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Cerci D, Vitzthum K. [Smoke-free in Psychiatry - A Qualitative Analysis of Staff Perspectives]. PSYCHIATRISCHE PRAXIS 2024; 51:157-162. [PMID: 37989202 DOI: 10.1055/a-2184-3979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND People with mental illness are more likely to be nicotine-dependent and they have a shorter life expectancy as a result of smoking. Although guidelines recommend smoking cessation support, this is rarely provided by psychiatric staff who often view the implementation of smoke-free policies critically. METHOD We undertook inductive thematic analysis of the free-text fields of a staff survey on smoking. RESULTS Feedback on the topic was often emotional and related to the areas patient care, staff and the protection of non-smokers. Participants were often concerned that smoking cessation could worsen the patient's psychiatric condition or lead to aggressive behavior. CONCLUSIONS There is no scientific evidence for these concerns. It is important to counteract false assumptions by providing the appropriate training on smoking cessation.
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Affiliation(s)
- Deniz Cerci
- Klinik für Forensische Psychiatrie, Universitätsmedizin Rostock
| | - Karin Vitzthum
- Institut für Tabakentwöhnung und Raucherprävention, Vivantes Klinikum Neukölln, Berlin
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2
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Zhang X, Liang Y, Huang Y, Liu S, Li Q, Wang S, Wu G, Du Z, Wang Y, Wang J, Hu Y, Zang S, Hu Y, Shang X, Zhang X, Zhang L, Brown A, Zhu Z, He M, Yu H. Evaluation of the Observational Associations and Shared Genetics Between Glaucoma With Depression and Anxiety. Invest Ophthalmol Vis Sci 2024; 65:12. [PMID: 38466289 PMCID: PMC10929750 DOI: 10.1167/iovs.65.3.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/29/2024] [Indexed: 03/12/2024] Open
Abstract
Purpose Glaucoma, a leading cause of blindness worldwide, is suspected to exhibit a notable association with psychological disturbances. This study aimed to investigate epidemiological associations and explore shared genetic architecture between glaucoma and mental traits, including depression and anxiety. Methods Multivariable logistic regression and Cox proportional hazards regression models were employed to investigate longitudinal associations based on UK Biobank. A stepwise approach was used to explore the shared genetic architecture. First, linkage disequilibrium score regression inferred global genetic correlations. Second, MiXeR analysis quantified the number of shared causal variants. Third, specific shared loci were detected through conditional/conjunctional false discovery rate (condFDR/conjFDR) analysis and characterized for biological insights. Finally, two-sample Mendelian randomization (MR) was conducted to investigate bidirectional causal associations. Results Glaucoma was significantly associated with elevated risks of hospitalized depression (hazard ratio [HR] = 1.54; 95% confidence interval [CI], 1.01-2.34) and anxiety (HR = 2.61; 95% CI, 1.70-4.01) compared to healthy controls. Despite the absence of global genetic correlations, MiXeR analysis revealed 300 variants shared between glaucoma and depression, and 500 variants shared between glaucoma and anxiety. Subsequent condFDR/conjFDR analysis discovered 906 single-nucleotide polymorphisms (SNPs) jointly associated with glaucoma and depression and two associated with glaucoma and anxiety. The MR analysis did not support robust causal associations but indicated the existence of pleiotropic genetic variants influencing both glaucoma and depression. Conclusions Our study enhances the existing epidemiological evidence and underscores the polygenic overlap between glaucoma and mental traits. This observation suggests a correlation shaped by pleiotropic genetic variants rather than being indicative of direct causal relationships.
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Affiliation(s)
- Xiayin Zhang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yingying Liang
- Department of Ophthalmology, Guangzhou First People's Hospital, Guangzhou, China
| | - Yu Huang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Division of Population Health and Genomics, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom
| | - Shunming Liu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Qinyi Li
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Shan Wang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Guanrong Wu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Zijing Du
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yaxin Wang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Jinghui Wang
- Hainan Eye Hospital and Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Haikou, China
| | - Yunyan Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Siwen Zang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Yijun Hu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Xianwen Shang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Xueli Zhang
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Lei Zhang
- Clinical Medical Research Center, Children's Hospital of Nanjing Medical University, Nanjing, China
- Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Andrew Brown
- Division of Population Health and Genomics, University of Dundee, Ninewells Hospital and Medical School, Dundee, Scotland, United Kingdom
| | - Zhuoting Zhu
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Mingguang He
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- School of Optometry, The Hong Kong Polytechnic University, Hong Kong, China
| | - Honghua Yu
- Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Artificial Intelligence in Medical Image Analysis and Application, Guangzhou, China
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Batra A, Eck S, Riegel B, Friedrich S, Fuhr K, Torchalla I, Tönnies S. Hypnotherapy compared to cognitive-behavioral therapy for smoking cessation in a randomized controlled trial. Front Psychol 2024; 15:1330362. [PMID: 38476396 PMCID: PMC10929270 DOI: 10.3389/fpsyg.2024.1330362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024] Open
Abstract
Worldwide, more than eight million people die each year as a result of tobacco use. A large proportion of smokers who want to quit are interested in alternative smoking cessation methods, of which hypnotherapy is the most popular. However, the efficacy of hypnotherapy as a tobacco cessation intervention cannot be considered sufficiently proven due to significant methodological limitations in the studies available to date. The aim of the present study was to compare the efficacy of a hypnotherapeutic group program for smoking cessation with that of an established cognitive-behavioral group program in a randomized controlled trial. A total of 360 smokers who were willing to quit were randomly assigned to either hypnotherapy (HT) or cognitive-behavioral therapy (CBT) at two study sites, without regard to treatment preference. They each underwent a 6 weeks smoking cessation course (one 90 min group session per week) and were followed up at regular intervals over a 12 months period. The primary outcome variable was defined as continuous abstinence from smoking according to the Russell standard, verified by a carbon monoxide measurement at three measurement time points. Secondary outcome variables were 7 days point prevalence abstinence during the 12 months follow up and the number of cigarettes the non-quitters smoked per smoking day (smoking intensity). Generalized estimating equations were used to test treatment condition, hypnotic suggestibility, and treatment expectancy as predictors of abstinence. The two interventions did not differ significantly in the proportion of participants who remained continuously abstinent throughout the follow-up period (CBT: 15.6%, HT: 15.0%) and also regarding the 7 days abstinence rates during the 12 months follow-up (CBT: 21.2%, HT: 16.7%). However, when controlling for hypnotic suggestibility, CBT showed significantly higher 7 days abstinence rates. In terms of the continuous abstinence rates, it can be concluded that the efficacy of hypnotherapeutic methods for smoking cessation seem to be comparable to established programs such as CBT. Clinical trial registration ClinicalTrials.gov, identifier NCT01129999.
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Affiliation(s)
- Anil Batra
- Department for Psychiatry and Psychotherapy, Section for Addiction Research and Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | - Sandra Eck
- Department for Psychiatry and Psychotherapy, Section for Addiction Research and Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | | | | | - Kristina Fuhr
- Department for Psychiatry and Psychotherapy, Section for Addiction Research and Medicine, University Hospital Tuebingen, Tuebingen, Germany
| | | | - Sven Tönnies
- Department of Clinical Psychology and Psychotherapy, University Hamburg, Hamburg, Germany
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4
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Marchal-Mateos MI, López-Núñez C, Fernández-Artamendi S. Effectiveness of Contingency Management in Tobacco Smokers with Depressive Symptoms: A Systematic Review. Subst Use Misuse 2024; 59:792-804. [PMID: 38268117 DOI: 10.1080/10826084.2024.2302169] [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: 01/26/2024]
Abstract
Background: Effective interventions are required to address tobacco smoking in people with depressive symptomatology. In this context, contingency management could be one useful therapeutic strategy. Objectives: This study is a systematic review of tobacco cessation interventions for smokers with depressive symptomatology including a contingency management component, evaluating their efficacy with regards to tobacco abstinence, depressive symptomatology, adherence to treatment and other variables related to tobacco use. For this purpose, a search was carried out in Pubmed, PsycINFO, Cochrane, Web of Science and ClinicalTrials.gov in September 2022. The quality of the studies was assessed using the Cochrane Risk of Bias tool. Results: Of the 208 articles identified, six were included in this review. Results: For the most part, the research included suggests that contingency management is an effective strategy for improving abstinence outcomes, adherence, and other smoking-related variables such as delay discounting and intensity of cigarette demand in smokers with depressive symptomatology. Conclusions: Although contingency management could be a promising intervention in tobacco smokers with depressive symptomatology, further research in this area is still required.
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Affiliation(s)
| | - Carla López-Núñez
- Department of Personality, Evaluation and Psychological Treatment, Universidad de Sevilla, Sevilla, Spain
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5
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Martinez Agulleiro L, Patil B, Firth J, Sawyer C, Amann BL, Fonseca F, Torrens M, Perez V, Castellanos FX, Kane JM, Guinart D. A systematic review of digital interventions for smoking cessation in patients with serious mental illness. Psychol Med 2023; 53:4856-4868. [PMID: 37161690 PMCID: PMC10476065 DOI: 10.1017/s003329172300123x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/11/2023]
Abstract
Tobacco smoking is highly prevalent among patients with serious mental illness (SMI), with known deleterious consequences. Smoking cessation is therefore a prioritary public health challenge in SMI. In recent years, several smoking cessation digital interventions have been developed for non-clinical populations. However, their impact in patients with SMI remains uncertain. We conducted a systematic review to describe and evaluate effectiveness, acceptability, adherence, usability and safety of digital interventions for smoking cessation in patients with SMI. PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, PsychINFO and the Cochrane Tobacco Addiction Group Specialized Register were searched. Studies matching inclusion criteria were included and their information systematically extracted by independent investigators. Thirteen articles were included, which reported data on nine different digital interventions. Intervention theoretical approaches ranged from mobile contingency management to mindfulness. Outcome measures varied widely between studies. The highest abstinence rates were found for mSMART MIND (7-day point-prevalent abstinence: 16-40%). Let's Talk About Quitting Smoking reported greater acceptability ratings, although this was not evaluated with standardized measures. Regarding usability, Learn to Quit showed the highest System Usability Scale scores [mean (s.d.) 85.2 (15.5)]. Adverse events were rare and not systematically reported. Overall, the quality of the studies was fair to good. Digitally delivered health interventions for smoking cessation show promise for improving outcomes for patients with SMI, but lack of availability remains a concern. Larger trials with harmonized assessment measures are needed to generate more definitive evidence and specific recommendations.
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Affiliation(s)
- Luis Martinez Agulleiro
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Bhagyashree Patil
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA
| | - Joseph Firth
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, M13 9 PL
| | - Chelsea Sawyer
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, M13 9 PL
| | - Benedikt L. Amann
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Francina Fonseca
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Marta Torrens
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Universitat de Vic i Central de Catalunya, Vic, Spain
| | - Victor Perez
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Francisco Xavier Castellanos
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - John M. Kane
- Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Daniel Guinart
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
- Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
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6
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DeAtley T, Harrison A, Cassidy R, Kuo C, Higgins ST, Tidey JW. Subjective experiences, contexts, and risk perceptions of very low nicotine content cigarettes and electronic cigarettes among people with depression and anxiety disorders who smoke. Drug Alcohol Depend 2023; 244:109767. [PMID: 36638679 PMCID: PMC9974802 DOI: 10.1016/j.drugalcdep.2023.109767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 12/06/2022] [Accepted: 01/06/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND A low-nicotine product standard is currently under consideration by the U.S. Food and Drug Administration (FDA). This standard may be more effective if alternative, non-combusted sources of nicotine are concurrently available. This qualitative study explored the lived experiences of people with depression and anxiety disorders who used very low nicotine content (VLNC) cigarettes with or without e-cigarettes during a randomized controlled trial. METHODS We conducted semi-structured qualitative interviews with participants (n = 20) as they completed a 16-week blinded trial of VLNC cigarettes with or without electronic cigarettes. Interviews explored 1) experiences with these products, 2) social and environmental contexts for use and 3) relative risk perceptions. Interviews were transcribed and analyzed using a hybrid inductive and deductive thematic analysis. RESULTS Concurrent access to e-cigarettes helped to ease the transition from usual-brand cigarettes to VLNC cigarettes. Some participants held misperceptions that VLNC cigarettes could reduce cancer risk whereas others did not. Participants expressed skepticism about the safety of e-cigarettes and the authenticity of the VLNC cigarettes. Smoking restrictions influenced e-cigarette use in some instances, but product preference was the overriding factor that influenced use. Participants did not note effects on psychiatric symptoms. CONCLUSIONS Should a nicotine reduction policy be implemented with e-cigarettes concurrently available on the market, tailored messaging for people with anxiety and depression disorders may be necessary to educate people about and the availability of alternative sources of nicotine, such as e-cigarettes, as well as the relative risk of VLNC cigarettes and e-cigarettes.
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Affiliation(s)
- Teresa DeAtley
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA.
| | - Abigail Harrison
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | - Rachel Cassidy
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | - Caroline Kuo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
| | - Stephen T Higgins
- Department of Psychological Science, University of Vermont, VT 05405, USA
| | - Jennifer W Tidey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI 02912, USA
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7
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Staff perspectives on smoking cessation treatment in German psychiatric hospitals. J Public Health (Oxf) 2023. [DOI: 10.1007/s10389-022-01811-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Abstract
Aim
Although people with mental illness show a greater severity of nicotine dependence and have a significantly reduced life expectancy because of it, psychiatric staff rarely offer their patients smoking cessation support and are reluctant to encourage patients to quit. In order to improve smoking cessation treatment for psychiatric patients, such staff resistance must be better understood.
Subjects and methods
A total of 448 members of staff in eight psychiatric units in Berlin were surveyed in relation to their attitudes towards smoking cessation.
Results
Although most participants recognize the importance of smoking cessation in psychiatric patients, they state that they do not adhere to international guidelines which recommend regularly asking patients about their smoking habits and offering cessation support. Staff have little knowledge about how to facilitate smoking cessation treatment and about the influences of smoking on the metabolism of drugs. They also harbor misconceptions about how smoking affects their patients’ mental well-being. Many express concern that a quit attempt might thwart psychiatric treatment and lead to aggressive behavior—assumptions unsupported by scientific evidence. The overwhelming majority does not believe it to be realistic that patients can manage to give up smoking during treatment.
Conclusions
Staff training should be directed to heighten awareness of the international guidelines and treatment options for smoking cessation and impart knowledge on how smoking impacts both the physical and mental health of psychiatric patients.
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8
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Ellison-Barnes A, Galiatsatos P. Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. Med Clin North Am 2022; 106:1067-1080. [PMID: 36280333 DOI: 10.1016/j.mcna.2022.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is a strong evidence base for the use of existing pharmacotherapies to support tobacco cessation, alone or in combination, ideally with concurrent behavioral interventions. Future pharmacotherapies under development may assist in the most refractory cases. Incorporating current and future therapies into a longitudinal chronic care model for tobacco dependence will help a diverse range of patients achieve independence from nicotine addiction.
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Affiliation(s)
- Alejandra Ellison-Barnes
- The Tobacco Treatment and Cancer Screening Clinic, The Johns Hopkins Health System, Baltimore, MD, USA; Division of General Internal Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Panagis Galiatsatos
- The Tobacco Treatment and Cancer Screening Clinic, The Johns Hopkins Health System, Baltimore, MD, USA; Division of Pulmonary and Critical Care Medicine, The Johns Hopkins School of Medicine, Baltimore, MD, USA.
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9
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Morar T, Robertson L. Smoking cessation among people with mental illness: A South African perspective. S Afr Fam Pract (2004) 2022; 64:e1-e9. [PMID: 36073100 PMCID: PMC9453116 DOI: 10.4102/safp.v64i1.5489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 05/31/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022] Open
Abstract
Tobacco use is recognised as a serious, worldwide public health concern. Smoking cessation is of great interest across a wide range of medical specialities, including family medicine. However, smoking cessation among people with mental illness (PWMI) has attracted scant attention in South African literature. This is despite PWMI suffering disproportionately from the damages of tobacco. The harms of smoking are not limited to physical health but extend to mental health. This article discusses the need for multifaceted smoking cessation treatments for PWMI in the public health sector, taking into consideration the prevalence and unique drivers of smoking in this population. A brief overview of patterns of tobacco use, associated harms and smoking cessation interventions in South Africa is given; all within the context of mental illness.
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Affiliation(s)
- Tejil Morar
- Department of Psychiatry, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg.
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10
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Néstor S, Carlos P, Cristina P, José MR, Ignacio B, Pilar S. TOBACCO USE DISORDER AND DUAL DISORDERS Joint statement by the Spanish Psychiatry Society and the Spanish Dual Disorders Society. ACTAS ESPANOLAS DE PSIQUIATRIA 2022; 50:77-138. [PMID: 35731182 PMCID: PMC11095114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
Tobacco Use Disorder (TUD) is a health problem of the first order in the world population, affecting a vulnerable population, such as people with other mental disorders, whose morbidity and mortality are increased as a result.
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Affiliation(s)
- Szerman Néstor
- Instituto de Psiquiatría y Salud Mental, Hospital General Universitario Gregorio Marañón, Madrid, España. Miembro de la Sociedad Española de Patología Dual (SEPD)
| | - Parro Carlos
- Instituto de Psiquiatría y Salud Mental, Hospital General Universitario Gregorio Marañón, Madrid, España. Miembro de la Sociedad Española de Patología Dual (SEPD)
| | - Pinet Cristina
- Unidad Toxicomanías, Servicio de Psiquiatría, Hospital Sant Pau, Barcelona, España. Miembro de la Sociedad Española de Psiquiatría (SEP)
| | - Martínez-Raga José
- Departamento de Psiquiatría y Psicología Médica. Hospital Universitario Doctor Peset y Universitat de Valencia. Valencia, España. Miembro de la Sociedad Española de Patología Dual (SEPD)
| | - Basurte Ignacio
- Dirección médica de Psiquiatría y Salud Mental de la Clínica López Ibor. Madrid, España. Profesor vinculado de la Universidad Europea de Madrid. Madrid, España. Miembro de la Sociedad Española de Patología Dual (SEPD)
| | - Saiz Pilar
- Catedrática de Psiquiatría. Universidad de Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Universitario de Neurociencias del Principado de Asturias (INEUROPA), Instituto de Investigación sanitaria del Principado de Asturias (ISPA), Servicio de Salud del Principado de Asturias (SESPA). Asturias, España. Miembro de la Sociedad Española de Psiquiatría (SEP)
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Kertes J, Neumark Y, Grunhaus L, Stein-Reisner O. Factors impeding psychiatrists from promoting smoking cessation among people with serious mental illness – A mixed methods study. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2022. [DOI: 10.1080/00207411.2022.2079349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jennifer Kertes
- Dept Health Evaluation & Research, Maccabi HealthCare Services, Israel
| | - Yehuda Neumark
- Hadassah Braun School of Public Health and Community Medicine, Hebrew University, Israel
| | - Leon Grunhaus
- School of Medicine, Hebrew University of Jerusalem; founder and owner of Mind Clinic, the center for advanced psychiatric treatments in Tel Aviv, Israel
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12
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Wiley RC, Oliver AC, Snow MB, Bunn JY, Barrows AJ, Tidey JW, Lee DC, Sigmon SC, Gaalema DE, Heil SH, Markesich C, Villanti AC, Higgins ST. The Impact of the Covid-19 Pandemic on Smoking Among Vulnerable Populations. Nicotine Tob Res 2022; 25:282-290. [PMID: 35605264 PMCID: PMC9384158 DOI: 10.1093/ntr/ntac135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 05/17/2022] [Accepted: 05/21/2022] [Indexed: 01/12/2023]
Abstract
AIM While accumulating evidence suggests that people modified their smoking during the ongoing COVID-19 pandemic, it remains unclear whether those most at risk for tobacco-related health disparities did so. The current study examined changes in smoking among several vulnerable smoker populations during the COVID-19 pandemic. METHODS A web-based survey was distributed in 2020 to 709 adults with socioeconomic disadvantage, affective disorders, or opioid use disorder who participated in a previous study investigating the effects of very low nicotine content (VLNC) cigarettes on smoking. Current smoking status and rate, and adoption of protective health behaviors in response to the pandemic (eg social distancing, mask wearing) were examined. RESULTS Among 332 survey respondents (46.8% response rate), 84.6% were current smokers. Repeated measures ANOVA showed that current cigarettes/day (CPD) was higher during COVID than pre-COVID (12.9 ± 1.0 versus 11.6 ± 1.0; p < .001). Most respondents had adopted protective health behaviors to prevent infection (>79% for all behaviors). More than half indicated that they were still leaving their homes specifically to buy cigarettes (64.6%) and were buying more packs per visit to the store (54.5%) than pre-COVID. Individuals unemployed at the time of the survey experienced greater increases in CPD (from 11.4 ± 1.4 to 13.3 ± 1.4, p = .024) as did those with higher levels of anxiety (from 11.5 ± 1.1 to 13.6 ± 1.1, p < .001). CONCLUSIONS Smoking increased during the COVID-19 pandemic in this sample of adults from vulnerable populations, even while most adopted protective health measures to prevent infection. Unemployment and anxiety might identify those at greatest risk for increases in tobacco use. IMPLICATIONS Individuals from populations especially vulnerable to smoking might be at risk for greater harm from cigarette smoking during times of pandemic-related stress. Public health interventions are warranted to ameliorate increases in smoking among these populations. Special attention should be paid to those experiencing unemployment and high anxiety.
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Affiliation(s)
- Rhiannon C Wiley
- Corresponding author: Rhiannon C. Wiley, Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, University Health Center, 1 S. Prospect Street, Burlington, VT 05401, USA. Telephone: 802-656-1982;
| | - Anthony C Oliver
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Miranda B Snow
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Janice Y Bunn
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Medical Biostatistics, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Anthony J Barrows
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI
| | - Dustin C Lee
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Stacey C Sigmon
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychological Science, University of Vermont, Burlington, VT,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Diann E Gaalema
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychological Science, University of Vermont, Burlington, VT,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Sarah H Heil
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychological Science, University of Vermont, Burlington, VT,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Catherine Markesich
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychological Science, University of Vermont, Burlington, VT
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychological Science, University of Vermont, Burlington, VT,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, Larner College of Medicine, University of Vermont, Burlington, VT,Department of Psychological Science, University of Vermont, Burlington, VT,Department of Psychiatry, Larner College of Medicine, University of Vermont, Burlington, VT
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Masaki K, Taketa RM, Nakama MK, Kawamoto CT, Pokhrel P. Relationships Between Depressive Symptoms, Anxiety, Impulsivity and Cigarette and E-cigarette Use Among Young Adults. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:51-57. [PMID: 35261985 PMCID: PMC8899082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Depression and anxiety have been associated with cigarette use among young people. Higher impulsivity has also been associated with increased smoking behavior. However, relatively less is known about the associations between depression, anxiety, impulsivity and e-cigarette use and how these associations compare with the associations between depression, anxiety, impulsivity and cigarette smoking. In addition, little is known about how impulsivity influences the relationships between depression, anxiety, cigarette, and e-cigarette use. This study tested the hypothesis that higher depression and anxiety symptoms are associated with higher e-cigarette use and cigarette smoking in a similar way, and that these associations would be stronger among those with higher impulsivity. A sample of 2,622 young adults (18-25 year olds; 54% women) enrolled in 4-year and 2-year colleges in Hawai'i participated in a cross-sectional survey. Approximately 68% of the sample reported no use of either e-cigarettes or cigarettes, 13% reported only e-cigarette use, 9% reported only cigarette smoking, and 11% reported use of both. The study found that higher depressive and anxiety symptoms and higher impulsivity were significantly associated with current cigarette and e-cigarette use. For example, one unit increases in depression, anxiety, and impulsivity were associated with 34%, 17%, and 38% increased odds of e-cigarette use versus non-use, respectively. Impulsivity was found to significantly moderate the association between higher anxiety and higher cigarette smoking, such that the association was stronger among those with higher impulsivity. Impulsivity was not found to moderate any other association. Results suggest that tobacco product use prevention education should target children and young adults with higher internalizing symptoms, with particular attention to those who show higher impulsivity.
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Affiliation(s)
- Kelly Masaki
- Population Sciences in the Pacific Program, University of Hawai‘i Cancer Center, University of Hawai‘i at Manoa, Honolulu, HI
| | - Rachel M. Taketa
- Population Sciences in the Pacific Program, University of Hawai‘i Cancer Center, University of Hawai‘i at Manoa, Honolulu, HI
| | - Mark K. Nakama
- Population Sciences in the Pacific Program, University of Hawai‘i Cancer Center, University of Hawai‘i at Manoa, Honolulu, HI
| | - Crissy T. Kawamoto
- Population Sciences in the Pacific Program, University of Hawai‘i Cancer Center, University of Hawai‘i at Manoa, Honolulu, HI
| | - Pallav Pokhrel
- Population Sciences in the Pacific Program, University of Hawai‘i Cancer Center, University of Hawai‘i at Manoa, Honolulu, HI
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14
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Reed GL, Colby SM, Sokolovsky AW, Snell LM, DeAtley T, Tidey JW. Predicting Non-Adherence With Very Low Nicotine Content Cigarettes Among Adults With Serious Mental Illness Who Smoke. Nicotine Tob Res 2021; 24:914-918. [PMID: 34958368 PMCID: PMC9048920 DOI: 10.1093/ntr/ntab271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Reducing the nicotine content of cigarettes is a promising policy intervention to decrease cigarette dependence among people who smoke. Randomized trials support the potential efficacy of a reduced nicotine product standard for cigarettes. However, interpretation of such trials is challenged by incomplete adherence to the randomized treatment assignment, as some participants may continue to use commercial cigarettes not provided by the trial. The current study examined prevalence and predictors of non-adherence among trial participants with serious mental illness (SMI). AIMS AND METHODS Adults with SMI who smoke daily and were not trying to quit (N = 58) were randomized to receive very low nicotine content (VLNC) or normal nicotine content cigarettes over 6 weeks. We investigated predictors of biologically assessed non-adherence in participants assigned to VLNC cigarettes (n = 30). Predictors included subjective responses to VLNC cigarettes, baseline nicotine dependence and dependence motives, and psychiatric symptom severity. We fit a series of linear models regressing non-adherence metrics onto covariates (gender; menthol preference) and focal predictors. RESULTS Nearly all participants (96%) were estimated to be less than completely adherent to VLNC cigarettes. Lower enjoyment ratings of respiratory tract sensations of VLNC cigarettes predicted a greater degree of non-adherence (b = -.40, SE = .14, 95% CI: -0.71, -0.10). CONCLUSIONS Less positive subjective response to smoking VLNC cigarettes was the only significant predictor of incomplete adherence among individuals with SMI, consistent with prior research in a general population sample. This suggests the potential for shared strategies to help different smoking populations adjust to a reduced nicotine product standard. IMPLICATIONS Results offer preliminary insight into potential barriers to adherence in SMI populations. Adherence might be enhanced by supplementing VLNC cigarettes with alternative sources of non-combusted nicotine, paired with educational campaigns to encourage quitting or switching to less harmful products. Future studies should replicate these analyses in a larger sample of individuals with SMI who smoke.
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Affiliation(s)
- Grace L Reed
- Corresponding Author: Grace L. Reed, Center for Alcohol and Addiction Studies, Brown University School of Public Health, 69 Brown St, #4867, Providence, RI 02912, USA. Telephone: 401-595-2666; E-mail:
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Alexander W Sokolovsky
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - L Morgan Snell
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Teresa DeAtley
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
| | - Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, USA
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15
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Cao X, Wu J, Gu Y, Liu X, Deng Y, Ma C. Post-traumatic Stress Disorder and Risk Factors in Patients With Acute Myocardial Infarction After Emergency Percutaneous Coronary Intervention: A Longitudinal Study. Front Psychol 2021; 12:694974. [PMID: 34970178 PMCID: PMC8712448 DOI: 10.3389/fpsyg.2021.694974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
This study aimed to investigate the status and risk factors of post-traumatic stress disorder (PTSD) in patients with acute myocardial infarction (AMI) after emergency percutaneous coronary intervention (PCI) in acute and convalescence phases. A longitudinal study design was used. Two questionnaire surveys were conducted in the acute stage of hospitalization, and 3 months after onset in patients. Logistic regression was used to analyze the risk factors for PTSD in AMI patients. The incidence of PTSD was 33.1 and 20.4% in acute and convalescent patients, respectively. The risk factors related to PTSD were door-to-balloon time (DTB) (≥92.6 min), left ventricular ejection fraction (LVEF) (<50%), smoking, anxiety, and depression. AMI patients after PCI had PTSD in the acute and convalescent stage. The findings indicate that tailored measures should be developed and carried out to prevent PTSD and improve the mental health of patients with AMI after undergoing PCI.
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Affiliation(s)
- Xiaocui Cao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Jiaqi Wu
- School of Nursing, Guangzhou Medical University, Guangzhou, China
| | - Yuqin Gu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Xuemei Liu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yaping Deng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Chunhua Ma
- School of Nursing, Guangzhou Medical University, Guangzhou, China
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16
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Greenhalgh EM, Brennan E, Segan C, Scollo M. Monitoring changes in smoking and quitting behaviours among Australians with and without mental illness over 15 years. Aust N Z J Public Health 2021; 46:223-229. [PMID: 34821438 DOI: 10.1111/1753-6405.13185] [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: 06/01/2021] [Revised: 10/01/2021] [Accepted: 10/01/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study examines smoking prevalence and quitting behaviours among Australians with and without mental illness. METHODS Analysis of data from Australia's triennial National Drug Strategy Household Surveys 2004-2019. The prevalence of regular smokers, never smokers, the quit proportion, cigarette consumption, and use of cessation aids were examined for those with and without mental illness. RESULTS Among Australians with mental illness, there was a significant decrease in regular smokers and significant increases in never smokers and in the proportion of ever smokers who had quit between 2004 and 2019. Smokers with mental illness were generally as likely to attempt to quit and more likely to use cessation support; however, they were also more likely to report unsuccessful quit attempts. Smokers with mental illness who had quit reported lower levels of psychological distress than those still smoking. CONCLUSION Since 2004, there have been some encouraging trends in reducing tobacco use among people with mental illness; however, smoking rates remain substantially higher than among those without mental illness. Implications for public health: Findings highlight the importance of routinely identifying smokers with mental illness and improving access and adherence to best practice smoking cessation treatment.
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Affiliation(s)
| | - Emily Brennan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Victoria
| | - Catherine Segan
- Quit, Cancer Council Victoria, Victoria.,Centre for Health Policy, School of Population and Global Health, University of Melbourne, Victoria
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17
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Kertes J, Neumark Y, Grunhaus L, Stein-Reisner O. Comparison of Perceptions and Smoking Cessation Experiences Between Smokers With and Without Serious Mental Illness in a Large Health Maintenance Organization. J Dual Diagn 2021; 17:284-295. [PMID: 34651553 DOI: 10.1080/15504263.2021.1979348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Smoking prevalence is threefold higher among people with serious mental illness (PWSMI) than in the general population, yet smoking cessation rates for PWSMI are lower. Numerous reasons have been posited as to why tobacco use is higher and abstinence rates are lower among PWSMI. This study explores smoking cessation perceptions and experiences among PWSMI and people without serious mental illness (SMI). METHODS Participants in this cross-sectional study were recruited from among members of a large health maintenance organization (HMO) in Israel who had registered for or commenced a smoking cessation program in 2015 through 2017. The sample comprised 208 PWSMI and a matched sample of people without SMI (N = 428). Telephone surveys were used to collect information about smoking status and smoking/cessation history, use of smoking cessation programs and aids (prescription medications, nicotine replacement therapy, electronic cigarettes), motivation and intention to quit, self-efficacy (to quit), smoking cessation outcome expectancies, physician support to quit, barriers and facilitators for those who had not quit, and reinforcements/challenges for those who had quit. RESULTS Of those without SMI, 27% quit smoking compared to 20% of PWSMI (p = .051). Irrespective of mental health status, the most significant predictor of abstinence was the use of smoking cessation prescription medications. Family physicians were significantly less likely to inquire about motivation to quit, refer to smoking cessation programs, or prescribe smoking cessation medications for PWSMI than for people without SMI. Beyond these factors, no differences were noted between respondents with and without SMI regarding motivation to quit, intention to quit, and abstinence self-efficacy. PWSMI who had not quit were more likely to be concerned about how quitting might affect their functioning and how they would pass the time without cigarettes. CONCLUSIONS PWSMI have similar levels of motivation and intention to quit smoking as those without SMI. However, they are disadvantaged by the reduced support received from their family physicians and lower cessation medication usage. Efforts to promote the implementation of smoking cessation treatment guidelines will help promote smoking abstinence among PWSMI.
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Affiliation(s)
- Jennifer Kertes
- Department of Health Evaluation & Research, Maccabi HealthCare Services, Tel Aviv, Israel
| | - Yehuda Neumark
- Hadassah Braun School of Public Health and Community Medicine, Hebrew University, Jerusalem, Israel
| | - Leon Grunhaus
- School of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Orit Stein-Reisner
- Head of Department of Mental Health Services, Maccabi HealthCare Services, Tel Aviv, Israel
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18
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Monroe DC, McDowell CP, Kenny RA, Herring MP. Dynamic associations between anxiety, depression, and tobacco use in older adults: Results from The Irish Longitudinal Study on Ageing. J Psychiatr Res 2021; 139:99-105. [PMID: 34058656 PMCID: PMC8527842 DOI: 10.1016/j.jpsychires.2021.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 03/29/2021] [Accepted: 05/01/2021] [Indexed: 12/14/2022]
Abstract
Evidence supports moderate-to-large reductions in anxiety, depression, and perceived stress after smoking cessation; however, much of the available evidence has focused on young adults. Therefore, this study quantified associations between smoking and smoking cessation on prevalent and incident generalised anxiety disorder (GAD) and major depression (MDD) in a nationally representative sample of Irish older adults. Participants (n = 6201) were community dwelling adults aged ≥50 years resident in Ireland. Smoking status and self-reported doctor diagnosis of anxiety or depression prior to baseline were assessed at baseline (i.e., Wave 2). At baseline and 2-, 4-, and 6-year follow-up (i.e., Waves 3-5), GAD and MDD were assessed by the Composite International Diagnostic Interview Short-Form. Logistic regression quantified cross-sectional and prospective associations (odds ratios (ORs) and 95% confidence intervals (95%CIs)) between smoking status and mental health. Prevalence and incidence of GAD was 9.1% (n = 566) and 2.8% (n = 148), respectively. Prevalence and incidence of depression was 11.1% (n = 686) and 6.4% (n = 342), respectively. Following full adjustment, current smokers had higher odds of prevalent GAD (OR = 1.729, 1.332-2.449; p < 0.001) and MDD (OR = 1.967, 1.548-2.499; p < 0.001) than non-smokers. Former smokers had higher odds of prevalent GAD than non-smokers (OR = 1.276, 1.008-1.616; p < 0.001). Current smokers did not have higher odds of incident MDD (OR = 1.399, 0.984-1.990; p = 0.065) or GAD than non-smokers (1.039, 0.624-1.730; p = 0.881). Findings may have important implications for interventions designed to curb tobacco abuse, which tend to be less successful among those with anxiety and depression.
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Affiliation(s)
- Derek C. Monroe
- Department of Kinesiology, University of North Carolina at Greensboro, NC, USA,Department of Neurology, University of California-Irvine, Irvine, CA, USA
| | - Cillian P. McDowell
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland,School of Medicine, Trinity College Dublin, Ireland,Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland,School of Medicine, Trinity College Dublin, Ireland,Mercer’s Institute for Successful Ageing, St James’s Hospital, Dublin, Ireland
| | - Matthew P. Herring
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Ireland,Physical Activity for Health Research Cluster, Health Research Institute, University of Limerick, Limerick, Ireland,Department of Physical Education and Sport Sciences, University of Limerick, Limerick, Ireland
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19
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Bonevski B, Manning V, Wynne O, Gartner C, Borland R, Baker AL, Segan CJ, Skelton E, Moore L, Bathish R, Chiu S, Guillaumier A, Lubman DI. QuitNic: A Pilot Randomized Controlled Trial Comparing Nicotine Vaping Products With Nicotine Replacement Therapy for Smoking Cessation Following Residential Detoxification. Nicotine Tob Res 2021; 23:462-470. [PMID: 32770246 PMCID: PMC7885782 DOI: 10.1093/ntr/ntaa143] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 07/30/2020] [Indexed: 12/22/2022]
Abstract
Introduction The QuitNic pilot trial aimed to test the feasibility of providing a nicotine vaping product (NVP) compared with combination nicotine replacement therapy (NRT) to smokers upon discharge from a smoke-free residential substance use disorder (SUD) treatment service. Methods QuitNic was a pragmatic two-arm randomized controlled trial. At discharge from residential withdrawal, 100 clients received telephone Quitline behavioral support and either 12-week supply of NRT or an NVP. Treatment adherence and acceptability, self-reported abstinence, cigarettes smoked per day (CPD), frequency of cravings, and severity of withdrawal symptoms were assessed at 6 and 12 weeks. Results are reported for complete cases and for abstinence outcomes, penalized imputation results are reported where missing is assumed smoking. Results Retention on was 63% at 6 weeks and 50% at 12 weeks. At 12 weeks, 68% of the NRT group reported using combination NRT while 96% of the NVP group used the device. Acceptability ratings for the products were high in both groups. At 12 weeks, 14% of the NVP group and 18% of the NRT group reported not smoking at all in the last 7 days. Mean CPD among continued smokers decreased significantly between baseline to 12 weeks in both groups; from 19.91 to 4.72 for the NVP group (p < .001) and from 20.88 to 5.52 in the NRT group (p < .001). Cravings and withdrawal symptoms significantly decreased for both groups. Conclusions Clients completing residential withdrawal readily engaged with smoking cessation post-treatment when given the opportunity. Further research is required to identify the most effective treatments postwithdrawal for this population at elevated risk of tobacco-related harm. Trial registration number ACTRN12617000849392 Implications This pilot study showed that smoking cessation support involving options for nicotine replacement and Quitline-delivered cognitive behavioral counseling is attractive to people after they have been discharged from SUD treatment. Both nicotine vaping products and nicotine replacement therapies were highly acceptable and used by participants who reported reductions in cravings for cigarettes and perceptions of withdrawal symptoms and reductions in number of cigarettes smoked. Some participants self-reported abstinence from cigarettes—around one in five reported having quit smoking cigarettes at 12 weeks postdischarge. The results have significant public health implications for providing quit support following discharge from SUD treatment.
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Affiliation(s)
- Billie Bonevski
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Victoria Manning
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.,Turning Point, Eastern Health, Richmond, Australia
| | - Olivia Wynne
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Coral Gartner
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia.,Faculty of Health and Behavioural Sciences, Queensland Alliance of Environmental Health Sciences, The University of Queensland, Woolloongabba, Queensland, Australia
| | - Ron Borland
- The Cancer Council Victoria, Melbourne, Victoria, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Amanda L Baker
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Catherine J Segan
- The Cancer Council Victoria, Melbourne, Victoria, Australia.,Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Eliza Skelton
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Lyndell Moore
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Ramez Bathish
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.,Turning Point, Eastern Health, Richmond, Australia
| | - Simon Chiu
- Hunter Medical Research Institute (HMRI), Lambton, NSW, Australia
| | - Ashleigh Guillaumier
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia
| | - Dan I Lubman
- Monash Addiction Research Centre and Eastern Health Clinical School, Monash University, Box Hill, Victoria, Australia.,Turning Point, Eastern Health, Richmond, Australia
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20
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Martucci VL, Richmond B, Davis LK, Blackwell TS, Cox NJ, Samuels D, Velez Edwards D, Aldrich MC. Fate or coincidence: do COPD and major depression share genetic risk factors? Hum Mol Genet 2021; 30:619-628. [PMID: 33704461 DOI: 10.1093/hmg/ddab068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 01/12/2023] Open
Abstract
Major depressive disorder (MDD) is a common comorbidity in chronic obstructive pulmonary disease (COPD), affecting up to 57% of patients with COPD. Although the comorbidity of COPD and MDD is well established, the causal relationship between these two diseases is unclear. A large-scale electronic health record clinical biobank and genome-wide association study summary statistics for MDD and lung function traits were used to investigate potential shared underlying genetic susceptibility between COPD and MDD. Linkage disequilibrium score regression was used to estimate genetic correlation between phenotypes. Polygenic risk scores (PRS) for MDD and lung function traits were developed and used to perform a phenome-wide association study (PheWAS). Multi-trait-based conditional and joint analysis identified single-nucleotide polymorphisms (SNPs) influencing both lung function and MDD. We found genetic correlations between MDD and all lung function traits were small and not statistically significant. A PRS-MDD was significantly associated with an increased risk of COPD in a PheWAS [odds ratio (OR) = 1.12, 95% confidence interval (CI): 1.09-1.16] when adjusting for age, sex and genetic ancestry, but this relationship became attenuated when controlling for smoking history (OR = 1.08, 95% CI: 1.04-1.13). No significant associations were found between the lung function PRS and MDD. Multi-trait-based conditional and joint analysis identified three SNPs that may contribute to both traits, two of which were previously associated with mood disorders and COPD. Our findings suggest that the observed relationship between COPD and MDD may not be driven by a strong shared genetic architecture.
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Affiliation(s)
- Victoria L Martucci
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Bradley Richmond
- Department of Veterans Affairs Medical Center, Nashville, TN 37212, USA.,Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Lea K Davis
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Timothy S Blackwell
- Department of Veterans Affairs Medical Center, Nashville, TN 37212, USA.,Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Cell and Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Nancy J Cox
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - David Samuels
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Department of Molecular Physiology and Biophysics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
| | - Digna Velez Edwards
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37232, USA
| | - Melinda C Aldrich
- Vanderbilt Genetics Institute, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.,Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN 37232, USA.,Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN 37232, USA
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21
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Hwong AR, Schmittdiel J, Schillinger D, Newcomer JW, Essock S, Zhu Z, Dyer W, Young-Wolff KC, Mangurian C. Smoking cessation treatment for individuals with comorbid diabetes and serious mental illness in an integrated health care delivery system. Addict Behav 2021; 114:106697. [PMID: 33129613 DOI: 10.1016/j.addbeh.2020.106697] [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] [Received: 03/13/2020] [Revised: 08/11/2020] [Accepted: 09/29/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Smoking is a significant modifiable risk factor for mortality for persons with serious mental illness (SMI), who have a life expectancy 15-20 years shorter than the general population. Individuals with SMI and comorbid diabetes who are smokers face an even higher risk of cardiovascular complications and early death. Yet despite high rates of smoking among people with SMI, tobacco cessation interventions have not been broadly offered to this population. METHODS We conducted a retrospective cohort study using electronic health records from 2014 in a large integrated care delivery system to examine whether use of smoking cessation pharmacotherapy among smokers with type 2 diabetes varies by serious mental illness (SMI) diagnosis. We analyzed smoking cessation medication prescription fills among adult smokers with diabetes, comparing those with SMI (N = 634) and without SMI (N = 18,021). Risk ratios were adjusted for age, gender, race, urban area type, and medical facility. RESULTS Of the SMI group, 19.09% filled at least one smoking cessation prescription compared to 9.73% of the non-SMI group (adjusted risk ratio 1.80 [95% CI 1.52-2.13]; p < .001). For the SMI group, primary care providers wrote 80.24% of prescriptions, while psychiatrists wrote 8.81% of prescriptions. CONCLUSIONS These findings offer an example of a delivery system with higher uptake of smoking cessation pharmacotherapy among people with SMI than without SMI, and highlight the opportunity to provide more smoking cessation interventions in mental health care settings.
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Asharani PV, Lau JH, Ai Ling Seet V, Devi F, Wang P, Roystonn K, Lee YY, Cetty L, Teh WL, Verma S, Mok YM, Chong SA, Subramaniam M. Smoking-Related Health Beliefs in a Sample of Psychiatric Patients: Factors Associated with the Health Beliefs and Validation of the Health Belief Questionnaire. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041571. [PMID: 33562257 PMCID: PMC7916053 DOI: 10.3390/ijerph18041571] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/28/2021] [Accepted: 02/01/2021] [Indexed: 12/12/2022]
Abstract
This study examined the (a) health beliefs and emotions (perception of risk, benefits, severity, and worry) about smoking among current and former smokers, (b) their awareness of health warnings, (c) factors associated with smoking-related health beliefs, and (d) the factor structure of the health belief questionnaire. Participants (n = 184) were recruited from a tertiary psychiatric care hospital. Current smokers showed a significantly higher risk perception and lower perceived benefits compared to former smokers. Younger age (<40 years), nicotine dependence (ND), a history of smoking-related diseases (SRD), and intention to quit were significantly associated with a higher risk perception in current smokers. Younger age, a history of SRDs, and motivation to quit were positively associated with health beliefs, while the latter two were associated with worry. Motivation and younger age were associated with a better perception of benefits and severity. Information on the cigarette packets was the major source of awareness for the sample, and 69% reported that existing campaigns were not effective in discouraging their smoking. Personalized risk communication and educational initiatives must focus on improving the knowledge of risk, benefits, and increase motivation to promote health cognition and thus smoking cessation.
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Affiliation(s)
- P. V. Asharani
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
- Correspondence: ; Tel.: +65-63892961
| | - Jue Hua Lau
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Vanessa Ai Ling Seet
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Fiona Devi
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Peizhi Wang
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Kumarasan Roystonn
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Ying Ying Lee
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Laxman Cetty
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Wen Lin Teh
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Swapna Verma
- Early Psychosis Intervention Programme, Institute of Mental Health, Singapore 539747, Singapore;
- Office of Education, Duke-NUS Medical School, 8 College Road, Singapore 169857, Singapore
| | - Yee Ming Mok
- Department of Mood and Anxiety, Institute of Mental Health, Singapore 539747, Singapore;
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, Singapore 539747, Singapore; (J.H.L.); (V.A.L.S.); (F.D.); (P.W.); (K.R.); (Y.Y.L.); (L.C.); (W.L.T.); (S.A.C.); (M.S.)
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23
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Okubo R, Tabuchi T. Smoking and drinking among patients with mental disorders: Evidence from a nationally representative Japanese survey. J Affect Disord 2021; 279:443-450. [PMID: 33120245 DOI: 10.1016/j.jad.2020.10.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/24/2020] [Accepted: 10/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND No studies to date have addressed the association of mental disorder with smoking and drinking behaviors independent of anxiety and depressive symptoms. We therefore examined this association, stratified by age and sex, to determine the target population for behavioral modification in Japan. METHODS We analyzed data from participants aged 20-79 years without hospitalized or institutionalized status who participated in the nationwide Comprehensive Survey of Living Conditions conducted in 2016. Prevalence ratios (PRs) for current smoking, heavy daily smoking (>20 cigarettes per day), at-risk drinking (>100 g alcohol per week), and heavy drinking (>350 g) were calculated with adjustment for potential confounders. After stratification by age (20-39, 40-64, and 65-79 years) and sex, prevalence and PRs were calculated using propensity scores. RESULTS From among 340,194 participants, 8275 (2.4%) had mental disorder. Presence of mental disorder was significantly associated with current smoking (PR=1.18, 95%CI=1.12-1.23) and heavy daily smoking (PR=1.35, 95%CI=1.21-1.50) and inversely associated with at-risk drinking (PR=0.70, 95%CI=0.66-0.75). PRs for smoking behavior were higher in women than in men and in younger adults than in the other age groups. They were particularly high in younger women (PR=1.67 for current smokers and PR=2.17 for heavy daily smokers). LIMITATIONS Our findings were obtained from a cross-sectional study. CONCLUSION This is the first evidence that the association of mental disorder with smoking behavior is independent of anxiety and depressive symptoms. Our results indicate the need for tailored behavioral modification interventions for young people with mental disorders in Japan, particularly young women.
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Affiliation(s)
- Ryo Okubo
- Department of Clinical Epidemiology, Translational Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka 541-8567, Japan
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24
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Japuntich SJ, Hammett PJ, Rogers ES, Fu S, Burgess DJ, El Shahawy O, Melzer AC, Noorbaloochi S, Krebs P, Sherman SE. Effectiveness of Proactive Tobacco Cessation Treatment Outreach Among Smokers With Serious Mental Illness. Nicotine Tob Res 2021; 22:1433-1438. [PMID: 31957794 DOI: 10.1093/ntr/ntaa013] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 01/17/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION People with serious mental illness (SMI) have a high smoking prevalence and low quit rates. Few cessation treatments are tested in smokers with SMI. Mental health (MH) providers are reluctant to address smoking. Proactive tobacco cessation treatment strategies reach out directly to smokers to offer counseling and medication and improve treatment utilization and quit rates. The current study is a secondary analysis of a randomized controlled trial of proactive outreach for tobacco cessation treatment in VA MH patients. AIMS AND METHODS Participants (N = 1938, 83% male, mean age 55.7) across four recruitment sites, who were current smokers and had a MH visit in the past 12 months, were identified using the electronic medical record. Participants were randomized to Intervention (telephone outreach call plus invitation to engage in MH tailored telephone counseling and assistance obtaining nicotine replacement therapy) or Control (usual care). The current study assessed outcomes in participants with SMI (N = 982). RESULTS Compared to the Control group, participants assigned to the Intervention group were more likely to engage in telephone counseling (22% vs. 3%) and use nicotine replacement therapy (51% vs. 41%). Participants in the Intervention group were more likely to be abstinent (7-day point prevalence; 18%) at 12 months than participants in the Control group (11%) but equally likely to make quit attempts. CONCLUSIONS Proactive tobacco cessation treatment is an effective strategy for tobacco users with SMI. Proactive outreach had a particularly strong effect on counseling utilization. Future randomized clinical trials examining proactive tobacco treatment approaches in SMI treatment settings are needed. IMPLICATIONS Few effective treatment models exist for smokers with SMI. Proactive tobacco cessation outreach with connections to MH tailored telephone counseling and medication promotes tobacco abstinence among smokers with SMI and is an effective treatment strategy for this underserved population.
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Affiliation(s)
- Sandra J Japuntich
- Department of Clinical Pharmacology and Toxicology, Hennepin Healthcare, Minneapolis, MN
| | - Patrick J Hammett
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Erin S Rogers
- Department of Medicine, VA New York Harbor Healthcare System, New York, NY.,Department of Population Health, New York University School of Medicine, New York, NY
| | - Steven Fu
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Diana J Burgess
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Omar El Shahawy
- Department of Population Health, New York University School of Medicine, New York, NY
| | - Anne C Melzer
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Siamak Noorbaloochi
- VA HSR&D Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN.,Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Paul Krebs
- Department of Mental Health, VA San Diego Healthcare System, San Diego, CA
| | - Scott E Sherman
- Department of Medicine, VA New York Harbor Healthcare System, New York, NY.,Department of Population Health, New York University School of Medicine, New York, NY
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25
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Ward M. Increasing Psychiatrists' Role in Addressing the Cardiovascular Health of Patients With Severe Mental Illness. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:24-30. [PMID: 34483763 DOI: 10.1176/appi.focus.20200036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The early mortality of individuals with serious mental illness has long been documented yet persists despite calls for change. Individuals with serious mental illness have a higher rate of medical morbidity than those in the general population across all categories of disease. Cardiovascular disease is particularly prevalent in this population, and it is the leading cause of death for persons with serious mental illness. Addressing cardiovascular risk factors is essential to closing the mortality gap, yet patients with serious mental illness often receive poor continuity of medical care, and psychiatrists are often their only physicians. Thus, to have an impact on the mortality gap, psychiatrists must address the cardiovascular health of their patients with serious mental illness. Here, the author presents a framework of intervention at varying levels of intensity for psychiatrists to increase their role in addressing the cardiovascular health of patients with serious mental illness.
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Affiliation(s)
- Martha Ward
- Department of Psychiatry and Behavioral Sciences and Department of Medicine, Emory University School of Medicine, Atlanta
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26
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Evins AE, West R, Benowitz NL, Russ C, Lawrence D, McRae T, Maravic MC, Heffner JL, Anthenelli RM. Efficacy and Safety of Pharmacotherapeutic Smoking Cessation Aids in Schizophrenia Spectrum Disorders: Subgroup Analysis of EAGLES. Psychiatr Serv 2021; 72:7-15. [PMID: 33138708 DOI: 10.1176/appi.ps.202000032] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy and safety of varenicline, bupropion, and nicotine replacement therapy (NRT) among smokers with schizophrenia spectrum disorders in post hoc analyses of Evaluating Adverse Events in a Global Smoking Cessation Study data. METHODS Smokers with schizophrenia spectrum disorder (N=390) and without a psychiatric illness (control group, N=4,028) were randomly assigned to receive varenicline, bupropion, NRT patch, or placebo for 12 weeks. Outcomes included abstinence rates during treatment and follow-up, number needed to treat (NNT) for abstinence, incidence of neuropsychiatric adverse events (NPSAEs), and temporal relationship between NPSAEs and abstinence status. RESULTS Smokers with schizophrenia smoked more and had greater dependence and fewer prior trials of cessation pharmacotherapy at baseline. At each time point, smokers with schizophrenia assigned to varenicline had significantly greater odds of abstinence compared with their matched placebo group, with NNT comparable to the control group. Bupropion and NRT increased odds of abstinence; confidence intervals (CIs) included 1 for some comparisons, and NNT for smokers with schizophrenia was greater than for the control group. No treatment was associated with significantly more NPSAEs, compared with placebo, in either cohort. The estimated NPSAE rate was 5% (95% CI=3.0-7.7) for smokers with schizophrenia and 1% (95% CI=0.6-2.1) for the control group. Over one-third of NPSAEs occurred during partial or full abstinence, suggesting a multifactorial nature. CONCLUSIONS For smokers with schizophrenia, varenicline led to significantly higher abstinence rates, and NNT was comparable to the control group. A significant proportion of NPSAEs occurred during early abstinence. No treatment significantly increased NPSAE prevalence.
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Affiliation(s)
- A Eden Evins
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Robert West
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Neal L Benowitz
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Cristina Russ
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - David Lawrence
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Thomas McRae
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Melissa Culhane Maravic
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Jaimee L Heffner
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
| | - Robert M Anthenelli
- Department of Psychiatry, Massachusetts General Hospital, Boston (Evins, Maravic); Department of Psychiatry, Harvard Medical School, Boston (Evins); Department of Epidemiology and Public Health, University College London, London (West); Departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy, University of California, San Francisco (Benowitz); Pfizer, New York (Russ, Lawrence, McRae); Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle (Heffner); Department of Psychiatry, University of California, San Diego (Anthenelli)
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27
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Vestergaard JH, Sivapalan P, Sørensen R, Eklöf J, Achir Alispahic I, von Bülow A, Seersholm N, Jensen JUS. Depressive symptoms among patients with COPD according to smoking status: a Danish nationwide case-control study of 21 184 patients. ERJ Open Res 2020; 6:00036-2020. [PMID: 33294426 PMCID: PMC7701339 DOI: 10.1183/23120541.00036-2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 09/08/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Depressive symptoms appear more often among patients with COPD and are associated with reduced disease control and increased mortality. Both smoking and COPD increase the risk of depressive symptoms. Whether smoking cessation among COPD patients affects the occurrence of depressive symptoms is unknown. We hypothesised that smoking cessation in patients with COPD leads to reduced use of antidepressants and fewer admissions to psychiatric hospitals with depression, anxiety or bipolar disorder. Methods We conducted a nationwide retrospective case-control study, in patients from The Danish Register for COPD with spirometry-verified COPD, age ≥40 years, a history of smoking and absence of cancer. Consistent smokers were matched 1:1 with ex-smokers using a propensity score model. Prescription fillings of antidepressants and risk of admissions to psychiatric hospitals with either depression, anxiety or bipolar disorder both descriptively was assessed by Cox proportional hazard models. Results We included 21 184 patients. A total of 2011 consistent smokers collected antidepressant prescriptions compared with 1821 ex-smokers. Consistent smoking was associated with increased risk of filling prescription on antidepressants (HR 1.4, 95% CI 1.3-1.5, p<0.0001) and with increased risk of psychiatric hospital admission with either depression, anxiety or bipolar disorder (HR 2.0, 95% CI 1.6-2.5). The associations persisted after adjustment for former use of antidepressants. Conclusion Consistent smoking among COPD patients was associated with increased use of antidepressants and admissions to psychiatric hospitals with either depression, anxiety or bipolar disorder, compared to smoking cessation.
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Affiliation(s)
- Jakob Hedemark Vestergaard
- Dept of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark
| | - Pradeesh Sivapalan
- Dept of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark.,Dept of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Rikke Sørensen
- Dept of Cardiology, Rigshospitalet, University Hospital of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Josefin Eklöf
- Dept of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark
| | - Imane Achir Alispahic
- Dept of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark
| | - Anna von Bülow
- Dept of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark
| | - Niels Seersholm
- Dept of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark
| | - Jens-Ulrik Stæhr Jensen
- Dept of Internal Medicine, Respiratory Medicine Section, Herlev and Gentofte Hospital, University Hospital of Copenhagen, Hellerup, Denmark.,PERSIMUNE, Dept of Infectious Diseases, Rigshospitalet, Copenhagen, Denmark
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28
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Abstract
Blood oxygen level dependent (BOLD) fMRI is a common technique for measuring brain activation that could be affected by low-level carbon monoxide (CO) exposure from, e.g. smoking. This study aimed to probe the vulnerability of BOLD fMRI to CO and determine whether it may constitute a significant neuroimaging confound. Low-level (6 ppm exhaled) CO effects on BOLD response were assessed in 12 healthy never-smokers on two separate experimental days (CO and air control). fMRI tasks were breath-holds (hypercapnia), visual stimulation and fingertapping. BOLD fMRI response was lower during breath holds, visual stimulation and fingertapping in the CO protocol compared to the air control protocol. Behavioural and physiological measures remained unchanged. We conclude that BOLD fMRI might be vulnerable to changes in baseline CO, and suggest exercising caution when imaging populations exposed to elevated CO levels. Further work is required to fully elucidate the impact on CO on fMRI and its underlying mechanisms.
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Affiliation(s)
- Caroline Bendell
- Biological and Medical Sciences, Oxford Brookes University, Oxford, UK
| | - Shakeeb H Moosavi
- Biological and Medical Sciences, Oxford Brookes University, Oxford, UK
| | - Mari Herigstad
- Biomolecular Sciences Research Centre, Department of Biosciences and Chemistry, Sheffield Hallam University, Sheffield, UK
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29
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Gowarty MA, Kung NJ, Maher AE, Longacre MR, Brunette MF. Perceptions of Mobile Apps for Smoking Cessation Among Young People in Community Mental Health Care: Qualitative Study. JMIR Form Res 2020; 4:e19860. [PMID: 33006560 PMCID: PMC7568217 DOI: 10.2196/19860] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Young adults with serious mental illness are over twice as likely to have tobacco use disorder than those in the general population and are less likely to utilize proven treatment methods during quit attempts. However, little research has evaluated the efficacy of interventions for this group. Smartphone apps may be an underutilized tool for tobacco use disorder among young adults with serious mental illness. OBJECTIVE The aim of this study was to explore attitudes toward smoking cessation apps and preferences regarding app design in young adult smokers with serious mental illness. METHODS Five focus groups involving 25- to 35-year-old adults with serious mental illness receiving treatment at a community mental health center were conducted between May 2019 and August 2019. Three researchers independently coded transcripts and identified themes using thematic analysis. RESULTS Participants (n=22) were individuals who smoke daily: 10 (46%) self-identified as female, 18 (82%) self-identified as White, and 9 (41%) had psychotic disorders. Key themes that emerged included a general interest in using health apps; a desire for apps to provide ongoing motivation during a quit attempt via social support, progress tracking, and rewards; a desire for apps to provide distraction from smoking; concerns about app effectiveness due to a lack of external accountability; and concerns that apps could trigger cravings or smoking behavior by mentioning cigarettes or the act of smoking. CONCLUSIONS Apps have the potential to support smoking cessation or reduction efforts among young adults with serious mental illness. However, they may require tailoring, optimization, and clinical support to effectively promote cessation in this population.
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Affiliation(s)
- Minda A Gowarty
- Departments of Internal Medicine and Community and Family Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States.,Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Nathan J Kung
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Ashley E Maher
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Meghan R Longacre
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Mary F Brunette
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
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30
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Lee S, Oh Y, Kim H, Kong M, Moon J. Implications of electronic cigarette use for depressive mood: A nationwide cross-sectional study. Medicine (Baltimore) 2020; 99:e22514. [PMID: 33019453 PMCID: PMC7535681 DOI: 10.1097/md.0000000000022514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Despite the controversy surrounding electronic cigarette (e-cigarette) safety, global consumption has been rapidly increasing. We investigated the relationship between e-cigarette use and mental health conditions in adults of various ages.We conducted a secondary data analysis of adults aged 19 to 80 who participated in the first year of the 7th Korea National Health and Nutrition Examination Survey (2016). The total number of participants was 5469, including 3398 non-smokers, 1700 smokers who had never used e-cigarettes, and 371 smokers who had previously used e-cigarettes, selected based on self-report questionnaires. Mental health factors including stress status, depressive mood, suicide plan, and suicide attempt were assessed by self-reported questionnaire. The Patient Health Questionnaire (PHQ-9) was used to assess depressive mood, with a cut-off value of 10. The relationship between e-cigarette use and stress status with depressive mood were analyzed with adjustment for potential confounders.Both male and female smokers who previously used e-cigarettes showed higher levels of stress than non-smokers or smokers who had never used e-cigarettes. The average PHQ-9 score was higher among previous e-cigarette-using smokers relative to non-smokers and smokers who had never used e-cigarettes, regardless of gender. The number of participants with depressive mood was significantly higher in the group of smokers who previously used e-cigarettes. In multivariable-adjusted logistic regression analyses, there was a significantly higher odds ratio for higher stress in male smokers who had previously used e-cigarettes and for depressive mood in female smokers who had previously used e-cigarettes, compared with non-smokers.This study analyzed the association between adult e-cigarette use and mental health conditions, including stress and depressive mood, and showed that e-cigarette use was significantly related to both conditions in men and women.
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Affiliation(s)
- Sumin Lee
- School of Medicine, Jeju National University
| | - Yunhwan Oh
- Department of Family Medicine, Jeju National University Hospital
| | - Hyeonju Kim
- Department of Family Medicine, Jeju National University Hospital
- Department of Family Medicine, School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Mihee Kong
- Department of Family Medicine, Jeju National University Hospital
- Department of Family Medicine, School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Jihyun Moon
- Department of Family Medicine, Jeju National University Hospital
- Department of Family Medicine, School of Medicine, Jeju National University, Jeju, Republic of Korea
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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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Higgins ST, Tidey JW, Sigmon SC, Heil SH, Gaalema DE, Lee D, Hughes JR, Villanti AC, Bunn JY, Davis DR, Bergeria CL, Streck JM, Parker MA, Miller ME, DeSarno M, Priest JS, Cioe P, MacLeod D, Barrows A, Markesich C, Harfmann RF. Changes in Cigarette Consumption With Reduced Nicotine Content Cigarettes Among Smokers With Psychiatric Conditions or Socioeconomic Disadvantage: 3 Randomized Clinical Trials. JAMA Netw Open 2020; 3:e2019311. [PMID: 33079196 PMCID: PMC7576411 DOI: 10.1001/jamanetworkopen.2020.19311] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE This study is part of a programmatic effort evaluating the effects of reducing nicotine content of cigarettes to minimally addictive levels. OBJECTIVE To examine whether very low-nicotine-content (VLNC) cigarettes decrease smoking rates and dependence severity among smokers with psychiatric disorders or socioeconomic disadvantage. DESIGN, SETTING, AND PARTICIPANTS These 3 randomized clinical trials were performed at the University of Vermont, Brown University, and Johns Hopkins University between October 2016 and September 2019. Participants received 12 weeks of exposure to study cigarettes with nicotine content ranging from levels representative of commercial cigarettes (15.8 mg nicotine/g tobacco) to less than a hypothesized addiction threshold (2.4 mg/g and 0.4 mg/g). Daily smokers from 3 at-risk populations participated: individuals with affective disorders, exemplifying smokers with mental illness; individuals with opioid use disorder, exemplifying smokers with substance use disorders; and women with high school educations or less, exemplifying smokers with socioeconomic disadvantage. Data were analyzed from September 2019 to July 2020. INTERVENTIONS Random assignment to 1 of 3 study cigarettes provided weekly at no cost for 12 weeks. MAIN OUTCOMES AND MEASURES The primary outcome was between-group differences in mean total cigarettes smoked daily (CPD) during week 12; secondary outcomes included CPD for study and nonstudy cigarettes and dependence severity across weeks analyzed using analysis of covariance, random coefficients growth modeling, or repeated measures analysis of variance. RESULTS A total of 775 participants were included (mean [SD] age, 35.59 [11.05] years; 551 [71.10%] women [owing to 1 population being exclusively women]); participants smoked a mean (SD) of 17.79 (9.18) CPD at study intake. A total of 286 participants were randomized to 0.4 mg/g, 235 participants were randomized to 2.4 mg/g, and 254 participants were randomized to 15.8 mg/g. Participants randomized to VLNC cigarettes had decreased mean [SEM] total CPD during week 12 across populations (Cohen d = 0.61; P < .001). At week 12, mean (SEM) CPD decreased to 17.96 (0.98) CPD in the 0.4 mg/g group and to 19.53 (1.07) CPD in the 2.4 mg/g group, both of which were significantly different from the 15.8 mg/g group (25.08 [1.08] CPD at week 12) but not each other (0.4 mg/g adjusted mean difference: -7.54 [95%CI, -9.51 to -5.57]; 2.4 mg/g adjusted mean difference: -5.34 [95% CI, 7.41 to -3.26]). Several secondary outcomes differed across populations randomized to VLNCs, including mean total CPD across weeks, with linear trends lower in participants receiving 0.4 mg/g (-0.28 [95%CI, -0.39 to -0.18]; P < .001) and 2.4 mg/g (-0.13 [95%CI, -0.25 to -0.01]; P < .001) doses compared with those receiving the 15.8 mg/g dose (0.30 [95% CI, 0.19 to 0.41]). Fagerström Test of Nicotine Dependence mean total scores were significantly lower in participants who received VLNCs (Cohen d = 0.12; P < .001), with those who received the 0.4 mg/g dose (mean [SD] score, 3.99 [0.06]; P < .001 vs 15.8 mg/g) or 2.4 mg/g dose (mean [SD] score, 4.07 [0.06]; P = .01 vs 15.8 mg/g) differing from those who received the 15.8 mg/g dose (mean [SD] score, 4.31 [0.06]) but not from each other. CONCLUSIONS AND RELEVANCE These findings demonstrate that decreasing the nicotine content of cigarettes to very low levels reduced smoking rate and nicotine-dependence severity in these high-risk populations, effects that may facilitate successful cessation. TRIAL REGISTRATION ClinicalTrials.gov Identifiers: NCT02232737, NCT02250664, NCT02250534.
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Affiliation(s)
- Stephen T. Higgins
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Jennifer W. Tidey
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Stacey C. Sigmon
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Sarah H. Heil
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Diann E. Gaalema
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Dustin Lee
- Yale University Tobacco Center of Regulatory Science, Yale University School of Medicine, New Haven, Connecticut
| | - John R. Hughes
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Andrea C. Villanti
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Janice Y. Bunn
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Danielle R. Davis
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
- Yale University Tobacco Center of Regulatory Science, Yale University School of Medicine, New Haven, Connecticut
| | - Cecilia L. Bergeria
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
- Behavioral Pharmacology Research Unit, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joanna M. Streck
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Maria A. Parker
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
- School of Public Health, Indiana University, Bloomington
| | - Mollie E. Miller
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Michael DeSarno
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Jeff S. Priest
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Patricia Cioe
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island
| | - Douglas MacLeod
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
| | - Anthony Barrows
- UVM Tobacco Center of Regulatory Science, University of Vermont, Burlington
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Garey L, Olofsson H, Garza T, Rogers AH, Kauffman BY, Zvolensky MJ. Directional Effects of Anxiety and Depressive Disorders with Substance Use: a Review of Recent Prospective Research. CURRENT ADDICTION REPORTS 2020. [DOI: 10.1007/s40429-020-00321-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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García-Pérez Á, Vallejo-Seco G, Weidberg S, González-Roz A, Secades-Villa R. Long-term changes in delay discounting following a smoking cessation treatment for patients with depression. Drug Alcohol Depend 2020; 212:108007. [PMID: 32370930 DOI: 10.1016/j.drugalcdep.2020.108007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/27/2020] [Accepted: 04/01/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Delay discounting (DD) has been identified as a trans-disorder process underlying addictive behaviors, including smoking. Previous studies have evaluated how different treatments for drug dependence have affected DD, showing mixed results. Furthermore, no study has examined the effects of changes in depression on DD rates. The aim of this study was to evaluate the impact of treatment type: cognitive behavioral treatment (CBT), CBT + behavioral activation (BA), or CBT + BA + contingency management (CM), and changes in smoking status and depression on DD rates in long-term follow-up among a sample of treatment-seeking smokers with depression. METHODS Participants were 180 treatment-seeking smokers with depression who were randomly assigned to one of the following treatment conditions: CBT (n = 60), CBT + BA (n = 60), and CBT + BA + CM (n = 60). Depressive symptomatology and major depression diagnosis were evaluated through the BDI-II and the SCID-I of the DSM-IV-TR. DD rates were assessed using the DD task with hypothetical monetary rewards. Smoking status, DD, and depressive symptomatology were collected at baseline, at end-of-treatment and at one-, two-, three-, and six-month follow-ups. RESULTS CM for smoking cessation reduces DD rates (p = .0094). Smoking abstinence (p = .0024) and reduction in depressive symptoms (p = .0437) were associated with decreases in DD rates in long-term follow-up. CONCLUSIONS CM interventions for smoking cessation, smoking abstinence, and the improvement of depression contribute to reductions in DD over time.
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Affiliation(s)
- Ángel García-Pérez
- Department of Psychology. University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain.
| | | | - Sara Weidberg
- Department of Psychology. University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
| | - Alba González-Roz
- Department of Psychology. University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
| | - Roberto Secades-Villa
- Department of Psychology. University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
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Garey L, Olofsson H, Garza T, Shepherd JM, Smit T, Zvolensky MJ. The Role of Anxiety in Smoking Onset, Severity, and Cessation-Related Outcomes: a Review of Recent Literature. Curr Psychiatry Rep 2020; 22:38. [PMID: 32506166 DOI: 10.1007/s11920-020-01160-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Anxiety is one of the most common mental health conditions globally and co-occurs with smoking at a markedly high rate. The present review offers a narrative overview of the most recent research on the role of anxiety in smoking onset, maintenance, and cessation-related outcomes. Additionally, given the rise in electronic cigarette use, we review the emerging literature on the influence of anxiety on e-cigarette use. RECENT FINDINGS Evidence across studies varied as to the role of anxiety or anxiety symptoms in smoking behavior. The most consistent findings suggested that those with anxiety are more likely to be a smoker, supporting a high rate of co-occurrence across these conditions. Less consistent evidence was observed for the association between anxiety and onset, indicators of severity, and cessation outcomes. Although there is robust evidence for an association between smoking and anxiety, there were considerable discrepancies for the precise role of anxiety in smoking onset, severity, and cessation outcomes. Future work utilizing more sophisticated methodologies is needed to identify causal relations as well as putative moderators and mediators of the anxiety-smoking relation.
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Affiliation(s)
- Lorra Garey
- Department of Psychology, University of Houston, Room 126 Heyne Building, Houston, TX, 77204, USA.
| | - Hannah Olofsson
- Department of Psychology, University of Houston, Room 126 Heyne Building, Houston, TX, 77204, USA
| | - Tatyana Garza
- Department of Psychology, University of Houston, Room 126 Heyne Building, Houston, TX, 77204, USA
| | - Justin M Shepherd
- Department of Psychology, University of Houston, Room 126 Heyne Building, Houston, TX, 77204, USA
| | - Tanya Smit
- Department of Psychology, University of Houston, Room 126 Heyne Building, Houston, TX, 77204, USA
| | - Michael J Zvolensky
- Department of Psychology, University of Houston, Room 126 Heyne Building, Houston, TX, 77204, USA.,Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,HEALTH Institute, University of Houston, Houston, TX, 77204, USA
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Dreyer J, Pooe JM, Dzikiti L, Krüger C. Factors associated with the successful completion of a substance rehabilitation programme at a psychiatric training hospital. S Afr J Psychiatr 2020; 26:1255. [PMID: 32161678 PMCID: PMC7059449 DOI: 10.4102/sajpsychiatry.v26i0.1255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/29/2019] [Indexed: 11/24/2022] Open
Abstract
Background Comorbid psychiatric and substance use disorders are common and present several treatment challenges. Aim The aim of this study was to determine which patient and substance factors are associated with the completion of a substance rehabilitation programme in psychiatric inpatients. Setting The study was conducted at the Substance Rehabilitation Unit (SRU) at Weskoppies Hospital, a psychiatric training hospital in South Africa, which offers a 6-week programme at the hospital for psychiatric inpatients. Methods This descriptive, retrospective hospital-based study was carried out comparing completers and non-completers of the SRU programme with respect to patient and substance factors. All patients accepted into the SRU during 2013–2014 were included (n = 119). Data were collected over a year (2016–2017) from the clinical files, SRU referral forms, SRU attendance register, hospital computerised demographic records, nursing notes and administration files using a data collection sheet designed by the researchers for this study. Comparison between completers and non-completers was performed using Chi-Square or Fisher’s Exact tests. Results The SRU accepted 119 patients from January 2013 to December 2014. The majority of the sample were involuntary patients (n = 39), 30–49 years old (n = 57), male (n = 89), unmarried (n = 112), never having received a disability grant (n = 27), unemployed (n = 96) and with a Grade 8–11 education (n = 49). Substance-induced psychotic disorders (n = 39), schizophrenia (n = 29) and bipolar disorders (n = 22) were found to be common. Frequent medical comorbidities included head injury (n = 27), cardiovascular disease (n = 18) and HIV reactivity (n = 7). Cannabis (n = 98), alcohol (n = 94) and nicotine (n = 90) were the most frequently used substances. Level of education (p = 0.004), disability grant status (p = 0.004), Nyaope use (p = 0.001) and nicotine use (p = 0.049) were statistically seen to be significantly associated with completion. Psychiatric diagnoses and general medical comorbidity were not associated with completion. Conclusions This study has yielded several results in areas that have not yet been well researched in South Africa. Risk factors for non-completion may include lower levels of education, being on a disability grant and using Nyaope or nicotine, but may vary in different settings. Future research should focus on identifying further factors that may affect completion of substance rehabilitation in psychiatric inpatients, the role of disability grants in patients with co-occurring disorders and the effect of Nyaope and nicotine use on treatment outcomes in this population. Effective and accessible interventions to assist vulnerable patients also need to be identified.
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Affiliation(s)
- Justine Dreyer
- Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Jacobeth M Pooe
- Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Loveness Dzikiti
- School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Christa Krüger
- Department of Psychiatry, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Al Rifai M, Mirbolouk M, Obisesan OH, Jia X, Nasir K, Merchant AT, Blaha M, Virani S. The Association of Electronic Cigarette Use and the Subjective Domains of Physical and Mental Health: The Behavioral Risk Factor Surveillance System Survey. Cureus 2020; 12:e7088. [PMID: 32226689 PMCID: PMC7096000 DOI: 10.7759/cureus.7088] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Individuals who use electronic cigarettes (e-cigarettes) may have a poor perception of physical and mental health. We, therefore, studied the association of e-cigarettes with subjectively reported health domains. Methods We utilized cross-sectional data from the 2016 and 2017 Behavioral Risk Factor Surveillance System (BRFSS), a nationally representative U.S. telephone-based survey. All variables were self-reported. E-cigarette use was characterized as never, former, or current. Health domains included overall health, physical health, and mental health, which was assessed as the frequency of emotional support, life satisfaction, and feeling stressed. Weighted multivariable-adjusted logistic regression models were used to examine the association between e-cigarette use and these health domains. Results Our study population consisted of 755,355 (79%) never e-cigarette users, 111,940 (16%) former users, and 28,917 (5%) current users. There was a significant association between e-cigarette use and the less favorable perceived state of overall health, physical health, or mental health. For example, the OR (95% CI) for the association of current e-cigarette use with health domains was as follows: good perception of overall health: 0.78 (0.74,0.83), physical health: 0.69 (0.66,0.73), adequate emotional support: 0.89 (0.79,0.99), feeling satisfied: 0.83 (0.71,0.96), or being free of stress: 0.64 (0.53,0.76). Similar results were obtained in younger individuals (aged 18-34 years). Conclusions E-cigarette use is associated with a less favorable perception of physical and mental health as compared to never use, particularly among younger adults. These results have important implications for clinicians for patient counseling and regulatory agencies to regulate e-cigarette sales.
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Affiliation(s)
| | | | - Olufunmilayo H Obisesan
- Epidemiology and Public Health, The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, USA
| | - Xiaoming Jia
- Cardiology, Baylor College of Medicine, Houston, USA
| | - Khurram Nasir
- Cardiology, Debakey Heart & Vascular Center, Houston Methodist Hospital, Houston, USA
| | - Anwara T Merchant
- Epidemiology and Biostatistics, Arnold School of Public Health, Columbia, USA
| | | | - Salim Virani
- Cardiology, Michael E. Debakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, USA
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Brunette MF, Ferron JC, McGurk SR, Williams JM, Harrington A, Devitt T, Xie H. Brief, Web-Based Interventions to Motivate Smokers With Schizophrenia: Randomized Trial. JMIR Ment Health 2020; 7:e16524. [PMID: 32039811 PMCID: PMC7055792 DOI: 10.2196/16524] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In-person motivational interventions increase engagement with evidence-based cessation treatments among smokers with schizophrenia, but access to such interventions can be limited because of workforce shortages and competing demands in mental health clinics. The use of digital technology to deliver interventions can increase access, but cognitive impairments in schizophrenia may impede the use of standard digital interventions. We developed an interactive, multimedia, digital motivational decision support system for smokers with schizophrenia (Let's Talk About Smoking). We also digitalized a standard educational pamphlet from the National Cancer Institute (NCI Education). Both were tailored to reduce cognitive load during use. OBJECTIVE We conducted a randomized trial of Let's Talk About Smoking versus NCI Education to test whether the interactive motivational intervention was more effective and more appealing than the static educational intervention for increasing use of smoking cessation treatment, quit attempts, and abstinence among smokers with schizophrenia, accounting for the level of cognitive functioning. METHODS Adult smokers with schizophrenia (n=162) were enrolled in the study from 2014 to 2015, randomly assigned to intervention condition, and assessed in person at 3- and 6-month follow-ups. Interventions were delivered on a laptop computer in a single session. All participants had access to standard, community-delivered cessation treatments during follow-up. Multivariate models were used to evaluate outcomes. RESULTS Treatment initiation outcomes were not different between intervention conditions (27/84 [32%] for Let's Talk About Smoking vs 36/78 [46%] for NCI Education; odds ratio [OR] 0.71 [95% CI 0.37-1.33]); 38.9% (63/162) of participants initiated treatment. Older age (OR 1.03 [95% CI 1.00-1.07]; P=.05), higher education (OR 1.21 [95% CI 1.04-1.41]; P=.03), and fewer positive symptoms (OR 0.87 [95% CI 0.80-0.96]; P=.01) predicted cessation treatment initiation, whereas level of cognition did not. The mean satisfaction and usability index score was higher for Let's Talk About Smoking versus NCI Education (8.9 [SD 1.3] vs 8.3 [SD 2.1]; t120.7=2.0; P=.045). Quit attempts (25/84, 30% vs 36/78, 46%; estimate [Est]=-0.093, SE 0.48; P=.85) and abstinence (1/84, 1% vs 6/78, 7%; χ21=3.4; P=.07) were not significantly different between intervention conditions. Cognitive functioning at baseline (Est=1.47, SE 0.47; P=.002) and use of any behavioral or medication cessation treatment (Est=1.43, SE 0.47; P=.003) predicted quit attempts with self-reported abstinence over the 6-month follow-up. CONCLUSIONS The interactive, multimedia intervention was not more effective than the static, text-based intervention among smokers with schizophrenia. Both tailored digital interventions resulted in levels of treatment engagement and quit attempts that were similar to findings from previous studies of in-person interventions, confirming the potential role of digital interventions to educate and motivate smokers with schizophrenia to use cessation treatment and to quit smoking. These findings indicate that additional cessation treatment is needed after brief education or motivational interventions, and that cessation treatment should be adjusted for people with cognitive impairment. TRIAL REGISTRATION ClinicalTrials.gov NCT02086162; https://clinicaltrials.gov/show/NCT02086162.
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Affiliation(s)
- Mary F Brunette
- Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock, Concord, NH, United States
- Dartmouth-Hitchcock, Concord, NH, United States
| | | | | | | | - Amy Harrington
- University of Massachusetts, Worcester, MA, United States
| | | | - Haiyi Xie
- Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock, Concord, NH, United States
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Johnson AL, Kaye J, Baker TB, Fiore MC, Cook JW, Piper ME. Psychiatric comorbidities in a comparative effectiveness smoking cessation trial: Relations with cessation success, treatment response, and relapse risk factors. Drug Alcohol Depend 2020; 207:107796. [PMID: 31864163 PMCID: PMC7076564 DOI: 10.1016/j.drugalcdep.2019.107796] [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] [Received: 08/30/2019] [Revised: 11/26/2019] [Accepted: 11/26/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Comorbid psychiatric diagnoses have been shown to predict cessation failure. The relative impact of various diagnoses on cessation and other cessation processes is rarely studied, particularly among a general population. The impact of psychiatric history among primary care patients seeking cessation services on nicotine dependence, cessation outcomes, treatment effects and adherence, and withdrawal symptoms was examined. METHODS Secondary data analysis of a multi-site comparative effectiveness smoking cessation trial was conducted. Adult smokers (n = 1051; 52.5 % Female, 68.1 % white) completed a structured clinical interview at baseline to assess psychiatric diagnostic history (past-year and lifetime). Nicotine dependence was assessed via self-report measures at baseline. Point-prevalence abstinence was assessed at 8 weeks and 6 months post-quit. Withdrawal symptoms were assessed for one week pre- and post-quit using ecological momentary assessment. Treatment adherence was self-reported at 1, 4, 8, and 12 weeks post-quit. RESULTS Past-year substance use disorder, lifetime mood disorder, and > one lifetime diagnosis, were related to lower rates of short-term, but not long-term, cessation. Lifetime psychiatric diagnosis was related to elevated nicotine dependence, particularly to secondary dependence motives associated with instrumental tobacco use. History of psychiatric diagnosis was associated with increased withdrawal-related craving. There was little evidence that psychiatric diagnostic status moderated the effects of the tested pharmacotherapies on long-term abstinence. CONCLUSIONS Psychiatric diagnoses affect risk factors that exert their effects early in the post-quit process and highlight the potential utility of examining transdiagnostic risk factors to better understand the relations between psychiatric vulnerabilities and the smoking cessation process.
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Affiliation(s)
- Adrienne L. Johnson
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705,Correspondence concerning this article should be addressed to Megan E. Piper, Ph.D., Center for Tobacco Research and Intervention, University of Wisconsin, Madison, WI, 53711; Tel: 608-265-5472; Fax: 608-265-3102;
| | - Jesse Kaye
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705
| | - Timothy B. Baker
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Michael C. Fiore
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
| | - Jessica W. Cook
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,William S. Middleton Memorial Veterans Hospital, 2500 Overlook Terrace, Madison, WI 53705
| | - Megan E. Piper
- University of Wisconsin School of Medicine and Public Health, Center for Tobacco Research and Intervention, 1930 Monroe St., Ste. 200, Madison, WI, 53711,University of Wisconsin School of Medicine and Public Health, Department of Medicine, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI 53705
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Japuntich SJ, Dunne EM, Krieger NH, Ryan PM, Rogers E, Sherman SE, Fu SS. Proactive Tobacco Treatment in a Behavioral Health Home. Community Ment Health J 2020; 56:328-332. [PMID: 31520255 DOI: 10.1007/s10597-019-00458-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 09/07/2019] [Indexed: 12/30/2022]
Abstract
Tobacco use is rarely addressed in community mental healthcare despite high patient smoking prevalence. Community mental health centers have systems in place that could be used to comprehensively address tobacco use. This study tested feasibility of, satisfaction with, and safety of proactive tobacco treatment (tobacco outreach to offer connection to tobacco cessation treatment). Behavioral health home patients who smoke were randomly assigned to usual care (UC; N = 11) or proactive care (PC; N = 9). All participants were called 3-months post-randomization for follow-up. PC patients reported high satisfaction with the program and experienced no adverse events or mental health symptom exacerbation during treatment. PC patients reported greater reductions in cigarettes per day, more quit attempts, and more cessation medication utilization than UC patients. Proactive outreach for tobacco cessation is feasible in a behavioral health home, acceptable to patients, and may reduce smoking heaviness and promote quit attempts.
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Affiliation(s)
- Sandra J Japuntich
- Hennepin Healthcare Research Institute, 701 Park Ave. S.9.303, Minneapolis, MN, 55415, USA.
| | - Eugene M Dunne
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, The Alpert Medical School of Brown University, Providence, RI, USA
| | - Naomi H Krieger
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, USA
| | | | - Erin Rogers
- VA New York Harbor Healthcare System, New York City, NY, USA
- Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA
| | - Scott E Sherman
- VA New York Harbor Healthcare System, New York City, NY, USA
- Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA
| | - Steven S Fu
- VA HSR&D Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, 55417, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
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Simoila L, Isometsä E, Suvisaari J, Halmesmäki E, Lindberg N. Obstetric and perinatal health outcomes related to schizophrenia: A national register-based follow-up study among Finnish women born between 1965 and 1980 and their offspring. Eur Psychiatry 2020; 52:68-75. [DOI: 10.1016/j.eurpsy.2018.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/27/2018] [Accepted: 04/03/2018] [Indexed: 01/08/2023] Open
Abstract
AbstractBackground:This national register-based study assesses obstetric and perinatal health outcomes in women with schizophrenia and their offspring.Methods:Using the Care Register for Health Care, we identified Finnish women who were born in 1965- 1980 and diagnosed with schizophrenia. For each case, five age- and place-of-birth- matched controls were obtained from the Central Population Register of Finland. They were followed from the day when the disorder was diagnosed in specialized health-care (the index day) until 31.12.2013. Information related to births was obtained from the Medical Birth Register and the Register of Congenital Malformations. We focused on singleton pregnancies that led to a delivery after the index day. We restricted the analysis of deliveries in controls to those that occurred after the index day of the case. Maternal age, marital status, smoking status, sex of the newborn, and parity were used as covariates in adjusted models.Results:We identified 1162 singleton births among women with schizophrenia and 4683 among controls. Schizophrenic women had a 1.4-fold increased risk of induction of labor, delivery by cesarean section, and delivery by elective cesarean section. Regarding offspring, the risk of premature birth and the risk of low Apgar score at 1 min (<7) were 1.6-fold, of resuscitation 2.5-fold, and of neonatal monitoring 2.1-fold higher.Conclusions:Schizophrenia associates with some specific delivery methods, but delivery complications are rare and their prevalence does not differ from that observed among community women. Maternal schizophrenia associates with some negative perinatal health outcomes of the offspring.
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Simoila L, Isometsä E, Gissler M, Suvisaari J, Halmesmäki E, Lindberg N. Schizophrenia and pregnancy: a national register-based follow-up study among Finnish women born between 1965 and 1980. Arch Womens Ment Health 2020; 23:91-100. [PMID: 30762149 PMCID: PMC6987069 DOI: 10.1007/s00737-019-0948-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 01/30/2019] [Indexed: 12/27/2022]
Abstract
To assess psychosocial and somatic risk factors related to pregnancy, and pregnancy-related complications or disorders in women with schizophrenia compared to population controls. In this register-based cohort study, we identified all Finnish women who were born in 1965-1980 and diagnosed with schizophrenia in psychiatric care before 31 December 2013. For each case, five age- and place-of-birth matched controls were randomly selected. They were followed from the day when the disorder was diagnosed in specialized health care till the end of 2013. The mean follow-up time was 14.0 + 6.91 vs. 14.3 + 6.89 years. Altogether, 1162 singleton pregnancies were found among affected women and 4683 among controls. Affected women were significantly older and more often single; their body mass index before pregnancy was significantly higher, and they smoked significantly more often both in the beginning of pregnancy and after the first trimester than controls. They showed a significantly higher odds for pathologic oral glucose tolerance test (odds ratio (OR) 1.66, 95% confidence interval (95% CI) 1.27-2.17), initiation of insulin treatment (OR 1.84, 95% CI 1.15-2.93), fast fetal growth (OR 1.62, 95% CI 1.03-2.52), premature contractions (OR 2.42, 95% CI 1.31-4.49), hypertension (OR 1.81, 95% CI 1.01-3.27), and pregnancy-related hospitalizations (OR 1.97, 95% CI 1.66-2.33). Suspected damage to the fetus from alcohol/drugs was significantly more common among affected women than controls. Women with schizophrenia have higher prevalence of psychosocial and somatic risk factors related to pregnancy, as well as pregnancy-related complications and disorders than non-affected women.
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Affiliation(s)
- Laura Simoila
- grid.424664.60000 0004 0410 2290Psychiatry, Helsinki University and Helsinki University Hospital, Psykiatriakeskus, P.O. Box 590, 00029 HUS, Finland
| | - Erkki Isometsä
- grid.424664.60000 0004 0410 2290Psychiatry, Helsinki University and Helsinki University Hospital, Psykiatriakeskus, P.O. Box 590, 00029 HUS, Finland
| | - Mika Gissler
- grid.14758.3f0000 0001 1013 0499National Institute for Health and Welfare, Information Services Department, Mannerheimintie 166, 00270 Helsinki, Finland ,grid.1374.10000 0001 2097 1371Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3, 20520 Turku, Finland ,grid.4714.60000 0004 1937 0626Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Alfred Nobels allé 23, 14183 Huddinge, Sweden
| | - Jaana Suvisaari
- grid.14758.3f0000 0001 1013 0499National Institute for Health and Welfare, Mental Health Unit, P.O.Box 30, 00271 Helsinki, Finland
| | - Erja Halmesmäki
- Femeda-clinic, Kalevankatu 9 A, 00100 Helsinki, Finland ,grid.424664.60000 0004 0410 2290Obstetrics and Gynecology, Helsinki University and Helsinki University Hospital, Naistenklinikka, P.O. Box 140, 00029 HUS, Finland
| | - Nina Lindberg
- Forensic Psychiatry, Helsinki University and Helsinki University Hospital, Psykiatriakeskus, P.O. Box 590, 00029, HUS, Finland.
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Tidey JW, Colby SM, Denlinger-Apte RL, Goodwin C, Cioe PA, Cassidy RN, Swift RM, Lindgren BR, Rubin N, Murphy SE, Hecht SS, Hatsukami DK, Donny EC. Effects of 6-Week Use of Very Low Nicotine Content Cigarettes in Smokers With Serious Mental Illness. Nicotine Tob Res 2019; 21:S38-S45. [PMID: 31867650 PMCID: PMC6939771 DOI: 10.1093/ntr/ntz133] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/30/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION The US Food and Drug Administration is considering implementing a reduced-nicotine standard for cigarettes. Given the high rate of smoking among people with serious mental illness (SMI), it is important to examine the responses of these smokers to very low nicotine content (VLNC) cigarettes. METHODS This trial compared the effects of VLNC (0.4 mg nicotine/g tobacco) and normal nicotine content cigarettes (15.8 mg/g) over a 6-week period in non-treatment-seeking smokers with schizophrenia, schizoaffective disorder, or bipolar disorder (n = 58). Linear regression was used to examine the effects of cigarette condition on cigarettes per day, subjective responses, nicotine and tobacco toxicant exposure, craving, withdrawal symptoms, and psychiatric symptoms. RESULTS At week 6, participants in the VLNC condition smoked fewer cigarettes per day, had lower breath carbon monoxide levels, lower craving scores, and rated their study cigarettes lower in satisfaction, reward, enjoyment, and craving reduction than those in the normal nicotine content condition (ps < .05). Week 6 psychiatric and extrapyramidal symptoms did not differ by condition, except for scores on a measure of parkinsonism, which were lower in the VLNC condition (p < .05). There were no differences across conditions on total nicotine exposure, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, withdrawal symptoms, or responses to abstinence. CONCLUSIONS These results suggest that a reduced-nicotine standard for cigarettes would reduce smoking among smokers with SMI. However, the lack of effect on total nicotine exposure indicates VLNC noncompliance, suggesting that smokers with SMI may respond to a reduced-nicotine standard by substituting alternative forms of nicotine. IMPLICATIONS Results from this trial suggest that a reduced-nicotine standard for cigarettes would reduce smoking rates and smoke exposure in smokers with SMI, without increasing psychiatric symptoms. However, noncompliance with VLNC cigarettes was observed, suggesting that these smokers might respond to a reduced-nicotine standard by substituting alternative forms of nicotine.
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Affiliation(s)
- Jennifer W Tidey
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Suzanne M Colby
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Rachel L Denlinger-Apte
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Christine Goodwin
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Patricia A Cioe
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Rachel N Cassidy
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | - Robert M Swift
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
| | | | - Nathan Rubin
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Sharon E Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Stephen S Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | | | - Eric C Donny
- Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC
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Obisesan OH, Mirbolouk M, Osei AD, Orimoloye OA, Uddin SMI, Dzaye O, El Shahawy O, Al Rifai M, Bhatnagar A, Stokes A, Benjamin EJ, DeFilippis AP, Blaha MJ. Association Between e-Cigarette Use and Depression in the Behavioral Risk Factor Surveillance System, 2016-2017. JAMA Netw Open 2019; 2:e1916800. [PMID: 31800073 PMCID: PMC6902792 DOI: 10.1001/jamanetworkopen.2019.16800] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE The prevalence of the use of electronic cigarettes (e-cigarettes) in the United States has grown rapidly since their introduction to the market more than a decade ago. While several studies have demonstrated an association between combustible cigarette smoking and depression, the association between e-cigarette use and depression has not been thoroughly studied. OBJECTIVE To examine the association between e-cigarette use and depression in a nationally representative sample of the adult population in the United States. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of the Behavioral Risk Factor Surveillance System database, 2016 to 2017. The Behavioral Risk Factor Surveillance System is the largest national telephone-based survey of randomly sampled adults in the United States. A total of 892 394 participants with information on e-cigarette use and depression were included. Data analysis was conducted in May 2019. EXPOSURES Electronic cigarette use status defined by self-report as never, former, or current use. MAIN OUTCOMES AND MEASURES Self-reported history of a clinical diagnosis of depression. RESULTS Of the 892 394 participants (414 326 [29.0%] aged ≥60 years; 502 448 [51.3%] women), there were 28 736 (4.4%) current e-cigarette users, of whom 13 071 (62.1%) were aged between 18 and 39 years. Compared with never e-cigarette users, current e-cigarette users were more likely to be single, male, younger than 40 years, and current combustible cigarette smokers (single, 120 797 [24.3%] vs 10 517 [48.4%]; men, 318 970 [46.6%] vs 14 962 [60.1%]; aged 18-39 years, 129 085 [32.2%] vs 13 071 [62.1%]; current combustible cigarette use, 217 895 [7.9%] vs 8823 [51.8%]). In multivariable adjusted models, former e-cigarette users had 1.60-fold (95% CI, 1.54-1.67) higher odds of reporting a history of clinical diagnosis of depression than never users, whereas current e-cigarette users had 2.10 (95% CI, 1.98-2.23) times higher odds. Additionally, higher odds of reporting depression were observed with increased frequency of use among current e-cigarette users compared with never users (daily use: odds ratio, 2.39; 95% CI, 2.19-2.61; occasional use: odds ratio, 1.96; 95% CI, 1.82-2.10). Similar results were seen in subgroup analyses by sex, race/ethnicity, smoking status, and student status. CONCLUSIONS AND RELEVANCE This study found a significant cross-sectional association between e-cigarette use and depression, which highlights the need for prospective studies analyzing the longitudinal risk of depression with e-cigarette use. If confirmed by other study designs, the potential mental health consequences may have regulatory implications for novel tobacco products.
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Affiliation(s)
- Olufunmilayo H. Obisesan
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | | | - Albert D. Osei
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Olusola A. Orimoloye
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - S. M. Iftekhar Uddin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Omar Dzaye
- Johns Hopkins University, Baltimore, Maryland
- Department of Radiology and Neuroradiology, Charité, Berlin, Germany
| | - Omar El Shahawy
- Section on Tobacco, Alcohol, and Drug Use, Department of Population Health, School of Medicine, New York University, New York
- Public Health Research Center, New York University, Abu Dhabi, United Arab Emirates
| | - Mahmoud Al Rifai
- Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas
| | - Aruni Bhatnagar
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- University of Louisville, Louisville, Kentucky
| | - Andrew Stokes
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Boston University, Boston, Massachusetts
| | - Emelia J. Benjamin
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Boston University, Boston, Massachusetts
| | - Andrew P. DeFilippis
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- University of Louisville, Louisville, Kentucky
| | - Michael J. Blaha
- The American Heart Association Tobacco Regulation and Addiction Center, Dallas, Texas
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
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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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Gogos A, Skokou M, Ferentinou E, Gourzis P. Nicotine consumption during the prodromal phase of schizophrenia - a review of the literature. Neuropsychiatr Dis Treat 2019; 15:2943-2958. [PMID: 31802874 PMCID: PMC6801495 DOI: 10.2147/ndt.s210199] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/11/2019] [Indexed: 12/12/2022] Open
Abstract
Recent research has fueled a debate concerning the role of nicotine in the emergence of schizophrenia. The three main hypotheses are: (a) the self-medication effect, (b) the causal relationship hypothesis, or (c) the shared diathesis hypothesis. To explore this role, the study of nicotine consumption during the initial prodromal phase of schizophrenia offers important opportunities. In the present work, 10 relevant studies are reviewed, out of 727 retrieved citations, in order to address questions regarding the prevalence of smoking in the prodromal period, the time of smoking initiation, existing patterns of tobacco use in relation with the escalation of prodromal symptoms into first psychotic episode, and potential differences in symptomatology between smokers and nonsmokers. Even though there was considerable heterogeneity among studies, relevant findings are discussed. Prevalence of nicotine use during the prodromal period was reported to be 16.6-46%. Tobacco use was found to be taken up most often before or during the prodromal period of schizophrenia. Even though a protective role of smoking has been reported by one study, other studies report an increased risk for psychosis, with hazard ratios 2.77 (95% CI: 2.34-3.43) and 2.21 (95% CI: 1.11-4.42) for female and male heavy smokers (11-20 and >20 cigarettes/day), respectively. In a different study, the risk of onset was associated with the progressive use of cannabis and tobacco prior to onset, particularly with rapid escalation to the highest levels of use. Also, nicotine use in ultra high risk (UHR) for developing psychosis subjects is associated with elevated cognitive performance, namely better processing speed, visual learning, and spatial working memory. As a conclusion, it appears that evidence accumulates supporting a possible etiologic role of smoking, in the emergence of schizophrenia along with diverse effects on patients' symptomatology, already demonstrable at the prodromal phase. Future research employing better-defined criteria should further explore the patterns of use and effects of nicotine during the schizophrenia prodrome.
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Affiliation(s)
| | - Maria Skokou
- Department of Psychiatry, University Hospital of Patras, Rion, Patras, Greece
| | | | - Philippos Gourzis
- Department of Psychiatry, University Hospital of Patras, Rion, Patras, Greece
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Okoli CTC, El-Mallakh P, Seng S. Which Types of Tobacco Treatment Interventions Work for People with Schizophrenia? Provider and Mental Health Consumer Perspectives. Issues Ment Health Nurs 2019; 40:870-879. [PMID: 30388915 DOI: 10.1080/01612840.2018.1490833] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
People with schizophrenia and other psychotic disorders (PWS) consume tobacco at high rates, resulting in disproportionate tobacco-related morbidity and mortality. Conventional tobacco treatment (TT) approaches may not adequately address unique affective, cognitive, and social challenges of PWS during cessation. This study sought to obtain provider and mental health consumer perspectives on effective, desirable, applicable, and acceptable components of TT for PWS. This convergent mixed-method study used structured interviews and a cross-sectional survey to obtain data. Eighteen mental health consumers and six mental health providers were engaged in face-to-face or telephone interviews. The qualitative data were analyzed using content analysis and theme identification and descriptive statistics were used for the analysis of quantitative data. In the qualitative analysis, consumers endorsed education, counseling, social support, and pharmacotherapy as key TT components. Consumers further stressed the need for flexible interventions that are available at any point in a quit attempt. Both providers and consumers endorsed targeting TT interventions to consider learning needs, potential cognitive issues, and motivation for behavioral change. Providers encouraged a recovery-driven TT framework with peer support and health promotion activities. Quantitative findings mirrored the qualitative findings with support sessions, relapse prevention, and skills training having the highest desirability, applicability, and acceptability TT component scores. Providers and consumers agreed on components of an effective TT program targeted to PWS. Given these findings, it is crucial to further investigate successful TT approaches for PWS and to test whether targeted or tailored programs are more effective than conventional approaches.
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Affiliation(s)
- Chizimuzo T C Okoli
- Tobacco Treatment and Prevention Division, Tobacco Policy Research Program, University of Kentucky College of Nursing , Lexington , Kentucky , USA
| | - Peggy El-Mallakh
- Tobacco Treatment and Prevention Division, Tobacco Policy Research Program, University of Kentucky College of Nursing , Lexington , Kentucky , USA
| | - Sarret Seng
- Tobacco Treatment and Prevention Division, Tobacco Policy Research Program, University of Kentucky College of Nursing , Lexington , Kentucky , USA
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Aschbrenner KA, Naslund JA, Gill L, Hughes T, O’Malley AJ, Bartels SJ, Brunette MF. Qualitative analysis of social network influences on quitting smoking among individuals with serious mental illness. J Ment Health 2019; 28:475-481. [PMID: 28675331 PMCID: PMC5876150 DOI: 10.1080/09638237.2017.1340600] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 03/17/2017] [Accepted: 04/14/2017] [Indexed: 10/19/2022]
Abstract
Objective: The prevalence of cigarette smoking among adults with serious mental illness (SMI) remains high in the United States despite the availability of effective smoking cessation treatment. Identifying social influences on smoking and smoking cessation may help enhance intervention strategies to help smokers with SMI quit. The objective of this qualitative study was to explore social network influences on efforts to quit smoking among adults with SMI enrolled in a cessation treatment program. Methods: Participants were 41 individuals with SMI enrolled in a Medicaid Demonstration Project of smoking cessation at community mental health centers. A convenience sampling strategy was used to recruit participants for social network interviews exploring the influence of family, friends, peers, and significant others on quitting smoking. A team-based analysis of qualitative data involved descriptive coding, grouping coded data into categories, and identifying themes across the data. Results: Social barriers to quitting smoking included pro-smoking social norms, attitudes, and behaviors of social network members, and negative interactions with network members, either specific to smoking or that triggered smoking. Social facilitators to quitting included quitting with network members, having cessation role models, and social support for quitting from network members. Conclusions: Similar to the general population, social factors appear to influence efforts to quit smoking among individuals with SMI enrolled in cessation treatment. Interventions that leverage positive social influences on smoking cessation have the potential to enhance strategies to help individuals with SMI quit smoking.
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Affiliation(s)
- Kelly A. Aschbrenner
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - John A. Naslund
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Lydia Gill
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | | - Alistair J. O’Malley
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
| | - Stephen J. Bartels
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Mary F. Brunette
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, NH, USA
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Underner M, Perriot J, Brousse G, de Chazeron I, Schmitt A, Peiffer G, Harika-Germaneau G, Jaafari N. Arrêt et réduction du tabac chez le patient souffrant de schizophrénie. L'ENCEPHALE 2019; 45:345-356. [PMID: 31153585 DOI: 10.1016/j.encep.2019.04.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 02/08/2023]
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Dual Versus Never Use of E-Cigarettes Among American Indians Who Smoke. Am J Prev Med 2019; 57:e59-e68. [PMID: 31377092 PMCID: PMC6702079 DOI: 10.1016/j.amepre.2019.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Many American Indian communities have a high prevalence of smoking and e-cigarette use, but factors associated with their dual use are rarely studied. METHODS In 2016, a total of 375 American Indian adults who smoke completed paper surveys regarding cigarette and e-cigarette use and provided saliva for cotinine levels. In 2018, cross-sectional analyses were performed, comparing dual users (12%), defined as using e-cigarettes on some or every day for the past 30 days, with never users of e-cigarettes (37%). RESULTS Compared with never users, dual users were younger, more often reported history of depression (56% and 29%, respectively; p<0.01) and family history of smoking-related disease (77% and 59%, respectively; p<0.05), had lower harm perceptions of e-cigarettes (27% and 47%, respectively; p<0.01) or vapor (14% and 35%, respectively; p<0.01), and more often perceived e-cigarettes as cessation aids (75% and 16%, respectively; p<0.01) and as less harmful than cigarettes (70% and 17%, respectively; p<0.01). Dual users were less often uncertain/unknowing about e-cigarette benefits or harms (p<0.01) and more often reported likelihood to quit smoking (49% and 24%, respectively; p<0.01) and prior attempt to quit smoking, ever (89% and 67%, respectively; p<0.01) or in the past year (55% and 32%, respectively; p=0.01). Cigarette consumption and cotinine levels did not differ between groups. Dual users more often tried other nicotine products (p<0.02) and more often lived with a vaping partner/spouse (45% and 6%, respectively; p<0.01). CONCLUSIONS Dual users perceived e-cigarettes as less harmful than cigarettes and more as cessation aids than cigarette-only users did, but cigarette consumption did not differ between groups. Whether e-cigarettes will reduce smoking-related disparities among American Indian people remains undetermined.
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