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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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Thaker P, Gartner C, Kisely S, Plever S. Systematic review of tobacco smoking prevalence among young people in treatment for first-episode psychosis. Int J Ment Health Nurs 2024. [PMID: 38606655 DOI: 10.1111/inm.13332] [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: 07/24/2023] [Revised: 02/28/2024] [Accepted: 03/27/2024] [Indexed: 04/13/2024]
Abstract
To determine whether smoking prevalence in first-episode psychosis (FEP) is different than in people with established psychosis in long-term treatment. A systematic review of cross-sectional, case-control and cohort studies identified from searches of PubMed, Embase, CINAHL and PsycINFO up to 12 August 2023. 20 studies out of 2773 screened titles were included. There was no clear pattern of smoking by diagnosis as smoking rates in people with FEP ranged from 43% to 78%, while in those with established psychosis, it ranged from 19% to 76%. The wide range of smoking levels in both populations precluded conclusions as to whether smoking rates are different between people with FEP and established psychosis suggesting that factors other than the time course of the illness influence smoking levels.
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Affiliation(s)
- Parth Thaker
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Coral Gartner
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, Queensland, Australia
| | - Steve Kisely
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| | - Sally Plever
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame (Tobacco Endgame CRE), The University of Queensland, Brisbane, Queensland, Australia
- Metro North Mental Health, Brisbane, Queensland, Australia
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3
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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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Streck JM, Potter K, Pachas G, Cather C, Nielsen L, Eden Evins A. Alternative combusted tobacco product and multiple tobacco product use among individuals with serious mental illness enrolled in a large pragmatic randomized controlled trial. Addict Behav 2024; 148:107844. [PMID: 37678006 DOI: 10.1016/j.addbeh.2023.107844] [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: 05/23/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Use of combustible alternative tobacco products (ATPs; e.g., little cigars, loose tobacco, multiple tobacco product types [TPTs]) is increasingly common. Inexpensive, combusted ATPs (e.g little cigars) are predominantly marketed to lower-income communities. Prevalence of combusted ATP use among those with serious mental illness (SMI) is unknown. METHODS We examined rates and correlates of combusted ATP use and association with tobacco abstinence in a secondary analysis of a single-cohort (N = 1007) trial of tobacco-smoking adults with SMI and severe SMI-related functional impairment. The parent study aimed to test a community-health worker-delivered intervention for promoting smoking cessation among adults with SMI. Participants were surveyed at baseline on demographic and smoking characteristics including combusted TPT (cigarettes, cigars/little cigars, loose tobacco), and breath carbon-monoxide (CO). CO-verified 7-day point-prevalence tobacco abstinence was assessed at Year 2. RESULTS At baseline, 59% of participants reported using cigarettes only, 25% multiple (>1) combusted TPTs, 12% cigars/little cigars only, and 4% loose tobacco (e.g., "rollies", pipes) only. Those reporting any ATP use at baseline had higher expired CO concentration and reported using more tobacco products per day than exclusive cigarette users (p's < 0.05). ATP use was not associated with abstinence in adjusted logistic regression models (p's > 0.05). CONCLUSIONS Use of ATPs was associated with use of more tobacco products per day and greater tobacco toxicant exposure than exclusive cigarette use in this population. Future policy efforts work to change preferential taxation policies (e.g., lower taxation for cigar products) and disproportionate marketing of ATPs to lower-income communities.
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Affiliation(s)
- Joanna M Streck
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA; Tobacco Research & Treatment Center, Division of General Internal Medicine, Department of Medicine, MGH, Boston, MA, USA.
| | - Kevin Potter
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Gladys Pachas
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Corinne Cather
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
| | - Lindsay Nielsen
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA
| | - A Eden Evins
- Center for Addiction Medicine, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
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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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Tildy BE, McNeill A, East K, Gravely S, Fong GT, Cummings KM, Borland R, Chan GCK, Lim CCW, Gartner C, Yong HH, Brose LS. Self-reported depression and anxiety and healthcare professional interactions regarding smoking cessation and nicotine vaping: Findings from 2018 International Tobacco Control Four Country Smoking and Vaping (ITC 4CV) Survey. Tob Prev Cessat 2023; 9:26. [PMID: 37533461 PMCID: PMC10391919 DOI: 10.18332/tpc/168288] [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: 04/18/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 08/04/2023]
Abstract
INTRODUCTION People with mental health conditions are disproportionately affected by smoking-related diseases and death. The aim of this study was to assess whether health professional (HP) interactions regarding smoking cessation and nicotine vaping products (NVPs) differ by mental health condition. METHODS The cross-sectional 2018 International Tobacco Control Four Country (Australia, Canada, England, United States) Smoking and Vaping Survey data included 11040 adults currently smoking or recently quit. Adjusted weighted logistic regressions examined associations between mental health (self-reported current depression and/or anxiety) and visiting a HP in last 18 months; receiving advice to quit smoking; discussing NVPs with a HP; and receiving a recommendation to use NVPs. RESULTS Overall, 16.1% self-reported depression and anxiety, 7.6% depression only, and 6.6% anxiety only. Compared with respondents with no depression/anxiety, those with depression (84.7%, AOR=2.65; 95% CI: 2.17-3.27), anxiety (82.2%, AOR=2.08; 95% CI: 1.70-2.57), and depression and anxiety (87.6%, AOR=3.74; 95% CI: 3.19-4.40) were more likely to have visited a HP. Among those who had visited a HP, 47.9% received advice to quit smoking, which was more likely among respondents with depression (AOR=1.58; 95% CI: 1.34-1.86), and NVP discussions were more likely among those with depression and anxiety (AOR=1.63; 95% CI: 1.29-2.06). Of the 6.1% who discussed NVPs, 33.5% received a recommendation to use them, with no difference by mental health. CONCLUSIONS People with anxiety and/or depression who smoke were more likely to visit a HP than those without, but only those with depression were more likely to receive cessation advice, and only those with depression and anxiety were more likely to discuss NVPs. There are missed opportunities for HPs to deliver cessation advice. NVP discussions and receiving a positive recommendation to use them were rare overall.
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Affiliation(s)
- Bernadett E. Tildy
- Addictions Department, King’s College London, Addiction Sciences Building, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
| | - Ann McNeill
- Addictions Department, King’s College London, Addiction Sciences Building, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
| | - Katherine East
- Addictions Department, King’s College London, Addiction Sciences Building, London, United Kingdom
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, United States
| | - Ron Borland
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Gary C. K. Chan
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Queensland, Australia
| | - Carmen C. W. Lim
- National Centre for Youth Substance Use Research, Faculty of Health and Behavioral Sciences, University of Queensland, Queensland, Australia
- School of Psychology, Faculty of Health and Behavioral Sciences, University of Queensland, Queensland, Australia
| | - Coral Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, Faculty of Medicine, School of Public Health, University of Queensland, Herston, Australia
| | - Hua-Hie Yong
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Leonie S. Brose
- Addictions Department, King’s College London, Addiction Sciences Building, London, United Kingdom
- SPECTRUM Consortium, London, United Kingdom
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Recognising the importance of chronic lung disease: a consensus statement from the Global Alliance for Chronic Diseases (Lung Diseases group). Respir Res 2023; 24:15. [PMID: 36639661 PMCID: PMC9838069 DOI: 10.1186/s12931-022-02297-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/15/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Chronic respiratory diseases are disorders of the airways and other structures of the lung, and include chronic obstructive pulmonary disease (COPD), lung cancer, asthma, bronchiectasis, interstitial lung diseases, occupational lung diseases and pulmonary hypertension. Through this article we take a broad view of chronic lung disease while highlighting (1) the complex interactions of lung diseases with environmental factors (e.g. climate change, smoking and vaping) and multimorbidity and (2) proposed areas to strengthen for better global patient outcomes. CONCLUSION We suggest new directions for the research agenda in high-priority populations and those experiencing health disparities. We call for lung disease to be made a research priority with greater funding allocation globally.
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Schöttl SE, Niedermeier M, Kopp-Wilfling P, Frühauf A, Bichler CS, Edlinger M, Holzner B, Kopp M. Add-on exercise interventions for smoking cessation in people with mental illness: a systematic review and meta-analysis. BMC Sports Sci Med Rehabil 2022; 14:115. [PMID: 35729669 PMCID: PMC9210718 DOI: 10.1186/s13102-022-00498-y] [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] [Received: 12/14/2021] [Accepted: 06/07/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Smoking is the most common substance use disorder among people with mental illness. In contrast to people without mental illness, among whom the proportion of smokers has declined in recent decades, the proportion of smokers among people with mental illness remains high. There is a growing body of literature suggesting the use of exercise interventions in combination with smoking cessation in people without mental illness, but to our knowledge the available studies on this treatment option in people with mental illness have not been systematically reviewed. Therefore, this systematic review and meta-analysis aims to assess the effectiveness of exercise interventions as an adjunctive treatment for smoking cessation in people with mental illness. METHODS Electronic databases (PubMed, Web of Science, PsycInfo, Sport Discus and Base) were searched for randomised controlled trials and prospective single-group studies that investigated exercise interventions in combination with smoking cessation programmes alone or in comparison with a control group in people with mental illness. A meta-analysis using the Mantel-Haenszel fixed-effect model was conducted to estimate the overall effect of treatment on smoking cessation (abstinence rate at the end of the intervention and at 6-month follow-up). RESULTS Six studies, five randomised controlled trials and one study with a prospective single-group design, were included in the systematic review and four randomised controlled trials were included in the meta-analysis. The meta-analysis found a significantly higher abstinence rate after additional exercise at the end of the intervention [risk ratio (RR) 1.48, 95% confidence interval (CI) 1.13-1.94], but not at the 6-month follow-up (RR 1.34, 95% CI 0.89-2.04). CONCLUSIONS Exercise appears to be an effective adjunctive therapy to temporarily increase abstinence rates in individuals with mental illness at the end of the intervention. However, due to the small number of included studies and some risk of bias in the included studies, the results should be treated with caution. Therefore, future studies with larger samples are needed to provide a more accurate estimate of the effect in people with mental illness. Registration The systematic review and meta-analysis were registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42020178630).
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Affiliation(s)
- Stefanie E Schöttl
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria.
| | - Martin Niedermeier
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - Prisca Kopp-Wilfling
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Anika Frühauf
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - Carina S Bichler
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
| | - Monika Edlinger
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Bernhard Holzner
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatry I, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Martin Kopp
- Department of Sport Science, University of Innsbruck, Fürstenweg 185, 6020, Innsbruck, Austria
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9
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Plever S, Gartner CE. Smoking cessation assistance should be free, accessible, and part of routine care. Med J Aust 2022; 216:345-346. [DOI: 10.5694/mja2.51468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Sally Plever
- Metro North Hospital and Health Service Brisbane QLD
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame University of Queensland Brisbane QLD
| | - Coral E Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame University of Queensland Brisbane QLD
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10
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Internalizing problems are associated with initiation and past 30-Day use of flavored tobacco products. Addict Behav 2022; 125:107162. [PMID: 34763300 PMCID: PMC8637941 DOI: 10.1016/j.addbeh.2021.107162] [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: 03/18/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Tobacco use remains disproportionately common among adults with internalizing problems. The rising prevalence of flavored tobacco use among this population may be a contributing factor. Using data from Wave 4 of the Population Assessment of Tobacco and Health Study, this study examined differences across adult ever tobacco users by severity of internalizing problems, in initiation of tobacco use with a flavored product and past 30-day (current) flavored tobacco use (n = 27,425). Severity of internalizing problems was measured using the Global Appraisal of Individual Needs-Short Screener Internalizing Disorder Screener. Tobacco use variables included initiation with or current use of a flavored product, assessed separately for each product. Weighted chi-square tests and multivariable modified Poisson regression models were used to examine the associations between severity of internalizing problems and each outcome. RESULTS Controlling for covariates, ever users with severe internalizing problems were more likely to have initiated with flavors for cigarettes (adjusted prevalence ratio [aPR]: 1.16, 95% confidence interval [CI]: 1.09,1.24), cigarillos (aPR: 1.09, 95% CI: 1.03, 1.16), electronic nicotine products (aPR: 1.08, 95% CI: 1.03, 1.13) and smokeless tobacco (aPR: 1.15, 95% CI: 1.04, 1.27), relative to those with low internalizing problems. Ever users with severe internalizing problems were more likely to currently use a flavored tobacco product for cigarettes (aPR: 1.15, 95% CI: 1.07, 1.24) and cigarillos (aPR: 1.15, 95% CI: 1.04, 1.28). CONCLUSIONS Flavored tobacco use seems disproportionately common among tobacco users with severe internalizing problems, across a variety of measures.
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Tripodi E, Jarman R, Morell R, Teasdale SB. Prevalence of food insecurity in community-dwelling people living with severe mental illness. Nutr Diet 2021; 79:374-379. [PMID: 34608729 DOI: 10.1111/1747-0080.12706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 11/29/2022]
Abstract
AIM The present study aimed to measure the prevalence and severity of food insecurity in people with a severe mental illness, defined as schizophrenia and related psychoses, and bipolar disorder; and explore relationships between food insecurity status, and sociodemographic and clinical characteristics. METHODS This cross-sectional study recruited community-dwelling people with severe mental illness receiving clozapine and/or a long-acting injectable antipsychotic medication within three mental health services in Sydney, Australia. Participants completed the 18-item Household Food Insecurity Access Scale. Sociodemographic and medical information was obtained from participants' medical records. Independent samples t-test and chi-square analyses were used to test for between group differences based on food insecurity status. Binary logistic regression analyses adjusting for age and gender were used to determine the odds ratio. RESULTS One-hundred and eighty-eight people completed the assessment: 63% were male, mean age was 49.2 ± 12.4 years, and the majority (85%) had a diagnosis of schizophrenia. Food insecurity was detected in 31% of participants. Of those who were food insecure, 12% were classified as severe, 13% as moderate and 7% as mild. Tobacco smoking was higher in food insecure people compared to food secure people (odds ratio = 3.1, 95% CI 1.3 to 7.1, p = 0.01). Food insecurity status was not associated with demographic, diagnostic or other clinical data. CONCLUSIONS Food insecurity is highly prevalent among community-dwelling people with severe mental illness receiving clozapine and/or long-acting injectable antipsychotic medication. Food security screening should be considered as routine care for this population group.
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Affiliation(s)
- Elise Tripodi
- South Eastern Sydney Local Health District, Bondi Junction, New South Wales, Australia
| | - Rebecca Jarman
- South Eastern Sydney Local Health District, Bondi Junction, New South Wales, Australia
| | - Rachel Morell
- School of Psychiatry, University of New South Wales & Mindgardens Neuroscience Network, Kensington, New South Wales, Australia
| | - Scott B Teasdale
- School of Psychiatry, University of New South Wales & Mindgardens Neuroscience Network, Kensington, New South Wales, Australia
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Grassi L, Stivanello E, Belvederi Murri M, Perlangeli V, Pandolfi P, Carnevali F, Caruso R, Saponaro A, Ferri M, Sanza M, Fioritti A, Meggiolaro E, Ruffilli F, Nanni MG, Ferrara M, Carozza P, Zerbinati L, Toffanin T, Menchetti M, Berardi D. Mortality from cancer in people with severe mental disorders in Emilia Romagna Region, Italy. Psychooncology 2021; 30:2039-2051. [PMID: 34499790 PMCID: PMC9290959 DOI: 10.1002/pon.5805] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/11/2022]
Abstract
Objective To examine cancer‐related mortality in patients with severe mental disorders (SMI) in the Emilia Romagna (ER) Region, Northern Italy, during the period 2008–2017 and compare it with the regional population. Methods We used the ER Regional Mental Health Registry identifying all patients aged ≥18 years who had received an ICD‐9CM system diagnosis of SMI (i.e., schizophrenia or other functional psychosis, mania, or bipolar affective disorders) during a 10‐year period (2008–2017). Information on deaths (date and causes of death) were retrieved through the Regional Cause of Death Registry. Comparisons were made with the deaths and cause of deaths of the regional population over the same period. Results Amongst 12,385 patients suffering from SMI (64.1% schizophrenia spectrum and 36.9% bipolar spectrum disorders), 24% (range 21%–29%) died of cancer. In comparison with the general regional population, the mortality for cancer was about 50% higher among patients with SMI, irrespective if affected by schizophrenia or bipolar disorders. As for the site‐specific cancers, significant excesses were reported for stomach, central nervous system, respiratory, and pancreas cancer with a variability according to psychiatric diagnosis and gender. Conclusions Patients suffering from SMI had higher mortality risk than the regional population with some differences according to cancer type, gender, and psychiatric diagnosis. Proper cancer preventive and treatment interventions, including more effective risk modification strategies (e.g., smoking cessation, dietary habits) and screening for cancer, should be part of the agenda of all mental health departments in conjunction with other health care organizations, including psycho‐oncology.
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Affiliation(s)
- Luigi Grassi
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Elisa Stivanello
- Department of Public Health, Local Health Trust of Bologna, Bologna, Italy
| | - Martino Belvederi Murri
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | | | - Paolo Pandolfi
- Department of Public Health, Local Health Trust of Bologna, Bologna, Italy
| | - Fabio Carnevali
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Rosangela Caruso
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Bologna, Italy
| | - Mila Ferri
- General Directorate of Health and Social Policies, Bologna, Italy
| | - Michele Sanza
- Department of Mental Health and Substance Abuse, Local Health Trust of Romagna, Cesena, Italy
| | - Angelo Fioritti
- Department of Mental Health and Substance Abuse, Local Health Trust of Bologna, Bologna, Italy
| | - Elena Meggiolaro
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Federica Ruffilli
- Psycho-Oncology Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Maria Giulia Nanni
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Maria Ferrara
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy.,Department of Psychiatry, Yale University, School of Medicine, New Haven, Connecticut, USA.,Program for Specialized Treatment Early in Psychosis (STEP), Connecticut Mental Health Center, New Haven, Connecticut, USA
| | - Paola Carozza
- Integrated Department of Mental Health and Pathological Addictions, Local Health Trust of Ferrara, Ferrara, Italy
| | - Luigi Zerbinati
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Tommaso Toffanin
- Department of Neuroscience and Rehabilitation, Institute of Psychiatry, University of Ferrara, Ferrara, Italy
| | - Marco Menchetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Domenico Berardi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
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13
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Sharma-Kumar R, Puljević C, Morphett K, Meurk C, Gartner C. The Acceptability and Effectiveness of Videos Promoting Smoking Cessation Among Australians Experiencing Mental Illness. HEALTH EDUCATION & BEHAVIOR 2021; 49:506-515. [PMID: 34496656 DOI: 10.1177/10901981211034738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are high rates of tobacco smoking among people who experience mental illness (MI). While videos are an effective method of disseminating health-related information, there is limited research investigating the effectiveness of video-delivered education promoting smoking cessation among people living with MI. This formative study aimed to investigate the effectiveness and acceptability of targeted video resources providing smoking cessation information and advice to smokers with MI. This study used a mixed-method design; 29 Australian smokers living with MI completed a preinterview survey including 12 questions assessing knowledge about smoking cessation, watched six videos developed by the research team providing information about smoking cessation, took part in semistructured interviews about the videos' quality, content, and format, and then completed a postinterview survey identical to the preinterview survey to assess changes in smoking cessation-related knowledge. A Wilcoxon signed rank test was used to calculate changes in cessation-related knowledge, and thematic analysis was used to identify common themes in qualitative data. We found a statistically significant increase in participants' smoking cessation-related knowledge scores after watching the videos. Participants indicated an overall high level of acceptability of the videos' quality, content, and format, and findings from the semistructured interviews reflected these favorable views. This study's findings provide a new understanding of the effectiveness and acceptability of customized video-based education to promote smoking cessation among people living with MI, and can be used to inform the content and focus of video resources aimed at increasing knowledge about smoking cessation for people experiencing MI.
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Affiliation(s)
- Ratika Sharma-Kumar
- School of Medicine and Public Health, The University of Newcastle, Newcastle, Australia
| | - Cheneal Puljević
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Australia.,Centre for Health Services Research, The University of Queensland, Brisbane, Australia
| | - Kylie Morphett
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Australia
| | - Carla Meurk
- Queensland Centre for Mental Health Research, Brisbane, Australia
| | - Coral Gartner
- NHMRC Centre for Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Australia
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14
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Browne J, Halverson TF, Vilardaga R. Engagement with a digital therapeutic for smoking cessation designed for persons with psychiatric illness fully mediates smoking outcomes in a pilot randomized controlled trial. Transl Behav Med 2021; 11:1717-1725. [PMID: 34347865 DOI: 10.1093/tbm/ibab100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Understanding the mechanisms of change of digital therapeutics is a critical step to improve digital health outcomes and optimize their development. Access to and engagement with digital content is arguably a core mechanism of change of these interventions. However, the mediational role of app engagement has been largely unexamined. To evaluate the mediational effect of engaging with a digital therapeutic for smoking cessation designed for adults with psychiatric disorders. Secondary analysis of a pilot clinical trial of 62 adults with serious mental illness who were randomized to receive either a tailored digital therapeutic (Learn to Quit) or a digital therapeutic for the general public (NCI QuitGuide). Engagement was captured using background analytics of app utilization, including (a) number of interactions with app content, (b) minutes/day of app use, and (c) number of days used. The main outcome was reductions in cigarettes per day from baseline to the four-month endpoint. Mediational analysis followed the Preacher and Hayes bootstrap method. Number of application interactions fully mediated reductions in cigarettes per day in the Learn to Quit application but not in QuitGuide (Average Causal Mediation Effect = .31, p = .02). Minutes/day of app use played an uncertain role, and number of days used was not a significant mediator. Results suggest that one of the mechanisms of action of the Learn to Quit device, engagement with theory-based content, functioned as intended. Future research of digital therapeutics should emphasize granular approaches to evaluating apps' mechanisms of action.
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Affiliation(s)
- Julia Browne
- Geriatric Research, Education and Clinical Center, Durham VA Health Care System, Durham, NC 27705, USA.,Durham VA Health Care System, Durham, NC 27705, USA
| | - Tate F Halverson
- Durham VA Health Care System, Durham, NC 27705, USA.,Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC 27705, USA
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15
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Hawes MR, Roth KB, Cabassa LJ. Systematic Review of Psychosocial Smoking Cessation Interventions for People with Serious Mental Illness. J Dual Diagn 2021; 17:216-235. [PMID: 34281493 PMCID: PMC8647929 DOI: 10.1080/15504263.2021.1944712] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Tobacco smoking is a major driver of premature mortality in people with serious mental illness (SMI; e.g., schizophrenia, bipolar disorder). This systematic literature review described randomized control trials of psychosocial smoking cessation interventions for people with SMI, rated their methodological rigor, evaluated the inclusion of racial/ethnic and sexual/gender minorities, and examined smoking cessation outcomes. Methods: Eligible studies included peer-reviewed articles published between 2009 and 2020 that examined psychosocial smoking cessation interventions in people with SMI. We used the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines to conduct our review and the Methodological Quality Rating Scale to evaluate methodological rigor. Results: Eighteen studies were included. Ten were categorized as high methodological rigor given their study characteristics (e.g., longer follow-up) and eight as lower methodological rigor based on their characteristics (e.g., not intent-to-treat). Racial/ethnic and sexual/gender minorities were under-represented in these studies. A range of psychosocial interventions were examined including motivational enhancements, smoking cessation education, cognitive behavioral strategies, and contingency management. Most studies also provided smoking cessation medications (e.g., NRT, bupropion), although provision was not always uniform across treatment conditions. Three studies found the intervention condition achieved significantly higher abstinence from smoking compared to the comparison group. Seven studies found the intervention condition achieved significantly higher reductions in smoking compared to the comparison group. Conclusions: Studies finding significant differences between the intervention and comparison groups shared common evidenced-based components, including providing smoking cessation medications (e.g., NRT, bupropion), motivational enhancement techniques, and cessation education and skills training, but differed in intensity (e.g., number and frequency of sessions), duration, and modality (e.g., group, individual, technology). Methodological limitations and a small number of studies finding significant between-group differences prevent the identification of the most effective psychosocial smoking cessation interventions. Clinical trial designs (e.g., SMART, factorial) that control for the provision of psychosocial medications and allow for the identification of optimal psychosocial treatments are needed. Future studies should also ensure greater inclusion of racial/ethnic and sexual/gender minorities and should be culturally/linguistically adapted to improve treatment engagement and study outcomes.
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Affiliation(s)
- Mark R Hawes
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kimberly B Roth
- Department of Community Medicine, Mercer University School of Medicine, Savannah, Georgia, USA
| | - Leopoldo J Cabassa
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
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16
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Long-term antibiotic use during early life and risks to mental traits: an observational study and gene-environment-wide interaction study in UK Biobank cohort. Neuropsychopharmacology 2021; 46:1086-1092. [PMID: 32801349 PMCID: PMC8115166 DOI: 10.1038/s41386-020-00798-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 07/26/2020] [Accepted: 08/04/2020] [Indexed: 02/08/2023]
Abstract
The relationships between long-term antibiotic use during early life and mental traits remain elusive now. A total of 158,444 subjects from UK Biobank were used in this study. Linear regression analyses were first conducted to assess the correlations between long-term antibiotic use during early life and mental traits. Gene-environment-wide interaction study (GEWIS) was then performed by PLINK2.0 to detect the interaction effects between long-term antibiotic use during early life and genes on the risks of mental traits. Finally, DAVID tool was used to conduct gene ontology (GO) analysis of the identified genes interacting with long-term antibiotic use during early life. We found negative associations of long-term antibiotic use during early life with remembrance (p value=1.74 × 10-6, b = -0.10) and intelligence (p value=2.64 × 10-26, b = -0.13), and positive associations of long-term antibiotic use during early life with anxiety (p value = 2.75 × 10-47, b = 0.12) and depression (p value=2.01 × 10-195, b = 0.25). GEWIS identified multiple significant genes-long-term antibiotic use during early life interaction effects, such as ANK3 (rs773585997, p value = 1.78 × 10-8) for anxiety and STRN (rs140049205, p value = 1.88 × 10-8) for depression. GO enrichment analysis detected six GO terms enriched in the identified genes interacting with long-term antibiotic use during early life for anxiety, such as GO:0030425~dendrite (p value = 3.41 × 10-2) and GO:0005886~plasma membrane (p value = 3.64 × 10-3). Our study results suggest the impact of long-term antibiotic use during early life on the development of mental traits.
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17
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Mortality in mental health patients of the Emilia-Romagna region of Italy: A registry-based study. Psychiatry Res 2021; 296:113702. [PMID: 33418461 DOI: 10.1016/j.psychres.2020.113702] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/29/2020] [Indexed: 12/21/2022]
Abstract
Evidence from previous research demonstrated a gap in mortality between patients with mental disorders and the general population. However, a more exhaustive assessment is required to address this public health issue. The aim of this study was to provide comprehensive analysis of mortality examining all causes of death and all psychiatric diagnoses. We conducted a 10-year retrospective cohort study, including all in and out patients registered in the Mental Health Registry of Emilia-Romagna, Italy. Standardized mortality ratios (SMRs) were calculated. The cohort consisted of 137,351 patients 11,236 of whom died during the study period and the overall SMR was 1.99. 85.9 % of excess mortality was attributable to a broad range of natural causes. Diseases of circulatory and respiratory systems as well as neoplasms were the principal contributors to the mortality gap. All psychiatric conditions led to a higher risk of death. The greatest excess was due to neoplasms in depressed and neurotic patients and to cardiovascular diseases in patients with schizophrenia and personality disorders. Our results highlight the need for close collaboration between mental and primary health care services with the aim of reducing excess mortality as a result of medical diseases among all patients suffering from psychiatric condition.
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18
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Johnson SE, Mitrou F, Lawrence D, Zubrick SR, Wolstencroft K, Ennals P, Hall C, McNaught E. Feasibility of a Consumer Centred Tobacco Management intervention in Community Mental Health Services in Australia. Community Ment Health J 2020; 56:1354-1365. [PMID: 32036516 DOI: 10.1007/s10597-020-00573-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 02/01/2020] [Indexed: 11/29/2022]
Abstract
This study tested a new program for helping smokers with severe mental illness to reduce their tobacco use, together with determining the feasibility of such research in community mental health settings in Australia. Five Neami National sites trialled a Consumer Centred Tobacco Management program called Kick the Habit (n = 34). The intervention included two weeks of free Nicotine Replacement Therapy (patches only) but participants also used a variety of self-funded delivery types in addition or as an alternative to the subsidised nicotine patch. At the 3-month follow-up, Kick the Habit participants had reduced their number of daily cigarettes, dependency levels and average weekly expenditure on tobacco. Although a larger study is required, Kick the Habit represents a promising intervention for tobacco management in community mental health services. The challenges and lessons learnt for scaling up to a larger trial and integration into business-as-usual practice across multiple sites are discussed.
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Affiliation(s)
- Sarah E Johnson
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.
- Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA, 6009, Australia.
| | - Francis Mitrou
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Centre for Child Health Research, The University of Western Australia, Perth, Australia
| | - David Lawrence
- Graduate School of Education, The University of Western Australia, Perth, Australia
| | - Stephen R Zubrick
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Centre for Child Health Research, The University of Western Australia, Perth, Australia
| | | | | | - Cristal Hall
- Neami National (Head Office), Melbourne, Australia
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19
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Dregan A, McNeill A, Gaughran F, Jones PB, Bazley A, Cross S, Lillywhite K, Armstrong D, Smith S, Osborn DPJ, Stewart R, Wykes T, Hotopf M. Potential gains in life expectancy from reducing amenable mortality among people diagnosed with serious mental illness in the United Kingdom. PLoS One 2020; 15:e0230674. [PMID: 32218598 PMCID: PMC7100972 DOI: 10.1371/journal.pone.0230674] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/05/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To estimate the potential gain in life expectancy from addressing modifiable risk factors for all-cause mortality (excluding suicide and deaths from accidents or violence) across specific serious mental illness (SMI) subgroups, namely schizophrenia, schizoaffective disorders, and bipolar disorders in a Western population. METHODS We have used relative risks from recent meta-analyses to estimate the population attribution fraction (PAF) due to specific modifiable risk factors known to be associated with all-cause mortality within SMI. The potential gain in life expectancy at birth, age 50 and age 65 years were assessed by estimating the combined effect of modifiable risk factors from different contextual levels (behavioural, healthcare, social) and accounting for the effectiveness of existing interventions tackling these factors. Projections for annual gain in life expectancy at birth during a two-decade was estimated using the Annual Percentage Change (APC) formula. The predicted estimates were based on mortality rates for year 2014-2015. RESULTS Based on the effectiveness of existing interventions targeting these modifiable risk factors, we estimated potential gain in life expectancy at birth of four (bipolar disorders), six (schizoaffective disorders), or seven years (schizophrenia). The gain in life expectancy at age 50 years was three (bipolar disorders) or five (schizophrenia and schizoaffective disorders) years. The projected gain in life expectancy at age 65 years was three (bipolar disorders) or four (schizophrenia and schizoaffective disorders) years. CONCLUSIONS The implementation of existing interventions targeting modifiable risk factors could narrow the current mortality gap between the general and the SMI populations by 24% (men) to 28% (women). These projections represent ideal circumstances and without the limitation of overestimation which often comes with PAFs.
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Affiliation(s)
- Alex Dregan
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Ann McNeill
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Fiona Gaughran
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Anna Bazley
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - Sean Cross
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - Kate Lillywhite
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - David Armstrong
- School of Population Health and Environmental Sciences, King’s College London, London, United Kingdom
| | - Shubulade Smith
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - David P. J. Osborn
- Division of Psychiatry, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust and London, London, United Kingdom
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20
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Murray EG, Isbister GK, McCrabb S, Halpin SA, Bonevski B. An examination of factors associated with tobacco smoking amongst patients presenting with deliberate self-poisoning. J Affect Disord 2020; 260:544-549. [PMID: 31539691 DOI: 10.1016/j.jad.2019.09.057] [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: 06/06/2019] [Revised: 09/05/2019] [Accepted: 09/11/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Understand factors related to related to tobacco smoking amongst individuals who present with deliberate self-harm is important. This article explores the relationship between tobacco use with mental health diagnoses and substance use in a cohort of overdose admissions. METHODS Secondary analysis of an existing health service database with 7133 patients admitted for deliberate self-poisonings from 1997 to 2013 was conducted. A data collection form was used on admission to capture information on patient demographics, drugs ingested, use of drugs of misuse, regular medications and management and complications of poisoning. The data was analysed using a multiple logistic regression model. RESULTS Within a deliberate self-poisoning population, those diagnosed with: an amphetamine substance use disorder (OR = 1.84, p < .001), alcohol use disorder (OR = 1.68, p < .001), other substance use disorder (OR = 1.77, p < .001), psychotic diagnoses (OR = 1.17, p = .032), or had a history of self-harm (OR = 1.15, p = .011) were more likely to be a current tobacco smoker. Those who were older (OR = 0.99, p < .001) or diagnosed with a mood disorder (OR = 0.87, p = .018) were less likely to smoke tobacco. LIMITATIONS The study was unable to differentiate between suicide attempts and self-harm self-poisonings. CONCLUSIONS Among a deliberate self-poisoning population those who were younger, diagnosed with a variety of substance use disorders, or had a history of previous self-poisoning were more likely to use tobacco. Those with a mood disorder were less likely to smoke tobacco.
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Affiliation(s)
- Edward G Murray
- School of Psychology, Faculty of Science, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Geoffrey K Isbister
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, 1 University Drive, Callaghan, NSW 2308, Australia; Department of Clinical Toxicology and Pharmacology, Calvary Mater Newcastle, Waratah NSW 2294, Australia
| | - Sam McCrabb
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, 1 University Drive, Callaghan, NSW 2308, Australia
| | - Sean A Halpin
- School of Psychology, Faculty of Science, University of Newcastle, Callaghan, NSW 2308, Australia
| | - Billie Bonevski
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, 1 University Drive, Callaghan, NSW 2308, Australia.
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21
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Ganz O, Rimal RN, Cohn AM, Johnson AL, Delnevo CD, Horn K. Receptivity to Tobacco Advertising among Young Adults with Internalizing Problems: Findings from the Population Assessment of Tobacco and Health Study. Subst Use Misuse 2020; 55:546-556. [PMID: 31718377 DOI: 10.1080/10826084.2019.1688349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Many risk factors for tobacco use among the general young adult population, such as tobacco advertising receptivity, have gone unexamined among those with internalizing problems, despite disproportionately high rates of tobacco use. Objective: The objective of this study was to examine the interrelationship of internalizing problems, tobacco advertising receptivity, and tobacco use among young adults using data from Wave 1 of the Population Assessment for Tobacco and Health Study. Methods: The sample included 9,110 young adults (ages 18-24). Multivariable logistic regression models examined the association between internalizing problems and advertising receptivity and tobacco use. Separate models were run for cigarettes, cigars, e-cigarettes, smokeless tobacco and any tobacco use. An interaction term (receptivity × internalizing problems) was added to each model. Results: Except for smokeless tobacco, individuals with high internalizing problems reported greater odds of product use compared to those with low internalizing problems. There was no association between internalizing problems and use of smokeless tobacco. For all products, receptivity was positively associated with tobacco use. A borderline significant interaction was detected between cigarette advertising receptivity and internalizing problems, such that the magnitude of the relationship between receptivity to cigarette advertising and cigarette use was stronger for those with high internalizing problems compared those with low internalizing problems. Conclusions/Importance: The relationship between cigarette advertising receptivity and cigarette use may differ for those with and without internalizing problems. Disproportionate receptivity to risk-promoting messages among young adults with internalizing problems could exacerbate disparities in cigarette use.
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Affiliation(s)
- Ollie Ganz
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Rajiv N Rimal
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Amy M Cohn
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.,Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Amanda Lee Johnson
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Kimberly Horn
- Department of Population Health Sciences, Virginia Tech Carilion Research Institute, Virginia Tech, Roanoke, Virginia, USA
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22
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Higuchi Y, Fujiwara M, Nakaya N, Fujimori M, Hayashibara C, So R, Shinkawa I, Sato K, Yada Y, Kodama M, Takenaka H, Kishi Y, Kakeda K, Uchitomi Y, Yamada N, Inagaki M. Change in smoking cessation stage over 1 year in patients with schizophrenia: a follow up study in Japan. BMC Psychiatry 2019; 19:367. [PMID: 31752799 PMCID: PMC6873402 DOI: 10.1186/s12888-019-2351-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 10/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We performed a follow up study about willingness and behaviors to quit smoking among smokers with schizophrenia in Japan. METHODS Participants were outpatients with schizophrenia aged 20-69 years who had been visiting the hospital for ≥1 year as of April 1, 2016, and had visited the hospital more than once in the previous 6 months. A baseline survey on smoking behaviors including current smoking status and smoking cessation stage, was administered in 420 participants that were randomly extracted from a patient pool (n = 680) in 2016, and a follow-up survey was administered in 2017. We calculated the distribution and change in smoking cessation stage, number of smokers and nonsmokers after 1 year, and quitting rate from a naturalistic 1-year smoking-cessation follow up. RESULTS The number of baseline respondents was 350; 113 current smokers and 68 former smokers. Among the 113 current smokers, 104 (92.0%) were followed for 1 year, 79 (70.0%) were interested in smoking cessation, and only 7 had received smoking cessation treatments at baseline. Among the tracked 104 participants, only 6 (5.8%) stopped smoking after 1 year. Among the 25 participants who had intentions to quit smoking within 6 months at baseline, 6 (24.0%) maintained their intention to quit smoking for 1 year, and 16 (64.0%) did not maintain their intention to quit smoking. CONCLUSIONS Our findings showed that many smokers with schizophrenia were interested in quitting smoking, but few patients received treatment and actually quit smoking. Timely intervention, including the option to receive smoking cessation treatment, is necessary for those patients with schizophrenia who smoke. TRIAL REGISTRATION UMIN Clinical Trials Registry (UMIN000023874, registered on August 31, 2016).
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Affiliation(s)
- Yuji Higuchi
- Taiyo Hills Hospital, 2200 Abe, Ochiaicho, Takahashi City, Okayama, 716-0061 Japan
| | - Masaki Fujiwara
- 0000 0004 0631 9477grid.412342.2Department of Neuropsychiatry, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Naoki Nakaya
- 0000 0001 2248 6943grid.69566.3aDepartment of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, 2-1 Seiryo, Sendai, 980-8573 Japan
| | - Maiko Fujimori
- 0000 0001 2168 5385grid.272242.3Division of Health Care Research, Behavioral Sciences and Survivorship Research and Division of Cohort Consortium Research, Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - Chinatsu Hayashibara
- grid.443236.4Division of Occupational Therapy, Faculty of Care and Rehabilitation, Seijoh University, 2-172 Fukinodai, Tokai City, Aichi 476-8588 Japan
| | - Ryuhei So
- grid.474879.1Okayama Psychiatric Medical Center, 3-16 Shikatahon-machi, Kita-ku, Okayama, 700-0915 Japan
| | - Ikuta Shinkawa
- grid.474879.1Okayama Psychiatric Medical Center, 3-16 Shikatahon-machi, Kita-ku, Okayama, 700-0915 Japan
| | - Kojiro Sato
- grid.474879.1Okayama Psychiatric Medical Center, 3-16 Shikatahon-machi, Kita-ku, Okayama, 700-0915 Japan
| | - Yuji Yada
- grid.474879.1Okayama Psychiatric Medical Center, 3-16 Shikatahon-machi, Kita-ku, Okayama, 700-0915 Japan
| | - Masafumi Kodama
- grid.474879.1Okayama Psychiatric Medical Center, 3-16 Shikatahon-machi, Kita-ku, Okayama, 700-0915 Japan
| | - Hiroshi Takenaka
- grid.474879.1Okayama Psychiatric Medical Center, 3-16 Shikatahon-machi, Kita-ku, Okayama, 700-0915 Japan
| | - Yoshiki Kishi
- grid.474879.1Okayama Psychiatric Medical Center, 3-16 Shikatahon-machi, Kita-ku, Okayama, 700-0915 Japan
| | - Kyoko Kakeda
- 0000 0001 0659 9825grid.278276.eDepartment of Neuropsychiatry, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Yosuke Uchitomi
- 0000 0001 2168 5385grid.272242.3Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center Hospital and Behavioral Sciences and Survivorship Research, Center for Public Health Sciences, National Cancer Center, Tsukiji, Chuo-ku, Tokyo, 104-0045 Japan
| | - Norihito Yamada
- 0000 0001 1302 4472grid.261356.5Department of Neuropsychiatry, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Science, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Masatoshi Inagaki
- Department of Psychiatry, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, Shimane, 693-8501, Japan.
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Chan G, Leung J, Gartner C, Yong HH, Borland R, Hall W. Correlates of electronic cigarette use in the general population and among smokers in Australia - Findings from a nationally representative survey. Addict Behav 2019; 95:6-10. [PMID: 30784874 DOI: 10.1016/j.addbeh.2019.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 02/05/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
AIMS In Australia, sales of nicotine containing electronic cigarettes (also known as e-cigarette) are banned unless approved as a therapeutic good. The aims of this study were to estimate the prevalence of e-cigarette use and its correlates in Australia using a nationally representative survey. METHOD We analysed data from the largest drug use survey in Australia (the National Drug Strategy Household Survey [NDSHS]; N = 22,354). RESULTS We estimated that 227,000 Australians (1.2% of the population) were current e-cigarettes users, and 97,000 (0.5%) used them daily. Individuals who were male, younger, had higher level of psychological distress, and smoked were more likely to use electronic cigarettes. Among smokers, an intention to quit and reduction in smoking was associated with experimentation and daily use of e-cigarette, but not with occasional use. Recent quitting was associated with daily use. CONCLUSION Overall, the prevalence of e-cigarette use was low in 2016 in Australia. Smoking status was the strongest correlates of e-cigarette use. Patterns of vaping were differentialy associated with an intention to quit smoking, smoking reduction and recent quitting. Some smokers may attempt to use e-cigarettes to cut-down their tobacco use, and those who vaped daily were mostly likely to be recent quitters.
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Can e-cigarettes improve the well-being of people with mental health disorders? THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 73:170-171. [PMID: 31350106 DOI: 10.1016/j.drugpo.2019.07.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 11/21/2022]
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Kalkhoran S, Thorndike AN, Rigotti NA, Fung V, Baggett TP. Cigarette Smoking and Quitting-Related Factors Among US Adult Health Center Patients with Serious Mental Illness. J Gen Intern Med 2019; 34:986-991. [PMID: 30783880 PMCID: PMC6544702 DOI: 10.1007/s11606-019-04857-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 12/13/2018] [Accepted: 01/10/2019] [Indexed: 12/31/2022]
Abstract
INTRODUCTION US adults with serious mental illness (SMI), compared to those without SMI, have a higher prevalence of smoking, which contributes to a shorter life expectancy. This study compared current smoking and quitting-related characteristics of low-income US adults with and without SMI who received healthcare at federally funded health centers. METHODS Using cross-sectional data from adults ≥ 18 years old in the nationally representative 2014 Health Center Patient Survey (n = 5592), we compared the prevalence of ever and current smoking among adults with and without SMI and calculated quit ratios as the percentage of ever smokers who have quit smoking. We examined the association between SMI and receiving advice to quit, making quit attempts, and having plans to quit in the next 30 days using multivariable logistic regression. RESULTS A total of 1376 (23%) of participants had SMI. Ever smoking prevalence was 68% in adults with SMI and 41% in adults without SMI, and current smoking prevalence was 48% and 22%, respectively. The quit ratio was 30% and 46% among participants with and without SMI, respectively. Compared to smokers without SMI, more smokers with SMI reported receiving advice to quit in the past 12 months (aOR 2.47, 95% CI 1.20-5.07). Smokers with and without SMI did not differ significantly in their odds of having made a past-12-month quit attempt or plans to quit. CONCLUSIONS Smokers with SMI seen in federally funded health centers were just as likely to have made a quit attempt and to have plans to quit as smokers without SMI. Despite a higher likelihood of receiving clinician advice to quit, the lower quit ratio in this population suggests that advice alone is unlikely to be sufficient. These results underscore the need for augmented strategies to promote smoking cessation and reduce the excess burden of tobacco-related disease in patients with SMI.
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Affiliation(s)
- Sara Kalkhoran
- Tobacco Research and Treatment Center, General Medicine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA. .,Harvard Medical School, Boston, MA, USA.
| | - Anne N Thorndike
- Tobacco Research and Treatment Center, General Medicine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Nancy A Rigotti
- Tobacco Research and Treatment Center, General Medicine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Vicki Fung
- Harvard Medical School, Boston, MA, USA.,Mongan Institute, Massachusetts General Hospital, Boston, MA, USA
| | - Travis P Baggett
- Tobacco Research and Treatment Center, General Medicine Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, MA, USA
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26
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Spears CA, Jones DM, Weaver SR, Yang B, Pechacek TF, Eriksen MP. Electronic nicotine delivery system (ENDS) use in relation to mental health conditions, past-month serious psychological distress and cigarette smoking status, 2017. Addiction 2019; 114:315-325. [PMID: 30291763 PMCID: PMC6314897 DOI: 10.1111/add.14464] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/29/2018] [Accepted: 09/28/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND AIMS Adults with mental health conditions (MHC) exhibit disproportionately high smoking prevalence and experience profound tobacco-related disparities. US nationally representative surveys from 2012 to 2015 found relatively high usage of electronic nicotine delivery systems (ENDS; e.g. e-cigarettes) among adults with MHC. However, research has not examined these associations specifically among never smokers. Aims were to examine associations among MHC diagnosis, serious psychological distress (SPD) and ENDS use and to test whether associations varied by cigarette smoking status. DESIGN Cross-sectional US nationally representative survey. SETTING United States, 2017. PARTICIPANTS A total of 5762 adults (52.0% female; 64.8% non-Hispanic white, 11.4% non-Hispanic black, 15.9% Hispanic, 7.9% non-Hispanic other). MEASUREMENTS Outcomes were lifetime, current and current daily ENDS use. Predictors were lifetime MHC, past-month SPD and cigarette smoking status, and covariates were gender, age, race/ethnicity, education and annual household income. FINDINGS lifetime MHC and past-month SPD were each associated with higher likelihood of having ever used ENDS (P ≤ 0.001), currently using ENDS (P ≤ 0.001) and currently using ENDS daily (P < 0.05). There were interactions between MHC and smoking status in predicting ENDS use, such that MHC status predicted higher lifetime and current ENDS use specifically among never and current smokers. Never smokers with MHC had 2.62 higher odds [95% confidence interval, (CI) = 1.54, 4.45] of current ENDS use than those without MHC. Among never smokers, those with MHC indicated higher expectations that ENDS would improve relaxation and concentration (P < 0.05). CONCLUSIONS In 2017, US adults with versus without mental health conditions (MHC) were more likely to use electronic nicotine delivery systems (ENDS). In particular, both never and current smokers with MHC reported disproportionately high rates of current ENDS use.
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Affiliation(s)
- Claire Adams Spears
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA,Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, GA, USA,Correspondence: Claire Adams Spears, Ph.D., Assistant Professor, Health Promotion and Behavior, School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302-3995.
| | - Dina M. Jones
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Scott R. Weaver
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA,Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Bo Yang
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Terry F. Pechacek
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA,Division of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Michael P. Eriksen
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA, USA,Division of Health Management and Policy, School of Public Health, Georgia State University, Atlanta, GA, USA
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Birnbaum S. Moving Beyond the Behavior-Change Framework for Smoking Cessation: Lessons for a Critical Ontology From the Case of Inpatient Psychiatric Units. J Am Psychiatr Nurses Assoc 2019; 25:289-297. [PMID: 29865901 DOI: 10.1177/1078390318779125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND: Leading scholars have called on nursing schools to pay more attention to smoking cessation in the education of nursing students. AIM: This article argues that attention to this subject should include a rethinking of the behavior-change framework that forms the methodological basis of this field. METHOD: Drawing on classic and contemporary work in sociology, anthropology, and critical public health, this article explores the specific example of smoking in long-term inpatient units to illustrate the limitations of a behavior-based ontology and suggest an alternative conceptual vocabulary. RESULTS: An alternative approach posits smoking as a social practice. It sheds light on situational factors that incentivize smoking and might be contributing to patient resistance to cessation. CONCLUSIONS: A different conceptual framing of smoking can point to interventions beyond the level of individuals, focusing instead on the broader interface between people and situations, where decisions and desires meet institutional and organizational dynamics and structures of opportunity and access.
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Affiliation(s)
- Shira Birnbaum
- 1 Shira Birnbaum, PhD, RN, Simmons College School of Nursing and Health Sciences, Department of Health Professions Education, Boston, MA, USA
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28
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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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29
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Smith PH, Chhipa M, Bystrik J, Roy J, Goodwin RD, McKee SA. Cigarette smoking among those with mental disorders in the US population: 2012-2013 update. Tob Control 2018; 29:29-35. [PMID: 30377242 DOI: 10.1136/tobaccocontrol-2018-054268] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 09/28/2018] [Accepted: 10/03/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND Recent nationally representative estimates from the USA suggest the prevalence of cigarette smoking continues to be much higher among those with mental disorders compared with those without; however, prevalence estimates for current cigarette use by specific diagnoses are outdated. METHODS We analysed data from the National Epidemiologic Survey on Alcohol and Related Conditions III (2012-2013). We estimated the prevalence of lifetime and past-year smoking, lifetime and past-year daily smoking, and lifetime smoking cessation among ever smokers (ie, the quit ratio) among those with common mood, anxiety and substance use disorders in comparison to those without these disorders. RESULTS Across disorders, smoking prevalence was higher and the quit ratio was lower among those with common mental disorders compared with those without, with twofold to sixfold relativedifferences in the odds of the magnitude. CONCLUSIONS Despite tobacco control advances since 2000 and resulting declines in smoking prevalence, smoking remains extraordinarily more common among those with mood, anxiety and substance use disorders, with highest rates among those with bipolar and substance use disorders.
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Affiliation(s)
- Philip H Smith
- Department of Kinesiology and Health, Miami University, Oxford, Ohio, USA
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York City, New York, USA
| | - Mohammad Chhipa
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York City, New York, USA
| | - Josef Bystrik
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York City, New York, USA
| | - Jordan Roy
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York City, New York, USA
| | - Renee D Goodwin
- Department of Epidemiology and Biostatistics, School of Public Health, City University of New York, New York City, New York, USA
- Institute for Implementation Science in Population Health, City University of New York, New York City, New York, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, USA
| | - Sherry A McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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30
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Aschbrenner KA, Bobak C, Schneider EJ, Naslund JA, Brunette MF, O’Malley AJ. Egocentric social networks and smoking among adults with serious mental illness. Transl Behav Med 2018; 8:531-539. [PMID: 30016519 PMCID: PMC6065543 DOI: 10.1093/tbm/ibx014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Evidence-based smoking cessation treatment is safe and effective for smokers with serious mental illness (SMI); however, quit rates remain low in this population. We explored how social networks influence smoking outcomes among people with SMI who participated in smoking cessation treatment at community mental health centers. We conducted egocentric social network interviews with 41 individuals with SMI who participated in a statewide Medicaid demonstration project of smoking cessation treatment. We estimated the proportions of current smokers, former smokers, and never smokers in participants' (i.e., egos') networks and examined support for quitting from alters, defined as family, friends, peers, or significant others. We used logistic regression and mixed-effect logistic regression to explore the relationship between social network variables and ego's smoking status following cessation treatment. Egos reported an average of 5.9 ± 2.2 alters; 52% of alters were current smokers; 18% were former smokers; and 30% never smoked. The majority (57%) of alters helped an ego quit smoking. The presence of former smokers in the network was associated with decreased odds that the ego was smoking post-treatment. Egos whose friends were highly interconnected were less likely to smoke after treatment. Former smokers in the network may be a valuable resource for quitting particularly for vulnerable groups where there is a high prevalence and acceptability of smoking. Our initial findings suggest that a highly interconnected friendship network structure may be beneficial for people with SMI who are trying to quit smoking.
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Affiliation(s)
- Kelly A Aschbrenner
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Carly Bobak
- Program in Quantitative Biomedical Sciences, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - A James O’Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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31
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Camenga DR, Tindle HA. Weighing the Risks and Benefits of Electronic Cigarette Use in High-Risk Populations. Med Clin North Am 2018; 102:765-779. [PMID: 29933828 DOI: 10.1016/j.mcna.2018.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
This article reviews the current evidence on electronic cigarette (e-cigarette) safety and efficacy for smoking cessation, with a focus on smokers with cardiovascular disease, pulmonary disease, or serious mental illness. In the United States, adult smokers use e-cigarettes primarily to quit or reduce cigarette smoking. An understanding of the potential risks and benefits of e-cigarette use may help clinicians counsel smokers about the potential impact of e-cigarettes on health.
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Affiliation(s)
- Deepa R Camenga
- Yale School of Medicine, 464 Congress Avenue Suite 260, New Haven, CT 06519, USA.
| | - Hilary A Tindle
- Vanderbilt University Medical Center, 2525 West End, Suite 370, Nashville, TN 37203, USA
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32
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Witt DR, Patten CA. Treatment of Tobacco Use Disorder and Mood Disorders in Adolescents. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0216-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Noblett S, Beenstock J, Noblett J, Ireland J, Ormiston S. Implementing National Institute for Health and Care Excellence smoke-free guidance in a secure facility: an evaluation of the prescribing costs in clozapine users. BJPsych Bull 2018; 42:59-62. [PMID: 29544555 PMCID: PMC6001849 DOI: 10.1192/bjb.2017.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
UNLABELLED Aims and method The increased rates of smoking in people with mental illness is well documented, and establishing smoke-free mental health environments has been emphasised over recent years. This article examines the financial costs of implementing smoke free guidance and assesses the cost associated with patients who were prescribed clozapine and who committed to stopping smoking cigarettes for the duration of the study period. RESULTS Patients (38) who were prescribed clozapine were included in the study. A moderate reduction in dose was noted with a moderate reduction in prescribing costs. The total increase in cost for the whole group, however, was £17 624, largely due to the use of nicotine replacement therapy and an increase in the number of clozapine assay tests. Clinical implications Further studies on implementing this important policy change are needed. The positive effects must be balanced with increased financial pressure on Mental Health Trusts. Declarations of interest None.
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Affiliation(s)
- Stephen Noblett
- Lancashire Care National Health Service Foundation Trust,Preston,UK
| | - Jane Beenstock
- Lancashire Care National Health Service Foundation Trust,Preston,UK
| | | | - Joanne Ireland
- Lancashire Care National Health Service Foundation Trust,Preston,UK
| | - Sarah Ormiston
- Lancashire Care National Health Service Foundation Trust,Preston,UK
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34
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Sharma R, Meurk C, Bell S, Ford P, Gartner C. Australian mental health care practitioners' practices and attitudes for encouraging smoking cessation and tobacco harm reduction in smokers with severe mental illness. Int J Ment Health Nurs 2018; 27:247-257. [PMID: 28160384 DOI: 10.1111/inm.12314] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 11/27/2022]
Abstract
Reducing the burden of physical illness among people living with severe mental illnesses (SMI) is a key priority. Smoking is strongly associated with SMIs resulting in excessive smoking related morbidity and mortality in smokers with SMI. Smoking cessation advice and assistance from mental health practitioners would assist with reducing smoking and smoking-related harms in this group. This study examined the attitudes and practices of Australian mental health practitioners towards smoking cessation and tobacco harm reduction for smokers with SMI, including adherence to the 5As (ask, assess, advise, assist and arrange follow up) of smoking cessation. We surveyed 267 Australian mental health practitioners using a cross-sectional, online survey. Most practitioners (77.5%) asked their clients about smoking and provided health education (66.7%) but fewer provided direct assistance (31.1-39.7%). Most believed that tobacco harm reduction strategies are effective for reducing smoking related risks (88.4%) and that abstinence from all nicotine should not be the only goal discussed with smokers with SMI (77.9%). Many respondents were unsure about the safety (56.9%) and efficacy (39.3%) of e-cigarettes. Practitioners trained in smoking cessation were more likely (OR: 2.9, CI: 1.5-5.9) to help their clients to stop smoking. Community mental health practitioners (OR: 0.3, CI: 0.1-0.9) and practitioners who were current smokers (OR: 0.3, CI: 0.1-0.9) were less likely to adhere to the 5As of smoking cessation intervention. The results of this study emphasize the importance and need for providing smoking cessation training to mental health practitioners especially community mental health practitioners.
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Affiliation(s)
- Ratika Sharma
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Carla Meurk
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.,Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Archerfield, Queensland, Australia
| | - Stephanie Bell
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Pauline Ford
- School of Dentistry, The University of Queensland, Brisbane, Queensland, Australia
| | - Coral Gartner
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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35
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Iyer R, Smith D, Lawn S. An audit of the management of nicotine withdrawal in an Australian inpatient unit: are we there yet? Australas Psychiatry 2018; 26:13-19. [PMID: 28967286 DOI: 10.1177/1039856217732481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES This paper reports outcomes of a clinical audit of smoke-free policy implementation within an Australian inpatient psychiatric setting. It aimed to evaluate assessment of smoking status and subsequent management of nicotine withdrawal, and investigate any patient factors influencing these processes. METHODS A total of 67 medical case notes were retrospectively analysed for inpatients admitted to psychiatric units of a general hospital in South Australia, from July to September 2015. Patient demographic variables and information from the hospital's Smoking Assessment and Management Form (SAMF) were recorded. Data analysis involved descriptive statistics and Chi-square tests of association between dependent variables (how the SAMF was completed) and independent variables (sex, voluntary status, diagnosis). RESULTS The SAMF was implemented for most patients (76.1%), with 64.71% completed within 24 hours of admission; though, many were incomplete. Nicotine dependence was not properly assessed for 42.3% of smokers; 69.23% were prescribed nicotine replacement therapy (NRT), despite most scoring moderate to high nicotine dependence. No statistically significant relationships were found between patient factors and form completion. CONCLUSIONS SAMF completion was timely for most patients; however, sections important for determining support actions remained largely incomplete, suggesting patients' nicotine withdrawal is not being adequately addressed. More work is needed to improve inpatient staff's assessment to ensure optimal care.
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Affiliation(s)
- Reena Iyer
- Medical Intern, SA Health, Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, SA, Australia
| | - David Smith
- Senior Researcher, Flinders Human Behaviour & Health Research Unit, Department of Psychiatry, Flinders University, Adelaide, SA, Australia
| | - Sharon Lawn
- Director, Flinders Human Behaviour & Health Research Unit, Department of Psychiatry, Margaret Tobin Centre (Room 4T306), Flinders University, Adelaide, SA, Australia
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36
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Sharma R, Alla K, Pfeffer D, Meurk C, Ford P, Kisely S, Gartner C. An appraisal of practice guidelines for smoking cessation in people with severe mental illness. Aust N Z J Psychiatry 2017; 51:1106-1120. [PMID: 28859486 DOI: 10.1177/0004867417726176] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To review the quality of current smoking cessation guidelines that include recommendations for people with severe mental illness. METHODS A systematic search of scientific databases, central government health authority websites, psychiatry peak bodies, guideline clearing houses and Google was undertaken for relevant smoking cessation guidelines. Three reviewers independently assessed guideline quality using the AGREE II (Appraisal of Guidelines for REsearch and Evaluation II) instrument. Two reviewers extracted recommendations specific to smokers with severe mental illness. RESULTS Thirteen guidelines met the inclusion criteria. Seven guidelines scored ⩾60% in at least four domains. Median scores for 'Editorial independence', 'Rigour of development', 'Stakeholder Involvement' and 'Applicability' were less than 60%. The highest median scores were for 'Scope and purpose' (87%, 69-96%) and 'Clarity of presentation' (87%, 56-98%). 'Editorial independence' (33.3%, 0-86%) and 'Rigour of development' (54%, 11-92%) had the lowest median domain scores. The guidelines varied greatly in their recommendations but the majority recommended nicotine replacement therapy, bupropion or varenicline as first-line pharmacotherapy, along with behavioural support. CONCLUSION Many guidelines did not adequately report their methods or the competing interests of the authors. Future guidelines development may benefit from more specifically addressing AGREE II criteria and the needs of smokers with severe mental illness.
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Affiliation(s)
- Ratika Sharma
- 1 School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Kristel Alla
- 1 School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Daniel Pfeffer
- 1 School of Public Health, The University of Queensland, Herston, QLD, Australia
| | - Carla Meurk
- 1 School of Public Health, The University of Queensland, Herston, QLD, Australia.,2 Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Wacol, QLD, Australia
| | - Pauline Ford
- 3 School of Dentistry, The University of Queensland, Brisbane, QLD, Australia
| | - Steve Kisely
- 4 School of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Coral Gartner
- 1 School of Public Health, The University of Queensland, Herston, QLD, Australia
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Gage SH, Maynard OM. Smoke-free policies in psychiatric hospitals need resources. Lancet Psychiatry 2017; 4:509-510. [PMID: 28624179 DOI: 10.1016/s2215-0366(17)30241-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/10/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Suzanne H Gage
- Department of Psychological Sciences, University of Liverpool, Liverpool L69 7ZA, UK.
| | - Olivia M Maynard
- School of Experimental Psychology, University of Bristol, Bristol, UK
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38
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Sharma R, Gartner CE, Castle DJ, Mendelsohn CP. Should we encourage smokers with severe mental illness to switch to electronic cigarettes? Aust N Z J Psychiatry 2017. [PMID: 28633573 DOI: 10.1177/0004867417697823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ratika Sharma
- 1 School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Coral E Gartner
- 1 School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - David J Castle
- 2 St Vincent's Hospital Melbourne and Department of Psychiatry, The University of Melbourne, Parkville, VIC, Australia.,3 Department of Psychiatry, University of Cape Town, Cape Town, South Africa.,4 School of Psychiatry & Clinical Neurosciences, The University of Western Australia, Crawley, WA, Australia.,5 Faculty of Health, Arts and Design, Swinburne University, Hawthorn, VIC, Australia
| | - Colin P Mendelsohn
- 6 School of Public Health and Community Medicine, The University of New South Wales, Sydney, NSW, Australia
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Baker AL. Commentary on Mathew et al. (2017): Improving the effectiveness of interventions to reduce smoking among people living with severe mental ill-health. Addiction 2017; 112:413-414. [PMID: 28168789 DOI: 10.1111/add.13723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/29/2016] [Accepted: 12/05/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW, Australia
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Sharma R, Wigginton B, Meurk C, Ford P, Gartner CE. Motivations and Limitations Associated with Vaping among People with Mental Illness: A Qualitative Analysis of Reddit Discussions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 14:ijerph14010007. [PMID: 28025516 PMCID: PMC5295258 DOI: 10.3390/ijerph14010007] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/27/2016] [Accepted: 12/19/2016] [Indexed: 02/06/2023]
Abstract
This study aims to understand the nature and significance of online lay discussions about e-cigarettes and mental illness. We systematically searched the website Reddit.com using keywords related to e-cigarettes and mental illness. We coded relevant posts into themes under the framework of motivations for and limitations of vaping for people with mental illness. The thematic analysis included 3263 comments from 133 discussion threads. Six themes were classified as motivations to vape for people with mental illness: Self-medication; Quitting smoking; Freedom and control; Hobby; Social connectedness; and Motivation from caregivers and online communities. The limitations of vaping included: Unsatisfactory substitute for cigarettes and psychiatric medicines; Drug interactions; Nicotine addiction; Risks of e-liquid; Practical difficulties and Cost. People with mental illness; and their carers; use online discussion boards like Reddit to discuss the benefits and limitations of e-cigarettes for people with mental illness. Both positive and negative views exist. Media platforms like Reddit may shape the opinions of stakeholders and generate lay expertise about contentious health topics such as e-cigarettes. These findings have implications for policy and practice concerning assisting smokers with mental illness to reduce their health risk through switching to e-cigarettes.
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Affiliation(s)
- Ratika Sharma
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
| | - Britta Wigginton
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
| | - Carla Meurk
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Locked Bag 500, Archerfield, QLD 4018, Australia.
| | - Pauline Ford
- School of Dentistry, The University of Queensland, Herston, QLD 4006, Australia.
| | - Coral E Gartner
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
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41
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Meurk C, Ford P, Sharma R, Fitzgerald L, Gartner C. Views and Preferences for Nicotine Products as an Alternative to Smoking: A Focus Group Study of People Living with Mental Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13111166. [PMID: 27886046 PMCID: PMC5129376 DOI: 10.3390/ijerph13111166] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 11/12/2016] [Accepted: 11/14/2016] [Indexed: 11/27/2022]
Abstract
Aims and Background: People living with mental disorders experience a disproportionately higher burden of tobacco-related disease than the general population. Long-term substitution with less harmful nicotine products could reduce the tobacco-related harm among this population. This study investigated the views and preferences of people with mental health disorders about different nicotine products and their use as long-term substitutes for cigarettes. Methods: Semi-structured focus group discussion followed by a brief questionnaire. The discussion transcripts were analysed for content and themes and quantitative data summarised with descriptive statistics. Results: Twenty-nine participants took part in four focus groups. Vaping devices were the most acceptable nicotine products discussed; however preferences for nicotine products were individual and varied along aesthetic, pragmatic, sensory and symbolic dimensions. The concept of tobacco harm reduction was unfamiliar to participants, however they generally agreed with the logic of replacing cigarettes with less harmful nicotine products. Barriers to activating tobacco harm reduction included the symbolism of smoking and quitting; the importance placed on health; the consumer appeal of alternatives; and cost implications. Discussion and Conclusions: Engaging this population in tobacco harm reduction options will require communication that challenges black and white thinking (a conceptual framework in which smoking cigarettes or quitting all nicotine are the only legitimate options) as in practice this serves to support the continuance of smoking. Consumers should be encouraged to trial a range of nicotine products to find the most acceptable alternative to smoking that reduces health harms. Providing incentives to switch to nicotine products could help overcome barriers to using less harmful nicotine products among mental health consumers.
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Affiliation(s)
- Carla Meurk
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Locked Bag 500, Archerfield, QLD 4018, Australia.
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
| | - Pauline Ford
- School of Dentistry, The University of Queensland, Herston, QLD 4006, Australia.
| | - Ratika Sharma
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
| | - Lisa Fitzgerald
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
| | - Coral Gartner
- School of Public Health, The University of Queensland, Herston, QLD 4006, Australia.
- UQ Centre for Clinical Research, The University of Queensland, Herston, QLD 4006, Australia.
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