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Scroll To Continue According to Truth, “tobacco use disproportionately affects many marginalized populations— including people in low-income communities1, racial and ethnic minorities, LGBT individuals2, and those with mental illness— who have a long and documented history of being targeted by the tobacco industry.”3,4,5,6 1. Lee, J. G. L., Henriksen, L., Rose, S. W., Moreland-Russell, S., & Ribisl, K. M. (2015). A Systematic Review of Neighborhood Disparities in Point-of-Sale Tobacco Marketing. American Journal of Public Health, 105(9), e8-18. https://doi.org/10.2105/AJPH.2015.302777 2. Hinds, J. T., Loukas, A., & Perry, C. L. (2019). Explaining Sexual Minority Young Adult Cigarette Smoking Disparities. Psychology of Addictive Behaviors : Journal of the Society of Psychologists in Addictive Behaviors, 33(4), 371–381. https://doi.org/10.1037/adb0000465 3. Centers for Disease Control and Prevention (CDC). (2015). Best Practices User Guide: Health Equity in Tobacco Prevention and Control. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 4. Smoking Cessation Leadership Center (SCLC). (2015, December 8). Achieving Health Equity in Tobacco Control. Smoking Cessation Leadership Center. Retrieved from https://smokingcessationleadership.ucsf.edu/factsheets/achieving-health-equity-tobacco-control 5. Creamer, M. R., Wang, T. W., Babb, S., Cullen, K. A., Day, H., Willis, G., Jamal, A., & Neff, L. (2019). Tobacco Product Use and Cessation Indicators Among Adults—United States, 2018. Morbidity and Mortality Weekly Report, 68(45), 1013–1019. https://doi.org/10.15585/mmwr.mm6845a2 6. Centers for Disease Control and Prevention (CDC). (n.d.) Behavioral Risk Factor Surveillance System Survey Data [BRFSS]. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Low-income Communities More than 25% of people living below the poverty line smoke1, which is 2x more than people who live above the poverty line. Additionally, 35-45% of children living below the poverty line live with a smoker.2 In contrast to white-collar workers, blue-collar workers are more likely to start smoking earlier in life and in larger quantities. They are also more likely to suffer from tobacco related illnesses.3,4 Individuals living below the poverty line attempt to quit smoking at the same rate as individuals living above the poverty line, but are less successful.5 1. Jamal, A., King, B. A., Neff, L. J., Whitmill, J., Babb, S. D., & Graffunder, C. M. (2016). Current Cigarette Smoking Among Adults - United States, 2005-2015. MMWR. Morbidity and mortality weekly report, 65(44), 1205–1211. https://doi-org.ezproxy.lib.utexas.edu/10.15585/mmwr.mm6544a2 2. Health Resources and Services Administration, Maternal and Child Health Bureau. (2007). The National Survey of Children’s Health: The Child’s Family. https://mchb.hrsa.gov/nsch/07rural/moreinfo/pdf/nsch07family.pdf 3. Arheart, K. L., Lee, D. J., Dietz, N. A., Wilkinson, J. D., Clark, J. D., LeBlanc, W. G., Serdar, B., & Fleming, L. E. (2008). Declining trends in serum cotinine levels in US worker groups: The power of policy. Journal of Occupational and Environmental Medicine, 50(1), 57–63. https://doi.org/10.1097/JOM.0b013e318158a486 4. Su, C., Syamlal, G., Tamers, S., Li J., & Luckhaupt, S.E. (2019). Workplace Secondhand Tobacco Smoke Exposure Among U.S. Nonsmoking Workers. MMWR. Morbidity and Mortality Weekly Report, 68. https://doi.org/10.15585/mmwr.mm6827a2 5. U. S. Department of Health and Human Services. (2014). The Health Consequences of Smoking—50 Years of Progress. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. Low Income Communities People who live in low-income communities: Have a higher exposure to secondhand smoke1 Receive less information about the risks of smoking/using tobacco products than those who don’t live in low-income communities2 Have a higher exposure to tobacco retailers and are often targets of tobacco marketing3 Approximately 75% of homeless adults use tobacco. 1. Baggett, T. P., Rigotti, N. A., & Campbell, E. G. (2016). Cost of Smoking among Homeless Adults. New England Journal of Medicine, 374(7), 697–698. https://doi.org/10.1056/NEJMc1508556 25% 50% 75% 100% True or False. There are higher rates of smoking in individuals with a low socio-economic status. True or False. There are higher rates of smoking in individuals with a low socio-economic status. True False quizonehelper Correct Wrong More than 25% of people living below the poverty line smoke, which is 2x more than people who live above the poverty line. 1. Jamal, A., King, B. A., Neff, L. J., Whitmill, J., Babb, S. D., & Graffunder, C. M. (2016). Current Cigarette Smoking Among Adults - United States, 2005-2015. MMWR. Morbidity and mortality weekly report, 65(44), 1205–1211. https://doi-org.ezproxy.lib.utexas.edu/10.15585/mmwr.mm6544a2 Connect with a Group Campaign for Tobacco-Free Kids AMPLIFY Geographic Health Equity Alliance National Native Network Nuestras Voces Network Asian Pacific Partners for Empowerment, Advocacy and Leadership “Tobacco use disproportionately affects many racial and ethnic minorities because of where they live”1 Click on the windows to learn more. 1. Truth Initiative. (2017, February 03). Tobacco is a Social Justice Issue: Racial and Ethnic Minorities. Truth Initiative. https://truthinitiative.org/research-resources/targeted-communities/tobacco-social-justice-issue-racial-and-ethnic-minorities 2. Henriksen, L., Schleicher, N. C., Dauphinee, A. L., & Fortmann, S. P. (2012). Targeted advertising, promotion, and price for menthol cigarettes in California high school neighborhoods. Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco, 14(1), 116–121. https://doi.org/10.1093/ntr/ntr122 3. Resnick, E.A., Jackson, K.L., Barker, D.C., & Chaloupka, F.J. (2012) Cigarette Pricing Differs by U.S. Neighborhoods – A BTG Research Brief. Chicago, IL: Bridging the Gap Program, Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago. http://www.bridgingthegapresearch.org/_asset/d49910/btg_tobacco_brief_FINAL_011113.pdf 4. U.S. Department of Health and Human Services. (1998). Tobacco Use Among U.S. Racial/ Ethnic Minortiy Groups – African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: A report of the Surgeon General.https://www.cdc.gov/tobacco/data_statistics/sgr/1998/complete_report/pdfs/complete_report.pdf 5. Lee, J. G. L., Henriksen, L., Rose, S. W., Moreland-Russell, S., & Ribisl, K. M. (2015). A Systematic Review of Neighborhood Disparities in Point-of-Sale Tobacco Marketing. American Journal of Public Health, 105(9), e8-18. https://doi.org/10.2105/AJPH.2015.302777 6. U. S. Department of Health and Human Services. (2014). The Health Consequences of Smoking—50 Years of Progress. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 7. Zinser, M. C., Pampel, F. C., & Flores, E. (2011). Distinct Beliefs, Attitudes, and Experiences of Latino Smokers: Relevance for Cessation Interventions. American Journal of Health Promotion : AJHP, 25(5 Suppl), eS1-e15. https://doi.org/10.4278/ajhp.100616-QUAN-200 8. Trinidad, D. R., Xie, B., Fagan, P., Pulvers, K., Romero, D. R., Blanco, L., & Sakuma, K.-L. K. (2015). Disparities in the Population Distribution of African American and Non-Hispanic White Smokers Along the Quitting Continuum. Health Education & Behavior : The Official Publication of the Society for Public Health Education, 42(6), 742–751. https://doi.org/10.1177/1090198115577376 9. Fakunle, D. O., Curriero, F. C., Leaf, P. J., Furr-Holden, D. M., & Thorpe, R. J. (2019). Black, white, or green? The effects of racial composition and socioeconomic status on neighborhood-level tobacco outlet density. Ethnicity & Health, 0(0), 1–16. https://doi.org/10.1080/13557858.2019.1620178 Minority smoker in the window Menthol cigarettes, which are easier to smoke and harder to quit, are heavily marketed to black communities.2 Menthol smoker in the window Predominately black neighborhoods tend to have lower prices for menthol cigarettes.3 Young asian man in the window Urban Asian American communities have more tobacco advertising and fewer health warnings than white neighborhoods.4 Young hispanic woman in the window Retailers in Hispanic neighborhoods are more liekly to sell tobacco products to underage individuals.5 Another hispanic woman in the window Racial and ethnic minorities typically have less access to cessation services.6,7,8 Young black woman in the window Stores in black neighborhoods were significantly more likely to have tobacco advertisements inside and outside than stores in neighborhoods with fewer black people.9 Which population has the highest rates of tobacco use? Which population has the highest rates of tobacco use? A. Asian Americans B. African Americans C. American Indians & Alaska Natives D. Individuals of Hispanic & Latino Descent quiztwohelper Correct Wrong Of all the racial and ethnic groups in the U.S., American Indians and Alaska Natives have the highest prevalence of tobacco use. Compared to the 13.7% of U.S. adults who smoke cigarettes, 22.6% of American Indian and Alaska Native adults smoke. 1. Odani, S. (2017). Prevalence and Disparities in Tobacco Product Use Among American Indians/Alaska Natives—United States, 2010–2015. MMWR. Morbidity and Mortality Weekly Report, 66. https://doi.org/10.15585/mmwr.mm6650a2 Sexual and gender minority (SGM) populations experience stress related to social stigma & discriminatory treatment. Additionally, individuals who identify as transgender are especially vulnerable to tobacco use because of high rates of substance abuse, depression, HIV infection, and social and employment discrimination. 1. Centers for Disease Control and Prevention. Current Cigarette Smoking Among Adults—United States, 2005–2013. Morbidity and Mortality Weekly Report 2014;63(47):1108-12 [accessed 2018 Jun 1]. % of Adults ≥18 Years Who Reported Cigarette Use Every Day or Some Days 13.5% Heterosexual 20.6% Lesbian/Gay/Bisexual Sexual Orientation 1. Creamer, M. R., Wang, T. W., Babb, S., Cullen, K. A., Day, H., Willis, G., Jamal, A., & Neff, L. (2019). Tobacco Product Use and Cessation Indicators Among Adults—United States, 2018. Morbidity and Mortality Weekly Report, 68(45), 1013–1019. https://doi.org/10.15585/mmwr.mm6845a2 SGM Facts 20.6% of LGB adults1 and 35.5% of transgender adults smoke cigarettes.2 LGBT individuals are less likely to have health insurance than straight individuals & 5x more likely to never intend to call a smoking cessation hotline.3 GBT men have similar exposure to tobacco cessation advertising as straight individuals, but are 20% less likely than straight men to be aware of smoking quitlines.4 LGBT adults smoke at rates almost 2.5x higher than heterosexual adults, are significantly more likely to smoke menthol cigarettes5, & have a higher prevalence of smoking other types of tobacco.6 Bisexual women are up to 3.5x more likely to smoke & have a higher nicotine dependence than hetero-sexual women.7 1. Centers for Disease Control and Prevention. (2016). Current Cigarette Smoking Among Adults- United States, 2005-2015. Morbidity and Mortalilty Weekly Report. 65(44):1205-1211. 2. Buchting, F. O., Emory, K. T., Scout, null, Kim, Y., Fagan, P., Vera, L. E., & Emery, S. (2017). Transgender Use of Cigarettes, Cigars, and E-Cigarettes in a National Study. American Journal of Preventive Medicine, 53(1), e1–e7. https://doi.org/10.1016/j.amepre.2016.11.022 3. Fallin, A., Goodin, A., Lee, Y. O., & Bennett, K. (2015). Smoking characteristics among lesbian, gay, and bisexual adults. Preventive Medicine, 74, 123–130. https://doi.org/10.1016/j.ypmed.2014.11.026 4. Centers for Disease Control and Prevention (CDC). (2015). Best Practices User Guide: Health Equity in Tobacco Prevention and Control. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. 5. Fallin, A., Goodin, A. J., & King, B. A. (2015). Menthol Cigarette Smoking among Lesbian, Gay, Bisexual, and Transgender Adults. American Journal of Preventive Medicine, 48(1), 93–97. https://doi.org/10.1016/j.amepre.2014.07.044 6. Lee, J. G. L., Griffin, G. K., & Melvin, C. L. (2009). Tobacco use among sexual minorities in the USA, 1987 to May 2007: A systematic review. Tobacco Control, 18(4), 275–282. https://doi.org/10.1136/tc.2008.028241 7. Fallin, A., Goodin, A., Lee, Y. O., & Bennett, K. (2015). Smoking characteristics among lesbian, gay, and bisexual adults. Preventive Medicine, 74, 123–130. https://doi.org/10.1016/j.ypmed.2014.11.026 Connect with a Group The National LGBT Cancer Network LGBT Health Link In the U.S, smoking rates are higher among heterosexual/straight adults, than in LGBT adults. True or False. In the U.S, smoking rates are higher among heterosexual/straight adults, than in LGBT adults. True False quizthreehelper Correct Wrong LGBT adults smoke at rates almost 2.5x higher than heterosexual adults. 1. Fallin, A., Goodin, A. J., & King, B. A. (2015). Menthol Cigarette Smoking among Lesbian, Gay, Bisexual, and Transgender Adults. American Journal of Preventive Medicine, 48(1), 93–97. https://doi.org/10.1016/j.amepre.2014.07.044 Mental Health Examples of mental health conditions include, but are not limited to: anxiety, depression, ADD/ADHD, and substance use disorders. Individuals with mental illnesses, behavioral health conditions, and trauma histories have disproportionate tobacco use rates and are more likely to lack access to health insurance, cessation resources, and healthcare. Studies have also "linked some mental health disorders with biological tendencies to use nicotine and difficulty quitting. Williams, J. M, Steinberg, M. L., Griffiths, K. G., & Cooperman, N. (2013). Smokers with behavioral health comorbidity should be designated a tobacco use disparity group. American Journal of Public Health. 103(9), 1549-1555. Centers for Disease Control and Prevention. (2013 February). Vital Signs Fact Sheet: Adult Smoking Focusing on People with Mental Illness. Retrieved from https://www.cdc.gov/vitalsigns/smokingandmentalillness/index.html American Academy of Family Physicians. (n.d.) Behavioral Health and Tobacco Cessation. Retrieved from https://www.aafp.org/family-physician/patient-care/care-resources/tobacco-and-nicotine/office-champions/behavioral-health-tobacco-cessation.html Schroeder, S. A., & Morris, C. D. (2010). Confronting a neglected epidemic: tobacco cessation for persons with mental illnesses and substance abuse problems. Annual Review of Public Health. 31, 297-314. Mental Health 40% of the cigarettes smoked in the US are by people with mental health conditions.1 1 in 3 adults with mental health conditions smoke, while 1 in 5 adults without mental health conditions smoke.1 Individuals with mental health conditions live about 5 years less than others.2,3 The top causes of death are heart disease, cancer, and lung disease, which are all tied to tobacco.4 1. Centers for Disease Control and Prevention. (2013, February 8). Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years with Mental Illness — United States, 2009–2011. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6205a2.htm?s_cid=mm6205a2_w 2. Latoo, J., Mistry, M., & Dunne, F. J. (2013). Physical morbidity and mortality in people with mental illness | British Journal of Medical Practitioners. https://www.bjmp.org/content/physical-morbidity-and-mortality-people-mental-illness 3. Plana-Ripoll, O., Pedersen, C. B., Agerbo, E., Holtz, Y., Erlangsen, A., Canudas-Romo, V., Andersen, P. K., Charlson, F. J., Christensen, M. K., Erskine, H. E., Ferrari, A. J., Iburg, K. M., Momen, N., Mortensen, P. B., Nordentoft, M., Santomauro, D. F., Scott, J. G., Whiteford, H. A., Weye, N., … Laursen, T. M. (2019). A comprehensive analysis of mortality-related health metrics associated with mental disorders: A nationwide, register-based cohort study. The Lancet,394(10211), 1827–1835. https://doi.org/10.1016/S0140-6736(19)32316-5 4. Centers for Disease Control and Prevention (CDC). (2020). People with Mental Health Conditions. Atlanta: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. Adults who experience serious psychological distress are more likely to be current smokers than adults who haven't. % of Adults ≥18 Years Who Reported Cigarette Use Every Day or Some Days 31.6% YES 13% NO Serious Psychological Distress 1. Creamer, M. R., Wang, T. W., Babb, S., Cullen, K. A., Day, H., Willis, G., Jamal, A., & Neff, L. (2019). Tobacco Product Use and Cessation Indicators Among Adults—United States, 2018. Morbidity and Mortality Weekly Report, 68(45), 1013–1019. https://doi.org/10.15585/mmwr.mm6845a2 A sudy designed to examine the long-term associations between depressive symptoms and e-cigarette use, found that: Wiernika, E., Airagnes, G., Lequy, E., Gomajee, R., Melchior, M., Faou, A. L., Limosin, F., Goldberg, M., Zins, M., & Lemogne, C. (2018). Electronic cigarette use is associated with depressive symptoms among smokers and former smokers: Cross-sectional and longitudinal findings from the Constances cohort. Addictive Behaviors, 90, 85-91. Higher depressive symptoms were associated with higher ecigarette use + Higher amounts of nicotine concentration were associated with higher depressive symptoms Fewer than half of U.S. mental health and substance abuse treatment facilities offer evidence-based tobacco cessation treatments. 1. University of Colorado Denver. (2009, January). Smoking cessation for persons with mental illness: A toolkit for mental health providers. Denver, Colorado: Department of Psychiatry, Behavioral Health and Wellness Program. Lifetime smoking rates of patients diagnosed with: 90% Schizophrenia and other psychotic disorders 82.5% Major depression disorder 59% Bipolar disorder American Academy of Family Physicians. (n.d.) Behavioral Health and Tobacco Cessation. Retrieved from https://www.aafp.org/family-physician/patient-care/care-resources/tobacco-and-nicotine/office-champions/behavioral-health-tobacco-cessation.html Maryland Tobacco Control Resource Center. (n.d.) Mental Illness. Retrieved from https://marylandtcrc.org/special-populations/mental-illness People with a history of severe trauma are twice as likely to develop a smoking dependence than those without a history of severe trauma. Herrick, H., & Austin, E. (2014). The effect of adverse experiences on the health of current smoker. SCHS Studies. Mental Health People with mental illnesses are at a higher risk for cigarette use and nicotine addiction & are less likely to stop smoking than those without mental illness. They are also more likely to lack access to cessation resources, health Insurance, and health care and have low incomes and stressful living conditions. 1. Centers for Disease Control and Prevention. (2013, February 8). Vital Signs: Current Cigarette Smoking Among Adults Aged ≥18 Years with Mental Illness — United States, 2009–2011. https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6205a2.htm?s_cid=mm6205a2_w 2. Centers for Disease Control and Prevention. Vital Signs Fact Sheet: Adult Smoking Focusing on People With Mental Illness, February 2013. National Center for Chronic Disease and Health Promotion, Office on Smoking and Health, 2013 [accessed 2018 Jun 18]. "individuals who use cocaine and opioids have higher rates of cigarette smoking." Additionally, each year, approximately 200,000 adults with both a mental health disorder and substance use disorder die from tobacco related diseases. American Academy of Family Physicians. (n.d.) Behavioral Health and Tobacco Cessation. Retrieved from https://www.aafp.org/family-physician/patient-care/care-resources/tobacco-and-nicotine/office-champions/behavioral-health-tobacco-cessation.html Hall, S. M., & Prochaska, J. J. (2009). Treatment of smokers with co-occurring disorders: emphasis on integration in mental health and addiction treatment settings. Annual Review of Clinical Psychoogyl. 5, 409-431. Kalman, D., Morissette, S., & George, T. P. (2010). Co-morbidity of smoking in patients with psychiatric and substance use disorders. American Journal of Addiction. 14(2),106-23. Centers for Disease Control and Prevention. (2020, march 3). What We Know: Tobacco Use and Quitting among Individuals with Behavioral Health Conditions. Retrieved from https://www.cdc.gov/tobacco/disparities/what-we-know/behavioral-health-conditions/index.html On average, individuals with mental health conditions live ____ years less than individuals without mental health conditions. On average, individuals with mental health conditions live ____ years less than individuals without mental health conditions. A. 3 years B. 5 years C. 7 years D. 9 years quiztwohelper Correct Wrong Individuals with mental health conditions live about 5 years less than others.1,2 The top causes of death among adults with mental health conditions are heart disease, cancer, and lung disease, which are all tied to tobacco.3 1. Latoo, J., Mistry, M., & Dunne, F. J. (2013). Physical morbidity and mortality in people with mental illness | British Journal of Medical Practitioners. https://www.bjmp.org/content/physical-morbidity-and-mortality-people-mental-illness 2. Plana-Ripoll, O., Pedersen, C. B., Agerbo, E., Holtz, Y., Erlangsen, A., Canudas-Romo, V., Andersen, P. K., Charlson, F. J., Christensen, M. K., Erskine, H. E., Ferrari, A. J., Iburg, K. M., Momen, N., Mortensen, P. B., Nordentoft, M., Santomauro, D. F., Scott, J. G., Whiteford, H. A., Weye, N., … Laursen, T. M. (2019). A comprehensive analysis of mortality-related health metrics associated with mental disorders: A nationwide, register-based cohort study. The Lancet,394(10211), 1827–1835. https://doi.org/10.1016/S0140-6736(19)32316-5 3. Centers for Disease Control and Prevention (CDC). (2020). People with Mental Health Conditions. Atlanta: Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. Thank You for viewing our presentation. Since you have elected not to submit this for class credit you may now return home or view some of the other chapters. chapter 1: addiction & Cessation > chapter 2: products > chapter 3: costs > chapter 5: Tobacco 101 > A complete list of all of the cited references can be downloaded here. Your Email Address In order to recieve your certificate please remember to use the same email address when you complete each chapter. Submit for credit × Information message In order to submit this module for credit you must watch all of the videos, complete the excercises and answer all of the quiz questions.