Declines in Smoking Prompt Health Groups to Set Ambitious New Goal

New target is to reduce smoking among adults with mental illnesses/substance use to 20% by 2022

A group of two dozen health groups and leaders in behavioral health and tobacco control has set an ambitious new goal to reduce smoking among persons with behavioral health issues, following new data showing the group’s previous goal was reached more rapidly than anticipated.

In 2016, the National Partnership on Behavioral Health and Tobacco Use, led by the American Cancer Society and the Smoking Cessation Leadership Center, set a goal to reduce smoking among adults with mental illnesses and/or substance use disorders from the 34% measured as of 2015 to 30% by the year 2020, thereby preventing an estimated one million deaths.

The most recent National Survey on Drug Use and Health (NSDUH) shows that the smoking rate among those populations has now dropped to 30.5%. Upon the new data’s release last year, the Partnership reconvened its 24-member organizations at ACS Atlanta headquarters in November, 2018. Attendees included leaders from public health agencies, behavioral health provider organizations, federal health agencies, advocacy groups, and health insurance and private corporations. They set an ambitious new target to reduce smoking rates to 20% by the year 2022, and proposed strategies to achieve that goal.

Members of the National Partnership on Behavioral Health and Tobacco Use include:

  • American Academy of Family Physicians (AAFP)
  • American Cancer Society (ACS)
  • American Cancer Society Cancer Action Network (ACS CAN)
  • American Cancer Society National Lung Cancer Roundtable (NLCRT)
  • American Lung Association (ALA)
  • American Psychiatric Association (APA)
  • American Psychiatric Nurses Association (APNA)
  • American Psychological Association
  • Centers for Disease Control and Prevention Office on Smoking and Health (CDC)
  • National Alliance on Mental Illness (NAMI)
  • National Association of Social Workers (NASW)
  • National Association of State Mental Health Program Directors (NASMHPD)
  • National Council for Behavioral Health
  • North American Quitline Consortium (NAQC)
  • Optum
  • Pfizer
  • Robert Wood Johnson Foundation (RWJF)
  • Smoking Cessation Leadership Center (SCLC)
  • Substance Abuse and Mental Health Services Administration (SAMHSA)
  • Tobacco Control Legal Consortium (TCLC)
  • Truth Initiative
  • UnitedHealth Group
  • U.S. Department of Housing and Urban Development
  • U.S. Department of Veterans Affairs
  • University of Wisconsin—Center for Tobacco Research and Intervention

The Partnership’s new action plan consists of multiple strategies that fall into six categories: peer education, policy changes, provider education and implementation, systems change, communications, and innovation. Each of the 24 participating organizations pledged to undertake specific actions towards achieving the “20 by 22” target; multiple collaborative activities were also proposed. These collaborative efforts range from trainings, public communications and program implementations, to policy statements and educational offerings.

Clearly, many factors in addition to the work of the Partners contributed to this decline in smoking prevalence. Examples of the many strategic actions undertaken by Partners during the past two years include:

  • The National Association of State Mental Health Program Directors (NASMHPD) adopted a groundbreaking national policy statement strongly recommending that all behavioral health settings be tobacco-free and offer smoking cessation services. This policy applies to all state mental health programs and facilities in the United States.
  • The U.S. Department of Housing and Urban Development (HUD) implemented an historic rule in July 2018 creating a sweeping smoke-free policy for all public health authority (PHA) locations, eliminating the use of all combustible (burned) tobacco products in all public housing living units, indoor common areas in public housing, and in PHA administrative office buildings. Multiple national partners – including the American Cancer Society, the Smoking Cessation Leadership Center, the American Lung Association and the North American Quitline Consortium, among others – are now working to support this rule and PHA residents across the nation by collaborating with community health centers, promoting the use of toll-free quitlines and employing other resources to aid residents in quitting. They are also helping to guide and support PHAs and their residents in reinforcing effective community adherence to the new smoke-free standard.
  • Optum, the nation’s largest Quitline vendor, developed and implemented the Tobacco Cessation Behavioral Health Program, which utilized a new helpline to support thousands of smokers with reported behavioral health conditions in their quest to become tobacco-free. The program is now being offered in 4 states (FL, MN, OK, SC) and continues to evolve.
  • The National Partnership on Behavioral Health and Tobacco Use submitted a joint public comment to the Centers for Medicare and Medicaid Services (CMS), urging the agency to retain two important tobacco measures as quality indicators (TOB-1 and TOB-3). Due to strong public comment response, CMS retained the tobacco measure regarding tobacco use at discharge (TOB-3), allowing health professionals to be reimbursed for providing this service – a critical component of ensuring more robust delivery of tobacco treatment services.
  • The Smoking Cessation Leadership Center, in partnership with the National Council for Behavioral Health, and the Substance Abuse and Mental Health Services Administration, held Leadership Academy State Strategy Sessions in New Jersey, Pennsylvania, South Carolina, Kansas, and North Carolina, convening state health leaders to strengthen strategies to reduce smoking prevalence among the behavioral health population in their respective states. In September 2018, SCLC was named the National Center of Excellence for Tobacco-Free Recovery by SAMHSA in order to continue these and similar efforts.

“The new data on smoking in the behavioral health population are very encouraging,” said Cliff Douglas, J.D., the American Cancer Society’s vice president for tobacco control. “But smoking rates remain more than twice as high for patients with a behavioral health condition compared to the general population, so while we can take a moment to celebrate, we must accelerate our efforts to reduce smoking among those most at risk, who are frequently marginalized from society.”

“There are about 65 million adults in the U.S. with one or more behavioral health conditions,” said Steven Schroeder, M.D., director of the Smoking Cessation Leadership Center at the University of California, San Francisco. “Based on the current estimate of a 30.5% smoking rate, that translates to about 19 million adult smokers with a behavioral health condition, or 56 percent of the approximately 34 million adult smokers in the U.S. Reducing smoking among persons with behavioral health conditions to the 20% target would mean 6 million fewer smokers. And since half of smokers die from a tobacco-related condition, this would mean potentially 3 million premature smoking-related deaths averted. Accomplishing such a goal would be a momentous public health achievement.”