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Lokko H, Avor WMK. On the pathway to health equity: Creating a harm reduction strategy for a large academic acute care hospital. Healthc Manage Forum 2025; 38:23-29. [PMID: 39037245 DOI: 10.1177/08404704241264243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024]
Abstract
An urban centre in southwestern Ontario continues to be faced with the extensive impacts of high rates of substance use. To more effectively meet the Quintuple Aim, in a way that authentically considers patients who use substances, the need for a cohesive, comprehensive organizational harm reduction strategy at the large academic acute care hospital providing community and regional healthcare services was clear. Community-based harm reduction expertise was leveraged to support the development work. Information gathered through literature review and interviews with patients, internal staff and leaders, partner healthcare agencies, and Canadian hospitals leading in harm reduction work provided key insights and supported the formulation of emerging recommendations that will be used to shape the acute care hospital's formal organizational harm reduction strategy.
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Affiliation(s)
- Heather Lokko
- London Health Sciences Centre, London, Ontario, Canada
- Western University, London, Ontario, Canada
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Küçükaksu MH, van Meijel B, Jansen L, Hoekstra T, Adriaanse MC. A smoking cessation intervention for people with severe mental illness treated in ambulatory mental health care (KISMET): study protocol of a randomised controlled trial. BMC Psychiatry 2023; 23:108. [PMID: 36797709 PMCID: PMC9933801 DOI: 10.1186/s12888-023-04599-x] [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: 01/06/2023] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Smoking among people with severe mental illness (SMI) is highly prevalent and strongly associated with poor physical health. Currently, evidence-based smoking cessation interventions are scarce and need to be integrated into current mental health care treatment guidelines and clinical practice. Therefore, the present study aims to evaluate the implementation and effectiveness of a smoking cessation intervention in comparison with usual care in people with SMI treated by Flexible Assertive Community Treatment (FACT) teams in the Netherlands. METHODS A pragmatic, cluster-randomised controlled trial with embedded process evaluation will be conducted. Randomisation will be performed at the level of FACT teams, which will be assigned to the KISMET intervention or a control group (care as usual). The intervention will include pharmacological treatment combined with behavioural counselling and peer support provided by trained mental health care professionals. The intervention was developed using a Delphi study, through which a consensus was reached on the core elements of the intervention. We aim to include a total of 318 people with SMI (aged 18-65 years) who smoke and desire to quit smoking. The primary outcome is smoking status, as verified by carbon monoxide measurements and self-report. The secondary outcomes are depression and anxiety, psychotic symptoms, physical fitness, cardiovascular risks, substance use, quality of life, and health-related self-efficacy at 12 months. Alongside the trial, a qualitative process evaluation will be conducted to evaluate the barriers to and facilitators of its implementation as well as the satisfaction and experiences of both patients and mental health care professionals. DISCUSSION The results of the KISMET trial will contribute to the evidence gap of effective smoking cessation interventions for people treated by FACT teams. Moreover, insights will be obtained regarding the implementation process of the intervention in current mental health care. The outcomes should advance the understanding of the interdependence of physical and mental health and the gradual integration of both within the mental health care system. TRIAL REGISTRATION Netherlands Trial Register, NTR9783. Registered on 18 October 2021.
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Affiliation(s)
- Müge H. Küçükaksu
- grid.12380.380000 0004 1754 9227Department of Health Sciences and Amsterdam Public Health research institute, Faculty of Science, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands
| | - Berno van Meijel
- grid.16872.3a0000 0004 0435 165XDepartment of Psychiatry, Amsterdam UMC and Amsterdam Public Health research institute, Amsterdam, Netherlands ,grid.448984.d0000 0003 9872 5642Department of Health, Sports & Welfare, Inholland University of Applied Sciences, De Boelelaan 1109, 1081HV Amsterdam, The Netherlands ,grid.476585.d0000 0004 0447 7260Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Lola Jansen
- grid.12380.380000 0004 1754 9227Department of Health Sciences and Amsterdam Public Health research institute, Faculty of Science, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands
| | - Trynke Hoekstra
- grid.12380.380000 0004 1754 9227Department of Health Sciences and Amsterdam Public Health research institute, Faculty of Science, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands
| | - Marcel C. Adriaanse
- grid.12380.380000 0004 1754 9227Department of Health Sciences and Amsterdam Public Health research institute, Faculty of Science, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081BT, Amsterdam, The Netherlands
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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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Patterson JG, Macisco JM, Glasser AM, Wermert A, Nemeth JM. Psychosocial factors influencing smoking relapse among youth experiencing homelessness: A qualitative study. PLoS One 2022; 17:e0270665. [PMID: 35881608 PMCID: PMC9321375 DOI: 10.1371/journal.pone.0270665] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 06/14/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES In the United States, up to 70% of youth experiencing homelessness smoke cigarettes. Many are interested in quitting; however, little is known about psychosocial factors influencing smoking relapse in this population. This study, part of a larger project to develop an optimized smoking cessation intervention for youth experiencing homelessness, aimed to describe how psychosocial factors influence smoking relapse in this group. METHODS This study describes the smoking relapse experiences of 26 youth tobacco users, aged 14-24 years, who were recruited from a homeless drop-in center in Ohio. We conducted semi-structured interviews to understand how stress, opportunity, and coping contribute to smoking relapse. RESULTS Five themes emerged from the data: (1) smoking as a lapse in emotional self-regulation in response to stress; (2) smoking as active emotional self-regulation in response to stress; (3) social opportunities facilitate smoking in the context of emotion-focused stress coping; (4) problem-focused stress coping; and (5) opportunity facilitates smoking relapse. CONCLUSIONS Stress was a primary driver of smoking relapse among youth experiencing homelessness, yet social and environmental opportunities to smoke also precipitated relapse. Interventions to improve abstinence among this population should target foundational stressors, coping skills, social supports, and nicotine dependence.
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Affiliation(s)
- Joanne G. Patterson
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio, United States of America
| | - Joseph M. Macisco
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, Ohio, United States of America
| | - Allison M. Glasser
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, Ohio, United States of America
| | - Amy Wermert
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, Ohio, United States of America
| | - Julianna M. Nemeth
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio, United States of America
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, Ohio, United States of America
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Alghzawi H, Trinkoff A, Zhu S, Storr C. Remission from nicotine dependence among people with severe mental illness who received help/services for tobacco/nicotine use. Int J Methods Psychiatr Res 2020; 29:1-11. [PMID: 32945054 PMCID: PMC7723218 DOI: 10.1002/mpr.1845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 05/18/2020] [Accepted: 05/20/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES A growing body of evidence supports pharmacological interventions to assist smoking cessation in people with severe mental illness (SMI); that is, lifetime major depressive disorder, bipolar disorders, or schizophrenia. Little is known about whether behavioral services are also associated with high probability of remission from nicotine dependence as compared to other types of help/services received (pharmacological, behavioral, or both). METHODS A sample of 726 American lifetime adult smokers with SMI and a history of nicotine dependence, who received help/services for tobacco/nicotine use, were identified. These data came from a limited public use dataset, the 2012-2013 NESARC-III. Survival analysis was used to compare the probability of remission from nicotine dependence and the time needed for full remission from nicotine dependence by type of help/services received for tobacco/nicotine use. RESULTS Remission was more frequent among those who received behavioral services. In addition, the average time from onset of nicotine dependence until full remission from nicotine dependence was shorter among those who received behavioral services. CONCLUSIONS The current study suggests a clinical need for behavioral interventions to promote the probability of remission from nicotine dependence among smokers with SMI. Health care providers could play a role in educating and encouraging smokers with SMI to seek and utilize behavioral services.
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Affiliation(s)
- Hamzah Alghzawi
- Department of Family and Community Health, School of NursingUniversity of MarylandBaltimoreMarylandUSA
| | - Alison Trinkoff
- Department of Family and Community Health, School of NursingUniversity of MarylandBaltimoreMarylandUSA
| | - Shijun Zhu
- Department of Organizational Systems and Adult Health, School of NursingUniversity of MarylandBaltimoreMarylandUSA
| | - Carla Storr
- Department of Family and Community Health, School of NursingUniversity of MarylandBaltimoreMarylandUSA
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Is there an association between perceived social support and cardiovascular health behaviours in people with severe mental illnesses? Soc Psychiatry Psychiatr Epidemiol 2020; 55:1659-1669. [PMID: 32424502 PMCID: PMC7585561 DOI: 10.1007/s00127-020-01879-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 05/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE People with severe mental illnesses (SMI) have an increased risk of cardiovascular disease (CVD). Research in the general population suggests that social support may protect against increased CVD morbidity and mortality; however, this may not apply to those with SMI. We aimed to explore the association between perceived social support and attendance at primary care nurse CVD risk reduction clinic appointments and CVD risk-reducing behaviours in an SMI population with elevated CVD risk factors. METHODS We used longitudinal and cross-sectional data from a randomised controlled trial on 326 adults with SMI recruited via 76 general practices in England. Multilevel regression analysis estimated the effect of perceived social support on attendance at CVD risk reduction clinic appointments over 6 months, and adherence to CVD medication, physical activity, diet, smoking and alcohol use at baseline, adjusted by age, sex, ethnicity, deprivation, psychiatric diagnosis and employment. RESULTS Perceived social support predicted greater appointment attendance in unadjusted (IRR = 1.005; 1.000-1.010; p = 0.05) but not adjusted analysis (IRR = 1.003; 0.998-1.009; p = 0.25). Perceived social support was associated with greater adherence to medication; for each 1% increase in social support, there was a 4.2% increase in medication adherence (OR = 1.042; 1.015-1.070; p = 0.002). No association was found between greater perceived social support and greater physical activity, lower sedentary behaviour, healthier diet, lower alcohol use or being a non-smoker. CONCLUSIONS Social support may be an important facilitator for CVD medication adherence and is potentially important for primary care appointment attendance; however, alternative strategies might be needed to help people with SMI engage in physical activity, healthier diets and to reduce their smoking and alcohol use.
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Hides L, Quinn C, Stoyanov S, Kavanagh D, Baker A. Psychological interventions for co-occurring depression and substance use disorders. Cochrane Database Syst Rev 2019; 2019:CD009501. [PMID: 31769015 PMCID: PMC6953216 DOI: 10.1002/14651858.cd009501.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Comorbid depression and substance use disorders are common and have poorer outcomes than either disorder alone. While effective psychological treatments for depression or substance use disorders are available, relatively few randomised controlled trials (RCTs) have examined the efficacy of these treatments in people with these comorbid disorders. OBJECTIVES To assess the efficacy of psychological interventions delivered alone or in combination with pharmacotherapy for people diagnosed with comorbid depression and substance use disorders. SEARCH METHODS We searched the following databases up to February 2019: Cochrane Central Register of Controlled Trials, PubMed, Embase, CINAHL, Google Scholar and clinical trials registers. All systematic reviews identified, were handsearched for relevant articles. SELECTION CRITERIA The review includes data from RCTs of psychological treatments for people diagnosed with comorbid depression and substance use disorders, using structured clinical interviews. Studies were included if some of the sample were experiencing another mental health disorder (e.g. anxiety); however, studies which required a third disorder as part of their inclusion criteria were not included. Studies were included if psychological interventions (with or without pharmacotherapy) were compared with no treatment, delayed treatment, treatment as usual or other psychological treatments. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. MAIN RESULTS Seven RCTs of psychological treatments with a total of 608 participants met inclusion criteria. All studies were published in the USA and predominately consisted of Caucasian samples. All studies compared different types of psychological treatments. Two studies compared Integrated Cognitive Behavioural Therapy (ICBT) with Twelve Step Facilitation (TSF), another two studies compared Interpersonal Psychotherapy for Depression (IPT-D) with other treatment (Brief Supportive Therapy (BST) or Psychoeducation). The other three studies compared different types or combinations of psychological treatments. No studies compared psychological interventions with no treatment or treatment as usual control conditions. The studies included a diverse range of participants (e.g. veterans, prisoners, community adults and adolescents). All studies were at high risk of performance bias, other main sources were selection, outcome detection and attrition bias. Due to heterogeneity between studies only two meta-analyses were conducted. The first meta-analysis focused on two studies (296 participants) comparing ICBT to TSF. Very low-quality evidence revealed that while the TSF group had lower depression scores than the ICBT group at post-treatment (mean difference (MD) 4.05, 95% confidence interval (CI) 1.43 to 6.66; 212 participants), there was no difference between groups in depression symptoms (MD 1.53, 95% CI -1.73 to 4.79; 181 participants) at six- to 12-month follow-up. At post-treatment there was no difference between groups in proportion of days abstinent (MD -2.84, 95% CI -8.04 to 2.35; 220 participants), however, the ICBT group had a greater proportion of days abstinent than the TSF group at the six- to 12-month follow-up (MD 10.76, 95% CI 3.10 to 18.42; 189 participants). There were no differences between the groups in treatment attendance (MD -1.27, 95% CI -6.10 to 3.56; 270 participants) or treatment retention (RR 0.95, 95% CI 0.72 to 1.25; 296 participants). The second meta-analysis was conducted with two studies (64 participants) comparing IPT-D with other treatment (Brief Supportive Psychotherapy/Psychoeducation). Very low-quality evidence indicated IPT-D resulted in significantly lower depressive symptoms at post-treatment (MD -0.54, 95% CI -1.04 to -0.04; 64 participants), but this effect was not maintained at three-month follow-up (MD 3.80, 95% CI -3.83 to 11.43) in the one study reporting follow-up outcomes (38 participants; IPT-D versus Psychoeducation). Substance use was examined separately in each study, due to heterogeneity in outcomes. Both studies found very low-quality evidence of no significant differences in substance use outcomes at post-treatment (percentage of days abstinent, IPD versus Brief Supportive Psychotherapy; MD -2.70, 95% CI -28.74 to 23.34; 26 participants) or at three-month follow-up (relative risk of relapse, IPT-D versus Psychoeducation; RR 0.67, 95% CI 0.30 to 1.50; 38 participants). There was also very low-quality evidence for no significant differences between groups in treatment retention (RR 1.00, 95% CI 0.81 to 1.23; 64 participants). No adverse events were reported in any study. AUTHORS' CONCLUSIONS The conclusions of this review are limited due to the low number and very poor quality of included studies. No conclusions can be made about the efficacy of psychological interventions (delivered alone or in combination with pharmacotherapy) for the treatment of comorbid depression and substance use disorders, as they are yet to be compared with no treatment or treatment as usual in this population. In terms of differences between psychotherapies, although some significant effects were found, the effects were too inconsistent and small, and the evidence of too poor quality, to be of relevance to practice.
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Affiliation(s)
- Leanne Hides
- The University of QueenslandSchool of PsychologySt Lucia, BrisbaneQueenslandAustralia4072
| | - Catherine Quinn
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - Stoyan Stoyanov
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - David Kavanagh
- Queensland University of TechnologySchool of Psychology and Counselling, Institute of Health and Biomedical Innovation60 Musk AvenueKelvin GroveBrisbaneQueenslandAustralia4059
| | - Amanda Baker
- University of Newcastle, CallaghanCentre for Brain and Mental Health ResearchNewcomen Street, James Fletcher HospitalNewcastleNew South WalesAustralia2300
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Aschbrenner KA, Naslund JA, Gill L, Hughes T, O’Malley AJ, Bartels SJ, Brunette MF. Qualitative analysis of social network influences on quitting smoking among individuals with serious mental illness. J Ment Health 2019; 28:475-481. [PMID: 28675331 PMCID: PMC5876150 DOI: 10.1080/09638237.2017.1340600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 03/17/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Abstract
Objective: The prevalence of cigarette smoking among adults with serious mental illness (SMI) remains high in the United States despite the availability of effective smoking cessation treatment. Identifying social influences on smoking and smoking cessation may help enhance intervention strategies to help smokers with SMI quit. The objective of this qualitative study was to explore social network influences on efforts to quit smoking among adults with SMI enrolled in a cessation treatment program. Methods: Participants were 41 individuals with SMI enrolled in a Medicaid Demonstration Project of smoking cessation at community mental health centers. A convenience sampling strategy was used to recruit participants for social network interviews exploring the influence of family, friends, peers, and significant others on quitting smoking. A team-based analysis of qualitative data involved descriptive coding, grouping coded data into categories, and identifying themes across the data. Results: Social barriers to quitting smoking included pro-smoking social norms, attitudes, and behaviors of social network members, and negative interactions with network members, either specific to smoking or that triggered smoking. Social facilitators to quitting included quitting with network members, having cessation role models, and social support for quitting from network members. Conclusions: Similar to the general population, social factors appear to influence efforts to quit smoking among individuals with SMI enrolled in cessation treatment. Interventions that leverage positive social influences on smoking cessation have the potential to enhance strategies to help individuals with SMI quit smoking.
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Affiliation(s)
- Kelly A. Aschbrenner
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - John A. Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Lydia Gill
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | - Alistair J. O’Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Stephen J. Bartels
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Mary F. Brunette
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
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Factors associated with Quitline and pharmacotherapy utilisation among low-socioeconomic status smokers. Addict Behav 2019; 89:113-120. [PMID: 30290299 DOI: 10.1016/j.addbeh.2018.09.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 09/19/2018] [Accepted: 09/24/2018] [Indexed: 11/22/2022]
Abstract
AIMS To examine factors associated with Quitline and pharmacotherapy utilisation in low socioeconomic status (low-SES) smokers enrolled in a smoking cessation trial. METHODS Baseline data was used from a large-scale smoking cessation randomised controlled trial (RCT). Logistic regression models were used to examine predictors of treatment utilisation prior to entering the RCT and perceived effectiveness of past and future use. RESULTS A total of 1047 smokers consented and prior to enrolment 92% had previously tried to quit smoking, 86% had ever used quit support, 83% had used pharmacotherapy at least once and 38% had ever utilised Quitline. For those who had used pharmacotherapies, 71% used NRT, of which 21% had used dual NRT products. In the last 12-months, 27% utilised Quitline and 50% utilised NRT. Ever use of Quitline was negatively associated with self-efficacy to quit (OR: 0.80; 95% CI: 0.68, 0.94 p < .01) and positively associated with being diagnosed with a mental health condition (OR: 1.50; 95% CI: 1.01, 2.25 p < .05). Recent use of NRT was positively associated with mental health condition (OR: 1.39; 95% CI: 1.02, 1.90 p < .05) and negatively associated with alcohol consumption (OR: 0.69; 95% CI: 0.52, 0.92 p < .01). CONCLUSION Past use of Quitline and pharmacotherapy treatment was associated with self-efficacy to quit, sociodemographic variables, mental health conditions and alcohol consumption. Community-based strategies that target smoking, mental health and drug and alcohol problems may overcome some of the barriers that prevent low-SES populations from engaging with smoking cessation support.
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Sharma-Kumar R, Meurk C, Ford P, Beere D, Gartner C. Are Australian smokers with mental illness receiving adequate smoking cessation and harm reduction information? Int J Ment Health Nurs 2018; 27:1673-1688. [PMID: 29718549 DOI: 10.1111/inm.12465] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/21/2018] [Indexed: 02/05/2023]
Abstract
Provision of smoking cessation support in the form of advice and information is central to increasing quit rates, including among people with mental illness (MI), who have 3-5 times higher odds of smoking than those without MI. This study investigated the extent and perceived utility of quit smoking advice and information available to Australian smokers with MI through face-to-face, semi-structured, in-depth interviews with 29 current smokers with MI. Qualitative analysis identified four major sources of quit smoking advice and information: (i) mental health practitioners; (ii) Quitline; (iii) social networks; and (iv) Internet and media. All identified sources, including formal sources (mental health practitioners and Quitline), were perceived as providing inadequate information about quitting smoking, particularly regarding optimal usage of nicotine replacement therapy (NRT). Social networks emerged as a substantial source of quit smoking advice and information, especially for nontraditional methods such as vaping. Participants showed high interest in receiving support from peer-led smoking cessation groups. A minority of participants reported that they had received quit smoking information from Internet and media; this was largely restricted to negative reports about e-cigarettes and short advertisements for nicotine replacement therapy. Our findings suggest that more can be done to provide smokers with MI with practical smoking cessation advice and support. Comprehensive information resources tailored for smokers with MI should be developed and disseminated via multiple pathways. We also recommend a number of policy and practice reforms to promote smoking cessation among those with MI.
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Affiliation(s)
- Ratika Sharma-Kumar
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Carla Meurk
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Pauline Ford
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Diana Beere
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia
| | - Coral Gartner
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Aschbrenner KA, Naslund JA, Gill L, Bartels SJ, O'Malley AJ, Brunette MF. Preferences for Smoking Cessation Support from Family and Friends Among Adults with Serious Mental Illness. Psychiatr Q 2017; 88:701-710. [PMID: 28091796 PMCID: PMC5511779 DOI: 10.1007/s11126-016-9485-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Engaging natural supports may be a promising strategy to promote the use of evidence-based smoking cessation treatment for individuals with serious mental illness (SMI) who smoke. This qualitative study explored preferences for support for quitting from family and friends among individuals with SMI who participated in cessation treatment. Participants were 41 individuals with SMI enrolled in a Medicaid Demonstration Project of smoking cessation at community mental health centers. Open-ended questions asked during a social network interview explored participants' preferences for more support for quitting smoking from family and friends. The qualitative data was coded and common themes were identified across the dataset. Three primary preferences emerged for smoking cessation support from family members and friends: 1) more practical support for quitting (e.g., financial help with purchasing cessation medications); 2) more emotional support for quitting (e.g., encouraging progress toward quitting); and 3) changing their own smoking behaviors in the presence of participants (e.g., don't smoke around them or offer them cigarettes). Individuals with SMI who participated in smoking cessation treatment at community mental health centers indicated several ways that family members and friends could support their efforts to quit smoking. Understanding how people with SMI want support from family and friends to quit smoking will inform strategies to leverage these natural resources to promote the use of evidence-based smoking cessation treatment and support smoking abstinence for this population.
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Affiliation(s)
- Kelly A Aschbrenner
- Centers for Health and Aging, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA.
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA.
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - John A Naslund
- Centers for Health and Aging, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Lydia Gill
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Stephen J Bartels
- Centers for Health and Aging, Geisel School of Medicine at Dartmouth, 46 Centerra Parkway, Suite 200, Lebanon, NH, 03766, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - A James O'Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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12
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Travaglini LE, Li L, Brown CH, Bennett ME. Predictors of smoking cessation group treatment engagement among veterans with serious mental illness. Addict Behav 2017; 75:103-107. [PMID: 28728038 PMCID: PMC5616105 DOI: 10.1016/j.addbeh.2017.07.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 06/29/2017] [Accepted: 07/08/2017] [Indexed: 12/31/2022]
Abstract
High prevalence rates of tobacco use, particularly cigarettes, pose a serious health threat for individuals with serious mental illness (SMI), and research has demonstrated the effectiveness of pharmacotherapy and psychosocial interventions to reduce tobacco use in this group. However, few studies have considered predictors of tobacco cessation treatment engagement among individuals with SMI. The current study examined predictors of engagement in smoking cessation groups among veterans with SMI engaged in mental health services at three VA medical centers. All veterans were participating in a smoking cessation treatment study. Of 178 veterans who completed baseline assessments, 127 (83.6%) engaged in treatment, defined as attending at least three group sessions. Forty-one (N=41) predictors across five domains (demographics, psychiatric concerns, medical concerns, smoking history, and self-efficacy to quit smoking) were identified based on previous research and clinical expertise. Using backward elimination to determine a final multivariable logistic regression model, three predictors were found to be significantly related to treatment engagement: marital status (never-married individuals more likely to engage); previous engagement in group smoking cessation services; and greater severity of positive symptoms on the Brief Psychiatric Rating Scale. When included in the multivariable logistic regression model, the full model discriminates between engagers and non-engagers reasonably well (c statistic=0.73). Major considerations based on these findings are: individuals with SMI appear to be interested in smoking cessation services; and serious psychiatric symptomatology should not discourage treatment providers from encouraging engagement in smoking cessation services.
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Affiliation(s)
- Letitia E Travaglini
- VA Capital Healthcare Network Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD 21201, United States; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
| | - Lan Li
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
| | - Clayton H Brown
- VA Capital Healthcare Network Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD 21201, United States; Department of Epidemiology & Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
| | - Melanie E Bennett
- VA Capital Healthcare Network Mental Illness, Research, Education, and Clinical Center (MIRECC), Baltimore, MD 21201, United States; Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, United States.
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13
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Li W, Gao L, Chen H, Cao N, Sun B. Prediction of injunctive and descriptive norms for willingness to quit smoking: The mediating role of smoking risk perception. JOURNAL OF SUBSTANCE USE 2017. [DOI: 10.1080/14659891.2017.1394378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Weijian Li
- Institute of Psychological and Brain Sciences, Zhejiang Normal University, Jinhua, Zhejiang, China
| | - Lingfeng Gao
- Institute of Psychological and Brain Sciences, Zhejiang Normal University, Jinhua, Zhejiang, China
| | - Haide Chen
- Institute of Psychological and Brain Sciences, Zhejiang Normal University, Jinhua, Zhejiang, China
| | - Ningmeng Cao
- Institute of Psychological and Brain Sciences, Zhejiang Normal University, Jinhua, Zhejiang, China
| | - Binghai Sun
- Institute of Psychological and Brain Sciences, Zhejiang Normal University, Jinhua, Zhejiang, China
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14
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Lawn S, Bowman J, Wye P, Wiggers J. Exploring the Potential for Family Carers to Support People With Mental Illness to Stop Smoking. J Dual Diagn 2017; 13:52-59. [PMID: 27918872 DOI: 10.1080/15504263.2016.1267829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cigarette smoking poses significant health burdens for people with mental illness. They die sooner than they should, and smoking is a major contributor to their high rates of morbid chronic physical health conditions and early mortality, compared to the general population. Family carers provide important support to people with mental illness. However, family carers' perspectives of smoking by their family members with mental illness are largely absent from the research literature and from practice, despite smoking rates remaining high and quit rates remaining low for this population. We know little about how family carers are or could be involved in supporting people with mental illness who smoke to stop smoking. This paper aims to provide a discussion of the opportunities for family carers to support their family member's smoking cessation and a discussion of our preliminary research on this topic. From the available literature, it appears that family carers are well placed to support smoking cessation for this population; however, they struggled physically, philosophically, and emotionally with perceived responsibilities involving their family member's smoking and the caring role. They felt isolated and asserted that there was limited support from service providers to assist them. We concluded that family carers are important agents within the person's immediate environment who could help them to improve their smoking cessation success. This suggests also that mental health services and other health service providers could benefit from including family carers in their efforts to support smoking cessation for people with mental illness who smoke.
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Affiliation(s)
- Sharon Lawn
- a Flinders Human Behavior and Health Research Unit , Department of Psychiatry , School of Medicine, Flinders University , Adelaide , South Australia , Australia
| | - Jenny Bowman
- b School of Psychology , Faculty of Science and Information Technology, University of Newcastle , Newcastle , New South Wales , Australia
| | - Paula Wye
- b School of Psychology , Faculty of Science and Information Technology, University of Newcastle , Newcastle , New South Wales , Australia
| | - John Wiggers
- c School of Medicine and Public Health , Faculty of Health and Medicine, University of Newcastle , Newcastle , New South Wales , Australia.,d Hunter New England Population Health , NSW Health Hunter New England Local Health District , Newcastle , New South Wales , Australia
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15
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Metse AP, Wiggers J, Wye P, Moore L, Clancy R, Wolfenden L, Freund M, Van Zeist T, Stockings E, Bowman JA. Smoking and environmental characteristics of smokers with a mental illness, and associations with quitting behaviour and motivation; a cross sectional study. BMC Public Health 2016; 16:332. [PMID: 27080019 PMCID: PMC4832515 DOI: 10.1186/s12889-016-2969-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 03/18/2016] [Indexed: 11/11/2022] Open
Abstract
Background Persons with a mental illness are less likely to be successful in attempts to quit smoking. A number of smoking and environmental characteristics have been shown to be related to quitting behaviour and motivation of smokers generally, however have been less studied among smokers with a mental illness. This study aimed to report the prevalence of smoking characteristics and a variety of physical and social environmental characteristics of smokers with a mental illness, and explore their association with quitting behaviour and motivation. Methods A cross-sectional descriptive study was undertaken of 754 smokers admitted to four psychiatric inpatient facilities in Australia. Multivariable logistic regression analyses were undertaken to explore the association between smoking and environmental characteristics and recent quitting behaviour and motivation. Results Participants were primarily daily smokers (93 %), consumed >10 cigarettes per day (74 %), and highly nicotine dependent (51 %). A third (32 %) lived in a house in which smoking was permitted, and 44 % lived with other smokers. The majority of participants believed that significant others (68–82 %) and health care providers (80–91 %) would be supportive of their quitting smoking. Reflecting previous research, the smoking characteristics examined were variously associated with quitting behaviour and motivation. Additionally, participants not living with other smokers were more likely to have quit for a longer duration (OR 2.02), and those perceiving their psychiatrist to be supportive of a quit attempt were more likely to have had more quit attempts in the past six months (OR 2.83). Conclusions Modifiable characteristics of the physical and social environment, and of smoking, should be considered in smoking cessation interventions for persons with a mental illness.
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Affiliation(s)
- Alexandra P Metse
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.
| | - John Wiggers
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Longworth Ave, Wallsend, NSW, 2287, Australia
| | - Paula Wye
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Longworth Ave, Wallsend, NSW, 2287, Australia
| | - Lyndell Moore
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Richard Clancy
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Centre for Translational Neuroscience and Mental Health, Corner Edith and Platt Streets, Waratah, NSW, 2298, Australia
| | - Luke Wolfenden
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia.,Hunter New England Population Health, Longworth Ave, Wallsend, NSW, 2287, Australia
| | - Megan Freund
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Tara Van Zeist
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
| | - Emily Stockings
- National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street, Randwick, NSW, 2031, Australia
| | - Jenny A Bowman
- University of Newcastle, University Drive, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Lot 1 Kookaburra Circuit, New Lambton Heights, NSW, 2305, Australia
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16
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Weinstein LC, Stefancic A, Cunningham AT, Hurley KE, Cabassa LJ, Wender RC. Cancer screening, prevention, and treatment in people with mental illness. CA Cancer J Clin 2016; 66:134-51. [PMID: 26663383 PMCID: PMC4783271 DOI: 10.3322/caac.21334] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
People with mental illness die decades earlier in the United States compared with the general population. Most of this disparity is related to preventable and treatable chronic conditions, with many studies finding cancer as the second leading cause of death. Individual lifestyle factors, such as smoking or limited adherence to treatment, are often cited as highly significant issues in shaping risk among persons with mental illness. However, many contextual or systems-level factors exacerbate these individual factors and may fundamentally drive health disparities among people with mental illness. The authors conducted an integrative review to summarize the empirical literature on cancer prevention, screening, and treatment for people with mental illness. Although multiple interventions are being developed and tested to address tobacco dependence and obesity in these populations, the evidence for effectiveness is quite limited, and essentially all prevention interventions focus at the individual level. This review identified only one published article describing evidence-based interventions to promote cancer screening and improve cancer treatment in people with mental illness. On the basis of a literature review and the experience and expertise of the authors, each section in this article concludes with suggestions at the individual, interpersonal, organizational, community, and policy levels that may improve cancer prevention, screening, and treatment in people with mental illness.
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Affiliation(s)
- Lara C Weinstein
- Associate Professor, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Ana Stefancic
- Staff Research Associate, Columbia University-School of Social Work, New York, NY
| | - Amy T Cunningham
- Clinical Research Coordinator III, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Katelyn E Hurley
- Clinical Research Specialist, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA
| | | | - Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA and Professor, Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA
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17
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Coletti DJ, Brunette M, John M, Kane JM, Malhotra AK, Robinson DG. Responses to Tobacco Smoking-Related Health Messages in Young People With Recent-Onset Schizophrenia. Schizophr Bull 2015; 41:1256-65. [PMID: 26316595 PMCID: PMC4601721 DOI: 10.1093/schbul/sbv122] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Virtually no research has examined the responses of youth with recent-onset psychosis (ROP) to smoking-related health warnings. We examined predictors of response and tested hypotheses that participants with ROP would (a) assess warnings as less effective than a healthy comparison (HC) group, and (b) assess video warnings as more effective than pictures. ROP participants (n = 69) had <2 years of prior antipsychotic treatment; the HC group (n = 79) had no major mental illness. Participants viewed 10 pictorial warnings, 8 videos depicting similar messages, and were interviewed regarding tobacco use, health literacy, and smoking knowledge. We assessed response at baseline and at 4-week follow-up. ROP participants were more likely than HC to smoke tobacco (49.3% vs 10.1%) and had lower levels of health literacy and smoking-related knowledge. Cannabis was used by 46.4% of ROP participants. Effectiveness ratings were high for both picture and video warnings with no differences between media. ROP participants compared to HC and nonsmokers compared to smokers were more likely to perceive warnings as effective. Effectiveness was associated with negative affect and greater emotional arousal. We assessed 33 smokers at follow-up; 5 (15%) identified as nonsmokers, 15 (45%) made a quit attempt, and 16 (49%) reported that the warnings influenced their smoking. Results indicate that young people with psychotic disorders respond favorably to health warnings. Effective messages depict health consequences clearly, elicit negative emotions, and may impact smoking behavior. Future research is needed to understand the effects of mode of presentation and message comprehension on smoking behavior.
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Affiliation(s)
- Daniel J. Coletti
- *To whom correspondence should be addressed; North Shore-LIJ Division of General Internal Medicine, 865 Northern Blvd, Suite 102, Great Neck, NY 11021, US; tel: 718-470-4606, fax: 516-622-5005, e-mail:
| | - Mary Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Majnu John
- The Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY;,Division of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY
| | - John M. Kane
- The Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY;,Division of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY;,Departments of Psychiatry and Molecular Medicine, Hofstra-LIJ School of Medicine, Hempstead, NY
| | - Anil K. Malhotra
- The Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY;,Division of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY;,Departments of Psychiatry and Molecular Medicine, Hofstra-LIJ School of Medicine, Hempstead, NY
| | - Delbert G. Robinson
- The Center for Psychiatric Neuroscience, Feinstein Institute for Medical Research, Manhasset, NY;,Division of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY;,Departments of Psychiatry and Molecular Medicine, Hofstra-LIJ School of Medicine, Hempstead, NY
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