University of New England

New Program Aims at the Root Cause of Smoking Among Underserved Populations in Maine

People living in poverty, often with a background of domestic abuse and particularly those with mental illness, smoke more, begin smoking earlier, and die from smoking-related diseases at a much higher rate than the general population, according to research being done by University of New England social work professors Stephen Rose and Thomas McLaughlin.

Their project was awarded a grant from the American Legacy Foundation for a total of $387,500 over a three-year period (with funding ending this coming August). The project is a collaborative effort with partners including Counseling Services, Inc. (CSI) and the University of New England’s University Health Care in Saco.

Their initial findings led to the creation of the Collaborative Care Project where a team of health professionals work with people referred from CSI to create a partnership for health. The focus is to identify and address each patient’s priority health issues. The results, thus far, have been encouraging.

“The current anti-smoking campaigns in Maine are working well with many segments of the population,” said Rose, “but we’ve barely begun to address the most critical group.”

In Maine, he explains, poverty levels are high, with 50 percent of full-time workers earning less than a livable wage. In addition, Maine has very high rates of domestic and child abuse, something that former Gov. Angus King called “Maine’s public health enemy No. 1.” When Rose and the other researchers began to study this issue, there was no research data about linking smoking to poverty, abuse and major mental health problems.

The Research
Rose and McLaughlin’s research started with gathering health data on the clients at CSI, with their current database including 1,350 people. Many of these clients had never seen a primary care physician, nor been asked for their health histories, particularly surrounding smoking.

In this population so far the reseachers discovered that 65 percent of the people applying to CSI for mental health services are heavy smokers. On average they started smoking in their mid-teens, have smoked heavily for more than 15-18 years and are likely to come from low income families, many with chaotic and violent early lives.

Currently, these people live well below 50 percent of York County’s median income level and include many who are single parents with two or more dependents. Their illnesses are more severe than those of non-smokers, with 59 percent of the population having been hospitalized for major illnesses as opposed to 3 percent of non-smokers.

The researchers found that most of these patients rarely see a regular primary care physician for their health care needs, have multiple medical or health problems, and for many, struggle with obesity and poverty-related issues such as adequate housing, heat, or hunger.

A Medical Costs Issue
Rose stated that with skyrocketing medical costs being a huge concern, addressing this issue should be important to all Mainers, not just those living below the poverty level or those with mental illnesses.

“Patients such as these are often forced to go to the emergency room for health care, often after their health issues have become critical, requiring much more intervention with much higher associated costs,” Rose said. “It is hoped that the Collaborative Care Project can get at the root causes of many of these high risk health behavior issues and help patients affect some positive changes. This is a complex problem as many people already have very serious chronic illnesses such as heart conditions, respiratory diseases, diabetes or cancer.”

Community-Based Groups
Working in partnership with CSI’s CEO Sherry Sabo, Ph.D., several community-based groups - consisting of CSI clients interested in enhancing their health - have been formed in CSI service centers.

The groups are led by a Legacy Project social worker Robyn Merrill. The idea for these group sessions came out of information gathered directly from 10 clients who were hired to design a program they felt would work for people such as themselves.

The groups, currently based in Biddeford, Sanford and Kittery at social clubs and a day hospital, do not focus on smoking cessation, rather they are set up to address the issues the people in the groups feel are most critical. Some of these issues have included poverty, homelessness, their illnesses, interpersonal problems, and so on. Interestingly enough, within the groups, various solutions to health problems have developed – such as one subgroup forming to go swimming each week at the local Y.

Positive Interactions
As part of all the positive interaction and discussions within the groups, with clients feeling that someone is finally paying attention to the real issues in their lives, they are now starting to come forward on their own to talk about quitting smoking. One client recently said, “This group has helped me appreciate myself – and in order to stop smoking, I have to appreciate myself.”

Project's Future
In August of 2005, the grant money will run out. Rose said they hope to keep the program going for at least another 3 years.

“We’ve learned so much, but it’s not enough yet. We need to learn lots more about exactly what social conditions were present in people’s lives that came before their smoking, obesity or mental illness, and fed into their involvement in ongoing smoking and poverty. It’s vital to the state of health care in Maine,” he said. “This population will continue to grow, as poverty and income inequality expand, and if we don’t deal with it at the ground level, and provide this type of population-specific collaborative care program, the state’s Medicaid budget will only continue to grow with more institutional care being required.”

(Press release issued Jan. 4, 2005)