Smoking behaviour, motives, motivation to quit and self-efficacy among patients in a secure mental health service: comparison with staff controls

Motives of Tobacco Use Among Young Adults in the United States Air Force

PURPOSE

Research has focused on cigarette use motives and have not included military personnel. The current study assessed tobacco use motives for different products, and differences within males and females and those with different racial identities given historical disparities in tobacco use.

DESIGN

A cross-sectional survey about tobacco use was administered from October 2019 to February 2022.

SETTING

Four Technical Training bases in the US.

SAMPLE

Air Force Airmen who used tobacco (N = 3243).

MEASURES

Questions were about sociodemographic characteristics, tobacco use, and the Tobacco Motives Inventory (representing affect regulation, boredom, enhancement, and social motives).

ANALYSIS

Linear regressions assessed associations between overall tobacco use and motives. Stratified analyses assessed associations between tobacco use and motives among males and females, and individuals from different racial backgrounds. Logistic regressions assessed differences in motives and use of different tobacco products between "some day" and "everyday" users.

RESULTS

Overall, boredom (B = .09, SE = .01) and affect regulation (B = .05, SE = .00) motives were associated with higher tobacco use. Males and females and individuals from different racial backgrounds endorsed different motives, but all endorsed boredom as a motive for higher tobacco use. Individuals who used cigarettes, e-cigarettes, or smokeless tobacco "some days" endorsed higher social motives than everyday users, but everyday users endorsed different motives across products.

CONCLUSION

There are motives differentiating between "some day" and "everyday" users of tobacco products, which may need to be differentially targeted in intervention programs. Additionally, there are some overlapping motives (affect regulation, boredom) that may be beneficial to address with all tobacco users.

Multidisciplinary barriers to addressing tobacco cessation during an inpatient psychiatric hospitalization

Tobacco use and resultant health complications disproportionately impact individuals with psychiatric disorders. Inpatient psychiatric hospitalizations provide an opportunity to initiate tobacco treatment. In this study, electronic medical record review identified demographic and clinical information, smoking status, and tobacco cessation treatment offered for adults hospitalized on two acute, non-smoking psychiatric units in Massachusetts from January 2016 to March 2018. We additionally conducted semi-structured interviews with 15 inpatient nursing, psychiatry, psychology and social work providers regarding their tobacco cessation treatment practices and perceived facilitators and barriers to addressing tobacco use on psychiatric inpatient units. Chart review identified 1099 of 3140 (35%) people admitted reporting daily tobacco smoking. On discharge, 5 (0.005%) of inpatient smokers received a prescription for varenicline, 43 (0.04%) for dual-nicotine replacement therapy, 211 (19.2%) for nicotine patch, and 5 (0.005%) for bupropion. Barriers to inpatient smoking cessation treatment initiation identified in qualitative interviews included: 1) smoking cessation as low priority, 2) smoking cessation as the responsibility of outpatient providers, 3) lack of education about tobacco treatment, and 4) treatment discussions framed as preventing withdrawal. Given the potential to impact a large percentage of psychiatric tobacco users, future interventions should investigate provision of tobacco cessation counseling and pharmacotherapy in inpatient settings, with interventions that take into account the barriers and opportunities presented in this study.

Reasons for smoking and barriers to cessation among adults with serious mental illness: A qualitative study

AIMS

Most research into reasons for smoking among adults with serious mental illness (SMI) has focused on reasons related to SMI symptoms. The current study reports reasons for smoking and barriers to cessation that are both related and unrelated to SMI symptoms among adults with SMI.

METHODS

Four focus groups were conducted among current smokers receiving outpatient care for a psychotic disorder in 2017 (N = 24). Participants were asked why they currently smoke and their barriers to quitting smoking.

RESULTS

Smoking as a coping mechanism and to self-medicate SMI symptoms were reasons for current smoking and barriers to cessation. Avoidance of other unhealthy behaviors, routine, and enjoyment emerged as reasons for smoking and barriers to cessation that were unrelated to mental illness.

CONCLUSION

Consideration of factors that are both related and unrelated to SMI symptoms in smoking cessation interventions and brief cessation counseling may improve cessation success in this population.

Associations of health insurance coverage, mental health problems, and drug use with mental health service use in US adults: an analysis of 2013 National Survey on Drug Use and Health

OBJECTIVE

To estimate the prevalence of mental health service use among US adults, examine the associations of mental health service use with health insurance coverage, mental health problems and drug use, and detect health disparities.

METHODS

This was a cross-sectional study with 5,434 adults receiving mental health service out of 37,424 adult respondents from the 2013 National Survey on Drug Use and Health. Weighted univariate and multiple logistic regression analyses were used to estimate the associations of potential factors with mental health service use.

RESULTS

The overall prevalence of mental health services use was 14.7%. Our results showed that being female, aging, having a major depressive episode, serious psychological distress, and illicit drug or alcohol abuse/dependence were positively associated with mental health service use; whereas being African American, Asian or Hispanic ethnicity, married, and having any form of insurance were negatively associated with mental health service use . Stratified analysis by insurance types showed that Medicaid/CHIP, CHAMPUS, and other insurance were positively associated with mental health service use.

CONCLUSIONS

Health insurance coverage, mental health problems, and drug abuse or dependence were associated with mental health service use in US adults. Furthermore, adults with different insurances had disparities in access of mental health service.

Opinions of Hospitalized Patients with Mental Disorders and Patients in Basic Health Units in Brazil Regarding Tobacco Smoking

This study aims to investigate the opinions of psychiatric patients and the general population on the smoking ban in health service facilities. A cross-sectional study was carried out in a mental health outpatient care unit (MHOC; n = 126), a psychiatric hospital (PH; n = 126), and a basic health unit (BHU; n = 126). The participants in the hospital were less in favor of the smoking ban compared with those attending out-of-hospital units (MHOC, 84%; PH, 69%; and BHU, 100%). Subjects with four or more psychiatric admissions (odds ratio (OR), 3.24) and smokers (OR, 3.18) were most likely to agree that patients have the right to smoke in health service facilities. The psychiatric population was less tolerant of the smoking ban, reflecting the culture of smoking in mental health service facilities.

Prospective study of provided smoking cessation care in an inpatient psychiatric setting

OBJECTIVE

People with mental health difficulties (MHD) are more likely to smoke and to have smoking-related diseases, yet little research has investigated the provision of smoking cessation care in psychiatric inpatient settings. This study aimed to evaluate current levels of cessation care provided, and 3-month quit-rates, in one such setting in Ireland.

METHODS

From January to October 2016, inpatients across all 8 adult wards of St Patrick's University Hospital were recruited to participate in a baseline face-to-face survey (N = 246), assessing demographic information, smoking history and quit attempts, motivation to quit, nicotine dependence, attitudes towards cessation advice and actual care received. For baseline current smokers (n = 84) who consented, casenotes were also audited for documentation of smoking status and cessation care (n = 77/84) while quit rates were assessed at three months (n = 72/84), including a carbon monoxide test for those who reported quitting.

RESULTS

Current smoking prevalence was 34% (n = 84/246). At baseline 75% of smokers wanted to quit and 48% reported they would like cessation advice while in hospital. Few reported receiving cessation advice from any healthcare professional in the past year (13%), while just 6% had smoking cessation care clearly documented in their casenotes. The 3-month quit-rate was 17%, with a 100% pass rate for those completing an objective CO validation test.

CONCLUSION

Despite a high current smoking prevalence among psychiatric inpatients, and similar motivation and quit rates to other populations, current cessation care rates are low. Smoking cessation care needs to be prioritised in psychiatric settings.

Evidence-Based Practice in Forensic Mental Health Nursing: A Critical Review

METHOD

Literature searches of databases, particularly CINAHL, using key phrases were undertaken.

RESULTS

Some authors argue that there is a lack of evidence in forensic mental health (FMH) nursing, with few randomized controlled trials and other methods providing definitive, generalizable evidence. However, literature searches revealed randomized controlled trials of relevance to FMH nursing, many qualitative studies by FMH nurses, and arguments for clinical experience and knowledge of service users, and the latter's views, as sources of evidence.

DISCUSSION AND IMPLICATIONS FOR NURSING PRACTICE

Research findings can be applied to practice, both directly and indirectly. Examples are given of ways that evidence can be used to inform FMH nursing interventions related to therapeutic ward environments, including communication, therapeutic relationships, preventing retraumatization, and enabling physical health. The complex nature of "evidence" is considered in relation to risk assessment and management.

CONCLUSIONS FOR NURSING PRACTICE

FMH nursing can be based on a wide range of sources of evidence. The types of evidence used in practice depend on individual service users' needs and views. In evaluating evidence, it is necessary to be aware of its complex, diverse nature. A distinction can be made between definitive, widely generalizable research findings and evidence with limited generalizability, requiring FMH nurses' judgments about whether it is applicable to their own area of practice. Recommendations for related education and research are made.

Taking actions to quit chewing betel nuts and starting a new life: taxi drivers' successful experiences of quitting betel nut chewing

AIMS AND OBJECTIVES

To understand taxi drivers' successful experiences of quitting betel nut chewing.

BACKGROUND

Previous studies verified that betel nut chewing significantly increases the risk of oral cancer. In Taiwan, taxi drivers work for approximately 10-13 hours per day, and 31·7-80% of them choose to chew betel nuts for their invigorating qualities, which enable them to work more hours and receive more income.

DESIGN

A qualitative research design was used.

METHODS

This study used the grounded theory method with purposive sampling to perform in-depth interviews with male taxi drivers who had successfully quit betel nut chewing for more than six months.

RESULTS

The interviewed participants were 25 taxi drivers aged 45-67 who had chewed betel nuts for an average of 30·9 years. A constant comparative analysis of the 25 interviews revealed six categories, namely the first experience of chewing betel nuts, a part of work and life, perceiving the impact of betel nuts, trying to change, acting to quit betel nut chewing and starting a new life.

CONCLUSIONS

During the cessation process, taxi drivers tended to be affected by their addiction to chewing betel nuts and the temptation of friends' invitations to chew betel nuts. However, their recognition of the physical effects of betel nut chewing and their sense of responsibility and commitment to family were the critical factors affecting their determination to quit betel nut chewing. Their willpower to not to chew betel nuts and the source of their motivation to exercise self-control also contributed to their success.

RELEVANCE TO CLINICAL PRACTICE

Healthcare personnel should understand the experiences and perceptions of betel nut chewers, strengthen their understanding of the effects of betel nut chewing on physical health during the cessation period and support their self-efficacy and quitting behaviours with the assistance of significant others.

Smoking behavior among patients and staff: a snapshot from a major metropolitan hospital in Melbourne, Australia

Background

A cross-sectional study was conducted to provide a snapshot of smoking behavior among staff and patients at a major metropolitan hospital in Melbourne.

Methods

Patients and staff were surveyed using a questionnaire exploring demographics, nicotine dependence (Fagerstrom test), readiness to quit, and preference for smoking cessation options.

Results

A total of 1496 people were screened within 2 hours; 1,301 participated (1,100 staff, 199 patients). Mean age was 42 years, 68% were female. There were 113 (9%) current smokers and 326 (25%) ex-smokers. Seven percent of the staff were current smokers compared with 19% of the patients. The Fagerstrom test showed that 47% of patients who smoked were moderately nicotine dependent compared with 21% of staff. A third of the staff who smoked did not anticipate health problems related to smoking. Most patients (79%) who smoked disagreed that their current health problems were related to smoking. Although more than half of the current smokers preferred pharmacotherapy, one in two of them did not prefer behavior counseling; with consistent results among staff and patients. Multivariate analyses showed that patients were three times more likely (odds ratio 3.0, 95% confidence interval 1.9–4.7) to smoke than staff.

Conclusion

This study reports lower prevalence of smoking among hospital staff compared with national data. It also indicates an under-appreciation of health effects of smoking, and a preference not to use conventional methods of quitting.