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Streck JM, Weinberger AH, Pacek LR, Gbedemah M, Goodwin RD. Cigarette Smoking Quit Rates Among Persons With Serious Psychological Distress in the United States From 2008 to 2016: Are Mental Health Disparities in Cigarette Use Increasing? Nicotine Tob Res 2020; 22:130-134. [PMID: 30351429 DOI: 10.1093/ntr/nty227] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/19/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Prior work suggests that the prevalence of cigarette smoking is persistently higher among people with mental health problems, relative to those without. Lower quit rates are one factor that could contribute to higher prevalence of smoking in this group. This study estimated trends in the cigarette quit rates among people with and without past-month serious psychological distress (SPD) from 2008 to 2016 in the United States. METHODS Data were drawn from 91 739 adult participants in the 2008-2016 National Survey on Drug Use and Health, a repeated, cross-sectional, national survey. Linear time trends of cigarette quit rates, stratified by past-month SPD, were assessed using logistic regression models with continuous year as the predictor. RESULTS Cigarette quit rates among individuals with past-month SPD were lower than among those without SPD every year from 2008 to 2016. Quit rates did not change appreciably among those with past-month SPD (odds ratio = 1.02 [0.99, 1.06]) from 2008 to 2016, whereas quit rates increased among those without past-month SPD (odds ratio = 1.02 [1.01, 1.02]). CONCLUSIONS In the United States, quit rates among individuals with past-month SPD are approximately half than quit rates of those without SPD and have not increased over the past decade. This discrepancy in quit rates may be one factor driving increasing disparities in prevalence of smoking among those with versus without mental health problems. Tobacco control efforts require effective and targeted interventions for those with mental health problems. IMPLICATIONS Cigarette smoking quit rates have not increased among persons with serious mental health problems over the past decade. This work extends prior findings showing that smoking prevalence is not declining as quickly among persons with serious mental health problems. Findings suggest that diverging trends in quit rates are one possible driver of the persistent disparity in smoking by mental health status. Innovation in both tobacco control and targeted interventions for smokers with mental health problems is urgently needed.
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Affiliation(s)
- Joanna M Streck
- Department of Psychological Science, College of Arts and Sciences, University of Vermont, Burlington, VT.,Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT
| | - Andrea H Weinberger
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY.,Department of Epidemiology and Population Health, Yeshiva University Albert Einstein College of Medicine, Bronx, NY
| | - Lauren R Pacek
- Division of Addictions, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
| | - Misato Gbedemah
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY.,Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, NY.,Institute for Implementation Science in Population Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
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152
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Huang L, Kern ML, Oades LG. Strengthening University Student Wellbeing: Language and Perceptions of Chinese International Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5538. [PMID: 32751837 PMCID: PMC7432493 DOI: 10.3390/ijerph17155538] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/23/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022]
Abstract
Students at the tertiary education level in Australia are at increased risk of experiencing high levels of psychological distress, with international students at particularly high risk for poor adjustment. As mental health and wellbeing strongly correlate with students' academic performance and general overseas experience, a growing number of studies focus on what universities can do to effectively support students' wellbeing. However, assumptions are made about what wellbeing is, strategies primarily focus on treating mental ill-health, and treatment approaches fail to account for cultural differences. This study aimed to explore how Chinese international students understand wellbeing, the language used about and for wellbeing, and activities that students believe strengthen their own and others' wellbeing. Eighty-four Chinese international students completed the online survey, and a subset of 30 students participated in semi-structured interviews. Data were analysed using thematic, phenomenographic, and language analyses. Physical health and mental health appeared as the key components that participants believed defined wellbeing, and intrapersonal activities were perceived as the primary approach used to strengthen wellbeing. Findings help broaden the understanding of wellbeing concept from the population of tertiary students, identify students' perspectives of activities that strengthen their wellbeing, offer a snapshot of the language used by Chinese students around wellbeing, and provide new data of population health through a wellbeing lens.
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Affiliation(s)
- Lanxi Huang
- Melbourne Graduate School of Education, University of Melbourne, Melbourne 3010, Australia; (M.L.K.); (L.G.O.)
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153
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Hammett PJ, Japuntich SJ, Sherman SE, Rogers ES, Danan ER, Noorbaloochi S, El-Shahawy O, Burgess DJ, Fu SS. Proactive tobacco treatment for veterans with posttraumatic stress disorder. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2020; 13:114-122. [PMID: 32614201 DOI: 10.1037/tra0000613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Individuals with posttraumatic stress disorder (PTSD) smoke at higher rates compared to the general population and experience significant barriers to initiating cessation treatment. Proactive outreach addresses these barriers by directly engaging with smokers and facilitating access to treatment. The objective of the present study was to evaluate a proactive outreach intervention for increasing rates of treatment utilization and abstinence among veteran smokers with and without PTSD. METHOD This is a secondary analysis of a randomized controlled trial conducted from 2013 to 2017 that demonstrated the effectiveness of proactive outreach among veterans using Veterans Affairs mental health care services. Electronic medical record data were used to identify participants with (n = 355) and without (n = 1,583) a diagnosis of PTSD. Logistic regressions modeled cessation treatment utilization (counseling, nicotine replacement therapy [NRT], and combination treatment) and abstinence (7-day point prevalence and 6-month prolonged at 6- and 12-month follow-ups) among participants randomized to proactive outreach versus usual care in the PTSD and non-PTSD subgroups, respectively. RESULTS Compared to usual care, proactive outreach increased combined counseling and NRT utilization among participants with PTSD (odds ratio [OR] = 26.25, 95% confidence interval [3.43, 201.17]) and without PTSD (OR = 10.20, [5.21, 19.98]). Proactive outreach also increased 7-day point prevalence abstinence at 12 months among participants with PTSD (OR = 2.62, [1.16, 5.91]) and without PTSD (OR = 1.61, [1.11, 2.34]). CONCLUSIONS Proactive outreach increased treatment utilization and abstinence among smokers with and without PTSD. Smokers with PTSD may need additional facilitation to initiate cessation treatment but are receptive when it is offered proactively. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | | | - Steven S Fu
- VA HSR&D Center for Care Delivery and Outcomes Research
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154
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Papadakis S, Katsaounou P, Kyriakos CN, Balmford J, Tzavara C, Girvalaki C, Driezen P, Filippidis FT, Herbeć A, Hummel K, McNeill A, Mons U, Fernández E, Fu M, Trofor AC, Demjén T, Zatoński WA, Willemsen M, Fong GT, Vardavas CI. Quitting behaviours and cessation methods used in eight European Countries in 2018: findings from the EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2020; 30:iii26-iii33. [PMID: 32918825 PMCID: PMC7526775 DOI: 10.1093/eurpub/ckaa082] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND We examined quit attempts, use of cessation assistance, quitting beliefs and intentions among smokers who participated in the 2018 International Tobacco Control (ITC) Europe Surveys in eight European Union Member States (England, Germany, Greece, Hungary, the Netherlands, Poland, Romania and Spain). METHODS Cross-sectional data from 11 543 smokers were collected from Wave 2 of the ITC Six European Country (6E) Survey (Germany, Greece, Hungary, Poland, Romania and Spain-2018), the ITC Netherlands Survey (the Netherlands-late 2017) and the Four Countries Smoking and Vaping (4CV1) Survey (England-2018). Logistic regression was used to examine associations between smokers' characteristics and recent quit attempts. RESULTS Quit attempts in the past 12 months were more frequently reported by respondents in the Netherlands (33.0%) and England (29.3%) and least frequently in Hungary (11.5%), Greece (14.7%), Poland (16.7%) and Germany (16.7%). With the exception of England (35.9%), the majority (56-84%) of recent quit attempts was unaided. Making a quit attempt was associated with younger age, higher education and income, having a smoking-related illness and living in England. In all countries, the majority of continuing smokers did not intend to quit in the next 6 months, had moderate to high levels of nicotine dependence and perceived quitting to be difficult. CONCLUSIONS Apart from England and the Netherlands, smokers made few quit attempts in the past year and had low intentions to quit in the near future. The use of cessation assistance was sub-optimal. There is a need to examine approaches to supporting quitting among the significant proportion of tobacco users in Europe and increase the use of cessation support as part of quit attempts.
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Affiliation(s)
- Sophia Papadakis
- School of Medicine, University of Crete (UoC), Heraklion, Greece
- Division of Prevention and Rehabilitation, University of Ottawa Heart Institute, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Paraskevi Katsaounou
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina N Kyriakos
- School of Medicine, University of Crete (UoC), Heraklion, Greece
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - James Balmford
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Chara Tzavara
- First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Charis Girvalaki
- School of Medicine, University of Crete (UoC), Heraklion, Greece
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
| | - Pete Driezen
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada
| | - Filippos T Filippidis
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Department of Primary Care and Public Health, Imperial College, London, UK
| | - Aleksandra Herbeć
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- Tobacco and Alcohol Research Group, University College London, London, UK
| | - Karin Hummel
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Ann McNeill
- Department of Addictions, King’s College London, London, UK
| | - Ute Mons
- German Cancer Research Center (DKFZ), Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, Heidelberg, Germany
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat (Barcelona), Catalonia
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Catalonia
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L’Hospitalet de Llobregat, Catalonia
- Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain
| | - Marcela Fu
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L’Hospitalet de Llobregat (Barcelona), Catalonia
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Catalonia
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L’Hospitalet de Llobregat, Catalonia
- Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain
| | - Antigona C Trofor
- University of Medicine and Pharmacy ‘Grigore T. Popa’ Iasi, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
| | - Witold A Zatoński
- Health Promotion Foundation, Warsaw, Poland
- European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Marc Willemsen
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo (UW), Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Constantine I Vardavas
- School of Medicine, University of Crete (UoC), Heraklion, Greece
- European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
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155
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Kohn JN, Kosciolek T, Marotz C, Aleti G, Guay-Ross RN, Hong SH, Hansen S, Swafford A, Knight R, Hong S. Differing salivary microbiome diversity, community and diurnal rhythmicity in association with affective state and peripheral inflammation in adults. Brain Behav Immun 2020; 87:591-602. [PMID: 32061904 DOI: 10.1016/j.bbi.2020.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 02/04/2020] [Accepted: 02/09/2020] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Tomasz Kosciolek
- Department of Pediatrics, United States; Current affiliation: Małopolska Centre of Biotechnology, Jagiellonian University, Krakow, Poland
| | | | | | | | | | | | | | - Rob Knight
- Department of Pediatrics, United States; Center for Microbiome Innovation, United States; Department of Computer Science and Engineering, United States; Department of Bioengineering, United States
| | - Suzi Hong
- Department of Psychiatry, United States; Center for Microbiome Innovation, United States; Department of Family Medicine and Public Health, University of California, San Diego, United States.
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156
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Spears CA, Jones DM, Weaver SR, Yang B, Pechacek TF, Eriksen MP. Use of and perceptions about electronic nicotine delivery systems (ENDS) among people with mental health conditions or serious psychological distress, 2018. Drug Alcohol Depend 2020; 212:108049. [PMID: 32442748 PMCID: PMC7867116 DOI: 10.1016/j.drugalcdep.2020.108049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND People with mental health conditions (MHC) experience health disparities related to combustible tobacco use, and recent studies suggest disproportionately high use of electronic nicotine delivery systems (ENDS, e.g., e-cigarettes) among adults with MHC. Continued surveillance of ENDS use by MHC status is needed, as well as in-depth examinations of why adults with versus without MHC are using ENDS. METHODS Using 2018 U.S. nationally representative data (N = 5878), this study examined associations between MHC and serious psychological distress (SPD) with ENDS use. Among current ENDS users (n = 544), associations between MHC and SPD with perceived benefits and reasons for using ENDS were also investigated. RESULTS Both MHC and SPD were associated with higher likelihood of having ever used ENDS, currently using ENDS, and currently using ENDS daily. There was an interaction between SPD and smoking status in predicting current ENDS use such that the association between SPD and higher current ENDS use was stronger among never smokers. Compared to those without MHC, participants with MHC indicated that using ENDS helped them feel more relaxed and that stress management was a more important reason for ENDS use. CONCLUSIONS U.S. adults with MHC (and particularly never smokers with SPD) report disproportionately high use of ENDS. Individuals with MHC may be particularly likely to use ENDS for relaxation and stress management.
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Affiliation(s)
- Claire Adams Spears
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA.
| | - Dina M Jones
- Center for the Study of Tobacco, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham Street, Little Rock, AR, 72205, USA
| | - Scott R Weaver
- Department of Population Health Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
| | - Bo Yang
- Department of Communication, University of Arizona, 1103 E. University Blvd., Tucson, AZ, 85721-0025, USA
| | - Terry F Pechacek
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
| | - Michael P Eriksen
- Department of Health Policy and Behavioral Sciences, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
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157
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Brose LS, Brown J, McNeill A. Mental health and smoking cessation-a population survey in England. BMC Med 2020; 18:161. [PMID: 32580770 PMCID: PMC7315517 DOI: 10.1186/s12916-020-01617-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/06/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To reduce inequalities between individuals with and without mental health problems, a better understanding is required of triggers and success of quit attempts among the third of smokers with mental health problems. The aim was to assess whether there are differences by mental health status in (i) triggers for quit attempts, (ii) use of evidence-based support (iii) and quit success. METHODS Monthly cross-sectional household surveys of representative samples of the adult population in England. In 2016/2017, 40,831 adults were surveyed; 1956 who had attempted to stop smoking cigarettes in the past year were included. Logistic regressions assessed associations between mental health (ever diagnosis, past-year treatment, past-month distress), triggers, support used and quit success, adjusting for sociodemographic and smoking characteristics. RESULTS Concern about future health, current health problems and expense of smoking were the most common triggers overall. For respondents with an ever diagnosis, past-year treatment or serious past-month distress, quit attempts were more frequently triggered by current health problems. Non-evidence-based support and e-cigarettes were used most often, and this did not differ by mental health status. Respondents with an ever diagnosis and moderate or serious distress were less likely to have used non-prescription nicotine replacement therapy (NRT). Respondents with past-year treatment or serious distress were more likely to have used prescription medication/behavioural support. Quit success did not differ by mental health status. Compared with non-evidence-based support, non-prescription NRT conferred no benefit. There was some evidence that prescription medication/behavioural support was beneficial (depending on outcome and adjustment, ORs ranged from 1.46, 95% CI 0.92-2.31, to 1.69, 1.01-2.86). E-cigarettes were associated with higher success rates after adjustment for different indicators of mental health (ORs ranged from 2.21, 1.64-2.98, to 2.25, 1.59-3.18). CONCLUSIONS Smokers with mental health problems were more likely to have attempted to quit because of health problems and were more likely to have used gold standard support (medication and behavioural support) than other smokers. E-cigarettes were strongly associated with increased success and were used similarly by those with and without mental health problems, indicating that improved uptake of e-cigarettes for smoking cessation among smokers with mental health problems could help address inequalities.
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Affiliation(s)
- Leonie S Brose
- Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK.
- , .
| | - Jamie Brown
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Ann McNeill
- Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London, SE5 8BB, UK
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158
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Carroll AJ, Mathew AR, Leone FT, Wileyto EP, Miele A, Schnoll RA, Hitsman B. Extended Nicotine Patch Treatment Among Smokers With and Without Comorbid Psychopathology. Nicotine Tob Res 2020; 22:24-31. [PMID: 30215785 DOI: 10.1093/ntr/nty191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/08/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Individuals with psychiatric conditions smoke at higher rates than the general population and may need more intensive treatment to quit. We examined whether or not extended treatment with nicotine patch, combined with behavior counseling, would disproportionally benefit smokers with versus without a lifetime psychiatric condition. METHODS We conducted a secondary analysis of data from an effectiveness trial of treatment with 12 counseling sessions (48 weeks) and 21-mg nicotine patch (8, 24, or 52 weeks) among 525 adult daily smokers. A structured clinical interview assessed past and current psychiatric disorders (major depression, generalized anxiety disorder, alcohol abuse and/or dependence, and substance abuse and/or dependence), as described in the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). Abstinence was bioverified at week 52. Logistic regression evaluated the effect of the psychiatric status × treatment duration interaction on abstinence at week 52, covarying for sociodemographics, baseline psychological symptoms, and treatment adherence. RESULTS At baseline, 115 (21.9%) participants were diagnosed with one or more psychiatric conditions. The psychiatric status × treatment duration interaction was significant for week 52 abstinence (p = .027). Abstinence rates between smokers with versus without a psychiatric condition in the 24-week treatment arm (9.3% vs. 31.5% abstinent) significantly differed from the 8-week treatment arm (18.8% vs. 22.3%), p = .017. Abstinence rates for smokers with (22.5%) versus without a psychiatric condition (19.7%) in the 52-week treatment arm did not differ from those in the 8-week arm. CONCLUSIONS Targeted smoking cessation treatment, rather than extending treatment duration, may be especially warranted to optimize treatment for smokers with comorbid mood, anxiety, and substance use disorders. IMPLICATIONS Individuals with psychiatric conditions smoke at higher rates and have greater difficulty quitting compared to those in the general population, but little is known about how to best optimize treatment for this high tobacco burden population. The present study found that cessation response to extended duration treatment with the transdermal nicotine patch did not differ for smokers with versus without comorbid anxiety, mood, and substance use disorders in a large-scale clinical effectiveness trial. Development of targeted behavioral treatments may be required to optimize abstinence outcomes for this high-risk population, rather than simply extending the duration of pharmacotherapy treatments.
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Affiliation(s)
- Allison J Carroll
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Amanda R Mathew
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Frank T Leone
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Presbyterian Medical Center, University of Pennsylvania, Philadelphia, PA
| | - E Paul Wileyto
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrew Miele
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Robert A Schnoll
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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159
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Veit T, Munker D, Leuschner G, Mümmler C, Sisic A, Kauke T, Schneider C, Irlbeck M, Michel S, Eser-Valerie D, Huber M, Barton J, Milger K, Meiser B, Behr J, Kneidinger N. High prevalence of falsely declaring nicotine abstinence in lung transplant candidates. PLoS One 2020; 15:e0234808. [PMID: 32555678 PMCID: PMC7302701 DOI: 10.1371/journal.pone.0234808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/02/2020] [Indexed: 11/18/2022] Open
Abstract
Tobacco use after lung transplantation is associated with adverse outcome. Therefore, active smoking is regarded as a contraindication for lung transplantation and should be excluded prior to placement on the waiting list. The aim of the study was to compare self-reporting with a systematic cotinine based screening approach to identify patients with active nicotine abuse. Nicotine use was systematically assessed by interviews and cotinine test in all lung transplant candidates at every visit in our center. Patients were classified according to the stage prior to transplantation and cotinine test results were compared to self-reports and retrospectively analyzed until June 2019. Of 620 lung transplant candidates, 92 patients (14.8%) had at least one positive cotinine test. COPD as underlying disease (OR 2.102, CI 1.110–3.981; p = 0.023), number of pack years (OR 1.014, CI 1.000–1.028; p = 0.047) and a time of cessation less than one year (OR 2.413, CI 1.410–4.128; p = 0.001) were associated with a positive cotinine test in multivariable regression analysis. The majority of non-COPD patients (n = 13, 72.2%) with a positive test had a cessation time of less than one year. 78 patients (84.7%) falsely declared not consuming any nicotine-based products prior to the test. Finally, all never smokers were test negative. In conclusion, our data demonstrate that active nicotine use is prevalent in transplant candidates with a high prevalence of falsely declaring nicotine abstinence. COPD was the main diagnosis in affected patients. Short cessation time and a high number of pack years are risk factors for continued nicotine abuse.
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Affiliation(s)
- Tobias Veit
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Dieter Munker
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Gabriela Leuschner
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Carlo Mümmler
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Alma Sisic
- Transplant Center, University of Munich, Munich, Germany
| | - Teresa Kauke
- Department of Thoracic Surgery, University of Munich, Munich, Germany
| | | | - Michael Irlbeck
- Department of Anaesthesiology, University of Munich, LMU, Munich, Germany
| | - Sebastian Michel
- Clinic of Cardiac Surgery, University of Munich, LMU, Munich, Germany
| | - Daniela Eser-Valerie
- Department of Psychiatry and Psychotherapy, University of Munich, LMU, Munich, Germany
| | - Maximilian Huber
- Department of Psychiatry and Psychotherapy, University of Munich, LMU, Munich, Germany
| | - Jürgen Barton
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Katrin Milger
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Bruno Meiser
- Transplant Center, University of Munich, Munich, Germany
| | - Jürgen Behr
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
| | - Nikolaus Kneidinger
- Department of Internal Medicine V, Comprehensive Pneumology Center(CPC-M), Member of the German Center for Lung Research (DZL), University of Munich, Munich, Germany
- * E-mail:
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160
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Bradley T, Bartlem K, Campbell E, Wye P, Rissel C, Reid K, Regan T, Bailey J, Bowman J. Characteristics of participants utilising a telephone-based coaching service for chronic disease health risk behaviours: A retrospective examination comparing those with and without a mental health condition. Prev Med Rep 2020; 19:101123. [PMID: 32477854 PMCID: PMC7248287 DOI: 10.1016/j.pmedr.2020.101123] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/24/2020] [Accepted: 05/09/2020] [Indexed: 11/17/2022] Open
Abstract
People with mental health conditions engage with health coaching phone services. The prevalence and extent of some health risk behaviours is higher in this group. Confidence in ability to change health risk behaviours is lower in this group.
The NSW Get Healthy Service® (GHS) is a free telephone-based coaching service in NSW, Australia, which supports behaviour change around healthy eating and physical activity. The aims of this study were to 1) assess the proportion of coaching participants within GHS who report having had a mental health condition, and 2) describe and compare the health risk profiles and confidence for behaviour change of coaching participants with and without a mental health condition. Secondary data analysis was conducted on information collected via participant self-report as a part of the coaching process for 11,925 participants who enrolled in a GHS coaching program for the first time between January 2015 and December 2017. Twenty six percent (n = 3106) of participants reported having had a significant mental health condition that required treatment from a health professional. Participants who reported a mental health condition were significantly less likely (54%) to be meeting guidelines for physical activity than participants without a mental health condition (64%); more likely to be overweight/obese (89%) compared to those without (81%); and reported lower confidence for changing exercise, nutrition and weight. There were no significant differences in proportions meeting fruit or vegetable intake recommendations. People with a mental health condition represent approximately a quarter of GHS participants. This group of participants presented higher levels of health risks and expressed lower confidence in behaviour change than program participants without such a condition. Future service planning and development may consider this variation in participant profiles.
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Affiliation(s)
- Tegan Bradley
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305, Australia
| | - Kate Bartlem
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305, Australia
| | - Elizabeth Campbell
- Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW 2287, Australia
| | - Paula Wye
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Chris Rissel
- NSW Office of Preventive Health, Liverpool Hospital, Don Everett Building, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Kate Reid
- NSW Office of Preventive Health, Liverpool Hospital, Don Everett Building, Locked Bag 7103, Liverpool BC, NSW 1871, Australia
| | - Timothy Regan
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Jacqueline Bailey
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305, Australia
| | - Jenny Bowman
- University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.,Hunter Medical Research Institute, Lot 1, Kookaburra Cct, New Lambton Heights, NSW 2305, Australia
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Jacobs R, Aylott L, Dare C, Doran T, Gilbody S, Goddard M, Gravelle H, Gutacker N, Kasteridis P, Kendrick T, Mason A, Rice N, Ride J, Siddiqi N, Williams R. The association between primary care quality and health-care use, costs and outcomes for people with serious mental illness: a retrospective observational study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08250] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background
Serious mental illness, including schizophrenia, bipolar disorder and other psychoses, is linked with high disease burden, poor outcomes, high treatment costs and lower life expectancy. In the UK, most people with serious mental illness are treated in primary care by general practitioners, who are financially incentivised to meet quality targets for patients with chronic conditions, including serious mental illness, under the Quality and Outcomes Framework. The Quality and Outcomes Framework, however, omits important aspects of quality.
Objectives
We examined whether or not better quality of primary care for people with serious mental illness improved a range of outcomes.
Design and setting
We used administrative data from English primary care practices that contribute to the Clinical Practice Research Datalink GOLD database, linked to Hospital Episode Statistics, accident and emergency attendances, Office for National Statistics mortality data and community mental health records in the Mental Health Minimum Data Set. We used survival analysis to estimate whether or not selected quality indicators affect the time until patients experience an outcome.
Participants
Four cohorts of people with serious mental illness, depending on the outcomes examined and inclusion criteria.
Interventions
Quality of care was measured with (1) Quality and Outcomes Framework indicators (care plans and annual physical reviews) and (2) non-Quality and Outcomes Framework indicators identified through a systematic review (antipsychotic polypharmacy and continuity of care provided by general practitioners).
Main outcome measures
Several outcomes were examined: emergency admissions for serious mental illness and ambulatory care sensitive conditions; all unplanned admissions; accident and emergency attendances; mortality; re-entry into specialist mental health services; and costs attributed to primary, secondary and community mental health care.
Results
Care plans were associated with lower risk of accident and emergency attendance (hazard ratio 0.74, 95% confidence interval 0.69 to 0.80), serious mental illness admission (hazard ratio 0.67, 95% confidence interval 0.59 to 0.75), ambulatory care sensitive condition admission (hazard ratio 0.73, 95% confidence interval 0.64 to 0.83), and lower overall health-care (£53), primary care (£9), hospital (£26) and mental health-care costs (£12). Annual reviews were associated with reduced risk of accident and emergency attendance (hazard ratio 0.80, 95% confidence interval 0.76 to 0.85), serious mental illness admission (hazard ratio 0.75, 95% confidence interval 0.67 to 0.84), ambulatory care sensitive condition admission (hazard ratio 0.76, 95% confidence interval 0.67 to 0.87), and lower overall health-care (£34), primary care (£9) and mental health-care costs (£30). Higher general practitioner continuity was associated with lower risk of accident and emergency presentation (hazard ratio 0.89, 95% confidence interval 0.83 to 0.97) and ambulatory care sensitive condition admission (hazard ratio 0.77, 95% confidence interval 0.65 to 0.92), but not with serious mental illness admission. High continuity was associated with lower primary care costs (£3). Antipsychotic polypharmacy was not statistically significantly associated with the risk of unplanned admission, death or accident and emergency presentation. None of the quality measures was statistically significantly associated with risk of re-entry into specialist mental health care.
Limitations
There is risk of bias from unobserved factors. To mitigate this, we controlled for observed patient characteristics at baseline and adjusted for the influence of time-invariant unobserved patient differences.
Conclusions
Better performance on Quality and Outcomes Framework measures and continuity of care are associated with better outcomes and lower resource utilisation, and could generate moderate cost savings.
Future work
Future research should examine the impact of primary care quality on measures that capture broader aspects of health and functioning.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 25. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
| | - Lauren Aylott
- Expert by experience
- Hull York Medical School, York, UK
| | | | | | - Simon Gilbody
- Hull York Medical School, York, UK
- Department of Health Sciences, University of York, York, UK
| | - Maria Goddard
- Centre for Health Economics, University of York, York, UK
| | - Hugh Gravelle
- Centre for Health Economics, University of York, York, UK
| | - Nils Gutacker
- Centre for Health Economics, University of York, York, UK
| | | | - Tony Kendrick
- Primary Care and Population Sciences, Aldermoor Health Centre, University of Southampton, Southampton, UK
| | - Anne Mason
- Centre for Health Economics, University of York, York, UK
| | - Nigel Rice
- Centre for Health Economics, University of York, York, UK
| | - Jemimah Ride
- Centre for Health Economics, University of York, York, UK
| | - Najma Siddiqi
- Hull York Medical School, York, UK
- Department of Health Sciences, University of York, York, UK
- Bradford District Care NHS Foundation Trust, Bradford, UK
| | - Rachael Williams
- Clinical Practice Research Datalink, Medicines and Healthcare products Regulatory Agency, London, UK
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Malik AO, Peri-Okonny P, Gosch K, Thomas M, Mena C, Hiatt WR, Jones PG, Provance JB, Labrosciano C, Jelani QUA, Spertus JA, Smolderen KG. Association of Perceived Stress Levels With Long-term Mortality in Patients With Peripheral Artery Disease. JAMA Netw Open 2020; 3:e208741. [PMID: 32573710 PMCID: PMC7312389 DOI: 10.1001/jamanetworkopen.2020.8741] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Identifying modifiable risk factors, such as stress, that could inform the design of peripheral artery disease (PAD) management strategies is critical for reducing the risk of mortality. Few studies have examined the association of self-perceived stress with outcomes in patients with PAD. OBJECTIVE To examine the association of high levels of self-perceived stress with mortality in patients with PAD. DESIGN, SETTING, AND PARTICIPANTS This cohort study analyzed data from the registry of the Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT) study, a multicenter study that enrolled patients with new or worsening symptoms of PAD who presented to 16 subspecialty clinics across the US, the Netherlands, and Australia from June 2, 2011, to December 3, 2015. However, the present study included only patients in the US sites because assessments of mortality for patients in the Netherlands and Australia were not available. Data analysis was conducted from July 2019 to March 2020. EXPOSURE Self-perceived stress was quantified using the 4-item Perceived Stress Scale (PSS-4), with a score range of 0 to 16. A score of 6 or higher indicated high stress in this cohort. Missing scores were imputed using multiple imputation by chained equations with predictive mean matching. Stress was assessed at baseline and at 3-, 6-, and 12-month follow-up. Patients who reported high levels of stress at 2 or more follow-up assessments were categorized as having chronic stress. MAIN OUTCOMES AND MEASURES All-cause mortality was the primary study outcome. Such data for the subsequent 4 years after the 12-month follow-up were obtained from the National Death Index. RESULTS The final cohort included 765 patients, with a mean (SD) age of 68.4 (9.7) years. Of these patients, 57.8% were men and 71.6% were white individuals. High stress levels were reported in 65% of patients at baseline and in 20% at the 12-month follow-up. In an adjusted Cox proportional hazards regression model accounting for demographics, comorbidities, disease severity, treatment type, and socioeconomic status, exposure to chronic stress during the 12 months of follow-up was independently associated with increased risk of all-cause mortality in the subsequent 4 years (hazard ratio, 2.12; 95% CI, 1.14-3.94; P = .02). CONCLUSIONS AND RELEVANCE In thie cohort study of patients with PAD, higher stress levels in the year after diagnosis appeared to be associated with greater long-term mortality risk, even after adjustment for confounding factors. These findings suggest that, given that stress is a modifiable risk factor for which evidence-based management strategies exist, a holistic approach that includes assessment of chronic stress has the potential to improve survival in patients with PAD.
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Affiliation(s)
- Ali O. Malik
- Department of Cardiovascular Medicine, University of Missouri, Kansas City, Kansas City
- Department of Cardiovascular Medicine, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Poghni Peri-Okonny
- Department of Cardiovascular Medicine, University of Missouri, Kansas City, Kansas City
- Department of Cardiovascular Medicine, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Kensey Gosch
- Department of Cardiovascular Medicine, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Merrill Thomas
- Department of Cardiovascular Medicine, University of Missouri, Kansas City, Kansas City
| | - Carlos Mena
- Vascular Outcomes Program, Department of Internal Medicine, Yale University, New Haven, Connecticut
| | | | - Philip G. Jones
- Department of Cardiovascular Medicine, University of Missouri, Kansas City, Kansas City
- Department of Cardiovascular Medicine, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Jeremy B. Provance
- Department of Cardiovascular Medicine, University of Missouri, Kansas City, Kansas City
| | | | - Qurat-ul-ain Jelani
- Vascular Outcomes Program, Department of Internal Medicine, Yale University, New Haven, Connecticut
| | - John A. Spertus
- Department of Cardiovascular Medicine, University of Missouri, Kansas City, Kansas City
- Department of Cardiovascular Medicine, Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
| | - Kim G. Smolderen
- Department of Internal Medicine, Yale University, New Haven, Connecticut
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163
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Lima DR, Carvalho CFC, Guimarães-Pereira BBS, Loreto AR, Frallonardo FP, Ismael F, Andrade AGD, Castaldelli-Maia JM. Abstinence and retention outcomes in a smoking cessation program among individuals with co-morbid substance use and mental disorders. J Psychiatr Res 2020; 125:121-128. [PMID: 32272242 DOI: 10.1016/j.jpsychires.2020.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/21/2020] [Accepted: 03/23/2020] [Indexed: 02/06/2023]
Abstract
Tobacco use is the leading cause of preventable death in the world. Although cigarette smoking prevalence has decreased, there are still disparities in morbidity and mortality experienced by individuals with substance use and/or mental disorders when compared to general population. The aim of this study was to compare treatment outcomes between three subgroups of smokers: individuals with substance use disorder (SUD-only), individuals with mental disorder without substance use disorders (MD-only), and individuals with co-morbid substance use and mental disorder (SUD + MD). Data of 498 smokers enrolled in a 6-week smoking cessation program in Brazil were analyzed. Sociodemographic, medical and tobacco use information were collected at baseline. Treatment included group cognitive behavioral therapy (CBT) and pharmacotherapy. The primary outcome was defined as "self-report 4-week quitter" (SR4WQ), a standardized measure to assess treatment success. Retention to treatment was also investigated. Associations between groups were analyzed using unadjusted and adjusted logistic regression models. The results showed that SUD + MD had worse outcomes when compared to the other two groups. After adjusting for level of smoking dependence and the use of medication, abstinence and retention to treatment of SUD-only became equivalent to SUD + MD. Because tobacco and other substance addictions share similar mechanisms, having history of SUD might impair successful results of conventional smoking programs. There is a need to further investigate specific variables associated with treatment success for a more resistant subgroup of individuals in mental health and perhaps to invest in more intensive actions, such as the use of combined pharmacotherapy and adapted CBT approaches.
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Affiliation(s)
- Danielle Ruiz Lima
- Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr.Ovídio Pires de Campos, 785, Cerqueira César, 05403-010, São Paulo, SP, Brazil.
| | - Carlos Felipe Cavalcanti Carvalho
- ABC Center for Mental Health Studies, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil
| | - Bruna Beatriz Sales Guimarães-Pereira
- Department of Neuroscience, Medical School, ABC Foundation, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil
| | - Aline Rodrigues Loreto
- Department of Neuroscience, Medical School, ABC Foundation, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil
| | - Fernanda Piotto Frallonardo
- ABC Center for Mental Health Studies, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil; Universidade Municipal de São Caetano do Sul - Campus Centro, Rua Santo Antonio, 50 - São Caetano do Sul, São Paulo, 09521-160, Brazil
| | - Flávia Ismael
- ABC Center for Mental Health Studies, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil; Universidade Municipal de São Caetano do Sul - Campus Centro, Rua Santo Antonio, 50 - São Caetano do Sul, São Paulo, 09521-160, Brazil
| | - Arthur Guerra de Andrade
- Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr.Ovídio Pires de Campos, 785, Cerqueira César, 05403-010, São Paulo, SP, Brazil; ABC Center for Mental Health Studies, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil; Department of Neuroscience, Medical School, ABC Foundation, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil
| | - João Mauricio Castaldelli-Maia
- Instituto de Psiquiatria, Faculdade de Medicina FMUSP, Universidade de São Paulo, Rua Dr.Ovídio Pires de Campos, 785, Cerqueira César, 05403-010, São Paulo, SP, Brazil; ABC Center for Mental Health Studies, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil; Department of Neuroscience, Medical School, ABC Foundation, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André - SP, 09060-870, Santo André, SP, Brazil
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164
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Scheuermann TS, Onge JMS, Ramaswamy M, Cox LS, Ahluwalia JS, Nollen NL. The Role of Neighborhood Experiences in Psychological Distress among African American and White Smokers. RACE AND SOCIAL PROBLEMS 2020; 12:133-144. [PMID: 34084252 PMCID: PMC8172079 DOI: 10.1007/s12552-020-09281-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Residential area characteristics and discrimination have been associated with psychological distress. Differences in these relationships across racial groups are not well understood. We examined the relative role of perceived discrimination, neighborhood problems and neighborhood cohesion/trust in explaining differences in psychological distress (indicated by anxiety and depressive symptoms) between 224 African American and 225 White smokers (income ≤ 400% federal poverty level) in a smoking cessation intervention study. Surveys were linked to US census-tract data. We conducted random intercept Poisson multi-level regression models and examined interactions between race and neighborhood experiences. African Americans had greater risk of anxiety and depressive symptoms and greater individual and neighborhood disadvantage than Whites. Controlling for objective neighborhood characteristics, when perceived discrimination and perceived neighborhood characteristics were added to the regression models the association between anxiety symptoms and race were no longer statistically significant; the association between depressive symptoms and race decreased but remained statistically significant. Lower neighborhood social cohesion/trust and greater neighborhood problems increased depressive symptoms for African Americans, but not for Whites. Perceived discrimination and neighborhood social cohesion/trust outweighed the importance of race in explaining anxiety symptoms. These findings underscore the need for multi-level interventions addressing social and environmental contexts.
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Affiliation(s)
- Taneisha S. Scheuermann
- Department of Population Health, University of Kansas
School of Medicine, Kansas City, KS, USA
| | - Jarron M. Saint Onge
- Department of Population Health, University of Kansas
School of Medicine, Kansas City, KS, USA
- Department of Sociology, University of Kansas, Lawrence,
USA
| | - Megha Ramaswamy
- Department of Population Health, University of Kansas
School of Medicine, Kansas City, KS, USA
| | - Lisa Sanderson Cox
- Department of Population Health, University of Kansas
School of Medicine, Kansas City, KS, USA
| | - Jasjit S. Ahluwalia
- Department of Behavioral and Social Sciences, Brown
University School of Public Health, Providence, RI, USA
| | - Nicole L. Nollen
- Department of Population Health, University of Kansas
School of Medicine, Kansas City, KS, USA
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165
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Hammett PJ, Lando HA, Erickson DJ, Widome R, Taylor BC, Nelson D, Japuntich SJ, Fu SS. Proactive outreach tobacco treatment for socioeconomically disadvantaged smokers with serious mental illness. J Behav Med 2020; 43:493-502. [PMID: 31363948 PMCID: PMC7525931 DOI: 10.1007/s10865-019-00083-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
Smokers with serious mental illness (SMI) face individual, interpersonal, and healthcare provider barriers to cessation treatment utilization and smoking abstinence. Proactive outreach strategies are designed to address these barriers by promoting heightened contact with smokers and facilitating access to evidence-based treatments. The present study examined the effect of proactive outreach among smokers with SMI (n = 939) who were enrolled in the publicly subsidized Minnesota Health Care Programs (MHCP) and compared this effect to that observed among MHCP smokers without SMI (n = 1382). Relative to usual care, the intervention increased treatment utilization among those with SMI (52.1% vs 40.0%, p = 0.002) and without SMI (39.3% vs 25.4%, p < 0.001). The intervention also increased prolonged smoking abstinence among those with SMI (14.9% vs 9.4%, p = 0.010) and without SMI (17.7% vs 13.6%, p = 0.09). Findings suggest that implementation of proactive outreach within publicly subsidized healthcare systems may alleviate the burden of smoking in this vulnerable population. Trial Registration ClinicalTrials.gov identifier: NCT01123967.
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Affiliation(s)
- Patrick J Hammett
- VA HSR&D Center for Care Delivery and Outcomes Research (CCDOR), VA Medical Center (152), Minneapolis VA Health Care System, Minneapolis, MN, USA.
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| | - Harry A Lando
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Darin J Erickson
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Brent C Taylor
- VA HSR&D Center for Care Delivery and Outcomes Research (CCDOR), VA Medical Center (152), Minneapolis VA Health Care System, Minneapolis, MN, USA
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - David Nelson
- VA HSR&D Center for Care Delivery and Outcomes Research (CCDOR), VA Medical Center (152), Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sandra J Japuntich
- Hennepin Healthcare Research Institute, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Steven S Fu
- VA HSR&D Center for Care Delivery and Outcomes Research (CCDOR), VA Medical Center (152), Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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166
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Caponnetto P, Polosa R, Robson D, Bauld L. Tobacco smoking, related harm and motivation to quit smoking in people with schizophrenia spectrum disorders. Health Psychol Res 2020; 8:9042. [PMID: 32510003 PMCID: PMC7267811 DOI: 10.4081/hpr.2020.9042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/20/2020] [Indexed: 02/06/2023] Open
Abstract
This narrative review focuses on the topic of tobacco smoking amongst people with schizophrenia spectrum disorders. We searched PubMed, PsycInfo and Scopus databases for schizophrenia spectrum disorders and smoking and included articles about the epidemiology of tobacco smoking in people with schizophrenia spectrum disorders, examining the relationship between smoking and mental health. This narrative review describes that a higher prevalence, frequency and impact of both high nicotine dependence and its harmful effects in patients with schizophrenia spectrum disorders compared with those in the general population. Despite several existent theories, the reasons for high smoking rates, the high dependence on nicotine and severity of nicotine withdrawal symptoms are not fully understood. The main aim of this paper is to inform mental health personnel and particularly clinical and health psychologists about the impact and role of tobacco smoking for smokers with schizophrenia spectrum disorders.
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Affiliation(s)
| | | | | | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- UK Centre for Tobacco & Alcohol Studies, Nottingham, UK
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167
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Cruvinel E, Liebman E, Leite I, Hu J, Richter KP. Prevalence of smoking, quit attempts and access to cessation treatment among adults with mental illness in Brazil: a cross-sectional analysis of a National Health Survey. BMJ Open 2020; 10:e033959. [PMID: 32461292 PMCID: PMC7259849 DOI: 10.1136/bmjopen-2019-033959] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Determine the national prevalence of smoking and factors related to smoking among adults with mental illness (PLWMI; people living with mental illness) in Brazil. DESIGN Cross-sectional study. SETTING We used data from the nationally representative general health survey Pesquisa Nacional de Saude of 2013, which included the Global Adult Tobacco Survey (GATS) module. PARTICIPANTS The survey used a complex probabilistic sample to collect data from 60 202 Brazilians 18 years or older. Primary and secondary outcomes: smoking prevalence and access to smoking cessation treatment. We also assessed past tobacco use, quit attempts and quit ratio among people with and without mental illness. Analyses were conducted in R and were weighted to account for the survey design and generate national estimates. RESULTS In Brazil, the 2013 smoking prevalence among PLWMI was 28.4% and among people with no mental illness was 12.8%. Both groups had high rates of past-year quit attempts (51.6% vs 55.3%) but the lifetime quit ratio among PLWMI was much lower than those with no mental illness (37% vs 54%). Adjusted odds showed PLWMI were more likely to be current smokers (OR (95% CI)=2.60 (2.40 to 2.82), less likely to be former smokers (OR (95% CI)=0.62 (0.55 to 0.70)) and as likely to have tried to quit in the past year (OR (95% CI)=0.90 (0.78 to 1.02)). Very few (3.7%) PLWMI and fewer with no mental illness (2.6%) received cessation treatment. CONCLUSION Smoking rates among PLWMI are roughly double the rate in the general population. Compared with Brazilian smokers without mental illness, those with mental illness were significantly less likely to quit even though as many tried to. Few Brazilians appear to be using publicly available cessation services. Expanding utilisation of treatment might be a good place to start for Brazil to further decrease the prevalence of smoking among PLWMI.
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Affiliation(s)
- Erica Cruvinel
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Edward Liebman
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Isabel Leite
- School of Medicine, Federal University of Juiz de Fora, Juiz de Fora, MG, Brazil
| | - Jinxiang Hu
- Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kimber P Richter
- Department of Population Health, University of Kansas Medical Center, Kansas City, Kansas, USA
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168
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Keizer I, Gex-Fabry M, Croquette P, Humair JP, Khan AN. Tobacco craving and withdrawal symptoms in psychiatric patients during a motivational enhancement intervention based on a 26-hour smoking abstinence period. Tob Prev Cessat 2020; 5:22. [PMID: 32411885 PMCID: PMC7205071 DOI: 10.18332/tpc/109785] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/31/2019] [Accepted: 06/02/2019] [Indexed: 01/13/2023]
Abstract
INTRODUCTION In psychiatric patients, tobacco withdrawal symptoms are frequently seen as a barrier to smoking cessation; however, further studies are warranted in this specific population. METHODS Patients receiving in- or out-patient mental health care participated in a motivational enhancement program including a 26-hour tobacco abstinence experience with professional support and optional nicotine replacement therapy. The study included 174 subjects, of whom 159 were evaluated 1 week before and at the end of the 26-hour abstinence period. Repeated assessments included the Minnesota Nicotine Tobacco Withdrawal Scale Revised (MNWS-R), two items of the Mood and Physical Symptoms Scale (MPSS) regarding craving, the State-Trait Anxiety Inventory (STAI-S), the Beck Depression Inventory (BDI-21), and the World Health Organization Well-Being Index (WHO-5). RESULTS More than half the participants (52.3%) succeeded in 26-hour smoking abstinence. Craving was the most frequent MNWS-R withdrawal symptom (28.3% scored ≥3 on a 0–4 scale). Comparison of pre- and post-intervention data revealed significant improvements in 13 of 16 MNWS-R symptoms as well as craving (MPSS) and well-being, and significant decreases in anxiety and depression. Increasing MNWS-R craving scores and greater depression were both significantly associated with lower success in the 26-hour smoking abstinence period. CONCLUSIONS The negative effects of tobacco withdrawal symptoms in psychiatric patients may be substantially overestimated. Participation in a supportive structured motivational intervention with a 26-hour smoking cessation experience was well tolerated and contributed to temporary improvements in mental state. Craving is an interesting symptom to evaluate during smoking cessation attempts.
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Affiliation(s)
- Ineke Keizer
- Department of Mental Health and Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Marianne Gex-Fabry
- Department of Mental Health and Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Patrice Croquette
- Department of Mental Health and Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland
| | - Jean-Paul Humair
- Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Carrefour Addictions, CIPRET, Geneva, Switzerland
| | - Aqal N Khan
- Department of Mental Health and Psychiatry, Geneva University Hospitals (HUG), Geneva, Switzerland
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169
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Carstens C, Linley J. Desire to Quit Smoking in an Outpatient Population of Persons with Serious Mental Illness. J Behav Health Serv Res 2020; 47:560-568. [DOI: 10.1007/s11414-020-09698-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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170
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García-Pérez Á, Weidberg S, González-Roz A, Alonso-Pérez F, Secades-Villa R. Relationship between delay discounting and depression in cigarette smokers and non-smokers. Addict Behav 2020; 103:106251. [PMID: 31874376 DOI: 10.1016/j.addbeh.2019.106251] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/03/2019] [Accepted: 12/03/2019] [Indexed: 02/06/2023]
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171
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Abstract
While prevalence of tobacco use in the US general population is declining, prevalence among those with opioid use disorder (OUD) remains high and results in excessive tobacco-related disease and premature mortality. Among smokers with OUD, tobacco cessation rates are negligible without treatment. However, both low-intensity behavioral interventions and more intensive motivational interventions yield negligible cessation rates. While contingency management has potent short-term cessation effects, effects are not maintained at post-intervention follow-up. Evidence-based smoking cessation pharmacotherapies, such as nicotine replacement therapy, bupropion, and varenicline, result in very modest cessation rates among smokers with OUD. Intensification of pharmacotherapy, such as high-dose and combination nicotine replacement therapy or extended medication treatment, has failed to improve cessation outcomes compared with standard treatment regimens. Targeting the unique challenges faced by smokers with OUD, including nicotine-opioid interactions and poor medication adherence, has potential to improve cessation outcomes, but further research is needed to optimize intervention efficacy among smokers with OUD.
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172
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Monfared IG, Harttgen K, Vollmer S. Individual and social predictors of smoking and obesity: A panel study in Germany. SSM Popul Health 2020; 10:100558. [PMID: 32140542 PMCID: PMC7047176 DOI: 10.1016/j.ssmph.2020.100558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 01/08/2020] [Accepted: 02/09/2020] [Indexed: 11/25/2022] Open
Abstract
This is a longitudinal study of changes in smoking behaviour as well as becoming overweight/obese (OW/OB) and the strength of their association with personal factors such as self-control, mental health, and socioeconomic status (SES) versus their connection with the behaviour of other household members. Furthermore, we investigate that in terms of roles within a household, who is more vulnerable towards the behaviour of others. We used a hybrid model that followed individual adults (person-level fixed-effect) who participated in a national representative panel survey in Germany, SOEP, between 2008 and 2016 and answered all SF-12 items (N = 6874). The count of members in a household showing the associated adverse health behaviour was the nested random-effect. Compared with other predictors, the likelihood of a person becoming OW/OB had the strongest association with the number of cohabits who were also OW/OB and it became worse as this number increased (OR 7.18, 95% CI: 2.10-24.54 and 12.44, 95% CI: 1.53-100.85, for men and women respectively, e.g. compared with being married 2.83, 95% CI: 2.28-3.53 and 1.82, 95% CI: 1.42-2.34). However, for smoking the same rapid trend was not observed. Particularly, becoming OW/OB in female (adult) children was strongly associated with the behaviour of others (compared with household head or partner). For smoking the strongest link with others was among women who were head of the household. For both behaviours, we found neither mental health nor self-control to be strong predictors. Our findings indicate that various factors do not play equal roles in changes in health behaviour and particularly for women, becoming OW/OB is strongly connected with the behaviour of others. We further discuss the potential importance of social norms that might be helpful in developing more effective policies incorporating social connections as well as norms.
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Affiliation(s)
- Ida G. Monfared
- Centre for Modern Indian Studies & Department of Economics, University of Göttingen, Göttingen, Germany
| | | | - Sebastian Vollmer
- Centre for Modern Indian Studies & Department of Economics, University of Göttingen, Göttingen, Germany
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173
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Myers MG, Strong DR, Chen TC, Linke SE. Enhancing engagement in evidence-based tobacco cessation treatment for smokers with mental illness: A pilot randomized trial. J Subst Abuse Treat 2020; 111:29-36. [DOI: 10.1016/j.jsat.2019.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 12/19/2019] [Accepted: 12/27/2019] [Indexed: 12/24/2022]
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174
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Prochaska JJ, Gates EF, Davis KC, Gutierrez K, Prutzman Y, Rodes R. The 2016 Tips From Former Smokers® Campaign: Associations With Quit Intentions and Quit Attempts Among Smokers With and Without Mental Health Conditions. Nicotine Tob Res 2020; 21:576-583. [PMID: 30496491 DOI: 10.1093/ntr/nty241] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/07/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION People living with mental health conditions (MH+) are more likely to smoke cigarettes than people without mental health conditions (MH-) and to experience tobacco-related disparities. The Tips From Former Smokers® (Tips®) campaign is a proven population-level strategy for motivating smokers to quit. In 2016, Tips included ads featuring Rebecca, a former smoker with depression. We evaluated self-reported frequency of exposure to the Rebecca and other Tips ads in association with quit intentions and quit attempts among MH+ and MH- smokers. METHODS Intentions to quit and past 6-month quit attempts lasting at least 24 hours were reported from a two-wave longitudinal online survey conducted before and after the 2016 Tips campaign with a nationally representative sample of US adult cigarette smokers with (MH+, N = 777) and without (MH-, N = 1806) lifetime mental health conditions. RESULTS In 2016, among MH+ respondents, greater exposure to the Rebecca ads was significantly associated with increased odds of intending to quit in the next 30 days (adjusted odds ratio [AOR] = 1.40, p < .05) and with reporting a quit attempt in the past 6 months (AOR = 1.25, p < .05). Among MH- respondents, greater exposure to the other Tips ads was associated with increased odds of making a quit attempt (AOR = 1.19, p < .05). CONCLUSIONS Exposure to the Rebecca ads was associated with a greater likelihood of intentions to quit and quit attempts among MH+ smokers; whereas, exposure to the other (non-mental-health-related) Tips ads was associated with a greater likelihood of quit attempts among MH- smokers. IMPLICATIONS National media campaigns are an important population-level strategy for reaching specific population groups who are experiencing tobacco-related disparities. The findings support the inclusion of ads featuring people living with mental health conditions in national tobacco education media campaigns, such as Tips.
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Affiliation(s)
| | - Emily F Gates
- Department of Measurement, Evaluation, Statistics, & Assessment, Boston College, Chestnut Hill, MA
| | - Kevin C Davis
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, NC
| | | | - Yvonne Prutzman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD
| | - Robert Rodes
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA
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175
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Jokela M, García-Velázquez R, Gluschkoff K, Airaksinen J, Rosenström T. Health behaviors and psychological distress: changing associations between 1997 and 2016 in the United States. Soc Psychiatry Psychiatr Epidemiol 2020; 55:385-391. [PMID: 31346633 DOI: 10.1007/s00127-019-01741-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 06/24/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Smoking rates have declined with a slower pace among those with psychological distress compared to those without. We examined whether other health behaviors (heavy alcohol consumption, physical inactivity, short sleep duration) showed similar trends associated with psychological distress. We also examined differences by age and birth cohort. METHODS Data were from the annually repeated cross-sectional U.S. National Health Interview Surveys (NHIS) of 1997-2016 (total n = 603,518). Psychological distress was assessed with the 6-item Kessler Psychological Distress Scale (K6). RESULTS Psychological distress became more strongly associated with smoking (OR 1.09 per 10 years; 95% CI 1.07, 1.12), physical inactivity (OR 1.08; 1.05, 1.11), and short sleep (OR 1.12; 1.06, 1.18), but less strongly associated with heavy alcohol consumption (OR 0.93; 0.89, 0.98). The associations of smoking and alcohol consumption attenuated with age, whereas the association with physical inactivity strengthened with age. Compared to older birth cohorts, smoking became more strongly associated with psychological distress among younger birth cohorts up to those born in the 1980s. CONCLUSIONS The strength of associations between psychological distress and health behaviors may vary by time period, age, and birth cohort.
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Affiliation(s)
- Markus Jokela
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, PO Box 63, 00014, Helsinki, Finland.
| | - Regina García-Velázquez
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, PO Box 63, 00014, Helsinki, Finland
| | - Kia Gluschkoff
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, PO Box 63, 00014, Helsinki, Finland
| | - Jaakko Airaksinen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, PO Box 63, 00014, Helsinki, Finland
| | - Tom Rosenström
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, PO Box 63, 00014, Helsinki, Finland.,Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
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Siegel SD, Lerman C, Flitter A, Schnoll RA. The Use of the Nicotine Metabolite Ratio as a Biomarker to Personalize Smoking Cessation Treatment: Current Evidence and Future Directions. Cancer Prev Res (Phila) 2020; 13:261-272. [PMID: 32132120 PMCID: PMC7080293 DOI: 10.1158/1940-6207.capr-19-0259] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/20/2019] [Accepted: 07/01/2019] [Indexed: 12/15/2022]
Abstract
The nicotine metabolite ratio (NMR), a genetically informed biomarker of rate of nicotine metabolism, has been validated as a tool to select the optimal treatment for individual smokers, thereby improving treatment outcomes. This review summarizes the evidence supporting the development of the NMR as a biomarker of individual differences in nicotine metabolism, the relationship between the NMR and smoking behavior, the clinical utility of using the NMR to personalize treatments for smoking cessation, and the potential mechanisms that underlie the relationship between NMR and smoking cessation. We conclude with a call for additional research necessary to determine the ultimate benefits of using the NMR to personalize treatments for smoking cessation. These future directions include measurement and other methodologic considerations, disseminating this approach to at-risk subpopulations, expanding the NMR to evaluate its efficacy in predicting treatment responses to e-cigarettes and other noncigarette forms of nicotine, and implementation science including cost-effectiveness analyses.See all articles in this Special Collection Honoring Paul F. Engstrom, MD, Champion of Cancer Prevention.
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Affiliation(s)
- Scott D Siegel
- Value Institute and Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, Delaware.
| | - Caryn Lerman
- Department of Psychiatry and Norris Cancer Center, University of Southern California, Los Angeles, California
| | - Alex Flitter
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
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177
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Factors associated with tobacco cessation attempts among inpatients in a psychiatric hospital. J Smok Cessat 2020. [DOI: 10.1017/jsc.2020.3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
AbstractIntroductionSeveral effective evidence-based tobacco treatment approaches can optimize cessation attempts; however, little is known about the utilization of such strategies by people with mental illnesses (MI) during their cessation attempts.AimsTo examine methods used during and factors associated with tobacco cessation attempts among people with MI.MethodsSelf-administered cross-sectional survey data were obtained from 132 tobacco using inpatients from a psychiatric facility in Kentucky, USA.ResultsOur study found ‘cold turkey’ as the most reported method by inpatient tobacco users with MI in their prior cessation attempts regardless of the psychiatric diagnosis category. Multivariate logistic regression found ethnicity (OR 26.1; 95% CI 2.9–237.1), age at 1st smoke (OR 1.1; 95% CI 1.0–1.1), importance to quit (OR 1.2; 95% CI 1.0–1.4), and receipt of brief tobacco treatment interventions (OR 1.1; 95% CI 1.0–1.3) significantly associated with quit attempt in the past year.ConclusionDespite the existence of various evidence-based approaches to enhance tobacco cessation among people with MI, ‘cold-turkey’ was the most preferred method in this sample. In addition, this study highlighted ethnicity, importance to quit, age at 1st smoke, and receipt of brief interventions as important factors to consider when tailoring tobacco cessation in this population. Though ethnicity is a non-modifiable factor, an informed provider may intervene skillfully by addressing socio-cultural barriers specific to an ethnic group. Lower ratings on the motivation ruler and early age of smoking initiation could also inform providers when using motivational interviewing and other evidence-based tobacco-cessation approaches.
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178
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Johnson AL, Kaye J, Baker TB, Fiore MC, Cook JW, Piper ME. Psychiatric comorbidities in a comparative effectiveness smoking cessation trial: Relations with cessation success, treatment response, and relapse risk factors. Drug Alcohol Depend 2020; 207:107796. [PMID: 31864163 PMCID: PMC7076564 DOI: 10.1016/j.drugalcdep.2019.107796] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Comorbid psychiatric diagnoses have been shown to predict cessation failure. The relative impact of various diagnoses on cessation and other cessation processes is rarely studied, particularly among a general population. The impact of psychiatric history among primary care patients seeking cessation services on nicotine dependence, cessation outcomes, treatment effects and adherence, and withdrawal symptoms was examined. METHODS Secondary data analysis of a multi-site comparative effectiveness smoking cessation trial was conducted. Adult smokers (n = 1051; 52.5 % Female, 68.1 % white) completed a structured clinical interview at baseline to assess psychiatric diagnostic history (past-year and lifetime). Nicotine dependence was assessed via self-report measures at baseline. Point-prevalence abstinence was assessed at 8 weeks and 6 months post-quit. Withdrawal symptoms were assessed for one week pre- and post-quit using ecological momentary assessment. Treatment adherence was self-reported at 1, 4, 8, and 12 weeks post-quit. RESULTS Past-year substance use disorder, lifetime mood disorder, and > one lifetime diagnosis, were related to lower rates of short-term, but not long-term, cessation. Lifetime psychiatric diagnosis was related to elevated nicotine dependence, particularly to secondary dependence motives associated with instrumental tobacco use. History of psychiatric diagnosis was associated with increased withdrawal-related craving. There was little evidence that psychiatric diagnostic status moderated the effects of the tested pharmacotherapies on long-term abstinence. CONCLUSIONS Psychiatric diagnoses affect risk factors that exert their effects early in the post-quit process and highlight the potential utility of examining transdiagnostic risk factors to better understand the relations between psychiatric vulnerabilities and the smoking cessation process.
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Affiliation(s)
- Adrienne L. Johnson
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705,Correspondence concerning this article should be addressed to Megan E. Piper, Ph.D., Center for Tobacco Research and Intervention, University of Wisconsin, Madison, WI, 53711; Tel: 608-265-5472; Fax: 608-265-3102;
| | - Jesse Kaye
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705
| | - Timothy B. Baker
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Michael C. Fiore
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Jessica W. Cook
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705
| | - Megan E. Piper
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
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179
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Kagabo R, Gordon AJ, Okuyemi K. Smoking cessation in inpatient psychiatry treatment facilities: A review. Addict Behav Rep 2020; 11:100255. [PMID: 32467844 PMCID: PMC7244912 DOI: 10.1016/j.abrep.2020.100255] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/06/2020] [Accepted: 01/21/2020] [Indexed: 12/02/2022] Open
Abstract
Smoking rates are high among people with psychiatric illness. Smoking cessation interventions are rarely available in inpatient psychiatry settings. Smokers with psychiatric illness are just as interested in quitting smoking.
Background Tobacco-related diseases are a leading cause of death among individuals with severe mental illness (SMI), yet interventions to address tobacco cessation are rare in inpatient settings where persons with SMI are hospitalized. While cigarette smoking rates have declined in the general population, they remain high in persons with SMI. Inpatient settings would be a prime location to intervene on tobacco consumption among persons with SMI. The objective of this review was to examine evidence of smoking cessation interventions in psychiatric inpatient facilities. Method Using narrative overview guidelines, we searched PubMed, PsycINFO, and CINAHL for smoking cessation RCT studies published between 1950 and 2018. Studies included had to have at least started in inpatient psychiatry settings. Examples of search terms included: smoking cessation in inpatient psychiatry, smoking cessation in inpatient mental health treatment facilities, and smoking cessation and mental health. Results Following the inclusion criteria, eight RCT studies were reviewed. One study was among adolescent psychiatric inpatient smokers ages 13–17, and 7 were among adult psychiatric inpatients with mean age 41 years. Treatment periods lasting 8 to 12 weeks started in inpatient settings and continued post discharge. A combination of behavioral and pharmacological interventions were used. Pharmacological interventions were nicotine replacement therapies, and at least one study used varenicline. At baseline, participants smoked an average of 18.1 cigarettes per day. Conclusion Smoking cessation in inpatient psychiatry settings is rare or delayed. There is a need for more tailored treatments among this population to help them quit smoking.
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Affiliation(s)
- Robert Kagabo
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
- Corresponding author at: 375 Chipeta Way Ste. A, Salt Lake City, UT 84108, United States.
| | - Adam J. Gordon
- Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, UT, United States
| | - Kola Okuyemi
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, United States
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Halonen JI, Mänty M, Pietiläinen O, Kujanpää T, Kanerva N, Lahti J, Lahelma E, Rahkonen O, Lallukka T. Physical working conditions and subsequent disability retirement due to any cause, mental disorders and musculoskeletal diseases: does the risk vary by common mental disorders? Soc Psychiatry Psychiatr Epidemiol 2020; 55:1021-1029. [PMID: 31893288 PMCID: PMC7395011 DOI: 10.1007/s00127-019-01823-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 12/24/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Physical work exposures and common mental disorders (CMD) have been linked to increased risk of work disability, but their joint associations with disability retirement due to any cause, mental disorders or musculoskeletal diseases have not been examined. METHODS The data for exposures and covariates were from the Finnish Helsinki Health Study occupational cohort surveys in 2000-2002, 2007 and 2012. We used 12,458 observations from 6159 employees, who were 40-60 years old at baseline. CMD were measured by the General Health Questionnaire (GHQ-12, cut-off point 3+). Four self-reported work exposures (hazardous exposures, physical workload, computer and shift work) were combined with CMD and categorized as "neither", "work exposure only", "CMD only", and "both". Associations with register-based disability retirement were assessed with Cox proportional hazards models for sample survey data adjusting for confounders over 5-year follow-up. Additionally, synergy indices were calculated for the combined effects. RESULTS Those reporting CMD and high physical workload had a greater risk of disability retirement due to any cause (HR 4.26, 95% CI 3.60-5.03), mental disorders (HR 5.41, 95% CI 3.87-7.56), and musculoskeletal diseases (HR 4.46, 95% CI 3.49-5.71) when compared to those with neither. Synergy indices indicated that these associations were synergistic. Similar associations were observed for CMD and hazardous exposures, but not for combined exposures to CMD and computer or shift work. CONCLUSIONS Identification of mental health problems among employees in physically demanding jobs is important to support work ability and reduce the risk of premature exit from work due to disability.
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Affiliation(s)
- Jaana I Halonen
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland.
- Finnish Institute of Occupational Health, Työterveyslaitos, 40, 00032, Helsinki, Finland.
- Finnish Institute for Health and Welfare, 30, 00271, Helsinki, Finland.
| | - Minna Mänty
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Olli Pietiläinen
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Tero Kujanpää
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, 8000, 90014, Oulu, Finland
| | - Noora Kanerva
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Jouni Lahti
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Eero Lahelma
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, 20, 00014, Helsinki, Finland
- Finnish Institute of Occupational Health, Työterveyslaitos, 40, 00032, Helsinki, Finland
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Kim HHS, Kim HJ, Kim EM. Exploring the Association between Suicidality and Smoking Behavior among School-Based Children in Lao People's Democratic Republic (PDR). J Psychoactive Drugs 2020; 52:46-55. [PMID: 31888423 DOI: 10.1080/02791072.2019.1707914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study examines the relationship between suicidality and smoking behavior. Specifically, it examines how and the degree to which suicide ideation and plan are associated with the probability of being a regular smoker among school-based children. Data come from Lao Student Health Survey (2017), a project funded by the National Research Foundation of Korea. Using primary hierarchically nested data (students clustered in classrooms across schools), we investigate the complex interplay between suicidality and smoking behavior in Lao PDR, a low-income country located in Southeast Asia. Results from fitting two-level random intercept models show that net of controls (e.g., gender, age, parental regulation, self-rated health, household SES), the likelihood of daily smoking is higher among students who have seriously considered committing suicide or have planned a suicide attempt. Controlling for individual-level factors, significant classroom-level contextual effects are also found with respect to peer relations. Finally, we observe a cross-level interaction: the positive association between suicide intent and odds of smoking is weaker in classrooms with better peer relations.
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Affiliation(s)
| | - Hyun Jin Kim
- Department of sociology, Ewha Womans University, Seoul, Republic of Korea
| | - Eun Mee Kim
- Department of International Studies (GSIS), Ewha Womans University, Seoul, Republic of Korea
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Disparities in cancer screening in people with mental illness across the world versus the general population: prevalence and comparative meta-analysis including 4 717 839 people. Lancet Psychiatry 2020; 7:52-63. [PMID: 31787585 DOI: 10.1016/s2215-0366(19)30414-6] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/03/2019] [Accepted: 10/03/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Since people with mental illness are more likely to die from cancer, we assessed whether people with mental illness undergo less cancer screening compared with the general population. METHODS In this systematic review and meta-analysis, we searched PubMed and PsycINFO, without a language restriction, and hand-searched the reference lists of included studies and previous reviews for observational studies from database inception until May 5, 2019. We included all published studies focusing on any type of cancer screening in patients with mental illness; and studies that reported prevalence of cancer screening in patients, or comparative measures between patients and the general population. The primary outcome was odds ratio (OR) of cancer screening in people with mental illness versus the general population. The Newcastle-Ottawa Scale was used to assess study quality and I2 to assess study heterogeneity. This study is registered with PROSPERO, CRD42018114781. FINDINGS 47 publications provided data from 46 samples including 4 717 839 individuals (501 559 patients with mental illness, and 4 216 280 controls), of whom 69·85% were women, for screening for breast cancer (k=35; 296 699 individuals with mental illness, 1 023 288 in the general population), cervical cancer (k=29; 295 688 with mental illness, 3 540 408 in general population), colorectal cancer (k=12; 153 283 with mental illness, 2 228 966 in general population), lung and gastric cancer (both k=1; 420 with mental illness, none in general population), ovarian cancer (k=1; 37 with mental illness, none in general population), and prostate cancer (k=6; 52 803 with mental illness, 2 038 916 in general population). Median quality of the included studies was high at 7 (IQR 6-8). Screening was significantly less frequent in people with any mental disease compared with the general population for any cancer (k=37; OR 0·76 [95% CI 0·72-0·79]; I2=98·53% with publication bias of Egger's p value=0·025), breast cancer (k=27; 0·65 [0·60-0·71]; I2=97·58% and no publication bias), cervical cancer (k=23; 0·89 [0·84-0·95]; I2=98·47% and no publication bias), and prostate cancer (k=4; 0·78 [0·70-0·86]; I2=79·68% and no publication bias), but not for colorectal cancer (k=8; 1·02 [0·90-1·15]; I2=97·84% and no publication bias). INTERPRETATION Despite the increased mortality from cancer in people with mental illness, this population receives less cancer screening compared with that of the general population. Specific approaches should be developed to assist people with mental illness to undergo appropriate cancer screening, especially women with schizophrenia. FUNDING None.
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183
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Al-Mrayat YD, Okoli CTC, Studts CR, Rayens MK, Hahn EJ. The Psychometric Properties of the Minnesota Tobacco Withdrawal Scale Among Patients With Mental Illness. Biol Res Nurs 2019; 22:247-255. [PMID: 31854206 DOI: 10.1177/1099800419895573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Approximately 65% of psychiatric inpatients experience moderate-to-severe nicotine withdrawal (NW), a set of symptoms appearing within 24 hr after an abrupt cessation or reduction of use of tobacco-containing products in those using nicotine daily for at least a couple of weeks. The Minnesota Tobacco Withdrawal Scale (MTWS) is a widely used instrument for detecting NW. However, the psychometric properties of the MTWS have not previously been examined among patients with serious mental illness (SMI) undergoing tobacco-free hospitalization. The objective of this study was to examine the validity and reliability of the MTWS among patients with SMI during tobacco-free psychiatric hospitalization. METHODS Reliability was tested by examining Cronbach's α and item analysis. Validity was examined through hypothesis testing and exploratory factor analysis (N = 255). RESULTS The reliability analysis yielded a Cronbach's α coefficient of .763, an inter-item correlations coefficient of .393, and item-total correlations between .291 and .691. Hypothesis testing confirmed the construct validity of the MTWS, and an exploratory factor analysis yielded a unidimensional scale. CONCLUSION The MTWS demonstrated adequate reliable and valid psychometric properties for measuring NW among patients with SMI. Nurses and other health-care professionals may use this instrument in clinical practice to identify patients with SMI experiencing NW. The MTWS is psychometrically sound for capturing NW during tobacco-free psychiatric hospitalization. Future research should examine the efficacy of the MTWS in measuring NW in this population over an extended period of hospitalization.
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Affiliation(s)
| | | | | | - Mary K Rayens
- The University of Kentucky College of Nursing, Lexington, KY, USA
| | - Ellen J Hahn
- The University of Kentucky College of Nursing, Lexington, KY, USA
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184
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Higuchi Y, Fujiwara M, Nakaya N, Fujimori M, Hayashibara C, So R, Shinkawa I, Sato K, Yada Y, Kodama M, Takenaka H, Kishi Y, Kakeda K, Uchitomi Y, Yamada N, Inagaki M. Change in smoking cessation stage over 1 year in patients with schizophrenia: a follow up study in Japan. BMC Psychiatry 2019; 19:367. [PMID: 31752799 PMCID: PMC6873402 DOI: 10.1186/s12888-019-2351-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 10/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We performed a follow up study about willingness and behaviors to quit smoking among smokers with schizophrenia in Japan. METHODS Participants were outpatients with schizophrenia aged 20-69 years who had been visiting the hospital for ≥1 year as of April 1, 2016, and had visited the hospital more than once in the previous 6 months. A baseline survey on smoking behaviors including current smoking status and smoking cessation stage, was administered in 420 participants that were randomly extracted from a patient pool (n = 680) in 2016, and a follow-up survey was administered in 2017. We calculated the distribution and change in smoking cessation stage, number of smokers and nonsmokers after 1 year, and quitting rate from a naturalistic 1-year smoking-cessation follow up. RESULTS The number of baseline respondents was 350; 113 current smokers and 68 former smokers. Among the 113 current smokers, 104 (92.0%) were followed for 1 year, 79 (70.0%) were interested in smoking cessation, and only 7 had received smoking cessation treatments at baseline. Among the tracked 104 participants, only 6 (5.8%) stopped smoking after 1 year. Among the 25 participants who had intentions to quit smoking within 6 months at baseline, 6 (24.0%) maintained their intention to quit smoking for 1 year, and 16 (64.0%) did not maintain their intention to quit smoking. CONCLUSIONS Our findings showed that many smokers with schizophrenia were interested in quitting smoking, but few patients received treatment and actually quit smoking. Timely intervention, including the option to receive smoking cessation treatment, is necessary for those patients with schizophrenia who smoke. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN000023874, registered on August 31, 2016).
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Affiliation(s)
- Yuji Higuchi
- Taiyo Hills Hospital, 2200 Abe, Ochiaicho, Takahashi City, Okayama, 716-0061 Japan
| | - Masaki Fujiwara
- 0000 0004 0631 9477grid.412342.2Department of Neuropsychiatry, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Naoki Nakaya
- 0000 0001 2248 6943grid.69566.3aDepartment of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo, Sendai, 980-8573 Japan
| | - Maiko Fujimori
- 0000 0001 2168 5385grid.272242.3Division of Health Care Research, Behavioral Sciences and Survivorship Research and Division of Cohort Consortium Research, Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - Chinatsu Hayashibara
- grid.443236.4Division of Occupational Therapy, Faculty of Care and Rehabilitation, Seijoh University, 2-172 Fukinodai, Tokai City, Aichi 476-8588 Japan
| | - Ryuhei So
- grid.474879.1Okayama Psychiatric Medical Center, 3-16 Shikatahon-machi, Kita-ku, Okayama, 700-0915 Japan
| | - Ikuta Shinkawa
- grid.474879.1Okayama Psychiatric Medical Center, 3-16 Shikatahon-machi, Kita-ku, Okayama, 700-0915 Japan
| | - Kojiro Sato
- grid.474879.1Okayama Psychiatric Medical Center, 3-16 Shikatahon-machi, Kita-ku, Okayama, 700-0915 Japan
| | - Yuji Yada
- grid.474879.1Okayama Psychiatric Medical Center, 3-16 Shikatahon-machi, Kita-ku, Okayama, 700-0915 Japan
| | - Masafumi Kodama
- grid.474879.1Okayama Psychiatric Medical Center, 3-16 Shikatahon-machi, Kita-ku, Okayama, 700-0915 Japan
| | - Hiroshi Takenaka
- grid.474879.1Okayama Psychiatric Medical Center, 3-16 Shikatahon-machi, Kita-ku, Okayama, 700-0915 Japan
| | - Yoshiki Kishi
- grid.474879.1Okayama Psychiatric Medical Center, 3-16 Shikatahon-machi, Kita-ku, Okayama, 700-0915 Japan
| | - Kyoko Kakeda
- 0000 0001 0659 9825grid.278276.eDepartment of Neuropsychiatry, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Yosuke Uchitomi
- 0000 0001 2168 5385grid.272242.3Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital and Behavioral Sciences and Survivorship Research, Center for Public Health Sciences, National Cancer Center, Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - Norihito Yamada
- 0000 0001 1302 4472grid.261356.5Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Masatoshi Inagaki
- Department of Psychiatry, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
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185
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Secades-Villa R, González-Roz A, Vallejo-Seco G, Weidberg S, García-Pérez Á, Alonso-Pérez F. Additive effectiveness of contingency management on cognitive behavioural treatment for smokers with depression: Six-month abstinence and depression outcomes. Drug Alcohol Depend 2019; 204:107495. [PMID: 31491583 DOI: 10.1016/j.drugalcdep.2019.06.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/02/2019] [Accepted: 06/03/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Depression and smoking co-occur at high rates and there is a lack of evidence on the efficacy of treatments specifically tailored to this population. This randomized controlled trial sought to compare the effectiveness of cognitive behavioural treatment (CBT) combined with behavioural activation (BA) and the same treatment protocol plus contingency management (CM). METHODS A sample of 120 adult smokers (70.8%: females) with severe depressive symptoms were randomly allocated to: CBT + BA (n = 60) or CBT + BA + CM (n = 60). Smoking and depression outcomes were reported at end of treatment, 1-, 2-, 3-, and 6-month follow-ups. Self-reported smoking status was biochemically verified, and depression was assessed using the Beck Depression Inventory-II. RESULTS At end of treatment, the overall quit rate was 69.2% (83/120). CM showed an additive effect on CBT + BA in enhancing abstinence rates. The significant effect of group [F(1,155) = 9.55, p = .0024], time [F(4,96) = 7.93, p < .0001], and group by time interaction [F(4,96) = 6.12, p = .0002], indicated that CM is more effective for generating longer durations of abstinence beyond those of CBT+BA. All treatment conditions equally promoted sustained reductions in depression across time [F(1,111) = 0.53, p = .4665]. A greater number of days of continuous abstinence and lower depressive symptoms mutually influenced each other. CONCLUSIONS Depressed smokers achieve high cessation rates without suffering negative mood changes. Quitting smoking is not detrimental and adding CM to CBT + BA enhances long-lasting abstinence rates while promoting large depression improvements.
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Affiliation(s)
- Roberto Secades-Villa
- Department of Psychology. University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
| | - Alba González-Roz
- Department of Psychology. University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain.
| | | | - Sara Weidberg
- Department of Psychology. University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
| | - Ángel García-Pérez
- Department of Psychology. University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
| | - Fernando Alonso-Pérez
- Department of Psychology. University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
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186
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Rogers ES, Wysota CN. Tobacco Screening and Treatment of Patients With a Psychiatric Diagnosis, 2012-2015. Am J Prev Med 2019; 57:687-694. [PMID: 31564608 DOI: 10.1016/j.amepre.2019.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 06/18/2019] [Accepted: 06/19/2019] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Smoking disproportionately affects individuals with psychiatric diagnoses. Providers can play a role in reducing tobacco-related morbidity among people with a psychiatric diagnosis by routinely screening and treating all patients for tobacco use. This study seeks to identify rates of tobacco screening, counseling, and medication orders during outpatient visits with adults who have a psychiatric diagnosis. METHODS Data from the 2012-2015 National Ambulatory Medical Care Survey were examined to calculate the proportion of visits with people who have a psychiatric diagnosis that included tobacco screening, counseling, or smoking-cessation medications. Logistic regression was used to identify patient and visit factors associated with tobacco screening and treatment. All analyses were conducted in 2018. RESULTS Seventy-two percent of visits included tobacco screening, 23% of visits with tobacco users included cessation counseling, and 4% of visits with tobacco users included a cessation medication order. Visits were more likely to include tobacco screening if they were for a nonpsychiatric condition, were >30 minutes, or were with a primary care physician (p<0.05). Visits were less likely to include tobacco screening if they were with a black, non-Hispanic patient or patient with Medicaid (p<0.05). Visits were more likely to include cessation counseling if they were for a nonpsychiatric condition (p<0.05), and were less likely to include counseling if they were with a Hispanic or self-pay patient (p<0.05). CONCLUSIONS There is still room for improvement in providing equitable treatment for people with psychiatric conditions for smoking, particularly in nonprimary settings.
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Affiliation(s)
- Erin S Rogers
- Department of Population Health, New York University Langone Health, New York, New York; Research Service, VA NY Harbor Healthcare System, New York, New York.
| | - Christina N Wysota
- Department of Population Health, New York University Langone Health, New York, New York
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187
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Tzelepis F, Paul CL, Williams CM, Gilligan C, Regan T, Daly J, Hodder RK, Byrnes E, Byaruhanga J, McFadyen T, Wiggers J. Real-time video counselling for smoking cessation. Cochrane Database Syst Rev 2019; 2019:CD012659. [PMID: 31684699 PMCID: PMC6818086 DOI: 10.1002/14651858.cd012659.pub2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Real-time video communication software such as Skype and FaceTime transmits live video and audio over the Internet, allowing counsellors to provide support to help people quit smoking. There are more than four billion Internet users worldwide, and Internet users can download free video communication software, rendering a video counselling approach both feasible and scalable for helping people to quit smoking. OBJECTIVES To assess the effectiveness of real-time video counselling delivered individually or to a group in increasing smoking cessation, quit attempts, intervention adherence, satisfaction and therapeutic alliance, and to provide an economic evaluation regarding real-time video counselling. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, CENTRAL, MEDLINE, PubMed, PsycINFO and Embase to identify eligible studies on 13 August 2019. We searched the World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov to identify ongoing trials registered by 13 August 2019. We checked the reference lists of included articles and contacted smoking cessation researchers for any additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs), randomised trials, cluster RCTs or cluster randomised trials of real-time video counselling for current tobacco smokers from any setting that measured smoking cessation at least six months following baseline. The real-time video counselling intervention could be compared with a no intervention control group or another smoking cessation intervention, or both. DATA COLLECTION AND ANALYSIS Two authors independently extracted data from included trials, assessed the risk of bias and rated the certainty of the evidence using the GRADE approach. We performed a random-effects meta-analysis for the primary outcome of smoking cessation, using the most stringent measure of smoking cessation measured at the longest follow-up. Analysis was based on the intention-to-treat principle. We considered participants with missing data at follow-up for the primary outcome of smoking cessation to be smokers. MAIN RESULTS We included two randomised trials with 615 participants. Both studies delivered real-time video counselling for smoking cessation individually, compared with telephone counselling. We judged one study at unclear risk of bias and one study at high risk of bias. There was no statistically significant treatment effect for smoking cessation (using the strictest definition and longest follow-up) across the two included studies when real-time video counselling was compared to telephone counselling (risk ratio (RR) 2.15, 95% confidence interval (CI) 0.38 to 12.04; 2 studies, 608 participants; I2 = 66%). We judged the overall certainty of the evidence for smoking cessation as very low due to methodological limitations, imprecision in the effect estimate reflected by the wide 95% CIs and inconsistency of cessation rates. There were no significant differences between real-time video counselling and telephone counselling reported for number of quit attempts among people who continued to smoke (mean difference (MD) 0.50, 95% CI -0.60 to 1.60; 1 study, 499 participants), mean number of counselling sessions completed (MD -0.20, 95% CI -0.45 to 0.05; 1 study, 566 participants), completion of all sessions (RR 1.13, 95% CI 0.71 to 1.79; 1 study, 43 participants) or therapeutic alliance (MD 1.13, 95% CI -0.24 to 2.50; 1 study, 398 participants). Participants in the video counselling arm were more likely than their telephone counselling counterparts to recommend the programme to a friend or family member (RR 1.06, 95% CI 1.01 to 1.11; 1 study, 398 participants); however, there were no between-group differences on satisfaction score (MD 0.70, 95% CI -1.16 to 2.56; 1 study, 29 participants). AUTHORS' CONCLUSIONS There is very little evidence about the effectiveness of real-time video counselling for smoking cessation. The existing research does not suggest a difference between video counselling and telephone counselling for assisting people to quit smoking. However, given the very low GRADE rating due to methodological limitations in the design, imprecision of the effect estimate and inconsistency of cessation rates, the smoking cessation results should be interpreted cautiously. High-quality randomised trials comparing real-time video counselling to telephone counselling are needed to increase the confidence of the effect estimate. Furthermore, there is currently no evidence comparing real-time video counselling to a control group. Such research is needed to determine whether video counselling increases smoking cessation.
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Affiliation(s)
- Flora Tzelepis
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Christine L Paul
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
| | - Christopher M Williams
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Conor Gilligan
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
| | - Tim Regan
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Justine Daly
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Rebecca K Hodder
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Emma Byrnes
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - Judith Byaruhanga
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
| | - Tameka McFadyen
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
| | - John Wiggers
- University of NewcastleSchool of Medicine and Public HealthUniversity DriveCallaghanNSWAustralia2308
- Hunter Medical Research InstituteNew LambtonAustralia
- Hunter New England Local Health DistrictHunter New England Population HealthWallsendAustralia
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188
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Tidey JW. The Bad and Good News About Tobacco Treatment for People With Comorbid Conditions in the US Health Care System. Nicotine Tob Res 2019; 21:1451-1452. [DOI: 10.1093/ntr/ntz150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/14/2019] [Indexed: 11/14/2022]
Affiliation(s)
- Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
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189
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Shahwan S, Abdin E, Shafie S, Chang S, Sambasivam R, Zhang Y, Vaingankar JA, Teo YY, Heng D, Chong SA, Subramaniam M. Prevalence and correlates of smoking and nicotine dependence: results of a nationwide cross-sectional survey among Singapore residents. BMJ Open 2019; 9:e032198. [PMID: 31630110 PMCID: PMC6803088 DOI: 10.1136/bmjopen-2019-032198] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Since the Singapore Mental Health Study in 2010 which reported a 16.0% prevalence rate for current smokers and 4.5% for nicotine dependence, new anti-smoking strategies have been implemented. The aim of this study was to compare smoking trends from the 2010 study with the second Singapore Mental Health Study in 2016 (SMHS 2016). METHODS A survey of 6126 individuals aged 18 years and above randomly selected among Singapore residents was conducted using the same methodology as the 2010 study. The measures used in this analysis were sociodemographic questions, the Composite International Diagnostic Interview which assessed for psychiatric disorders, the Fagerstrom Test for Nicotine Dependence and a list of chronic physical conditions that were prevalent in Singapore. Logistic regression analyses were used to test for associations between smoking/nicotine-dependence and other measures. RESULTS In the SMHS 2016, 16.1% were current smokers and 3.3% were nicotine-dependent. As compared with non-smokers, current smokers were more likely to be younger, male gender, of ethnic minority and had lower/vocational education level. Younger age, male gender, lower/vocational education and psychiatric disorders (major depression, bipolar disorder and alcohol use disorders) predicted nicotine dependence. No associations were found between nicotine dependence and any of the chronic conditions. CONCLUSION The prevalence of current smokers in the population has plateaued while that of nicotine dependence has decreased from 2010. However, the study did not investigate the use of e-cigarettes. Inequalities in smoking and nicotine dependence continue to pervade the population particularly among those of ethnic minority, lower/vocational education and the mentally ill.
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Affiliation(s)
- Shazana Shahwan
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Saleha Shafie
- Research Division, Institute of Mental Health, Singapore, Singapore
| | - Sherilyn Chang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Yunjue Zhang
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Yik Ying Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Derrick Heng
- Epidemiology & Disease Control Division, Ministry of Health, Government of Singapore, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
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190
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Gogos A, Skokou M, Ferentinou E, Gourzis P. Nicotine consumption during the prodromal phase of schizophrenia - a review of the literature. Neuropsychiatr Dis Treat 2019; 15:2943-2958. [PMID: 31802874 PMCID: PMC6801495 DOI: 10.2147/ndt.s210199] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/11/2019] [Indexed: 12/12/2022] Open
Abstract
Recent research has fueled a debate concerning the role of nicotine in the emergence of schizophrenia. The three main hypotheses are: (a) the self-medication effect, (b) the causal relationship hypothesis, or (c) the shared diathesis hypothesis. To explore this role, the study of nicotine consumption during the initial prodromal phase of schizophrenia offers important opportunities. In the present work, 10 relevant studies are reviewed, out of 727 retrieved citations, in order to address questions regarding the prevalence of smoking in the prodromal period, the time of smoking initiation, existing patterns of tobacco use in relation with the escalation of prodromal symptoms into first psychotic episode, and potential differences in symptomatology between smokers and nonsmokers. Even though there was considerable heterogeneity among studies, relevant findings are discussed. Prevalence of nicotine use during the prodromal period was reported to be 16.6-46%. Tobacco use was found to be taken up most often before or during the prodromal period of schizophrenia. Even though a protective role of smoking has been reported by one study, other studies report an increased risk for psychosis, with hazard ratios 2.77 (95% CI: 2.34-3.43) and 2.21 (95% CI: 1.11-4.42) for female and male heavy smokers (11-20 and >20 cigarettes/day), respectively. In a different study, the risk of onset was associated with the progressive use of cannabis and tobacco prior to onset, particularly with rapid escalation to the highest levels of use. Also, nicotine use in ultra high risk (UHR) for developing psychosis subjects is associated with elevated cognitive performance, namely better processing speed, visual learning, and spatial working memory. As a conclusion, it appears that evidence accumulates supporting a possible etiologic role of smoking, in the emergence of schizophrenia along with diverse effects on patients' symptomatology, already demonstrable at the prodromal phase. Future research employing better-defined criteria should further explore the patterns of use and effects of nicotine during the schizophrenia prodrome.
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Affiliation(s)
| | - Maria Skokou
- Department of Psychiatry, University Hospital of Patras, Rion, Patras, Greece
| | | | - Philippos Gourzis
- Department of Psychiatry, University Hospital of Patras, Rion, Patras, Greece
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191
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Hassanzadah M, Bitar AH, Khanfar NM, Khasawneh FT, Lutfy K, Shankar GS. A retrospective cohort study of the prevalence of anxiety and agitation in schizophrenic smokers and the unmet needs of smoking cessation programs. Medicine (Baltimore) 2019; 98:e17375. [PMID: 31577741 PMCID: PMC6783193 DOI: 10.1097/md.0000000000017375] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/27/2019] [Accepted: 09/03/2019] [Indexed: 11/26/2022] Open
Abstract
Achieving abstinence in schizophrenic smokers using a combination of medications and cognitive behavioral therapy is feasible; however, abstinence rates are significantly lower compared to the general population and studies are scanty. Additionally, maintaining sustained abstinence and preventing relapse is a major limiting factor and represents key tasks in managing tobacco dependence in schizophrenic patients. Several theories have been postulated to explain the higher tendency of tobacco use among schizophrenic individuals. Schizophrenic patients may use nicotine as a "self-medication" strategy to improve negative symptoms of schizophrenia. However, studies suggest that although nicotine may act as an anxiolytic acutely, chronic use of nicotine may lead to increased anxiety with the possibility of increased catecholamines, which is confirmed with the prevalence of tachycardia and hypertension in smokers in general. On this basis, the main objective of our present study was to assess anxiety in schizophrenic smoking and nonsmoking patients by comparing the number of anxiety and agitation episodes and evaluating the amount of antianxiety/antiagitation medication used by each group. A separate objective was to document the unmet needs of smoking cessation programs in treating schizophrenic patients. Consequently, in the present retrospective cohort study, it was observed that schizophrenic smokers tend to have higher anxiety episodes and utilize as-needed medications at a higher frequency compared to nonsmokers for the relief of anxiety and agitation symptoms. Further research is warranted to examine these results on a larger scale.
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Affiliation(s)
| | - Adib H Bitar
- Aurora Charter Oak Behavioral Healthcare, Covina, CA
| | - Nile M Khanfar
- College of Pharmacy, Nova Southeastern University, Palm Beach, FL
| | - Fadi T Khasawneh
- School of Pharmacy, The University of Texas at El Paso, El Paso, TX
| | - Kabirullah Lutfy
- College of Pharmacy, Western University of Health Sciences, Pomona, CA
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192
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Cunningham R, Poppe K, Peterson D, Every-Palmer S, Soosay I, Jackson R. Prediction of cardiovascular disease risk among people with severe mental illness: A cohort study. PLoS One 2019; 14:e0221521. [PMID: 31532772 PMCID: PMC6750572 DOI: 10.1371/journal.pone.0221521] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 08/08/2019] [Indexed: 02/07/2023] Open
Abstract
Objective To determine whether contemporary sex-specific cardiovascular disease (CVD) risk prediction equations underestimate CVD risk in people with severe mental illness from the cohort in which the equations were derived. Methods We identified people with severe mental illness using information on prior specialist mental health treatment. This group were identified from the PREDICT study, a prospective cohort study of 495,388 primary care patients aged 30 to 74 years without prior CVD that was recently used to derive new CVD risk prediction equations. CVD risk was calculated in participants with and without severe mental illness using the new equations and the predicted CVD risk was compared with observed risk in the two participant groups using survival methods. Results 28,734 people with a history of recent contact with specialist mental health services, including those without a diagnosis of a psychotic disorder, were identified in the PREDICT cohort. They had a higher observed rate of CVD events compared to those without such a history. The PREDICT equations underestimated the risk for this group, with a mean observed:predicted risk ratio of 1.29 in men and 1.64 in women. In contrast the PREDICT algorithm performed well for those without mental illness. Conclusions Clinicians using CVD risk assessment tools that do not include severe mental illness as a predictor could by underestimating CVD risk by about one-third in men and two-thirds in women in this patient group. All CVD risk prediction equations should be updated to include mental illness indicators.
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Affiliation(s)
- Ruth Cunningham
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
- * E-mail:
| | - Katrina Poppe
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Debbie Peterson
- Department of Public Health, University of Otago Wellington, Wellington, New Zealand
| | - Susanna Every-Palmer
- Department of Psychological Medicine, University of Otago Wellington, Wellington, New Zealand
| | - Ian Soosay
- School of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rod Jackson
- Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
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193
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Moeller SJ, Fink DS, Gbedemah M, Hasin DS, Galea S, Zvolensky MJ, Goodwin RD. Trends in Illicit Drug Use Among Smokers and Nonsmokers in the United States, 2002-2014. J Clin Psychiatry 2019; 79:17m11718. [PMID: 29894597 PMCID: PMC6139671 DOI: 10.4088/jcp.17m11718] [Citation(s) in RCA: 18] [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] [Received: 05/25/2017] [Accepted: 11/27/2017] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Cigarette smoking has declined in the United States. Still, identifying prevalent and modifiable barriers to quitting can help inform the next steps for tobacco control. Illicit drug use, which may be increasingly common in the United States, could be one such factor. We investigated the relationship between past-month illicit drug use and cigarette smoking status and estimated trends in the prevalence of past-month illicit drug use by cigarette smoking status from 2002 to 2014 in the United States. METHODS The 2002-2014 National Survey on Drug Use and Health was used to obtain nationally representative data on past-month illicit drug use. RESULTS From 2002 to 2014, past-month illicit drug use (for all drugs considered) was nearly 5 times more common among current smokers than among never smokers (adjusted odds ratio = 4.79) and nearly twice as prevalent in former smokers as in never smokers (adjusted odds ratio = 1.99). Illicit drug use increased linearly over time from 2002 to 2014 in the entire general population (ie, across and within current smokers, former smokers, and never smokers). This increasing trend in drug use was most rapid among former smokers (relative to current smokers and never smokers) and was largely, but not entirely, driven by increases in cannabis use. CONCLUSIONS Illicit drug use is most prevalent among current cigarette smokers. Yet, the rate of increase in illicit drug use prevalence was most rapid among former smokers. Because former smokers outnumber current smokers in the general population, it may be important to monitor former smokers into the future for potential negative drug-related outcomes.
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Affiliation(s)
- Scott J Moeller
- Department of Psychiatry, Stony Brook University School of Medicine, Stony Brook, New York, USA
| | - David S Fink
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Misato Gbedemah
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, USA
| | - Deborah S Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- New York State Psychiatric Institute, New York, New York, USA
| | - Sandro Galea
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Houston, Texas, USA
- Department of Behavioral Sciences, University of Texas, and MD Anderson Cancer Center, Houston, Texas, USA
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, 55 West 125th St, New York, NY 10027.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, New York, USA
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194
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Abstract
AbstractIntroductionThe use of electronic cigarettes (e-cigarettes) in smokers with mental health conditions (MHC) is not well understood.AimsThis study aims to compare e-cigarette users and non-users among veteran smokers with MHC to characterize differences in smoking behavior, motivation to quit, psychological distress, primary psychiatric diagnosis, and other factors.MethodsBaseline survey data were used from a randomized smoking cessation trial enrolling smokers with MHC from four Veterans Health Administration hospitals. Participants were categorized as current, former (having ever tried an e-cigarette), or never e-cigarette users. Pearson's χ2 and ANOVA Type-3 F-tests were used to test the bivariate associations between e-cigarette use and variables measured.ResultsAmong 1,836 participants, mean age was 58 years (STD ± 12.5), 87% were male, 15% were current e-cigarette users (n = 275), and 27% were former users (n = 503). Sixty-five percent of e-cigarette users reported ‘wanting to quit smoking’ as a primary reason. Mean readiness to quit smoking (1–10) was 7.2, 6.8, and 6.4 for current, former, and never e-cigarette users, respectively (P = 0.0002). Sixty-three percent of current and former users and 55% of never-users reported some mental distress on Kessler-6 scale (P = 0.0003, OR = 1.4, 95% CI 1.1–1.7). A primary psychiatric diagnosis of alcohol or substance use disorder was recorded for 50% of current or former users and 60% of never-users (P = 0.0003, OR = 0.69, 95% CI 0.56–0.84).ConclusionsE-cigarette users were more ready to quit and most often reported using e-cigarettes to assist with quitting. E-cigarette users had more psychological distress and were less likely to have substance use disorders as their primary psychiatric diagnosis.
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195
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Velasco ER, Florido A, Milad MR, Andero R. Sex differences in fear extinction. Neurosci Biobehav Rev 2019; 103:81-108. [PMID: 31129235 PMCID: PMC6692252 DOI: 10.1016/j.neubiorev.2019.05.020] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/08/2019] [Accepted: 05/19/2019] [Indexed: 12/18/2022]
Abstract
Despite the exponential increase in fear research during the last years, few studies have included female subjects in their design. The need to include females arises from the knowledge gap of mechanistic processes underlying the behavioral and neural differences observed in fear extinction. Moreover, the exact contribution of sex and hormones in relation to learning and behavior is still largely unknown. Insights from this field could be beneficial as fear-related disorders are twice as prevalent in women compared to men. Here, we review an up-to-date summary of animal and human studies in adulthood that report sex differences in fear extinction from a structural and functional approach. Furthermore, we describe how these factors could contribute to the observed sex differences in fear extinction during normal and pathological conditions.
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Affiliation(s)
- E R Velasco
- Institut de Neurociències, Universitat Autònoma de Barcelona, Spain
| | - A Florido
- Institut de Neurociències, Universitat Autònoma de Barcelona, Spain
| | - M R Milad
- Department of Psychiatry, University of Illinois at Chicago, USA
| | - R Andero
- Institut de Neurociències, Universitat Autònoma de Barcelona, Spain; CIBERSAM, Corporació Sanitaria Parc Taulí, Sabadell, Spain; Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Spain.
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196
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Scheeres A, Xhezo R, Julius R, Coffman R, Frisby J, Weber L, Streeter J, Leone F, Bettigole C, Lawman H. Changes in voluntary admission and restraint use after a comprehensive tobacco-free policy in inpatient psychiatric health facilities. Subst Abus 2019; 41:252-258. [PMID: 31295085 DOI: 10.1080/08897077.2019.1635556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Cardiovascular and respiratory diseases, predominantly due to tobacco use, are the leading causes of death among individuals with serious and persistent mental illness. However, many psychiatric health facilities do not routinely treat tobacco use disorder. The purpose of the current study was to examine the impact of implementing a tobacco-free policy in inpatient psychiatric health facilities in a large, urban setting on behavioral problems, treatment access, and tobacco treatment. Methods: Data on seclusion and restraint incidents, voluntary commitment at admission for each hospitalization episode, and nicotine replacement therapy (NRT) prescriptions were collected through secondary analysis of Medicaid administrative records from baseline in January 2015 (n = 8983) to follow-up in December 2016 (n = 9685) at 14 inpatient psychiatric health facilities. Results: There were no significant changes from baseline to follow-up in odds of seclusion and restraint incidents or voluntary admission status. There was a significant increase in the odds of NRT prescriptions at both 30 and 180 days post discharge (odds ratio [OR] range = 1.58-2.09, P < .01). Conclusions: In a large, urban setting among Medicaid enrollees, implementation of a tobacco-free policy in inpatient psychiatric health facilities had no negative impact on behavioral problems or treatment access and improved access to NRT, although overall NRT use remained low. This study challenges perceptions among some providers that addressing tobacco use disorder will negatively impact treatment outcomes in individuals with serious mental illness. These findings support tobacco-free policies in psychiatric health facilities and the role of psychiatric health providers in treating tobacco use in this population, which is at high risk for tobacco-related mortality.
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Affiliation(s)
- Annaka Scheeres
- Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
| | - Regina Xhezo
- Community Behavioral Health, Philadelphia, Pennsylvania, USA
| | - Rose Julius
- Community Behavioral Health, Philadelphia, Pennsylvania, USA
| | - Ryan Coffman
- Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
| | - Jarma Frisby
- Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
| | - Luise Weber
- Community Behavioral Health, Philadelphia, Pennsylvania, USA
| | | | - Frank Leone
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cheryl Bettigole
- Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
| | - Hannah Lawman
- Division of Chronic Disease Prevention, Philadelphia Department of Public Health, Philadelphia, Pennsylvania, USA
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197
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McCombe G, Harrold A, Brown K, Hennessy L, Clarke M, Hanlon D, O'Brien S, Lyne J, Corcoran C, McGorry P, Cullen W. Key Worker-Mediated Enhancement of Physical Health in First Episode Psychosis: Protocol For a Feasibility Study in Primary Care. JMIR Res Protoc 2019; 8:e13115. [PMID: 31293240 PMCID: PMC6652125 DOI: 10.2196/13115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/27/2019] [Accepted: 03/30/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Studies have demonstrated that, for patients with psychosis, a majority of the decline in health status and functioning emerges during the first few years after the onset of illness. This knowledge led to the development of specialized early intervention services (EISs) targeting patients experiencing their first episode of psychosis. The central component of EISs is often assertive case management delivered by a multidisciplinary team, where an appointed key worker is responsible for coordinating treatment and delivering various psychosocial interventions to service users. OBJECTIVE This paper outlines the protocol for a feasibility study examining how key workers may enhance physical health by supporting integration between primary and secondary care. METHODS Semistructured interviews were conducted with key stakeholder groups (General Practitioners and health care professionals working in mental health services). The interviews informed the development of the complex intervention involving a longitudinal pre-post intervention in 8 general practices in 2 regions in Ireland (one urban and one rural). Patients with first episode psychosis (FEP) will be identified from clinical records at general practices and mental health services. RESULTS Baseline and follow-up data (at 6 months) will be collected, examining measures of feasibility, acceptability, and intervention effect size. CONCLUSIONS Study findings will inform future practice by examining feasibility of key workers enhancing physical health through improved interaction between primary and secondary care. By identifying issues involved in enhancing recruitment and retention, as well as the likely effect size, the study will inform a future definitive intervention. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/13115.
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Affiliation(s)
- Geoff McCombe
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Aine Harrold
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Katherine Brown
- Dr Steeven's Hospital, Health Service Executive, Dublin, Ireland
| | | | | | | | | | - John Lyne
- Royal College of Surgeons Ireland, Dublin, Ireland.,North Dublin Mental Health Services, Dublin, Ireland
| | | | - Patrick McGorry
- University of Melbourne, Melbourne, Australia.,The National Centre of Excellence in Youth Mental Health, Orygen, Melbourne, Australia
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198
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Watson NL, Heffner JL, Mull KE, McClure JB, Bricker JB. Comparing Treatment Acceptability and 12-Month Cessation Rates in Response to Web-Based Smoking Interventions Among Smokers Who Do and Do Not Screen Positive for Affective Disorders: Secondary Analysis. J Med Internet Res 2019; 21:e13500. [PMID: 31219052 PMCID: PMC6607777 DOI: 10.2196/13500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/02/2019] [Accepted: 04/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Web-based cessation programs are now common for intervening with smokers. However, it remains unclear how acceptable or effective these interventions are among people with affective disorders and symptoms (ADS; eg, depression and anxiety). Research examining this is extremely limited, with mixed results on cessation rates. Additional large studies are needed to more fully understand whether Web-based interventions are similarly used and equally effective among people with and without affective disorder symptomology. If not, more targeted Web-based interventions may be required. OBJECTIVE The goal of the research was to compare Web-based treatment acceptability (defined by satisfaction and use) and 12-month cessation outcomes between smokers with and without ADS. METHODS Participants (N=2512) were adult smokers enrolled in a randomized, comparative effectiveness trial of two Web-based smoking interventions designed for the general population of smokers. At baseline, participants reported demographic and smoking characteristics and completed measures assessing ADS. Participants were then classified into subgroups based on their self-reported ADS-either into a no ADS group or into six nonmutually exclusive subgroups: depression, posttraumatic stress disorder (PTSD), panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and more than one ADS. Surveys at 12 months postrandomization included subjective ratings of treatment acceptability and self-reported smoking cessation. Treatment use (ie, number of log-ins and total duration of exposure) was assessed via automated records. RESULTS Relative to the no ADS group, all six ADS subgroups reported significantly greater satisfaction with their assigned Web treatment program, but they spent less time logged in than those with no ADS. For number of log-ins, a treatment arm by ADS group interaction was observed across all ADS subgroups except GAD, suggesting that relative to the no ADS group, they logged in less to one website but not the other. At the 12-month follow-up, abstinence rates in the no ADS group (153/520, 29.42%) were significantly higher than for participants who screened positive for depression (306/1267, 24.15%; P=.03), PTSD (294/1215, 24.19%; P=.03), PD (229/1003, 23.83%; P=.009), and two or more ADS (323/1332, 24.25%; P=.03). Post hoc analyses suggest the lower quit rates may be associated with differences in baseline nicotine dependence and levels of commitment to resist smoking in difficult situations. Website use did not explain the differential abstinence rates. CONCLUSIONS Despite reporting higher levels of treatment satisfaction, most smokers with ADS used their assigned intervention less often and had lower quit rates than smokers with no ADS at treatment onset. The results support the need for developing more targeted interventions for smokers with ADS. TRIAL REGISTRATION Clinical Trials.gov NCT01812278; https://clinicaltrials.gov/ct2/show/NCT01812278 (Archived by WebCite at http://www.webcitation.org/78L9cNdG4).
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Affiliation(s)
- Noreen L Watson
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Kristin E Mull
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Jonathan B Bricker
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
- University of Washington, Seattle, WA, United States
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199
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Low LTK, Ng CWL, Lee C. Nicotine dependence treatment: provision of a dedicated programme by the National Addictions Management Service. Singapore Med J 2019; 61:566-568. [PMID: 31197377 DOI: 10.11622/smedj.2019053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
| | - Charis Wei Ling Ng
- National Addictions Management Service, Institute of Mental Health, Singapore
| | - Cheng Lee
- National Addictions Management Service, Institute of Mental Health, Singapore
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200
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Klaassen Z, Wallis CJD, Kurdyak P, Kulkarni GS. Reply to Comment on: "The impact of psychiatric utilisation prior to cancer diagnosis on survival of solid organ malignancies''. Br J Cancer 2019; 121:195-196. [PMID: 31178590 PMCID: PMC6738033 DOI: 10.1038/s41416-019-0494-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 05/10/2019] [Accepted: 05/15/2019] [Indexed: 11/09/2022] Open
Affiliation(s)
- Zachary Klaassen
- Division of Urology, Medical College of Georgia - Augusta University, Augusta, GA, USA.,Georgia Cancer Center, Augusta, GA, USA
| | - Christopher J D Wallis
- Department of Surgery, Division of Urology, University of Toronto, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Paul Kurdyak
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Girish S Kulkarni
- Department of Surgery, Division of Urology, University of Toronto, University Health Network, Princess Margaret Cancer Centre, Toronto, ON, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.
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