30 May 2017 | Geneva - Action to stamp out tobacco use can help countries prevent millions of people falling ill and dying from tobacco-related disease, combat poverty and, according to a first-ever WHO report, reduce large-scale environmental degradation.

On World No Tobacco Day 2017, WHO is highlighting how tobacco threatens the development of nations worldwide, and is calling on governments to implement strong tobacco control measures. These include banning marketing and advertising of tobacco, promoting plain packaging of tobacco products, raising excise taxes, and making indoor public places and workplaces smoke-free.

Tobacco’s health and economic costs

Tobacco use kills more than 7 million people every year and costs households and governments over US$ 1.4 trillion through healthcare expenditure and lost productivity.

"Tobacco threatens us all," says WHO Director-General Dr Margaret Chan. "Tobacco exacerbates poverty, reduces economic productivity, contributes to poor household food choices, and pollutes indoor air."

Dr Chan adds: "But by taking robust tobacco control measures, governments can safeguard their countries' futures by protecting tobacco users and non-users from these deadly products, generating revenues to fund health and other social services, and saving their environments from the ravages tobacco causes."

All countries have committed to the 2030 Agenda for Sustainable Development, which aims to strengthen universal peace and eradicate poverty. Key elements of this agenda include implementing the WHO Framework Convention on Tobacco Control, and by 2030 reducing by one third premature death from noncommunicable diseases (NCDs), including heart and lung diseases, cancer, and diabetes, for which tobacco use is a key risk factor.

Tobacco scars the environment

The first-ever WHO report, Tobacco and its environmental impact: an overview, also shows the impact of this product on nature, including:

• Tobacco waste contains over 7000 toxic chemicals that poison the environment, including human carcinogens.
• Tobacco smoke emissions contribute thousands of tons of human carcinogens, toxicants, and greenhouse gases to the environment. And tobacco waste is the largest type of litter by count globally.
• Up to 10 billion of the 15 billion cigarettes sold daily are disposed in the environment.
• Cigarette butts account for 30–40% of all items collected in coastal and urban clean-ups.

Tobacco threatens women, children, and livelihoods

Tobacco threatens all people, and national and regional development, in many ways, including:

• Poverty: Around 860 million adult smokers live in low- and middle-income countries. Many studies have shown that in the poorest households, spending on tobacco products often represents more than 10% of total household expenditure – meaning less money for food, education and healthcare.
• Children and education: Tobacco farming stops children attending school. 10%–14% of children from tobacco-growing families miss class because of working in tobacco fields.
• Women: 60%–70% of tobacco farm workers are women, putting them in close contact with often hazardous chemicals.
• Health: Tobacco contributes to 16% of all noncommunicable diseases (NCDs) deaths.

For more information, please contact:

Paul Garwood
WHO Department of Communications
Telephone: +41 22 791 15 78
Mobile: +41 79 603 72 94
Email: garwoodp@who.int

Christian Lindmeier
WHO Department of Communications
Telephone: +41 22 791 1948
Mobile: +41 79 500 6552
Email: lindmeierch@who.int

May is Mental Health Month and a good time to revisit some of the common myths about smoking and behavioral health.

People with behavioral health conditions (mental illness and substance use disorders) smoke at higher rates than those without behavioral health conditions.  Alarmingly, people with mental illness and substance used disorders are dying up to 25 years earlier than the general population. The major causes of death are often smoking related cancer, heart disease, and lung disease.^1,2

Unfortunately, there are still misconceptions that smokers with behavioral health conditions are not interested in smoking cessation and lack the ability to quit.  There are also concerns that these smokers will experience increased psychiatric symptoms when they quit.³ As a result, providers may not include smoking cessation in their treatment plans.  Instead, they focus primarily on behavioral health symptom management.

The reality is that people with mental illness and substance use disorders want to quit smoking and can quit successfully. Health care professionals can play an essential role in this process. Providers can bolster a broad health and wellness philosophy for patients by seeing tobacco cessation as a key component of behavioral health treatment and recovery.

Myths and Facts About Smokers with Behavioral Health Conditions

Here are some common myths and facts about smokers with behavioral health conditions.

Myth #1: Persons with mental illness and substance use disorders don’t want to quit.

Fact: The majority of persons with mental illness and substance use disorders want to quit smoking and want information on cessation services and resources.

Several research studies indicate that the majority of persons with behavioral health conditions want to quit smoking and want information on cessation services and resources. ^{4, 5, 6} 

Myth #2:  Persons with mental illness and substance use disorders can’t quit smoking.

Fact:  Persons with mental illness and substance use disorders can successfully quit using tobacco.

There is a growing body of literature indicating that this clientele can quit.  For example, results from a large, internationally run randomized controlled trial showed that smokers with behavioral health conditions can quit successfully using nicotine patches, Zyban, or Chantix, compared to placebo, with no significant increase in neuropsychiatric adverse events.⁷

Myth #3:  Smoking cessation worsens psychiatric symptoms.

Fact:  Smoking cessation can improve psychiatric symptoms.

This myth has historical ties to the tobacco industry, which directly funded, or monitored, research supporting the idea that individuals with behavioral health conditions (schizophrenia in particular) were less susceptible to the harms of tobacco and that they needed tobacco as self-medication.  Fortunately, research has been emerging to debunk this myth.^8,9

Myth #4:  Smoking cessation will threaten recovery for persons with substance use disorders.

Fact:  Smoking cessation can enhance long-term recovery for persons with substance use disorders.¹⁰

Research has shown that smoking cessation can encourage and support recovery.  For example, a systematic review of 17 studies found that concurrent tobacco cessation treatment with individuals in addictions treatment was associated with 25% increased abstinence from alcohol and illicit drugs six months or longer after treatment. ⁶

Increasingly, these myths about smoking and behavioral health are giving way to the facts. This is important for a clientele who will benefit greatly from an integrated treatment approach that includes smoking cessation as a priority focus.

For More Information

For more information about smoking and behavioral health, please visit our website or explore our free CE Courses on a variety of smoking and behavioral health issues.

1 Colton, C. W. & Manderscheid, R. W. (2006). Congruencies in increased mortality rates, years of potential life lost, and causes of death among public mental health clients in eight states. Preventing Chronic Disease, 3(2).

2 Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA psychiatry, 72(4), 334-341.

3 Prochaska, J. J. (2010). Failure to treat tobacco use in mental health and addiction treatment settings: A form of harm reduction? Drug and Alcohol Dependence, 110(3), 177- 182.

4 Prochaska, J. J., Rossi, J. S., Redding, C. A., Rosen, A. B., Tsoh, J. Y., Humfleet, G. L., . . . Hall, S. M. (2004). Depressed smokers and stage of change: Implications for treatment interventions. Drug and Alcohol Dependence, 76(2), 143-151. doi:DOI: 10.1016/j.drugalcdep.2004.04.017

5 Prochaska, J. J.,Reyes, R.S., Schroeder, S.A., Daniels, A. S., Doederlein, A., & Bergeson, B. (2011). An online survey of tobacco use, intentions to quit, and cessation strateies among people living with bipolar disorder. Bipolar Disorders, 13(5-6), 466-473. doi:10.1111/j.1399-5618.2011.00944.x

6 Joseph, A. M., Willenbring, M. L., & Nugent, S. M. (2004). A randomized trial of concurrent versus delayed smoking intervention for patients in alcohol dependence treatment. Journal of Studies on Alcohol, 65(6), 681-691

7 Anthenelli, R. M., Benowitz, N. L., West, R., St Aubin, L., McRae, T., Lawrence, D., ... & Evins, A. E. (2016). Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): a double-blind, randomised, placebo-controlled clinical trial. The Lancet, 387(10037), 2507-2520.

8 Prochaska, J. J., Hall, S. M., Tsoh, J. Y., Eisendrath, S., Rossi, J. S., Redding, C. A., . . . Gorecki, J. A. (2008). Treating tobacco dependence in clinically depressed smokers: Effect of smoking cessation on mental health functioning. American Journal of Public Health, 98(3), 446-448. doi:10.2105/AJPH.2006.101147

9 Evins, A., Cather, C., Deckersbach, T., Freudenreich, O., Culhane, M., Olm-Shipman, C., . . . Rigotti, N. (2005). A double-blind placebo-controlled trial of bupropion sustained-release for smoking cessation in schizophrenia. Journal of Clinical Psychopharmacology, 25(3), 218-225. doi:10.1097/01.jcp.0000162802.54076.18

10 Prochaska, J. J., Delucchi, K., & Hall, S. M. (2004). A meta-analysis of smoking cessation interventions with individuals in substance abuse treatment or recovery. Journal of Consulting and Clinical Psychology, 72(6), 1144-1156. doi:10.1037/0022-006X.72.6.1144

Cigarette Tax Increases $2 on April 1

The California Smokers’ Helpline and its training and technical assistance arm, the Center for Tobacco Cessation, are pleased to host this free webinar on Thursday, March 23rd from noon to 1 pm PST, How to Start and Maintain a Smoking Cessation Group.

Webinar Overview

Smoking cessation groups have been a mainstay of cessation interventions for years, but starting and maintaining groups can sometimes prove challenging.  In this webinar Ken Fitzgerald from the Stanislaus County Office of Education and Zoila Reyna, MPH from the American Lung Association will offer insights, tools and resources for getting cessation groups up and running and for keeping them going:

• Ken will discuss the development of the Stop Tobacco And Nicotine Dependence (STAND) curriculum which was created as part of the smoke-free parks and colleges initiative, as well as recognize key partners and potential uses in local settings. 
• Zoila will discuss how to successfully facilitate tobacco cessation groups for adults and how the Freedom from Smoking Facilitator Training content has helped healthcare professionals in clinical settings address tobacco cessation needs in their own organizations.

Presenters

Ken Fitzgerald | Director of Student Services and Support
Stanislaus County Office of Education

Ken has been coordinating public health and prevention programs in Stanislaus County since 2002.  His experience includes leading policy initiatives for smoke-free outdoor areas in parks and colleges  He also helped develop the Protecting Health And Slamming Tobacco (PHAST) Youth Coalition, which has grown into one of the largest tobacco prevention youth coalitions in California.  Ken led in the development of the tobacco cessation curriculum known as Stop Tobacco And Nicotine Dependence (STAND).  He provides training and technical assistance to schools and community organizations to support student wellness and strengthen school climate. 

Zoila Reyna, MPH | Charter Director of Health Education
American Lung Association in California

Zoila trains and supports health professionals throughout California in tobacco cessation programs in both clinical and public settings. She received her Master’s Degree in Public Health from UC Davis. She has 10 years of experience in program management, community engagement, and public health programs for underserved populations, in both rural and urban areas.

Download our free Provider Toolkit, Online Referral Options to Evidence-Based Tobacco Treatment, from the California Smokers’ Helpline and its training and technical assistance arm, the Center for Tobacco Cessation.

In 2015, the California Department of Public Health (CDPH) determined that the California Smokers’ Helpline meets the Specialized Registry Reporting measure. Eligible professionals can choose to report smokers to the Helpline as part of their Meaningful Use Compliance.

The Helpline offers a variety of options for referring patients and clients to the Helpline's evidence-based telephone counseling for quitting smoking, including web-based referral, DIRECT messaging, and other Internet options.

Kristin Harms and Carrie Kirby with the California Smokers' Helpline describe the various options available for referring patients online to the Helpline including cost, technology requirements, and fulfillment of Meaningful Use Requirements.

Our free toolkit includes:

• Webinar recording and slide deck
• Provider flyer: Online Referral Options

The California Smokers’ Helpline and its training and technical assistance arm, the Center for Tobacco Cessation, are pleased to host this free webinar on Wednesday, March 1st from noon to 1 pm PST, Online Referral Options to Evidence-Based Tobacco Treatment.

Webinar Overview

The California Smokers' Helpline offers a variety of options for referring patients and clients to the Helpline's evidence-based telephone counseling for quitting smoking, including web-based referral, DIRECT messaging, and other Internet options.

In 2015, the California Department of Public Health (CDPH) determined that the California Smokers’ Helpline meets the Specialized Registry Reporting measure. Eligible professionals can choose to report smokers to the Helpline as part of their Meaningful Use Compliance.

Learn about the various options available for referring patients online to the Helpline, including cost, technology requirements, and fulfillment of Meaningful Use Requirements. Online referral offers health care providers a number of benefits:

• Easy, convenient, secure
• Referral to quitlines is associated with a significantly higher participation rate than simple advice to quit
• Helps healthcare systems achieve and document Meaningful Use of Electronic Health Records

Presenters

• Kristin Harms, Communications Manager, California Smokers' Helpline
• Carrie Kirby, M.S., Project Manager, California Smokers' Helpline
• Anthony Mayoral, Director of Operations and IT, California Smokers' Helpline

If you missed our webinar on January 18th, you can download our new provider toolkit, Child Health Providers Helping Family Members Quit Tobacco Use.

In this recorded webinar, Jonathan Winickoff, MD, MPH and Jyothi Marbin, MD discuss the impact of tobacco use on families, and list ways in which child health practices can effectively treat tobacco users in a family. They also describe how to implement the basic 3 step CEASE model in a busy office practice and share information about policies that can mitigate tobacco exposure in children.

Our free toolkit includes:

• Webinar Recording and Slide Deck
• Patient Fact Sheets:
  • What's in Cigarette Smoke?
  • Secondhand Smoke
  • Quit Aids

The New Year is a perfect time to encourage your patients and clients who smoke to make a quit attempt. To help smokers stay quit, the California Smokers' Helpline is offering its Top 10 Tips to Help Smokers Quit flyers in six languages.

Quit attempts are vitally important to population-based cessation as most tobacco users must try repeatedly to quit before they succeed. Fortunately, 70% of smokers say they want to quit. And, asking and advising a patient to quit can actually double the chance that he or she will try. 

So, take this opportunity before the New Year to ask all your patients if they smoke, advise them to quit, and provide them with our Top 10 Tips to Help Smokers Quit flyer. For smokers who need additional support, refer them to 1-800-NO-BUTTS (1-800-662-8887) our to our online registration form for free help and a plan to quit.