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Gal G, Levav I, Kodesh A. Impact of the mental health reform in Israel on health care and mortality among people with severe mental illness. Soc Psychiatry Psychiatr Epidemiol 2024; 59:1227-1234. [PMID: 37831080 DOI: 10.1007/s00127-023-02580-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 09/28/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVE Reports show disparities in the health care of people with severe mental illness (SMI). Yet, the moderating effect of mental health reforms on the health care disparities remain unexplored. The current study aimed to investigate the outcomes of the mental health reform in Israel on the use of health services among people with SMI. METHOD A case-control epidemiological study comparing the use of health services 3.5 years before and after the mental health reform for service users diagnosed with schizophrenia, schizoaffective disorder, and bipolar disorder. Data on health services included: blood cholesterol test (LDL), hemogalobin-A1C test, and visits to general practitioners (GPs) and specialists. Mortality was recorded. RESULTS Following the reform the number of visits to GPs was decreased among service users of the three SMI groups, as well as visits to specialists among service users with a schizoaffective or bipolar disorder. Following the reform service users of the three SMI groups showed no-change in the performance of LDL test. Complex findings were noted with regard to the performance of Hemoglobin-A1C test. Mortality rates were higher among service users with SMI and the relative risk were similar before and after the reform. CONCLUSIONS Users of the three SMI groups showed no benefits of the mental health reform in terms of use of health services. Improved health care can be attained by a closer collaboration between the primary physicians and community mental health services.
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Affiliation(s)
- Gilad Gal
- School of Psychology, The Academic College of Tel Aviv-Yaffo, Tel Aviv, Israel.
| | - Itzhak Levav
- Department of Community Mental Health, University of Haifa, Haifa, Israel
| | - Arad Kodesh
- Department of Community Mental Health, University of Haifa, Haifa, Israel
- Department of Mental Health, Meuhedet Health Services, Tel Aviv, Israel
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Ferron JC, Brunette MF, Aschbrenner KA, ElSayed MW, Pratt SI. Tobacco, Alcohol, and Drug Use Among Young Adults with Serious Mental Illness. Community Ment Health J 2024; 60:945-954. [PMID: 38427276 DOI: 10.1007/s10597-024-01246-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/01/2024] [Indexed: 03/02/2024]
Abstract
To inform early intervention, this study describes correlates of substance use among young people with serious mental illness (SMI) enrolled in integrated care in community mental health settings. 227 adults ages 18-35 were assessed for clinical characteristics and substance use. Logistic regressions were used to describe relationships between substance use and participant characteristics. Over a third (38.9%) reported daily cannabis, 15.9% past month other illicit drug, 13.5% frequent/heavy alcohol and 47.4% any of these; 50.2% reported daily tobacco smoking and 23.3% current vaping. Daily cannabis and tobacco were the most common combination. Alcohol, drug, and cannabis with tobacco were associated with higher mental health symptoms but not with emergency room or hospital utilization. Cannabis and other substance use was common and associated with higher symptoms but not with greater hospital utilization, suggesting that early intervention could prevent long-term negative consequences.
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Affiliation(s)
- Joelle C Ferron
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA.
- The Dartmouth Institute, Dartmouth College, Hanover, USA.
- Dartmouth Hitchcock Health System, Lebanon, USA.
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA
- Department of Family Medicine, Geisel School of Medicine at Dartmouth College, Concord, USA
- The Dartmouth Institute, Dartmouth College, Hanover, USA
- Dartmouth Hitchcock Health System, Lebanon, USA
| | - Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA
- Dartmouth Hitchcock Health System, Lebanon, USA
| | - Mohamed W ElSayed
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA
- Dartmouth Hitchcock Health System, Lebanon, USA
- New Hampshire Hospital, Concord, USA
| | - Sarah I Pratt
- Department of Psychiatry, Geisel School of Medicine at Dartmouth College, 70 Commercial Street, Suite 203, Concord, NH, 03301, USA
- The Dartmouth Institute, Dartmouth College, Hanover, USA
- Dartmouth Hitchcock Health System, Lebanon, USA
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Naylor H, Howie A, Every-Palmer S. Vaping in mental health inpatient units: A qualitative study of consumer and staff views on electronic nicotine delivery systems. Australas Psychiatry 2024; 32:230-234. [PMID: 38430065 DOI: 10.1177/10398562241236634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Abstract
OBJECTIVES The aim of this qualitative study was to explore the subjective experiences of consumers and staff members regarding the availability of electronic nicotine delivery systems (ENDS) in inpatient mental health units. METHODS Mental health consumers and staff members (n = 16) from rehabilitation and forensic inpatient units were interviewed in 2022. Thematic analysis of the transcripts was undertaken. RESULTS Our study identified four themes: The high salience of nicotine use in inpatient units, delivering nicotine in a resource scarce environment, weighing up the harms of ENDS as a smoking cessation tool, and a need for fair and consistent policy. CONCLUSIONS The main positive aspects identified were recognition of rights of consumers, a relative harm reduction compared to tobacco use, and ENDS as a positive factor in the therapeutic relationship. The main challenges identified were resourcing issues, ENDS being a potential source of tension and conflict and a lack of overarching policy guiding their use.
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Affiliation(s)
- Henry Naylor
- Mental Health, Addictions and Intellectual Disability Services 3DHB, Wellington, New Zealand
| | - Alex Howie
- Mental Health, Addictions and Intellectual Disability Services 3DHB, Wellington, New Zealand
| | - Susanna Every-Palmer
- Mental Health, Addictions and Intellectual Disability Services 3DHB, Wellington, New Zealand
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
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Ouanes S, Hashem LA, Makki I, Khan F, Mahgoub O, Wafer A, Dulaimy O, Amro R, Ghuloum S. Mortality in Qatari individuals with mental illness: a retrospective cohort study. Ann Gen Psychiatry 2024; 23:14. [PMID: 38637811 PMCID: PMC11027414 DOI: 10.1186/s12991-024-00499-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 03/25/2024] [Indexed: 04/20/2024] Open
Abstract
INTRODUCTION There is substantial evidence that people with mental illness have higher mortality rates than the general population. However, most of the studies were from Western countries, and it is not clear whether this finding also applies to Arab countries like Qatar. OBJECTIVES We aimed to explore whether mortality in patients with mental illness in Qatar, is different from those without. METHODS We conducted a retrospective cohort study, including all Qatari nationals deceased in 2017 and 2018, using the list of registered deaths from Hamad Medical Corporation (HMC) Mortuary. We divided the cohort of deceased people into two groups: with and without mental illness. For each of the groups, we collected the age at death, the reported cause of death as well as sociodemographic and clinical data. RESULTS There were 602 registered deaths in 2017 and 589 deaths in 2018. The prevalence of mental illness was 20.4%. Compared to subjects without mental illness, subjects with mental illness surprisingly had higher age at death (median ± IQR = 76.5 ± 22.1 years vs. 62.7 ± 32.9 years; p < .001). This difference persisted even after we controlled for covariates. Individuals with mental illness were more likely to die of an infection (OR = 1.98[1.44;2.71]), or of chronic respiratory disease (OR = 3.53 [1.66;7.52]) but less likely to die because of accidental (OR = 0.21[0.09;0.49]) or congenital causes (OR = 0.18[0.04;0.77]). CONCLUSION Contrary to most previous studies, we did not find that mortality was higher in Qatari individuals with mental illness. Sociocultural factors, free and easy-to-access healthcare, and an enhanced role of mental health professionals in detecting medical comorbidities may explain this finding.
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Affiliation(s)
- Sami Ouanes
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Lien Abou Hashem
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Ibrahim Makki
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Faisal Khan
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Omer Mahgoub
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Ahmed Wafer
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Omer Dulaimy
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Raed Amro
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar
| | - Suhaila Ghuloum
- Department of Psychiatry, Hamad Medical Corporation, POBOX 3050, Doha, Qatar.
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Sprenger S, Anderson JS. Dying to Quit: Understanding the Burden of Tobacco in Psychiatric Patients-A Clinical Review. J Psychiatr Pract 2024; 30:23-31. [PMID: 38227724 DOI: 10.1097/pra.0000000000000764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
Smoking is the leading cause of preventable death worldwide and remains a critical public health challenge. The burden of disease caused by smoking is disproportionately borne by persons living with mental illness. Public health efforts to address smoking have not historically translated to a significant reduction in smoking prevalence among patients with mental illness. Smoking is a substantial cause of morbidity and mortality among psychiatric patients who smoke at 1.7 to 3.3 times the rate of the general population. Among those with serious mental illness, tobacco-related illness accounts for half of all deaths. Nicotine dependence also interferes with treatment and worsens many psychiatric symptoms. Interventions are underutilized due to persistent misunderstandings regarding tobacco cessation for patients who are mentally ill. Addressing these misunderstandings is crucial in targeting the disparate rates of smoking in this population. Therefore, it is incumbent on psychiatrists to address the outsized effect that smoking has on patients with mental illness.
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Affiliation(s)
- Steven Sprenger
- SPRENGER, ANDERSON: Deparment of Psychiatry, Tristar Centennial Medical Center, Nashville, TN
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Vander Weg MW, Howren MB, Grant KM, Prochazka AV, Duffy S, Burke R, Cretzmeyer M, Parker C, Thomas EBK, Rizk MT, Bayer J, Kinner EM, Clark JM, Katz DA. A smoking cessation intervention for rural veterans tailored to individual risk factors: A multicenter randomized clinical trial. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 156:209191. [PMID: 37866436 DOI: 10.1016/j.josat.2023.209191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/24/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Rates of cigarette use remain elevated among those living in rural areas. Depressive symptoms, risky alcohol use, and weight concerns frequently accompany cigarette smoking and may adversely affect quitting. Whether treatment for tobacco use that simultaneously addresses these issues affects cessation outcomes is uncertain. METHODS The study was a multicenter, two-group, randomized controlled trial involving mostly rural veterans who smoke (N = 358) receiving treatment at one of five Veterans Affairs Medical Centers. The study randomly assigned participants to a tailored telephone counseling intervention or referral to their state tobacco quitline. Both groups received guideline-recommended smoking cessation pharmacotherapy, selected using a shared decision-making approach. The primary outcome was self-reported seven-day point prevalence abstinence (PPA) at three and six months. The study used salivary cotinine to verify self-reported quitting at six months. RESULTS Self-reported PPA was significantly greater in participants assigned to Tailored Counseling at three (OR = 1.66; 95 % CI: 1.07-2.58) but not six (OR = 1.35; 95 % CI: 0.85-2.15) months. Post hoc subgroup analyses examining treatment group differences based on whether participants had a positive screen for elevated depressive symptoms, risky alcohol use, and/or concerns about weight gain indicated that the cessation benefit of Tailored Counseling at three months was limited to those with ≥1 accompanying concern (OR = 2.02, 95 % CI: 1.20-3.42). Biochemical verification suggested low rates of misreporting. CONCLUSIONS A tailored smoking cessation intervention addressing concomitant risk factors enhanced short-term abstinence but did not significantly improve long-term quitting. Extending the duration of treatment may be necessary to sustain treatment effects.
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Affiliation(s)
- Mark W Vander Weg
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, United States of America; Department of Community and Behavioral Health, University of Iowa College of Public Health, United States of America; Department of Internal Medicine, University of Iowa Carver College of Medicine, United States of America; Department of Psychological and Brain Sciences, University of Iowa, United States of America; VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, United States of America.
| | - M Bryant Howren
- VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City, United States of America; Department of Behavioral Sciences and Social Medicine, Florida State University, United States of America; Florida Blue Center for Rural Health Research & Policy, United States of America
| | - Kathleen M Grant
- VA Nebraska-Western Iowa Health Care System, United States of America; University of Nebraska Medical Center Department of Medicine, United States of America
| | - Allan V Prochazka
- Primary Care, VA Eastern Colorado Health Care System, United States of America; Denver Seattle Center for Veteran-centric Value-based Research (DiSCoVVR), United States of America
| | - Sonia Duffy
- VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, United States of America; College of Nursing, Ohio State University, United States of America
| | - Randy Burke
- Mental Health Service, G.V. (Sonny) Montgomery VA Medical Center, United States of America; Department of Psychiatry, University of Mississippi School of Medicine, United States of America
| | | | - Christopher Parker
- Department of Pharmacy Practice and Science, University of Iowa College of Pharmacy, United States of America
| | - Emily B K Thomas
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | | | - Jennifer Bayer
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | - Ellen M Kinner
- Department of Psychological and Brain Sciences, University of Iowa, United States of America
| | - Jennifer M Clark
- Department of Neurology, University of Iowa, Carver College of Medicine, United States of America
| | - David A Katz
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, United States of America; Department of Internal Medicine, University of Iowa Carver College of Medicine, United States of America; Department of Epidemiology, University of Iowa College of Public Health, United States of America
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de Oliveira C, Mason J, Luu L, Iwajomo T, Simbulan F, Kurdyak P, Pechlivanoglou P. The PSY-SIM Model: Using Real-World Data to Inform Health Care Policy for Individuals With Chronic Psychotic Disorders. Schizophr Bull 2023:sbad175. [PMID: 38104255 DOI: 10.1093/schbul/sbad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
BACKGROUND AND HYPOTHESIS Few microsimulation models have been developed for chronic psychotic disorders, severe and disabling mental disorders associated with poor medical and psychiatric outcomes, and high costs of care. The objective of this work was to develop a microsimulation model for individuals with chronic psychotic disorders and to use the model to examine the impact of a smoking cessation initiative on patient outcomes. STUDY DESIGN Using health records and survey data from Ontario, Canada, the PSY-SIM model was developed to simulate health and cost outcomes of individuals with chronic psychotic disorders. The model was then used to examine the impact of the Smoking Treatment for Ontario Patients (STOP) program from Ontario on the development of chronic conditions, life expectancy, quality of life, and lifetime health care costs. STUDY RESULTS Individuals with chronic psychotic disorders had a lifetime risk of 63% for congestive heart failure and roughly 50% for respiratory disease, cancer and diabetes, and a life expectancy of 76 years. The model suggests the STOP program can reduce morbidity and lead to survival and quality of life gains with modest increases in health care costs. At a long-term quit rate of 4.4%, the incremental cost-effectiveness ratio of the STOP program was $41,936/QALY compared with status quo. CONCLUSIONS Smoking cessation initiatives among individuals with chronic psychotic disorders can be cost-effective. These findings will be relevant for decision-makers and clinicians looking to improving health outcomes among this patient population.
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Affiliation(s)
- Claire de Oliveira
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Joyce Mason
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Linda Luu
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Tomisin Iwajomo
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
| | - Frances Simbulan
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Institute for Mental Health Policy Research and Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Petros Pechlivanoglou
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada
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Medved S, Palavra IR, Gerlach J, Levaj S, Shields-Zeeman L, Bolinski F, Bradaš Z, Madžarac Z, Filipčić I, Rojnić Kuzman M. Changes in substance use and engagement in gaming/gambling in persons with severe mental illness during the COVID-19 pandemic and earthquakes: a community study in two points. Front Psychiatry 2023; 14:1264875. [PMID: 38169718 PMCID: PMC10758456 DOI: 10.3389/fpsyt.2023.1264875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/06/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction External stressors, such as COVID-19 pandemic and earthquake, can cause an increase in substance use and addictive behavior in persons with severe mental illnesses (SMI). We analyzed the changes and predictors of substance use and addictive behavior in SMI during these double disasters in Croatia. Methods Questionnaires exploring the presence of substance or behavior addiction disorder, mental ill health [Depression Anxiety Stress Scales-21 (DASS-21), Insomnia Severity Index (ISI), Perceived Stress Scale (PSS), Obsessive-Compulsive Inventory-Revised], coping mechanisms, and perceived social support [Multidimensional Scale of Perceived Social Support (MSPSS)] were administered among 90 participants with SMI included in the RECOVER-E study in May/June 2020 (first COVID-19 wave, Zagreb earthquake) and in December 2020/January 2021 (second COVID-19 wave, Petrinja earthquake). Results In both time points, a major increase was observed in tobacco smoking (25.0%; 28.6%, respectively) predicted by discontinuation of antidepressants and higher DASS-21 score. Increased sedative use was observed (24.4%; 23.8%, respectively) predicted by higher PSS and ISI scores, lower MSPSS scores, antipsychotic discontinuation and not receiving community mental health team (CMHT) service. Discussion In persons with SMI during a double disaster special attention needs to be given to reducing mental-ill health and stress, providing social support and continuity of psychiatric care, through medications and CMHTs.
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Affiliation(s)
- Sara Medved
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | | | | | - Sarah Levaj
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Laura Shields-Zeeman
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, Netherlands
| | - Felix Bolinski
- Netherlands Institute of Mental Health and Addiction (Trimbos Institute), Utrecht, Netherlands
| | - Zoran Bradaš
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Zoran Madžarac
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Igor Filipčić
- University Psychiatric Hospital Sveti Ivan, Zagreb, Croatia
- Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Martina Rojnić Kuzman
- Department of Psychiatry and Psychological Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Rajan S, Mitchell A, Zavala GA, Podmore D, Khali H, Chowdhury AH, Muliyala KP, Appuhamy KK, Aslam F, Nizami AT, Huque R, Shiers D, Murthy P, Siddiqi N, Siddiqi K. Tobacco use in people with severe mental illness: Findings from a multi-country survey of mental health institutions in South Asia. Tob Induc Dis 2023; 21:166. [PMID: 38098747 PMCID: PMC10720264 DOI: 10.18332/tid/174361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 12/17/2023] Open
Abstract
INTRODUCTION People with severe mental illness (SMI) tend to die early due to cardiovascular and respiratory diseases, which may be linked to tobacco use. There is limited information on tobacco use in people with SMI in low- and middle-income countries where most tobacco users reside. We present novel data on tobacco use in people with SMI and their access to tobacco cessation advice in South Asia. METHODS We conducted a multi-country survey of adults with SMI attending mental health facilities in Bangladesh, India, and Pakistan. Using data collected with a standardized WHO STEPS survey tool, we estimated the prevalence and distribution of tobacco use and assessed receipt of tobacco cessation advice. RESULTS We recruited 3874 participants with SMI; 46.8% and 15.0% of men and women consumed tobacco, respectively. Smoking prevalence in men varied by country (Bangladesh 42.8%, India 20.1% and Pakistan 31.7%); <4% of women reported smoking in each country. Smokeless tobacco use in men also varied by country (Bangladesh 16.2%, India 18.2% and Pakistan 40.8%); for women, it was higher in Bangladesh (19.1%), but similar in India (9.9%) and Pakistan (9.1%). Just over a third of tobacco users (38.4%) had received advice to quit tobacco. Among smokers, 29.1% (n=244) made at least one quit attempt in the past year. There was strong evidence for the association between tobacco use and the severity of depression (OR=1.29; 95% CI: 1.12-1.48) and anxiety (OR=1.29; 95% CI: 1.12-1.49). CONCLUSIONS As observed in high-income countries, we found higher tobacco use in people with SMI, particularly in men compared with rates reported for the general population in South Asia. Tobacco cessation support within mental health services offers an opportunity to close the gap in life expectancy between SMI and the general population. STUDY REGISTRATION ISRCTN88485933; https://doi.org/10.1186/ISRCTN88485933 39.
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Affiliation(s)
- Sukanya Rajan
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Alex Mitchell
- Department of Health Sciences, University of York, York, United Kingdom
| | - Gerardo A. Zavala
- Department of Health Sciences, University of York, York, United Kingdom
| | - Danielle Podmore
- Department of Health Sciences, University of York, York, United Kingdom
| | | | | | | | | | - Faiza Aslam
- Institute of Psychiatry, Rawalpindi, Pakistan
| | | | | | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health National Health Service Foundation Trust, Manchester City, United Kingdom
- Division of Psychology and Mental Health, The University of Manchester, Manchester City, United Kingdom
- School of Medicine, Keele University, Keele, United Kingdom
| | - Pratima Murthy
- National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Bradford District Care National Health Service Foundation Trust, Bradford, United Kingdom
- Hull York Medical School, Hull, United Kingdom
- Hull York Medical School, York, United Kingdom
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, Hull, United Kingdom
- Hull York Medical School, York, United Kingdom
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Bilenduke E, Anderson S, Brenner A, Currier J, Eberth JM, King J, Land SR, Risendal BC, Shannon J, Siegel LN, Wangen M, Waters AR, Zahnd WE, Studts JL. Equitable implementation of lung cancer screening: avoiding its potential to mirror existing inequities among people who use tobacco. Cancer Causes Control 2023; 34:209-216. [PMID: 37713024 PMCID: PMC10689540 DOI: 10.1007/s10552-023-01790-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 08/31/2023] [Indexed: 09/16/2023]
Abstract
PURPOSE Lung cancer is the leading cause of cancer death, but the advent of lung cancer screening using low-dose computed tomography offers a tremendous opportunity to improve lung cancer outcomes. Unfortunately, implementation of lung cancer screening has been hampered by substantial barriers and remains suboptimal. Specifically, the commentary emphasizes the intersectionality of smoking history and several important sociodemographic characteristics and identities that should inform lung cancer screening outreach and engagement efforts, including socioeconomic considerations (e.g., health insurance status), racial and ethnic identity, LGBTQ + identity, mental health history, military experience/veteran status, and geographic residence in addressing specific community risk factors and future interventions in efforts to make strides toward equitable lung cancer screening. METHODS Members of the Equitable Implementation of Lung Cancer Screening Interest Group with the Cancer Prevention and Control Network (CPCRN) provide a critical commentary based on existing literature regarding smoking trends in the US and lung cancer screening uptake to propose opportunities to enhance implementation and support equitable distribution of the benefits of lung cancer screening. CONCLUSION The present commentary utilizes information about historical trends in tobacco use to highlight opportunities for targeted outreach efforts to engage communities at high risk with information about the lung cancer screening opportunity. Future efforts toward equitable implementation of lung cancer screening should focus on multi-level implementation strategies that engage and work in concert with community partners to co-create approaches that leverage strengths and reduce barriers within specific communities to achieve the potential of lung cancer screening.
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Affiliation(s)
- Emily Bilenduke
- Department of Psychology, University of Colorado Denver, Denver, CO, USA.
| | - Shacoria Anderson
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Alison Brenner
- Division of General Medicine and Clinical Epidemiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, USA
| | - Jessica Currier
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Jan M Eberth
- Department of Health Management and Policy, Drexel University, Philadelphia, PA, USA
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Jaron King
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Stephanie R Land
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Betsy C Risendal
- Department of Community and Behavioral Health, Colorado School of Public Health, Cancer Prevention and Control Program, University of Colorado Cancer Center, Aurora, CO, USA
| | - Jackilen Shannon
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Leeann N Siegel
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Mary Wangen
- Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, NC, USA
| | - Austin R Waters
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Whitney E Zahnd
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Jamie L Studts
- Division of Medical Oncology, Department of Medicine, University of Colorado School of Medicine, Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, CO, USA.
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Du S, Yao J, Shen GC, Lin B, Udo T, Hastings J, Wang F, Wang F, Zhang Z, Ye X, Zhang K. Social Drivers of Mental Health: A U.S. Study Using Machine Learning. Am J Prev Med 2023; 65:827-834. [PMID: 37286016 DOI: 10.1016/j.amepre.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Social drivers of mental health can be compared on an aggregated level. This study employed a machine learning approach to identify and rank social drivers of mental health across census tracts in the U.S. METHODS Data for 38,379 census tracts in the U.S. were collected from multiple sources in 2021. Two measures of mental health problems-self-reported depression and self-assessed poor mental health-among adults and three domains of social drivers (behavioral, environmental, and social) were analyzed on the basis of the unit of census tracts using the Extreme Gradient Boosting machine learning approach in 2022. The leading social drivers were found in each domain in the main sample and in the subsamples divided on the basis of poverty and racial segregation. RESULTS The three domains combined explained more than 90% of the variance of both mental illness indicators. Self-reported depression and self-assessed poor mental health differed in major social drivers. The two outcome indicators had one overlapping correlate from the behavioral domain: smoking. Other than smoking, climate zone and racial composition were the leading correlates from the environmental and social domains, respectively. Census tract characteristics moderated the impacts of social drivers on mental health problems; the major social drivers differed by census tract poverty and racial segregation. CONCLUSIONS Population mental health is highly contextualized. Better interventions can be developed on the basis of census tract-level analyses of social drivers that characterize the upstream causes of mental health problems.
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Affiliation(s)
- Shichao Du
- Department of Sociology, University at Albany, State University of New York, Albany, New York
| | - Jie Yao
- Department of Epidemiology & Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, New York
| | - Gordon C Shen
- Department of Management, Policy & Community Health, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Betty Lin
- Department of Psychology, College of Arts and Sciences, University at Albany, State University of New York, Albany, New York
| | - Tomoko Udo
- Department of Epidemiology & Biostatistics, School of Public Health, University at Albany, State University of New York, Rensselaer, New York; Department of Health Policy, Management & Behavior, School of Public Health, University at Albany, State University of New York, Rensselaer, New York
| | - Julia Hastings
- Department of Health Policy, Management & Behavior, School of Public Health, University at Albany, State University of New York, Rensselaer, New York
| | - Fei Wang
- Institute of Artificial Intelligence for Digital Health, Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York; Division of Health Informatics, Department of Population Health Sciences, Weill Cornell Medicine, Cornell University, New York, New York
| | - Fusheng Wang
- Department of Biomedical Informatics, School of Medicine and College of Engineering and Applied Sciences, Stony Brook University, Stony Brook, New York; Department of Computer Science, Stony Brook University, Stony Brook, New York
| | - Zhe Zhang
- Department of Geography, Texas A&M University, College Station, Texas
| | - Xinyue Ye
- Department of Landscape Architecture & Urban Planning, Texas A&M University, College Station, Texas
| | - Kai Zhang
- Department of Environmental Health Sciences, School of Public Health, University of Albany, State University of New York, Rensselaer, New York.
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12
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Lunding SH, Ueland T, Aas M, Høegh MC, Werner MCF, Rødevand L, Johansen IT, Hjell G, Ormerod MBEG, Ringen PA, Ottesen A, Lagerberg TV, Melle I, Andreassen OA, Simonsen C, Steen NE. Tobacco smoking related to childhood trauma mediated by cognitive control and impulsiveness in severe mental disorders. Schizophr Res 2023; 261:236-244. [PMID: 37806047 DOI: 10.1016/j.schres.2023.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 05/26/2023] [Accepted: 09/24/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND People with severe mental disorders (SMDs) show an increased prevalence of tobacco smoking compared to the general population. Tobacco smoking and other adult adverse health behaviors have been associated with traumatic experiences in childhood. In the present study we investigated the relationship between childhood trauma and tobacco smoking in people with SMDs, including the possible mediating role of cognitive- and personality characteristics, i.e. cognitive control, impulsiveness, affective lability and self-esteem. METHODS Enrolled in the study were 871 participants with schizophrenia (SCZ, N = 484) and bipolar (BD, N = 387) spectrum disorders. We assessed tobacco smoking behavior (yes/no and amount), and history of childhood trauma with the Childhood Trauma Questionnaire. Data on cognitive control, impulsiveness, affective lability, and self-esteem were available in subsamples. We performed linear and logistic regressions, and conducted mediation analyses in PROCESS. All analyses were as standard adjusted for age, sex, and diagnostic group. RESULTS Experience of one or more subtypes of childhood trauma was significantly associated with smoking tobacco in SMDs (p = 0.002). There were no significant associations between childhood trauma and amount of tobacco smoking. Cognitive control and impulsiveness were significant mediators between childhood trauma and tobacco smoking. CONCLUSIONS These findings indicate the experience of childhood trauma as a predisposing factor for tobacco smoking in SMDs. Cognitive control and impulsiveness were suggested as mediating mechanisms, indicating the importance of considering inhibition related self-regulatory aspects in efforts to improve health behavior in individuals with SMDs and childhood trauma.
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Affiliation(s)
- Synve Hoffart Lunding
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Torill Ueland
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychology, University of Oslo, Oslo, Norway
| | - Monica Aas
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Margrethe Collier Høegh
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Maren Caroline Frogner Werner
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Linn Rødevand
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Torp Johansen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Gabriela Hjell
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatry, Ostfold Hospital, Graalum, Norway
| | | | - Petter Andreas Ringen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Akiah Ottesen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Trine Vik Lagerberg
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Melle
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole A Andreassen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Carmen Simonsen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Early Intervention in Psychosis Advisory Unit for South East Norway, Oslo University Hospital, Oslo, Norway
| | - Nils Eiel Steen
- NORMENT, Division of Mental Health and Addiction, Oslo University Hospital & Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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13
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Balbuena L, Peters E, Speed D. Using polygenic risk scores to investigate the evolution of smoking and mental health outcomes in UK biobank participants. Acta Psychiatr Scand 2023; 148:447-456. [PMID: 37607129 DOI: 10.1111/acps.13601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 07/17/2023] [Accepted: 07/20/2023] [Indexed: 08/24/2023]
Abstract
OBJECTIVE Mendelian randomization studies report a bi-directional relation between cigarette smoking and mental disorders, yet from a clinical standpoint, mental disorders are the focus of treatment. Here, we used an event history framework to understand their evolution in the life course. Our objective was to estimate the relative contribution of genetic predispositions and self-reported smoking status (never, former, and present smoker) to hospitalizations for major depression, bipolar disorder, and schizophrenia. METHODS We calculated polygenic risk scores (PRS) for ever smoking, pack-years of smoking as a proportion of adult life, and neuroticism in 337,140 UK Biobank participants of white British ancestry. These PRS and self-reported smoking status were entered as explanatory variables in survival models for hospitalization. RESULTS The estimated single nucleotide polymorphisms heritabilities (h2 ) were 23%, 5.7%, and 5.7% for pack-years, ever smoking, and neuroticism respectively. PRS pack-years and PRS neuroticism were associated with higher hospitalization risk for mental disorders in all smoking status groups. The hazard for mental health hospitalization was higher in both previous (HR: 1.50, CI: 1.35-1.67) and current (HR: 3.58, 2.97-4.31) compared to never smokers, after adjusting for confounders. CONCLUSION Since genetic liabilities for smoking and neuroticism are fixed at conception and smoking initiation generally started before age 20, our results show that preventing smoking in adolescents probably prevents the development of mental disorders.
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Affiliation(s)
- Lloyd Balbuena
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Evyn Peters
- Department of Psychiatry, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Doug Speed
- Center for Quantitative Genetics and Genomics, Aarhus University, Aarhus, Denmark
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14
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Kang W. Age and mental health moderate the association between environmental concern (EC) and smoking frequency: smoking as a polluting behavior. Front Public Health 2023; 11:1089148. [PMID: 37860793 PMCID: PMC10582950 DOI: 10.3389/fpubh.2023.1089148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 08/31/2023] [Indexed: 10/21/2023] Open
Abstract
It is well-recognized that smoking is detrimental to the environment. However, much less is understood about smoking behavior from an environmental perspective with a focus on environmental concern (EC). This study aims to establish the association between EC and smoking frequency in smokers and test whether age and mental health moderate such an association. Obtained by analyzing data using regressions on smokers (N = 3,599) from Understanding Society: the UK Household Longitudinal Study (UKHLS), which is a representative sample in the UK, the results revealed that age and mental health moderate the association between EC and smoking frequency. This association is important to understand because smoking pollutes the environment, and very few studies have looked at smoking behavior from an environmental perspective.
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Affiliation(s)
- Weixi Kang
- Department of Brain Sciences, Imperial College London, London, United Kingdom
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15
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Sheffer CE, Shevorykin A, Freitas-Lemos R, Vantucci D, Carl E, Bensch L, Marion M, Erwin DO, Smith PH, Williams JM, Ostroff JS. Advancing Proficiencies for Health Professionals in the Treatment of Tobacco Use Among Marginalized Communities: Development of a Competency-Based Curriculum and Virtual Workshop. Subst Abus 2023; 44:313-322. [PMID: 37842906 DOI: 10.1177/08897077231200987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND Tobacco-related disparities are a leading contributor to health inequities among marginalized communities. Lack of support from health professionals is one of the most cited barriers to tobacco cessation reported by these communities. Improving the proficiencies with which health professionals incorporate social and cultural influences into therapeutic interactions has the potential to address this critical barrier. In general, training to improve these proficiencies has shown promise, but the specific proficiencies required for treating tobacco use among marginalized communities are unknown. This project aimed to develop a competency-based curriculum to improve these proficiencies among health professionals with experience and training in the evidence-based treatment of tobacco use, and then pilot test the content delivered via an expert review of a virtual, self-paced workshop. METHODS We used the Delphi Technique to systematically identify the specific competencies and corresponding knowledge and skill sets required to achieve these proficiencies. Educational content was developed to teach these competencies in a virtual workshop. The workshop was evaluated by 11 experts in the field by examining pre- and post-training changes in perceived knowledge, skill, and confidence levels and other quantitative and qualitative feedback. Repeated measures analysis of variance and paired sample t-tests were used to examine pre-post training differences. RESULTS Six competencies and corresponding skill sets were identified. After exposure to the virtual workshop, the experts reported significant increases in the overall proficiency for each competency as well as increases in nearly all levels of knowledge, skill, and confidence within the competency skill sets. Qualitative and quantitative findings indicate that content was relevant to practice. CONCLUSIONS These findings provide preliminary support for 6 competencies and skills sets needed to improve therapeutic interpersonal interactions that recognize the importance of social and cultural influences in the treatment of tobacco use.
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Affiliation(s)
- Christine E Sheffer
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Alina Shevorykin
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | | | - Darian Vantucci
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ellen Carl
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Lindsey Bensch
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Matthew Marion
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Deborah O Erwin
- Department of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Philip H Smith
- Department of Kinesiology, Nutrition and Health, Miami University, Oxford, OH, USA
| | - Jill M Williams
- Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Jamie S Ostroff
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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16
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Plever S, Kisely S, Bonevski B, McCarthy I, Emmerson B, Ballard E, Anzolin M, Siskind D, Allan J, Gartner C. Can improvement in delivery of smoking cessation care be sustained in psychiatry inpatient settings through a system change intervention? An analysis of statewide administrative health data. Aust N Z J Psychiatry 2023; 57:1375-1383. [PMID: 37038343 DOI: 10.1177/00048674231164566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
OBJECTIVE This study evaluated maintenance of improved delivery of smoking cessation assistance in adult acute psychiatry inpatient units 3 years post statewide implementation of a system change intervention through analysis of a statewide administrative health dataset. METHOD Rates of documenting smoking status and providing a brief smoking cessation intervention (the Smoking Cessation Clinical Pathway) in all eligible Queensland public adult acute psychiatry inpatient units (N = 57) during the implementation phase (October 2015-September 2017) of a system change intervention were compared to the maintenance phase (October 2017-October 2020) using interrupted time series analysis. RESULTS Across implementation and maintenance phases, the percentage of discharges from psychiatry inpatient units that had a smoking status recorded remained high with the statewide average exceeding 90% (implementation phase 93.2%, 95% confidence interval = [92.4, 93.9]; and maintenance phase 94.6%, 95% confidence interval = [94.0, 95.2]). The percentage of discharges statewide with a completed Pathway stabilised during the maintenance phase (change in slope -3.7%, 95% confidence interval = [-5.2, -2.3]; change in level 0.4%, 95% confidence interval = [-7.0, 7.9]). CONCLUSION An evidence-based smoking cessation intervention implemented with a system change intervention resulted in sustained improvement in addressing smoking in adult inpatient psychiatry units up to 3 years post implementation.
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Affiliation(s)
- Sally Plever
- The QLD Mental Health Clinical Collaborative, Metro North Mental Health, Brisbane, QLD, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, QLD, Australia
| | - Steve Kisely
- Department of Psychiatry, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
- Metro South Addiction and Mental Health Service, Brisbane, QLD, Australia
| | - Billie Bonevski
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, QLD, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Irene McCarthy
- The QLD Mental Health Clinical Collaborative, Metro North Mental Health, Brisbane, QLD, Australia
| | - Brett Emmerson
- The QLD Mental Health Clinical Collaborative, Metro North Mental Health, Brisbane, QLD, Australia
| | - Emma Ballard
- QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia
| | - Melissa Anzolin
- The QLD Mental Health Clinical Collaborative, Metro North Mental Health, Brisbane, QLD, Australia
| | - Dan Siskind
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, QLD, Australia
- Department of Psychiatry, School of Clinical Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - John Allan
- Mental Health Alcohol and Other Drugs Branch, Clinical Excellence Queensland, Queensland Health, Brisbane, QLD, Australia
| | - Coral Gartner
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, QLD, Australia
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17
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Hilton C, Morris A, Burnside G, Harris R, Aggarwal VR, Procter S, Griffiths R, French P, Laverty L, Lobban F, Berry K, Shiers D, Golby R, Fazekas F, Valemis K, Perry A, Newens C, Kerry E, Mupinga P, Gkioni E, Lodge C, Dawber A, Elliott E, Lunat F, Palmier-Claus J. A two-arm, randomised feasibility trial using link workers to improve dental visiting in people with severe mental illness: a protocol paper. Pilot Feasibility Stud 2023; 9:157. [PMID: 37684682 PMCID: PMC10485965 DOI: 10.1186/s40814-023-01383-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND People with severe mental illness (e.g. psychosis, bipolar disorder) experience poor oral health compared to the general population as shown by more decayed, missing and filled teeth and a higher prevalence of periodontal disease. Attending dental services allows treatment of oral health problems and support for prevention. However, people with severe mental illness face multiple barriers to attending routine dental appointments and often struggle to access care. Link work interventions use non-clinical support staff to afford vulnerable populations the capacity, opportunity, and motivation to navigate use of services. The authors have co-developed with service users a link work intervention for supporting people with severe mental illness to access routine dental appointments. The Mouth Matters in Mental Health Study aims to explore the feasibility and acceptability of this intervention within the context of a feasibility randomised controlled trial (RCT) measuring outcomes related to the recruitment of participants, completion of assessments, and adherence to the intervention. The trial will closely monitor the safety of the intervention and trial procedures. METHODS A feasibility RCT with 1:1 allocation to two arms: treatment as usual (control) or treatment as usual plus a link work intervention (treatment). The intervention consists of six sessions with a link worker over 9 months. Participants will be adults with severe mental illness receiving clinical input from secondary care mental health service and who have not attended a planned dental appointment in the past 3 years. Assessments will take place at baseline and after 9 months. The target recruitment total is 84 participants from across three NHS Trusts. A subset of participants and key stakeholders will complete qualitative interviews to explore the acceptability of the intervention and trial procedures. DISCUSSION The link work intervention aims to improve dental access and reduce oral health inequalities in people with severe mental illness. There is a dearth of research relating to interventions that attempt to improve oral health outcomes in people with mental illness and the collected feasibility data will offer insights into this important area. TRIAL REGISTRATION The trial was preregistered on ISRCTN (ISRCTN13650779) and ClinicalTrials.gov (NCT05545228).
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Affiliation(s)
- Claire Hilton
- The Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Abigail Morris
- The Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Girvan Burnside
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Rebecca Harris
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | - Sarah Procter
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Robert Griffiths
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Paul French
- Manchester Metropolitan University, Manchester, UK
- Pennine Care NHS Foundation Trust, Ashton-Under-Lyne, UK
| | - Louise Laverty
- Division of Informatics, Imaging and Data Sciences, University of Manchester, Manchester, UK
| | - Fiona Lobban
- The Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Katherine Berry
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
| | - David Shiers
- Division of Psychology & Mental Health, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Rebecca Golby
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Fanni Fazekas
- Pennine Care NHS Foundation Trust, Ashton-Under-Lyne, UK
| | - Kyriakos Valemis
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Antonia Perry
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Connie Newens
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Eirian Kerry
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Efstathia Gkioni
- Institute of Population Health, University of Liverpool, Liverpool, UK
- Liverpool Clinical Trials Centre, Clinical Directorate, University of Liverpool, Liverpool, UK
| | - Christopher Lodge
- The Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
| | - Alison Dawber
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Emma Elliott
- School of Dentistry, University of Leeds, Leeds, UK
| | - Farah Lunat
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK
| | - Jasper Palmier-Claus
- The Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK.
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, UK.
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18
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Winslow VA, Jagai JS, Makelarski JA, Wroblewski KE, Lindau ST, Vu M. Social Risk and Smoking Among Women Smokers Early in the COVID-19 Pandemic: The Role of Mental Health. J Womens Health (Larchmt) 2023; 32:960-969. [PMID: 37379463 PMCID: PMC10510694 DOI: 10.1089/jwh.2023.0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023] Open
Abstract
Background: We examined patterns of smoking in relation to health-related socioeconomic vulnerability (HRSV) among U.S. women early in the pandemic and whether mental health symptoms mediated these relationships. Materials and Methods: Data were obtained from the April 2020 National U.S. Women's Health COVID-19 Study (N = 3200). Among current smokers, adjusted odds of increased smoking since the start of the pandemic (vs. same or less) by incident and worsening HRSVs were modeled. Structural equation modeling was used to assess anxiety, depression, and traumatic stress symptoms as mediators of the relationship between six HRSVs (food insecurity; housing, utilities, and transportation difficulties; interpersonal violence; financial strain) and increased smoking early in the pandemic. Results: Nearly half (48%) of current smokers reported increased smoking since the pandemic started. Odds of increased smoking were higher among women with incident financial strain (aOR = 2.0, 95% CI 1.2-3.3), incident food insecurity (aOR = 2.9, 95% CI 1.7-5.1), any worsening HRSV (aOR = 2.2, 95% CI 1.5-3.0), and worsening food insecurity (aOR = 1.9, 95% CI 1.3-3.0). Anxiety symptoms were a significant, partial mediator of the relationship between increased smoking and any worsening HRSVs (proportion mediated = 0.17, p = 0.001) and worsening food insecurity (0.19, p = 0.023), specifically. Depression symptoms were a significant, partial mediator of the relationship between increased smoking and any worsening HRSVs (0.15, p = 0.004) and incident financial strain (0.19, p = 0.034). Traumatic stress was not a significant mediator of any tested relationship. Conclusions: Anxiety and depression symptoms partially explain the relationship between rising socioeconomic vulnerability and increased smoking among women early in the pandemic. Addressing HRSVs and mental health may help reduce increased smoking during a public health crisis.
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Affiliation(s)
- Victoria A. Winslow
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Jyotsna S. Jagai
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Jennifer A. Makelarski
- Department of Obstetrics and Gynecology, The University of Chicago, Chicago, Illinois, USA
| | - Kristen E. Wroblewski
- Department of Public Health Sciences, The University of Chicago, Chicago, Illinois, USA
| | - Stacy Tessler Lindau
- Department of Obstetrics and Gynecology and Medicine-Geriatrics and Palliative Medicine, The University of Chicago and The University of Chicago Comprehensive Cancer Center, Chicago, Illinois, USA
| | - Milkie Vu
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
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19
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Daumit GL, Evins AE, Cather C, Dalcin AT, Dickerson FB, Miller ER, Appel LJ, Jerome GJ, McCann U, Ford DE, Charleston JB, Young DR, Gennusa JV, Goldsholl S, Cook C, Fink T, Wang NY. Effect of a Tobacco Cessation Intervention Incorporating Weight Management for Adults With Serious Mental Illness: A Randomized Clinical Trial. JAMA Psychiatry 2023; 80:895-904. [PMID: 37378972 PMCID: PMC10308301 DOI: 10.1001/jamapsychiatry.2023.1691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/05/2023] [Indexed: 06/29/2023]
Abstract
Importance Tobacco smoking drives markedly elevated cardiovascular disease risk and preventable death in persons with serious mental illness, and these risks are compounded by the high prevalence of overweight/obesity that smoking cessation can exacerbate. Guideline-concordant combined pharmacotherapy and behavioral smoking cessation treatment improves abstinence but is not routinely offered in community settings, particularly to those not seeking to quit smoking immediately. Objective To determine the effectiveness of an 18-month pharmacotherapy and behavioral smoking cessation intervention incorporating weight management and support for physical activity in adults with serious mental illness interested in quitting smoking within 1 or 6 months. Design, Setting, and Participants This was a randomized clinical trial conducted from July 25, 2016, to March 20, 2020, at 4 community health programs. Adults with serious mental illness who smoked tobacco daily were included in the study. Participants were randomly assigned to intervention or control, stratified by willingness to try to quit immediately (within 1 month) or within 6 months. Assessors were masked to group assignment. Interventions Pharmacotherapy, primarily varenicline, dual-form nicotine replacement, or their combination; tailored individual and group counseling for motivational enhancement; smoking cessation and relapse prevention; weight management counseling; and support for physical activity. Controls received quitline referrals. Main Outcome and Measures The primary outcome was biochemically validated, 7-day point-prevalence tobacco abstinence at 18 months. Results Of the 298 individuals screened for study inclusion, 192 enrolled (mean [SD] age, 49.6 [11.7] years; 97 women [50.5%]) and were randomly assigned to intervention (97 [50.5%]) or control (95 [49.5%]) groups. Participants self-identified with the following race and ethnicity categories: 93 Black or African American (48.4%), 6 Hispanic or Latino (3.1%), 90 White (46.9%), and 9 other (4.7%). A total of 82 participants (42.7%) had a schizophrenia spectrum disorder, 62 (32.3%) had bipolar disorder, and 48 (25.0%) had major depressive disorder; 119 participants (62%) reported interest in quitting immediately (within 1 month). Primary outcome data were collected in 183 participants (95.3%). At 18 months, 26.4% of participants (observed count, 27 of 97 [27.8%]) in the intervention group and 5.7% of participants (observed count, 6 of 95 [6.3%]) in the control group achieved abstinence (adjusted odds ratio [OR], 5.9; 95% CI, 2.3-15.4; P < .001). Readiness to quit within 1 month did not statistically significantly modify the intervention's effect on abstinence. The intervention group did not have significantly greater weight gain than the control group (mean weight change difference, 1.6 kg; 95% CI, -1.5 to 4.7 kg). Conclusions and Relevance Findings of this randomized clinical trial showed that in persons with serious mental illness who are interested in quitting smoking within 6 months, an 18-month intervention with first-line pharmacotherapy and tailored behavioral support for smoking cessation and weight management increased tobacco abstinence without significant weight gain. Trial Registration ClinicalTrials.gov Identifier: NCT02424188.
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Affiliation(s)
- Gail L. Daumit
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - A. Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Corinne Cather
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Arlene T. Dalcin
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
| | | | - Edgar R. Miller
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lawrence J. Appel
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Gerald J. Jerome
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- College of Health Professions, Towson University, Towson, Maryland
| | - Una McCann
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel E. Ford
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jeanne B. Charleston
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Deborah R. Young
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Joseph V. Gennusa
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stacy Goldsholl
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Courtney Cook
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tyler Fink
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Nae-Yuh Wang
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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20
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López-Cuadrado T, Szmulewicz A, Öngür D, Martínez-Alés G. Clinical characteristics and outcomes of people with severe mental disorders hospitalized due to COVID-19: A nationwide population-based study. Gen Hosp Psychiatry 2023; 84:234-240. [PMID: 37633121 DOI: 10.1016/j.genhosppsych.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 08/11/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2023]
Abstract
OBJETIVE Hospitalized COVID-19 patients with severe mental illness (SMI) have worse outcomes than counterparts without SMI. Barriers in access to acute care medical procedures among SMI patients may partially explain this phenomenon. Here, we examined differences in critical care admission and in-hospital mortality between hospitalized COVID-19 patients with and without SMI. METHODS This population-based study used Spain's nationwide electronic health records. Based on International Classification Diseases, Tenth Revision, ICD-10-CM codes, we identified all patients aged ≥15 years hospitalized due to COVID-19 between July 1st-December 31st, 2020, and compared patients with and without SMI in terms of (i) critical care admission and (ii) in-hospital mortality - overall and stratified by age. We used logistic regression models including sex, age, and comorbidity burden as measured by Charlson Comorbidity Index Score as covariates. RESULTS Of 118,691 hospital admissions due to COVID-19 of people aged ≥15 years, 1512 (1.3%) included a diagnosis of SMI. Compared to non-SMI patients, SMI patients had higher in-hospital mortality (OR,95%CI: 1.63,1.42-1.88) and were less frequently admitted to critical care (OR,95%CI: 0.70,0.58-0.85). Admission to critical care in SMI patients was lower than for non-SMI counterparts only among individuals aged ≥60 years. The magnitude of the difference in in-hospital mortality between SMI and non-SMI patients decreased as age increased. CONCLUSIONS Individuals with SMI had reduced critical care admission and increased in-hospital mortality compared non-SMI counterparts, suggesting that differences in delivery of acute care medical procedures may partially explain higher risk of negative outcomes among COVID-19 patients with SMI.
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Affiliation(s)
- Teresa López-Cuadrado
- Department of Chronic Diseases Epidemiology, National Center for Epidemiology, Carlos III Health Institute, Madrid, Spain.
| | - Alejandro Szmulewicz
- CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Dost Öngür
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA; Psychotic Disorders Division, McLean Hospital, Belmont, MA, USA
| | - Gonzalo Martínez-Alés
- CAUSALab, Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Mental Health Network Biomedical Research Center (CIBERSAM), Madrid, Spain; Hospital La Paz Institute for Health Research (IDIPaz), Madrid, Spain
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21
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Zvolska K, Tichopad A, Stepankova L, Pankova A, Adamcekova Z, Donin G, Rafl J, Kralikova E. Increasing prevalence of mental disorders in smokers seeking treatment of tobacco dependence: a retrospective observational study. BMC Psychiatry 2023; 23:621. [PMID: 37620772 PMCID: PMC10464239 DOI: 10.1186/s12888-023-05115-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND There has been a noticeable relative increase in psychiatric comorbidities among smokers as opposed to the general population. This is likely due to comparatively slower decrease in smoking prevalence among individuals with mental health conditions. This study aims to assess the prevalence trend of past or current mental health disorders in individuals seeking specialized smoking cessation assistance. METHODS We conducted a retrospective single-centre observational study to assess the presence of mental disorders such as anxiety, depression, bipolar affective disorder, or schizophrenia in personal history of 6,546 smokers who sought treatment at the Centre for Treatment of Tobacco Dependence in Prague, Czech Republic between 2006 and 2019. The study examined the impact of gender, age, and the effect of successive years on the prevalence of the mental disorders using Poisson distribution regression. RESULTS In the studied cohort, 1,743 patients (26.6%) reported having one or more mental disorders. Compared to patients without a psychiatric disorder, they exhibited similar levels of carbon monoxide in expired air (mean 17 ppm, SD 11 ppm) and scored one point higher on the Fagerström Test of Cigarette Dependence. Among smokers with a mental disorder, women were more prevalent (62%) than men (38%). The prevalence of mental disorders increased on average by 4% every year, rising from 23% in 2006 to 35% in 2019. CONCLUSIONS Consistent with the observation that the prevalence of smoking among people with any mental disorder is higher and declining at a slower rate than in the general population, there is a steadily increasing percentage of these patients seeking specialized treatment over time. Professionals who offer tobacco dependence treatment should be aware of the upward trend in psychiatric disorders among smokers, as more intensive treatment may be needed. Similarly, psychiatric care should pay attention to smoking of their patients.
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Affiliation(s)
- Kamila Zvolska
- Centre for Treatment of Tobacco Dependence, the 3rdMedical Department - Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic.
| | - Ales Tichopad
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University, Prague, Czech Republic
| | - Lenka Stepankova
- Centre for Treatment of Tobacco Dependence, the 3rdMedical Department - Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Alexandra Pankova
- Centre for Treatment of Tobacco Dependence, the 3rdMedical Department - Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Zuzana Adamcekova
- Centre for Treatment of Tobacco Dependence, the 3rdMedical Department - Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
| | - Gleb Donin
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University, Prague, Czech Republic
| | - Jakub Rafl
- Department of Biomedical Technology, Faculty of Biomedical Engineering, Czech Technical University, Prague, Czech Republic
| | - Eva Kralikova
- Centre for Treatment of Tobacco Dependence, the 3rdMedical Department - Department of Endocrinology and Metabolism, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
- Institute of Hygiene and Epidemiology, First Faculty of Medicine, Charles University, General University Hospital, Prague, Czech Republic
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22
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Martinez Agulleiro L, Patil B, Firth J, Sawyer C, Amann BL, Fonseca F, Torrens M, Perez V, Castellanos FX, Kane JM, Guinart D. A systematic review of digital interventions for smoking cessation in patients with serious mental illness. Psychol Med 2023; 53:4856-4868. [PMID: 37161690 PMCID: PMC10476065 DOI: 10.1017/s003329172300123x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/11/2023]
Abstract
Tobacco smoking is highly prevalent among patients with serious mental illness (SMI), with known deleterious consequences. Smoking cessation is therefore a prioritary public health challenge in SMI. In recent years, several smoking cessation digital interventions have been developed for non-clinical populations. However, their impact in patients with SMI remains uncertain. We conducted a systematic review to describe and evaluate effectiveness, acceptability, adherence, usability and safety of digital interventions for smoking cessation in patients with SMI. PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, PsychINFO and the Cochrane Tobacco Addiction Group Specialized Register were searched. Studies matching inclusion criteria were included and their information systematically extracted by independent investigators. Thirteen articles were included, which reported data on nine different digital interventions. Intervention theoretical approaches ranged from mobile contingency management to mindfulness. Outcome measures varied widely between studies. The highest abstinence rates were found for mSMART MIND (7-day point-prevalent abstinence: 16-40%). Let's Talk About Quitting Smoking reported greater acceptability ratings, although this was not evaluated with standardized measures. Regarding usability, Learn to Quit showed the highest System Usability Scale scores [mean (s.d.) 85.2 (15.5)]. Adverse events were rare and not systematically reported. Overall, the quality of the studies was fair to good. Digitally delivered health interventions for smoking cessation show promise for improving outcomes for patients with SMI, but lack of availability remains a concern. Larger trials with harmonized assessment measures are needed to generate more definitive evidence and specific recommendations.
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Affiliation(s)
- Luis Martinez Agulleiro
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Bhagyashree Patil
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA
| | - Joseph Firth
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, M13 9 PL
| | - Chelsea Sawyer
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, M13 9 PL
| | - Benedikt L. Amann
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Francina Fonseca
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Marta Torrens
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Universitat de Vic i Central de Catalunya, Vic, Spain
| | - Victor Perez
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Francisco Xavier Castellanos
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - John M. Kane
- Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Daniel Guinart
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
- Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
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23
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Tran DD, Davis JP, Tucker JS, Bricker JB, Lee DS, Fitzke RE, Pedersen ER. Cigarette Smoking and Depression Among U.S. Veterans: Longitudinal Associations With Posttraumatic Stress Disorder. Nicotine Tob Res 2023; 25:1496-1504. [PMID: 37094359 PMCID: PMC10347971 DOI: 10.1093/ntr/ntad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 03/09/2023] [Accepted: 04/21/2023] [Indexed: 04/26/2023]
Abstract
INTRODUCTION Cigarette smoking and depression are associated with morbidity and mortality. Among veterans, approximately 22% are current smokers and 11%-15% have been diagnosed with depression. Although prior research suggests a strong association between smoking and depression among veterans, little research has examined trajectories of smoking and depressive symptoms and their correlates over time in this population. AIMS AND METHODS Using parallel process growth curve modeling, we examined the longitudinal relationship between smoking and depression and tested whether posttraumatic stress disorder (PTSD) symptoms predict smoking and depression trajectories over 18 months (February 2020-August 2021). Veterans were recruited for an online, longitudinal study and responded to surveys across five-time points (baseline N = 1230; retention = 79.3%-83.3% across waves). RESULTS Associations indicated that more frequent smoking at baseline was associated with steeper increases in depression symptom severity, and greater depression severity at baseline was associated with a less steep decrease in smoking frequency over time. PTSD was associated with less smoking at time 1 but more frequent smoking at times 3-5 as well as greater depression across all time points. CONCLUSIONS Findings provide support that the growth trajectories of smoking and depression are linked, and PTSD symptoms are associated with these trajectories among veterans. Addressing these factors simultaneously in veteran treatment centers or through tobacco cessation efforts may be beneficial. IMPLICATIONS This study offers strong evidence that the growth trajectories of smoking and depression are linked, and PTSD symptoms affect these trajectories among veterans, who represent a largely understudied population despite high rates of substance use and mental health problems. Results of this study strengthen the case for a more integrated treatment approach in which both smoking and mental health concerns are simultaneously addressed, which may yield more beneficial physical health and clinical outcomes for post-9/11 veterans.
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Affiliation(s)
- Denise D Tran
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
| | - Jordan P Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CAUSA
| | | | - Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA USA
- Department of Psychology, University of Washington, Seattle, WA USA
| | - Daniel S Lee
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
| | - Reagan E Fitzke
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
| | - Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CAUSA
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24
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Rubenstein D, Pacek LR, Smith C, McClernon FJ, Enyioha C, Vilardaga R. Stagnant daily smoking prevalence between 2008 and 2019 among Black and Hispanic adults with serious psychological distress. Drug Alcohol Depend 2023; 248:109943. [PMID: 37247521 PMCID: PMC10330890 DOI: 10.1016/j.drugalcdep.2023.109943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND Racial/ethnic minority status and mental illness independently drive inequity in cigarette smoking and related morbidity. Racial/ethnic minority groups suffer a disproportionate burden of tobacco-related diseases. People with serious mental illness (SMI) smoke at up to 7 times the rate of the general population. There is a need to quantify smoking prevalence and trends among people at the intersection of both groups. METHODS This study analyzes 2008-2019 data from the National Survey on Drug Use and Health. Linear time trends of daily smoking prevalence were assessed among people with serious psychological distress (SPD; marker for SMI) and people without SPD reporting White, Black, Hispanic, and Other race/ethnicity using logistic regression, with survey year as the predictor. Models with year-by-smoking status interaction terms and F-tests assessed differential time trends. RESULTS The prevalence of daily smoking among people without SPD decreased over time among people reporting White (aOR=0.96, p<0.001), Black (aOR=0.96, p<0.001), Hispanic (aOR=0.95, p<0.001), and Other (aOR=0.97, p=0.002) race/ethnicity. Among people with SPD, the smoking prevalence decreased among people with White race/ethnicity (aOR=0.95, p<0.001), with no significant changes among people of Black, Hispanic, and Other race/ethnicity. CONCLUSIONS Smoking among people with SPD who report Black and Hispanic race/ethnicity has not changed significantly in the past 11 years, despite decreasing among non-SPD and White groups. People who are Black/Hispanic and people with SPD struggle to quit smoking, which is amplified intersectionally. Tailored interventions may be a better mechanism to reduce barriers to smoking cessation in this population.
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Affiliation(s)
- Dana Rubenstein
- Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, 27705, United States; Clinical and Translational Science Institute, Duke University School of MedicineDurham, NC, 27701, United States
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, 27705, United States
| | - Caitlyn Smith
- Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, 27705, United States
| | - F Joseph McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, 27705, United States; Clinical and Translational Science Institute, Duke University School of MedicineDurham, NC, 27701, United States
| | - Chineme Enyioha
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599United States
| | - Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University School of MedicineDurham, NC, 27705, United States.
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Mazumdar P, Zavala G, Aslam F, Muliyala KP, Chaturvedi SK, Kandasamy A, Nizami A, Ul Haq B, Kellar I, Jackson C, Thomson H, McDaid D, Siddiqi K, Hewitt C, Siddiqi N, Gilbody S, Murthy P, Dadirai Mdege N. IMPACT smoking cessation support for people with severe mental illness in South Asia (IMPACT 4S): A protocol for a randomised controlled feasibility trial of a combined behavioural and pharmacological support intervention. PLoS One 2023; 18:e0287185. [PMID: 37315070 DOI: 10.1371/journal.pone.0287185] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 05/30/2023] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION The prevalence of smoking is high among people living with severe mental illness (SMI). Evidence on feasibility, acceptability and effectiveness of smoking cessation interventions among smokers with SMI is lacking, particularly in low- and middle-income countries. We aim to test the feasibility and acceptability of delivering an evidence-based intervention,i.e., the IMPACT smoking cessation support for people with severe mental illness in South Asia (IMPACT 4S) intervention that is a combination of behavioural support and smoking cessation pharmacotherapies among adult smokers with SMI in India and Pakistan. We will also test the feasibility and acceptability of evaluating the intervention in a randomised controlled trial. METHODS We will conduct a parallel, open label, randomised controlled feasibility trial among 172 (86 in each country) adult smokers with SMI in India and Pakistan. Participants will be allocated 1:1 to either Brief Advice (BA) or the IMPACT 4S intervention. BA comprises a single five-minute BA session on stopping smoking. The IMPACT 4S intervention comprises behavioural support delivered in upto 15 one-to-one, face-to-face or audio/video, counselling sessions, with each session lasting between 15 and 40 minutes; nicotine gum and/or bupropion; and breath carbon monoxide monitoring and feedback. Outcomes are recruitment rates, reasons for ineligibility/non-participation/non-consent of participants, length of time required to achieve required sample size, retention in study and treatments, intervention fidelity during delivery, smoking cessation pharmacotherapy adherence and data completeness. We will also conduct a process evaluation. RESULTS Study will address- uncertainty about feasibility and acceptability of delivering smoking cessation interventions, and ability to conduct smoking cessation trials, among adult smokers with SMI in low- and middle-income countries. CONCLUSIONS This is to inform further intervention adaptation, and the design and conduct of future randomised controlled trials on this topic. Results will be disseminated through peer-review articles, presentations at national, international conferences and policy-engagement forums. TRIAL REGISTRATION ISRCTN34399445 (Updated 22/03/2021), ISRCTN Registry https://www.isrctn.com/.
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Affiliation(s)
- Papiya Mazumdar
- Department of Health Sciences, University of York, York, United Kingdom
- School of Politics and International Studies, University of Leeds, Leeds, United Kingdom
| | - Gerardo Zavala
- Department of Health Sciences, University of York, York, United Kingdom
| | - Faiza Aslam
- Institute of Psychiatry, Rawalpindi, Pakistan
| | | | | | - Arun Kandasamy
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Asad Nizami
- Institute of Psychiatry, Rawalpindi, Pakistan
| | - Baha Ul Haq
- Institute of Psychiatry, Rawalpindi, Pakistan
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, United Kingdom
| | - Cath Jackson
- Department of Health Sciences, University of York, York, United Kingdom
- Valid Research Ltd, Wetherby, United Kingdom
| | | | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, Heslington, United Kingdom
| | - Catherine Hewitt
- Department of Health Sciences, University of York, York, United Kingdom
| | - Najma Siddiqi
- Department of Health Sciences, University of York, York, United Kingdom
- Hull York Medical School, Heslington, United Kingdom
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, United Kingdom
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
- Hull York Medical School, Heslington, United Kingdom
| | - Pratima Murthy
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
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Schnoll RA, Leone FT, Quinn MH, Stevens N, Flitter A, Wileyto P, Kimberly J, Beidas RS, Hatzell J, Siegel SD, Crawford G, Hill N, Deatley T, Ziedonis D. A randomized clinical trial testing two implementation strategies to promote the treatment of tobacco dependence in community mental healthcare. Drug Alcohol Depend 2023; 247:109873. [PMID: 37084508 PMCID: PMC10198962 DOI: 10.1016/j.drugalcdep.2023.109873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/23/2023]
Abstract
INTRODUCTION People with serious mental illness (SMI) are more likely to smoke and less likely to receive tobacco treatment. Implementation strategies may address clinician and organizational barriers to treating tobacco in mental healthcare. METHODS A cluster-randomized trial (Clinic N=13, Client N=610, Staff N=222) tested two models to promote tobacco treatment in community mental healthcare: standard didactic training vs. Addressing Tobacco Through Organizational Change (ATTOC), an organizational model that provides clinician and leadership training and addresses system barriers to tobacco treatment. Primary outcomes were changes in tobacco treatment from clients, staff, and medical records. Secondary outcomes were changes in smoking, mental health, and quality of life (QOL), and staff skills and barriers to treat tobacco. RESULTS Clients at ATTOC sites reported a significant increase in receiving tobacco treatment from clinician at weeks 12 and 24 (ps<0.05) and tobacco treatments and policies from clinics at weeks 12, 24, 36, and 52 (ps<0.05), vs. standard sites. ATTOC staff reported a significant increase in skills to treat tobacco at week 36 (p=0.05), vs. standard sites. For both models, tobacco use medications, from clients (week 52) and medical records (week 36), increased (ps<0.05), while perceived barriers decreased at weeks 24 and 52 (ps<0.05); 4.3% of clients quit smoking which was not associated with model. QOL and mental health improved over 24 weeks for both models (ps<0.05). CONCLUSIONS Standard training and ATTOC improve use of evidence-based tobacco treatments in community mental healthcare without worsening mental health, but ATTOC may more effectively address this practice gap.
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Affiliation(s)
- Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, United States.
| | - Frank T Leone
- Pulmonary, Allergy, & Critical Care Division, University of Pennsylvania, United States
| | - Mackenzie Hosie Quinn
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Nathaniel Stevens
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Alex Flitter
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Paul Wileyto
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - John Kimberly
- The Wharton School of Business, University of Pennsylvania, United States
| | - Rinad S Beidas
- Perelman School of Medicine, University of Pennsylvania, United States; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, United States
| | - Jane Hatzell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Scott D Siegel
- Institute for Research on Equity & Community Health (iREACH) and Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System,United States
| | - Grace Crawford
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Naja Hill
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | - Teresa Deatley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
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McLeish AC, Walker KL, Keith RJ, Hart JL. The Role of Perceived Neighborhood Cohesion in the Association between Depressive Symptoms and Cigarette Smoking. Subst Use Misuse 2023; 58:1295-1301. [PMID: 37232382 PMCID: PMC10413331 DOI: 10.1080/10826084.2023.2215331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Greater depression has been linked to increased smoking rates. However, the mechanisms underlying this association are not fully understood. It is possible that high perceived neighborhood cohesion may serve as one such mechanism given its associations with decreased depression and smoking. Having increased levels of depression likely impacts one's perceptions of neighborhood cohesion, which could lead to further increases in depression and a need to manage these symptoms via cigarette smoking. As a first test of this theory, the current study examined the effect of neighborhood cohesion on the association between depressive symptoms and smoking frequency and quantity among past 30-day cigarette smokers. METHODS Participants were 201 combustible cigarette smokers (Mage = 48.33, SD = 11.64; 63.2% female; 68.2% White) who completed self-report measures as part of a larger study of environmental influences on cardiac health. RESULTS Greater depressive symptoms were associated with lower levels of perceived neighborhood cohesion, and there was a significant indirect effect of greater depressive symptoms on heavier smoking through decreased neighborhood cohesion (b = .07, SE = .04, 95% CI [.003, .15]). There was no significant indirect effect for daily smoking. CONCLUSION These results suggest that neighborhood cohesion is an important contextual factor that serves as one explanatory mechanism for the well-established relationship between depression and smoking quantity. Thus, there may be utility in implementing interventions focused on increasing neighborhood cohesion as a way to decrease smoking behavior.
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Affiliation(s)
- Alison C. McLeish
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, KY, USA
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA
- Superfund Research Center, School of Medicine, University of Louisville, Louisville, KY, USA
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX, USA
| | - Kandi L. Walker
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA
- Superfund Research Center, School of Medicine, University of Louisville, Louisville, KY, USA
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX, USA
- Department of Communication, University of Louisville, Louisville, KY, USA
| | - Rachel J. Keith
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA
- Superfund Research Center, School of Medicine, University of Louisville, Louisville, KY, USA
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX, USA
| | - Joy L. Hart
- Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY, USA
- Superfund Research Center, School of Medicine, University of Louisville, Louisville, KY, USA
- American Heart Association Tobacco Center for Regulatory Science, Dallas, TX, USA
- Department of Communication, University of Louisville, Louisville, KY, USA
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Wang Y, Duan Z, Weaver SR, Self-Brown SR, Ashley DL, Emery SL, Huang J. The Short-Term and Long-Term Associations Between Receiving Tobacco Discounts or Coupons and Smoking Cessation Among U.S. Adult Cigarette Smokers With Intention to Quit. Nicotine Tob Res 2023; 25:699-708. [PMID: 36124654 PMCID: PMC10032185 DOI: 10.1093/ntr/ntac216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/31/2022] [Accepted: 09/15/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION To examine the associations between baseline receipt of cigarette and non-cigarette tobacco discounts or coupons and smoking cessation at follow-up among US adult cigarette smokers with the intention to quit at baseline. AIMS AND METHODS Data were from the Population Assessment of Tobacco and Health (PATH) study wave 3 (October 2015-October 2016), wave 4 (December 2016-January 2018), and wave 5 (December 2018-November 2019) surveys. Two separate sets of analyses were conducted using wave 3-4 data (N = 3707) and wave 4-5 data (N = 6251). Specifically, wave 4 was used as the 1-year follow-up of wave 3 to examine the short-term association, and wave 5 was used as the 2-year follow-up of wave 4 to examine the longer-term association. Study population were current established cigarette smokers with the intention to quit (within 1 year for wave 3-4 data) at baseline. Exposure was self-reported past 12-month receipt of discounts or coupons for cigarettes and non-cigarette tobacco products at baseline, and outcome was self-reported completely quitting cigarette smoking at follow-up. Baseline single-wave weights were applied, and multivariate logistic regressions were used to estimate the adjusted associations. RESULTS Participants who received cigarette discounts or coupons at baseline were less likely to quit completely for both 1-year follow-up (aOR = 0.66, 95% CI: 0.48 to 0.90) and 2-year follow-up (aOR = 0.74, 95% CI: 0.61 to 0.90). Baseline receipt of discounts or coupons for non-cigarette tobacco products were not consistently associated with cigarette smoking cessation at follow-up. CONCLUSIONS Receipt of cigarette discounts or coupons was associated with a reduced likelihood of successful quitting among cigarette smokers with intention to quit. Policies restricting cigarette coupons may help them quit completely. IMPLICATIONS This study found that among baseline current established cigarette smokers with intention to quit in the United States, baseline receipt of cigarette discounts or coupons was negatively associated with cigarette smoking cessation for both 1-year follow-up and 2-year follow-up. Baseline receipt of discounts or coupons for e-cigarettes, cigars, and other tobacco products were not consistently significantly associated with cigarette smoking cessation at follow-up. Our study results indicated that policies restricting cigarette coupons may help increase the likelihood of successful smoking cessation for smokers with intention to quit.
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Affiliation(s)
- Yu Wang
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Scott R Weaver
- Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Shannon R Self-Brown
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - David L Ashley
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
| | | | - Jidong Huang
- Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, Atlanta, GA, USA
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Lilly G, Calvert GM. The World Trade Center Health Program: Smoking cessation. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2023; 78:249-252. [PMID: 36919568 PMCID: PMC10910591 DOI: 10.1080/19338244.2023.2185190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Cigarette smoking can cause and/or worsen a variety of health conditions. The U.S. Preventive Services Task Force (USPSTF) recommends that smoking cessation services be offered to all adults who currently smoke, and governmental and non-governmental professional organizations support providing these interventions to patients who smoke. The World Trade Center (WTC) Health Program, a federal program that provides health monitoring and treatment to those directed exposed to the September 11, 2001 terrorist attacks, provides smoking cessation therapy for eligible members. This paper identifies treatment strategies for smoking cessation and references the treatment coverage policy in the WTC Health Program. In addition, this paper notes the higher smoking prevalence among those with mental health conditions such as posttraumatic stress disorder (PTSD), and the need for heightened cessation efforts given the lower quit success rates among such persons.
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Affiliation(s)
- Gerald Lilly
- World Trade Center Health Program, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Cincinnati, OH, USA
| | - Geoffrey M Calvert
- World Trade Center Health Program, National Institute for Occupational Safety and Health (NIOSH), Centers for Disease Control and Prevention (CDC), Cincinnati, OH, USA
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30
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Tran DD, Morrell HER. E-Cigarette Use: The Effects of Psychological Vulnerabilities, Perceptions, and Intentions to Use E-Cigarettes. Psychol Rep 2023:332941231161277. [PMID: 36869868 DOI: 10.1177/00332941231161277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Little research has examined the effects that psychological vulnerabilities (i.e., difficulty with emotion regulation, depressed mood, distress tolerance) have on the perceptions of e-cigarettes, intent to use e-cigarettes, and actual e-cigarette use. Data were collected via an online survey from 837 adults (55.6% male, Mage = 29.2, 71.7% Caucasian). The two path analytic models predicting lifetime and current use fit the data well. Difficulty with emotion regulation was positively associated with depressed mood and negatively associated with distress tolerance, while distress tolerance was negatively associated with depressed mood. Depressed mood was positively associated with perceived benefits of e-cigarette use, and perceived benefits was positively associated with intent to use. Perceived benefits and intent to use were significantly associated with both lifetime and current use. Findings enhance our understanding of the effects that mood and emotion-related factors have on perceptions of, intent to use, and actual use of e-cigarettes, which may have important implications for prevention and cessation.
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Affiliation(s)
- Denise D Tran
- Department of Psychology, 166486Loma Linda University, Loma Linda, CA, USA
| | - Holly E R Morrell
- Department of Psychology, 166486Loma Linda University, Loma Linda, CA, USA
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DeAtley T, Harrison A, Cassidy R, Kuo C, Higgins ST, Tidey JW. Subjective experiences, contexts, and risk perceptions of very low nicotine content cigarettes and electronic cigarettes among people with depression and anxiety disorders who smoke. Drug Alcohol Depend 2023; 244:109767. [PMID: 36638679 PMCID: PMC9974802 DOI: 10.1016/j.drugalcdep.2023.109767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/06/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND A low-nicotine product standard is currently under consideration by the U.S. Food and Drug Administration (FDA). This standard may be more effective if alternative, non-combusted sources of nicotine are concurrently available. This qualitative study explored the lived experiences of people with depression and anxiety disorders who used very low nicotine content (VLNC) cigarettes with or without e-cigarettes during a randomized controlled trial. METHODS We conducted semi-structured qualitative interviews with participants (n = 20) as they completed a 16-week blinded trial of VLNC cigarettes with or without electronic cigarettes. Interviews explored 1) experiences with these products, 2) social and environmental contexts for use and 3) relative risk perceptions. Interviews were transcribed and analyzed using a hybrid inductive and deductive thematic analysis. RESULTS Concurrent access to e-cigarettes helped to ease the transition from usual-brand cigarettes to VLNC cigarettes. Some participants held misperceptions that VLNC cigarettes could reduce cancer risk whereas others did not. Participants expressed skepticism about the safety of e-cigarettes and the authenticity of the VLNC cigarettes. Smoking restrictions influenced e-cigarette use in some instances, but product preference was the overriding factor that influenced use. Participants did not note effects on psychiatric symptoms. CONCLUSIONS Should a nicotine reduction policy be implemented with e-cigarettes concurrently available on the market, tailored messaging for people with anxiety and depression disorders may be necessary to educate people about and the availability of alternative sources of nicotine, such as e-cigarettes, as well as the relative risk of VLNC cigarettes and e-cigarettes.
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Affiliation(s)
- Teresa DeAtley
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA.
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | - Rachel Cassidy
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | - Caroline Kuo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | - Stephen T Higgins
- Department of Psychological Science, University of Vermont, VT 05405, USA
| | - Jennifer W Tidey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
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32
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Salameh TN, Hall LA, Hall MT. Cigarette Smoking Cessation Counselling in Pregnant Smokers with Mental Illness/Substance Use Disorders. West J Nurs Res 2023; 45:234-241. [PMID: 36196024 PMCID: PMC9902998 DOI: 10.1177/01939459221127803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Our objective was to determine if past-year mental illness and substance use disorders (SUD) among pregnant smokers predicted the probability of receipt of counselling for cigarette smoking cessation. A secondary analysis of data from the National Survey on Drug Use and Health 2016-2019 was conducted. We found that approximately 83% of pregnant smokers (N = 373) received screening for cigarette smoking, and 65% received cessation counselling. Having mental illness predicted the probability of receipt of counselling for smoking cessation in pregnant smokers (adjusted odds ratio [AOR]: 3.75; 95% confidence interval [CI]: 1.25-11.27). However, having SUD (alcohol [AOR: 2.30; 95%CI: 0.57-9.26] or illicit drug use [AOR: 1.32; 95%CI: 0.26-6.82]) or comorbid mental illness and SUD (AOR: 0.23; 95%CI: 0.03-2.03) was not associated with receipt of counselling for smoking cessation. Practice guidelines and policy initiatives are needed to reduce cigarette use and its related adverse health outcomes in pregnant smokers with SUD.
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Affiliation(s)
| | - Lynne A Hall
- University of Louisville School of Nursing, Louisville, KY, USA
| | - Martin T Hall
- University of Louisville Kent School of Social Work, Louisville, KY, USA
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33
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Marques de Oliveira R, Ferreira-Santos JL, Ferreira-Furegato AR. [Previous and current use profile of psychiatric and general population]. Rev Salud Publica (Bogota) 2023; 21:430-438. [PMID: 36753266 DOI: 10.15446/rsap.v21n4.67831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 06/02/2019] [Indexed: 11/09/2022] Open
Abstract
OBJETIVE To describe and to compare the previous and the current tobacco use profile between psychiatric population of secondary and tertiary levels of care and general population of basic health care. METHODS Descriptive epidemiological/analytical cross sectional study with 378 participants from three Brazilian health services: a) Basic Unity of Health (BUH); b) Mental Health Ambulatory (MHA); c) Psychiatric Hospital (PH). The answers provided during individual interviews were registred in mobile device. Data were submitted to descriptive statistics, Fischer's exact test, analysis of variance and Kruskal-Wallis test. RESULTS In the PH all were daily smokers, noticing lower prevalence in MHA (94.1%) and in BUH (91.7%). Among the products utilized has highlighted manufactured cigarettes (98%), followed by roll-your-own cigarettes (39%). The average of cigarettes smoked per day (MHA=19,3, PH=25,3, BUH=17,2) and the percentage of multiple tobacco products users (MHA=28.1%, PH=55.3%, BUH=9.1%) were higher in PH. 73% of smokers exceed ≥ 4% of familiar income with tobacco. In PH were identified higher commitment. Smokers of PH were less advised to stop smoking (MHA=50%, PH=39.5%, BUH=50%). CONCLUSION The current tobacco use profile by psychiatric hospital smokers differs from the others. Besides higher tobacco dependency, they smoked a higher amount of cigarettes per day, compromised higher perceptual of personal income to buy tobacco and used multiples tobacco products as well as received less support to stop smoking.
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Creedon TB, Wayne GF, Progovac AM, Levy DE, Cook BL. Trends in cigarette use and health insurance coverage among US adults with mental health and substance use disorders. Addiction 2023; 118:353-364. [PMID: 36385708 DOI: 10.1111/add.16052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 09/10/2022] [Indexed: 11/18/2022]
Abstract
AIMS To estimate recent trends in cigarette use and health insurance coverage for United States adults with and without mental health and substance use disorders (MH/SUD). DESIGN Event study analysis of smoking and insurance coverage trends among US adults with and without MH/SUD using 2008-19 public use data from the National Survey on Drug Use and Health, an annual, cross-sectional survey. SETTING USA. PARTICIPANTS A nationally representative sample of non-institutionalized respondents aged 18-64 years (n = 448 762). MEASUREMENTS Outcome variables were three measures of recent cigarette use and one measure of past-year health insurance coverage. We compared outcomes between people with and without MH/SUD (MH disorder: past-year mental illness, predicted from Kessler-6 and the World Health Organization-Disability Assessment Schedule impairment scale; SUD: met survey-based DSM-IV criteria for past-year alcohol, cannabis, cocaine or heroin use disorder) and over time. FINDINGS Comparing pooled data from 2008 to 2009 and from 2018 to 2019, current smoking rates of adults with MH/SUD decreased from 37.9 to 27.9% while current smoking rates of adults without MH/SUD decreased from 21.4 to 16.3%, a significant difference in decrease of 4.9 percentage points (pts) [95% confidence interval (CI) = 3.3-6.6 pts]. Daily smoking followed similar patterns (difference in decrease of 3.9 pts (95% CI = 2.3-5.4 pts). Recent smoking abstinence rates for adults with MH/SUD increased from 7.4 to 10.9%, while recent smoking abstinence rates for adults without MH/SUD increased from 9.6 to 12.0%, a difference in increase of 1.0 pts (95% CI = -3.0 to 0.9 pts). In 2018-19, 11% of net reductions in current smoking, 12% of net reductions in daily smoking and 12% of net increases in recent smoking abstinence coincided with greater gains in insurance coverage for adults with MH/SUD compared to those without MH/SUD. CONCLUSIONS Improvements in smoking and abstinence outcomes for US adults with mental health and substance use disorders appear to be associated with increases in health insurance coverage.
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Affiliation(s)
- Timothy B Creedon
- Office of the Assistant Secretary for Planning and Evaluation, US Department of Health and Human Services, Washington, DC, USA
| | | | - Ana M Progovac
- Health Equity Research Laboratory, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Douglas E Levy
- Mongan Institute, Health Policy Research Center, Massachusetts General Hospital, Boston, MA, USA.,Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Benjamin Lê Cook
- Health Equity Research Laboratory, Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Fragala MS, Tong CH, Hunter JL, Jelovic NA, Hayward JI, Carr S, Kim PM, Peters ME, Birse CE. Facilitating Mental Health Treatment Through Proactive Screening and Concierge Services in the Workplace. J Occup Environ Med 2023; 65:160-166. [PMID: 36190912 PMCID: PMC9897277 DOI: 10.1097/jom.0000000000002707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study is to determine if a proactive employer-sponsored mental health program closed gaps in detection and treatment of mental health conditions. METHODS Of n = 56,442 eligible, n = 8170 (14.5%) participated in the optional screening. Participants with mental health risk were offered care concierge services including support, care planning, and connection to care. Difference in behavioral health care utilization, diagnoses, and prescriptions were evaluated postintervention through claims analysis. RESULTS Compared with controls (n = 2433), those receiving concierge services (n = 369) were more likely to fill mental health prescriptions (adjusted hazards ratio [HR], 1.2; 1.0-1.5; P = 0.042), use professional mental health services (adjusted HR, 1.4; 1.1-1.8; P = 0.02), and use new mental health services (adjusted HR, 1.9; 1.2-2.8; P = 0.004) in the following 6 months. CONCLUSIONS This proactive mental health program with care concierge services identified risk, connected individuals to mental health care, and facilitated mental health treatment, among program participants.
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Gao N, Solomon P, Clay Z, Swarbrick P. A pilot study of wellness coaching for smoking cessation among individuals with mental illnesses. J Ment Health 2023; 32:183-189. [PMID: 33999729 DOI: 10.1080/09638237.2021.1922630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Smoking continues to be a major health concern among persons with mental illnesses. AIMS This pilot study compared smoking outcomes between wellness-coaching for smoking cessation and a control group. METHODS Thirty-one individuals were enrolled in an educational group on smoking cessation and 23 completed an eight-session manualized education. Following this educational group, 11 of 23 participants were randomly assigned to wellness coaching for four months and 12 to a control condition. ANCOVAs were used to compare group differences in smoking outcomes. RESULTS Fagerström Nicotine Dependence Index (FTND) score of the participants who received the wellness coaching intervention decreased significantly as compared to the control group, indicating a lower level of nicotine dependence. The outcomes of average number of cigarettes smoked daily and breath carbon monoxide level showed tendencies towards reductions for wellness coaching, although not statistically significant compared to the control condition. CONCLUSIONS Suggestions are shared about the feasibility of wellness coaching as well as barriers and challenges learned in implementing such an intervention to assist individuals with mental illnesses in quitting or reducing smoking.
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Affiliation(s)
- Ni Gao
- Department of Psychiatric Rehabilitation and Counseling Professions, School of Health Professions, Rutgers University. Piscataway, NJ, USA
| | - Phyllis Solomon
- School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Zakia Clay
- Fairleigh Dickinson University, School of Pharmacy and Health Sciences, Florham Park, NJ, USA
| | - Peggy Swarbrick
- Wellness Institute Director Collaborative Support Programs of New Jersey, Freehold, NJ, USA.,Center of Alcohol & Substance Use Studies, Graduate School of Applied and Professional Psychology, Piscataway, NJ, USA
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Puljević C, Feulner L, Hobbs M, Erku D, Bonevski B, Segan C, Baker A, Hefler M, Cho A, Gartner C. Tobacco endgame and priority populations: a scoping review. Tob Control 2023:tc-2022-057715. [PMID: 36720648 DOI: 10.1136/tc-2022-057715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
AIM To summarise the research literature on the impacts or perceptions of policies to end tobacco use at a population level (ie, tobacco endgame policies) among people from eight priority population groups (experiencing mental illness, substance use disorders, HIV, homelessness, unemployment or low incomes, who identify as lesbian, gay, bisexual, transgender, queer or intersex (LGBTQI+) or who have experienced incarceration). METHODS Guided by JBI Scoping Review Methodology, we searched six databases for original research examining the impacts or perceptions of 12 tobacco endgame policies among eight priority populations published since 2000. We report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. RESULTS Of the 18 included studies, one described perceptions of five endgame policies among people on low incomes in Aotearoa (New Zealand), and 17 focused on the effectiveness or impacts of a very low nicotine content (VLNC) cigarette standard among people experiencing mental illness (n=14), substance use disorders (n=8), low incomes (n=6), unemployment (n=1) or who identify as LGBTQI+ (n=1) in the USA. These studies provide evidence that VLNC cigarettes can reduce tobacco smoking, cigarette cravings, nicotine withdrawal and nicotine dependence among these populations. CONCLUSIONS Most of the tobacco endgame literature related to these priority populations focuses on VLNC cigarettes. Identified research gaps include the effectiveness of endgame policies for reducing smoking, impacts (both expected and unexpected) and policy perceptions among these priority populations.
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Affiliation(s)
- Cheneal Puljević
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Leah Feulner
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Maria Hobbs
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel Erku
- Menzies Health Institute, Centre for Applied Health Economics, Griffith University, Brisbane, Queensland, Australia
| | - Billie Bonevski
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | | | - Amanda Baker
- Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Marita Hefler
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Ara Cho
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Coral Gartner
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Teferra AA, Wing JJ, Lu B, Xu W, Roberts ME, Ferketich AK. Examining trends in health care access measures among low-income adult smokers in Ohio: 2012-2019. Prev Med Rep 2023; 31:102106. [PMID: 36820365 PMCID: PMC9938324 DOI: 10.1016/j.pmedr.2022.102106] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/30/2022] [Accepted: 12/31/2022] [Indexed: 01/03/2023] Open
Abstract
Smokers are more likely to be low-income with limited access to health services. Although Medicaid expansion under the Patient Protection and Affordable Care Act improved access to care for low-income adults, long-term trends in health care access among low-income smokers remain uncharacterized. The study evaluated changes in five access measures among low-income nonelderly (19-64) adults (N = 28976) across smoking status using pooled data from a statewide survey in Ohio covering pre- (i.e., 2012) and post-Medicaid expansion periods (2015, 2017, and 2019) guided by a comprehensive framework of health care access. We found improvements in some, but not all, health care access measures among low-income smokers in the post-Medicaid-expansion period compared to the pre-expansion period. Compared to 2012, the odds for unmet dental care needs declined in 2015 (aOR = 0.67, 95 % CI = 0.45-1.01), 2017 (aOR = 0.53, 95 % CI = 0.35-0.81), and 2019 (aOR = 0.65, 95 % CI = 0.40-1.05) (p trend < 0.001). Similarly, the odds for unmet other health care needs (i.e., medical exams and supplies) were lower in 2015 (aOR = 0.64, 95 % CI = 0.39-1.06), 2017 (aOR = 0.56, 95 % CI = 0.34-0.93), and 2019 (aOR = 0.47, 95 % CI = 0.27-0.83) (p trend < 0.001). Difficulty paying medical bills was also significantly lower in 2015 (aOR = 0.62, 95 % CI = 0.43-0.89), 2017 (aOR = 0.57, 95 % CI = 0.39-0.83) and 2019 (aOR = 0.57, 95 % CI = 0.37-0.87) (p trend < 0.001). While there was notable progress in measures of affordability (i.e., paying medical bills) as well as care availability and accommodation (i.e., unmet needs), there were no meaningful changes in the approachability of care (i.e., having a usual source of care).
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Affiliation(s)
- Andreas A. Teferra
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, OH, USA,Corresponding author at: Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute, Nationwide Children's Hospital, 431 S. 18th St., Columbus, OH, USA.
| | - Jeffrey J. Wing
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Bo Lu
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Wendy Xu
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Megan E. Roberts
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Amy K. Ferketich
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
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Nagawa CS, Lane IA, Davis M, Wang B, Pbert L, Lemon SC, Sadasivam RS. Experiences Using Family or Peer Support for Smoking Cessation and Considerations for Support Interventions: A Qualitative Study in Persons With Mental Health Conditions. J Dual Diagn 2023; 19:40-48. [PMID: 36576889 DOI: 10.1080/15504263.2022.2159732] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: The current study aimed to understand how people with mental health conditions who currently smoke or recently quit engaged with family members or peers when quitting and assessed interest in involving family or peers in cessation interventions. Methods: Adults with mental health conditions who smoke or had quit within the past 5 years were recruited from publicly funded mental health programs (N = 24). We conducted virtual qualitative interviews between November 2020 and August 2021 and analyzed the data using the rapid thematic analytic approach. Results: Most participants were men (62%), and 71% were current smokers. We found that: having family/peers who were interested in quitting presented communal quitting opportunities, communication that facilitated quitting tended to be encouraging, and strong relationships with family members increased willingness to involve them in cessation interventions. But family or peer support was less helpful for individuals who were not ready to quit. Conclusion: Training family and peers to engage in supportive behaviors may promote cessation in this population. Cessation interventions may benefit from recruiting support partners who share a strong relationship with the smoker.
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Affiliation(s)
- Catherine S Nagawa
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Ian A Lane
- Tan Chingfen Graduate School of Nursing, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Maryann Davis
- Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Bo Wang
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Lori Pbert
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Stephenie C Lemon
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Rajani S Sadasivam
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA.,Department of Psychiatry, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Lin SY, Zhou W, Koch JR, Barnes AJ, Yang R, Xue H. The Association Between Tobacco Retailer Outlet Density and Prevalence of Cigarette Smoking in Virginia. Nicotine Tob Res 2023; 25:36-42. [PMID: 35752162 DOI: 10.1093/ntr/ntac154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/22/2022] [Accepted: 06/23/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE We examine the association between tobacco retail outlet density and adult smoking prevalence at the county level in Virginia, controlling for spatial autocorrelations. AIMS AND METHODS Pooling data from 2020 County Health Rankings (compiled data from various sources including, but not limited to, the National Center for Health Statistics-Mortality Files, the Behavioral Risk Factor Surveillance System (BRFSS), and the American Community Survey) and Counter Tools, we conducted regression analyses that accounted for spatial autocorrelation (spatial lag models, LMlag) and adjusted for county-level access to healthcare, demographics, SES, environmental factors, risk conditions or behaviors, and population health measures. RESULTS Our estimates provide evidence that every increase of one tobacco retail outlet per 1000 persons was associated with 1.16 percentage points (95% CI: 0.80-1.52) higher smoking prevalence at the county level in Virginia after controlling for spatial autocorrelation. The effect of outlet density was largely explained by social determinants of health such as SES, risky conditions or behaviors, and environmental factors. We further noticed that the impact of social determinants of health were closely related and can be explained by indicators of population health (rates of mental distress (β = 1.49, 95% CI: 1.31-1.67) and physical inactivity (β = 0.07, 95% CI: 0.04-0.10). CONCLUSIONS Although higher tobacco outlet density was associated with an increase in county-level smoking prevalence, the impact of outlet density was largely explained by social determinants of health and mental illness. Improving well-being at the community level could be a promising strategy in future tobacco control policies. IMPLICATION The influence of tobacco outlet density seems to be explained by other social determinants of health and population level of mental or physical health. Thus, efforts to reduce tobacco use and consequent negative health effects should explore the impact of improving regional living standards. However, a sole focus on economic growth may not be sufficient, whereas a focus on such things as promoting work-life balance and improving overall well-being at the community level may be more.
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Affiliation(s)
- Shuo-Yu Lin
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, USA
| | - Weiyu Zhou
- Department of Statistics, Volgenau School of Engineering, George Mason University, Fairfax, VA, USA
| | - J Randy Koch
- Department of Psychology and the Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA
| | - Andrew J Barnes
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Ruixin Yang
- Department of Geography and Geoinformation Science, College of Science, George Mason University, Fairfax, VA, USA
| | - Hong Xue
- Department of Health Administration and Policy, College of Health and Human Services, George Mason University, Fairfax, VA, USA
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Simon J, Wienand D, Park AL, Wippel C, Mayer S, Heilig D, Laszewska A, Stelzer I, Goodwin GM, McDaid D. Excess resource use and costs of physical comorbidities in individuals with mental health disorders: A systematic literature review and meta-analysis. Eur Neuropsychopharmacol 2023; 66:14-27. [PMID: 36345094 DOI: 10.1016/j.euroneuro.2022.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/28/2022] [Accepted: 10/01/2022] [Indexed: 11/06/2022]
Abstract
Individuals with mental health disorders (MHDs) have worse physical health than the general population, utilise healthcare resources more frequently and intensively, incurring higher costs. We provide a first comprehensive overview and quantitative synthesis of literature on the magnitude of excess resource use and costs for those with MHDs and comorbid physical health conditions (PHCs). This systematic review (PROSPERO CRD42017075319) searched studies comparing resource use or costs of individuals with MHDs and comorbid PHCs versus individuals without comorbid conditions published between 2007 and 2021. We conducted narrative and quantitative syntheses, using random-effects meta-analyses to explore ranges of excess resource use and costs across care segments, comparing to MHD only, PHC only, or general population controls (GPC). Of 20,075 records, 228 and 100 were eligible for narrative and quantitative syntheses, respectively. Most studies were from the US, covered depression or schizophrenia, reporting endocrine/metabolic or circulatory comorbidities. Frequently investigated healthcare segments were inpatient, outpatient, emergency care and medications. Evidence on lost productivity, long-term and informal care was rare. Substantial differences exist between MHDs, with depressive disorder tending towards lower average excess resource use and cost estimates, while excess resource use ranges between +6% to +320% and excess costs between +14% to +614%. PHCs are major drivers of resource use and costs for individuals with MHDs, affecting care segments differently. Significant physical health gains and cost savings are potentially achievable through prevention, earlier identification, management and treatment, using more integrated care approaches. Current international evidence, however, is heterogeneous with limited geographical representativeness and comparability.
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Affiliation(s)
- Judit Simon
- Department of Health Economics, Center of Public Health, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria; Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom.
| | - Dennis Wienand
- Department of Health Economics, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - A-La Park
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Christoph Wippel
- Department of Health Economics, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Susanne Mayer
- Department of Health Economics, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Daniel Heilig
- Department of Health Economics, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Agata Laszewska
- Department of Health Economics, Center of Public Health, Medical University of Vienna, Vienna, Austria
| | - Ines Stelzer
- Ludwig Boltzmann Institute Applied Diagnostics, Vienna, Austria
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - David McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
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Loretan CG, Wang TW, Watson CV, Jamal A. Disparities in Current Cigarette Smoking Among US Adults With Mental Health Conditions. Prev Chronic Dis 2022; 19:E87. [PMID: 36548524 PMCID: PMC9809393 DOI: 10.5888/pcd19.220184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Prevalence of cigarette smoking is disproportionally high among US adults with mental health conditions. Adults with mental health conditions who smoke cigarettes are at increased risk for smoking-related illness and death compared with adults without mental health conditions. METHODS We analyzed pooled data from the 2019 and 2020 National Survey on Drug Use and Health to provide national estimates of current cigarette smoking prevalence among US adults aged 18 years or older who reported having in the past year any mental illness, serious mental illness, mild or moderate mental illness, serious psychological distress, and/or major depressive episode (N = 19,398) and state-level estimates for any mental illness. RESULTS Prevalence of cigarette smoking for serious mental illness was 27.2%; serious psychological distress and major depressive disorder, 25.0%; serious psychological distress, 24.5%; any mental illness, 22.8%; mild or moderate mental illness, 21.2%; and major depressive disorder, 17.6%. State-level cigarette smoking prevalence among adults with any mental illness ranged from 11.7% in Utah to 42.1% in Louisiana, with a median of 24.7%. CONCLUSION The prevalence of current cigarette smoking is higher among adults with any mental illness, psychological distress, and major depressive disorder than among those without any mental illness, especially among adults who are non-Hispanic American Indian or Alaska Native, Hispanic, lesbian, gay, or bisexual and among those who are experiencing poverty, are uninsured, or have been arrested and booked in the past year. Continued improvement in integration of smoking cessation interventions into mental health treatment, equitable implementation of comprehensive commercial tobacco control policies, and population-specific approaches could reduce cigarette smoking among adults with mental health conditions.
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Affiliation(s)
- Caitlin G. Loretan
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Teresa W. Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Christina V. Watson
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ahmed Jamal
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Fredman Stein K, Sawyer K, Daryan S, Allen J, Taylor G. Service-user experiences of an integrated psychological intervention for depression or anxiety and tobacco smoking in improving access to psychological therapies services: A qualitative investigation into mechanisms of change in quitting smoking. Health Expect 2022; 26:498-509. [PMID: 36482862 PMCID: PMC9854291 DOI: 10.1111/hex.13684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 11/23/2022] [Accepted: 11/25/2022] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION High smoking prevalence leads to increased morbidity and mortality in individuals with depression/anxiety. Integrated interventions targeting both smoking and mood have been found to be more effective than those targeting smoking alone, but the mechanisms of change of these interventions have not been investigated. This qualitative study aimed to understand participants' experiences of the mechanisms underlying change in smoking behaviour following an integrated cognitive behavioural technique-based intervention for smoking cessation and depression/anxiety. METHODS This study was embedded within an ongoing randomized-controlled acceptability and feasibility trial (http://www.isrctn.com/ISRCTN99531779). Semistructured interviews were conducted with 15 IAPT service users. Data were analysed using thematic analysis. During the interviews, participants were asked open-ended questions about their quitting experience and perception of how the intervention aided their behaviour change. RESULTS Five themes were identified. Acquiring an increased awareness of smoking patterns: participants described an increased understanding of how smoking was contributing towards their mental health difficulty. Developing individualized strategies: participants described acquiring 'a couple of tricks up your sleeve' that were helpful in making smoking cessation feel more 'manageable'. Practitioner style as 'supportive but not lecture-y': participants expressed how important the therapeutic alliance was in helping change their smoking behaviour. Importance of regular sessions: participants expressed the importance of 'having someone that's checking in on you'. Having the opportunity to access the intervention at 'the right time': participants described the intervention as the 'push' that they 'needed'. CONCLUSIONS Participants identified key factors towards smoking behaviour change. Perceived increased awareness of how smoking negatively impacted participants' mental health, and the opportunity to be offered smoking cessation treatment in a 'non-judgemental', 'supportive' environment, with regular sessions and individualized strategies contributed to successful smoking cessation outcomes. If similar results are found in more diverse samples, these aspects should be embedded within integrated interventions for smoking cessation and depression/anxiety. PATIENT OR PUBLIC CONTRIBUTION Persons with lived experience of depression, anxiety and tobacco addiction contributed towards the design of the interview schedule, participant information sheets and the debriefing process. This was to ensure that interview questions were relevant, nonjudgemental and acceptable for those who did not manage to quit smoking.
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Affiliation(s)
| | - Katherine Sawyer
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
| | - Shadi Daryan
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
| | | | - Gemma Taylor
- Addiction and Mental Health Group (AIM), Department of PsychologyUniversity of BathBathUK
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Dickerson F, Goldsholl S, Yuan CT, Dalcin A, Eidman B, Minahan E, Gennusa III JV, Mace E, Cullen B, Evins AE, Cather C, Wang NY, McGinty EM, Daumit GL. Promoting Evidence-Based Tobacco Cessation Treatment in Community Mental Health Clinics: Protocol for a Pilot Study (Preprint). JMIR Res Protoc 2022; 12:e44787. [PMID: 37171851 DOI: 10.2196/44787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 03/25/2023] [Accepted: 03/27/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Tobacco smoking is highly prevalent among persons with serious mental illness (SMI) and is the largest contributor to premature mortality in this population. Evidence-based smoking cessation therapy with medications and behavioral counseling is effective for persons with SMI, but few receive this treatment. Mental health providers have extensive experience working with clients with SMI and frequent treatment contacts, making them well positioned to deliver smoking cessation treatment. However, few mental health providers feel adequately trained to deliver this treatment, and many providers believe that smokers with SMI are not interested in quitting or have concerns about the safety of smoking cessation pharmacotherapy, despite substantial evidence to the contrary. OBJECTIVE We present the protocol for the pilot "IMPACT" (Implementing Action for Tobacco Smoking Cessation Treatment) study, which aims to pilot test a multicomponent implementation intervention to increase the delivery of evidence-based tobacco smoking cessation treatment in community mental health clinics. METHODS We are using a prepost observational design to examine the effects of an implementation intervention designed to improve mental health providers' delivery of the following four evidence-based practices related to smoking cessation treatment: (1) assessment of smoking status, (2) assessment of willingness to quit, (3) behavioral counseling, and (4) pharmacotherapy prescribing. To overcome key barriers related to providers' knowledge and self-efficacy of smoking cessation treatment, the study will leverage implementation strategies including (1) real-time and web-based training for mental health providers about evidence-based smoking cessation treatment and motivational interviewing, including an avatar practice module; (2) a tobacco smoking treatment protocol; (3) expert consultation; (4) coaching; and (5) organizational strategy meetings. We will use surveys and in-depth interviews to assess the implementation intervention's effects on providers' knowledge and self-efficacy, the mechanisms of change targeted by the intervention, as well as providers' perceptions of the acceptability, appropriateness, and feasibility of both the evidence-based practices and implementation strategies. We will use data on care delivery to assess providers' implementation of evidence-based smoking cessation practices. RESULTS The IMPACT study is being conducted at 5 clinic sites. More than 50 providers have been enrolled, exceeding our recruitment target. The study is ongoing. CONCLUSIONS In order for persons with SMI to realize the benefits of smoking cessation treatment, it is important for clinicians to implement evidence-based practices successfully. This pilot study will result in a set of training modules, implementation tools, and resources for clinicians working in community mental health clinics to address tobacco smoking with their clients. Trial Registration: ClinicalTrials.gov NCT04796961; https://clinicaltrials.gov/ct2/show/NCT04796961. TRIAL REGISTRATION ClinicalTrials.gov NCT04796961; https://clinicaltrials.gov/ct2/show/NCT04796961. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/44787.
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Harlow AF, Stokes AC, Brooks DR, Benjamin EJ, Leventhal AM, McConnell RS, Barrington‐Trimis JL, Ross CS. Prospective association between e-cigarette use frequency patterns and cigarette smoking abstinence among adult cigarette smokers in the United States. Addiction 2022; 117:3129-3139. [PMID: 35913015 PMCID: PMC9804676 DOI: 10.1111/add.16009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 07/05/2022] [Indexed: 01/07/2023]
Abstract
AIMS To estimate the association of longitudinal patterns of e-cigarette use with cigarette smoking abstinence, after accounting for time-dependent confounding and selection bias. DESIGN Secondary analysis of longitudinal national cohort data. Using marginal structural models and four waves of the population assessment of tobacco and health (wave 1, 2013-14; wave 2, 2014-15; wave 3, 2015-16; wave 4, 2016-18), we estimated the association of vaping frequency across waves 2 and 3 with 12-month sustained cigarette smoking abstinence at wave 4, adjusting for time-dependent confounders at waves 1 and 2 and selection bias due to drop-out with inverse probability of treatment and censoring weights. SETTING United States. PARTICIPANTS/CASES A total of 5699 adults (18+ years) who smoked cigarettes and did not vape at wave 1. MEASUREMENTS The exposure was vaping frequency at waves 2 and 3 (non-use, non-daily use, daily use), representing nine possible combinations of vaping frequency across two waves. Non-use at both waves was the exposure reference group. The primary outcome was sustained 12-month cigarette smoking abstinence at wave 4. FINDINGS Among 5699 adults who smoked cigarettes at wave 1, a total of 560 (9.8%) reported smoking abstinence at wave 4. Compared with nonuse at both waves, daily vaping at both waves [risk ratio (RR) = 3.82, 95% confidence interval (CI) = 2.59-5.64] and non-use at wave 2 followed by daily vaping at wave 3 (RR = 2.50, 95% CI = 1.66-3.77) were positively associated with smoking abstinence; non-daily vaping at both waves was inversely associated with smoking abstinence (RR = 0.28, 95% CI = 0.11-0.75). Results persisted after accounting for misclassification of e-cigarette use and cigarette smoking abstinence and after restricting to participants with plans to quit smoking. CONCLUSIONS In a US cohort of adult smokers, longitudinal patterns of vaping frequency appear to predict smoking abstinence, even after accounting for several sources of systematic error. Consistent daily vaping is associated with increased chances of cigarette smoking abstinence, while consistent non-daily vaping is associated with decreased chances of smoking abstinence.
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Affiliation(s)
- Alyssa F. Harlow
- University of Southern California, Department of Population and Public Health SciencesInstitute for Addiction ScienceLos AngelesCAUSA,Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Andrew C. Stokes
- Department of Global HealthBoston University School of Public HealthBostonMAUSA
| | - Daniel R. Brooks
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Emelia J. Benjamin
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA,Department of MedicineBoston University School of Medicine and Boston Medical CenterBostonMAUSA
| | - Adam M. Leventhal
- University of Southern California, Department of Population and Public Health SciencesInstitute for Addiction ScienceLos AngelesCAUSA
| | - Rob S. McConnell
- University of Southern California, Department of Population and Public Health SciencesInstitute for Addiction ScienceLos AngelesCAUSA
| | - Jessica L. Barrington‐Trimis
- University of Southern California, Department of Population and Public Health SciencesInstitute for Addiction ScienceLos AngelesCAUSA
| | - Craig S. Ross
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
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Jella TK, Cwalina TB, Vallier HA. Concurrent Mental Illness and Financial Barriers to Mental Health Care Among a Nationally Representative Sample of Orthopaedic Trauma Survivors. J Orthop Trauma 2022; 36:665-673. [PMID: 36399680 DOI: 10.1097/bot.0000000000002433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To understand prevalence and factors associated with concurrent mental illness and financial barriers to mental health care after orthopaedic trauma. DESIGN This is a retrospective, cross-sectional study. SETTING Interview-based survey was conducted across representative sample of 30,000 US households. PATIENTS/PARTICIPANTS The study included 2,309 survey respondents reporting a fracture over the past 3 months, between 2004 and 2017. INTERVENTION Screening for financial barriers to mental health care. MAIN OUTCOME MEASUREMENTS Prevalence and factors associated with concurrent mental illness and financial barriers to mental health care based on sociodemographic and injury characteristics were the main outcome measurements. RESULTS Of the 2309 orthopaedic trauma survivors included in our analysis, 203 patients [7.8%, 95% confidence interval (CI): 6.4%-9.2%] were determined to experience severe mental illness, of whom 54 (25.3%, 95% CI: 18.0%-32.6%) and 86 (40.9%, 95% CI: 31.5%-50.2%) reported financial barriers to counseling and pharmacotherapy, respectively. Factors associated with concurrent severe mental illness and cost barriers to care were 45 to 64 years of age [adjusted odds ratios (AOR) 5.1, 95% CI: 1.7-15, P = 0.004], income below 200% of the Federal Poverty Threshold (AOR 2.5, 95% CI: 1.2-5.3, P = 0.012), and unemployment at the time of injury (AOR 3.9, 95% CI: 1.4-11, P = 0.009). CONCLUSIONS Approximately one half of orthopaedic trauma survivors with severe mental illness face financial barriers to some form of mental health services. Younger, minority, and low socioeconomic status patients are most affected. These data suggest the presence of postdiagnosis disparities in mental health access that may be improved through direct provision and subsidization of integrated mental health support services for high-risk populations. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Tarun K Jella
- Case Western Reserve University, Department of Orthopaedic Surgery, Cleveland, OH
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Evins AE, Cather C, Maravic MC, Reyering S, Pachas GN, Thorndike AN, Levy DE, Fung V, Fischer MA, Schnitzer K, Pratt S, Fetters MD, Deeb B, Potter K, Schoenfeld DA. A Pragmatic Cluster-Randomized Trial of Provider Education and Community Health Worker Support for Tobacco Cessation. Psychiatr Serv 2022; 74:365-373. [PMID: 36349498 DOI: 10.1176/appi.ps.20220187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Individuals with serious mental illness have a high prevalence of tobacco use disorder and related early mortality but underutilize smoking cessation medication. The authors determined whether clinician-delivered education to primary care providers regarding safety, efficacy, and importance of cessation medication (provider education [PE]) alone or combined with community health worker (CHW) support would increase tobacco abstinence in this population, compared with usual care. METHODS All adult current tobacco smokers receiving psychiatric rehabilitation for serious mental illness through two community agencies in Greater Boston were eligible, regardless of readiness to quit smoking. Primary care clinics were cluster randomized to PE or usual care, with a nested, participant-level randomization to CHW or no CHW in PE-assigned clinics. The primary outcome was blindly assessed, biochemically verified tobacco abstinence at year 2. RESULTS Overall, 1,010 eligible participants were enrolled. PE was delivered to providers in 53 of 55 assigned clinics; 220 of 336 CHW-assigned participants consented to CHW support. Year 2 abstinence rates were significantly higher among participants assigned to PE+CHW versus usual care (12% vs. 5%; adjusted odds ratio [AOR]=2.40, 95% confidence interval [CI]=1.20-4.79) or PE alone (12% vs. 7%; AOR=1.84, 95% CI=1.04-3.24). No effect of PE alone on abstinence was detected. Compared with participants assigned to usual care, those assigned to PE+CHW had greater odds of varenicline use (OR=2.77, 95% CI=1.61-4.75), which was associated with higher year 2 abstinence (OR=1.97, 95% CI=1.16-3.33). CONCLUSIONS Combined PE and CHW tobacco cessation support increased tobacco abstinence rates among adults with serious mental illness.
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Affiliation(s)
- A Eden Evins
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Corinne Cather
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Melissa Culhane Maravic
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Sally Reyering
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Gladys N Pachas
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Anne N Thorndike
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Douglas E Levy
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Vicki Fung
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Michael A Fischer
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Kristina Schnitzer
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Sarah Pratt
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Michael D Fetters
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Bianca Deeb
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - Kevin Potter
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
| | - David A Schoenfeld
- Massachusetts General Hospital, Boston; Harvard Medical School, Boston (Evins, Cather, Pachas, Thorndike, Levy, Fung, Potter, Schoenfeld); Bay Cove Human Services, Boston (Reyering, Deeb); Boston Medical Center, Boston University School of Medicine, Boston (Fischer); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, Hanover, New Hampshire (Pratt); Mixed Methods Research Program, Department of Family Medicine, University of Michigan, Ann Arbor (Fetters)
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Pemovska T, Jovanović N. Physical health of individuals with psychosis - a mixed method study. Int Rev Psychiatry 2022; 34:827-836. [PMID: 36645188 DOI: 10.1080/09540261.2022.2151341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
People with psychosis have poorer physical health than the general population and this aspect of care delivery has largely been neglected. The IMPULSE trial (ISRCTN 11913964) investigated a psychosocial intervention prompting people with psychosis to discuss their physical health concerns with mental health clinicians. This mixed-method study explored a series of clinical meetings over 6 months to understand how physical health is discussed, what actions are taken, and if these translated into benefits for the participating individuals with psychosis. 221 individuals with psychosis were included, attending 847 clinical meetings over 6 months. Results show that, when prompted, most participants (54%) took up the opportunity to discuss their physical health at least once. These individuals were keen to make changes such as adopt healthy diet, stop smoking, lose weight, etc. Despite taking steps to achieve these goals, after 6 months no improvement was detected in subjective satisfaction with physical health, severity of physical health problems or satisfaction with services. Adopting healthier lifestyle behaviours is difficult even in motivated individuals. Future research is needed to determine innovative approaches to promote lifestyle change in individuals with psychosis.
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Affiliation(s)
- Tamara Pemovska
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.,NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, United Kingdom
| | - Nikolina Jovanović
- Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
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Badekar A, Rajalu BM, Muliyala KP, Sharma P, Chand PK, Murthy P. Prevalence and severity of tobacco use and access to tobacco cessation among tertiary care psychiatric in-patients in India. Indian J Psychiatry 2022; 64:572-578. [PMID: 36714672 PMCID: PMC9881721 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_405_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 09/20/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background Rates of smoking in persons with mental illness are reported to be two times higher than those without mental illness in developed countries. We aimed to examine the prevalence and severity of tobacco use, and access to tobacco cessation services among tertiary care psychiatric in-patients in India. Methods In this cross-sectional study, 500 consecutive adult in-patients in tertiary care with ICD 10 diagnoses, F20-59, were administered a sociodemographic and clinical proforma, Clinical Global Impression-Severity scale, Fagerstrom Test for Nicotine Dependence, Tobacco Craving Questionnaire, Reasons for quitting questionnaire, and Smoke Scale-Adults. Urine cotinine levels were estimated in the last 100 patients. Details of tobacco use and cessation interventions provided were obtained. Results Overall prevalence of current tobacco use was 34.00%; 34.3%, 32.6%, 43.6%, and 16.7% in patients of F20-29, F30-39, F40-49, and F50-59 categories, respectively. Males used tobacco products at a significantly higher rate (44.85% vs. 17.58% in females) and were highly dependent. Smokeless tobacco use was reported in 20.5% and 18% of female patients with F20-29 and F30-39 diagnoses, respectively. More than half of the tobacco users were not asked about tobacco use and 89.4% of the users were provided no prior assistance for cessation at the time of assessment. Urinary cotinine levels were significantly greater for those who use smokeless forms than smokers or dual users. Conclusions Nearly a third of psychiatric in-patients are current users of tobacco. Moderate to severe tobacco dependence was observed across psychiatric diagnoses. The assessment and interventions provided were suboptimal.
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Affiliation(s)
- Amol Badekar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Banu Manickam Rajalu
- Department of Nursing, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Krishna Prasad Muliyala
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Priyamvada Sharma
- Department of Clinical Pharmacology and Neurotoxicology, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Prabhat Kumar Chand
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Pratima Murthy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
- Department of Director, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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50
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Perman-Howe PR, McNeill A, Brose LS, Tildy BE, Langley TE, Robson D. The Effect of Tobacco Control Mass Media Campaigns on Smoking-Related Behavior Among People With Mental Illness: A Systematic Literature Review. Nicotine Tob Res 2022; 24:1695-1704. [PMID: 35358321 PMCID: PMC9597075 DOI: 10.1093/ntr/ntac079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/24/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Tobacco control mass media campaigns (MMCs) can be effective generally, but little is known about their effects among people with mental illness. The objectives of this study were to systematically review: (1) Whether tobacco control MMCs affect smoking-related outcomes among people with mental illness. (2) Cost-effectiveness. AIMS AND METHODS Data sources: MEDLINE, Embase, PsycInfo, Web of Science, CINAHL, the Cochrane Library (searched March 2021), reference lists of included articles and relevant systematic reviews. Study eligibility criteria: Population: Adults with mental illness and experience of smoking tobacco and/or using other nicotine-containing products. Intervention/exposure: Tobacco control MMC messages. Comparator: No exposure, other tobacco control intervention(s), no comparator. Primary outcome: Changes in quitting behaviors. Study design: All primary research. Quantitative data were appraised using the EPHPP tool, qualitative data using CASP's Studies Checklist. Data were synthesized narratively. RESULTS Eight studies were included, seven were at high risk of bias. There was inconclusive evidence of the effect of MMCs on quit attempts and intentions to quit among people with mental illness. Increasing advertisement exposure did not increase quit attempts or intentions to quit among those with mental illness, however, increased exposure to an advertisement that addressed smoking and mental health did. None of the studies assessed cost-effectiveness. CONCLUSIONS Findings should be interpreted with caution as data are limited and of low or moderate quality. There is evidence to suggest that tobacco control MMCs have limited impact on those with mental illness, although campaigns that are specific to smoking and mental health may be effective. IMPLICATIONS There is a paucity of good-quality evidence of the effect of tobacco control MMC messages among people with mental illness. Careful consideration should be given to the design of future studies that evaluate MMCs in order to minimize the risk of bias, establish causality, and ensure the findings reflect real-world implementation. Further research should examine the need for MMC messages that address mental health.
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Affiliation(s)
| | - Ann McNeill
- Addictions Department, King’s College London, London, UK
| | - Leonie S Brose
- Addictions Department, King’s College London, London, UK
| | | | - Tessa E Langley
- University of Nottingham, School of Medicine, Nottingham, UK
| | - Debbie Robson
- Addictions Department, King’s College London, London, UK
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