Transcript RMTTS-C - Behavioral Health and Wellness Program

Rocky Mountain
Tobacco Treatment
Specialist Certification
(RMTTS-C) Program
Module 2:
Priority Populations
Module 2: Priority Populations
Objectives
 Discuss tobacco industry targeting
 Review prevalence and patterns of tobacco use
for priority populations
 Discuss culturally competent and tailored care
 Discuss treatment strategies for specific
demographic/cultural groups
© 2016 BHWP
Priority Populations
Why Do Tobacco Use
Rates Differ?
Tobacco Industry Targeting
Tobacco companies:
 Sought out individuals in vulnerable populations
and those with limited access to cessation services
 Promoted smoking in treatment settings
 Monitored or directly funded research supporting
the idea that individuals with schizophrenia need to
smoke to manage symptoms
 Market to youth and adolescents as well as certain
racial/ethnic groups
© 2016 BHWP
Why It Works
Specific population groups are more susceptible
to targeting due to:
 Exposure to stigma and chronic life stressors
 Lack of access to or unaware of Medicaid or other
benefits
 More likely to have misconceptions about tobacco
cessation treatments or are unaware of the benefits
of these treatments
 Less likely to receive advice to stop smoking or are
unaware of the health effects of smoking
© 2016 BHWP
Demographic Characteristics
There are several demographic characteristics
that may influence patterns of tobacco use
among the U.S. population:
Geography
Socioeconomic Status
Sex/Gender
Race/Ethnicity
Age
Behavioral Health
© 2016 BHWP
Geography
Tobacco Use and Geography
© 2016 BHWP
Neighborhood Level Effects
 Higher density of tobacco
retail outlets
 More aggressive POS
marketing
 Neighborhoods targeted for
direct mail of coupons
 Higher prevalence of heart
disease
 Higher incidence of tobaccorelated self-deprivation
© 2016 BHWP
Priority Populations
Sex & Gender
Tobacco Use and Sexual Orientation
Smoking prevalence is higher for lesbian, gay or
bisexual adults (26.6%) than for heterosexual
adults (17.6%)
 Lesbian women are more than twice as likely to
engage in tobacco use regardless of age
 Gay men at age 18 are 80% more likely to be
current smokers
 Gay men younger than 50 are 60% more likely to
be current smokers
© 2016 BHWP
Tobacco Use and Gender
 Tobacco use is:
‒ Higher among men (18.8%) than
women (14.8%)
 Men have higher rates of smokeless
tobacco use (4.8% versus 0.3%) and
cigars/cigarillos (3.2% versus 0.7%)
 Mortality rates from smoking are now
equal between genders
© 2016 BHWP
Tobacco Use and Women
 Research indicates there may be
generational differences between women
and men in cessation behaviors
 Women tend to smoke less for nicotine
reinforcement and more for non-nicotine
reinforcement, such as:
‒ Sensory effects of smoking
‒ Management of stress and negative
mood
‒ Secondary social reinforcement
‒ Weight management
© 2016 BHWP
Tobacco Use and Women
 Greater risk of developing a smoking-related
disease than men
 Gender-specific health issues and pregnancy
complications
 More difficulty quitting
© 2016 BHWP
Tobacco Use and Women Who Are
Pregnant or Postpartum
 Smoking during pregnancy remains a major
health problem
 Of women who are pregnant or plan to become
pregnant:
‒
‒
‒
‒
22% smoke before pregnancy
Of those, 45% quit by last trimester
Of those, 53% relapse by 4 months after delivery
Additionally, 14% smoke at some point during
pregnancy
© 2016 BHWP
Benefits of Quitting
During and After Pregnancy
Quitting smoking during and after pregnancy:
 Reduces health problems for the
fetus/baby
 Decreases delivery complications
 Increases long-term health
of the mother
© 2016 BHWP
Priority Populations
Age
Tobacco Use and Age
Age
Prevalence
18-24
16.7%
25-44
20.0%
45-64
18.0%
65+
8.5%
Nearly 100% of adults who are daily smokers
started using tobacco before the age of 26
© 2016 BHWP
Tobacco Use and Youth (12-17)
 23% of U.S. high
school students report
tobacco use in the last
30 days
 As with adults, rates of
tobacco use are higher
among youth with a
behavioral health
diagnosis
90% of youth try tobacco
before age 18
88% of daily adult smokers
started smoking by age 18
99% of adult smokers become
daily users before the age of 26
© 2016 BHWP
Tobacco Use and
Young Adults (18-25)
 24% of young adults report tobacco use
 Report the highest usage rates of
hookah, cigars/cigarillos, regular pipe
and e-cigarettes as compared to other
age groups
 72% of young adults who use tobacco,
either socially or daily, become
tobacco-dependent adults
© 2016 BHWP
Social Pressures
Youth and young adults
are more susceptible to
social and environmental
pressures to use tobacco
© 2016 BHWP
Tobacco Use and Older Adults
Older adults are more likely to:
 Be motivated by negative
health consequences
 Not receive tobacco
cessation resources due to
provider beliefs about their
desire to quit
Older adults have been found to quit smoking at
rates comparable to those of younger smokers.
© 2016 BHWP
Priority Populations
Low Socioeconomic
Status
Tobacco Use and Socioeconomic Status
 Working class, low-income and low educational
level populations have the highest percentages
of smoking behaviors
 As a comparison, smoking rates for individuals:
At or above poverty level
Below poverty level
Undergraduate degree
GED
15%
26%
8%
43%
© 2016 BHWP
Tobacco Use and Poverty
 70%-80% of adults who are homeless smoke
 41% of homeless service organizations offer
tobacco cessation services
 Tobacco needs to
be addressed not
only as a health
issue, but as a social
justice issue
© 2016 BHWP
Tobacco Use and Occupation
Job stress, exposure to occupational hazards, shift
work and other factors impact tobacco use
Adult Tobacco Use in Selected Industries
35%
30%
32%
30%
27%
25%
20%
17%
13%
15%
10%
5%
21%
19%
9%
9%
2%
8%
2%
0%
Education Professional U.S. Air Force
Mining
Construction U.S. Marine
Services
Services
Corps
Current Cigarette Smoking
Current Smokeless Tobacco Use
© 2016 BHWP
Priority Populations
Race/Ethnicity
Tobacco Use and Race/Ethnicity
Race/Ethnicity
Prevalence
American Indian/Native
Alaskan
Multiple race
29.2%
White
18.2%
Black
17.5%
Hispanic
11.2%
Asian
9.5%
27.9%
© 2016 BHWP
Priority Populations
Behavioral Health
Tobacco Use and Behavioral Health
Populations
60
61-90% Schizophrenia
51-70% Bipolar Disorder; 49-80% Other Drug Abuse
50
45-60% PTSD
40
38-42% ADHD; 36-80% Major Depression
34-80% Alcohol Abuse; 32-60% Anxiety
30
20
10
Behavioral Health populations are
nicotine dependent at rates 2-3 times
higher than the general population
0
1957
1980
1998
Men
2003
2008
2013
Women
© 2016 BHWP
Tobacco Use Affects Mental Health
Care and Treatment
Persons with behavioral health conditions who
use tobacco:




Have more psychiatric symptoms
Have increased hospitalizations
Require higher dosages of medications
Are twice as likely to leave against the advice of
their doctors, if withdrawal symptoms are not
treated
© 2016 BHWP
Tobacco Use Affects Treatment &
Recovery from Addiction
 People who are alcohol dependent are three times
more likely to use tobacco
 Tobacco use is a strong predictor in use of illegal
substances, such as methamphetamines, cocaine,
and opiates
 Addressing tobacco dependence during treatment
for other substances is associated with a 25%
increase in long-term abstinence rates from alcohol
and other substances
© 2016 BHWP
Quitting: It Can Be Done
Persons with behavioral
health conditions:
 Are able to quit using
 75% want to quit using
 65% tried to quit in the last
12 months
© 2016 BHWP
Culturally
Competent Care
Tobacco Cessation: What Works?
Population
Interventions








Price increases
Media campaigns
Insurance coverage
Point-of-sale strategies
Tobacco-free policies
Psychosocial treatment
Quitlines
Web- or mobile phone-based
interventions
 NRT/cessation medications
© 2016 BHWP
Tobacco Cessation: What Works?
Individual
Interventions








Price increases
Media campaigns
Insurance coverage
Point-of-sale strategies
Tobacco-free policies
Psychosocial treatment
Quitlines
Web- or mobile phone-based
interventions
 NRT/cessation medications
© 2016 BHWP
Clinical Best Practices
 Stages of change and the 5As
 Pharmacotherapy
 Counseling
 Individual (MI, CBT)
 Group
 Telephonic
 Community referrals
 Tobacco-free policies
(workplace, treatment sites, at home)
© 2016 BHWP
Guiding Principles
 Offer tobacco cessation treatment and
resources to everyone
 Provide education on risks and benefits
 Avoid making assumptions about a person’s
culture and potential barriers to quitting
 ASK questions and EMPOWER people to
make a choice to quit
 Provide tailored and culturally competent
interventions
© 2016 BHWP
Tailored Care Works
 Tailored care can be intensive or minor but
will always be beneficial
 Tailored interventions work for diverse groups
and for diverse treatment areas
 For example:
‒ Tailored Motivational Interviewing doubled
quit rates
‒ Tailored self-help materials led to more quit
rates, more use of pre-quitting strategies, and
higher quit rates
© 2016 BHWP
Tailored Care Works
Promotoras
All Nations
Breath of Life
© 2016 BHWP
What is a Tailored Intervention?
 Uses members of the community as
leaders and guides
 Responsive to the unique needs of a
community
 Appeal to aspirational values within
the community
 Contains images and language familiar
to the audience
© 2016 BHWP
Special Considerations
 Cost
‒ Be open and forthright
‒ Critical for reducing anxiety
for certain groups
 Technology
‒ Effective for young adults/
youth
‒ Be aware of the “technology
gap”
© 2016 BHWP
Special Considerations
 Language
‒ Provide service in the language of
the patient
‒ Should match literacy level
 Location
‒ Discuss barriers (i.e., transportation,
access, scheduling, etc.)
‒ Provide services within communities
© 2016 BHWP
Special Considerations
 Stigma
‒ Asking for and receiving help can be
difficult
‒ Ensure privacy
 Counseling modality
‒ Peer services
‒ Intensive behavioral therapy
 Pharmacotherapy
© 2016 BHWP
ADDRESSING Model
© 2016 BHWP
Priority Populations
Discussion