What are Tobacco Disparities?
UW-CTRI recognizes that tobacco use affects all users negatively, but unfortunately has exponential negative effects on people from specific populations. According to the CDC, 14% of adults smoked in 2019. Smoking was especially high among:
HOW UW-CTRI ADDRESSES TOBACCO DISPARITIES
UW-CTRI has been addressing tobacco disparities for decades, and isn’t done yet. Here are some examples of how UW-CTRI tries to help the groups most at risk from the harms from tobacco use via outreach, research, marketing, and staff development.
Importantly, UW-CTRI doesn’t conduct these projects in a vacuum; rather, the Center values its partnerships with community advocates, local organizations, government agencies and its funders.
UW-CTRI partnered to help residents in low-income communities of Milwaukee. It was called the ZIP Code Project. The project hired people from the community to help their neighbors by going door-to-door, by hosting events, and by various communication vehicles.
Here’s how the Wisconsin Tobacco Quit Line addresses various tobacco disparities, free of charge, by being available 24/7 to anyone in Wisconsin at 800-QUIT-NOW. The Quit Line has proven to be an effective way to bring evidence-based tobacco dependence treatment to smokers from disparate programs. More than half of Quit Line callers are under-insured. The Quit Line serves a higher percentage of people from minority communities than are represented in the general Wisconsin population.
Behavioral Health patients smoke nearly half the cigarettes in America. UW-CTRI works to help them quit. This includes working with behavioral health providers, the Bucket Approach and interacting with behavioral health patients.
UW-CTRI Regional Outreach Specialists also train healthcare providers across the state on how to address all tobacco disparities. The outreach team also works with the leaders of health systems to incorporate systematic changes that ensure all patients are screened for tobacco use and offered the care they need to quit.
Incarcerated individuals are a vulnerable disparity group, one that suffers from multiple types of disadvantages. UW-CTRI has partnered with the Wisconsin Department of Corrections to address this issue. UW-CTRI outreach staff have trained prison staff on how to offer tobacco addiction programs so inmates don’t restart smoking once they are paroled. UW-CTRI has conducted research on how to help people who are incarcerated to live tobacco-free. And, the Wisconsin Nicotine Treatment Integration Project, which includes UW-CTRI staff, has funded grants to the Chippewa Valley Correctional Facility. That program has been successful:
UW-CTRI partnered with Milwaukee-area public health advocates and the city of Milwaukee to reach out to residents living at HUD-supported housing in Milwaukee. This included education and a survey of how smoke-free housing has changed their lives. They published results.
UW-CTRI partners with First Breath to help pregnant and postpartum women quit smoking.
UW-CTRI welcomes participants from all walks of life and backgrounds in its research studies. UW-CTRI maintains offices in downtown Milwaukee and Madison, and regularly recruits and enrolls *more* study participants from disparate populations than are represented in the general Wisconsin population. The goal is to learn about tobacco addiction among diverse populations, how best to help them quit, and to intervene with free resources to help them avoid the harms of tobacco use.
In another study known as BREATHE 2, about 22% of participants were from communities of color. In this UW-CTRI study of two health clinics, researchers examined how clinics in different communities referred patients to the study at different rates.
For the Wisconsin Smokers’ Health Study 2, 17% of participants represented minority racial groups. This compares to a percent of 13% racial minority in Wisconsin. Read Fechell’s story and see Sean talk about his experience:
Military Veterans are more likely to suffer from the harms of tobacco use than non-veterans, especially if the veterans have suffered PTSD during their military service. UW-CTRI and the VA have collaborated to study the best ways to help Veterans quit tobacco use. UW-CTRI Researcher Dr. Jessica Cook has reached a major career milestone, receiving a merit award from the Veterans Administration (VA). The primary objective of her research is to produce an empirically validated treatment that increases smoking cessation in veterans with posttraumatic stress disorder (PTSD), one that can be easily integrated into smoking cessation clinics and/or mental health clinics within VA facilities. PTSD is highly prevalent in the VA patient population and is associated with a rate of smoking (53% – 66%) that far exceeds that of VA enrollees in general (22%). PTSD is also associated with unusually high rates of smoking-cessation-treatment failure.
The use of commercial tobacco on tribal lands tends to be higher than the general population in America. UW-CTRI has collaborated with with tribes to conduct research to learn more about commercial tobacco use, how to avoid the harms of commercial use, and how to help tribal members keep traditional tobacco use sacred. The Wisconsin Tobacco Quit Line also collaborates with tribes to offer a service dedicated to helping people of American Indian decent to quit commercial use.
To read more research from UW-CTRI on tobacco disparities, click here.
COMMUNICATIONS & STUDY RECRUITMENT
UW-CTRI is committed to reaching out to communities most vulnerable to the harms caused by tobacco use. For example, the Quit Line Disparities Study has run ads on social media and TV in areas often targeted by Big Tobacco. UW-CTRI has also advertised on Facebook for low-income populations and on Instagram for teens who vape. The ZIP Code Project created ads on billboards in low-income communities in Milwaukee and hired people from the community to reach out to residents door-to-door and at special events. UW-CTRI has collaborated with community health centers, churches, barbershops, media outlets, and other groups to reach at-risk communities.
UW-CTRI collaborated on a letter to the editor called, Tobacco: a Dual Risk to Black Lives. The QUITS Study news conferences in downtown Milwaukee and in Madison led to 2200 volunteers for the study.
UW-CTRI partnered with Milwaukee-area public health advocates from the Wisconsin American Tobacco Prevention Networks and the Milwaukee Housing Authority to reach out to residents living at HUD-supported housing in Milwaukee. This included education and a survey of how smoke-free housing has changed their lives. They published results.
UW-CTRI has been collaborating with the Wisconsin Department of Health Services for nearly 15 years on the Wisconsin Nicotine Treatment Integration Project (WiNTiP), which includes not only outreach to behavioral health providers and their clients, but also to policymakers who create the framework environment that supports successful attempts to quit tobacco use. WiNTiP has partnered in key ways:
- First, The Bureau of Prevention, Treatment and Recovery (BPTR) within the Division of Care and Treatment Services (DCTS) within the Wisconsin Department of Health Services (DHS) issued a Grant Funding Opportunity for Opioid and Methamphetamine Treatment Centers. Under the requirement section, it stated, “The Program shall address nicotine use, and its cessation, along with opioid and/or methamphetamine recovery. Studies show those who give up nicotine while in treatment for other substance use disorders have a higher success rate in maintaining recovery.”
- Second, the 2019 Wisconsin Act 9 authorized the DHS to pilot a Medicaid health home benefit for people with significant substance use disorders and who have co-morbid mental health and other health conditions. The proposed health home pilots will build on DHS efforts to develop a more integrated health care approach and to assure that people with substance use disorders (SUD) have quick access to the range of comprehensive addiction and mental health treatment, primary health care, and supports they need to assist their recovery. In response, BPTR requested applications under “Wisconsin Hub and Spoke Health Homes: Supporting People with Opioid and other Substance Use Disorders.” Organizations that apply and are accepted will be “hubs” to serve as the medical, health, and service home to people with substance abuse disorders and co-morbid mental illness. These “hubs” will develop and use “spokes” through which care and treatment take place. BPTR intends to select up to three such hubs. Hubs are required to address tobacco use as part of its wellness obligation. We provide the following tobacco language to be considered for the HUB contracts:
- “Treatment programs are required to address smoking (prevention and cessation) under this contract. Toward this goal, treatment programs are required to develop a plan to address the tobacco use and nicotine dependence of its clients. At a minimum, this plan will include five elements. First, it will include an assessment of client use of all nicotine/tobacco products, including e-cigarettes. Second, it will record tobacco dependence, as defined by ASAM criteria, as a problem in care plans when present. Third, there will be an assessment of client’s motivation to quit. Fourth, for all those who use tobacco products, the care plan will specify evidence-based tobacco dependence interventions that are appropriate to the motivation of the client. Clients who want to quit will be given assistance to do so. Those not yet ready to quit will receive interventions designed to increase motivation to quit. Fifth, tobacco-related outcomes will be measured both at the individual client level and as a treatment program as a whole.”
- BPTR accepted this draft language and made it part of the Hub and Spoke contract.
- Third, the Governor’s State Council on Alcohol and Other Drug Abuse (SCAODA) voted to adopt a policy that recommends integrating Tobacco Use Disorders into Wisconsin Substance Use Disorder treatment services, and to make it a standard of practice at recovery centers. Chapter 75 establishes the standards for community substance abuse service. The current text specifically excludes nicotine in its definition of “substance use disorder.” The new language, shepherded by WiNTiP, specifically includes nicotine in its definition of “substance.” Further, the new draft language requires all substance abuse treatment programs to have policies about being tobacco free and providing evidence-based tobacco dependence treatment. This new Chapter 75 is currently out for public comment. All comments to date about to the new tobacco language have been supportive.
UW-CTRI has also led significant national efforts in policy to address tobacco use among all populations, but including disparate populations. Those include:
- A National Action Plan for Tobacco Cessation
- A bold, comprehensive plan to promote smoking cessation nationally. Dr. Michael Fiore, UW-CTRI director, served as committee chair.
- Clinical Practice Guideline: Treating Tobacco Use and Dependence
- Widely viewed as the gold standard for treating tobacco use among patients, this document has been cited more than 5,000 times and disseminated to health-care providers across the globe.
- New England Journal of Medicine
- Treating Smokers in the Health Care Setting, by UW-CTRI Director Dr. Michael Fiore and UW-CTRI Director of Research Timothy Baker
UW-CTRI fosters staff diversity and follows UW hiring policies.
In addition, the Center nurtures career development. For example, UW-CTRI Researcher Deejay Zwaga has earned disparities supplemental funding for her research. Students and postdoctoral fellows have come from virtually every background, and several have been international students. Many have gone on to become successful researchers and health care providers.
For staff education and development, the Center regularly hosts guest speakers who address various topics, frequently on tobacco disparities and the projects that address them.
UW-CTRI also trains medical students on how to treat tobacco dependence, particularly within populations that exponentially suffer from its effects.
UW-CTRI would like to thank its partners, without whom this work would not be possible, at least not to the same degree. This includes the Salvation Army, US National Institutes of Health, Centers for Disease Control, Centers for Medicare and Medicaid Services, US Food and Drug Administration, US Health Resources and Services Administration, US Department of Veterans Affairs, UW Atherosclerosis Imaging Research Program, UW Comprehensive Cancer Center, UW Department of Family Medicine, UW Institute for Clinical and Translational Research, UW Department of Medicine, UW School of Medicine and Public Health, Wisconsin African American Tobacco Prevention Network, Wisconsin Tobacco Prevention and Poverty Network, Wisconsin Department of Corrections, Wisconsin Department of Health Services, the Wisconsin Partnership Program and the Wisconsin Women’s Health Foundation.
“Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles to health such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.” –Robert Wood Johnson Foundation