DiversityNursing Blog

California Lawmakers Want to Raise Smoking Age Limit

Posted by Erica Bettencourt

Mon, Feb 02, 2015 @ 11:43 AM

3 excuses for smoking 1 resized 600

Should the legal age for smoking be raised from 18 to 21? That’s the question being pondered by lawmakers in California, where a growing contingent of health advocates are seeking to make their state’s minimum smoking age the highest in the United States.

Known as Bill 151, the legislation, which was proposed by Democrat Senator Ed Hernandez last Thursday, is designed to limit tobacco smoking among young people. Hernandez says it’s about preventing people from becoming addicted to cigarettes when they’re most vulnerable.

“Tobacco companies are aware that people tend to become addicted to smoking if they start it at young age,” Hernandez said. “Senate Bill 151 proposes to increase the legitimate smoking age in California from 18 to 21 years in an offer to restrain tobacco smoking in children and teenagers.”

Hernandez has evidence to support his cause. According to the American Lung Association, nine in ten smokers take up the habit right around the time they reach age eighteen. Overall, it’s estimated that about 36,000 California children begin smoking each year.

Hernandez says it’s time to take a tougher approach when it comes to preventing young people from smoking. “We can no more bear to sit on the sidelines while huge tobacco markets to our children and gets another era of youngsters snared on an item that will at last kill them,” Hernandez said.

California is not the first state to make this venture. Utah, New Jersey, Maryland, and Colorado have all tried to raise the smoking age from 18 to 21, with every attempt ending in failure.

Source: www.activebeat.com

Topics: age, laws, government, California, smoking, cigarettes, tobacco, health, health care

Commentary: Psychiatric Mental Health Nurse Practitioners Can Help Address Increased Demand for Mental Health Services

Posted by Alycia Sullivan

Mon, May 19, 2014 @ 03:30 PM

By Susan Chapman and Bethany J. Phoenix

describe the image

Because the Affordable Care Act requires that individual and small-group plans include coverage for mental health care that is comparable to that for general medical care, many analysts expect the demand for mental health services to dramatically increase over the next few years. In California, finding enough mental health providers to meet the demand will be a challenge, as the federal Health Resources and Services Administration has identified 128 Mental Health Professional Shortage Areas in our state.

After documenting vacancy rates for mental health professionals in county-operated mental health programs and state hospitals, the California Mental Health Planning Council suggested that one way to address this shortage is to increase the recruitment and preparation of psychiatric/mental health nurse practitioners (PMHNPs) as primary mental health providers. Given the direction of health care service delivery in the US, perhaps the most important advantage PMHNPs offer is that they are educated in an integrative practice model that stresses connections between physical and mental health and emphasizes health promotion. This is especially critical in public mental health settings, where many patients struggle to get to any health care appointment, much less multiple appointments with multiple providers.

Using PMHNPs to address shortages and increase access to care in public mental health settings, however, faces a number of challenges. To help understand and address these challenges, we are collaborating with the California Institute for Mental Health (CiMH) to conduct a Robert Wood Johnson Foundation-funded study that will include case studies in five California counties with a history of using PMHNPs. The aim is to document best practices, identify unnecessary restrictions on NP practice and formulate strategies to remove these restrictions. By the conclusion of the study in 2015, we hope to have evidence-based information for key stakeholders – from public mental health care systems to state policymakers – about how PMHNPs can help increase access to mental health services in the state.

describe the image

One thing the study will allow us to do is examine in more detail presumed barriers that have emerged both anecdotally and from prior research. To begin with, just as with primary care, there is a need to rapidly fill the pipeline by incentivizing existing and future students to work in public mental health. That’s why beginning in 2009, California’s Mental Health Services Act began funding educational stipends to PMHNP students at three schools of nursing, including UC San Francisco. The stipend requires that students “pay back” their stipend by working in a public mental health setting for the equivalent of a year of service for each year of stipend funding.

That’s a fine start, but many of our colleagues across the state are concerned that scope-of-practice laws and the lack of good practice models for PMHNPs in California appear to undermine the effort to prime the pipeline.

For example, UCSF School of Nursing faculty member Aaron Miller was educated in Oregon and says that the biggest difference between the two states is that, “In Oregon, NPs can practice without a collaborative agreement with a physician…and the scope-of-practice law in Oregon contains an explicit description of the NP’s scope of practice: assessment, diagnosis, creation of plan and treatment.” By contrast, he says, in California NPs must always have a collaborative agreement in place with a supervising physician, and in every setting they have to devise agreed-upon standardized procedures that define what the NP can do – essentially, the scope of practice. Moreover, at present, practice models in the state do not facilitate optimal billing for PMHNP services.

Ebony Anderson, one of our former stipend students, says these limitations have dampened her willingness to strike out into independent practice as a psychiatric mental health nurse practitioner.

Thus, even as many in the state recognize that NPs can provide high-quality care and organizations are starting to utilize NPs’ full scope of practice, a number of factors may be erecting unnecessary obstacles to meeting the mental health needs of many Californians – especially in areas already short on qualified providers. These factors include reimbursement challenges, the effort involved in defining acceptable scope for each setting and finding physicians willing to provide NPs with the mandated level of supervision – and bill for services under their provider numbers, if appropriate.

Our charge, among other things, is to examine how and to what degree these factors affect the state’s ability to meet expected growth in demand for mental health services. Such research is the lifeblood of policy change. Our hope is that the results of our work will enable the state to fully leverage an educational system that is training PMHNPs to deliver outstanding care but, at least at the moment, sending them into a health care system that is not yet taking full advantage of their strengths.

Susan Chapman and Bethany J. Phoenix are leading a study to examine the structural, practice and policy opportunities and barriers that affect psychiatric/mental health nurse practitioners’ ability to most effectively use their skills and expertise in public mental health settings. Chapman directs the Health Policy Nursing specialty in the Department of Social and Behavioral Sciences at UC San Francisco School of Nursing. Phoenix is vice chair of the School’sDepartment of Community Health Systems and coordinates the School’s Psychiatric/Mental Health Nursing specialty. The study is supported by the Robert Wood Johnson Foundation’s Future of Nursing National Research Agenda, which is coordinated by the Interdisciplinary Nursing Quality Research Initiative, a national program of the Robert Wood Johnson Foundation.

Source: Science of Caring

Topics: California, study, ACA, Robert Wood Johnson Foundation, nurse practitioners, CiMH

Click me

ABOUT US

DiversityNursing.com is a national “niche” website for Nurses from student nurses up to CNO’s. We are a Career Job Board, Community and Information Resource for all Nurses regardless of age, race, gender, religion, education, national origin, sexual orientation, disability or physical characteristics. 

Subscribe to Email Updates

Posts by Topic

see all