Program helps at-risk group beat nicotine addiction

More than 50 years after the U.S. Surgeon General first warned about the dangers of cigarettes, smoking rates have plummeted.

Yet despite irrefutable evidence that smoking causes cancer and other diseases, 15% of the population still smokes. Half of these smokers are people with mental health conditions such as schizophrenia or bipolar disorder.

“The smoking rate for this group is about two times higher than that of the general population,” says Janice Blalock, Ph.D., associate professor of Behavioral Science.

According to the Centers for Disease Control and Prevention, 1 in 5 U.S. adults has some form of mental health disorder, and 35 to 69 percent smoke cigarettes. In comparison, 15 percent of adults without such conditions are cigarette smokers.

Helping those diagnosed with such disorders quit smoking hasn’t been a priority, until now.

“Because some health care providers and facilities are more focused on treating their patients’ psychiatric diseases,” Blalock says, “they may not consider treating tobacco addiction.”

Some providers have feared that taking tobacco away might worsen patients’ conditions, and some facilities have even offered cigarettes as rewards for good behavior, Blalock says.

Blalock and Cho Lam, a senior faculty fellow in Psychology at Rice University, co-lead a program called Project TEACH (Tobacco Education and Cessation in the Health System), which trains community providers to deliver tobacco cessation services to mental health patients. Launched in 2015, Project TEACH is conducted in partnership with Rice University, the University of Houston and Austin Travis County Integral Care — Travis County’s provider of mental health services.

“I’ve been working in the mental health field 31 years and we operated under the misconception that because a person had a mental illness, they couldn’t stop smoking,” says Deborah Shedrick, program manager at Spindletop Center, a community behavioral health clinic based in Beaumont, Texas. “We found out they really did want to stop smoking, but nobody had ever asked them.”

The Spindletop Center is one of seven community behavioral health centers across the state participating in Project TEACH. They’re working with Texas’ Local Mental Health Authorities, organizations that are under contract with the Texas Department of State Health Services to deliver treatment in specific geographic areas of the state.

To connect MD Anderson’s experts with clinics statewide, Project TEACH uses a videoconferencing program called ECHO, or Extension for Community Healthcare Outcomes.

“The ECHO platform is readily available and used at the convenience of clinicians. This allows us to disseminate information effectively without having to visit and train in person,” says Jennifer Cofer, director of EndTobacco, an initiative of the cancer prevention and control platform of MD Anderson’s Moon Shots Program. The platform, along with the Lung Cancer Moon Shot, provides support for Project TEACH.

Using ECHO, counselors and physicians from MD Anderson’s Tobacco Treatment Program meet one hour each week with community providers. Sessions teach them how to help people with behavioral health needs stop smoking, and offer a forum for providers to discuss their most difficult and challenging cases.

Everyone involved learns something, including MD Anderson experts.

 “The experts listen to our feedback, and we share,” says Shedrick. “We’re all on the same team.”

Shedrick describes a complete cultural shift at Spindletop Center. She’s seen a number of clients successfully quit or reduce their tobacco use. Their lives, from health to finances, are transformed.

Project TEACH will soon expand to more clinics and provide more in-depth assistance.

“People with these conditions want to quit smoking and can quit, when given the proper assistance,” Blalock says. “The process may take longer and require more intensive interventions, but it can be done.”