Article archive / September 1, 2015
Originally published: . Volume 6, No. 9. Source pages: 1, 7, 8, 9.
In the spring the Legislature raised the tax on a pack of cigarettes by 50¢ and passed HB 158 to increase the awareness of the Smoking Cessation Trust. But after 50 years and major improvements, Louisiana still needs more quitters.
Dr. Sarah Moody-Thomas and Dr. Amy Copeland are in the vanguard of changes in the state. The Times talked to them about their work and efforts to reduce the leading preventable cause of death.
Last year marked the 50th anniversary of the 1964 Surgeon General’s report on smoking. The report, Smoking and Health: Report of the Advisory Committee to the Surgeon General, shocked a nation where a full 44 percent of people smoked and 56 percent did not believe in adverse health consequences for smokers.
For the next 50 years psychologists and behavioral scientists lent their effort to the public health challenge. The changes have been considerable. Today, only 17.8 percent of adults smoke.
But it is still not enough. Smoking accounts for one in five deaths. And in Louisiana 23.5 percent of adults and 12.1 percent of high school students smoke, according to the Campaign for Tobacco- Free Kids.
Dr. Sarah Moody- Thomas, the Charles L. Brown, Jr., MD Professor of Health Promotion at LSU Health Sciences Center-New Orleans, School of Public Health, is working diligently to push that number lower.
“Tobacco use remains the leading preventable cause of death and disease in the nation and the world,” Moody- Thomas said. “A question…What are psychologists willing to do to change this?” she said.
Dr. Moody-Thomas is the Director of the Behavioral and Community Health Services and the LSU Tobacco Control Initiative, called the TCI.
“These are exciting times in the field of tobacco control,” she said. “We have known for the past 100 years that tobacco use is harmful. Last year, with the publication of the 2014 Report of the Surgeon General, our nation celebrated 50 years of progress toward reducing tobacco use and the disease burden and mortality caused by smoking.”
“The discipline of Psychology should take pride in this anniversary,” she said, “the research and practice of our colleagues contributed to understanding the complex behaviors associated with tobacco use, addiction and cessation.”
Moody-Thomas points to several important figures. Numbers from 2011 to 2013 show that the rates declined from 25.7 to 23.5 percent for adults in Louisiana, she explained.
“Although low-income and minority populations continue to have the highest rates of smoking,” she said, “we’ve made small gains in reducing the prevalence of tobacco use among adults in the state.”
She noted that more males smoke (25.2 percent) compared to females (19.1 percent). High school graduates smoke more (35.9) than college graduates (13.2). And those earning less than $15,000 a year smoke more (31.9 percent) than those earning $50,000 a year (18.7)
More Caucasians smoke (22.6) than African Americans (20.8) or Hispanics (17.0). Also, Moody-Thomas noted that 33.8 percent of persons without health insurance report that they are smokers.
The political and culture climate in the state is seeing some changes. In June this year the legislature raised tax on cigarettes by 50 cents, from 36-cents to 86-cents a pack. Lawmakers also passed House Bill 158 to increase awareness of and access to smoking cessation programs and services available in Louisiana. The bill directed the Department of Health and Hospitals (DHH) to coordinate public health, Medicaid, and other programs with the Smoking Cessation Trust.
The Smoking Cessation Trust was established in 2011 after the judgment in a class action lawsuit, Scott v. American Tobacco Company, directed tobacco companies to fund a statewide 10-year smoking cessation program to benefit more than 200,000 Louisiana smokers.
Dr. Moody-Thomas is looking toward building on these changes. “The next steps are to use technology to increase awareness of free cessation resources available to tobacco users and expand utilization of the services,” she said.
“Our state has yet another landmark decision in the field of tobacco control––The Smoking Cessation Trust [SCT].” She said, “This free program offers evidence-based cessation services to smokers who are certified as members of the class.”
“The TCI has been working with partner facilities to implement the use of Interactive Voice Response (IVR) technology to increase awareness of SCT benefits and provide electronic referral to determine eligibility and certification.”
Dr. Moody-Thomas said she welcomes any opportunity to share information with anyone interested in learning more.
“Psychologists are among the health care professionals who may be eligible to bill the SCT for treating members of the class,” she said.
Louisiana residents who started smoking before September 1, 1988, may qualify to receive services. Approved members of this class can receive at no cost cessation services, including cessation medications, individual & group cessation counseling, telephone quit-line support, and/or Intensive cessation support services.
“Those interested in finding out if they are eligible for reimbursement for treating tobacco users should visit the SCT website,” Moody-Thomas said.
Moody-Thomas pointed out that some of the recent policy changes in the state may have a positive impact.
“The Smoke-free Air Ordinance in New Orleans and the statewide increase in the excise tax on a pack of cigarettes are among the policy changes,” she said.
“Recent legislation increased the tax on a pack of cigarettes from 36 to 86 cents,” she said. This increased tax on cigarettes may be important, “because research indicates every 10 percent increase in tax on a pack of cigarettes results in a 4 percent decrease in tobacco use among adults and a 6 to 7 percent decrease among youths.”
“And, price increases are even more effective in reducing smoking among males, Blacks, Hispanics, and lower- income smokers,” she explained.
The “…Clean Air ordinance gives voice to a unique group of underserved, and over-exposed, persons––musicians, and bar and casino workers,” she said. “The hope is that other cities and municipalities will adopt similar ordinances to protect the health of all residents.”
Fully implemented in seven of LSU’s public hospital facilities before the transition to public-private system, Dr. Moody-Thomas’ TCI program was a recognized success. Its patient “quit rates” doubled between 2007 and 2009. In 2010, the National Association of Public Hospitals recognized the TCI as an outstanding program for the use of health information technology in the identification and treatment of tobacco use.
“The TCI continues to provide evidence- based cessation services to patients, facility employees and community members throughout the state,” Moody- Thomas said. “These include provider training, individual and group behavioral counseling and cessation medications. We are emerging from the transition that occurred when oversight of the public hospital system transferred to private entities.”
“I chose to view this change as an opportunity,” she explained. “It has been an opportunity to share the skills, expertise and lessons learned during the successful ten-year development and evaluation of the TCI program.”
Dr. Moody-Thomas has extensive experience and background in the community. She has served as a member of the psychology faculties of Louisiana State University and University of New Orleans (UNO), and became chair of the psychology department at UNO. While at UNO she maintained a small clinical practice. Her expertise has been recognized by her appointment to two committees of the National Academy of Sciences Institute of Medicine: Preventing Nicotine Addiction in Children and Youths, and Cancer Research Among Minorities and the Medically Underserved.
Another group at the vanguard of work and research in smoking cessation is the team at the Louisiana State University (LSU) Smoking and Substance Abuse Clinical Research Laboratory, where Dr. Amy Copeland, Medical Psychologist, Associate Professor at LSU, and Adjunct Associate Professor at Pennington, leads a team of researchers and clinicians to help people stop smoking.
In combination with her research efforts to discover the cues for relapse, she and her team use empirically supported counseling techniques, and a combination of behavioral and pharmacological therapies, to produce best possible outcomes.
The Times asked Dr. Copeland and advanced doctoral student MacKenzie Peltier, M.A., about their work at their Smoking and Substance Abuse Clinical Research Laboratory.
“We continue to identify and investigate cognitive and affective variables that influence smoking and substance use initiation, maintenance, and cessation efforts,” Copeland said.
“Examples of these are smoking outcome expectancies, such the person’s beliefs about the reinforcing and punishing effects associated with smoking.” She pointed to examples such as “Smoking helps control my appetite” or “A cigarette helps me calm down when I’m nervous.”
“We’ve found in the past that cognitions such as these—especially those relating to management of negative moods are very potent motivators to smoke,” Copeland said, “and some such beliefs even persist in exsmokers despite their nonsmoking status. Unfortunately, these beliefs can be a risk for relapse.”
“One of our most exciting new studies involves the use of electronic cigarettes [e-cigs] and the attitudes toward their use, especially among college students on campus,” explained Copeland.
“Many users attempt to quit smoking regular cigarettes by using e- cig/vaping devices and are unaware that these present many of the same health concerns as do regular cigarettes. In fact, we’re finding that individuals who smoke regular cigarettes are the most uninformed about adverse effects of e-cigs, as compared to nonsmokers and current e-cig users.”
Copeland and MacKenzie see the new trends and efforts in public health as very positive. “The fact that Louisiana State University (LSU) is now a smoke-free campus is a huge accomplishment that many on campus have been striving for many years,” Copeland said. “My lab and graduate students were involved in the student organization that advocated for a Tobacco Free campus.”
“There will also be opportunities for us––our campus clinic––to assist those who violate this policy, as they will receive sanctions from the LSU Office of Student Advocacy and Accountability.”
“Also, it is important that there is a growing movement towards tobacco free policies,” she said, “but many are utilizing vaping/e-cigarettes to ‘get around’ the bans.” She noted that future policies need to include vaping to continue moving towards truly tobacco-free environments.
In the past, Copeland and her team have looked at heavy smokers who are not necessarily interested in quitting smoking. In a previous interview she explained, “We are using motivational interviewing strategies by providing health-related feedback on breath carbon monoxide, pulmonary lung functioning and blood pressure. We call it a health screen for smokers.”
“Most smokers want to quit, on some level,” she said. “If they are not particularly motivated at the time, then the more tailored the information is to their specific needs, as far as health feedback, the more meaningful it is to the patient.” Dr. Copeland explained, “Identifying concerns for the smoker can be key to motivating smokers to quit.”
One of her current manuscripts addresses this area, “Personalized health feedback to heavy smokers as a brief motivation interviewing strategy.” Copeland’s hope is that this type of brief intervention can ultimately be delivered in a primary care setting by health professionals.
She explained that the literature indicates that when physicians or psychologists spend just five minutes talking to patients about quitting smoking, it can make a “huge difference.”
“When they are ready, encourage the combination of behavioral counseling, cognitive behavioral, and some sort of pharmacotherapy. These make withdrawal a lot easier for people. It still takes work, but these certainly take the edge off of withdrawal symptoms.”
Dr. Copeland stated that there are many resources online, making good information and advice available to smokers who cannot, or opt not to, participate in face-to-face programs.
However, she said, “I still think the group setting is best for people. You can see the camaraderie develop among group members as they go through withdrawal together.” She noted that then they can support each other and implement the tools they’ve learned, the cognitive and behavioral coping responses, to get through the urges.
“Once people understand the associative nature of urges and cravings, and that laying down new memories and forming new associations will work, it’s going to get a lot easier.”
Dr. Sarah Moody-Thomas, Professor of Health Promotion at the LSU Health Sciences Center, School of Public Health. She is the Director of the LSU Tobacco Control Initiative.
This article is part of a historical newspaper archive. Read the original issue for its original layout, photographs and graphics.