Moving Forward In Spite Of It All

Like everyone else, the Smoking Cessation Leadership Center at UCSF has had to adapt to new ways of doing our work. Working remotely has brought its set of challenges, and we were concerned that the press of attending to the Covid-19 epidemic would sideline smoking cessation efforts, as clinical and public health interests and resources were understandably shifted to address the urgency of viral transmission. We are pleased to report, however, that the work continues, largely due to the strength of collaboration. And encouraging signs of progress are appearing. Specifically:

• Two virtual reconvening summits were held for the states of Pennsylvania and Indiana in August 2020, as part of our SAMHSA National Center for Excellence in Tobacco-Free Recovery. These were opportunities to welcome new state champions to their respective Leadership Academies and re-evaluate strategies outlined in their initial summits (in 2017 and 2019, respectively). These events would not have occurred without the extraordinary leadership of the PA and IN planning teams, particularly Barbara Fickel and Mark Modugno from Pennsylvania and Regina Smith and Miranda Spitznagle from Indiana. In addition, our colleagues at National Behavioral Health Network have been continuous partners for these events, including the planning process and post-event calls. Lastly, Josh Shapiro from the Capital Consulting Corporation ensured that the previously untested virtual format was a success, due to his technical prowess and ability to seamlessly coordinate breakout groups and communication functions. These summits are a testament to the benefits of collaboration having generated ambitious new goals as well as strategies to meet them. One specific example is Indiana, who was able to create a Request for Application to grant Behavioral Health organizations funds to help them go tobacco-free.
• Two national trainings on smoking and behavioral health were also held virtually in August 2020. These trainings were initially intended to be held in-person in the states of Alaska and Illinois, hosted by local leadership. However, due to COVID-19, the events were instead held in a virtual format with presentations from content experts across the country, presenting on the importance of addressing tobacco use among the behavioral health population, information on treatment and medications, and steps to implementing a tobacco-free campus policy, among other topics. In total, 667 individuals participated in these two trainings, with 209 individuals receiving CEUs for both events combined. Considering that the pandemic removed the possibility of individuals receiving accreditation for in-person trainings or events, the availability of credit for these educational trainings was very beneficial for the audience. Like the virtual state reconvening summits, these events relied on stalwart leadership of the planning teams in Alaska and Illinois, as well as the strong collaboration with National Behavioral Health Network and coordination from Capital Consulting Corporation. Ultimately, this work would not be possible without strong support from the Substance Abuse and Mental Health Services Administration (SAMHSA).
• The National Partnership on Behavioral Health & Tobacco Use continues to grow, with three new member organizations: American Society of Addiction Medicine (ASAM), Association of State and Territorial Health Officials (ASTHO) and National Association of Community Health Centers (NACHC).
• In addition, the National Partnership is now receiving substantial support from the Robert Wood Johnson Foundation. This will help the Partnership focus on new priorities identified among its members, including addressing tobacco use among the behavioral health population in light of COVID-19.
• We have seen continued high interest in webinars with 53% more registrants than last year for a combined total of 12,288 for all webinars:

1.Connecting to Care – How to Leverage Quitlines to Better Support Your Clients with NBHN with Chad Morris, PhD and Jim Pavlik, MA – June – 1139 registrants and 63 CEUs, with increasing numbers of behavioral health professionals claiming credit

2.Smoke-free Public Housing: Helping Residents Quit Tobacco, hosted by SCLC, ACS, and NAQC with Celine Mutuyemariya, M.Ed., Izzy Rivera, Katy L. Wynne, Ed.D., MSW, and Becky Slemons, MNPO – July – 710 registrations and 45 CEUs

3.Systems Change: Increasing Treatment for Tobacco Dependence in Behavioral Health with Brenna VanFrank, MD, MSPH – Sept. – 1091 registrations and 70 CEUs

4.Integrating Tobacco Treatment within Stanford Cancer Center: An NCI Moonshot Initiative with Jodi Prochaska, PhD, MPH and colleagues – Oct. – 620 registrations and 36 CEUs (numbers continue to increase)

• Within the past year, SCLC has received an incredible number of requests for the 1-800-QUIT-NOW blue quitline cards, totaling almost 200,000.
• There has been a small but sustained increase over the past few years in the percent of mental health and substance use treatment facilities across the country that have adopted smoke-free policies. The percent of facilities with smoke-free policies has increased from 48.6% for mental health treatment facilities and 34.5% for substance abuse treatment facilities in 2016 to 52.8% and 35% in 2020, respectively.[i]^,[ii] There has been major progress in specific states regarding smoke-free policies in 2020, with all of South Carolina’s state-supported community mental health centers becoming smoke-free and Alaska’s Copper River Native Association going smoke-free with significant help from staff who wanted to quit smoking themselves. Watch the video of their journey.
• Now, in Vermont, a pharmacist may prescribe, order, or administer tobacco cessation products in a manner consistent with valid State protocols.
• As part of the California Behavioral Health and Wellness Initiative (CABHWI), SCLC has supported several inpatient behavioral health agencies to develop tobacco-free grounds, implement procedures to routinely ask clients about tobacco use and adopt standardized Tobacco Use Assessment (TUA) forms. The results of these efforts show that current smokers in these facilities went from 54.2% to 26.6% in 18 months. Also encouraging is yet unpublished data for the same 18 month period showing 81% of patients being asked if they smoked (up from 62.2%) and 28.2% (up from 24%) being referred to a free quit line.
• Finally, we were thrilled to learn that, according to the 2019 National Survey on Drug Use and Health, conducted by SAMHSA, smoking prevalence declined among those with mental illness as well as drug abuse disorders, and at a rate faster than the general population. This continues a five-year trend that refutes the myths that this population does not want to stop smoking and is unable to. Of course, we don’t yet know what has happened to smoking rates since the start of the pandemic. Have the cumulative stresses induced some to resume smoking and/or to discourage cessation attempts? Has the lockdown encouraged quit attempts in order to protect family and close contacts? Most likely both outcomes have resulted, but it is too early to tell the net impact.

In any event, we continue to be impressed with the dedication of state and local clinicians and public health officials who are working to improve the health of the public by encouraging smoking cessation, even in these most difficult times. For our part, we promise to support you in every way that we can.