1. California Smokers’ Helpline Center for Tobacco Cessation Kirsten Hansen, MPP Curriculum Development Manager

2. Today’s Objectives California Smokers’ Helpline Services –Callers with Behavioral Health Conditions Coverage for Cessation Treatment Center for Tobacco Cessation Services –Ad Campaign

3. California Smokers’ Helpline 1-800-NO-BUTTS Free statewide tobacco cessation program Funded by tobacco taxes –Propositions 99 & 10 Scientifically proven to be effective Adults, teens, pregnant women and proxy Mon. – Fri.: 7:00am – 9:00pm & Sat. 9:00am – 1:00pm Multiple languages –Spanish, Mandarin & Cantonese, Korean, and Vietnamese

4. Available Services Self-help materials Referral lists of local cessation programs http://nobutts.org/CountyListings.aspx Individual telephone counseling Confidential One pre-quit call, multiple proactive follow-up calls Trained counseling staff

5. Types of Calls Intake session –5-7 min. call to determine client needs Initial counseling session –Comprehensive, 25-30 min. call –Preparation to quit –Setting a quit date Proactive follow-up sessions –Up to five 10-15 min. calls –Relapse prevention –Pharmacotherapy review

6. Days after quitting Relapse-Sensitive Scheduling Source: Zhu & Pierce (1995), Prof. Psych. Res.& Practice, 26, 624-625 Percent abstinent 3014730 1 100 80 60 40 20 0

7. Helpline Intervention Summary –Identify a strong reason –Bolster belief in ability –Develop a solid plan –Adopt a new view of self –Keep trying (Motivation) (Confidence) (Skills) (Self-image) (Perseverance)

8. Relapse Curves for the 3 Groups Source: Zhu et al. (1996), JCCP, 64, 202-211

9. Helpline Callers with Behavioral Health Conditions

10. Self-Reported Behavioral Health Conditions Among Helpline Callers Do you have any current mental health issues such as: –An anxiety disorder? –Depression? –Bipolar disorder? –Schizophrenia? –Drug or alcohol problem? If yes, have you been actively using/drinking in the last month?

11. Self-Reported Behavioral Health Conditions Among Helpline Callers % Smoking (Zhu,et al, 2009. Unpublished data)

12. Received Counseling No Mental Illness Mental Illness 74.0% 84.0% (Zhu,et al, 2009. Unpublished data)

13. Use of Nicotine Replacement Therapy (NRT) No Mental Illness Mental Illness 33.3% 41.7% (Zhu,et al, 2009. Unpublished data)

14. Quit Attempts No Mental Illness 53.1* 56.4* Quit in 2 Months (%) Mental Illness * Descriptive data, not based on results of a randomized controlled trial (Zhu,et al, 2009. Unpublished data)

15. Quitting Success 20.8* 19.0* 30-Day Point Prevalence (%) at 2 Months No Mental Illness Mental Illness (Zhu,et al, 2009. Unpublished data) * Descriptive data, not based on results of a randomized controlled trial

16. Points from the Helpline Smokers with mental illnesses call in high numbers –Across all demographics They appear to be more motivated –More likely to get counseling & use NRT The motivation and use of treatment seem to compensate for the vulnerability associated with their mental health condition. As a result, they are equally likely to try to quit & succeed Randomized controlled trials are needed to determine efficacy of telephone counseling for smokers with mental illnesses

17. Helpline Referral Options For smokers who want to be contacted by the Helpline: –Fax referral –Two-way call –Coming soon – electronic referral For smokers who prefer to contact the Helpline: –Gold Card –Regale Salud Card –Brochures

18. Free Helpline Materials Order free materials at www.nobutts.orgwww.nobutts.org

19. Coverage for Cessation Treatment

20. Public Coverage Medi-Cal –Behavior-modification, e.g. 1-800-NO-BUTTS –Prescription Zyban (12 wks), Chantix (12 wks) and NicoDerm CQ patches (14wks) Two courses per year – no break required CMSP and Path2Health –Medications require a pre-authorization Zyban, Nicorette gum, Nicotine patch (OTC patches only) and Nicotrol Nasal Spray Medicare –Prescription drug benefits – Part D –Reimburses for cessation counseling – CPT Codes 99406 (3-10 minute intervention) 99407 (>10 minute intervention)

21. Center for Tobacco Cessation

22. Overview Provider in-person trainings and webinars Technical assistance – incorporating cessation into patient care, electronic health records, quality measures Online, CME/CEU-approved training Digital & print ad campaign for behavioral health providers Webinars –July 31, 2012 – Mental Health http://cessationcenter.adobeconnect.com/e1ubot96yvb/event/registr ation.html?campaign ‑ id=santarosa –August 7, 2012 – Substance Use Disorders http://cessationcenter.adobeconnect.com/e390i3uk52i/event/registr ation.html?campaign ‑ id=santarosa

23. Ad Campaign Summary Target Audiences –Drug and alcohol counselors –Psychiatric nurses –Licensed clinical social workers –Marriage and family therapists –Licensed clinical psychologists –Physicians Family practice Psychiatry Internal medicine Core Message –"People with mental illness/substance use disorders want to quit smoking, can quit successfully, and you can help them quit."

24. More than half of patients in drug and alcohol treatment will die from tobacco- related disease. Smokers want to quit more than you may think. And they can. Talk to them about it. For more help, refer them to 1-800-NO- BUTTS. And visit nobutts.org for free training, resources and patient materials.

25. People with serious mental illness die up to 25 years earlier, often from tobacco- related diseases. Their desire to quit is stronger than you may think. Talk to them about it. For more help, refer them to 1-800-NO-BUTTS. And visit www.nobutts.org for free training, resources, and patient materials.

27. Thank you! Kirsten Hansen, MPP –858-300-1012 –k3hansen@ucsd.eduk3hansen@ucsd.edu –www.centerforcessation.orgwww.centerforcessation.org