Welcome to ’s 9th Annual Best Practices Conference

Medical and Clinical Interventions and Systems Change to Support Smoking Cessation

January 22, 2015 Turf Valley Resort Ellicott City, MD

Overview of the Conference

• Theme: Medical and Clinical Interventions and Systems Change to Support Smoking Cessation

• Welcome & Introductions • Maryland Tobacco Data Updates:

– Current Statewide Adult and Youth Tobacco Use Prevalence

• Keynote Presentations: – Dr. Chad Morris, Ph.D.

• National Lessons Learned: Integrating Tobacco Cessation into Behavioral Health Practices

– Dr. Nancy Rigotti, M.D. • Integrating Tobacco Cessation into Health Care Delivery Systems: Strategies for Inpatients, Outpatients, and

Populations

Lunchtime Updates • Current and Upcoming Legislation

• Kathleen Hoke, JD & William Tilburg, JD, Legal Resource Center for Public Health Policy, University of Maryland, Baltimore, Francis King Carey School of Law

• Updates on DHMH Initiatives

• Dawn Berkowitz, MPH, CHES, Director, Center for Tobacco Prevention & Control, Maryland Department of Health and Mental Hygiene

• 4th Annual Fax to Assist Award of Recognition

• Presented by Dr. Carlo DiClemente, Director, MDQuit

Afternoon Workshops • Early Afternoon Workshops (1:30pm to 2:30pm)

– Workshop A: Best Practices in Smoking Cessation in Medical Settings Nancy Rigotti, MD, Panel Moderator

– Workshop B: Peer Mentors to Promote Smoking Cessation in Persons with Serious Mental Illness Faith Dickerson, PhD

– Workshop C: Youth Prevention: Products and Trends among Middle- and High-School Youth Carlo DiClemente, PhD

Afternoon Workshops • Late Afternoon Workshops (2:30pm to 3:30pm)

– Workshop D: Challenges, Barriers, and Promising Practices for Behavioral Health Smoking Chad Morris, PhD, Panel Moderator

– Workshop E: FDA Regulation of Tobacco Products Kathleen Hoke, JD and William Tilburg, JD

– Workshop F: Tobacco Use and Cessation Among LGBT Populations Erik Augustson, PhD

CEUs • We would like to thank Michelle Darling and her staff at the

Maryland Behavioral Health Administration’s OWDT for sponsoring 6 Continuing Education Units (CEUs) for this conference.

• Please turn in your evaluation of the conference in order to

receive your CEU certificate. • All participants will receive 6 CEUs for attending.

OWDT - BHA’s CEUs

• The Office of Workforce Development and Training (OWDT) for the Behavioral Health Administration (BHA) is approved to grant Continuing Education Units by the organizations listed below:

• Alcohol and Drug Counselors – The Maryland Board of Professional Counselors and Therapists and the Maryland Addictions Professional Certification Board (MAPCB).

• Social Workers and Certified Professional Counselors – The Maryland State Board od Social Work Examiners has approved all OETAS courses for Category 1 CEU.

• Psychologists – The State Board of Examiners of Psychologists.

Housekeeping • Folders

– Agenda – Bios of Keynote Presenters & Select Articles – Evaluation – Housekeeping Sheet – Map of Conference Venue

• MDQuit Staff

• Restrooms

Clicker Technology Overview • We would like to share information using our clicker technology. • 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!

Current Statewide Adult & Youth Tobacco Use Prevalence:

Maryland Adult & Youth Tobacco Data

Carlo C. DiClemente, Ph.D. Director of MDQuit

“The century-long epidemic of cigarette smoking has caused an enormous avoidable public health tragedy. Since the first Surgeon General’s report in 1964 more than 20 million premature deaths can be attributed to cigarette smoking.”

(U.S. Surgeon General’s Report, 2014)

Effects of Smoking

(DHHS, 2014)

How many U.S. deaths per year can be attributed to cigarette smoking?

1 2 3 4

0% 0%0%0%

1. 180,000 2. 280,000 3. 380,000 4. 480,000

Annual U.S. Deaths Attributable to Smoking

* Average annual number of deaths 2000–2004 (CDC, 2012)

(CDC, 2013)

Lung Cancer 130,659

About

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)

Approximately how many U.S. adults currently smoke cigarettes?

1 2 3 4

0% 0%0%0%

1. 10% 2. 14% 3. 18% 4. 22%

U.S. Adult Tobacco Use

• According to most recent estimates*, 17.8% of all adults in the United States currently smoke cigarettes.

• This equates to roughly 42 million adults who smoke

today.

*Estimates based on 2013 National Health Interview Survey (NHIS) data

2013 Adult Current Smoking Prevalence: National (NHIS) and Maryland (BRFSS) Data

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

National Maryland

17.8% 16.4%

Per

cent

(%) C

urre

nt S

mok

ers

True of False: Current smoking prevalence is higher among adult Maryland males than

among adult females.

1 2

0%0%

1. True 2. False

2013 Adult Smoking Prevalence by Gender: National (NHIS) and Maryland (BRFSS) Data

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

National Maryland

20.50% 19.40%

15.30% 13.70%

Males Females

Per

cent

(%) C

urre

nt S

mok

ers

2013 Adult Smoking Prevalence by Education: National (NHIS) and Maryland (BRFSS) Data

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

Less than HS Graduate HS Graduate Some College College Graduate

33.20%

22% 20.90%

9.10%

24.30% 23.60%

17.70%

6.60%

National Maryland

Per

cent

(%) C

urre

nt S

mok

ers

Hispanic adults in Maryland are smoking cigarettes...

1 2 3

0% 0%0%

1. At significantly higher rates as Hispanics in the national sample

2. At roughly the same rate as Hispanics in the national sample

3. At significantly lower rates as Hispanics in the national sample

2013 Adult Smoking Prevalence by Race: National (NHIS) and Maryland (BRFSS) Data

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

White Black Hispanic Asian Other

19.40% 18.30%

12.10% 9.60%

26.50%

16.80% 17.40%

11.00% 9.50%

24.70%

National Maryland

Per

cent

(%) C

urre

nt S

mok

ers

10 Years of Maryland Adult Cigarette Smoking (BRFSS, 2003-2013)

20.1 19.5 18.9 17.7 17.1

14.9 15.2 15.2

19.1

16.2 16.4

0

5

10

15

20

25

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Per

cent

(%) C

urre

nt S

mok

ers

Between October 2013 & June 2014, what percentage of Maryland Quitline callers currently using e-cigarettes reported

using e-cigarettes to quit or cut down on other tobacco products?

1 2 3 4

0% 0%0%0%

1. 45% 2. 65% 3. 85% 4. 95%

E-Cigarette/Vapor Use by Maryland Adult Quitline Callers (10/1/13 – 6/30/14)

• Currently using E-Cig/Vapor 416

• Reason – Cut down on other tobacco 156 – Quit other tobacco 196 – Neither 60

Youth Tobacco Use Data

In the U.S., what percentage of current adult smokers began at or before the age of 18?

1 2 3 4

0% 0%0%0%

1. 70% 2. 80% 3. 90% 4. 100%

(CTFK, 2013)

90% of all adult smokers began at or before

the age of 18.

(CTFK, 2013)

High School Students

In 2013, how many underage U.S. high school youth in Maryland reported any* past month tobacco use?

1 2 3 4

0% 0%0%0%

* Includes cigarettes, cigars, bidis, kreteks, pipes, smokeless

(Data Source: Youth Risk Behavior Survey, 2013)

1. 8.9% 2. 13.9% 3. 16.9% 4. 20.9%

Maryland High School Youth Tobacco Use

(CTFK, 2014)

• In 2013, 16.9% of Maryland high school students reported current (past month) tobacco use.

(Data Source: Youth Risk Behavior Survey, 2013)

• Each Year…

− 4,200 Maryland youth become new daily smokers

True or False: Maryland High School Youth who identify as Gay, Lesbian, or Bisexual smoke at higher rates than

Heterosexual High School Youth.

1 2

0%0%

1. True 2. False

Source: 2013 Maryland Youth Risk Behavior Survey

Current Use of Any Tobacco Product by Sexual Identity Status–Maryland High School Students

(YTRBS, 2013)

0

10

20

30

40

Heterosexual Gay, Lesbian, Bisexual

14.4%

35.6%

Per

cent

(%) C

urre

nt U

sers

Trends in Maryland High School Youth Tobacco Use (YRBS, 2005-2013)

Source: MD YRBS Report (DHMH, 2014)

Key: = Decrease = No Change = Increase

Middle School Students

Current Use of Tobacco Products Among Middle School Youth: National (NYTS, 2012) -vs- Maryland (YTRBS, 2013)

0

5

10

15

Cigarettes Cigars Smokeless Tobacco

3.5% 2.8% 1.7%

3.9% 4.2% 3.0%

National Maryland

Per

cent

(%) C

urre

nt U

sers

Where do we go from here? • Recognize Maryland’s reduction in youth tobacco use rates from

2000 to 2012. – Focus on local public health strategies to address cessation and

prevention by utilizing efforts that are: school- and community-based, carry enforcement elements, allow for surveillance and evaluation.

• Consider attending Workshop C!

• Strengthen and Enforce Smoke/Tobacco-Free Policies – Numerous hospital campuses, college/universities, parks, beaches and

other recreational venues have gone smoke/tobacco-free in Maryland • Consider attending Workshops A & E!

Where do we go from here?

• Combat the misconception that the tobacco epidemic has been solved with continued evidence-based and innovative strategies. – Focus on behavioral health populations, pregnant women, and low

socio-economic populations who have been resistant to past efforts. • Consider attending Workshops B & D!

• Explore sub-populations of tobacco users where non-existent and stronger, evidence-based strategies need to be developed

• Consider attending Workshop F!