STOMP—Stop Tobacco On My People Statewide Network of Communities in New Mexico

1. PEOPLE WITH DISABILITIES & TOBACCO CONTROL STRATEGIES STOMP—Stop Tobacco On My People Statewide Network of Communities in New Mexico To promote awareness and action among New Mexicans disproportionately affected by tobacco in order to eliminate health disparities Coletta Reid, Director Debbie Vigil, Coordinator

2. Prevalence of Smoking in New Mexico • No Disability—22% • Disability that does not require assistance—24.6% • Disability that requires assistance—28.7% • Disability that requires institutionalization—even higher

3. Pressures to Smoke • Lack of recreational & exercise alternatives • Disenfranchisement & exclusion • Social isolation • Chronic pain • Too much free time • Feeling lonely & depressed

4. Pressures to Smoke • Wanting to “fit in” • Issues of independence • Advertising • Stress and anger reduction technique • Replace impulse to overeat • Form of control

5. Increased Dangers: Secondary conditions • Difficult breathing • Slow healing of skin wounds • More likely to get pressure sores • Increased chance of stomach ulcer

6. People with Disabilities • Higher rates of smoking • More likely to be planning to quit • More likely to have tried to quit • Less likely to have successfully quit • Smoke more cigarettes per day • Smoke first cigarette sooner after waking • Higher rates of exposure to secondhand smoke in the home

7. Smoking associated with • More days of restricted activity—unable to go to work/school • More secondary conditions—breathing problems, pressure sores • Worsening health compared to prior year • Poorer health status • More physician visits • Use of caffeine and other stimulants and alcohol

8. Smokers with Disabilities, report more • Low self-esteem • Depression • Chronic pain • Anxiety • Fatigue • Burns

9. STOMP • Mini-grants to rural Independent Living Center • Committee to plan Tobacco Forum • Tobacco Forum in April, 2003 • Tobacco survey at annual Disabilities Conference • Focus groups statewide • Working with advocates to develop strategic plan

10. Disability Culture: A Look at Different Models Mary Keener Beresford, Ph.D., Director New Mexico Commission on Disability Santa Fe, New Mexico

11. Charity Model • Pre WWII • Charity of religions • Institutionalization • Focus of responsibility: Person with Disability

12. Medical Model • Post WWII • Disability as a medical condition • Repair and send back out • Focus of responsibility: Person with Disability

13. Functional Limitation Model • Derived from Medical Model • Rehabilitate after medical community has done all they can • Dealing with what person cannot do • Focus of responsibility: Person with Disability

14. Social Model • Post disability rights movement • Independent living • Integration into society • Focus of Responsibility: Society

15. The Disability Movement Sherry Watson, Executive Director San Juan Center for Independence Farmington, New Mexico

16. Independent Living • Inclusion • Consumer control • Consumer directed services • Strength • Self-empowerment

17. Independent Living Centers (ILC) • Gathering places for individuals with disabilities • People with disabilities 51% of board and staff • Serve all persons with a disability • Committed to inclusion of diverse groups

18. ILC Core Services • Systems and individual advocacy • Information and referral • Peer support • Independent living skills training

19. Tobacco Coalitions Partner with ILC’s • Create clearinghouse for tobacco information • Meet with disability organizations • Identify issues, concerns, & recommendations • Provide technical assistance and training • Facilitate program planning and design • Conduct public summits

20. “Martin Luther King had a dream. We have a destiny, not a dream, a destiny to realize. We shall have the right to choose how we live and where we live.” --Mike Auberger, ADAPT

21. Access Issues for People with Disabilities Larry Lorenzo, Disability Activist Alliance for Disability Education Albuquerque, New Mexico

22. Access Not Just Physical • Equitable outreach efforts • Equal opportunity for prevention information • Equal access to services • Inclusion in all coalitions, programs, projects

23. Americans with Disability Act—ADA, 1990 • Significant civil rights law • Right to participation • Recognition of 54 million people with disabilities • Title II • Gov’t-funded programs & services • Title III • Public Places

24. Program Access • Policies and procedures • Evaluation of your facility—TTY, etc. • Staffing patterns • Program participant inclusion

25. Information/Accessible Materials • Alternative formats • Braille • Audio recordings • Computer disc • Large print/binders • Effective communication • Sign language interpreters • Computer-Assisted Realtime Translation (CART) • TTY • Closed-captioned films and videos

26. Physical Access • Universal design • Entrance and doors • Public areas: counters, elevators, signage • Public restrooms • Meeting rooms • Emergency exits and alarms • Transportation • Parking and Pathways

27. Living Well with a Disability Alice Ellison, Director of Operations San Juan Center for Independence Farmington, New Mexico

28. Philosophy • Independent living • Self-help and self-advocacy • Peer relationships and peer role models • Equal access to society • Full choice in all matters concerning themselves

29. Trends • Increase in disability among all age groups • Mainstreaming creates additional peer pressure on youth • Increase in obesity and lack of physical exercise (for everyone) • Growing need for public health programs

30. People with Disabilities who Smoke • Less visible • Undercounted • Underserved • Ignored by tobacco prevention movement

31. Developed Capacity to Address Tobacco • Built Life Savers Coalition • Trained tobacco-free support group facilitators • Created support groups • Sponsored town hall meeting for consumers, families & community • Delivered smoke-free educational presentations • Distributed smoke-free materials

32. Tobacco Issues for People with Disabilities • Taking away choice • Have a lot worse health problems • Independent form of pleasure, especially for mobility impaired • Have enough to deal with • Isolation--“my best friend”

33. Opportunities • Make standard in health promotion programs • Integrate into programs to prevent secondary conditions • Ally with physical activity projects • Insure inclusion in peer support initiatives • Train Personal Care Option consumers in secondhand smoke issues • Environmental interventions may be more effective

34. Cigarette Smoking in Psychiatric Patients Debra Dermata Las Vegas Medical Center Las Vegas, New Mexico

35. National Prevalence • Schizophrenia: 45%-93% • Major depression: 74% • Panic disorder: 55% • Post traumatic stress disorder: 53%-60% • Phobias: 48% • Generalized anxiety disorder: 47% • Bi-polar disorder: 45%

36. Why the Higher Rates? • Stimulates release of dopamine, norepinephrine & 5-HT • Self-medication • Attempt to reduce side effects • Environmental influences

37. Nicotine Effects on Schizophrenia • Increased alertness • Reduced anxiety • Decreased depression • Decreased lethargy • Reduction in hallucinations

38. Environmental Influences • Lax policies in institutions • Cigarette privileges as rewards/punishments • Smoking breaks used as “social time” • Patients and staff smoke together as bonding • Helps patients feel “in control” in uncontrollable environment

39. Nicotine and Medications • Speeds up metabolism (need higher doses of anti-psychotics) • Haldol may increase smoking • Clozapine may decrease smoking

40. Quitting • Major difficulty for mentally ill • Majority have desire to quit • Timing crucial—medication changes/highly symptomatic • Reduction rather than cessation • Modified materials to match cognitive abilities

41. STOMPnmstomp@earthlink.net 505-988-3473 National Council on Independent Living 1916 Wilson Blvd, Suite 209 Arlington, VA 22201 www.ncil.org ncil@ncil.org 703-525-3406