'Do more, smoke less!' Harm reduction in action for smokers with mental health/substance use problems who cannot or will not quit

Smoking Behavior and Wellness among Individuals in Substance Use Disorder Treatment

Tobacco-related morbidity and mortality disproportionately affect people with substance use disorders (SUD). Encouraging overall wellness may support tobacco use cessation. We investigated relationships between wellness (health status, physical activity, sugar-sweetened beverage (SSB) consumption), cigarette smoking, and smoking cessation among SUD treatment patients to inform clinical care. Cross-sectional surveys were conducted with 395 patients in 20 California residential SUD programs. Using multivariate regression, we examined associations between smoking status and wellness. Among smokers, we examined associations between lifetime smoking exposure, cessation behaviors and attitudes, and wellness. Compared to nonsmokers (n = 121), smokers (n = 274) reported more SSB consumption, poorer physical health, and more respiratory symptoms. Among smokers, SSB consumption and respiratory symptoms increased per ten pack-years of smoking. Smokers with respiratory symptoms reported higher motivation to quit and more use of nicotine replacement therapy (NRT). Smokers with more days of poor mental health reported lower motivation to quit. Overall, cigarette smoking was associated with other health-risk behaviors among SUD treatment patients. Respiratory symptoms may increase, and poor mental health may decrease, SUD patients' intent to quit smoking. To reduce chronic disease risk among SUD patients, treatment programs should consider promoting overall wellness concurrently with smoking cessation.

Nurse provision of support to help inpatients quit smoking

Issue addressed Identification of the factors that facilitate nurses to provide smoking cessation advice to hospitalised patients. Method Six semistructured focus groups with 26 nurses were conducted in June 2015. Participants completed a structured survey to collect patient demographic data and assess attitudes towards their role in addressing smoking cessation among inpatients. Results Important themes that emerged from the qualitative data were: nurses' negative perceptions of smokers, nurses' confidence in their knowledge of smoking cessation care and nurses' uncertainty around whose role it is to provide smoking cessation care. Conclusion Nurses require training in order to confidently and competently address smoking among inpatients as part of routine care. Formal ways to document the smoking status of inpatients and the offer of smoking cessation support from a nurse to an inpatient would enhance the communication between nurses around which inpatients had been asked about their smoking status and which had not. For patients who are resistant to conventional cessation strategies, innovative ways are needed to reduce the harm caused to them by tobacco use. So what? Nurses need to be provided with education and training around smoking cessation to increase their confidence and skills to provide smoking cessation care to inpatients.

Exploration of Sedentary Behavior in Residential Substance Abuse Populations: Results From an Intervention Study

BACKGROUND

There is a growing body of research linking sedentary behavior with increased risk of chronic disease and all-cause mortality. It is increasingly recommended that service providers address the multiple behavioral risk factors associated with these chronic diseases as part of routine substance abuse treatment.

OBJECTIVES

The study objective was to investigate rates of physical activity and sedentary behavior in a residential substance abuse population. In addition, efficacy of a sedentary behavior intervention, "Sit Switch," was examined for feasibility in this context.

METHODS

Participants (n = 54) were residents of The Salvation Army Recovery Service Centres located in Canberra and on the Gold Coast, Australia. Actigraph GT3X+ accelerometers were used to measure rates and patterns of sedentariness and physical activity. A nonrandomized controlled study of a single-session group intervention aimed at decreasing prolonged sitting ("Sit Switch") was conducted. Education, motivational-interviewing, and goal setting components underpinned the "Sit Switch" intervention.

RESULTS

Individuals were highly sedentary, spending 73% of daily activity at sedentary intensity engaged in inadequate levels of moderate physical activity (6.6%/day). The single session educational program did not lead to any significant changes in sedentary behavior. Conclusion/Importance: High levels of sedentariness and low levels of physical activity engagement are evident in residents in substance abuse treatment programs. It is strongly recommended that sedentariness, a modifiable risk behavior with independent consequences for cardiovascular disease and cancer, be addressed within residential programs.

Provision of Chronic Disease Preventive Care in Community Substance Use Services: Client and Clinician Report

INTRODUCTION

People with substance use problems have a higher prevalence of modifiable health risk behaviors. Routine clinician provision of preventive care may be effective in reducing such health behaviors. This study aimed to examine clinician provision of preventive care to clients of community substance use treatment services.

METHODS

A cross-sectional survey was undertaken with 386 clients and 54 clinicians of community substance use treatment services in one health district in New South Wales, Australia. Client- and clinician-reported provision of three elements of care (assessment, brief advice and referral) for three health risk behaviors (tobacco smoking, insufficient fruit and/or vegetable consumption and insufficient physical activity) was assessed, with associations with client characteristics examined.

RESULTS

Provision was highest for tobacco smoking assessment (90% client reported, 87% clinician reported) and brief advice (79% client reported, 80% clinician reported) and lowest for fruit and vegetable consumption (assessment 23%, brief advice 25%). Few clients reported being offered a referral (<10%). Assessment of physical activity and brief advice for all behaviors was higher for clients residing in rural/remote areas.

CONCLUSION

Assessment and brief advice were provided to the majority of clients for smoking, but sub-optimally for the other behaviors. Further investigation of barriers to the provision of preventive care within substance use treatment settings is required, particularly for referral to ongoing support.

Modifiable health risk behaviours and attitudes towards behaviour change of clients attending community-based substance use treatment services

Introduction and Aims

Health risk behaviours, such as smoking, nutrition and physical inactivity, are significant contributors to chronic disease for people with substance use disorders. This study reports the prevalence of these behaviours amongst substance use treatment clients, their attitudes towards modifying such behaviours and the acceptability of receiving support to do so. Client characteristics associated with risk status and interest in modifying behaviours were examined.

Design and Methods

A cross‐sectional survey was undertaken with clients of 15 community substance use treatment services within in New South Wales, Australia. Data for the study were collected via computer assisted telephone interviews.

Results

Of those contactable and eligible, 386 (71%) clients completed the survey. Clients reported a high prevalence of smoking (80%), insufficient fruit and/or vegetable consumption (89%) and insufficient physical activity (31%). Overall, 51–69% of clients reported considering modifying their health risk behaviours and 88–97% thought it was acceptable to be provided preventive care to address such behaviours. Younger clients were more likely to smoke (18–34 years (odds ratio [OR] = 4.6 [95% confidence interval [CI] = 1.9, 11.3]); 35–54 years (OR = 2.6 [95% CI = 1.2, 5.7])) and be interested in increasing vegetable consumption (18–34 years (OR = 4.4 [95% CI = 1.3, 14.8]); 35–54 years (OR = 8.0 [95% CI = 2.5, 25.4])) than older clients (≥55 years).

Discussion and Conclusions

There is a high prevalence of health risk behaviours amongst clients of community substance use treatment services. However, contrary to commonly cited barriers to care provision, clients are interested in modifying their risk behaviours and report that receiving preventive care to address these behaviours is acceptable. [Tremain D, Freund M, Wolfenden L, Wye P, Bowman J, Dunlop A, Gillham K, Bartlem K, McElwaine K, Gow B, Wiggers J. Modifiable health risk behaviours and attitudes towards behaviour change of clients attending community‐based substance use treatment services. Drug Alcohol Rev 2017;36:369–377.]

An audit of assessment and outcome of intervention at a quit smoking clinic in a homeless hostel

OBJECTIVE

We aim to report on smoking history, mental and physical health, and the results of interventions provided by a Quit Smoking Clinic (QSC) at a Sydney homeless men's shelter.

METHODS

We undertook an audit of questionnaires administered during the first QSC visit and a review of outcomes of QSC clients who attended the clinic more than once.

RESULTS

A total of 144 men were assessed at the QSC, with mean age 45.2 years (22-71) and mean smoking duration of 29 years. About half were receiving treatment for psychotic illness, and there were high rates of other psychiatric disorders, physical illness and substance use disorder. Carbon monoxide (CO) readings were significantly higher for those smoking discarded cigarette butts. Among the subset of clients who attended the clinic more than once (n=56), only four quit for more than a month and one for a year. However, the reported number of cigarettes smoked per day was significantly lower (p=0.001), with a significant reduction in CO (p<0.008).

CONCLUSIONS

This study confirms the difficulty that homeless men experience in quitting smoking, but demonstrates the potential to reduce the physical and financial harm of smoking through cessation support interventions in this setting.