1. Special Populations: Tobacco Use And Cultural Considerations Your name, institution, etc. here YOUR LOGO HERE (can paste to each slide)

2. …dedicated to eliminating children’s exposure to tobacco and secondhand smoke

3. Objective: To Understand Tobacco Use in “Special” Populations Teenagers Persons with psychiatric disorders Persons who are gay, lesbian, bisexual, transgender, or questioning their sexuality Members of minority groups

4. Teenagers

5. Teen Tobacco Use is a Big Problem Typically, tobacco use begins before age 18 years Every day, 3,450 people age 12 – 17 years initiate smoking 850 become regular, daily smokers

6. Teen Tobacco Users- 2010

7. Risk Factors for Experimentation and Use Friends who smoke Parents’ behaviors and attitudes Comorbid psychiatric disorders Anxiety, ADHD, substance abuse Concerns about weight gain

8. Teen Tobacco Users Are… More likely to be psychologically distressed, abuse other substances Less likely to be attached to parents, do well in school, participate in extracurricular activities, know the adverse effects of smoking

9. You Can Advocate for Some Protective Factors Individual, family, and environmental factors can guard against risky behaviors Close communication with parents Parental support High self-esteem Regular church attendance

10. Teen Tobacco Addiction Dependence is more severe if use begins in adolescence Those who begin as teens are more likely to become dependent, use for more years, and user more heavily Increased vulnerability may be due to still- developing brain

11. Tobacco Use Progresses Faster Than Anyone Expected Experimentation Regular Use Nicotine dependence, as indicated by craving, starts BEFORE daily or regular use! Interventions may be delivered at any stage

12. Why Does Tobacco Use Begin? Annual tobacco marketing - $10 billion/year Very effective with youth Promotions lower cost of cigarettes Free tobacco paraphernalia Smoking is depicted in magazines, movies

13. Smoking in Movies 50% show smoking- 2009 Number of depictions rises with rating In 2009, 54% of PG-13 movies contained tobacco imagery Younger children routinely exposed to movies meant for older children, adults

14. Viewing Smoking in Movies Increases Tobacco Use

15. Treating Teens Ask about tobacco as part of psychosocial history Privacy and confidentiality a must Use the same techniques used for adults, tailored to the values of the teen Pharmacotherapy can be used, but has not been shown effective with teens

16. Counseling Teens Most teen smokers are interested in quitting Even occasional users may be addicted Provide education on nicotine addiction and quitting strategies No evidence that quitting is easier for teens than adults – It takes the average adolescent daily smoker 18 YEARS to successfully complete cessation!!!

17. Counseling Their Parents Advise parents to Express disapproval of tobacco use Discourage friends who are smokers Keep the home smoke free – even if parents smoke Make tobacco products inaccessible Limit access to R-rated movies

18. Persons with Psychiatric Disorders

19. Are parents, too! 2-4x more likely to be tobacco dependent Increased risk of tobacco-related illness 60% of current smokers report a history of mental illness in their life Tobacco as a form of self-treatment

20. Will Cessation Affect Their Illness? Treatment is safe and is usually well tolerated Evidence supports an association between cessation and decreased relapse to alcohol and/or drug use Little evidence that nicotine withdrawal will escalate psychiatric symptoms

21. Special Considerations Be aware of increased tobacco use in persons with psychiatric illnesses Users with psychiatric disorders will require more than a brief intervention – Refer to intensive programs Address tobacco use in all settings – Including inpatient psychiatric facilities, detention centers, etc.

22. GLBTQ

23. GLBTQ (Gay, Lesbian, Bisexual Transgender, Questioning) Populations Smoking rates much higher: – 59% of self-classified GLBT youth – 30% gay men – 48% bisexuals 50% of self-classified youth initiated by age 13

24. LGBTQ Women Compared to their heterosexual counterparts: Female LGBT youth are 9.7x more likely to smoke Smoking prevalence for lesbian women is 1.5-2.4x higher Bisexual women 3.5x more likely to smoke

25. Why are LGBTQ Smoking Rates so High? Why are tobacco use rates so high? – Bars and dance clubs are typical social outlets – Targeted by tobacco industry – Social stressors

26. LGBTQ Cessation Only 75% have made a quit attempt Barriers to Cessation – Identity issues and stress – Increased feelings of being an outsider – Decrease in support from friends, family, community – Exposure to environments that support smoking – Lack of culturally appropriate material – Use of hetero-normative language by clinicians

27. Minority Groups

28. Racial Minority Groups Adult Smoking Prevalence Black, non-Hispanic 21.3% Asian, non-Hispanic 12% Hispanic 14.5% American Indian/ Alaska Native 23.2% Multi-Racial 29.5% (White, non-Hispanic 22.1%)

29. Tobacco Use by Black non-Hispanic Populations 21.3% of Black non-Hispanic adults smoke Males (24%) > females (19%) Black youth start smoking at older ages Making it out of high school without starting doesn’t mean they’ll never start Menthol cigarettes popular

30. Menthol Cigarettes 83% of Black smokers use mentholated brands; 24% of Caucasians Local anesthetic – relieves throat irritation May increase absorption of toxins Cooling, numbing properties may permit larger puffs, deeper, longer inhalations

31. Tobacco Use and Asian-Americans 12% of adult Asian-Americans smoke Males (16.9%) > females (7.5%) Asian-Americans initiate smoking later in life Among the most successful at quitting permanently

32. Tobacco Use and Hispanics 14.5% of Hispanic adults smoke Males (19%) > females (9.8%) Hispanic smokers are more likely to make a quit attempt than whites, though less likely to receive counseling, medications Hispanic households likely to have smoking bans

33. Tobacco Use and American Indians and Alaska Natives 23.2% of adult American Indians/Alaska Natives smoke Males (29.7%) > females (no data) Teen estimated at 46% Tobacco plays an important cultural role as a sacred gift of the earth

34. What Can We Do?

35. Barriers To Treatment in Special Populations Cost Language Culture – Culturally effective, appropriate education and cessation materials Geography

36. Potential Solutions Cost Language Culture – Culturally effective, appropriate education and cessation materials Geography

37. www.aap.org/richmondcenter Need more information? The AAP Richmond Center Audience-Specific Resources State-Specific Resources Cessation Information Funding Opportunities Reimbursement Information Tobacco Control E-mail List Pediatric Tobacco Control Guide

38. Questions?