Understanding Tobacco’s Deadly Tolls on Individuals, Families, and Communities. Steven A. Schroeder, MD SAMHSA’s State Policy Academy on Tobacco Control in Behavioral Health June 19, 2014 Presentation courtesy of the Smoking Cessation Leadership Center and Rx for Change.
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Understanding Tobacco’s Deadly Tolls on Individuals, Families, and Communities
Steven A. Schroeder, MD
SAMHSA’s State Policy Academy on Tobacco Control in Behavioral Health
June 19, 2014
Presentation courtesy of the Smoking Cessation Leadership Center and Rx for Change
Also suffer frommental illness and/or substance abuse
Behavioral Causes of Annual Deaths in the United States, 2000
Number of deaths (thousands)
Sexual Alcohol Motor Guns Drug Obesity/ Smoking
Behavior Vehicle Induced Inactivity
Source: Mokdad et al, JAMA 2004; 291:1238-1245
Mokdad et al; JAMA. 2005; 293:293
Acute myeloid leukemia
Bladder and kidney
Colon, liver, pancreas
Oral cavity and pharyngeal
Acute (e.g., pneumonia)
Chronic (e.g., COPD)
Abdominal aortic aneurysm
Coronary heart disease
Peripheral arterial disease
Type 2 diabetes mellitus
Reduced fertility in women
Poor pregnancy outcomes (ectopic pregnancy, congenital anomalies, low birth weight, preterm delivery)
Infant mortality; childhood obesity
Other effects: cataract; osteoporosis; Crohns; periodontitis,; poor surgical outcomes; Alzheimers; rheumatoid arthritis; less sleep
U.S. Department of Health and Human Services. The Health Consequences of Smoking: A Report of the Surgeon General, 2010.
-- higher prevalence
-- smoke more
-- more likely to smoke down to the butt
Sub Culture Urban Marketing
People with mental illnesses and/or addictions may spend up to 1/3 their income on cigarettes
A pack a day smoker spends on average…
$6.50 per day
$45.00 per week
$180 per month
$2,160 per year
$21,680 per 10 years
An estimated 7,000 compounds in tobacco smoke, including 69 proven human carcinogens
Nicotine does NOT cause the ill health effects of tobacco use.
There is no safe level of second-hand smoke.
USDHHS. (2006).The Health Consequences of Involuntary Exposure to Tobacco Smoke: Report of the Surgeon General.
Trends in cigarette current smoking among persons aged 18 or older
18% of adults are current smokers
70% want to quit
Graph provided by the Centers for Disease Control and Prevention. 1955 Current Population Survey; 1965–2010 NHIS. Estimates since 1992 include some-day smoking.
25.1% No high school diploma
45.3% GED diploma
23.8% High school graduate
22.3% Some college
9.3% Undergraduate degree
5.0% Graduate degree
Centers for Disease Control and Prevention. (2012). MMWR 61(44);889-894.
Percent/Number of Cigarettes Smoked Daily
* Schroeder, JAMA 2012; 308:1586
2007 NHIS data
Grant et al., 2004, Lasser et al., 2000
30%-35% of Behavioral Health Health Providers Smoke
Compared to general health care providersPrimary Care Physicians 1.7 %Emergency Physicians 5.7 %Psychiatrists 3.2 % Registered Nurses13.1%Dentists 5.8 %Dental Hygienists 5.4 %Pharmacists 4.5 %
NASMHPD Research Institute, Inc. (2006). Survey on Smoking Policies and Practices for Psychiatric Facilities.
Strouse R, Hall J and Kovac M. Survey of Health Professionals' Knowledge, Attitudes, Beliefs, and Behaviors Regarding Smoking Cessation Assistance and Counseling. Princeton, N.J.: Mathematica Policy Research, Inc., 2004, 1-16.
* Holford et al ; Cook et al,JAMA, 2014
*Response rates: 2005 – 55%, 2006 – 82%, 2008 – 75%, 2011 – 80%
Source: Schacht L, Ortiz G, Lane M. Smoking Policies and Practices in State Psychiatric Hospitals 2011. National Association of State Mental Health Program Directors Research Institute, Inc. Feb 29, 2012.
Prochaska, NEJM, July 21, 2011
Dopamine Reward Pathway
Stimulation of nicotine receptors
Ventral tegmental area
Nicotine enters brain
Ask. Every patient/client about tobacco use.
Advise. Every tobacco user to quit.
Refer. Determine willingness to quit. Provide information on quitlines.
Refer to Quitlines
Portal to other services
ADHA Smoking Cessation Initiative (SCI)
Do quitlines work for people with MI and/or SUD?
Are they able to meet the demand?
* Do Quitlines Have a Role in Serving the Tobacco Cessation Needs of Persons with Mental Illnesses and Substance Use Disorders? The Behavioral Health Advisory Forum (BHAF), Background Report, September 2010.
Data adapted from Cahill et al. (2012). Cochrane Database Syst Rev;Stead et al. (2012).
Cochrane Database Syst Rev; Hughes et al. (2007). Cochrane Database Syst Rev
Source: Lindson, N., Aveyard, P., & Hughes J.R. (2010). Reduction versus abrupt cessation in smokers who want to quit. Cochrane Database of Systematic Reviews, Issue 3.
*Cobb & Abrams. NEJM July 21, 2011; Fiore, Schroeder, Baker, NEJM Jan 23, 2014