In This Issue:
CHAD MORRIS, Ph.D., Director
Providing wellness training and consultation across the nation, I see emerging trends, in small towns to large cities. One common development is the concurrent use of tobacco products, marijuana, and electronic nicotine delivery systems (ENDS). Increasingly, communities are asking about dual use and how we might simultaneously address multiple addictions through policy and treatment. Over the last month, I have partnered with the California Health Collaborative, Central Kansas Foundation, and Vermont Department of Health to present on some of what we know, and what we do not know regarding tobacco, marijuana, and ENDS use.
The basic risks of combustible tobacco products and second-hand smoke exposure have been widely disseminated, but we speak much less about the intersection of marijuana and ENDS. With 29 states and Washington D.C. having legalized medical marijuana, the movement toward normalizing use is growing. California, Massachusetts, Maine, and Nevada passed new laws last November, making recreational use now legal in 7 states and the District of Columbia.
Living in Colorado, the first state to legalize recreational marijuana, we clearly still have much to learn. Healthcare findings following legalization are scant. Fears of crime waves or epidemic overdoses have not been realized, but legalization has also not brought the predicted state tax windfall and significant subsequent benefit to public services. We do know that the negative social, cognitive, and health effects of regular marijuana use on youth and young adults are very real and potentially irreversible, while the outcomes for adult users are mixed.
Regarding ENDS, there is no dispute that non-combustible products are much safer than cigarettes or other smoked tobacco. And we know that smokers are more likely to use ENDS instead of FDA-approved cessation medications to quit smoking, but it is still unclear how many are successfully quitting. Moreover, in the U.S. and tobacco control advocates have not embraced ENDS for smoking cessation to the degree that Europe and the U.K. have.
While safer than smoking, there are reasonable concerns regarding ENDS, particularly for youth and young adults. Large numbers of youth who never smoked are trying ENDS. In addition, marijuana use among youth is rampant, and many marijuana users modify ENDS to covertly vape marijuana as well as other drugs such as methamphetamine. To many youth and young adults, vaping is a counterculture lifestyle. ENDS and marijuana use do not have the social stigma and perceived harm associated with them that cigarettes do. It is striking how similarly many teenagers talk about ENDS and marijuana use. Vaping nicotine mixed with the newest strain of marijuana is the new “cool.”
How can we create a more substantial national dialogue and ask timely questions, such as:
- What are effective community-based treatment strategies for co-occurring marijuana and tobacco use?
- What role should quitlines or other national cessation resources play in addressing marijuana use?
- What should our messaging generally be regarding vaping—whether it is nicotine or marijuana?
- How can we simultaneously address second-hand marijuana and tobacco smoke-free policy?
- What are the most effective, synthesized approaches for educating adolescents and youth?
- What is public health’s role in moving forward?
- How do we create an effective continuity of care, including school health clinics, primary care, and behavioral health?
I would be very interested to hear your thoughts about these questions and any others I have not considered.
In other news…
We recently brought the Rocky Mountain Tobacco Treatment Specialist Certification Program (RMTTS-C) on the road to San Diego. Thanks to the County of San Diego Health & Human Services Agency for funding and hosting our program. If you missed your chance to attend our RMTTS-C Program in May, our next training in Denver will be held on October 23rd – 26th, or you could always host a training in your state.
And we have two Motivational Interviewing trainings right around the corner:
Our DIMENSIONS: Motivational Interviewing for Behavior Change—Level I training is being held on July 24th and 25th in Aurora, CO. REGISTER HERE!
Our DIMENSIONS: Motivational Interviewing for Behavior Change—Level II training is being held on August 28th and 29th. REGISTRATION COMING SOON!
A Study in Wellness
MARY MANCUSO, M.A., Clinical Associate
You are outside watering your trees on a hot day when a young man walks by with his Labrador Retriever. Sweat is dripping from his forehead, and his dog is panting. You immediately offer him and his dog a drink of water. Your subconscious mind has likely registered the man as active, fun, and caring rather than dangerous. You’ve encountered many engaging dog owners on your hikes in the mountains or visits to the river and know his “type.” You could even see yourself being friends with him.
It is likely that implicit bias has affected your willingness to help this man and his dog and thoughts about possible friendship. Implicit bias is defined as the attitudes or stereotypes that affect our understanding, actions, and decisions in an unconscious manner.1 Implicit bias does not, necessarily, have a negative connotation as illustrated in the example above. However, we often see the negative effects of implicit bias playing out in society in healthcare, education, housing, and legal settings as race, ethnicity, sex, age, or sexual orientation factor into being offered or denied various opportunities.
While explicit bias refers to our conscious beliefs and attitudes about individuals or groups of people, implicit bias operates on an unconscious level. It is triggered involuntarily and without awareness or intentional control, and it occurs in all of us.1 We may espouse egalitarian values and concerns for justice, but implicit bias can counter our true intentions due to its unconscious nature.
Much research has been conducted on the measurable effects of implicit bias, but in one frequently cited study, researchers created identical resumes and randomly assigned each one either a European or African American sounding name.2 Resumes with European sounding names received 50% more call backs for interviews than the resumes with African American sounding names. President Obama recognized this issue in the eulogy he gave for Honorable Reverend Clementa Pinckney and eight others who lost their lives in a shooting at a South Carolina church stating, “Maybe we now realize the way racial bias can infect us even when we don’t realize it, so that we’re guarding against not just racial slurs, but we’re also guarding against the subtle impulse to call Johnny back for a job interview but not Jamal.”3
Researchers are also studying effective interventions to reduce implicit bias. Increasing awareness and concern as well as employing cognitive strategies are particularly important. One study examined the effectiveness of an intervention designed to reduce the impact of implicit bias.4 Results indicate that implicit bias can be approached like other areas of behavior change: increasing awareness and concern, receiving education, and practicing countering strategies can help break the habit of engaging in implicit bias.
Having implicit biases means you are human, but your biases can be changed:1
- Educate Yourself – Take the Implicit Association Test (IAT) to become more aware of your unconscious views; take time to investigate and learn more about the effect of inequalities in society;
- Take Action – Seek out opportunities to interact with people who are different from you in various demographic areas (race, ethnicity, age, sex, sexual orientation) and try and put yourself in the place of others;
- Be Accountable – Explore your own beliefs and behaviors related to biases when you encounter bias and think about how you would explain such beliefs and behaviors to others.
- Staats, C., Capatosto, K., Wright, R. A., Jackson, V. W. (2016). State of the Science: Implicit Bias Review 2016. Columbus, OH: Kirwan Institute.
- Bertrand, M., Mullainathan, S. (2004). Are Emily and Greg more employable than Lakisha and Jamal? A field experiment on labor market discrimination. American Economic Review, 94(4): 991-1013.
- Obama, B. H. (2015). Remarks by the President in Eulogy for the Honorable Reverend Clementa Pinckney. The White House, Office of the Press Secretary. Charleston, SC.
- Devine, P. G., Forscher, P. S., Austin, A. J., Cox, W. T. (2012). Long-term reduction in implicit race bias: A prejudice habit-breaking intervention. Journal of Experimental Social Psychology, 48(6): 1267-1278.
- Cunningham, W. A., Preacher, K. J., Banaji, M. R. (2001). Implicit attitude measures: Consistency, stability, and convergent validity. Psychological Science, 12(2): 163-170.
Wellness in Practice
CINDY MORRIS, Psy.D., Clinical Director
I want to introduce you to someone. Her name is Beatrice. She is a huge Silver Maple that lives in our front yard. Positioned on the corner, she faces an intersection past which many people walk. Her green leaves often shake gently in the wind. You could almost hear a tinkle of laughter generated by the brush of her leaves. Her trunk is broad and strong, firmly rooted in the ground. It would take at least three people to completely encircle her trunk with their outstretched arms. Her branches and leaves form a wide canopy, providing a home to squirrels and birds alike as well as shade and shelter for anyone passing below.
Over the years, I have witnessed people taking a rest in her shade, staring in awe at her splendor, and, yes, even giving her a hug. Many of the same people come back time and again, visiting with her as they might with an old friend. I imagine the conversations they share. Or the comfort she radiates by her silent and steady presence. Given the company she attracts, it’s fair to say that she has an active social life.
We have met many people from our neighborhood and beyond who are familiar with Beatrice before they ever even know us. Often, we will say, we live in the house with the big tree and that’s all it takes. “Oh yes,” they say, “It’s our favorite tree.” In a city full of big trees, the fact that Beatrice is so well known feels special to me.
So, while our topic is social wellness, I’d like to include Beatrice in on the conversation. Trees have a powerful presence. We can share a long history with them. They can offer shade, beauty, and, yes, even companionship. I am fortunate to have Beatrice in my life. And I am pleased to know that I am not the only one who feels this way.
CHRISTINE GARVER-APGAR, Ph.D., Research Associate
Recently, I have been spending a lot of time exercising my professional networking muscles. Colleagues and I at BHWP have been investing time and energy to expand the work we do, targeting some of our efforts toward projects aimed at improving the health and wellness of families with young children. This is a relatively new focus for BHWP, so we have been developing new partnerships with community organizations, working with new local and national foundations and other funders, and forming new academic collaborations with researchers both locally and nationally. I have probably never written so many lengthy emails, organized and participated in so many conference calls, and scheduled so many in-person meetings with people I have never met and who work across a diverse range of professions. I am a rather poor “schmoozer,” so this marathon of professional socializing is both rewarding and exhausting.
Almost all of the professional training I received over the first 12 years of my research career occurred within the ivory tower (or rather, windowless basement laboratories of the ivory tower). To become an expert in a particular academic discipline, adopting an unapologetically narrow focus is a necessity. For years, I communicated almost entirely with colleagues in my own discipline who spoke the same language I did, who understood the same academic challenges I faced, and who shared or had already achieved the same professional goals to which I aspire. Under those protected circumstances, it was easy to ignore more general networking skills.
In my current position at BHWP, I can no longer hide behind my curriculum vitae. My worth is determined not just by the number of peer-reviewed publications to my name, but in my ability to communicate and collaborate effectively with people who operate in the “real world” – a world in which research findings are valued when they can be used in the near future to improve the lives of actual human beings. As a card-carrying member of the ivory tower, I will always defend the role of basic science. But engaging in basic science is a privilege, and scientists and academics have a responsibility to better communicate the value of our research to the wider public. My role at BHWP has given me the opportunity to gain invaluable perspective from a community of providers, advocates, policy-makers, and researchers. To successfully operate in the space between science and practice, I will continue to improve my networking endurance….one meeting, one phone call, one email at a time.
Made to Move
DEREK NOLAND, M.P.H., Community Liaison
As a relatively new transplant to the Denver area, seeking balanced social wellness has been an ongoing process over the past 16 months. By no means is social wellness easy to achieve and sustain in any setting or environment, but in my experience, the challenges are amplified upon relocating. Part of why I make that declaration is obvious – transplants simply do not have an existing local social network – but there’s another equally important element related to relocating that may be less apparent.
Fortunately, I have met a lot of great people since moving to Denver, and now have many new friends in our community. While that progress has taken significant effort, the process can be fun and rewarding at the same time. However, as I have gradually expanded my social network here, there have been unintended consequences. In short, expanding my social network in Denver has made it increasingly difficult to maintain relationships with friends – and even family – who are still living in places that I’ve previously called home. In fact, there almost seems to be an inverse relationship between time spent communicating with my new friends in Denver and my older friends.
So what can one do when faced with this type of dilemma? Obviously, we only have so much time and energy to spend talking and communicating with people, so sacrifices have to be made one way or another. Whether one decides to talk less to more people, talk more to less people, or cut back on other activities in order to spend even more time focused on social relationships, these sacrifices are real and may impact a person’s social wellness, and in turn, overall wellness. With fairly high stakes and complicated considerations to be made, taking a moment to reflect on the big picture, including one’s values and priorities, is critical.
And that is the main point I want to make. Regardless of what social wellness means to you, taking the time to think through your decisions and actions within this context should not be overlooked, and will likely improve your overall wellness. Consider your social wellness and identify what practices, activities, and people you think will make your life the most satisfying and fulfilling. For some, this may mean making difficult or conflicting short- and long-term adjustments in our habits and behaviors. In my case, having recognized that there are limits on my capacity to maintain relationships, I’m choosing to prioritize those relationships that mean the most.
The mission of the Behavioral Health and Wellness Program is to improve quality of life by facilitating evidence-based health behavior change for communities, organizations, and individuals