UW-CTRI colleagues presented the following presentations and posters at the National Conference on Tobacco or Health in the Sheraton Grand Riverwalk in Chicago August 26-28. Here’s a rundown.
Presentations
1. Equity in Action: Tobacco Use Disorder Treatment in Criminal Justice Systems. UW-CTRI Director Dr. Hasmeena Kathuria, Catherine Bonniot (UCSF), Dr. Chad Morris (Colorado), Michelene Krueger (Johnson County Department of Health).
Kathuria spoke about how and why UW-CTRI works to help people involved in the justice system to address their tobacco use: “At Boston Medical Center, I remember one of my patients told me that, when he left jail, ‘I didn’t even care about getting home safely. All I wanted to do was buy a cigarette.’”
“Nearly 90% of people who smoke before they were incarcerated go on to relapse and smoke once they leave the criminal justice system,” Kathuria said.
That’s why UW-CTRI Outreach Specialist Allison Gorrilla, who manages the Wisconsin Nicotine Treatment Integration Project (WiNTiP), has expanded its behavioral health provider outreach to include organizations who serve justice-involved individuals. It’s all thanks to funding from Wisconsin Department of Health Service’s Commercial Tobacco Prevention and Treatment Program.
Many people in the justice system have suffered from adverse childhood events – including trauma – and most of the common causes of death are related to tobacco use.
Kathuria shared that, through stakeholder engagement and partnership with the Wisconsin Department of Health Service’s Bureau of Community Forensic Services, Gorrilla was able to integrate tobacco screening and treatment into five contracted case management agencies who support clients with severe mental illness and substance use disorders in achieving stabilization with reentry in the community.
This was done through an in-depth review of the workflow, intake, and tobacco treatment plan forms, pre- and post-surveys, and training staff at case management agencies.
The post-training survey results showed that staff training had a positive impact on adoption of the 5As and on debunking myths about helping people quit smoking.
Through this work, the state-based case management agencies are now required to screen for tobacco use. UW-CTRI meets with DHS case managers annually to develop tobacco-treatment performance goals.
Next steps, Kathuria said, are to explore opportunities for UW-CTRI’s Outreach team to integrate tobacco treatment into Mendota Mental Health Institute, an inpatient psych facility that provides mental health treatment to adult and juvenile forensic patients who have been found incompetent to stand trial or not guilty due to mental illness.
2. Tobacco Cessation Strategies for Specific Populations. UW-CTRI Researcher Dr. Adrienne Johnson, Lorraine Lathen (Jump at the Sun), Dr. Chizimuzo Okoli (Kentucky), Jamie Federbush (Truth Initiative), Jessia Rath (Truth Initiative), Dr. Bassema Abufarsakh (Kentucky).
UW-CTRI Researcher Dr. Adrienne Johnson and Jump at the Sun Director Lorraine Lathen spoke about how they developed culturally specific motivational messages to promote smoking cessation in Black older adults. This work was supported by a developmental grant from the Wisconsin Alzheimer’s Disease Research Center.
“For older adults, who are three times more likely to die from smoking, research also shows that current smokers in this age group are 20% more likely to develop depression compared to non-smoking older adults,” Johnson said.
“They are also at an increased risk for mobility issues and nursing home placements. When we focus on African American or Black people who were smoking, there’s a variety of factors that make this group especially important and, unfortunately, more impacted by cigarette smoking. This is especially true in certain areas of the country, where the smoking rate for Black smokers is higher than white smokers. Wisconsin is one example of that, where the smoking rate of African Americans was 20.2%; that’s double the national smoking rate of 11.7%. We know that smoking increases the risk for Alzheimer’s disease, which is the most common form of dementia.”
Most advertisements that older Black adults see are by and for white people. So Lathen and Johnson set out to create ads for older Black adults who smoke.
“What’s the messaging that will work for older African American adult smokers to help them access evidence-based cessation programs?” Lathen said. “That was the goal of our message development.”
Lathen held focus groups with older Black adults. Based on their feedback, Johnson and Lathen developed both digital ads and videos with text and music.
After recruiting older Black adults nationwide to review the ads, Johnson found that the ads performed just as well as the non-culturally tailored ads (and better than a control) in measures shown to predict smoking cessation attempts. Older Black adults also felt more represented in the culturally specific ads, which may improve treatment engagement in the future.
While older Black adults felt dementia was a concern and potential motivation to quit, it wasn’t any more so than other health detriments from smoking.
Johnson and Lathen recommend speaking individually with older Black adults to see what inspires them – such as seeing their grandkids or playing bingo – and focusing on how quitting tobacco use can assist them in doing those things more often.
They will continue to develop messages for Black adults via a Patient-Centered Outcomes Research Institute (PCORI) grant.
Posters
1. Integrating Tobacco Treatment and Smoke-Free Policies in State Substance Use Recovery and Treatment Standards. UW-CTRI Regional Outreach Specialist Sarah Thompson. Thompson and colleagues shared key lessons learned from the process of revising state rules to integrate tobacco treatment into behavioral healthcare settings. They suggest developing partnerships before the project begins, understanding perspectives of state partners, having a viewpoint beyond the immediate project, and maintaining relationships over time. They also discussed implementation, including how to address varying levels of readiness, awareness, and buy-in among facilities. They noted that some clinicians may look to meet only the minimum standard where applicable and that examples and case studies are highly valued and frequently requested. Thompson also stressed the value of being responsive to each facility’s capacity, recognizing that tobacco integration is a small component of a major rule change.
2. How to Build a Community Advisory Board (CAB) Towards a PCORI Grant. UW-CTRI Research Director Dr. Megan Piper, UW-CTRI Outreach Director Karen Conner. Piper and Conner shared tips on how to develop a community advisory board to help get a grant. They recommend collaborating with an expert facilitator. They said the trust and prior relationships between the CAB members and the CAB Chair are invaluable. They suggest taking the time to plan the meetings – don’t wing it. Video conferences are efficient, they said, but in-person meetings give you an opportunity to build relationships and trust. Buy meals for the meetings, they advised. Be transparent about what decisions the CAB can and cannot make. They also emphasized the value of owning what you don’t know – embracing being an outsider – as a great opportunity to learn.