number of deaths 2005–2009 (DHHS, 2014)Lung Cancer

130,659About 480,000

U.S. Deaths Attributable Each Year to Cigarette Smoking

Coronary Heart Disease

99,300

Other Cancers

36,000

COPD

100,600

Cerebrovascular Disease (Stroke)

15,300

Other Heart Disease

25,500

Other Diagnoses

61,141

Other Vascular Diseases

11,500

(

DHHS, 2014)Slide12

Mortality: Tobacco and Behavioral Health

Individuals with chronic mental illness die on average 25 years earlier

than the general population Top 3 causes of death: CVD, lung disease, and diabetes mellitus In a 20 year longitudinal study of individuals with alcoholism or SUDsMortality rate was 48%

. Triple the expected 18%!HALF the deaths were attributed to smokingEach year, 200,000+ of the 480,000 deaths due to smoking are believed to be among individuals with mental health or substance use disorders.

Mauer, 2006; Hurt et al., 1996; Prochaska et al., 2013Slide13

Secondhand and

Third-Hand Smoke Slide14

What is Secondhand Smoke?

Inhalation of smoke from tobacco products by people other than the intended user

Contains at least 7,000

chemicals

Can

occur in two forms:

Side stream

smoke

– smoke burning from cigarette

Exhaled mainstream

smoke

– smoke exhaled from lungs

(CTFK, 2011; DHHS, 2010; DHHS, 2006)Slide15

“Secondhand smoke causes premature death and disease in children and in adults who do not smoke.”

~U.S. Surgeon General’s Report (DHHS, 2006; 2014)Slide16

Effects of Secondhand Smoke Exposure

(DHHS, 2014)Slide17

Exposure and Health Effects: Adults

Any amount of exposure to tobacco smoke is harmfulSecondhand smoke has been found to cause heart and lung disease in

non-smoking adults.(DHHS, 2014)

Annually:33,950 deaths due to heart disease7,330 deaths due to lung cancerSlide18

Exposure and Health Effects: Children

According to WHO (2013), worldwide an estimated

40% of children have at least one parent who smokes50% of children regularly breathe air polluted by tobacco smoke in public placesSHS contributes to:Increased risk of asthma attacksMore frequent missed days of schoolIncreased risk of respiratory infections (e.g. pneumonia, bronchitis)Hospitalizations

(WHO, 2013; CDC, 2014a; CDC, 2014b)Slide19

Preventing Exposure to SHS

In 2007, the WHO suggested that a 100% smoke-free environment should be implemented to prevent effects of secondhand smoke. At minimum:Keep the household or workplace smoke-free

Prohibit smoking in vehicles that transport childrenDo not smoke in the child’s room or any room with a child presentIn 2014, the Surgeon General’s report stated,“There is no safe level of exposure to tobacco smoke. Any exposure to tobacco smoke-even an occasional cigarette or exposure to secondhand smoke is harmful.”(CDC, 2012; DHHS, 2014; WHO, 2007)Slide20

What is Third-hand Smoke?

The persistence of tobacco smoke pollutants in dust and on surfaces after tobacco has been smoked.The residues of third-hand smoke can

linger on the skin, clothes, and furniture of individuals who smoke.Pollutants can remain in the environment for weeks to months after the act of smoking occurs.Three main exposure routes to Third-hand smoke:Involuntary inhalationIngestionDermal uptake

(Singer et al., 2002; Singer et al., 2004)Slide21

Exposure to Third-hand Smoke

Children are at greatest risk for exposure:Spend

more time indoorsIngest more dustAre closer to the floorTend to place objects in their mouthBreathe faster

Less-developed immune system

Pets are also highly affected by second & third-hand smoke, particularly if they spend most of the time indoors

(

Bertone

et al., 2002;

Reif

et al.,

1998;

Drehmer

et al., 2012)Slide22

Preventing Exposure to Third-hand Smoke

Third-Hand SmokeEfforts should be taken to enforce strict smoking bans within households, vehicles, and in the proximity of indoor areas

Consider a Smoke-free Policy!Cleaning and ventilation help, but are not enough to eliminate exposure(Drehmer et al., 2012;)Slide23

Preventing Exposure to Nicotine Poisoning

Nicotine PoisoningAcute nicotine poisoning can occur if a child ingests any tobacco/nicotine product (e.g. cigarette butts, e-cigarette liquid) or if nicotine is absorbed through skin or eyes.Keep all products containing nicotine (tobacco products, NRT) out of the reach of children

If exposure is suspected, call Poison Control: 1-800-222-1222(NIH, 2014; CDC, 2014)

Symptoms of nicotine poisoning include:Agitation, restlessness, or excitement

Muscular twitching

Burning sensation in the mouth

Drooling

Palpitations

Sweating

Confusion

Convulsions

Fainting

WeaknessSlide24

Benefits of Smoke-Free

PoliciesSlide25

Health Impacts of Smoke-Free Policies

Reviews of smoke-free policies/legislation have found significant health benefits, including:Reduction of pre-term births and hospital attendance for asthma by 10%

Increased cessation-related behavior among smokers—including decreased cigarette consumption and increased quit rate.Decreased rates of indoor smoking by 42%Fewer residential fires

(V Been et al., 2014; Pizacani et al., 2012; Messer et al., 2008)Slide26

Health Impacts of Smoke-Free

Policies: Secondhand Smoke ExposureSecondhand smoke exposure among nonsmokers in the home decreased by 24%

Remember Smoke Gets Around!In multiunit housing, a significant proportion of SHS found in smoke-permitted units travels to nonsmoking areas:64.3% of levels found in smoke-permitted units found in the hallways34.9

% of levels found in smoke-permitted units found in smoke-free units(King et al., 2010)Slide27

Smoke-free policies can save you and society money!

Reduce health care and loss of life costsReduce health/home owners insurance premiums

Limit liability for property ownersReduce property maintenance costs Plus, there is now an increasing demand for smoke-free housing!

Economic Impact of Smoke-Free Policies

(DHHS, 2014; LRC, 2012;

Smoke-free Housing New England, 2009

)

No Smoking

Light Smoking

Heavy Smoking

General

Cleaning

$240

$500

$720Slide28

What Can YOU

Do?Slide29

If You’re Ready to Quit…

Develop a Quit PlanSet a quit dateKnow your cessation optionsRemember-BH clients often need more intensive treatment!

Discuss cessation medications with your doctorGet SupportRecruit family and friends to assist your quit attemptRefer to Cessation Resources Slide30

If You’re Ready to Quit…

Remember…Individuals with mental health conditions and addictive disorders are interested

in quitting and can quit with appropriate supportThey may require more extensive support when quitting, so be patientNRT and/or medications are recommended to aid in the quit attemptFamily and provider support will be critical to support quit attemptsSlide31

Nicotine Replacement Therapy (NRT):Gum*

Patch*Nasal Spray

Dosages and preferences of products/combinations may vary across individuals, take a collaborative approach! Medications:Bupropion (Zyban; Wellbutrin SR)Varenicline (Chantix)Guided use of medications is recommended!

InhalerLozenge*

(*Available OTC)

If You’re Ready to Quit…

…Know Your OptionsSlide32

Maryland residents can receive

FREE

and

confidential smoking cessation phone counseling by:

C

alling

the State

Quitline

at

1

-

800-Quit Now (1-800-784-8669)

Or visiting www.smokingstopshere.com

Resources: The Maryland Tobacco

QuitlineSlide33

Maryland Tobacco Quitline

ServicesOperates 24 hours a day / 7 days a week

Free reactive and proactive phone coaching calls (4 calls)Extended services for pregnant women (10 calls) and adolescents (5 calls)Certified CoachesTM provide individually-tailored quit plansFree NRT (patch and/or gum) 12 week supply (Adults Only

)Additional online and text to quit services!Provides referrals to local county resources – cessation classes, in-person counseling and free medicationSlide34

Additional Resources

Local Health Departments Smoking cessation services and medication may be availableNicotine Anonymous- www.nicotine-anonymous.org/

A 12-step program to overcome nicotine addictionOther resources (hospitals, community organizations, etc.)Slide35

If You’re NOT Ready to Quit…

…Implement a Smoke-free Policy

“At present, the only means of effectively eliminating health risks associated with indoor exposure is to ban smoking activity.” - American Society of Heating, Refrigerating & Air Conditioning Engineers (ASHRAE) It is

NOT enough to:Move to another room when smokingTurn on a fanOpen a windowBlow smoke away from those not smokingUse air fresheners or candlesThese strategies can help reduce passive smoke exposure, but they

will

not

eliminate it

!

(CDC

,

2012)Slide36

Maintaining a Smoke-Free Home

To minimize smoke exposure in your home, use these strategies when going smoke-free:Keep the household

smoke-free, including visitorsProhibit smoking in vehicles that transport any non-smoker, particularly childrenDo not smoke in the child’s room or any room with a child present—consider smoking ONLY outside(WHO, 2013; CDC

, 2012)Slide37

If You have Family Members who Smoke…

Be supportive:40% of former smokers report that support from family and friends was integral to their success! Talk to Tobacco-Using Family Members

Strategies to Increase MotivationThe 4 E’sRefer to Cessation Resources (smokefree.gov)Slide38

If You have Family Members who Smoke…

12 Tips to Help a Loved One Quit:Understand that quitting is hard

Know your relationship styleStart the conversationAsk questionsListenDon’t lectureOffer distractionsBe patient and positiveDon’t be too hard on them if they slip

Celebrate successes (big and small)Help them de-stressBe there for the long haul(smokefree.gov)Slide39

Whether or not someone is

ready to quit using tobacco, there are some strategies you, as a family member or friend, can use to

encourage them to begin thinking about making a quit attempt or to support their decision to quit  These strategies can be simplified into the “

4 E’s”:EngageEducateEncourage

E

mpathize

If You have Family Members who Smoke…Slide40

Engage

Start a caring and respectful

conversation. Express your concerns about their smoking.Allow them to express to you what they enjoy about smoking and their fears about quitting. If they are prepared to quit, ask how you can help them reach their smoke-free goal and let them know you will give them the support they need

.Otherwise, continue to listen!Slide41

Educate

Rather than focus on risks and dangers of smoking, help them see the benefits of quitting:

Improvements in healthImprovements in physical appearance Save moneyFreedom from the addictionYou may also want to make them aware of how secondhand smoke can affect other family members, including

pets!Slide42

Encourage

Express confidence

in their ability to quit smoking.  Congratulate them on any progress they make—big or small!If they make a quit attempt, celebrate their progress along the way. 

If the person begins smoking again (lapse or relapse), encourage them to try again, and praise them for their effort in each and every attempt until it sticks!Slide43

Empathize

Imagine the magnitude of the challenge facing the

person who is interested in or trying to quit, and be patient with them as they struggle to overcome their addiction.   Remember, they may truly enjoy parts about their

smoking and this is a major lifestyle change for them. Slide44

Putting it All Together

Behavioral health populations smoke at a higher rate and often require more intensive treatment for smoking cessation.The good news: Quitting is possible!

If you want to quit now, there are many resources available to support your quit attempt.If you’re not ready, you can still take steps toward keeping you and your family members healthy.If you have a loved one who smokes, you can be a positive source of support with a few key strategies in mind.Slide45

Contact Us

UMBC

Department of Psychology1000 Hilltop Circle, Baltimore, MD 21250P: (410) 455-3628F: 410-4551755

E: info@mdquit.org Web: www.mdquit.org