Public Health Commons^™

Tobacco Treatment For Individuals With Substance Abuse And Psychiatric Disorders, Chizimuzo T.C. Okoli

Nursing Presentations

Overview of this presentation:

• Discuss smoking among persons with substance use and mental illness
• Present smoking cessation outcomes from an evidence-based program for persons with substance use disorders and mental Illness
• Conclusion with current and future Projects

Evidence-Based Smoking Cessation Treatment For Disparate Populations, Chizimuzo T.C. Okoli

Nursing Presentations

Overview of this presentation:

• Describe Research Group and Program of Research among disparate Populations
• Discuss smoking among persons with substance use and mental illness
• Present smoking cessation outcomes from evidence-based programs for persons with substance use disorders and mental Illness
• Conclusion with current and future Projects

The Vancouver General Hospital Smoking Cessation Clinic: Outcomes From A Specialist Cessation Service Within Cardiology, Milan Khara, Chizimuzo T.C. Okoli

Nursing Presentations

PURPOSE: The purpose of our study is to examine pilot treatment outcomes of an outpatient Smoking Cessation Clinic (SCC) provided within Cardiology Services.

RELEVANCE/CONTEXT: Populations with cardiac conditions often continue to smoke at high rates (up to 62%), even after experiencing life-threatening cardiac events. Smoking cessation can greatly reduce the risk of further occurrence of a cardiac event and associated mortality. However few Cardiology services in Canada offer smoking cessation services and few Cardiologists refer smoking patients to such services. The Vancouver General Hospital’s SCC is housed within Cardiology Services and offers a longitudinal approach to smoking cessation. This …

Smoking Cessation Outcomes Among Individuals With A History Of Psychotic Disorders As Compared To Those Without, Chizimuzo T.C. Okoli, Milan Khara

Nursing Presentations

Background: Psychotic disorders (e.g., Schizophrenia, schizoaffetive disorder) are associated with a higher smoking prevalence (relative to other psychiatric disorders) and smoking attributable mortality. Until recently, little has been done to address the disproportionate smoking in this population. The objectives of our study are to: 1) describe the characteristics of smokers with a history of psychiatric disorders (i.e., none, psychotic, and depressive/anxiety) and 2) examine smoking cessation/reduction outcomes by history of psychiatric disorders.

Methods: Retrospective analyses were conducted from charts of 982 participants accessing a tailored, evidence-based, tobacco treatment program within mental health and addictions services in Vancouver, Canada. Demographics, tobacco …

Outcomes Of A Smoking Cessation Clinic In Cardiology Services, Vancouver, Canada, Chizimuzo T.C. Okoli, Milan Khara

Nursing Presentations

BACKGROUND: Adults who have experienced cardiac events have a high burden of smoking and are likely to continue post cardiac event. Research in this population suggests that smoking cessation services offered to this population can reduce the re-occurrence of cardiac events by assisting patients in cessation. However, few cardiology clinics offer smoking cessation services and few cardiologists refer patients to such services. The Smoking Cessation Clinic (SCC) provides evidence-based smoking cessation treatment within Cardiology services in Vancouver General Hospital in Vancouver, Canada. The aim of this study was to evaluate the SCC program in terms of its program engagement …

Smoking On The Margins: An Equity Analysis Of Vancouver's Outdoor Smoke-Free Policy In Parks And On Beaches, Chizimuzo T.C. Okoli, Ann Pederson

Nursing Presentations

Background: Increasingly, jurisdictions worldwide are addressing smoking restrictions in outdoor public spaces to reduce secondhand smoke exposure, discourage youth initiation, enhance cessation, and reduce environmental hazards (i.e., fire and cigarette-related litter). However, there is little research on the policy context and health-equity impact of such policies to help guide wider implementation efforts.

Objectives: On September 1, 2010, the Board of Parks and Recreation in Vancouver, Canada, introduced a smoke-free bylaw for the city’s parks and beaches. The Smoking on the Margins project is examining the policy context and potential health-equity impact of this bylaw.

Methods: Applying critical multiplism and equity-focused …

Tobacco Treatment Outcomes From A Specialist Smoking Cessation Clinic Based Within Cardiology Services, Milan Khara, Chizimuzo T.C. Okoli

Nursing Presentations

BACKGROUND: Populations with cardiac conditions often continue to smoke at high rates (up to 62%), even after experiencing life-threatening cardiac events. The purpose of our study is to examine pilot treatment outcomes of an outpatient Smoking Cessation Clinic (SCC) provided within Cardiology Services.

METHODS: This study is based on a retrospective review of the charts of 118 participants of the SCC (between Sept 2010 and May 2012). The primary components of intervention include tailored pharmacotherapy and behavioural counselling. The main outcome of interest is self-reported 7-day point-prevalence of smoking abstinence verified by expired CO level (when available).

RESULTS: 34.7% …

Transforming Our Parks And Beaches, Chizimuzo T.C. Okoli

Nursing Presentations

This presentation covers a study that examines the health and health equity impact of the newly implemented smoke-free policy for Vancouver’s parks and beaches.

Understanding And Treating Smoking Among Individuals With A Mental Illness, Chizimuzo T.C. Okoli

Nursing Presentations

• Background and significance

• Reasons for smoking among individuals living with a mental illness

• Smoking cessation treatment for individuals living with a mental illness

Smoking On The Margins: An Equity Analysis Of The Outcomes Of An Outdoor Smoke-Free Policy, Chizimuzo T.C. Okoli, Ann Pederson

Nursing Presentations

• Purpose: To analyze the health and health equity impact of the newly implemented smoke-free policy for Vancouver’s parks and beaches

• CIHR Operating Grant: Population Health Intervention Research – designed to study an intervention in action not controlled by the investigators

• End date of funding, March 31, 2013 (with potential 12-month extension)

Treatment Outcomes Of A Tailored Smoking Cessation Programme For Individuals Accessing Addiction Treatment Services, Milan Khara, Chizimuzo T.C. Okoli

Nursing Presentations

Background: Individuals with substance use disorders (SUD) have disproportionately higher smoking prevalence and tobacco-related mortality than the general population. This high prevalence of smoking warrants a need for targeted tobacco treatment efforts.

Objectives: To examine smoking cessation outcomes and predictors of successful smoking cessation among individuals with SUD accessing a tobacco dependence clinic (TDC) within Addiction Services.

Methods: Based on clinical guidelines, participants of the TDC received behavioural therapy combined with tailored pharmacotherapy for tobacco treatment (at no cost). A retrospective chart review from 678 participants enrolled in the TDC between Sept 2007 and Dec 2011 was analyzed. 7-day point-prevalence …

Sex And Gender In Tobacco Reduction - The State Of The Evidence, Iris Torchalla, Chizimuzo T.C. Okoli

Nursing Presentations

• Global prevalence, risk, and mortality from smoking

• Gender/Sex specific diseases associated with tobacco use

• Gender/Sex specific reasons for smoking

• Gender/Sex specific factors in treating tobacco use

Special Ops: Vulnerable Populations And Tobacco Treatment, Chizimuzo T.C. Okoli, Audrey Darville

Nursing Presentations

• Reasons for Smoking among individuals with co-morbid substance use (SUD)and/or psychiatric disorders (PD)

• Smoking cessation treatment for individuals with co-morbid substance use (SUD) and/or psychiatric disorders (PD)

• Smoking among the Homeless population

The Tobacco Dependence Clinic: Gender Issues And Possibilities In Cessation Treatment, Chizimuzo T.C. Okoli, Milan Khara

Nursing Presentations

• The Tobacco Dependence Clinic (TDC) is a program that provides behavioural counselling and up to 6-7months of no-cost pharmacotherapy for clients through VCH Mental Health and Addiction Services

• Program is run with a team of nurses, counsellors, respiratory therapists, and a physician.

• Currently in 7 Addictions services located in community health centres in Vancouver.

Equity, Evidence & Ethics: Assessing The Implications Of Outdoor Smoke-Free Policies For Vulnerable Populations, Natasha Jategaonkar, Ann Pederson, Chizimuzo T.C. Okoli, Wendy Rice, Phoebe M. Long, Joan L. Bottorff, Natalie Hemsing, Lorraine Greaves

Nursing Presentations

Smoke-free policies in outdoor settings are becoming increasingly common. Economic and social conditions tend to influence tobacco use patterns as well as exposure to secondhand smoke. Thus, active and passive smoking are both health equity and social justice concerns.

Smoking on the Margins is a multi-component,mixed-methods project that applies an ethical framework to outdoor smoke-free policies in order to identify both concerns and opportunities to promote health and health equity.

Justification for smoke-free policies

Smoke-free spaces are primarily justified on the basis of three goals:

1) Reducing exposure to secondhand smoke;

2) Encouraging people to quit smoking; and

3) Preventing …

Smoking On The Margins? Assessing The Effects Of A Smoke-Free Law In Parks And On Beaches, Ann Pederson, Chizimuzo T.C. Okoli, Wendy Rice, Steve Chasey, Arezu Moshrefzadeh, Joan L. Bottorff, Natalie Hemsing, Lorraine Greaves, Nancy Poole

Nursing Presentations

This study uses a health equity lens to examine the development, adoption and implementation of an outdoor smoke-free bylaw in Vancouver, BC, Canada. The study aims to:

• Understand the health and health equity effects of a new outdoor smoke-free policy in parks and on beaches;

• Assess the differential impacts of the policy for diverse groups of women and men, in particular those with a high prevalence and susceptibility to smoking and those who are exposed to secondhand smoke (SHS);

• Develop recommendations to enhance the effectiveness of future smoke-free policies to reduce any unintended contributions to health inequities arising from their …

Effects Of A Smoke-Free Law In Parks And Beaches On Smoking Behaviour: Methods To Determine Effectiveness, Chizimuzo T.C. Okoli, Ann Pederson, Steve Chasey, Anna Liwander, Andrew Johnson

Nursing Presentations

OVERVIEW

As part of a comprehensive approach to tobacco control, smoke free laws have resulted in reductions of indoor air pollution, improvements in respiratory and cardiovascular health, reduction of smoking uptake by youth, and increasing tobacco use cessations in various jurisdictions.

Although many studies have demonstrated the beneficial effects of smoke-free policies in indoor spaces (e.g. restaurants, bars, workplaces, hospital settings, etc.), little is known about the effectiveness of such policies in outdoor public spaces.

On September 1^st, 2010, Vancouver’s smoke-free by-law for the city’s parks, beaches, and facilities came into effect.

The aims of this study are …

Outcomes Of A Tailored Smoking Cessation Program For Individuals With A Substance Use And/Or Psychiatric Disorder, Chizimuzo T.C. Okoli, Milan Khara

Nursing Presentations

BACKGROUND: Tobacco use remains a significant cause of morbidity and mortality globally. Although there has been a steady decline in the overall smoking prevalence in North America during the last decade some subsets of the population continue to smoke at high rates, particularly individuals with a history of substance use disorders (SUD) and/or psychiatric disorders (PD). Studies suggest that individuals with SUD’s and PD’s often have disproportionately higher smoking-related mortality. Studies further suggest that in clinical samples an estimated 75% of individuals with PD and up to 90% of individuals with PD concurrently smoke. This high prevalence of smoking among …

Smoking And Breast Cancer: Girls’ And Boys’ Reactions To Tailored, Internet Delivered Messages, Joan L. Bottorff, Chris G. Richardson, Rebecca Haines-Saah, John Oliff, Peter Hutchinson, Pamela A. Ratner, Chizimuzo T.C. Okoli, Carolyn Gotay, Kenneth Johnson

Nursing Presentations

Background

• Active smoking and exposure to secondhand smoke (SHS) are causally linked to premenopausal breast cancer (BC).

• To date, there have been few efforts to raise awareness of active smoking and SHS as risk factors for BC.

Purpose

• To develop and evaluate messages for Aboriginal and non-Aboriginal adolescent girls and boys to raise awareness about tobacco exposure as a risk factor for BC.

Outcomes Of An Intensive Smoking Cessation Program For Individuals With Substance Use Disorders, Milan Khara, Lindsay Killam, Chizimuzo T.C. Okoli

Nursing Presentations

BACKGROUND: Individuals with substance use disorders (SUD) are disproportionately affected by tobacco use morbidity and mortality. Yet, with adequate intervention, such individuals can be successful in their smoking cessation efforts. The Tobacco Dependence Clinic (TDC) provides tobacco dependence treatment using combined behavioural counseling and pharmacotherapy for clients through the Mental Health and Addiction Services of the Vancouver Coastal Health Authority, British Columbia, Canada.

OBJECTIVES: To a) provide smoking cessation outcomes of participants accessing the TDC b) examine predictors of program completion and smoking cessation of participants of the TDC.

METHODS: Participants of the TDC receive a structured 8 week group …

Tobacco Use Dependence And Approaches To Treatment, Audrey Darville, Chizimuzo T.C. Okoli

Nursing Presentations

Counseling Demonstrates a Dose-Response Effect/Comes in Many Forms

• Brief advice during a “window of opportunity” can increase quit attempts by 40%

• Medication combined with counseling doubles the success rate

• Quitlines: proactive fax to quitline most effective

• Online (becomeanex.org, smokefree.gov, mylastdip.com)

• Cooper Clayton Classes at many local health departments; schedules and provision of medication varies

• I-Phone apps/text to quit

Tailoring NRT to the tobacco user

• Studies show efficacy in smokers and smokeless tobacco users (Ebbert, et al, 2010)

• Combining patch with shorter acting form of NRT has been shown to be safe and effective (Stead, et al, Cochrane Review, 2008; Kozlowski, …

An Evidence-Based Approach To Address Tobacco Dependence Treatment In Mental Health And Addictions Settings, Chizimuzo T.C. Okoli

Nursing Presentations

Purpose: To examine the program completion and smoking cessation outcomes of a tobacco dependence treatment program for individuals with a history of substance use (SUD) and/or psychiatric disorders (PD). Despite the steady decline in the overall smoking prevalence in North America during the last decade some subsets of the population continue to smoke at high rates, particularly individuals with a SUD and/or PD. Among clinical samples, an estimated 75% of individuals with SUD and up to 90% of individuals with PD concurrently smoke. Such findings have prompted the need for tailored tobacco dependence treatment approaches in this population.

Methods: The …

Effects Of A Smoke-Free Law In Parks And Beaches On Smoking Behaviour: Methods To Determine Effectiveness, Chizimuzo T.C. Okoli, Andrew Johnson, Amanda Fallin, Ann Pederson, Anna Liwander

Nursing Presentations

As part of a comprehensive approach to tobacco control,smoke free laws have resulted in reductions of indoor air pollution, improvements in respiratory and cardiovascular health, reduction of smoking uptake by youth, and increasing tobacco use cessation in various jurisdictions. Although many studies have demonstrated the beneficial effects of smoke-free policies in indoor spaces (e.g., restaurants, bars, workplaces, hospital settings, etc.), little is known about the effectiveness of such policies in outdoor public spaces. On September 1st, 2010, Vancouver’s smoke-free by-law for the city’s parks, beaches, and facilities came into effect. The aims of this study are two-fold: a) to examine …

Smoking On The Margins? Assessing The Health Equity Effects Of A Smoke-Free Law In Parks And Beaches, Chizimuzo T.C. Okoli, Ann Pederson, Steve Chasey, Wendy Rice, Phoebe M. Long, Lorraine Greaves, Joan L. Bottorff, Nancy Poole, Natalie Hemsing

Nursing Presentations

Policies which aim to limit secondhand smoke (SHS) exposure by restricting spaces where people can smoke have been shown to improve population health and garner a high level of support from the public, health professionals and policy makers. Following local, national and international examples, Vancouver’s Board of Parks and Recreation approved a smoke-free by-law for the city’s parks, beaches, and facilities effective September 1, 2010. Research suggests that such smoke-free by-laws, when enacted indoors, may affect men and women in different ways, but little research has examined the effects of such outdoor smoking bans on women and men and other …

Outcomes Of A Tailored Tobacco Treatment Approach For Individuals With Substance Use Disorders And/Or Psychiatric Disorders, Chizimuzo T.C. Okoli, Milan Khara

Nursing Presentations

Summary of Key Findings

• Smoking abstinence at end of program:
• Intent to treat analysis: 31% (167/540)
• Among program completers: 41% (167/406)

• Significant predictors of abstinence:
• Having a history of an anxiety disorder is predictive of being less likely to quit smoking when compared to having no history of a psychiatric disorder.
• Having a lower CO level at program enrolment was a significant predictor of being more likely to quit.
• Attending the TDC program for a longer duration was a significant predictor of being more likely to quit.

Exposure To Secondhand Smoke And Nicotine Dependence, Chizimuzo T.C. Okoli, Ellen J. Hahn, Steven R. Browning, Mary Kay Rayens

Nursing Presentations

Background

• Nicotine dependence (ND) : “the smoking behavior accompanied by a reluctance to quit (Khurana, Batra, Patkar, & Leone, 2003).

• The US Public Health Service Clinical Practice Guideline ‘Treating Tobacco Use and Dependence’: A chronic condition that often requires repeated interventions (Office of the Surgeon General, 2000).

• Secondhand Smoke (SHS) is a potential source of exposure to high levels of nicotine. (Dimich-Ward, Gee, Brauer, Leung,1997)

• No current studies addressing the contribution of SHS to Nicotine Dependence (ND) or smoking behaviors

Assessing Workplace Tobacco Policies: A Community-Academic Partnership, Ellen J. Hahn, Mary Kay Rayens, Chizimuzo T.C. Okoli

Nursing Presentations

Purpose

• Describe the number and type of tobacco policies in manufacturing facilities

• Assess the resources for tobacco education and cessation

• Identify factors related to tobacco policies and practices within manufacturing facilities