“My Name is Sherrill and I’m a Recovering Smoker”

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Sherrill Wayland, MSW
SAGE
Metro St. Louis
 
 
 
 

“My Name is Sherrill and I’m a Recovering Smoker”

This was my opening comment for the “Voices of Community Partners” Panel, during the Community Engagement to Address Tobacco-related Health Disparities Pre-Conference at SRNT.  If you had told me a year ago that I would be asked to speak on a panel regarding smoking cessation programs, I would have laughed out loud. As a year ago, I was smoking a pack a day and on a really bad day maybe two. Fast forward a year and March 26th marks my one year anniversary of being tobacco free thanks to the Missouri Out, Proud and Healthy Project and the SAGE Metro St. Louis Smoking Cessation program.

Many of the health disparities prevalent in minority communities can be directly linked to smoking. Represented in the host of speakers during the pre-conference were institutional researchers and community partners working with minority communities including Native American, African American, East Asian Youth, HIV and LGBT communities. The common theme heard over and over was the importance of building collaborative relationships between research institutions and community based organizations based on trust and open communication. The community partners have a unique position to bring cultural understanding to the forefront of health disparities work. The research institutions bring invaluable resources through grant funds, technical assistance and capacity building. These collaborations empower community based organizations to deliver critical services to minority communities for addressing health disparities which would often not be possible without the support of research institutions.

 
SAGE Metro St. Louis is grateful for the work of the Out, Proud and Healthy Project from the University of Missouri – Columbia for the work they are doing to address health disparities within the LGBT community. Through building partnerships such as these, we can leverage our resources, conduct cutting edge research and most importantly, deliver services to the LGBT community designed to decrease health disparities which have historically been overlooked.

 
In closing, I encourage community based organizations to reach out in your communities to your research institutions and offer your support and partnership for the important work of community based research. It just might save a life!

SRNT Poster Watch: Tobacco Use Among LGBT Atlantans

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The Network for LGBT HEalth Equity
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Drum roll please! We are excited to present to you a poster from Georgia State University, Division of Respiratory Health (and check out the great the skeleton image)!

Poster-SRNT-Conference

Background: Lesbian, gay, bisexual, and transgender (LGBT) people are increasingly aware that disproportionately high smoking rates severely impact the health of their communities. Motivated to make change, a group of LGBT community members, policy makers, and researchers from Atlanta carried out a community-based participatory research project.

Objectives: The research sought to identify recommendations for culturally relevant smoking prevention and cessation interventions that could improve the health of Atlanta’s LGBT communities.

Methods: Incorporating a mixed-method approach, the project included four focus groups with 36 participants, a 20-item questionnaire completed by 685 people, and a community meeting with 30 participants.

Results: Among participants, the most favored interventions were: providing LGBT-specific cessation programs, raising awareness about LGBT smoking rates, and getting community venues to go smoke-free. Participants also suggested providing reduced-cost cessation products for low-income individuals, using LGBT “role models” to promote cessation, and ensuring that interventions reach all parts of the community.

Conclusions: Findings reinforce insights from community-based research with other marginalized communities. Similarities include the importance of tailoring cessation programs for specific communities, the need to acknowledge differences within these communities, and the significance of community spaces such as bars in shaping discussion of cessation. At the level of practice, this study highlights the need for heightened awareness. More specifically, the Atlanta LGBT community is largely unaware that high smoking rates affect its health, and is unlikely to take collective action to address the problem until the community understands the negative health impact.

SRNT Poster watch: An Examination of poly-tobacco use in sexual and gender minority individuals

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As you may know, the Society for Research on Nicotine and Tobacco 19th Annual International Meeting is taking place this week in Boston! We wanted to give a shout-out to some of our friends (and heroes) in LGBT Tobacco Control who will be presenting posters, and for those of you who won’t be able to be at the conference, a chance to see their work!

One of the main goals of the network (and this blog) is to link people with information. We are really excited that there is such an array of LGBT tobacco information at SRNT this year, and we thank all of the folks who have shared their posters and presentations with us!

Here is one of the first posters that is being presented at SRNT right now! (click the image to enlarge!)

SRNT 2013 Polytobacco Use of SGM Poster

SRNT Update 5: The New Wave of Cessation

Scary time today.  Early this morning I received a text from back home in Hawaii about all this crazy tsunami stuff after the terrible earthquake in Chile.  Worried all morning about my family back home, it was hard to really have my head in the game.  I still managed to take in some posters and presentations, but hadn’t been able to write up anything until now because I had been glued to the TV.  Things have now been pretty much cleared, so it’s back to tobacco and nicotine!

Speaking of waves, as far as tobacco research, one of those new waves is cessation for adolescents.  That was certainly represented in the presentations here at the SRNT conference.  Let me ruin the ending for you: cessation for youth can and does work.  At least that’s according to the presentations I attended.  There are some barriers and lessons learned that the presenters did an awesome job in talking about. Here’s a quick rundown of what I got:

You might not want to call your youth cessation program a cessation program: Susan Druker from the University of Massachusetts in her presentation talked about how they called their youth cessation research project “Air It Out”.  This as a way to counter the stigma associated with youth cessation and instead capitalized on the idea that teens want to talk and air our their feelings on “stuff.”

Don’t make your cessation program just for smokers: Dr. Jeffrey Fellows from Kaiser Permanente and Dr. Arthur Peterson from the Fred Hutchinson Cancer Research designed interventions that provided services for both smokers and non-smokers.  This also helped to reduce the stigma of a teen going into a cessation program.  This also helped in recruitment and retention into the program.  Non-smokers would get some preventive information about tobacco or about other health topics.

Be Proactive: speakers pointed out that proactive recruitment and services were key to the efficacy of their interventions.  All programs not only saw significant increases in cessation rates between control and experimental group, but also saw huge retention rates.  While some recruited through well visits to pediatricians, others recruited through schools.

Build rapport: As with most programs that utilize motivational interviewing for cessation programs, rapport is very important to teen cessation.  It starts all the way at the beginning by emphasizing confidentiality, as Air It Out did, and by utilizing trained counselors in motivational interviewing.  Air It Out sent out individualized notes to each teen, which Druker believes was key to their high retention rates.

Kaiser partnered with Free & Clear to provide telephone counseling.  The Fred Hutchinson treatment center also provided phone services while Air It Out provided face to face. The topics covered in the counseling were similar to the topics that are covered in adult cessation, and the cessation rates were similar to those of adults.  One difference is that the youth were not provided with NRT, as it’s still not approved by the FDA.

I will have one more blog entry talking about the awesome posters at the conference.  Too many to share, but I will try to give a taste.

SRNT Update 4: Tobacco and People Living With Cancer and HIV/AIDS

So this is day 3 for me in Baltimore and so far, aside of a little detour into food-poisoning-land, it’s been great.  Last night I got to see the touring Broadway show In The Heights and got to see it snow for the first time in my life. Both were great, in case you were wondering, although I felt like my ears were going to fall off (I mean in reference to the cold of the snow, not because of the show).  But you don’t want to hear about me, you want to hear bout the SRNT conference. 

On this update I wanted to focus on an excellent presentation give by Dr. Ellen Gritz on cancer and HIV/AIDS patients and tobacco use.  Turns out that over 20% of people living with cancer continue to smoke.  Yikes!  So obvious not only could tobacco use have contributed to the onset of cancer but there are other downsides once a person living with cancer continues to smoke.  For starters, it can worsen the side effects of treatment, however it also has adverse effects on the efficacy of treatment too.  If undergoing surgery, it can increase the complications of general anesthesia and detrimental to wound healing.  If a cancer patient is undergoing radiation, smoking can increase the toxicity of the treatment.  Nicotine itself induces resistance to chemotherapy.

After talking about the detrimental effects of tobacco on cancer, Dr. Gritz switched over to talking about the effects on people living with HIV/AIDS, and I got smarter and instead of typing on my computer I began to take pictures of slides…alright, so I copied it from someone in front of me, at least I know when to follow a good idea.

Anyway, as you can read in the picture below, smoking is a major cause of cardiovascular disease (CVD), and CVD has been rearing its ugly head more in this population as people living with HIV/AIDS have longer life expectancies.  Cancer also tends to be one of the top reasons of death for this population.  So there’s this terrible cycle that is perpetuated by continuing to smoke while living with HIV/AIDS. 

Me being smart and taking pics of the screen instead of notes

BUT, and that’s a big J.Lo BUT, the good news is that people with cancer and HIV/AIDS have shown that they want to quit just like everyone else.  Dr. Gritz ended by showing a pilot a project, conducted by Dr. Gary Humfleet from the University of California, San Francisco, which has shown that people with HIV/AIDS can quit tobacco right along with the rest of us.  Basically, follow the recommendations that are set forth in the mighty Quit Tobacco Bible (The Treating Tobacco Use and Dependence Clinical Practice Guidelines), but address barriers that are specific to people living with HIV/AIDS.  One the points that Dr. Humfleet clarified for me was that people with HIV/AIDS could be prescribed NRT.  I got to meet Dr. Humfleet during one of the posters sessions after a tip from Gustavo that he was in attendance.

Implications from all this is that we, as tobacco control advocates, should concentrate on building cessation programs that target people with caner and HIV/AIDS.  Furthermore, the old stereotype that people facing these challenges will not want to quit, because that’s a bunch of bologna.   Not only do these people want to quit just like most smokers do, they can, and they have a heightened risk of smoking interfering with their very important treatment.  Encourage clinicians to approach the subject of tobacco with their clients, and if they say “they won’t want to quit” tell them Pedro said “Si Se Puede!”

SRNT Update 3: Means to and ENDS

An interesting discussion emerged from Dr. Nathan Cobb’s presentation on E-cigarettes.  First and foremost, he asked, they not be called E-cigarettes, because it implies it is from tobacco, which E-cigs don’t contain tobacco.  Rather, they are Electronic Nicotine Delivery System, or ENDS for short.  In my own home state some people are looking towards ENDS as a cessation mechanism, and to that I would say “not so fast” after seeing Dr. Cobb’s presentation.

While ENDS would potentially be a safe way to deliver nicotine (although Nicotine itself is still not considered a safe substance), trace amounts of Tobacco-specific N-nitrosamines were found in some of the products tested by the FDA along with acetaldehyde, acetone, and formaldehyde.  What’s more scary is that different chemicals were found not just with differing brands but also even within the same brand.  There were also inconsistencies in the amount of nicotine in each puff, even within the same brand, and varied within the same cartridge from puff to puff.  Last, the level of nicotine in the blood was very low and didn’t do much to reduce urges in smokers.

That means that ENDS would not be a good cessation device even just for its nicotine delivery properties.  But that’s not the only danger.  Think about this: you’re helping your friend quit, and everything is going perfectly, then she says “Oh, I don’t have to worry about quitting anymore ‘cause there’s these electric cigarettes that are safe”.  Her motivation just went out the window, and you may have to work double time to get her into the preparation or action stage of quitting.  Because ENDS are bad for notice delivery chances smokers will relapse because they’re not getting the needed nicotine in their blood system.  So not only does it have the potential to screw with someone’s self-efficacy to quit but also may be setting them up for failure because of the low nicotine levels it delivers.

But consider this: snus on the other hand does deliver an adequate amount of nicotine but in some cases is less than half as dangerous than smoking, that’s according to the presentation by Dr. Lois Biener.  Here’s the danger, as she presented: tobacco companies are not marketing snus as a harm reduction approach, rather as an addition to smoking.  A Marlboro snus add Dr. Biener showed us clearly showed Marlboro trying to brand snus as another way smokers can get a nicotine fix, perhaps in the face of new bans around the country?  Can’t smoke in the job?  Just pick up a pack of snus and feel good until the next time you smoke.  It could also be a way to undermine a smoker’s quit attempt.  Most smokers WILL quit cold turkey, even though it may not be the least painful way.  Is this a way for Marlboro to get in the middle of someone who wants to quit smoking by creating a middle step between an ex-smoker and a current one?  With Marlboro deciding your quit plan I would venture to say you’re probably not going to quit for good.

But seriously, what if snus was remarketed and was aimed a people who wanted to quit smoking as a nicotine delivery aid?  While snus is definitely NOT safe, the difference in deadly risks between smoking and snus is large.  Will the tobacco field ever go into the realm of other public health disciplines that utilize harm reduction techniques?  What do you think?

SRNT Update 2: The Power of Communications

During the first Paper Sessions at the SRNT conference, there were a few things that stuck with me.  Here’s a quick rundown

Culture and Communications…

Back in Hawaii there is a small movement to stop segregating data by ethnicity.  You see, in Hawaii it’s hard to find someone who’s just one thing, usually most people are mixed with something.  So where do you classify them?  In the Japanese, in the Native Hawaiian, or the White column?  Usually they classify themselves, but the problem is still if we’re presenting data for a specific ethnicity what we really are presenting is people have at least that one ethnicity.  In any case, Dr. Monica Webb from the University of Miami had a good presentation on the power of culturally specific versus standard health education messages and materials.  In her randomized study, they placed African-Americans into two categories: one who received messages and materials specifically tailored to African-American and another who received standard materials.  The results showed that those in the culturally tailored intervention showed a higher readiness to quit, had more knowledge about tobacco overall, and had higher perceptions that African-Americans are at greater risk for tobacco use.  This is important, because it shows that culturally relevant materials do work.  However, in the issue of Hawaii, or for millions of highly acculturated immigrants, which culture do you target them through?

Speaking of culture and tobacco, the Dept. of Health in New Zealand presented on the difference between using text-based warning messages on packs versus using graphic messages.  What they found was that Maori people were most impacted by the graphic messages.

The Color Scheme

Dr. Maansi Bansal-Travers from the Roswell Park Cancer Institute presented a fascinating look into how important color is to cigarette packs.  In her study, they recruited smokers via Craigslist *giggle* to assign a description to a box of well-known and not very well know cigarettes.  The description that came with the box, such as “lights” or “ultra mild” were removed.  For the most part, the smokers were able to identify which ones were “light” and such based solely on the color of the packs.  Even more interesting is that the smokers then said that if they were worried about their health or wanted low-tar cigarettes they would probably pick those they identified as “light”.  SOOOO this means that just removing the label of “light” won’t do anything because the colors already convey the message the tobacco makers want to get across.  I wonder what color the cigarette boxes would have to be to incite the feeling of “puke”…add that to the “things that make you go hmmmm…”