1. New Pathways, New Connections: Tobacco and Behavioral Health Frances M. Harding, Director SAMHSA’s Center for Substance Abuse Prevention National Conference on Tobacco and Behavioral Health Bethesda, Maryland May 19, 2014

2. Creating communities where individuals, families, schools, faith-based organizations, and workplaces take action to: Promote emotional health Reduce the likelihood of mental illness, substance abuse including tobacco, and suicide SAMHSA Strategic Initiative #1: Prevention of Substance Abuse and Mental Illness SAMHSA’s objectives include: Reduce tobacco use among youth and persons with mental and substance use disorders.

3. Addressing Tobacco and Behavioral Health 480,000 tobacco-related U.S. deaths each year People with mental and substance use disorders: – Almost half of all U.S. tobacco deaths – 40 percent of all cigarettes smoked by adults People with mental illness: – Tobacco dependence most prevalent drug abuse disorder Smoking tobacco causes more deaths among clients in substance abuse treatment than the alcohol or drug use that brings them to treatment.

4. Collaborating to Address the Behavioral Health Disparity in Tobacco Use SAMHSA is working with agencies across the U.S. Department of Health and Human Services through the Working Group on Tobacco Control in Behavioral Health. The Primary Goal: To promote the implementation of tobacco- free policies and integration of tobacco cessation into treatment in behavioral health settings.

5. Smoking in Youth: Behavioral Impact People who start smoking before the age of 21 have the hardest time quitting. About 30 percent of youth smokers will continue smoking and die early from a smoking-related disease. Teen smokers are more likely to use alcohol and illegal drugs. They are more likely to have panic attacks, anxiety, disorders, and depression.

6. National Weighted Average Retailer Violation Rate National Weighted Average Retailer Violation Rate Since 1997

7. Teen cigarette smoking down by half since 2002 Synar program: – Direct effects on youth smoking – Two-thirds of states: sales rates < 10 percent – Multiple strategies work best – Link Synar effort with the larger tobacco control arena Family Smoking Prevention and Tobacco Control Act HHS tobacco control strategic plan CDC’s National Tobacco Control Program Meeting the Challenge of Youth Tobacco Use

8. The Changing Face of Tobacco Control Family Smoking Prevention and Tobacco Control Act – FDA authority to regulate tobacco (The Center for Tobacco Products) SAMHSA and FDA meet monthly for coordination meetings HHS-wide tobacco control strategic plan SAMHSA: integrating tobacco prevention and cessation in state Substance Abuse Prevention and Treatment Block Grant application

9. Emerging Issues Softening of public attitudes Changes in state and local laws

10. The Challenge of Integration Single state agencies and Synar State departments of health and broader tobacco control efforts

11. Collaborative Opportunities Public Health Clinical Medicine Substance Abuse Mental Health Prevention Treatment

12. Tobacco Control Resources www.TheRealCost.gov FDA Public Education Campaign

13. Collaboration: Foundation for Success Center for Substance Abuse Prevention Center for Mental Health Services Center for Substance Abuse Treatment Center for Behavioral Health Statistics and Quality www.samhsa.gov