STOMP—Stop Tobacco On My People

Statewide Network of Communities in New Mexico

To promote awareness and action among New Mexicans disproportionately affected by tobacco in order to eliminate health disparities

Coletta Reid, Director

Debbie Vigil, Coordinator

PEOPLE WITH DISABILITIES &

TOBACCO CONTROL STRATEGIES

Prevalence of Smoking in New Mexico

No Disability—22% Disability that does not require assistance

—24.6% Disability that requires assistance—28.7% Disability that requires institutionalization

—even higher

Pressures to Smoke

Lack of recreational & exercise alternatives

Disenfranchisement & exclusion Social isolation Chronic pain Too much free time Feeling lonely & depressed

Pressures to Smoke

Wanting to “fit in” Issues of independence Advertising Stress and anger reduction technique Replace impulse to overeat Form of control

Increased Dangers: Secondary conditions

Difficult breathing Slow healing of skin wounds More likely to get pressure sores Increased chance of stomach ulcer

People with Disabilities

Higher rates of smoking More likely to be planning to quit More likely to have tried to quit Less likely to have successfully quit Smoke more cigarettes per day Smoke first cigarette sooner after waking Higher rates of exposure to secondhand

smoke in the home

Smoking associated with

More days of restricted activity—unable to go to work/school

More secondary conditions—breathing problems, pressure sores

Worsening health compared to prior year Poorer health status More physician visits Use of caffeine and other stimulants and

alcohol

Smokers with Disabilities, report more

Low self-esteem Depression Chronic pain Anxiety Fatigue Burns

STOMP

Mini-grants to rural Independent Living Center

Committee to plan Tobacco Forum Tobacco Forum in April, 2003 Tobacco survey at annual Disabilities

Conference Focus groups statewide Working with advocates to develop

strategic plan

Disability Culture: A Look at Different

Models

Mary Keener Beresford, Ph.D., DirectorNew Mexico Commission on Disability

Santa Fe, New Mexico

Charity Model

Pre WWII Charity of religions Institutionalization Focus of responsibility: Person with

Disability

Medical Model

Post WWII Disability as a medical condition Repair and send back out Focus of responsibility: Person with

Disability

Functional Limitation Model

Derived from Medical Model Rehabilitate after medical community

has done all they can Dealing with what person cannot do Focus of responsibility: Person with

Disability

Social Model

Post disability rights movement Independent living Integration into society Focus of Responsibility: Society

The Disability Movement

Sherry Watson, Executive DirectorSan Juan Center for Independence

Farmington, New Mexico

Independent Living

Inclusion Consumer control Consumer directed services Strength Self-empowerment

Independent Living Centers (ILC)

Gathering places for individuals with disabilities

People with disabilities 51% of board and staff

Serve all persons with a disability Committed to inclusion of diverse groups

ILC Core Services

Systems and individual advocacy Information and referral Peer support Independent living skills training

Tobacco Coalitions Partner with ILC’s Create clearinghouse for tobacco

information Meet with disability organizations Identify issues, concerns, &

recommendations Provide technical assistance and training Facilitate program planning and design Conduct public summits

“Martin Luther King had a dream.

We have a destiny, not a dream, a destiny to realize.

We shall have the right to choose how we live and where we live.”

--Mike Auberger, ADAPT

Access Issues for People with Disabilities

Larry Lorenzo, Disability ActivistAlliance for Disability Education

Albuquerque, New Mexico

Access Not Just Physical

Equitable outreach efforts Equal opportunity for prevention

information Equal access to services Inclusion in all coalitions, programs,

projects

Americans with Disability Act—ADA, 1990 Significant civil rights law Right to participation Recognition of 54 million people with

disabilities Title II

Gov’t-funded programs & services Title III

Public Places

Program Access

Policies and procedures Evaluation of your facility—TTY,

etc. Staffing patterns Program participant inclusion

Information/Accessible Materials Alternative formats

• Braille• Audio recordings• Computer disc• Large print/binders

Effective communication• Sign language interpreters• Computer-Assisted Realtime Translation

(CART)• TTY

Closed-captioned films and videos

Physical Access

Universal design Entrance and doors Public areas: counters, elevators, signage Public restrooms Meeting rooms Emergency exits and alarms

Transportation Parking and Pathways

Living Well with a Disability

Alice Ellison, Director of OperationsSan Juan Center for Independence

Farmington, New Mexico

Philosophy

Independent living Self-help and self-advocacy Peer relationships and peer role models Equal access to society Full choice in all matters concerning

themselves

Trends

Increase in disability among all age groups

Mainstreaming creates additional peer pressure on youth

Increase in obesity and lack of physical exercise (for everyone)

Growing need for public health programs

People with Disabilities who Smoke

Less visible Undercounted Underserved Ignored by tobacco prevention

movement

Developed Capacity to Address Tobacco Built Life Savers Coalition Trained tobacco-free support group

facilitators Created support groups Sponsored town hall meeting for

consumers, families & community Delivered smoke-free educational

presentations Distributed smoke-free materials

Tobacco Issues for People with Disabilities Taking away choice Have a lot worse health problems Independent form of pleasure, especially

for mobility impaired Have enough to deal with Isolation--“my best friend”

Opportunities Make standard in health promotion

programs Integrate into programs to prevent

secondary conditions Ally with physical activity projects Insure inclusion in peer support initiatives Train Personal Care Option consumers in

secondhand smoke issues Environmental interventions may be more

effective

Cigarette Smoking in Psychiatric Patients

Debra DermataLas Vegas Medical Center

Las Vegas, New Mexico

National Prevalence

Schizophrenia: 45%-93% Major depression: 74% Panic disorder: 55% Post traumatic stress disorder: 53%-

60% Phobias: 48% Generalized anxiety disorder: 47% Bi-polar disorder: 45%

Why the Higher Rates?

Stimulates release of dopamine, norepinephrine & 5-HT

Self-medication Attempt to reduce side effects Environmental influences

Nicotine Effects on Schizophrenia

Increased alertness Reduced anxiety Decreased depression Decreased lethargy Reduction in hallucinations

Environmental Influences

Lax policies in institutions Cigarette privileges as

rewards/punishments Smoking breaks used as “social time” Patients and staff smoke together as

bonding Helps patients feel “in control” in

uncontrollable environment

Nicotine and Medications

Speeds up metabolism (need higher doses of anti-psychotics)

Haldol may increase smoking Clozapine may decrease smoking

Quitting

Major difficulty for mentally ill Majority have desire to quit Timing crucial—medication

changes/highly symptomatic Reduction rather than cessation Modified materials to match cognitive

abilities

STOMPnmstomp@earthlink.net

505-988-3473

National Council on Independent Living 1916 Wilson Blvd, Suite 209

Arlington, VA 22201

www.ncil.org

ncil@ncil.org

703-525-3406