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Peterson J, Prochazka AV, Battaglia C. Smoking cessation and care management for veterans with posttraumatic stress disorder: a study protocol for a randomized controlled trial. BMC Health Serv Res 2015; 15:46. [PMID: 25638351 PMCID: PMC4325951 DOI: 10.1186/s12913-015-0706-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 01/15/2015] [Indexed: 11/29/2022] Open
Abstract
Background Smoking remains the leading cause of preventable illness and mortality in the United States. Individuals with Posttraumatic Stress Disorder (PTSD) have smoking rates higher than that of others and fewer individuals with PTSD have quit smoking. This randomized controlled trial was designed to test the effectiveness of integrating telehealth care management and smoking cessation with motivational interviewing for Veterans with PTSD. Methods/Design All smokers with PTSD, regardless of their desire to quit, were invited to participate. Enrollment occurred between November 2009 and April 2013. Target enrollment was 120 participants. Enrolled participants were randomized to either the control group, receiving usual care including a telehealth PTSD program, with a device that delivered PTSD information and in-home care management, or the intervention group, which included (1) a telehealth PTSD program, (2) motivational interviewing-based smoking cessation curricula via the telehealth device, and (3) weekly motivational interviewing counseling phone calls. Outcomes are self-reported 24-hour quit attempts, progression along the stages of change and 7-day point prevalence quit smoking rates for the intervention group compared to usual care alone. Secondary outcomes include participants’ perception of care coordination, patient satisfaction with motivational interviewing, PTSD symptoms, pain, depression and quality of life. Discussion Motivational interviewing has been shown to increase readiness for change and smoking cessation care has been shown to be more successful when incorporated into in-person mental health care. Our study builds on previous studies. It integrates a written smoking cessation curriculum and phone-based motivational interviewing counseling into an established PTSD home telehealth care coordination program. This paper describes the design and methods of our randomized control trial. Trial registration ClinicalTrials.gov, NCT00908882, May 22, 2009.
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Affiliation(s)
- Jamie Peterson
- Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, USA.
| | - Allan V Prochazka
- Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, USA. .,University of Colorado, Aurora, CO, USA.
| | - Catherine Battaglia
- Department of Veterans Affairs, Eastern Colorado Health Care System, Denver, CO, USA. .,University of Colorado, Aurora, CO, USA.
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102
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Malte CA, Dennis PA, Saxon AJ, McFall M, Carmody TP, Unger W, Beckham JC. Tobacco use trajectories among a large cohort of treated smokers with posttraumatic stress disorder. Addict Behav 2015; 41:238-46. [PMID: 25452071 DOI: 10.1016/j.addbeh.2014.10.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 08/07/2014] [Accepted: 10/24/2014] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study identified distinct tobacco use trajectories across 18months in 943 veteran smokers with posttraumatic stress disorder (PTSD) in order to describe quit and relapse patterns, examine associations between trajectory groups on baseline characteristics and cessation service utilization, and explore group differences in mental health outcomes. METHODS Veterans who participated in a multisite, randomized trial of integrated smoking cessation care were grouped using k-means clustering based on reported daily tobacco use between baseline and 18months. Four trajectory clusters were identified: no reduction (62%), temporary reduction (11%), late sustained reduction (9%) and early sustained reduction (18%). RESULTS Median quit times in the early, late, temporary, and no reduction groups were 451, 141.5, 97, and 2days, respectively. Compared to the early reduction group, the temporary reduction group exhibited higher baseline depression (p<0.01) and anxiety (p<0.01), but did not differ in treatment received, with both groups attending significantly more cessation visits (p<0.001) and more likely to receive recommended pharmacotherapy (p<0.001) than the no reduction group between baseline and 6months. The early reduction group exhibited lower depression relative to the no reduction (p<0.01) and temporary reduction (p<0.01) groups across all assessments between baseline and 18months. Differences were not observed between groups in depressive or PTSD symptom change over time between baseline and 18months. CONCLUSIONS Tobacco use trajectories among treated smokers with PTSD vary distinctly. Characteristics of identified subgroups may lead to targeted interventions among smokers with PTSD and potentially other psychiatric disorders.
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Affiliation(s)
- Carol A Malte
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States.
| | - Paul A Dennis
- Research and Development Service, Durham Veterans Affairs Medical Center, Durham, NC, United States
| | - Andrew J Saxon
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Miles McFall
- Veterans Affairs Puget Sound Health Care System, Seattle, WA, United States; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Timothy P Carmody
- Veterans Affairs Medical Center, San Francisco, CA, United States; University of California, San Francisco, United States
| | - William Unger
- Providence Veterans Affairs Medical Center, Providence, RI, United States
| | - Jean C Beckham
- Veterans Affairs Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham, NC, United States; Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States
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103
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Hall KS, Hoerster KD, Yancy WS. Post-Traumatic Stress Disorder, Physical Activity, and Eating Behaviors. Epidemiol Rev 2015; 37:103-15. [DOI: 10.1093/epirev/mxu011] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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104
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Kelly MM, Sido H, Forsyth JP, Ziedonis DM, Kalman D, Cooney JL. Acceptance and commitment therapy smoking cessation treatment for veterans with posttraumatic stress disorder: a pilot study. J Dual Diagn 2015; 11:50-5. [PMID: 25491589 DOI: 10.1080/15504263.2014.992201] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Veterans with PTSD smoke at rates two to three times higher than the general population, while their quit rate is less than half that of the general population. The present study evaluated the feasibility, acceptability, and preliminary efficacy of Acceptance and Commitment Therapy for Veterans With Posttraumatic Stress Disorder (PTSD) and Tobacco Addiction (ACT-PT), which focuses on helping veterans overcome emotional challenges to quitting smoking. METHODS Veterans with current PTSD who smoked 15 or more cigarettes/day (N = 19) participated in an open trial of ACT-PT. Participants attended nine weekly individual counseling sessions and received eight weeks of nicotine patch therapy. Primary outcomes included feasibility and acceptability of the intervention, and secondary outcomes included expired-air carbon monoxide confirmed seven-day point prevalence abstinence, cravings, and PTSD symptoms. RESULTS The retention rate for ACT-PT was good (74%) and client satisfaction ratings were high. Participants made multiple quit attempts (M = 3.6, SD = 4.2) during the study period and were significantly more confident that they could quit smoking at three-month follow-up. At the end of treatment, 37% of participants were abstinent from smoking and 16% were abstinent at three-month follow-up. Overall, participants reduced their smoking by 62% at the end of treatment and 43% at three-month follow-up. PTSD symptoms and smoking urges significantly decreased from baseline to the end of treatment and three-month follow-up. CONCLUSIONS ACT-PT appears to be a promising smoking cessation treatment for veterans with PTSD. Future research should evaluate ACT-PT in a randomized controlled trial.
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Affiliation(s)
- Megan M Kelly
- a Edith Nourse Rogers Memorial Veterans Hospital , Bedford , Massachusetts , USA
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105
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Leventhal AM, Zvolensky MJ. Anxiety, depression, and cigarette smoking: a transdiagnostic vulnerability framework to understanding emotion-smoking comorbidity. Psychol Bull 2015; 141:176-212. [PMID: 25365764 PMCID: PMC4293352 DOI: 10.1037/bul0000003] [Citation(s) in RCA: 335] [Impact Index Per Article: 37.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Research into the comorbidity between emotional psychopathology and cigarette smoking has often focused upon anxiety and depression's manifest symptoms and syndromes, with limited theoretical and clinical advancement. This article presents a novel framework to understanding emotion-smoking comorbidity. We propose that transdiagnostic emotional vulnerabilities-core biobehavioral traits reflecting maladaptive responses to emotional states that underpin multiple types of emotional psychopathology-link various anxiety and depressive psychopathologies to smoking. This framework is applied in a review and synthesis of the empirical literature on 3 transdiagnostic emotional vulnerabilities implicated in smoking: (a) anhedonia (Anh; diminished pleasure/interest in response to rewards), (b) anxiety sensitivity (AS; fear of anxiety-related sensations), and (c) distress tolerance (DT; ability to withstand distressing states). We conclude that Anh, AS, and DT collectively (a) underpin multiple emotional psychopathologies, (b) amplify smoking's anticipated and actual affect-enhancing properties and other mechanisms underlying smoking, (c) promote progression across the smoking trajectory (i.e., initiation, escalation/progression, maintenance, cessation/relapse), and (d) are promising targets for smoking intervention. After existing gaps are identified, an integrative model of transdiagnostic processes linking emotional psychopathology to smoking is proposed. The model's key premise is that Anh amplifies smoking's anticipated and actual pleasure-enhancing effects, AS amplifies smoking's anxiolytic effects, and poor DT amplifies smoking's distress terminating effects. Collectively, these processes augment the reinforcing properties of smoking for individuals with emotional psychopathology to heighten risk of smoking initiation, progression, maintenance, cessation avoidance, and relapse. We conclude by drawing clinical and scientific implications from this framework that may generalize to other comorbidities.
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Affiliation(s)
- Adam M Leventhal
- Department of Psychology, Keck School of Medicine, University of Southern California
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106
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[Psychodynamic psychotherapy, lifestyle and prevention]. ZEITSCHRIFT FUR PSYCHOSOMATISCHE MEDIZIN UND PSYCHOTHERAPIE 2014; 60:350-67. [PMID: 25528871 DOI: 10.13109/zptm.2014.60.4.350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Patients with mental disorders frequently manifest unhealthy behavior, which contributes to their increased risk for chronic mental and somatic diseases as well as excess mortality rates of 10 years and more. It also impairs their well-being and the course of mental disorders.We analyzed whether by addressing unhealthy behavior prevention can be integrated into psychodynamic psychotherapy. METHODS We reviewed the literature on the role of unhealthy behavior for mental disorders, on the role of lifestyle risk factors in psychodynamic theory, and on barriers to the integration of addressing lifestyle in psychodynamic psychotherapy. RESULTS Smoking, unhealthy dietary habits, and physical inactivity constitute dysfunctional behavior, resulting from maladaptive self-representations and an impairment of emotion-regulation capacities. In psychodynamic psychotherapy this maladaptive behavior can be addressed and treated as a kind of defensive behavior and resistance. CONCLUSION We believe that by addressing unhealthy behavior prevention can become a crucial task for psychodynamic psychotherapists today.
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107
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Kowalkowski MA, Goltz HH, Petersen NJ, Amiel GE, Lerner SP, Latini DM. Educational opportunities in bladder cancer: increasing cystoscopic adherence and the availability of smoking-cessation programs. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:739-45. [PMID: 24719024 PMCID: PMC4412159 DOI: 10.1007/s13187-014-0649-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Cancer survivors who continue to smoke following diagnosis are at increased risk for recurrence. Yet, smoking prevalence among survivors is similar to the general population. Adherence to cystoscopic surveillance is an important disease-management strategy for non-muscle-invasive bladder cancer (NMIBC) survivors, but data from Surveillance, Epidemiology, and End Results program (SEER) suggest current adherence levels are insufficient to identify recurrences at critically early stages. This study was conducted to identify actionable targets for educational intervention to increase adherence to cystoscopic monitoring for disease recurrence or progression. NMIBC survivors (n = 109) completed telephone-based surveys. Adherence was determined by measuring time from diagnosis to interview date; cystoscopies received were then compared to American Urological Association (AUA) guidelines. Data were analyzed using non-parametric tests for univariate and logistic regression for multivariable analyses. Participants averaged 65 years (SD = 9.3) and were primarily white (95 %), male (75 %), married (75 %), and non-smokers (84 %). Eighty-three percent reported either Ta- or T1-stage bladder tumors. Forty-five percent met AUA guidelines for adherence. Compared to non-smokers, current smokers reported increased fear of recurrence and psychological distress (p < 0.05). In regression analyses, non-adherence was associated with smoking (OR = 33.91, p < 0.01), providing a behavioral marker to describe a survivor group with unmet needs that may contribute to low cystoscopic adherence. Research assessing survivorship needs and designing and evaluating educational programs for NMIBC survivors should be a high priority. Identifying unmet needs among NMIBC survivors and developing programs to address these needs may increase compliance with cystoscopic monitoring, improve outcomes, and enhance quality of life.
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Affiliation(s)
- Marc A Kowalkowski
- Levine Cancer Institute, Carolinas Healthcare System, 1021 Morehead Medical Drive, Charlotte, NC, USA,
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108
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Abstract
Background We examined electronic cigarette (EC) use, correlates of use, and associated changes in smoking behavior among smokers with serious mental illness in a clinical trial. Methods Adult smokers were recruited during acute psychiatric hospitalization (N = 956, 73% enrollment among approached smokers) in the San Francisco Bay Area between 2009–2013. At baseline, participants averaged 17 (SD = 10) cigarettes per day for 19 (SD = 14) years; 24% intended to quit smoking in the next month. Analyses examined frequency and correlates of EC use reported over the 18-month trial and changes in smoking behavior by EC use status. Findings EC use was 11% overall, and by year of enrollment, increased from 0% in 2009 to 25% in 2013. In multiple logistic regression, the likelihood of EC use was significantly greater with each additional year of recruitment, for those aged 18–26, and for those in the preparation versus precontemplation stage of change, and unlikely among Hispanic participants. EC use was unrelated to gender, psychiatric diagnosis, and measures of tobacco dependence at baseline. Further, over the 18-month trial, EC use was not associated with changes in smoking status or, among continued smokers, with reductions in cigarettes per day. Interpretation Within a clinical trial with smokers with serious mental illness, EC use increased over time, particularly among younger adults and those intending to quit tobacco. EC use was unrelated to changes in smoking. The findings are of clinical interest and warrant further study.
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109
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Young-Wolff KC, Fromont SC, Delucchi K, Hall SE, Hall SM, Prochaska JJ. PTSD symptomatology and readiness to quit smoking among women with serious mental illness. Addict Behav 2014; 39:1231-4. [PMID: 24813548 DOI: 10.1016/j.addbeh.2014.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Revised: 03/23/2014] [Accepted: 03/27/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Posttraumatic stress disorder (PTSD) is a risk factor for tobacco addiction. The majority of research on PTSD and smoking has been conducted with men, particularly combat veterans, and little is known about the association among women. In a clinical sample of women civilian smokers with serious mental illness (SMI), we examined the prevalence of PTSD symptomatology and associations with physical and mental health functioning, co-occurring substance use, nicotine dependence, and readiness to quit smoking. METHODS 376 adult women smokers aged 18-73 were recruited from 7 acute inpatient psychiatry units and screened by diagnostic interview for current PTSD symptomatology (PTSD(+)). In multiple regressions, we examined the associations of screening PTSD(+) with physical and mental health functioning; past-month drug use; past-year substance use disorders; nicotine dependence and readiness to quit smoking. RESULTS Nearly half the sample (43%) screened PTSD(+), which was significantly associated with the use of stimulants (OR=1.26) and opiates (OR=1.98), drug use disorders (OR=2.01), and poorer mental health (B=-2.78) but not physical health functioning. PTSD(+) status was unrelated to nicotine dependence, but predicted greater desire to quit smoking (B=2.13) and intention to stop smoking in the next month (OR=2.21). In multivariate models that adjusted for substance use disorders, physical and mental health functioning, and nicotine dependence, screening PTSD(+) remained predictive of greater desire and intention to quit smoking. CONCLUSION PTSD symptomatology was common in our sample of women smokers with SMI and associated with not only worse substance use and mental health, but also greater readiness to quit smoking, suggesting the need for and potential interest in integrative PTSD-addiction treatment among women.
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110
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An Anxiety Sensitivity Reduction Smoking-Cessation Program for Spanish-Speaking Smokers (Argentina). COGNITIVE AND BEHAVIORAL PRACTICE 2014. [DOI: 10.1016/j.cbpra.2013.10.005] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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111
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Metse AP, Bowman JA, Wye P, Stockings E, Adams M, Clancy R, Terry M, Wolfenden L, Freund M, Allan J, Prochaska JJ, Wiggers J. Evaluating the efficacy of an integrated smoking cessation intervention for mental health patients: study protocol for a randomised controlled trial. Trials 2014; 15:266. [PMID: 24996596 PMCID: PMC4091653 DOI: 10.1186/1745-6215-15-266] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/17/2014] [Indexed: 12/17/2022] Open
Abstract
Background Smoking rates, and associated negative health outcomes, are disproportionately high among people with mental illness compared to the general population. Smoke-free policies within mental health hospitals can positively impact on patients’ motivation and self-efficacy to address their smoking. However, without post-discharge support, preadmission smoking behaviours typically resume. This protocol describes a randomised controlled trial that aims to assess the efficacy of linking mental health inpatients to community-based smoking cessation supports upon discharge as a means of reducing smoking prevalence. Methods/Design Eight hundred participants with acute mental illness will be recruited into the randomised controlled trial whilst inpatients at one of four psychiatric inpatient facilities in the state of New South Wales, Australia. After completing a baseline interview, participants will be randomly allocated to receive either: ‘Supported Care’, a multimodal smoking cessation intervention; or ‘Normal Care’, consisting of existing hospital care only. The ‘Supported Care’ intervention will consist of a brief motivational interview and a package of self-help material for abstaining from smoking whilst in hospital, and, following discharge, 16 weeks of motivational telephone-based counselling, 12 weeks of free nicotine replacement therapy, and a referral to the Quitline. Data will be collected at 1, 6 and 12 months post-discharge via computer-assisted telephone interview. The primary outcomes are abstinence from smoking (7-day point prevalence and prolonged cessation), and secondary outcomes comprise daily cigarette consumption, nicotine dependence, quit attempts, and readiness to change smoking behaviour. Discussion If shown to be effective, the study will provide evidence in support of systemic changes in the provision of smoking cessation care to patients following discharge from psychiatric inpatient facilities. Trial registration Australian New Zealand Clinical Trials Registry ANZTCN:
ACTRN12612001042831. Date registered: 28 September 2012.
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Affiliation(s)
- Alexandra P Metse
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
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112
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Stockings EAL, Bowman JA, Baker AL, Terry M, Clancy R, Wye PM, Knight J, Moore LH, Adams MF, Colyvas K, Wiggers JH. Impact of a Postdischarge Smoking Cessation Intervention for Smokers Admitted to an Inpatient Psychiatric Facility: A Randomized Controlled Trial. Nicotine Tob Res 2014; 16:1417-28. [DOI: 10.1093/ntr/ntu097] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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113
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Duffy SA, Ronis DL, Karvonen-Gutierrez CA, Ewing LA, Dalack GW, Smith PM, Carmody TP, Hicks T, Hermann C, Reeves P, Flanagan P. Effectiveness of the Tobacco Tactics Program in the Department of Veterans Affairs. Ann Behav Med 2014; 48:265-74. [DOI: 10.1007/s12160-014-9605-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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114
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Abstract
The prevalence of smoking is higher in patients with psychiatric illness compared with the general population. Smoking causes chronic illnesses, which lead to premature mortality in those with psychiatric illness, is associated with greater burden of psychiatric symptoms, and contributes to the social isolation experienced by individuals with psychiatric disorders. Most patients with a psychiatric illness present initially to primary care rather than specialty care settings, and some patients receive care exclusively in the primary care setting. Therefore, family physicians and other primary care clinicians have an important role in the recognition and treatment of tobacco use disorders in patients with psychiatric illnesses. In this article we review common myths associated with smoking and psychiatric illness, techniques for implementing evidence-based tobacco use treatments, the evidence base for tobacco use treatment for patients with specific psychiatric diagnoses, and factors to consider when treating tobacco use disorders in patients with psychiatric illness.
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Affiliation(s)
- Joseph M Cerimele
- the Department of Psychiatry and Behavioral Sciences, the Department of Family Medicine, School of Medicine, and the Department of Health Services, School of Public Health, University of Washington, Seattle; and the Veteran's Affairs Puget Sound Health Care System, Seattle, WA
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115
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Ebert L, Malte C, Hamlett-Berry K, Beckham J, McFall M, Saxon A. Use of a learning collaborative to support implementation of integrated care for smoking cessation for veterans with posttraumatic stress disorder. Am J Public Health 2014; 104:1935-42. [PMID: 25208004 DOI: 10.2105/ajph.2013.301776] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the feasibility of incorporating integrated care (IC) for smoking cessation into routine treatment for posttraumatic stress disorder (PTSD) at Department of Veterans Affairs (VA) Medical Centers and the utility of the Learning Collaborative (LC) model in facilitating implementation. METHODS We conducted 2 LCs aimed at implementing IC for smoking cessation using multidisciplinary teams comprising 70 staff members from 12 VA PTSD clinics. Using questionnaires, we evaluated providers' perceptions of the LC methodology and the effectiveness and feasibility of routine IC delivery. We assessed number of providers delivering and patients receiving IC using medical record data. RESULTS More than 85% of participating VA staff considered the LC to be an effective training and implementation platform. The majority thought IC effectively addressed an important need and could be delivered in routine PTSD care. All LC participants who planned to deliver IC did so (n=52). Within 12 months of initial training, an additional 46 locally trained providers delivered IC and 395 veterans received IC. CONCLUSIONS The LC model effectively facilitated rapid and broad implementation of IC. Facilitators and barriers to sustained use of IC are unknown and should be identified to understand how best to promote ongoing access to evidence-based treatment for smoking cessation in mental health populations.
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Affiliation(s)
- Lori Ebert
- Lori Ebert is with the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC. Carol Malte is with the Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA. Kim Hamlett-Berry is with Clinical Public Health, Department of Veterans Affairs, Washington, DC. Jean Beckham is with the VA Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham. Miles McFall and Andrew Saxon are with the VA Puget Sound Health Care System, Seattle
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116
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Reporting of harms in randomized controlled trials of psychological interventions for mental and behavioral disorders: a review of current practice. Contemp Clin Trials 2014; 38:1-8. [PMID: 24607768 DOI: 10.1016/j.cct.2014.02.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/18/2014] [Accepted: 02/23/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Data suggest that certain psychological interventions can induce harm in a significant number of patients. While the need for adequate reporting of harms in clinical trials has repeatedly been emphasized, it is uncertain whether such information is routinely collected and reported in trials within this research field. METHOD We used the two major databases in clinical psychology and medicine (PsycINFO and PubMed) to identify original publications from 2010 reporting randomized controlled trials of psychological interventions for patients with mental and behavioral disorders. Two reviewers searched the full-text reports for information about monitoring of adverse events, side effects, and deterioration. RESULTS A total of 132 eligible trials were identified. Only 28 trials (21%) included information that indicated any monitoring of harms on patient level. Four (3%) of these trials provided a description of adverse events as well as the methods used for collecting these data. Five of the trials (4%) reported adverse events but did not give complete information about the method. An additional four reports (3%) briefly stated that no adverse events occurred, whereas 15 trials (11%) only provided information on deterioration or indicated monitoring of deterioration. The probability of including harm-related information was related to the journal impact factor. CONCLUSION Important information about harms is not reported systematically within this research field, suggesting that the risk of reporting bias is nontrivial in conclusions about the risk-benefit ratio of psychological treatments. Guidelines on how to define, detect, and report harms related to psychological interventions could facilitate better reporting.
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117
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Hooten WM, Townsend CO, Hays JT, Ebnet KL, Gauvin TR, Gehin JM, Laures HJ, Patten CA, Warner DO. A cognitive behavioral smoking abstinence intervention for adults with chronic pain: a randomized controlled pilot trial. Addict Behav 2014; 39:593-9. [PMID: 24333035 DOI: 10.1016/j.addbeh.2013.11.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/30/2013] [Accepted: 11/13/2013] [Indexed: 11/28/2022]
Abstract
Current evidence suggests it may be difficult for patients with chronic pain to quit smoking and, based on previous formative work, a 7-session individual and group-based cognitive behavioral (CB) intervention was developed. The primary aim of this randomized controlled pilot trial was to test the hypothesis that abstinence at month 6 would be greater among patients with chronic pain who received the CB intervention compared to a control condition. Upon admission to a 3-week interdisciplinary pain treatment (IPT) program, patients were randomized to receive the CB intervention (n=30) or the control condition (n=30). The 7-day point prevalence of self-reported smoking status was assessed at week 3 (upon completion of the 3-week IPT program) and at month 6 in an intent-to-treat analysis. At week 3, 30% (n=9) of patients in the CB condition were abstinent from smoking compared to 10% (n=3) in the control group (P=.104). At month 6, 20% (n=6) of patients who received the CB intervention were abstinent compared to none in the control group (P=.024). At week 3, a significant group by time interaction effect was found where the CB patients experienced greater improvements in self-efficacy from baseline compared to the control group (P=.002). A greater proportion of patients randomized to the CB group completed the IPT program (P=.052). The findings of this pilot trial suggest that integration of a CB-based smoking abstinence intervention into ongoing pain therapy may be an effective treatment for smokers with chronic pain.
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Affiliation(s)
- W Michael Hooten
- Department of Anesthesiology, Mayo College of Medicine, Rochester, MN, United States.
| | - Cynthia O Townsend
- Department of Psychiatry and Psychology, Mayo College of Medicine, Rochester, MN, United States
| | - J Taylor Hays
- Department of Internal Medicine, Mayo College of Medicine, Rochester, MN, United States
| | - Kaye L Ebnet
- Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - Thomas R Gauvin
- Department of Internal Medicine, Mayo College of Medicine, Rochester, MN, United States
| | - Jessica M Gehin
- Department of Nursing, Mayo Clinic, Rochester, MN, United States
| | - Heidi J Laures
- Department of Psychiatry and Psychology, Mayo College of Medicine, Rochester, MN, United States
| | - Christi A Patten
- Department of Psychiatry and Psychology, Mayo College of Medicine, Rochester, MN, United States
| | - David O Warner
- Department of Anesthesiology, Mayo College of Medicine, Rochester, MN, United States
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118
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Prevalence and correlates of smoking status among veterans affairs primary care patients with probable major depressive disorder. Addict Behav 2014; 39:538-45. [PMID: 24290879 DOI: 10.1016/j.addbeh.2013.10.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 10/10/2013] [Accepted: 10/22/2013] [Indexed: 11/23/2022]
Abstract
In an attempt to guide planning and optimize outcomes for population-specific smoking cessation efforts, the present study examined smoking prevalence and the demographic, clinical and psychosocial characteristics associated with smoking among a sample of Veterans Affairs primary care patients with probable major depression. Survey data were collected between 2003 and 2004 from 761 patients with probable major depression who attended one of 10 geographically dispersed VA primary care clinics. Current smoking prevalence was 39.8%. Relative to nonsmokers with probable major depression, bivariate comparisons revealed that current smokers had higher depression severity, drank more heavily, and were more likely to have comorbid PTSD. Smokers with probable major depression were also more likely than nonsmokers with probable major depression to have missed a health care appointment and to have missed medication doses in the previous 5months. Smokers were more amenable than non-smokers to depression treatment and diagnosis, and they reported more frequent visits to a mental health specialist and less social support. Alcohol abuse and low levels of social support were significant concurrent predictors of smoking status in controlled multivariable logistic regression. In conclusion, smoking prevalence was high among primary care patients with probable major depression, and these smokers reported a range of psychiatric and psychosocial characteristics with potential to complicate systems-level smoking cessation interventions.
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Kimbrel NA, Morissette SB, Gulliver SB, Langdon KJ, Zvolensky MJ. The effect of social anxiety on urge and craving among smokers with and without anxiety disorders. Drug Alcohol Depend 2014; 135:59-64. [PMID: 24331637 PMCID: PMC4040973 DOI: 10.1016/j.drugalcdep.2013.11.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 10/15/2013] [Accepted: 11/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Despite the often social nature of smoking, relatively little research has been conducted on the relationship between smoking and social anxiety disorder (SAD). METHOD Participants (N=99) included 34 smokers without current mental health disorders, 37 smokers with SAD, and 28 smokers who met criteria for other anxiety disorder diagnoses (e.g., panic disorder or generalized anxiety disorder, but not SAD). Nicotine and placebo patches were administered to participants in a counterbalanced manner across two assessment days. Urge and craving were assessed before and after a 5-h nicotine absorption/deprivation period. RESULTS Compared to smokers without current mental health disorders, smokers with SAD did not report greater nicotine dependence, but did endorse greater motivation to use nicotine to avoid negative outcomes. In addition, after controlling for demographic variables, smoking characteristics, pre-deprivation urge and craving, and other anxiety/depression symptoms, social anxiety symptoms uniquely predicted urge and craving in the placebo patch condition; however, social anxiety had no influence on urge and craving in the nicotine patch condition. CONCLUSIONS These findings suggest that one potential reason that smokers with SAD may have worse cessation outcomes is that they may experience higher levels of craving and urge to smoke during quit attempts. Thus, during a quit attempt, particularly in the absence of nicotine replacement therapy, smokers with SAD are likely to benefit from additional treatment aimed at managing or reducing their social anxiety symptoms.
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Affiliation(s)
- Nathan A. Kimbrel
- Durham Veterans Affairs Medical Center, Durham, NC, USA,The VA Mid-Atlantic Mental Illness Research, Education, and Clinical Center, Durham, NC, USA,Texas A&M Health Science Center, College Station, TX, USA,Corresponding Author: Nathan A. Kimbrel, Durham VA Medical Center, 508 Fulton Street, Durham, NC, USA, 27705. . Telephone: 011.919.286.0411, ext. 6759. Fax: 011.919.416.5959
| | - Sandra B. Morissette
- Texas A&M Health Science Center, College Station, TX, USA,VA VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA
| | - Suzy B. Gulliver
- Texas A&M Health Science Center, College Station, TX, USA,Scott & White Brain Research for American Veterans and Emergency Responders, Waco, TX, USA
| | - Kirsten J. Langdon
- National Center for PTSD, Women’s Health Sciences Division, VA Boston Healthcare System, Boston, MA, USA,Boston University School of Medicine, Boston, MA, USA
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Shealy SE, Winn JL. Integrating smoking cessation into substance use disorder treatment for military veterans: measurement and treatment engagement efforts. Addict Behav 2014; 39:439-44. [PMID: 24094921 DOI: 10.1016/j.addbeh.2013.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 05/20/2013] [Accepted: 07/22/2013] [Indexed: 11/26/2022]
Abstract
Military personnel and veterans smoke at higher rates than the general population, compromising physical performance readiness and health (Committee on Smoking Cessation in Military and Veteran Populations & Institute of Medicine, 2009). While efforts are being made within both the Department of Defense and the Veterans' Administration (VA) hospitals to prevent onset, change the smoking culture, and promote smoking cessation; smoking rates are increasing among combat deployed service members, and smoking rates are particularly high among veterans with mental health and other substance use disorders (McFall, 2006). Recent research supports making smoking cessation widely available and integrated with other forms of care (Gierisch et al., 2012; McFall et al., 2010). This paper describes the efforts of one VA substance use disorder (SUD) treatment program to integrate smoking cessation in routine care, including assessment of tobacco use and motivation and intention to quit via the proposed Nic-BAM assessment. Our team was 100% successful in incorporating the Nic-BAM into our regular assessment of treatment program participants. This suggests that staff members are amenable to assessing for tobacco addiction alongside other substance addictions. Although smoking did not decrease according to the Nic-BAM, an increase in the use of nicotine-replacement products suggests that participants are willing to initiate a quit attempt during SUD treatment. The availability of new evidence-based approaches for integration of tobacco cessation with mental health and SUD treatment may help to enhance programmatic efforts. Environmental changes are needed to fully incorporate tobacco recovery into SUD programming, and additional resources may include peer support specialists.
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Prochaska JJ, Fromont SC, Delucchi K, Young-Wolff KC, Benowitz NL, Hall S, Bonas T, Hall SM. Multiple risk-behavior profiles of smokers with serious mental illness and motivation for change. Health Psychol 2014; 33:1518-29. [PMID: 24467257 DOI: 10.1037/a0035164] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Individuals with serious mental illness (SMI) are dying on average 25 years prematurely. The leading causes are chronic preventable diseases. In the context of a tobacco-treatment trial, this exploratory study examined the behavioral risk profiles of adults with SMI to identify broader interventional needs. METHOD Recruited from five acute inpatient psychiatry units, participants were 693 adult smokers (recruitment rate = 76%, 50% male, 45% Caucasian, age M = 39, 49% had income < $10,000) diagnosed with mood disorders (71%), substance-use disorders (63%), posttraumatic stress disorder (39%), psychotic disorders (25%), and attention deficit-hyperactivity disorder (25%). The Staging Health Risk Assessment, the primary measure used in this study, screened for risk status and readiness to change 11 health behaviors, referencing the period prior to acute hospitalization. RESULTS Participants averaged 5.2 (SD = 2.1) risk behaviors, including smoking (100%), high-fat diet (68%), inadequate fruits/vegetables (67%), poor sleep (53%), physical inactivity (52%), and marijuana use (46%). The percent prepared to change ranged from 23% for tobacco and marijuana to 76% for depression management. Latent class analysis differentiated three risk groups: the global higher risk group included patients elevated on all risk behaviors; the global lower risk group was low on all risks; and a mood and metabolic risk group, characterized by inactivity, unhealthy diet, sleep problems, and poor stress and depression management. The global higher risk group (11% of sample) was younger, largely male, and had the greatest number of risk behaviors and mental health diagnoses; had the most severe psychopathologies, addiction-treatment histories, and nicotine dependence; and the lowest confidence for quitting smoking and commitment to abstinence. CONCLUSION Most smokers with SMI engaged in multiple risks. Expanding targets to treat co-occurring risks and personalizing treatment to individuals' multibehavioral profiles may increase intervention relevance, interest, and impact on health.
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Affiliation(s)
- Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University
| | | | - Kevin Delucchi
- Department of Psychiatry, University of California-San Francisco
| | - Kelly C Young-Wolff
- Stanford Prevention Research Center, Department of Medicine, Stanford University
| | - Neal L Benowitz
- Division of Clinical Pharmacology, Departments of Medicine and Bioengineering & Therapeutic Sciences, University of California-San Francisco
| | - Stephen Hall
- Department of Psychiatry, University of California-San Francisco
| | | | - Sharon M Hall
- Department of Psychiatry, University of California-San Francisco
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Cook BL, Wayne GF, Kafali EN, Liu Z, Shu C, Flores M. Trends in smoking among adults with mental illness and association between mental health treatment and smoking cessation. JAMA 2014; 311:172-82. [PMID: 24399556 PMCID: PMC5555156 DOI: 10.1001/jama.2013.284985] [Citation(s) in RCA: 374] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Significant progress has been made in reducing the prevalence of tobacco use in the United States. However, tobacco cessation efforts have focused on the general population rather than individuals with mental illness, who demonstrate greater rates of tobacco use and nicotine dependence. OBJECTIVES To assess whether declines in tobacco use have been realized among individuals with mental illness and examine the association between mental health treatment and smoking cessation. DESIGN, SETTING, AND PARTICIPANTS Use of nationally representative surveys of noninstitutionalized US residents to compare trends in smoking rates between adults with and without mental illness and across multiple disorders (2004-2011 Medical Expenditure Panel Survey [MEPS]) and to compare rates of smoking cessation among adults with mental illness who did and did not receive mental health treatment (2009-2011 National Survey of Drug Use and Health [NSDUH]).The MEPS sample included 32,156 respondents with mental illness (operationalized as reporting severe psychological distress, probable depression, or receiving treatment for mental illness) and 133,113 without mental illness. The NSDUH sample included 14,057 lifetime smokers with mental illness. MAIN OUTCOMES AND MEASURES Current smoking status (primary analysis; MEPS sample) and smoking cessation, operationalized as a lifetime smoker who did not smoke in the last 30 days (secondary analysis; NSDUH sample). RESULTS Adjusted smoking rates declined significantly among individuals without mental illness (19.2% [95% CI, 18.7-19.7%] to 16.5% [95% CI, 16.0%-17.0%]; P < .001) but changed only slightly among those with mental illness (25.3% [95% CI, 24.2%-26.3%] to 24.9% [95% CI, 23.8%- 26.0%]; P = .50), a significant difference in difference of 2.3% (95% CI, 0.7%-3.9%) (P = .005). Individuals with mental illness who received mental health treatment within the previous year were more likely to have quit smoking (37.2% [95% CI, 35.1%-39.4%]) than those not receiving treatment (33.1% [95% CI, 31.5%-34.7%]) (P = .005). CONCLUSIONS AND RELEVANCE Between 2004 and 2011, the decline in smoking among individuals with mental illness was significantly less than among those without mental illness, although quit rates were greater among those receiving mental health treatment. This suggests that tobacco control policies and cessation interventions targeting the general population have not worked as effectively for persons with mental illness.
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Affiliation(s)
- Benjamin Lê Cook
- Harvard Medical School/Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts
| | - Geoff Ferris Wayne
- Harvard Medical School/Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts
| | - E Nilay Kafali
- Harvard Medical School/Cambridge Health Alliance, Department of Psychiatry, Cambridge, Massachusetts
| | - Zimin Liu
- College of Economics and Management, Southwest University, Chongqing, People's Republic of China
| | - Chang Shu
- Harvard School of Public Health, Department of Epidemiology, Boston, Massachusetts
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Treatment of Comorbid Tobacco Addiction in Substance Use and Psychiatric Disorders. CURRENT ADDICTION REPORTS 2013. [DOI: 10.1007/s40429-013-0001-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Poston WS, Haddock CK, Jahnke SA, Jitnarin N. What do veterans service organizations' web sites say about tobacco control? Am J Health Promot 2013; 28:88-96. [PMID: 23631454 PMCID: PMC3778046 DOI: 10.4278/ajhp.120905-qual-426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Little is known about veterans service organizations (VSOs) and their perspectives on veterans smoking or military tobacco control. Veterans have high smoking rates and many started smoking in the military, where a culture promoting use exists. DESIGN A qualitative content analysis of VSO Web sites was conducted to classify health topics and identify tobacco-related information. SETTING Web sites were coded by trained raters from January to June of 2011. Data were entered, cleaned, and analyzed from July 2011 to January 2012. SUBJECTS Twenty-four active VSO Web sites meeting inclusion criteria were rated independently. MEASURES A comprehensive form was used to code 15 veteran-relevant health topics across multiple content areas/domains within the Web sites. Raters achieved 94.5% interrater agreement over nearly 5000 data points. ANALYSIS Health content was coded as present or not within multiple VSO Web site areas/domains. The frequency of coverage by each VSO Web site and the number of VSO Web sites that mentioned a health topic in different Web site areas/domains were tabulated. RESULTS A total of 277 health topics were addressed, with the top five being insurance/Tricare/Veterans Administration issues (28.2%), posttraumatic stress disorder (PTSD; 15.5%), disability/amputation/wounds (13.4%), Agent Orange (10.5%), and traumatic brain injury (9.0%). Tobacco was mentioned four times (1.4%) across all 24 VSO Web sites, and smoking cessation was never addressed. CONCLUSION VSO Web sites provide little information on tobacco-related topics and none offered information about smoking cessation. Given the high rates of tobacco use among veterans and active-duty service members, and the interaction between smoking and PTSD symptoms and treatment outcomes, VSOs should consider making tobacco control and smoking cessation higher-priority health issues on their Web sites.
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Affiliation(s)
- Walker S.C. Poston
- Institute for Biobehavioral Health Research, National Development and Research Institutes, Inc., 1920 West 143 Street, Suite 120, Leawood, KS 66224, Phone: 913-681-0300 office,
| | - Christopher K. Haddock
- Institute for Biobehavioral Health Research, National Development and Research Institutes, Inc., 1920 West 143 Street, Suite 120, Leawood, KS 66224, Phone: 913-681-0300 office,
| | - Sara A. Jahnke
- Institute for Biobehavioral Health Research, National Development and Research Institutes, Inc., 1920 West 143 Street, Suite 120, Leawood, KS 66224, Phone: 913-681-0300 office,
| | - Nattinee Jitnarin
- Institute for Biobehavioral Health Research, National Development and Research Institutes, Inc., 1920 West 143 Street, Suite 120, Leawood, KS 66224, Phone: 913-681-0300 office,
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van Hasselt FM, Krabbe PFM, van Ittersum DG, Postma MJ, Loonen AJM. Evaluating interventions to improve somatic health in severe mental illness: a systematic review. Acta Psychiatr Scand 2013; 128:251-60. [PMID: 23438505 DOI: 10.1111/acps.12096] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To present a systematic review of the evaluation of randomized interventions directed toward improving somatic health for patients with severe mental illness (SMI). METHOD A systematic search in PubMed, Embase, Cinahl, and PsycInfo was performed. The scope of the search was prospective studies for patients aged 18-70, published from January 2000 till June 2011. Randomized interventions directed toward improving somatic health for patients with SMI were selected. We excluded studies on elderly, children, and studies performed before 2000. Information on population, type of intervention, follow-up, outcome measures, and on authors' conclusions were drawn from the original articles. RESULTS Twenty-two original studies were included, presenting four types of interventions: health education (n = 9), exercise (n = 6), smoking cessation (n = 5), and changes in health care organization (n = 2). To evaluate the effect of these studies 93 different outcome measures were used in 16 categories. CONCLUSION Many interventions directed toward improving somatic health for patients with SMI have been started. These studies did not apply similar evaluations, and did not use uniform outcome measures of the effect of their interventions. Valuable comparisons on effectiveness are therefore almost impossible.
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Affiliation(s)
- F M van Hasselt
- Pharmacotherapy and Pharmaceutical Care, University of Groningen, Groningen, the Netherlands; GGZ WNB, Mental Health Hospital, Bergen op Zoom, the Netherlands
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Feldner MT, Smith RC, Monson CM, Zvolensky MJ. Initial evaluation of an integrated treatment for comorbid PTSD and smoking using a nonconcurrent, multiple-baseline design. Behav Ther 2013; 44:514-28. [PMID: 23768677 DOI: 10.1016/j.beth.2013.04.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Revised: 04/05/2013] [Accepted: 04/09/2013] [Indexed: 10/26/2022]
Abstract
The present study examined an integrated treatment for comorbid posttraumatic stress disorder (PTSD) and smoking entitled "Smoke-Free to Overcome PTSD: An Integrated Treatment" (STOP IT program). A nonconcurrent multiple-baseline design was used with six community-recruited adult smokers with PTSD to investigate both patient acceptance of the treatment and its initial efficacy on both PTSD and smoking. Potential order effects of exposure-based and affect management components were also examined. A gold-standard assessment strategy that included the Clinician Administered PTSD Scale (Blake et al., 1995) and biochemical verification of self-reported smoking status was employed to measure primary targets of treatment. Results suggested that the STOP IT program was well tolerated. There were clinically significant improvements in PTSD outcomes, but only temporary reductions in smoking. Participants' relatively low posttreatment smoking levels increased by the follow-up assessment, although not to baseline levels. Treatment component order did not appear to affect treatment outcomes, but those who were assigned to the exposure-focused writing prior to affect management training condition appeared more likely to discontinue treatment before beginning exposure. These preliminary data support the safety, acceptability, and potential efficacy of the STOP IT program. Future investigation of the STOP IT program should include testing the incremental efficacy of increasing the dose of smoking-focused intervention, as well as randomized controlled tests of the treatment that employ gold standards for treatment outcome research.
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van der Meer RM, Willemsen MC, Smit F, Cuijpers P. Smoking cessation interventions for smokers with current or past depression. Cochrane Database Syst Rev 2013:CD006102. [PMID: 23963776 DOI: 10.1002/14651858.cd006102.pub2] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Individuals with current or past depression are often smokers who are more nicotine dependent, more likely to suffer from negative mood changes after nicotine withdrawal, and more likely to relapse to smoking after quitting than the general population, which contributes to their higher morbidity and mortality from smoking-related illnesses. It remains unclear what interventions can help them to quit smoking. OBJECTIVES To evaluate the effectiveness of smoking cessation interventions, with and without specific mood management components, in smokers with current or past depression. SEARCH METHODS In April 2013, we searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, other reviews, and asked experts for information on trials. SELECTION CRITERIA Criteria for including studies in this review were that they had to be randomised controlled trials (RCTs) comparing smoking cessation interventions in adult smokers with current or past depression. Depression was defined as major depression or depressive symptoms. We included studies where subgroups of participants with depression were identified, either pre-stated or post hoc. The outcome was abstinence from smoking after six months or longer follow-up. We preferred prolonged or continuous abstinence and biochemically validated abstinence where available. DATA COLLECTION AND ANALYSIS When possible, we estimated pooled risk ratios (RRs) with the Mantel-Haenszel method (fixed-effect model). We also performed subgroup analyses, by length of follow-up, depression measurement, depression group in study, antidepressant use, published or unpublished data, format of intervention, level of behavioural support, additional pharmacotherapy, type of antidepressant medication, and additional nicotine replacement therapy (NRT). MAIN RESULTS Forty-nine RCTs were included of which 33 trials investigated smoking cessation interventions with specific mood management components for depression. In smokers with current depression, meta-analysis showed a significant positive effect for adding psychosocial mood management to a standard smoking cessation intervention when compared with standard smoking cessation intervention alone (11 trials, N = 1844, RR 1.47, 95% CI 1.13 to 1.92). In smokers with past depression we found a similar effect (13 trials, N = 1496, RR 1.41, 95% CI 1.13 to 1.77). Meta-analysis resulted in a positive effect, although not significant, for adding bupropion compared with placebo in smokers with current depression (5 trials, N = 410, RR 1.37, 95% CI 0.83 to 2.27). There were not enough trial data to evaluate the effectiveness of fluoxetine and paroxetine for smokers with current depression. Bupropion (4 trials, N = 404, RR 2.04, 95% CI 1.31 to 3.18) might significantly increase long-term cessation among smokers with past depression when compared with placebo, but the evidence for bupropion is relatively weak due to the small number of studies and the post hoc subgroups for all the studies. There were not enough trial data to evaluate the effectiveness of fluoxetine, nortriptyline, paroxetine, selegiline, and sertraline in smokers with past depression.Twenty-three of the 49 trials investigated smoking cessation interventions without specific components for depression. There was heterogeneity between the trials which compared psychosocial interventions with standard smoking cessation counselling for both smokers with current and past depression. Therefore, we did not estimate a pooled effect. One trial compared nicotine replacement therapy (NRT) versus placebo in smokers with current depression and found a positive, although not significant, effect (N = 196, RR 2.64, 95% CI 0.93 to 7.45). Meta-analysis also found a positive, although not significant, effect for NRT versus placebo in smokers with past depression (3 trials, N = 432, RR 1.17, 95% CI 0.85 to 1.60). Three trials compared other pharmacotherapy versus placebo and six trials compared other interventions in smokers with current or past depression. Due to heterogeneity between the interventions of the included trials we did not estimate pooled effects. AUTHORS' CONCLUSIONS Evidence suggests that adding a psychosocial mood management component to a standard smoking cessation intervention increases long-term cessation rates in smokers with both current and past depression when compared with the standard intervention alone. Pooled results from four trials suggest that use of bupropion may increase long-term cessation in smokers with past depression. There was no evidence found for the use of bupropion in smokers with current depression. There was not enough evidence to evaluate the effectiveness of the other antidepressants in smokers with current or past depression. There was also not enough evidence to evaluate the group of trials that investigated interventions without specific mood management components for depression, including NRT and psychosocial interventions.
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Jayasinghe UW, Harris MF, Taggart J, Christl B, Black DA. Gender differences in health-related quality of life of Australian chronically-ill adults: patient and physician characteristics do matter. Health Qual Life Outcomes 2013; 11:102. [PMID: 23800331 PMCID: PMC3691728 DOI: 10.1186/1477-7525-11-102] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 06/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aims of this study were to explore the health-related quality of life (HRQoL) in a large sample of Australian chronically-ill patients (type 2 diabetes and/or hypertension/ischaemic heart disease), to investigate the impact of characteristics of patients and their general practitioners on their HRQoL and to examine clinically significant differences in HRQoL among males and females. METHODS This was a cross-sectional study with 193 general practitioners and 2181 of their chronically-ill patients aged 18 years or more using the standard Short Form Health Survey (SF-12) version 2. SF-12 physical component score (PCS-12) and mental component score (MCS-12) were derived using the standard US algorithm. Multilevel regression analysis (patients at level 1 and general practitioners at level 2) was applied to relate PCS-12 and MCS-12 to patient and general practitioner (GP) characteristics. RESULTS Employment was likely to have a clinically significant larger positive effect on HRQoL of males (regression coefficient (B) (PCS-12) = 7.29, P < 0.001, effect size = 1.23 and B (MCS-12) = 3.40, P < 0.01, effect size = 0.55) than that of females (B(PCS-12) = 4.05, P < 0.001, effect size = 0.78 and B (MCS-12) = 1.16, P > 0.05, effect size = 0.16). There was a clinically significant difference in HRQoL among age groups. Younger men (< 39 years) were likely to have better physical health than older men (> 59 years, B = -5.82, P < 0.05, effect size = 0.66); older women tended to have better mental health (B = 5.62, P < 0.001, effect size = 0.77) than younger women. Chronically-ill women smokers reported clinically significant (B = -3.99, P < 0.001, effect size = 0.66) poorer mental health than women who were non-smokers. Female GPs were more likely to examine female patients than male patients (33% vs. 15%, P < 0.001) and female patients attending female GPs reported better physical health (B = 1.59, P < 0.05, effect size = 0.30). CONCLUSIONS Some of the associations between patient characteristics and SF-12 physical and/or mental component scores were different for men and women. This finding underlines the importance of considering these factors in the management of chronically-ill patients in general practice. The results suggest that chronically ill women attempting to quit smoking may need more psychological support. More quantitative studies are needed to determine the association between GP gender and patient gender in relation to HRQoL.
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Affiliation(s)
- Upali W Jayasinghe
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.
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Tobacco use and nicotine dependence among conflict-affected men in the Republic of Georgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:2185-97. [PMID: 23759953 PMCID: PMC3717731 DOI: 10.3390/ijerph10062185] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 05/06/2013] [Accepted: 05/16/2013] [Indexed: 11/17/2022]
Abstract
Background: There is very little evidence globally on tobacco use and nicotine dependence among civilian populations affected by armed conflict, despite key vulnerability factors related to elevated mental disorders and socio-economic stressors. The study aim was to describe patterns of smoking and nicotine dependence among conflict-affected civilian men in the Republic of Georgia and associations with mental disorders. Methods: A cross-sectional household survey using multistage random sampling was conducted in late 2011 among conflict-affected populations in Georgia. Respondents included in this paper were 1,248 men aged ≥18 years who were internally displaced persons (IDPs) and former IDPs who had returned in their home areas. Outcomes of current tobacco use, heavy use (≥20 cigarettes per day), and nicotine dependence (using the Fagerström Test for Nicotine Dependence) were used. PTSD, depression, anxiety and hazardous alcohol use were also measured, along with exposure to traumatic events and a range of demographic and socio-economic characteristics. Results: Of 1,248 men, 592 (47.4%) smoked and 70.9% of current smokers were heavy smokers. The mean nicotine dependence score was 5.0 and the proportion with high nicotine dependence (≥6) was 41.4%. In multivariate regression analyses, nicotine dependence was significantly associated with PTSD (β 0.74) and depression (β 0.85), along with older age (except 65+ years), and being a returnee (compared to IDPs). Conclusions: The study reveals very high levels of heavy smoking and nicotine dependence among conflict-affected persons in Georgia. The associations between nicotine dependence, PTSD and depression suggest interventions could yield synergistic benefits.
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McClernon FJ, Calhoun PS, Hertzberg JS, Dedert EA, Beckham JC. Associations between smoking and psychiatric comorbidity in U.S. Iraq- and Afghanistan-era veterans. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2013; 27:1182-1188. [PMID: 23713569 DOI: 10.1037/a0032014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The risk of smoking increases with specific psychiatric diagnoses (e.g., posttraumatic stress disorder); but the risk has also been shown to increase as a function of the number of psychiatric illnesses with which a person is diagnosed. The current study examined this association and other correlates of smoking-psychiatric comorbidity in a sample of U.S. Iraq- and Afghanistan-era veterans who have served since September 11, 2001. The sample consisted of 1,691 veterans (Mage = 37.5 years, 20.2% women, 53.2% minority). Veterans completed measures of smoking history, nicotine dependence, and smoking expectancies; they also underwent a structured diagnostic interview to establish any current and/or lifetime psychiatric diagnoses. Consistent with previous studies, the number of comorbid diagnoses was significantly associated with both heavy (>20 cigarettes/day) and light-to-moderate (≤20 cigarette/day) smoking. Moreover, among current smokers, significant correlations between self-reported dependence and number of diagnoses were observed. Examination of self-reported smoking expectancies revealed that a greater number of diagnoses were associated with greater expectancies of negative affect reduction, stimulation and state enhancement, taste and sensorimotor manipulation, social facilitation, craving and addiction, and boredom reduction. The present findings confirm the association between the number of comorbid diagnoses reported in previous studies, and extends those findings by identifying smoking expectancies differences among smokers with comorbid diagnoses.
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Hertzberg JS, Carpenter VL, Kirby AC, Calhoun PS, Moore SD, Dennis MF, Dennis PA, Dedert EA, Beckham JC. Mobile contingency management as an adjunctive smoking cessation treatment for smokers with posttraumatic stress disorder. Nicotine Tob Res 2013; 15:1934-8. [PMID: 23645606 DOI: 10.1093/ntr/ntt060] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Smokers with posttraumatic stress disorder (PTSD) smoke at higher prevalence rates and are more likely to relapse early in a quit attempt. Innovative methods are needed to enhance quit rates, particularly in the early quit period. Web-based contingency-management (CM) approaches have been found helpful in reducing smoking among other difficult-to-treat smoker populations but are limited by the need for computers. This pilot study builds on the web-based CM approach by evaluating a smartphone-based application for CM named mobile CM (mCM). METHODS Following a 2-week training period, 22 smokers with PTSD were randomized to a 4-week mCM condition or a yoked (i.e., noncontingent 4-week mCM condition). All smokers received 2 smoking cessation counseling sessions, nicotine replacement, and bupropion. Participants could earn up to $690 ($530 for mCM, $25.00 for assessments and office visits [up to 5], and $35.00 for equipment return). The average earned was $314.00. RESULTS Compliance was high during the 2-week training period (i.e., transmission of videos) (93%) and the 4-week treatment period (92%). Compliance rates did not differ by group assignment. Four-week quit rates (verified with CO) were 82% for the mCM and 45% for the yoked controls. Three-month self-report quit rates were 50% in the mCM and 18% in the yoked controls. CONCLUSIONS mCM may be a useful adjunctive smoking cessation treatment component for reducing smoking among smokers with PTSD, particularly early in a smoking quit attempt.
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Affiliation(s)
- Jeffrey S Hertzberg
- Research and Development Service, Durham Veterans Affairs Medical Center, Durham, NC
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132
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Schueller SM, Pérez-Stable EJ, Muñoz RF. A Mood Management Intervention in an Internet Stop Smoking Randomized Controlled Trial Does Not Prevent Depression: A Cautionary Tale. Clin Psychol Sci 2013; 1:401-412. [PMID: 25525565 DOI: 10.1177/2167702613484717] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Smoking and depression are related, and mood management interventions included in smoking cessation interventions can increase smoking abstinence rates. Could a mood management intervention embedded in an Internet-based smoking cessation intervention prevent major depressive episodes? Spanish- and English-speaking smokers (N = 17,430) from 191 countries were randomized to one of four online self-help intervention conditions (two with mood management). We analyzed preventive effects among those participants without a major depressive episode at baseline. The mood management intervention did not reduce the incidence of major depressive episodes in the following 12 months. However, we found a mood management by depression risk interaction (OR = 1.77, p = .004), such that high-risk participants who received the mood management intervention had an increased occurrence of major depressive episodes (32.8% vs. 26.6%), but not low-risk participants (11.6% vs. 10.8%). Further research on whether mood management interventions may have deleterious effects on subsets of smokers appears warranted.
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Affiliation(s)
- Stephen M Schueller
- Department of Psychiatry, University of California, San Francisco ; Department of Psychiatry, San Francisco General Hospital ; Department of Preventive Medicine, Northwestern University
| | | | - Ricardo F Muñoz
- Department of Psychiatry, University of California, San Francisco ; Department of Psychiatry, San Francisco General Hospital ; Palo Alto University
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133
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Abstract
Posttraumatic stress disorder (PTSD) is an anxiety disorder initiated by exposure to a traumatic event and characterized by intrusive thoughts about the event, attempts to avoid reminders of the event, and physiological hyperarousal. In a number of large prospective observational studies, PTSD has been associated with incident cardiovascular disease (CVD) and mortality. Also, in recent years, a number of studies have shown that cardiovascular events can themselves cause PTSD in more than 1 in 8 patients with acute coronary syndrome. Further, a few small studies suggest that PTSD secondary to an acute CVD event then places patients at increased risk for subsequent CVD events and mortality. In this article, we review the evidence for a link between PTSD and CVD, and discuss potential mechanisms for that association as well as future directions for research.
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Affiliation(s)
- Donald Edmondson
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY 10032, USA.
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134
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Gill JM, Saligan L, Lee H, Rotolo S, Szanton S. Women in recovery from PTSD have similar inflammation and quality of life as non-traumatized controls. J Psychosom Res 2013; 74:301-6. [PMID: 23497831 DOI: 10.1016/j.jpsychores.2012.10.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 10/03/2012] [Accepted: 10/29/2012] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Post-traumatic stress disorder (PTSD) is associated with greater concentrations of inflammatory biomarkers as well as substantial medical burden; however, it is not clear if these morbidity risks change following recovery from PTSD. In this study we compare women who have recovered from PTSD, to those with current PTSD, and healthy controls on their perceived health and inflammatory and metabolic biomarkers. METHODS We studied 3 groups of women: those with current PTSD, those who reported recovery from PTSD, and healthy non-traumatized controls, which were determined using standard diagnostic instruments. We obtained a morning blood sample and examined concentrations of inflammatory biomarkers of: interleukin 6 (IL-6) and c-reactive protein (CRP), and lipid concentrations. Lastly, we evaluated health related quality of life (HRQOL). RESULTS Women who had recovered from PTSD had a similar HRQOL and inflammatory biomarkers as non-traumatized controls. Their concentrations of inflammatory biomarkers were lower than women with current PTSD, and similar to non-traumatized controls. CONCLUSION Health perception as well as biological indicators of health significantly differ in women in recovery from PTSD, compared to those who remain symptomatic. These findings suggest that the psychological recovery is associated with normal levels of inflammatory biomarkers and HRQOL.
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Affiliation(s)
- Jessica M Gill
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.
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Piper ME, Rodock M, Cook JW, Schlam TR, Fiore MC, Baker TB. Psychiatric diagnoses among quitters versus continuing smokers 3 years after their quit day. Drug Alcohol Depend 2013; 128:148-54. [PMID: 22995766 PMCID: PMC3591817 DOI: 10.1016/j.drugalcdep.2012.08.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/16/2012] [Accepted: 08/21/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with psychiatric disorders are more likely to smoke and smoke more heavily than the general population, and they suffer disproportionally from smoking-related illnesses. However, little is known about how quitting versus continuing to smoke affects mental health and the likelihood of developing a psychiatric diagnosis. This study used data from a large prospective clinical trial to examine the relations of smoking cessation success with psychiatric diagnoses 1 and 3 years after the target quit day. METHODS This study enrolled 1504 smokers (83.9% white; 58.2% female) in a cessation trial that involved the completion of the Composite International Diagnostic Interview to assess psychiatric diagnoses and biochemical confirmation of point-prevalence abstinence at Baseline and Years 1 and 3. RESULTS Regression analyses showed that, after controlling for pre-quit (past-year) diagnoses, participants who were smoking at the Year 3 follow-up were more likely to have developed and maintained a substance use or major depressive disorder by that time than were individuals who were abstinent at Year 3. CONCLUSIONS Quitting smoking does not appear to negatively influence mental health in the long-term and may be protective with respect to depression and substance use diagnoses; this should encourage smokers to make quit attempts and encourage clinicians to provide cessation treatment.
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Affiliation(s)
- Megan E Piper
- Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, Madison, WI 53711, USA.
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136
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Ayala A, Geer M. Pharmacy considerations in tobacco cessation for patients suffering from posttraumatic stress disorder. Ment Health Clin 2013. [DOI: 10.9740/mhc.n131050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Multiple studies have associated post traumatic stress disorder (PTSD) with variable and high rates of smoking documented in different populations. This article will cover the neurobiology behind tobacco use, and its implications in those with PTSD. Discussion on cessation programs (e.g., effectiveness, drug interactions), and controversy over the use of varenicline will also be discussed.
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Affiliation(s)
- Allen Ayala
- Clinical Pharmacy Specialist- Psychiatry, VA Medical Center, Lebanon, PA
| | - Melanie Geer
- Clinical Pharmacy Specialist, VA Medical Center, Lebanon, PA
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137
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Using incentives to reduce substance use and other health risk behaviors among people with serious mental illness. Prev Med 2012; 55 Suppl:S54-60. [PMID: 22197799 PMCID: PMC3336027 DOI: 10.1016/j.ypmed.2011.11.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 11/23/2011] [Accepted: 11/30/2011] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Serious mental illness (SMI) is associated with high rates of tobacco and other drug dependence, poor treatment compliance, obesity and low levels of physical activity, which have severe medical and psychosocial consequences. Interventions that effectively reduce these health risk behaviors among people with SMI are urgently needed. METHODS Published reports from studies evaluating incentive-based treatments for promoting tobacco and other drug abstinence, treatment attendance, medication use and increased physical activity are reviewed. RESULTS Results of this review indicate the efficacy of incentive-based treatments for reducing tobacco and other drug use among people with SMI. Few studies have examined whether incentive-based treatments improve treatment attendance, medication use and physical activity levels in people with SMI; however, initial evidence is positive and indicates that further research in these areas is warranted. CONCLUSION Given the medical and psychosocial costs of tobacco and other drug use, treatment non-compliance and physical inactivity, and the efficacy of incentive-based treatments for improving these behaviors, such interventions should be further developed and integrated into behavioral health treatment programs for people with SMI.
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Longitudinal analysis of the relationship between PTSD symptom clusters, cigarette use, and physical health-related quality of life. Qual Life Res 2012; 22:1381-9. [DOI: 10.1007/s11136-012-0280-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2012] [Indexed: 10/27/2022]
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McKellar J, Wagner T, Harris A, Oehlert M, Buckley S, Moos R. One-year outcomes of telephone case monitoring for patients with substance use disorder. Addict Behav 2012; 37:1069-74. [PMID: 22651986 DOI: 10.1016/j.addbeh.2012.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 02/06/2012] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Many patients treated for substance use disorder (SUD) do not achieve lasting recovery from a single episode of treatment and require continuing care. The current randomized clinical trial investigated whether in-person continuing care as usual (CCAU) following intensive outpatient SUD treatment leads to better SUD outcomes when compared with telephone case monitoring (TCM). METHOD This study randomized 667 intensive SUD outpatients to telephone case monitoring versus face-to-face continuing care as usual at two sites. Patients completed data at baseline, 3 and 12months with telephone interviews. Data of interest include self-report of substance use, psychiatric symptoms, quality of life, and treatment satisfaction. We also evaluated potential interaction effects for distance to VA provider, SUD severity, and presence of co-morbid psychiatric disorder. RESULTS Participants randomized to the telephone case monitoring condition substantially engaged with face-to-face continuing care resulting in cross-over contamination. We addressed this issue by using randomization as an instrumental variable to evaluate the impact of telephone case monitoring (contamination adjusted, intent to treat analysis). Instrumental variable analyses indicated significant benefit of telephone case monitoring for drug and alcohol percent days abstinent and psychiatric symptom outcomes at 3-months follow-up, but not at 12-month follow-up. No interaction analyses were significant. DISCUSSION Participants receiving telephone case monitoring achieved better short term outcomes in terms of substance use and psychiatric symptoms. The "on treatment" effects suggests the need for future studies to investigate consumer (patient) perspectives on the optimal duration of telephone case monitoring and use of alternative monitoring methods such as text messaging.
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140
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Mackowick KM, Lynch MJ, Weinberger AH, George TP. Treatment of tobacco dependence in people with mental health and addictive disorders. Curr Psychiatry Rep 2012; 14:478-85. [PMID: 22821177 PMCID: PMC3722553 DOI: 10.1007/s11920-012-0299-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
People with mental health and addictive disorders (MHADs) have higher rates of cigarette smoking, and less success in quitting smoking compared with the general population. Moreover, tobacco-related medical illness may be the leading cause of death in the MHAD population. We discuss the scope of this comorbidity, and approaches to the treatment of tobacco dependence in people with MHAD, including schizophrenia, mood disorders, anxiety disorders, and alcohol and substance use disorders. Finally, at the level of health systems, we emphasize the importance of integrated treatment of tobacco dependence in MHADs.
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Affiliation(s)
- Kristen M. Mackowick
- Intramural Research Program, National Institute on Drug Abuse (NIDA), National Institutes of Health (NIH), Baltimore, MD USA; Institute of Medical Sciences, University of Toronto, Toronto, ON Canada
| | - Marie-Josee Lynch
- Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto; Schizophrenia Program, Centre for Addiction and Mental Health (CAMH), Toronto, ON Canada
| | - Andrea H. Weinberger
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
- Cancer Prevention and Control Research Program, Yale Cancer Center, New Haven, CT USA
| | - Tony P. George
- Division of Brain and Therapeutics, Department of Psychiatry, University of Toronto; Schizophrenia Program, Centre for Addiction and Mental Health (CAMH), Toronto, ON Canada
- Division of Substance Abuse, Department of Psychiatry, Yale University School of Medicine, New Haven, CT USA
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Abstract
BACKGROUND Whether the prevalence of type 1 or 2 diabetes is rising among people with psychopathology is uncertain. This study investigates changes in the prevalence of type 1 and type 2 diabetes associated with psychopathology in the adult Australian population from 2001 to 2008. METHODS Data analysed were from 48,359 participants aged ≥25 years from the 2001, 2004-05 or 2007-08 National Health Surveys. Lifetime diagnosis of type 1 and type 2 diabetes was determined by self-report. Psychopathology status was determined with the 10-item Kessler Psychological Distress Scale (using scores ≥30), contemporaneous use of antidepressants or anti-anxiety medications, or both. RESULTS Overall, the prevalence of type 1 diabetes remained stable whereas the prevalence of type 2 diabetes increased by 36% between 2001 and 2008. On average, odds ratios with 95% confidence intervals (95% CI) for type 1 and type 2 diabetes ranged from 1.43 (0.98, 2.10) to 2.44 (1.63, 3.64) and 1.32 (1.13, 1.53) to 1.67 (1.39, 2.02) for people with compared to those without psychopathology by any definition independent of socio-demographic covariates, consistently over the 8-year period. After further adjustments for lifestyle covariates, the strength of these odds ratios were attenuated and ranged from 1.32 (0.90, 1.95) to 2.24 (1.49, 3.36) and 1.16 (0.99,1.36) to 1.51 (1.24, 1.83) for type 1 and type 2 diabetes. LIMITATIONS Data were self-report from serial surveys. CONCLUSIONS The prevalence of both type 1 and type 2 diabetes was consistently higher for people with psychopathology from 2001 to 2008. Clinicians should consider routinely screening patients with diabetes for psychopathology and vice versa, as well as lifestyle risk factors, to inform practice for more effective management and prevention planning.
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Affiliation(s)
- Evan Atlantis
- Family & Community Health Research Group, School of Nursing and Midwifery, University of Western Sydney, Penrith, NSW, Australia.
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Morissette SB, Gulliver SB, Kamholz BW, Spiegel DA, Tiffany ST, Barlow DH. Transdermal nicotine during cue reactivity in adult smokers with and without anxiety disorders. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2012; 26:507-18. [PMID: 22686966 PMCID: PMC3443526 DOI: 10.1037/a0028828] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Transdermal nicotine almost doubles tobacco cessation rates; however, little is known about what happens to smokers during the quit process when they are wearing the nicotine patch and are confronted with high-risk smoking triggers. This is particularly important for smokers with psychological disorders who disproportionately represent today's smokers and have more trouble quitting. Using a mixed between- and within-subjects design, smokers with anxiety disorders (n=61) and smokers without any current Axis I disorders (n=38) received transdermal nicotine (21 mg) or a placebo patch over two assessment days separated by 48 hr. Urge to smoke was evaluated during a 5-hr patch absorption period (reflecting general smoking deprivation) and during imaginal exposure to theoretically high-risk triggers containing smoking cues, anxiety cues, both, or neutral cues. No differences were observed between smokers with and without anxiety disorders. Significant Patch×Time and Patch×Cue Content interactions were found. Both patch conditions experienced an increase in urge during the deprivation period, but postabsorption urge was significantly higher in the placebo condition, suggesting that transdermal nicotine attenuated the degree to which urge to smoke increased over time. During the cue reactivity trials, when participants received the nicotine patch, they experienced significantly lower urge in response to both smoking-only and neutral cues, but not when anxiety cues were present (alone or in combination with smoking cues). These data suggest that transdermal nicotine alleviates urge only under certain circumstances and that adjunctive interventions are likely necessary to address smoking urges in response to spikes in distress among smokers trying to quit.
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143
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Aversa LH, Stoddard JA, Doran NM, Au S, Chow B, McFall M, Saxon A, Baker DG. PTSD and depression as predictors of physical health-related quality of life in tobacco-dependent veterans. J Psychosom Res 2012; 73:185-90. [PMID: 22850258 DOI: 10.1016/j.jpsychores.2012.06.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 06/25/2012] [Accepted: 06/25/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Smoking, depression and PTSD are related to poor physical health outcomes and health-related quality of life (HRQoL). Previous studies examining the effects of quitting smoking on HRQoL have been mixed. This study aimed to examine the effects of PTSD, depressive symptoms and smoking cessation on HRQoL in a sample receiving treatment for PTSD. METHOD This study utilized archival interview and self-report data from a clinical trial (VA Cooperative Study 519) that recruited tobacco dependent veterans with chronic PTSD (N=943). RESULTS Analyses were conducted using hierarchical linear modeling and indicated that PTSD and depressive symptoms differentially affected the various physical health status domains. Additionally, quitting smoking was associated with better self-perceived health status and social functioning. CONCLUSION Our findings further explain the interrelationships of PTSD, depression, and smoking in the prediction of physical HRQoL and advocate the importance of integrated care.
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Affiliation(s)
- Laura H Aversa
- Veterans Affairs San Diego Healthcare System, 3350 La Jolla Village Dr.151, San Diego, CA 92161, USA
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144
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Intensive intervention for alcohol-dependent smokers in early recovery: a randomized trial. Drug Alcohol Depend 2012; 122:186-94. [PMID: 22014532 PMCID: PMC3288470 DOI: 10.1016/j.drugalcdep.2011.09.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 09/04/2011] [Accepted: 09/22/2011] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate the efficacy of an intensive tobacco cessation intervention for alcohol-dependent smokers in early recovery. METHODS A total of 162 alcohol-dependent smokers were randomized to either intensive intervention for smoking cessation or usual care. The intensive intervention consisted of 16 sessions of individual cognitive behavior therapy (CBT) and combination nicotine replacement therapy that lasted 26 weeks. Usual care involved referral to a free-standing smoking cessation program that provided smoking cessation counseling of varying duration and guideline-concordant medications. The primary cessation outcome was verified 7-day point prevalence abstinence (PPA) at 12, 26, 38, and 52 weeks. RESULTS At 12 and 26 weeks, the verified 7-day point-prevalence quit rate was significantly higher for the intensive intervention group than for the usual care group (both p=0.03). However, the quit rates for the two treatment groups were not significantly different at 38 or 52 weeks. Verified 30-day alcohol abstinence rates were not significantly different for the two treatment groups at any of the follow-up assessments. CONCLUSIONS The intensive smoking cessation intervention yielded a higher short-term smoking quit rate without jeopardizing sobriety. A chronic care model might facilitate maintenance of smoking cessation during the first year of alcohol treatment and perhaps for longer periods of time. It is hoped that studies such as this will inform the development of more effective interventions for concurrent alcohol and tobacco use disorders.
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Duffy SA, Kilbourne AM, Austin KL, Dalack GW, Woltmann EM, Waxmonsky JA, Noonan D. Risk of smoking and receipt of cessation services among veterans with mental disorders. Psychiatr Serv 2012; 63:325-32. [PMID: 22337005 PMCID: PMC3323716 DOI: 10.1176/appi.ps.201100097] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this study was to determine rates of smoking and receipt of provider recommendations to quit smoking among patients with mental disorders treated in U.S. Department of Veterans Affairs (VA) treatment settings. METHODS The authors conducted a secondary analysis of the yearly, cross-sectional 2007 Veterans Health Administration Outpatient Survey of Healthcare Experiences of Patients (N=224,193). Logistic regression was used to determine the independent association of mental health diagnosis and the dependent variables of smoking and receipt of provider recommendations to quit smoking. RESULTS Patients with mental disorders had greater odds of smoking, compared with those without mental disorders (p<.05). Those with various mental disorders reported similar rates of receiving services (more than 60% to 80% reported receiving selected services), compared with those without these disorders, except that those with schizophrenia had more than 30% lower odds of receiving advice to quit smoking from their physicians (p<.05). Moreover, those who had co-occurring posttraumatic stress disorder or substance use disorders had significantly greater odds of reporting that they received advice to quit, recommendations for medications, and physician discussions of quitting methods, compared with those without these disorders (p<.05). Older patients, male patients, members of ethnic minority groups, those who were unmarried, those who were disabled or unemployed, and those living in rural areas had lower odds of receiving selected services (p<.05). CONCLUSIONS The majority of patients with mental disorders served by the VA reported receiving cessation services, yet their smoking rates remained high, and selected groups were at risk for receiving fewer cessation services, suggesting the continued need to disseminate cessation services.
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Affiliation(s)
- Sonia A. Duffy
- Dr. Duffy, Dr. Kilbourne, Ms. Austin, and Dr. Woltmann are affiliated with the VA Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center 2215 Fuller Rd., Ann Arbor, MI 48105 (). Dr. Duffy, Dr. Kilbourne, and Dr. Dalack are with the Department of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Duffy is with the Department of Otolaryngology, University of Michigan, Ann Arbor, MI. Dr. Waxmonsky is with the Depression Center and the Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Duffy and Dr. Noonan are with the School of Nursing, University of Michigan, Ann Arbor, MI
| | - Amy M. Kilbourne
- Dr. Duffy, Dr. Kilbourne, Ms. Austin, and Dr. Woltmann are affiliated with the VA Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center 2215 Fuller Rd., Ann Arbor, MI 48105 (). Dr. Duffy, Dr. Kilbourne, and Dr. Dalack are with the Department of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Duffy is with the Department of Otolaryngology, University of Michigan, Ann Arbor, MI. Dr. Waxmonsky is with the Depression Center and the Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Duffy and Dr. Noonan are with the School of Nursing, University of Michigan, Ann Arbor, MI
| | - Karen L. Austin
- Dr. Duffy, Dr. Kilbourne, Ms. Austin, and Dr. Woltmann are affiliated with the VA Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center 2215 Fuller Rd., Ann Arbor, MI 48105 (). Dr. Duffy, Dr. Kilbourne, and Dr. Dalack are with the Department of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Duffy is with the Department of Otolaryngology, University of Michigan, Ann Arbor, MI. Dr. Waxmonsky is with the Depression Center and the Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Duffy and Dr. Noonan are with the School of Nursing, University of Michigan, Ann Arbor, MI
| | - Gregory W. Dalack
- Dr. Duffy, Dr. Kilbourne, Ms. Austin, and Dr. Woltmann are affiliated with the VA Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center 2215 Fuller Rd., Ann Arbor, MI 48105 (). Dr. Duffy, Dr. Kilbourne, and Dr. Dalack are with the Department of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Duffy is with the Department of Otolaryngology, University of Michigan, Ann Arbor, MI. Dr. Waxmonsky is with the Depression Center and the Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Duffy and Dr. Noonan are with the School of Nursing, University of Michigan, Ann Arbor, MI
| | - Emily M. Woltmann
- Dr. Duffy, Dr. Kilbourne, Ms. Austin, and Dr. Woltmann are affiliated with the VA Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center 2215 Fuller Rd., Ann Arbor, MI 48105 (). Dr. Duffy, Dr. Kilbourne, and Dr. Dalack are with the Department of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Duffy is with the Department of Otolaryngology, University of Michigan, Ann Arbor, MI. Dr. Waxmonsky is with the Depression Center and the Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Duffy and Dr. Noonan are with the School of Nursing, University of Michigan, Ann Arbor, MI
| | - Jeanette A. Waxmonsky
- Dr. Duffy, Dr. Kilbourne, Ms. Austin, and Dr. Woltmann are affiliated with the VA Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center 2215 Fuller Rd., Ann Arbor, MI 48105 (). Dr. Duffy, Dr. Kilbourne, and Dr. Dalack are with the Department of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Duffy is with the Department of Otolaryngology, University of Michigan, Ann Arbor, MI. Dr. Waxmonsky is with the Depression Center and the Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Duffy and Dr. Noonan are with the School of Nursing, University of Michigan, Ann Arbor, MI
| | - Devon Noonan
- Dr. Duffy, Dr. Kilbourne, Ms. Austin, and Dr. Woltmann are affiliated with the VA Ann Arbor Center for Clinical Management Research, Serious Mental Illness Treatment Resource and Evaluation Center 2215 Fuller Rd., Ann Arbor, MI 48105 (). Dr. Duffy, Dr. Kilbourne, and Dr. Dalack are with the Department of Psychiatry, University of Michigan, Ann Arbor, MI. Dr. Duffy is with the Department of Otolaryngology, University of Michigan, Ann Arbor, MI. Dr. Waxmonsky is with the Depression Center and the Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO. Dr. Duffy and Dr. Noonan are with the School of Nursing, University of Michigan, Ann Arbor, MI
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Gierisch JM, Straits-Tröster K, Calhoun PS, Beckham JC, Acheson S, Hamlett-Berry K. Tobacco use among Iraq- and Afghanistan-era veterans: a qualitative study of barriers, facilitators, and treatment preferences. Prev Chronic Dis 2012; 9:E58. [PMID: 22338598 PMCID: PMC3359099 DOI: 10.5888/pcd9.110131] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Military service and combat exposure are risk factors for smoking. Although evidence suggests that veterans are interested in tobacco use cessation, little is known about their reasons for quitting, treatment preferences, and perceived barriers to effective tobacco use cessation treatment. Our study objective was to elicit perspectives of Iraq- and Afghanistan-era veterans who had not yet quit smoking postdeployment to inform the development of smoking cessation services for this veteran cohort. Methods We conducted 3 focus groups among 20 participants in October 2006 at the Durham Veterans Affairs Medical Center to explore issues on tobacco use and smoking cessation for Iraq- and Afghanistan-era veterans who continued to smoke postdeployment. We used qualitative content analysis to identify major themes and organize data. Results Veterans expressed the belief that smoking was a normalized part of military life and described multiple perceived benefits of smoking. Although veterans expressed a high level of interest in quitting, they listed several behavioral, situational, and environmental triggers that derailed smoking cessation. They expressed interest in such cessation treatment features as flexible scheduling, free nicotine replacement therapy, peer support, and family inclusion in treatment. Conclusion Our results indicate that the newest cohort of veterans perceives smoking as endemic in military service. However, they want to quit smoking and identified several personal and environmental obstacles that make smoking cessation difficult. Our findings may inform programmatic efforts to increase successful quit attempts in this unique veteran population.
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Affiliation(s)
- Jennifer M Gierisch
- Center for Health Services Research in Primary Care, Durham Veterans Affairs (VA) Medical Center (152), 508 Fulton St, Durham, NC 27705, USA.
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147
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Heffner JL, DelBello MP, Anthenelli RM, Fleck DE, Adler CM, Strakowski SM. Cigarette smoking and its relationship to mood disorder symptoms and co-occurring alcohol and cannabis use disorders following first hospitalization for bipolar disorder. Bipolar Disord 2012; 14:99-108. [PMID: 22329477 PMCID: PMC3281507 DOI: 10.1111/j.1399-5618.2012.00985.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Cigarette smoking is highly prevalent among individuals with bipolar disorder (BD) and may adversely affect symptoms of the disorder, as well as the co-occurrence of other substance use disorders. However, anecdotal reports suggesting that smoking cessation caused a worsening of mood in smokers with BD have raised concerns about quitting. In the present study, we prospectively evaluated the course of BD, alcohol use disorders, and cannabis use disorders in relation to smoking and examined the relationship between smoking abstinence and changes in mood. METHODS Participants (N = 161) were adolescents (n=80) and adults (n = 81) with bipolar I disorder who were hospitalized for their initial mixed or manic episode. Participants were followed up to eight years post-hospitalization (median follow-up = 122 weeks) as part of a naturalistic, observational study of the longitudinal course of BD and substance use. RESULTS The course of BD symptoms in the 12 months following index hospitalization did not differ by smoking status in either the adolescent or the adult subsample. Among adolescents, smoking was associated with an increased risk of having a cannabis or alcohol use disorder, almost all of which were new-onset disorders, in the year following first hospitalization. Neither adolescents nor adults who were abstinent from smoking for at least two months experienced significant increases in depressive or manic symptoms. CONCLUSIONS Although cigarette smoking did not predict a worse course of BD, smoking was associated with an increased risk of developing alcohol and cannabis use disorders in adolescents with BD. Importantly, these data provide no evidence to suggest that abstinence from smoking is associated with worsening symptoms of depression or mania in the short term.
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Affiliation(s)
- Jaimee L Heffner
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Cincinnati, OH, USA.
| | - Melissa P DelBello
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert M Anthenelli
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA,Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA
| | - David E Fleck
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Caleb M Adler
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stephen M Strakowski
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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148
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Carmody TP, McFall M, Saxon AJ, Malte CA, Chow B, Joseph AM, Beckham JC, Cook JW. Smoking outcome expectancies in military veteran smokers with posttraumatic stress disorder. Nicotine Tob Res 2012; 14:919-26. [PMID: 22271610 DOI: 10.1093/ntr/ntr304] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Smoking outcome expectancies were investigated in treatment-seeking military Veteran smokers with posttraumatic stress disorder (PTSD). The investigation of smoking outcome expectancies may enhance our understanding of the relationship between PTSD and cigarette smoking. METHODS Participants were 943 military Veterans with a diagnosis of PTSD who were current smokers enrolled in a randomized multisite effectiveness trial to test whether the integration of smoking cessation treatment into mental health care (integrated care) improves prolonged abstinence rates compared with referral to specialized smoking cessation clinics (usual care). Using confirmatory factor analysis (CFA), we evaluated the conceptual model of smoking outcome expectancies measured on the Smoking Consequences Questionnaire-Adult (SCQ-A) version. The Kraemer method of mediation analysis was used to investigate the role of smoking outcome expectancies in mediating relationships between PTSD symptoms and smoking behavior, tobacco dependence, and abstinence self-efficacy. RESULTS The CFA supported the 10-factor structure of the SCQ-A in smokers with PTSD. Relationships between measures of PTSD symptoms and tobacco dependence were mediated by the smoking outcome expectancy regarding negative affect reduction. This same smoking outcome expectancy mediated relationships between PTSD symptoms and smoking abstinence self-efficacy. CONCLUSIONS The findings support the use of the SCQ-A as a valid measure of smoking outcome expectancies in military Veteran smokers with PTSD. Moreover, they suggest that smoking outcome expectancies may play an important role in explaining the relationship between PTSD and cigarette smoking.
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Affiliation(s)
- Timothy P Carmody
- San Francisco VA Medical Center, 4150 Clement Street, San Francisco, CA 94121, USA.
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149
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George TP, Wu BS, Weinberger AH. A Review of Smoking Cessation in Bipolar Disorder: Implications for Future Research. J Dual Diagn 2012; 8:126-130. [PMID: 22737046 PMCID: PMC3378056 DOI: 10.1080/15504263.2012.671717] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Tobacco smoking is common in people with bipolar disorder, and rates of smoking cessation are lower than in the general population. A literature review found eleven clinical research publications on bipolar disorder and tobacco, including only one smoking cessation pharmacotherapy trial. This article will review these findings and discuss possible reasons for the high rates of tobacco addiction among persons with bipolar disorder, as well as specific vulnerability factors that may contribute to tobacco treatment failure. An approach to the clinical assessment and treatment of tobacco dependence is described for this sub-group of smokers. Finally, recommendations are made for planning future treatment studies in persons with bipolar disorder and nicotine dependence.
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Affiliation(s)
- Tony P George
- Schizophrenia Program, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
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150
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Aubin HJ, Rollema H, Svensson TH, Winterer G. Smoking, quitting, and psychiatric disease: A review. Neurosci Biobehav Rev 2012; 36:271-84. [DOI: 10.1016/j.neubiorev.2011.06.007] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 06/14/2011] [Accepted: 06/15/2011] [Indexed: 11/25/2022]
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