Treating Tobacco Treating Tobacco Treating Tobacco Treating Tobacco Dependence and Providing Dependence and Providing Dependence and Providing Dependence and Providing Smoking Cessation Services: Smoking Cessation Services: What Have We Learned? What Have We Learned? Mark D. Ackerman, Ph.D Mark D Ackerman Ph D Mark D. Ackerman, Ph.D Mark D Ackerman Ph D Director, Tobacco Director, Tobacco Dependence Treatment Dependence Treatment Program Program g VA Medical Center/Emory University School VA Medical Center/Emory University School of Medicine, Atlanta, Georgia of Medicine, Atlanta, Georgia
OBJECTIVES OBJECTIVES OBJECTIVES OBJECTIVES Prevalence of tobacco use within VA Prevalence of tobacco use within VA Prevalence of tobacco use within VA Prevalence of tobacco use within VA Health Consequences of tobacco use Health Consequences of tobacco use P P Psychologist’s role as a leader within Psychologist’s role as a leader within h l h l i t’ i t’ l l l l d d ithi ithi behavior change and tobacco cessation behavior change and tobacco cessation Evidence Evidence- -based treatment approaches to based treatment approaches to tobacco cessation tobacco cessation Special Populations Special Populations
PREVALENCE PREVALENCE PREVALENCE PREVALENCE 19 8% 19 8% of Americans are current 19.8% 19.8% of Americans are current of Americans are current smokers of Americans are current smokers smokers smokers 46 million adults are smokers 46 million adults are smokers Smoking Smoking- -attributable costs to society: attributable costs to society: $96 billion per year medical expenses $96 billion per year medical expenses p p y y p p $97 billion lost productivity (CDC, 2007) $97 billion lost productivity (CDC, 2007) US US leading cause of premature death US US leading cause of premature death leading cause of premature death leading cause of premature death at 443,000 at 443,000 deaths each deaths each year year (CDC, 2010) (CDC, 2010) L Leading cause death/disease within VA L Leading cause death/disease within VA di di d d th/di th/di ithi ithi VA VA
2008 Current Smokers in VA Income <36K = 63% Income <36K = 63% Age 45-64y = 64%
2008 Survey of Veteran 2008 Survey of Veteran Enrollees (7.3 Million) Enrollees (7.3 Million) 70% of veterans (5 1 million) reported 70% of veterans (5 1 million) reported 70% of veterans (5.1 million) reported 70% of veterans (5.1 million) reported being an “ever” (current or former) smoker being an “ever” (current or former) smoker 72% (3.7 million) reported: former smoker 72% (3 7 million) reported: former smoker 72% (3.7 million) reported: former smoker 72% (3 7 million) reported: former smoker 30% (2.1 million) reported: never smoker 30% (2.1 million) reported: never smoker 18% (1.3 million)reported: “recent quitter” 18% (1.3 million)reported: “recent quitter” Current smokers make up 19.7% of the Current smokers make up 19.7% of the p entire VA enrollee population entire VA enrollee population
Prevalence of Smoking within Prevalence of Smoking within Chronic Veteran Population Chronic Veteran Population Veterans receiving chronic care likely Veterans receiving chronic care likely differ from veterans who responded to the differ from veterans who responded to the 2008 Survey 2008 Survey Reason: Higher rates of psychiatric Reason: Higher rates of psychiatric g g p y p y disorders, substance abuse and medical disorders, substance abuse and medical co co- -morbidities; morbidities; Same factors associated with increased Same factors associated with increased smoking within non smoking within non-VA population; smoking within non smoking within non VA population; VA population; VA population;
Current Enrollee Smokers by Current Enrollee Smokers by VISN VISN Highest % current smokers: Highest % current smokers: Highest % current smokers: Highest % current smokers: VISN 10: 24.8% VISN 10: 24.8% VISN 9: 24 3% VISN 9: 24 3% VISN 9: 24.3% VISN 9: 24.3% Lowest % current smokers: Lowest % current smokers: VISN 3: 12.8% VISN 3: 12.8% VISN 4 and 1: 16.6% and 16.7% VISN 4 and 1: 16.6% and 16.7% S S a d a d 6 6% a d 6 6% a d 6 6 % % Largest reduction in current smokers: Largest reduction in current smokers: VISN 7: 19 7% VISN 7: 19 7% VISN 7: 19.7% VISN 7: 19.7%
Atlanta VA Medical Center Atlanta VA Medical Center Decatur GA Decatur GA Decatur, GA Decatur, GA SITES OF CARE AND SERVICES OFFERED SITES OF CARE AND SERVICES OFFERED The The Atlanta VAMC has 405 authorized inpatient beds (273 hospital, 120 Atlanta VAMC has 405 authorized inpatient beds (273 hospital, 120 Community Living Center and 12 PRRTP) and is a tertiary care facility Community Living Center and 12 PRRTP) and is a tertiary care facility classified as a Complexity Level 1A facility. It is a teaching hospital, providing a classified as a Complexity Level 1A facility. It is a teaching hospital, providing a full range of patient care services complete with state full range of patient care services complete with state- -of of- -the the- -art technology, art technology, education and research. Comprehensive health care is provided through education and research. Comprehensive health care is provided through education and research Comprehensive health care is provided through education and research Comprehensive health care is provided through emergency medicine, primary care, tertiary care, and long emergency medicine, primary care, tertiary care, and long- -term care in the term care in the areas of medicine, surgery, mental health, physical medicine and rehabilitation, areas of medicine, surgery, mental health, physical medicine and rehabilitation, neurology, oncology, dentistry, geriatrics, and extended care. The Atlanta neurology, oncology, dentistry, geriatrics, and extended care. The Atlanta VAMC is part of the VA Southeast Network (VISN 7), which includes facilities VAMC is part of the VA Southeast Network (VISN 7), which includes facilities in Georgia, Alabama, and South Carolina. The Atlanta VAMC Community in Georgia, Alabama, and South Carolina. The Atlanta VAMC Community Li i Li i Living Center serves metro Atlanta and includes extended care rehabilitation, Living Center serves metro Atlanta and includes extended care rehabilitation, C C t t t t Atl Atl t t d i d i l d l d t t d d d d h bilit ti h bilit ti psycho psycho- -geriatric care, and general long term care. The facility also serves as a geriatric care, and general long term care. The facility also serves as a prosthetics treatment center, fabricating and supplying mechanical devices prosthetics treatment center, fabricating and supplying mechanical devices such as artificial limbs for patients within the states of Georgia, South Carolina such as artificial limbs for patients within the states of Georgia, South Carolina and Alabama. and Alabama.
Atlanta VA Tobacco Dependence Atlanta VA Tobacco Dependence T T Treatment Program Treatment Program t t t P t P Designated as a Program of Excellence in Designated as a “Program of Excellence” in Designated as a “Program of Excellence” in Designated as a Program of Excellence in 2007; 2007; Follow Follow- -up telephone survey of 432 veteran up telephone survey of 432 veteran p p p p y y participants treated over a 15 month period participants treated over a 15 month period (2001 (2001- -2004) revealed: 2004) revealed: Quit: 28.9% Smoking Less: 40.6% Quit: 28.9% Smoking Less: 40.6% Smoking Same: 28.9% or More: 1.6% Smoking Same: 28.9% or More: 1.6% Better group attendance = higher cessation Better group attendance = higher cessation (p=.002) (p=.002) Georgia Psychological Association, May 2004
Atlanta VA Tobacco Dependence Atlanta VA Tobacco Dependence Treatment Program Treatment Program 2009 2009 Total # veterans treated in group: 1586 Total # veterans treated in group: 1586 g Total Unique: 437 Total Unique: 437 First time group visits : 469 First time group visits : 469 First time group visits : 469 First time group visits : 469 Follow Follow- -up group attendee visits: 1117 up group attendee visits: 1117 No Show Rate: 51% No Show Rate: 51%
Psychologists as Leaders Psychologists as Leaders Psychologists as Leaders Psychologists as Leaders Behavior plays a primary role in health and Behavior plays a primary role in health and Behavior plays a primary role in health and Behavior plays a primary role in health and disease; disease; Smoking and tobacco use is a behavior Smoking and tobacco use is a behavior Smoking and tobacco use is a behavior, Smoking and tobacco use is a behavior, and is the leading cause of preventable and is the leading cause of preventable death and disease both within and outside death and disease both within and outside death and disease both within and outside death and disease both within and outside VA; VA; By virtue of psychologists behavior B By virtue of psychologists behavior B i t i t f f h l h l i t i t b h b h i i change expertise, we should and do take change expertise, we should and do take lead positions in tobacco cessation lead positions in tobacco cessation l l d d iti iti i i t b t b ti ti programs; programs;
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