- Karen Conner presented COVID-19 and Smoking EHR Data: 1 Million Patients and Counting. Twenty-one health systems, coordinated by UW, agreed to scan their electronic health record (EHR) data to identify all patients (inpatient, outpatient, etc.) who received care from February 1, 2020 to September 30, 2021, and who met specific COVID-19 criteria. Overall mortality among hospitalized COVID-19 patients fell from 18.6% in the first three months of the pandemic (April-June 2020) to 7.3% in the last three months of the study (July-September 2021). Men, those on Medicare, the severely obese, and those older than 60 had elevated mortality rates both early and late in the pandemic. ICU admission and intubation rates declined across the first 20 months of the pandemic. Black patients had a significantly lower mortality rate than Whites during the first three months of the pandemic and Hispanics had a significantly lower mortality rate by the end of the study period. Former smokers and patients with missing smoking status had elevated mortality relative to never smokers. NRT during COVID-19 hospitalization for current smokers may be beneficial. COVID-19 vaccination is associated with better hospital outcomes, including reduced mortality overall.
- Michael Fiore presented Integrating Tobacco Cessation Treatment on the Cancer Journey. Fiore discussed how 30 percent of cancer cases are caused by smoking and, according to the US Surgeon General, smoking increases all-cause mortality by 50 percent among oncology patients. He discussed how the Cancer Center Cessation Initiative (C3I) was created as part of NCI’s Cancer Moonshot initiative and has since treated more than 76,000 cancer patients. Results show that high rates of tobacco treatment reach and engagement can be achieved for cancer patients who smoke. There’s no one-size-fits all approach to it, Fiore said. Instead, cancer centers should take a team approach that works within their health system. Finally, Fiore discussed the NCI Monograph #23, which focused on effective quit-smoking treatment for cancer patients. Fiore said that, along with surgery, chemotherapy, and radiation—quit-smoking treatment should be the fourth pillar of cancer care. Smoking cessation after the diagnosis of cancer is highly likely to reduce all-cause mortality and cancer-specific mortality and should be integrated into standard oncology care.
- Jesse Kaye, Kari Ives, Bruce Christiansen, Maggie Nolan, Michael Fiore. Karen Conner presented the poster titled Rethinking Smoking Cessation Interventions for Individuals Before and After Release from Prison Base. Conner shared that prevalence of tobacco use among incarcerated populations is exceptionally high. While smoke-free prisons lead to temporary forced abstinence, the vast majority of people resume smoking following release from prison. Researchers surveyed 5,289 adult men with a substance use disorder who entered a minimum-security correctional facility. Over the past decade, there was no change in rates of tobacco use prior to incarceration (about 85 percent), representing a growing disparity as overall adult smoking prevalence in the U.S. declined 22 percent over this same period. Kaye said the survey revealed consistently low perceptions of being addicted to tobacco currently, no change in expectation of returning to tobacco-free homes, yet decreasing interest in help to remain tobacco-free. Developing programs for people who are incarcerated to help them avoid returning to tobacco use is one essential component of achieving health equity for this vulnerable population who continue to smoke at a high rate.
- Allison Gorrilla, Amy Skora, Sarah Thompson, Susan Lundsten, Karen Conner. Gorrilla presented the poster titled Improving Access to Tobacco Dependence Treatment for People Who are Justice-Involved. Gorrilla discussed how UW-CTRI partnered with the Wisconsin Department of Health Services and Department of Corrections to integrate tobacco cessation and relapse prevention treatment in behavioral health services provided during pre-release and reentry. To do so, they:
- Tailored a tobacco integration protocol to each agency’s existing workflow as well as services to address substance use disorders.
- Assisted agencies with identifying a tobacco quality-improvement measure.
- Planned follow-up meetings to discuss integration challenges and successes and tailor a sustainability plan.
- Found that tobacco interventions can be integrated into the existing workflow within reentry services. The Million Hearts Tobacco Cessation Change Package guided the process improvements to integrate tobacco treatment. A survey assessment helped to tailor integration strategies to agency’s needs and strengths.
- David “Mac” Macmaster. Tobacco Use Disorder Excluded from Substance Use Disorders for Nearly Half a Century. According to SAMHSA, approximately 200,000 people with behavioral health issues die from smoking every year. They’re more likely to die from their tobacco use than from their other behavioral health issues. Mac’s poster covered the history of efforts to incorporate Tobacco Use Disorder into Substance Use Disorder recovery services, including the Wisconsin Model: In October 2021, the Wisconsin Department of Health Services revised Wisc. Administrative Code DHS 75.24(7) with language that requires behavioral health providers who treat substance use disorders to formulate plans to assess and treat tobacco use and have a policy about smoke-free environments. The revision goes into effect October 1, 2022.