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2011 Interesting Reading

After Tobacco: What Would Happen If Americans Stopped Smoking?
Edited by Peter Bearman, Kathryn M Neckerman, and Leslie Wright

States have banned smoking in workplaces, restaurants, and bars. They have increased tobacco tax rates, extended “clean air” laws, and mounted dramatic antismoking campaigns. Yet tobacco use remains high among Americans, prompting many health professionals to seek bolder measures to reduce smoking rates, which has After Tobacco: What would happen if Americans stopped smoking?raised concerns about the social and economic consequences of these measures.

Retail and hospitality businesses worry smoking bans and excise taxes will reduce profit, and with tobacco farming and cigarette manufacturing concentrated in southeastern states, policymakers fear the decline of regional economies. Such concerns are not necessarily unfounded, though until now, no comprehensive survey has responded to these beliefs by capturing the impact of tobacco control across the nation. This book, the result of research commissioned by Legacy and Columbia University’s Institute for Social and Economic Research and Policy, considers the economic impact of reducing smoking rates on tobacco farmers, cigarette-factory workers, the southeastern regional economy, state governments, tobacco retailers, the hospitality industry, and nonprofit organizations that might benefit from the industry’s philanthropy. It also measures the effect of smoking reduction on mortality rates, medical costs, and Social Security. Concluding essays consider the implications of more vigorous tobacco control policy for law enforcement, smokers who face social stigma, the mentally ill who may cope through tobacco, and disparities in health by race, social class, and gender.

New report from Legacy on tobacco use and mental illness

A Hidden Epidemic: Tobacco Use and Mental Illness
Legacy has published a new report entitled "A Hidden Epidemic: Tobacco Use and Mental Illness."

The publication seeks to call attention to the issue of the high prevalence of tobacco use and nicotine dependence among people with mental illnesses and to highlight barriers to effective tobacco-cessation efforts to help people with mental illnesses quit. This publication also features examples of five projects that demonstrate how organizations across America are addressing tobacco-related disparities faced by people with mental illnesses.  Available for download from the Legacy website.

 

October 9, 2009
Smoking Cessation Program for Mental Health Patients Honors by American Psychiatric Association

New Brunswick, NJ -- The division of addiction psychiatry at Rutgers Robert Wood Johnson Medical School has championed efforts to reduce tobacco use among individuals with mental illness, a group estimated to consume nearly half of all cigarettes in the United States.  Those efforts have received national recognition by the American Psychiatric Association (APA), which granted a Silver Achievement Award to the CHOICES program today at a ceremony in New York City. 

CHOICES – Consumers Helping Others Improve Their Condition by Ending Smoking – employs peer counselors, called Consumer Tobacco Advocates (CTA), to promote smoking cessation in smokers with mental illness. The CTAs are nonsmokers or former smokers who are moderately impaired or disabled by mental illness. They receive 30 hours of intensive tobacco training and then reach out to their peers in mental health centers, psychiatric hospitals, group homes, and self-help centers. Their goal is not to provide treatment, but to assist and motivate their peers to address tobacco use by sharing their own experiences with quitting, providing educational materials, and linking their peers to treatment, referrals, advocacy and support for smoking cessation in New Jersey.

“Peers are less threatening than professionals,” said Jill Williams, MD, associate professor of psychiatry at Robert Wood Johnson Medical School and co-founder and medical director of the program. “CHOICES symbolizes empowerment and personal choice in recovery by utilizing peer counselors to deliver the vital message to smokers with mental illness that addressing tobacco use is important to their health and to motivate them to seek treatment.”

By presenting the Silver Award, the APA honored CHOICES’ unique peer-to-peer grass-roots approach to promoting tobacco cessation.  In its October issue of Psychiatric Services journal, the APA noted, “The CHOICES program exemplifies many aspects of a successful wellness and recovery initiative. For example, it targets a group with a vital health care need; seeks to reduce tobacco’s harm in a vulnerable group; focuses its efforts in the community, which best accommodates the target population; employs peers to reduce educational and cultural barriers; and develops successful partnerships with key stakeholders for sustainability.”

According to Dr. Williams and co-founder Marie Verna, the program’s advocacy director and senior training and consultation specialist at Rutgers University Behavioral Healthcare’s Center for Excellence in Psychiatry, the CHOICES team has conducted more than 280 community visits, reaching more than 9,600 smokers with mental illness, since the program’s inception in 2005.  The team also participates in consumer conferences and health-related fairs. 

In an outcome study of the CHOICES program, consumers that had met individually with a peer counselor for personalized feedback about their smoking experienced a significant decrease in the number of cigarettes smoked each day and an increase in the number of quit attempts.  Many study participants reported that after meeting with a CTA they had talked to their mental health provider about getting help with quitting smoking. Participants also reported that the CTAs were extremely knowledgeable about tobacco and interested in their smoking. Seventy percent of those surveyed said that talking to a peer about their smoking was much easier than talking to a mental health professional.

The CTAs also reported that their experience of working with CHOICES has helped them achieve greater recovery in their own mental illness.  Each has gone on to achieve personal milestones including participating in publications, statewide and consumer conferences on wellness and recovery and/or have gone on to seek additional formal education.  

CHOICES is based in the department of psychiatry at Robert Wood Johnson Medical School and partnered with the Mental Health Association of New Jersey, a consumer-driven mental health advocacy organization, and the New Jersey State Division of Mental Health Services, a primary source of funding for the program. CHOICES is listed as a best-practices resource in several national provider toolkits for the treatment of tobacco use in mental health settings, including those published by the Smoking Cessation Leadership and the Behavioral Health and Wellness Program of the University of Colorado in 2009. The CHOICES model is expanding beyond New Jersey to reach a larger audience of smokers. A multistate implementation of CHOICES is now underway on the West Coast.

More information on CHOICES, visit http://njchoices.org/.


October 20, 2009
Heartbeats: Smoking Cessation Program Draws National Attention

Pop quiz: What group is estimated to consume nearly half of all cigarettes in the United States? Go ahead, think about it. I'll wait.

Give up? ... Need more time?

The answer, according to research gathered by the American Psychiatric Association, or APA, is mental health patients.

You might find that surprising, but the CHOICES program of the division of addiction psychiatry at Robert Wood Johnson Medical School in New Brunswick does not.

The program has conducted a lot of research in this area, and recently was rewarded for its efforts by receiving national recognition from the APA in the form of a Silver Achievement Award.

CHOICES, or Consumers Helping Others Improve Their Condition by Ending Smoking, utilizes peer counselors to promote smoking cessation in mentally ill patients.

The counselors, who receive 30 hours of intensive training, are nonsmokers or former smokers who are moderately impaired or disabled by mental illness. Their goal is not to provide treatment, but to assist  smoking patients who are in mental health centers, psychiatric hospitals, group homes and self-help centers by linking them to treatment, referrals, advocacy and support for smoking cessation in Central Jersey.

"Peers are less threatening than professionals,'' said Dr. Jill Williams, associate professor of psychiatry at the medical school and co-founder and medical director of the program. "CHOICES symbolizes empowerment and personal choice in recovery by involving persons with mental illness talking with peers with mental illness who smoke and who may have low motivation to address their tobacco use.''

In presenting the Silver Award, the APA noted CHOICES' unique peer-to-peer approach to promoting tobacco cessation.

In the October issue of its Psychiatric Services journal, the APA said, "The CHOICES program exemplifies many aspects of a successful wellness and recovery initiative. For example, it targets a group with a vital health care need; seeks to reduce tobacco's harm in a vulnerable group; focuses its efforts in the community, which best accommodates the target population; employs peers to reduce educational and cultural barriers; and develops successful partnerships with key stakeholders for sustainability.''

The program has conducted more than 280 community visits and reached more than 9,600 smokers with mental illness since the program's inception in 2005. More information is available by visiting http://njchoices.org


Learning About Healthy Living (LAHL)

Although tobacco use and dependence is very common among people with serious mental illness (SMI) and a leading cause of morbidity and mortality, treatment options are limited, especially for lower motivated smokers who may not be ready for a “quit smoking” treatment. LAHL has been in use in mental health treatment programs in New Jersey since 2004. The LAHL treatment approach supports the current focus on wellness and recovery within the mental health field and is being used in mental health sites with great success.

The LAHL manual is now available as a publicly available resource. It is hoped that the dissemination of this valued resource will help more smokers with mental illness across the country. Click here to download LAHL.

We request that you please give us feedback about your experiences with the manual. (Feedback can be sent to Dr Jill Williams at williajm@rwjms.rutgers.edu) If you plan to publish about this experience using the LAHL materials we would ask that you cite the source and contributing authors.

We hope that you will find the materials helpful in your clinical work helping smokers with serious mental illness.

Williams JM, Ziedonis DM, Speelman N, Vreeland B, Zechner M, Rahim R, O’Hea E. Learning about Healthy Living: Tobacco and You Manual. Revised February 2012. Supported by a grant from the NJ Division of Mental Health Services.



UMDNJ Study Shows Menthol Cigarettes Are More Addictive

NEW BRUNSWICK – Menthol cigarettes are harder to quit, particularly among African American and Latino smokers, according to researchers at the University of Medicine and Dentistry of New Jersey (UMDNJ).

“Lower quit rates among African American and Latino menthol cigarette smokers at a tobacco treatment clinic” appears in next month's print edition of The International Journal of Clinical Practice. Journal subscribers may view it online now by visiting the following the Wiley-Blackwell link.


 Rutgers Robert Wood Johnson Medical School Physician Advocates for Eliminating Tobacco Use in Mental Health Facilities - Commentary in Journal of American Medical Association

New Brunswick, NJ – “The United States public mental health system must address the issue of tobacco use in psychiatric hospitals,” urges Jill Williams, MD, associate professor of psychiatry at Rutgers Robert Wood Johnson Medical School and at Rutgers School of Public Health, in the February 6 issue of the Journal of the American Medical Association. In the commentary, Dr. Williams implores mental health advocates to support a move toward tobacco-free hospital policies to create a healthy environment and improved behavioral outcomes for patients.

“Programs that treat behavioral health problems such as depression or schizophrenia are the only remaining sector of health care that fail to systematically help patients quit smoking,” Dr. Williams says.

In her commentary, Dr. Williams cites evidence of poor cardiovascular health and death in mental health patients that is on average 25 years earlier than the general population.  In addition to improving the patient’s physical health, tobacco dependence treatment further supports a patient’s success toward full mental recovery. Dr. Williams emphasizes that mental health advocates must demand increased access to tobacco dependence treatment, to ensure that patients receive safe alternatives to nicotine withdrawal.

Other advantages of eliminating tobacco use are fewer behavioral problems and less violence. Dr. Williams recognizes that opposition to eliminating tobacco use may result from fear of additional behavioral concerns in patients. However, she notes evidence to the contrary, reporting that faculty and staff in tobacco-free facilities actually spend less time in the bartering and control of tobacco products, thereby reducing incidents of conflict and consequently, providing additional and more effective treatment time.

Dr. Williams also points to the additional stigma smoking causes mental health patients, who are already ostracized from general society due to their illnesses. “Stigma is a resonating issue as the mental health community collectively and individually strives for greater community acceptance and integrations of individuals with mental illnesses,” says Dr. Williams. “Advocacy that aims to protect smoking can further marginalize and stigmatize smokers with mental illness who are looking to succeed in securing housing and employment.”

Ultimately, eliminating tobacco use is in line with national trends that call for mental health care to be more oriented toward wellness and recovery. Dr. Williams concludes, “Patients with mental illnesses deserve the same protection from tobacco exposure that benefits the rest of the public.”

Dr. Williams, of Clinton, NJ, serves as the director of the division of Addiction Psychiatry and director of Mental Health Tobacco Services at the Rutgers Robert Wood Johnson Medical School. She also is affiliated with the Rutgers School of Public Health Tobacco Dependence Program in New Brunswick and a member of the Cancer Institute of New Jersey.  She is a consultant to the New Jersey State Psychiatric Hospitals on Addressing Tobacco, which is funded by the New Jersey Division of Mental Health Services through Rutgers University Behavioral Healthcare.

Dr. Williams conducts research on smokers with serious mental illnesses including schizophrenia and bipolar disorder. Her research examines differences in nicotine intake, cigarette puffing and nicotine craving in individuals with schizophrenia in hopes that these discoveries will lead to better treatments in the future. She has received research funding from the National Institute of Drug Abuse (NIDA), the National Institute of Mental Health (NIMH) and the American Legacy Foundation.