Welcome to ‘s 5th Annual Best Practices Conference
January 21, 2011 Four Points by Sheraton BWI Airport Baltimore, MD Overview of the Conference • We are delighted to have Dr. Sherry McKee & Dr. William Riley as Keynote Speakers • Lunch with Updates from DHMH & Legal Resource Center – Award of Recognition for Joan Stine • Afternoon Sessions – Co-occurring Alcohol and Tobacco Use: Implications for Intervention – Smoking Cessation in Mental Health: Problems, Process & Peers Current Themes in Tobacco Use in the United States & Maryland Dr. Carlo DiClemente Director, MDQuit Overview
• We would like to share information in a new format – using our clicker technology Clicker lessons
• Immediate Audience Response Device • Anonymous • Radio Frequency- you don’t have to point it at anything • Just hit the number / letter you choose & it will appear in the LCD screen • You can change your response by just hitting a different number…but only one response will record per person! Tell us a little about yourselves … Are you …
1. Male 77% 2. Female
23%
1 2 Where do you primarily work?
1. DHMH / Health Department 51% 2. School / College / University 3. Hospital / Doctor‘s / Dental office
4. Non-profit 18% 13% 5. Faith-based 11% organization 7% 6. Other 0% 1 2 3 4 5 6 Where in Maryland do you work? 1. Baltimore: Anne Arundel, Baltimore City, Baltimore Co., Carroll, Harford, Howard 56% 2. Lower Eastern Shore: Dorchester, Somerset, Wicomico, Worcester 3. Southern Maryland: Calvert, Charles, St. Mary's 4. Suburban Washington: Frederick, Montgomery, Prince 24% George's 5. Upper Eastern Shore: Caroline, Cecil, Kent, Queen 9% 7% Anne's, Talbot 4% 6. Western Maryland: Allegany, 0%
Garrett, Washington 1 2 3 4 5 6 Now let‘s test your tobacco knowledge These are cigarettes.
70% 1. True
2. False 30%
1 2 FALSE! • Only the one wrapped in white paper is a cigarette • The other wrapped in brown paper includes tobacco in the paper and is a little cigar Similar Packaging, Dissimilar Taxes
• Little Cigars most often sold in packs of 20, but also sold in packs of 10 & ―loosies‖ Cigars come in many shapes & sizes Nationally, what is the most popular brand of cigarillos?
70% 1. Swisher Sweets 2. Black & Mild 3. Phillies 4. Dutch Masters
16% 9% 5%
1 2 3 4 Black & Mild is consistently the most preferred brand
Cigar Brand Used Most Often in Past 30 Days 30.0%
20.0%
10.0%
0.0% 2002 2003 2004 2005 2006 2007
Black & Mild Swisher Sweets Phillies Dutch Masters White Owl
Slide from Amber Thornton-Bullock‘s presentation ―Emerging Tobacco Products: ―New Products, Same Targets‖ accessed from http://tobaccofreepartners.com/pdfs/news/Legacy_NALBOH_Webinar_PPT_10_13_09FINAL.pdf Data Sources: NSDUH 2002-2007 In Maryland, who are more likely to be a current (i.e., past month) cigar user?
1. Adults 64% 2. Adults & Youth smoke at same rate 27% 3. Youth 9%
1 2 3 Ever & Current Cigar Use: Age Matters
50.0
40.0
32.5 30.0
12-17 MYTS 20.0 18-65+ MATS
10.0 9.0 5.7 3.8
0.0 Ever Smoked a Cigar Current Cigar (30 day) Challenges with Assessing Cigar Use • No stratified national survey data – often cigar use grouped together (i.e., small cigars, cigarillos, large cigars) – Surveys ask … Did you smoke cigars, cigarillos, or little cigars on at least 1 day in the past 30 • Some tobacco users do not self report as cigar users until brands are specified (e.g., Black & Milds) Stages of Smoking Initiation
Maryland Youth Stages of Smoking Initiation Precontemplation: Youth who are not currently smoking and expressed a firm commitment to not start in the next year Contemplation: Youth who are not currently smoking and did not express a firm commitment to not smoke in the next year Preparation: Youth who have minimally tried cigarettes (< 100 in their lifetime) who may be currently smoking (less than 5 days in past 30) and definitely plan on smoking within the next year Action: Youth who have smoked on 6 or more days during the past 30 day and have smoked for < 6 months Maintenance: Youth who have smoked on 6+ days during the past 30 days and have smoked for at least 6 months
DiClemente, 2003 Underage Smoking Initiation in 2008 • ~75% were in PC • ~ 20% were in Contemplation • ~ 3% were in Preparation (smoked < 100 cigs in lifetime) • 2% in Action (smoking regularly for < 6 months) • 3% in Maintenance (smoking regularly for > 6 months) 100.0% 83.00%
80.0% 67.4%
60.0% Middle School 40.0% High School 21.0% 14.40% 20.0% 3.9% 2.9% 4.7% 1.30% 0.01% 0.01% 0.0% PC C P A M
Non-smokers Current Smokers Stages of Smoking Initiation & Alcohol Use % of current adolescent ‗regular‘ smokers (A & M stages) reported past month alcohol use?
39%
1. ~5% 33% 2. ~10% 3. ~20% 4. ~50% 19%
5. ~80% 9%
0%
1 2 3 4 5 Overall 83% of current ‗regular‘ adolescent smokers reported using alcohol in the past month 100% 83% 80% 73%
60% 41% 40%
% past month alcohol use alcohol month past % 20% 13%
0% PC C P A / M
Non-smokers Current smokers What % of current adolescent ‘regular’ smokers reported binge drinking (i.e., 5+ more drinks in a row) in the past month?
40% 1. 2.5% 34% 2. 25% 3. 50% 4. 67% 5. 75% 14% 8% 4%
1 2 3 4 5 67% reported 1 or more binge episodes in the past month
100%
• Noticing the 80% pattern? 67% 60% 50%
40%
% past month binge month past % 21% 20% 5% 0% PC C P A / M
Non-smokers Current smokers What percent of youth report seeing Ads for tobacco products some or most of the time when they are on the Internet? 1. 5% 2. 15% 54% 3. 33% 4. 66% 30%
9% 7%
1 2 3 4 Of the youth who report using the Internet … see ads for cigs/tobacco products on Internet most or some of time 50
40 37.2 35.5 37.0 31.9 33.0 33.1 30
20
10
0 PC C P A M All Stages Source: 2008 MYTS
Maryland underage youth report being more likely to smoke which …
1. Cigarettes 37% 37% 2. Little Cigars 25% 3. Smoke both equally
1 2 3 More MD underage youth report smoking little cigars than cigarettes
30.0 25.9 24.4
20.3 20.8 20.0 16.4 17.2 17.2
11.7 12.4 12.4 10.0 10.2 10.0 9.4
4.8 5.5 2.7
0.0 < 12 12 13 14 15 16 17 Overall
2008 MYTS Little Cigar (30 days) Cigarettes (30 day) Smoking & Tobacco Use Among Young Adults & College Students Research suggests that less than half of college students who have smoked in the past month self-identify as ―smokers‖
71% 1. False 2. True
29%
1 2 What It Means to be a ―Smoker‖…
Source: Berg, C.J., Parelkar, P.P., Lessard, L., Escoffery, C., Kegler, M.C., Sterling, K.L., & Ahluwalia, J.S. (2010). Defining “smoker”: College student attitudes and related smoking characteristics. Nicotine & Tobacco Research, 12(9), 969-969. In comparison to youths (aged 12-17) and adults aged 26 and older, young adults aged 18-25 had the highest rate of current tobacco usage.
85% 1. True 2. False
15%
1 2 Highest Usage Rates Among Young Adults
In 2009, young adults aged 18-25 had the highest rate of current tobacco usage among the age groups: • 11.6% of youths aged 12-17, • 27.3% of adults aged 26 and older, & • 41.6% of young adults aged 18-25 currently smoke.
Young adults also reported having the highest usage rates for each of the various tobacco products: cigarettes, cigars, smokeless tobacco, & pipe tobacco
(SAMHSA, 2010) Current Tobacco Use by Age Groups in Maryland 50
40 30.4 30
20.1 20 17.6 13.8 15.2 10 8.0
0 12-17 18-24 25-34 35-44 45-64 65+
MYTS MATS
Sources: 2008 Maryland Youth Tobacco Survey (MYTS) & Maryland Adult Tobacco Survey (MATS) In 2009, the Prince George‘s County Council & the Baltimore City Health Commissioner issued a regulation imposing a minimum cigar pack size of:
58% 1. 3 cigars per pack 2. 5 cigars per pack 3. 10 cigars per pack 4. 20 cigars per pack 25% 15%
2%
1 2 3 4 Tobacco Regulation: Cigars
This regulation was designed to decrease sales of little cigars/cigarillos—which have become increasingly popular among youth and young adults (especially among minorities in urban settings).
―By requiring that these cigars be sold in packages of at least five, the real price of the product increases from less than $1.00 per individual stick to between $3.50 and $5.00 for a package (LRC, 2008).‖ Consumer Demand Analyses Consumer Demand Analysis
Reprint of article included in your folders Journey of Smokers in Maryland: 2000, 2002 & 2006 • Conducted an analysis of the journey of smokers in Maryland over time. • By 2006, the population of current adult smokers (aged 18 years) was smaller but seemed less interested in and able to quit. – More 2006 smokers were in earlier stages of change and less interested in making a quit attempt in the near future. Stages of Change of Maryland Smokers Over Time
2000 2002 2006 2008 Precontemplation 21.1 16.2 21.9 15.6 Contemplation 8.7 8.8 10.6 14.8 Preparation 8.2 9.2 4.8 10.3 Action 3.8 3.9 3.5 10.8 Maintenance 12.6 13.1 10.6 8.5 Long-Term Maintenance (5+) 45.7 48.7 48.6 39.8
Noteworthy Findings: Lower percentage of smokers in Precontemplation in 2008 Much higher percentage of smokers in both Preparation & Action in 2008 True or False: Most Maryland smokers quit cold turkey (i.e., w/out help)?
63% 1. True
2. False 37%
1 2 Used an Aid last time you tried to quit? 2006 2008 Precontemplation 32.5 27.7 Contemplation 34.0 32.7 Preparation 36.3 27.3 All Stages 33.5 29.4
Maryland Adult Tobacco Surveys Use of Nicotine Replacement Treatment (2006 MATS*)
* This question was not asked in 2008 What % of smokers are aware of Quitline cessation services?
1. 10% 33% 2. 20% 28% 24% 3. 33%
4. 45% 15%
1 2 3 4 Awareness of Smoking Cessation Services Delivered by LHD, QL, and Employers
50 45.0
40 33.5 30 28.2 28.2 22.5 23.6 20.5 21.6 20 17.9
10
0 Local Health Quitline Employer Department 2008 MATS Never Former Current Smoking Cessation in Persons with Serious Mental Illness In a sample of successful quitters from psychiatric rehabilitation programs, what was the top reason given for quitting...
1. Cost 52% 2. Advice from Docs 3. Advice from Friends 21% 21%
4. Health Concerns 5%
1 2 3 4 Smoking Cessation in Persons with SMI: Successful Quitters
• Primary Reasons for Quitting – Health concerns (73%); Cost (71%); – Advice from doctor (54%); Advice from others (64%) – Important to note, these are often the same Reasons given by Non-SMI smokers • Conclusions: – Persons with SMI are able to successfully quit smoking despite extensive histories of heavy smoking – Large portion (68%) willing to serve in peer helping roles for smoking cessation. Dickerson, F., Bennett, M., Dixon, L., Burke, E., Vaughan, C., Delahanty, J., DiClemente, C. Smoking cessation in persons with serious mental illness: the experience of successful quitters (In Press) Psychiatric Rehabilitation Journal Approximately 1 out of every 2 callers to the California QL has a mental health issue?
84% 1. True 2. False
16%
1 2 True! • Approximately half (48.9%) of callers report having at least one mental health, broken down as follows: – Any 48.9% – Depression 36.9% – Anxiety 27.8% – Bipolar 16.1% – Schizophrenia 7.1% – Drug / Alcohol 5.2%
Source: Zhu,et al, 2009. Unpublished data Over a period of 7 months in 2009, asked of over 20,000 callers in California http://smokingcessationleadership.ucsf.edu/Downloads/webinar_16_nov_18_2010.pdf Rates of QL Use
NO Mental Health Issue Mental Health Issue
Received Counseling 74.0% 84.0%
Use of Nicotine Replacement 33.3% 41.7% Therapy
Quit Attempts 53.1%* 56.4%* (within 2 months)
Quitting Success 20.8%* 19.0%* (30 day PP at 2 months)
*Descriptive data, not based on results of a randomized controlled trial Results from Zhu, et al., 2009, Unpublished data Slide from: http://smokingcessationleadership.ucsf.edu/Downloads/webinar_16_nov_18_2010.pdf Quitline Questions Maryland‘s Quitline‘s Internet component is called...
1. Online Coach ™ 56% 2. Web Coach™ 3. Net Instructor ™ 38% 4. www.Coach ™
6% 0%
1 2 3 4 What percentage of callers to the QL also use Web Coach ™?
36% 1. ~10%
2. ~20% 25% 3. ~35% 22% 4. ~45% 16%
1 2 3 4 What was the most popular answer for ‗How Heard About Quitline‘... 39% 1. Brochure 35% 2. Family / Friend 3. Health Professional 19% 4. TV Commercial
7%
(Represents 5,245 calls from Tobacco Users to the QL from 7/1/2009 to 6/30/2010) 1 2 3 4 How Heard About …
50.0%
40.0% 34.8% 30.0%
20.0% 17.5% 11.0% 10.0% 6.2%
0.0% Brochure Family / Health Prof. TV Friend
How Heard About
(Represents 5,245 calls from Tobacco Users to the QL from 7/1/2009 to 6/30/2010) The highest percentage of calls to the QL are from African Americans.
50% 50%
1. True 2. False
1 2 QL Callers by Race compared to the 2009 Census of the State of Maryland 80 63.0 60 49.3 45.0 40 29.7 20 5.2 0.9 1.1 0.4 0.1 0.1 3.51.6 0
QL Callers by Race 2009 Census
(Represents 5,245 calls from Tobacco Users to the QL from 7/1/2009 to 6/30/2010) One final question … Did you enjoy using Clicker Technology as a part of this presentation?
76% 1. Very much 2. A lot 3. It was okay 4. Not so much
16% 7% 0%
1 2 3 4 Questions?