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Rashidi Mohamed PM, Mohd Hairi F, Bullen C, Nordin ASA. The feasibility and efficacy of the group-based therapy for smoking cessation in Klang Valley, Malaysia. Tob Induc Dis 2024; 22:TID-22-50. [PMID: 38476513 PMCID: PMC10928854 DOI: 10.18332/tid/175617] [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: 03/16/2023] [Revised: 11/17/2023] [Accepted: 12/21/2023] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Tobacco epidemic is a global public health concern, killing more than 8 million people annually. Individual therapy is the standard of care of behavioral intervention for smoking cessation in Malaysia and group-based therapy for smoking cessation is an alternative to behavioral intervention commonly used in the western population effectively. The study explored the feasibility and efficacy of group-based therapy for smoking cessation for smokers who want to quit smoking at a quit smoking clinic and community centers in an urban setting in Malaysia. METHODS A total of 40 participants who were active smokers and fulfilled the criteria were recruited for the study at the quit smoking clinic. Participants were given behavioral support based on the GBT-M module and individually for 7 weeks with both groups receiving behavioral intervention plus pharmacotherapy. RESULTS The median age of participants was 48 years for individual therapy and 45 years for group therapy. Group-based therapy was comparable to individual therapy in smoking abstinence outcome at 4 weeks post quit date (35% vs 30%). CONCLUSIONS Group-based therapy was equally effective compared to individual therapy, similar to the western population. Using a group format should allow more people to be treated by a therapist, and therefore could be more cost-effective. Group-based therapy is an option to be included as part of the smoking cessation program in Malaysia.
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Affiliation(s)
- Pakri Mohamed Rashidi Mohamed
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Family Medicine, Faculty of Medicine, The National University of Malaysia, Kuala Lumpur, Malaysia
| | - Farizah Mohd Hairi
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Christopher Bullen
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Amer Siddiq Amer Nordin
- Department of Psychological Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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Pharmacotherapy for the Treatment of Tobacco Dependence. Respir Med 2023. [DOI: 10.1007/978-3-031-24914-3_4] [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: 03/05/2023]
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Lightfoot K, Panagiotaki G, Nobes G. Effectiveness of psychological interventions for smoking cessation in adults with mental health problems: A systematic review. Br J Health Psychol 2020; 25:615-638. [DOI: 10.1111/bjhp.12431] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/05/2020] [Indexed: 01/22/2023]
Affiliation(s)
| | | | - Gavin Nobes
- School of Psychology University of East Anglia Norwich UK
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Leone FT, Zhang Y, Evers-Casey S, Evins AE, Eakin MN, Fathi J, Fennig K, Folan P, Galiatsatos P, Gogineni H, Kantrow S, Kathuria H, Lamphere T, Neptune E, Pacheco MC, Pakhale S, Prezant D, Sachs DPL, Toll B, Upson D, Xiao D, Cruz-Lopes L, Fulone I, Murray RL, O’Brien KK, Pavalagantharajah S, Ross S, Zhang Y, Zhu M. Initiating Pharmacologic Treatment in Tobacco-Dependent Adults. An Official American Thoracic Society Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 202:e5-e31. [PMID: 32663106 PMCID: PMC7365361 DOI: 10.1164/rccm.202005-1982st] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Current tobacco treatment guidelines have established the efficacy of available interventions, but they do not provide detailed guidance for common implementation questions frequently faced in the clinic. An evidence-based guideline was created that addresses several pharmacotherapy-initiation questions that routinely confront treatment teams.Methods: Individuals with diverse expertise related to smoking cessation were empaneled to prioritize questions and outcomes important to clinicians. An evidence-synthesis team conducted systematic reviews, which informed recommendations to answer the questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to rate the certainty in the estimated effects and the strength of recommendations.Results: The guideline panel formulated five strong recommendations and two conditional recommendations regarding pharmacotherapy choices. Strong recommendations include using varenicline rather than a nicotine patch, using varenicline rather than bupropion, using varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition, initiating varenicline in adults even if they are unready to quit, and using controller therapy for an extended treatment duration greater than 12 weeks. Conditional recommendations include combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes.Conclusions: Seven recommendations are provided, which represent simple practice changes that are likely to increase the effectiveness of tobacco-dependence pharmacotherapy.
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Baliunas D, Zawertailo L, Voci S, Gatov E, Bondy SJ, Fu L, Selby PL. Variability in patient sociodemographics, clinical characteristics, and healthcare service utilization among 107,302 treatment seeking smokers in Ontario: A cross-sectional comparison. PLoS One 2020; 15:e0235709. [PMID: 32650339 PMCID: PMC7351500 DOI: 10.1371/journal.pone.0235709] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/19/2020] [Indexed: 11/19/2022] Open
Abstract
Background Since 2005, the Smoking Treatment for Ontario Patients (STOP) program has provided smoking cessation treatment of varying form and intensity to smokers through 11 distinct treatment models, either in-person at partnering healthcare organizations or remotely via web or telephone. We aimed to characterize the patient populations reached by different treatment models. Methods We linked self-report data to health administrative databases to describe sociodemographics, physical and mental health comorbidity, healthcare utilization and costs. Our sample consisted of 107,302 patients who enrolled between 18Oct2005 and 31Mar2016, across 11 models operational during different time periods. Results Patient populations varied on sociodemographics, comorbidity burden, and healthcare usage. Enrollees in the Web-based model were youngest (median age: 39; IQR: 29–49), and enrollees in primary care-based Family Health Teams were oldest (median: 51; IQR: 40–60). Chronic Obstructive Pulmonary Disease and hypertension were the most common physical health comorbidities, twice as prevalent in Family Health Teams (32.3% and 30.8%) than in the direct-to-smoker (Web and Telephone) and Pharmacy models (13.5%-16.7% and 14.7%-17.7%). Depression, the most prevalent mental health diagnosis, was twice as prevalent in the Addiction Agency (52.1%) versus the Telephone model (25.3%). Median healthcare costs in the two years up to enrollment ranged from $1,787 in the Telephone model to $9,393 in the Addiction Agency model. Discussion While practitioner-mediated models in specialized and primary care settings reached smokers with more complex healthcare needs, alternative settings appear better suited to reach younger smokers before such comorbidities develop. Although Web and Telephone models were expected to have fewer barriers to access, they reached a lower proportion of patients in rural areas and of lower socioeconomic status. Findings suggest that in addition to population-based strategies, embedding smoking cessation treatment into existing healthcare settings that reach patient populations with varying disparities may enhance equitable access to treatment.
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Affiliation(s)
- Dolly Baliunas
- Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Laurie Zawertailo
- Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sabrina Voci
- Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Susan J. Bondy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Peter L. Selby
- Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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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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Experiences of Tobacco Use among Chinese Individuals with Schizophrenia in Community-Based Residential Settings: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17010321. [PMID: 31906522 PMCID: PMC6981445 DOI: 10.3390/ijerph17010321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/28/2019] [Accepted: 12/31/2019] [Indexed: 11/17/2022]
Abstract
Although there is a high prevalence of smoking among individuals with schizophrenia, no previous attempt has been made to explore experiences of tobacco use and cessation within a Chinese sample of this population. A qualitative descriptive study was conducted to explore through the use of individual and semi-structured interviews the experiences of tobacco use and quitting in a sample Chinese population with schizophrenia. Twenty-three eligible participants with schizophrenia who currently smoke were recruited from three community residential mental health service settings. Four main themes representing the experiences of the participants were uncovered in this study: (1) smoking and illness; (2) environment and culture; (3) reasons for smoking; and (4) beliefs about cessation methods. The findings indicated that the participants considered the disease to be far more harmful than smoking, and perceived many benefits to smoking. Although some thought of quitting at times, most gave up the idea or failed to quit due to internal factors such as disease-related suffering, the use of an avoidance coping strategy, and a lack of cessation support. The most notable finding concerns the use of avoidance coping by the participants, who relied on smoking as a way to avoid the suffering brought about by the disease.
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Smoking cessation treatment outcomes among people with and without mental and substance use disorders: An observational real-world study. Eur Psychiatry 2020; 52:22-28. [DOI: 10.1016/j.eurpsy.2018.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 02/11/2018] [Accepted: 02/28/2018] [Indexed: 11/21/2022] Open
Abstract
AbstractBackground:There is a lack of studies evaluating smoking cessation treatment protocols which include people with and without mental and substance use disorders (MSUD), and which allows for individuals with MSUD undergoing their psychiatric treatment.Methods:We compared treatment success between participants with (n = 277) and without (n = 419) MSUD among patients in a 6-week treatment provided by a Brazilian Psychosocial Care Center (CAPS) from 2007 to 2013. Sociodemographic, medical and tobacco use characteristics were assessed at baseline. Tobacco treatment consisted of 1) group cognitive behavior therapy, which included people with and without MSUD in the same groups, and 2) pharmacotherapy, which could include either nicotine patches, nicotine gum, bupropion or nortriptyline. For participants with MSUD, tobacco treatment was integrated into their ongoing mental health treatment. The main outcome was 30-day point prevalence abstinence, measured at last day of treatment.Results:Abstinence rates did not differ significantly between participants with and without MSUD (31.1% and 34.4%, respectively). Variables that were significantly associated with treatment success included years smoking, the Heaviness of Smoking Index, and use of nicotine patch or bupropion.Conclusions:The inclusion of individuals with and without MSUD in the same protocol, allowing for individuals with MSUD undergoing their psychiatric treatment, generates at least comparable success rates between the groups. Predictors of treatment success were similar to those found in the general population. Facilities that treat patients with MSUD should treat tobacco use in order to reduce the disparities in morbidity and mortality experienced by this population.
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Smoking Ban in Psychiatric Inpatient Unit: An Iranian Study on the Views and Attitudes of the Mental Health Staff and Psychiatric Patients. PSYCHIATRY JOURNAL 2018; 2018:2450939. [PMID: 30310814 PMCID: PMC6166367 DOI: 10.1155/2018/2450939] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 07/19/2018] [Accepted: 08/09/2018] [Indexed: 11/17/2022]
Abstract
Although the move to smoke-free mental health inpatient settings is an internationally common and popular trend, these policies are neither implemented nor supported by any national program in Iran. This study investigates the attitude of mental health staff and psychiatric patients toward smoking cessation in 2 psychiatric inpatient units (psychosomatic and adult general psychiatry) in the Taleghani general hospital in Tehran. One hundred and twenty participants of this cross-sectional study consist of 30 mental health staff and 90 psychiatric patients. An eight-item questionnaire was used for collecting information. Both staff and patients expressed a positive attitude towards smoking cessation. Patients favoured the implementation of these policies and expressed a more positive attitude towards the feasibility. Sixty-three percent of patients and 57% of staff were opposed to smoking in the units. Seventy percent of patients reported the smoke-free ban as a feasible policy compared to 45% of staff who did the same. The implementation of the smoke-free policy has more support in both staff and patients than the continuation of smoking in psychiatric units. There is a need for an ongoing education and training for mental health care providers, in order to have a successful implementation of smoke-free policy.
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Alosaimi FD, Abalhassan M, Alhaddad B, Fallata EO, Alhabbad A, Alshenqiti R, Alassiry MZ. Gender differences and risk factors for smoking among patients with various psychiatric disorders in Saudi Arabia: a cross-sectional study. Int J Ment Health Syst 2018; 12:21. [PMID: 29755581 PMCID: PMC5934876 DOI: 10.1186/s13033-018-0201-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 04/16/2018] [Indexed: 01/06/2023] Open
Abstract
Background The higher prevalence of smoking among psychiatric patients is well established. However, gender-specific associations have rarely been the focus of studies among patients with various psychiatric disorders. The aim of this study was to estimate the gender-specific prevalence of current smoking by psychiatric patients and its association with various psychiatric disorders and the use of psychotropic medications. Methods A cross-sectional observational study was performed between July 2012 and June 2014. Patients were recruited from six hospitals located in the five regions of Saudi Arabia. Results Of the 1193 patients, 402 (33.7%) were current smokers. The incidence of current smoking was much higher among males than females (58.3% versus 6.7%, p < 0.001). In one or both genders, current smoking was associated with marital status, education, family income, residence, obesity, physical activity, substance abuse, inpatient status, previous psychiatric hospitalization, and age at onset of psychiatric illness. In both gender, smoking was higher in patients who had a secondary psychiatric disorder (66.7% versus 37.5%, respectively), those who had a primary psychotic disorder (63.7% versus 12.3%), and those taking antipsychotic medication (64.1% versus 8.3%) but lower in patients who had a primary depressive disorder (40.3% versus 4.3%), those who had a primary anxiety disorder (45.8% versus 0.0%), and those taking antidepressant medications (53.7% versus 3.6%). In a multivariate analysis adjusted for demographic/clinical characteristics and psychiatric disorders, current smoking was independently associated with primary psychotic disorders in females (OR = 3.47, 1.45–8.27, p = 0.005) but not in males. In a multivariate analysis adjusted for demographic/clinical characteristics and psychotropic medications, current smoking was independently associated with antipsychotic medication use in males (OR = 1.79, 1.10–2.93, p = 0.020). Current smoking was strongly associated with substance abuse in both univariate and multivariate analyses. Conclusion The prevalence of current smoking is high with marked gender difference in a large sample of mixed psychiatric patients in Saudi Arabia. Smoking-cessation programs may be urgently needed for these vulnerable patients.
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Affiliation(s)
- Fahad D Alosaimi
- 1Department of Psychiatry, King Saud University, # 55, King Khalid University Hospital, P.O. Box 7805, Riyadh, 11472 Saudi Arabia
| | - Mohammed Abalhassan
- 2Department of Medicine, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Bandar Alhaddad
- Department of neurosciences, Al-Imam Mohammad Bin Saud University, Riyadh, Saudi Arabia
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Shu BC, Lung FW, Guo SE, Chen KC, Fang SY, Wang AL. Ineffectiveness of the Tobacco Hazards Prevention Act in patients with severe and persistent mental illness. Public Health 2017; 153:118-127. [PMID: 29032168 DOI: 10.1016/j.puhe.2017.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 08/03/2017] [Accepted: 08/20/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The effect of the Tobacco Hazards Prevention Act (THPA) on the reduction of tobacco use in the general population in Taiwan is understood. However, there has been little research on how these policies affect people with severe and persistent mental illness (SPMI). Hence, the influence of the THPA on daily cigarette use by patients with SPMI was investigated in a 3-year follow-up. The risk and protective factors in smoking behavior and cessation were investigated. STUDY DESIGN This is an observational study. METHODS A total of 144 participants (78 of whom had smoked >100 cigarettes throughout their lifetime) were randomly selected from a healthcare network. Then, 100 of 144 patients with SPMI, included 50 smokers and 50 non-smokers, have agreed with 1st year follow-up. Eighty-two patients with SPMI, consisted of 44 smokers and 38 non-smokers, have agreed with 2nd year follow-up. RESULTS Although women were less likely to smoke than men, those who did smoke reduced the number of cigarettes less than men over the 3-year period. Less-educated patients were more likely to smoke than those who were more educated but reduced the number of daily cigarettes more after implementation of the THPA. Maternal overprotection was a risk factor and paternal care a protective factor for smoking. Addiction, a perception of pleasure, interpersonal relationships, and self-destructive behavior increased cigarette smoking. Patients perceived that smoking alleviated their depressive symptoms. CONCLUSIONS The THPA was ineffective for patients with SPMI. Some factors had different effects on the development of smoking behavior and the cessation process. Understanding the etiology of smoking can help policymakers establish more effective programs for smoking prevention and cessation.
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Affiliation(s)
- B-C Shu
- Institute of Allied Health Sciences and Department of Nursing, National Cheng Kung University, Tainan, Taiwan
| | - F-W Lung
- Calo Psychiatric Center, Pingtung County, Taiwan; Graduate Institute of Medical Science, National Defense Medical University, Taipei, Taiwan; Department of Neurology, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - S-E Guo
- Graduate Institute of Nursing and Chronic Diseases and Health Promotion Research Center, Chang Gung University of Science and Technology, Chiayi, Taiwan
| | - K-C Chen
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Addiction Research Center, National Cheng Kung University, Tainan, Taiwan
| | - S-Y Fang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - A-L Wang
- National Cheng Kung University Hospital Dou-Liou Branch, Tainan, Taiwan
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Loreto AR, Carvalho CFC, Frallonardo FP, Ismael F, Andrade AGD, Castaldelli-Maia JM. Smoking Cessation Treatment for Patients With Mental Disorders Using CBT and Combined Pharmacotherapy. J Dual Diagn 2017; 13:238-246. [PMID: 28489501 DOI: 10.1080/15504263.2017.1328149] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVES The aim of this study was to investigate smoking treatment effectiveness and retention in a population with and without mental disorders (MD). Participants received cognitive behavioral therapy (CBT) plus nicotine patch alone or in combination with other medications (i.e., gum, bupropion, or nortriptyline) for smoking cessation treatment in a Brazilian Psychosocial Care Center unit (CAPS), taking into account sociodemographics and smoking profile covariates. METHODS The study involved comparison of treatment success (seven-day point prevalence abstinence at the end of the treatment) and retention (presence of the individual in all of the four medical consultations and six group sessions) in two subsamples of patients with MD (n = 267) and without MD (n = 397) who were included in a six-week treatment provided by a CAPS from 2007 to 2013. The treatment protocol comprised group CBT and pharmacotherapy (nicotine patches, nicotine gums, and bupropion and nortriptyline available, prescribed by psychiatrists). RESULTS Within patients with MD, CBT plus nicotine patch plus bupropion (aOR = 2.00, 95% CI [1.14, 3.50], p = .015) and CBT plus nicotine patch plus gum (aOR = 2.10, 95% CI [1.04, 4.23], p = .036) were associated with treatment success. Within patients without MD, female gender (aOR = 0.60, 95% CI [0.37, 0.95], p = .031) and lower Heaviness of Smoking Index score (aOR = 0.80, 95% CI [0.65, 0.99], p = .048) were associated with treatment success. No variable was associated with dropout or retention within patients with or without MD. CONCLUSION Our findings support the use of CBT plus nicotine patch plus bupropion as well as CBT plus nicotine patch plus gum in samples with high rates of medical, psychiatric, and addiction disorders. These findings support those of previous studies in the general population. Pharmacological treatment associated with group CBT based on cognitive-behavioral concepts and combined with ongoing MD treatment seems to be the best option for smoking cessation treatment among patients with MD. Units that deal with patients with MD, such as CAPS in Brazil, should be encouraged to treat smoking addiction in this population. Future studies should investigate retention rates in other samples of patients with MD.
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Affiliation(s)
- Aline Rodrigues Loreto
- a Department of Neuroscience , Medical School, Fundação ABC , Santo André , São Paulo , Brazil
| | | | - Fernanda Piotto Frallonardo
- a Department of Neuroscience , Medical School, Fundação ABC , Santo André , São Paulo , Brazil.,c ABC Center for Mental Health Studies , Santo André , São Paulo , Brazil
| | - Flavia Ismael
- a Department of Neuroscience , Medical School, Fundação ABC , Santo André , São Paulo , Brazil.,c ABC Center for Mental Health Studies , Santo André , São Paulo , Brazil
| | - Arthur Guerra de Andrade
- a Department of Neuroscience , Medical School, Fundação ABC , Santo André , São Paulo , Brazil.,c ABC Center for Mental Health Studies , Santo André , São Paulo , Brazil.,d Department of Psychiatry , Medical School, University of São Paulo , São Paulo , São Paulo , Brazil
| | - João Maurício Castaldelli-Maia
- a Department of Neuroscience , Medical School, Fundação ABC , Santo André , São Paulo , Brazil.,b Clima Clinic , São Paulo , SP , Brazil.,c ABC Center for Mental Health Studies , Santo André , São Paulo , Brazil.,d Department of Psychiatry , Medical School, University of São Paulo , São Paulo , São Paulo , Brazil
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Farris SG, Aston ER, Zvolensky MJ, Abrantes AM, Metrik J. Psychopathology and tobacco demand. Drug Alcohol Depend 2017; 177:59-66. [PMID: 28575783 PMCID: PMC5534370 DOI: 10.1016/j.drugalcdep.2017.03.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Behavioral economic measurement of the relative value of tobacco (Cigarette Purchase Task; CPT) is used to examine individual differences in motivation for tobacco under certain contexts. Smokers with psychopathology, relative to those without, may demonstrate stronger demand for tobacco following a period of smoking deprivation, which could account for disparate rates of smoking and cessation among this subgroup. METHOD Participants (n=111) were community-recruited adult daily smokers who completed the CPT after a deprivation period of approximately 60min. Presence of psychopathology was assessed via clinical interview; 40.5% (n=45) of the sample met criteria for past-year psychological diagnosis. Specifically, 31.5% (n=35) had an emotional disorder (anxiety/depressive disorder), 17.1% (n=19) had a substance use disorder, and 19.1% of the sample had more than one disorder. RESULTS Smokers with any psychopathology showed significantly higher intensity (demand at unrestricted cost; $0) and Omax (peak expenditure for a drug) relative to smokers with no psychopathology. Intensity was significantly higher among smokers with an emotional disorder compared to those without. Smokers with a substance use disorder showed significantly higher intensity and Omax, and lower elasticity, reflecting greater insensitivity to price increases. Having≥2 disorders was associated with higher intensity relative to having 1 or no disorders. DISCUSSION Findings suggest that presence of psychopathology may be associated with greater and more persistent motivation to smoke. Future work is needed to explore the mechanism linking psychopathology to tobacco demand.
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Affiliation(s)
- Samantha G. Farris
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Blvd., Providence, RI 02906 USA,The Miriam Hospital, Centers for Behavioral and Preventative Medicine, 164 Summit St., Providence, RI 02906 USA,Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906 USA,Corresponding author: Samantha G. Farris, Ph.D. at Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior; 345 Blackstone Blvd, Butler Hospital, Providence, RI 02906. ; Phone: 401-455-6219; Fax: 401-455-6685
| | - Elizabeth R. Aston
- Brown University School of Public Health, Center for Alcohol and Addiction Studies, Box G-S121-5, Providence, RI 02912 USA
| | - Michael J. Zvolensky
- University of Houston, Department of Psychology, 126 Fred J. Heyne Building, Houston, TX 77204 USA,The University of Texas MD Anderson Cancer Center, Department of Behavioral Science, 1155 Pressler St., Houston, TX 77230 USA
| | - Ana M. Abrantes
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Blvd., Providence, RI 02906 USA,Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906 USA
| | - Jane Metrik
- Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior, 345 Blackstone Blvd., Providence, RI 02906, USA; Brown University School of Public Health, Center for Alcohol and Addiction Studies, Box G-S121-5, Providence, RI 02912, USA; Providence Veterans Affairs Medical Center, 830 Chalkstone Ave, Providence, RI 02908, USA.
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Forman-Hoffman VL, Hedden SL, Miller GK, Brown K, Teich J, Gfroerer J. Trends in cigarette use, by serious psychological distress status in the United States, 1998-2013. Addict Behav 2017; 64:223-228. [PMID: 27690139 DOI: 10.1016/j.addbeh.2016.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The study compared trends in current and heavy cigarette smoking between adults with and without serious psychological distress (SPD). METHODS This study examined data from 480,024 adults aged 18years or older in the 1998-2013 National Health Interview Survey (NHIS) public use files. SPD is defined as having a Kessler-6 score of 13 or higher in the past month. Trends in the prevalence of current smoking and heavy smoking for 2-year time periods were assessed among those with versus those without SPD using logistic regression; tests of interaction terms determined whether smoking trends differed by SPD status. RESULTS The prevalence of current smoking decreased over time among adults without SPD (adjusted odds ratio [AOR]=0.97, 95% CI=0.97-0.98), but remained stable among adults with SPD (AOR=1.01, 95% CI=0.99-1.03). Both groups had significant declines in heavy smoking over time; however, the rates of decline were greater among adults without versus with SPD (AOR=0.87, 95% CI=0.86-0.88 and AOR=0.91, 95% CI=0.88-0.94, respectively). CONCLUSIONS The prevalence of current smoking is not declining among adults with SPD, and the prevalence of heavy smoking is not declining as quickly among adults with SPD as compared with those without SPD. Smoking cessation efforts may need to target these populations and tailor programs accordingly.
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Affiliation(s)
| | - Sarra L Hedden
- Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics and Quality (CBHSQ), 5600 Fishers Lane, Room 2-1090, Rockville, MD 20857, USA
| | - Greta Kilmer Miller
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Kristen Brown
- RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC 27709, USA
| | - Judith Teich
- Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics and Quality (CBHSQ), 5600 Fishers Lane, Room 2-1090, Rockville, MD 20857, USA
| | - Joseph Gfroerer
- Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Behavioral Health Statistics and Quality (CBHSQ), 5600 Fishers Lane, Room 2-1090, Rockville, MD 20857, USA
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Brody AL, Zorick T, Hubert R, Hellemann GS, Balali S, Kawasaki SS, Garcia LY, Enoki R, Abraham P, Young P, McCreary C. Combination Extended Smoking Cessation Treatment Plus Home Visits for Smokers With Schizophrenia: A Randomized Controlled Trial. Nicotine Tob Res 2016; 19:68-76. [PMID: 27613888 DOI: 10.1093/ntr/ntw190] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/18/2016] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The majority of people with schizophrenia have a diagnosis of tobacco dependence during their lifetime. A major obstacle to reducing the burden of cigarette smoking in this population is that these smokers have lower quit rates when undergoing standard treatment compared to smokers with no mental illness. We sought to determine if combination extended treatment (COMB-EXT) and home visits (HV) would lead to improved outcomes in smokers with schizophrenia. METHODS Thirty-four cigarette smokers with schizophrenia completed either COMB-EXT with HV, COMB-EXT without HV, or treatment as usual (TAU) (random assignment). COMB-EXT consisted of group cognitive-behavioral therapy (CBT), bupropion, nicotine patch, and nicotine lozenge, which were initiated within 2 weeks and continued for 26 weekly visits. HV consisted of biweekly visits to the home with assessment of secondhand smoke (SHS) exposure and brief behavioral therapy with participants and others in the home environment. TAU consisted of group CBT plus serial single or combination medication trials as per standard care. RESULTS Smokers with schizophrenia who received COMB-EXT (with or without HV) had greater reductions in cigarettes per day than those treated with TAU (both ps < .01). In addition, 7-day point prevalence abstinence rates for the three groups were 45%, 20%, and 8%, respectively, which was significantly higher for COMB-EXT plus HV than TAU (χ2(1) = 4.8, p = .03). Groups did not differ significantly in the number of adverse events, and HV were easily scheduled. CONCLUSION COMB-EXT improves outcomes for smokers with schizophrenia. HV appeared to provide additional benefit for smoking cessation in this treatment-resistant population. IMPLICATIONS The clear benefit found here of rapidly initiated, combination, extended treatment over TAU suggests that aggressive and extended treatment should be considered in clinical practice for smokers with schizophrenia. Furthermore, HV to address SHS exposure showed initial promise for assisting smokers with schizophrenia in maintaining abstinence, indicating that this intervention may be worthy of future research.
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Affiliation(s)
- Arthur L Brody
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA; .,Department of Psychiatry, University of California at San Diego, San Diego, CA
| | - Todd Zorick
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Robert Hubert
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Gerhard S Hellemann
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Shabnam Balali
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Sarah S Kawasaki
- Department of Primary Care, Health Care for the Homeless, Baltimore, MD
| | - Lizette Y Garcia
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Ryutaro Enoki
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Paul Abraham
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Paulina Young
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Charles McCreary
- Department of Psychiatry, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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Knowles S, Planner C, Bradshaw T, Peckham E, Man MS, Gilbody S. Making the journey with me: a qualitative study of experiences of a bespoke mental health smoking cessation intervention for service users with serious mental illness. BMC Psychiatry 2016; 16:193. [PMID: 27278101 PMCID: PMC4898392 DOI: 10.1186/s12888-016-0901-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 06/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Smoking is one of the major modifiable risk factors contributing to early mortality for people with serious mental illness. However, only a minority of service users access smoking cessation interventions and there are concerns about the appropriateness of generic stop-smoking services for this group. The SCIMITAR (Smoking Cessation Intervention for Severe Mental Ill-Health Trial) feasibility study explored the effectiveness of a bespoke smoking cessation intervention delivered by mental health workers. This paper reports on the nested qualitative study within the trial. METHODS Qualitative semi-structured interviews were conducted with 13 service users receiving the intervention and 3 of the MHSCPs (mental health smoking cessation practitioners) delivering the intervention. Topic guides explored the perceived acceptability of the intervention particularly in contrast to generic stop-smoking services, and perceptions of the implementation of the intervention in practice. Transcripts were analysed using the Constant Comparative Method. RESULTS Generic services were reported to be inappropriate for this group, due to concerns over stigma and a lack of support from health professionals. The bespoke intervention was perceived positively, with both practitioners and service users emphasising the benefits of flexibility and personalisation in delivery. The mental health background of the practitioners was considered valuable not only due to their increased understanding of the service users' illness but also due to the more collaborative relationship style they employed. Challenges involved delays in liaising with general practitioners and patient struggles with organisation and motivation, however the MHSCP was considered to be well placed to address these problems. CONCLUSION The bespoke smoking cessation intervention was acceptable to service users and the both service users and practitioners reported the value of a protected mental health worker role for delivering smoking cessation to this group. The results have wider implications for understanding how to achieve integrated and personalised care for this high-risk population and further underscore the need for sensitised smoking cessation support for people with serious mental illness. TRIAL REGISTRATION Current Controlled Trials ISRCTN79497236 . Registered 3(rd) July 2009.
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Affiliation(s)
- Sarah Knowles
- NIHR School for Primary Care Research and Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL, UK.
| | - Claire Planner
- NIHR School for Primary Care Research and Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL UK
| | - Tim Bradshaw
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, M13 9PL UK
| | - Emily Peckham
- Department of Health Sciences, University of York, York, YO10 5DD UK
| | - Mei-See Man
- School of Social and Community Medicine, University of Bristol, Bristol, BS8 2PS UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD UK
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Baker HM, Ranney LM, Goldstein AO. Pilot Implementation of a Wellness and Tobacco Cessation Curriculum in North Carolina Group Homes. Community Ment Health J 2016; 52:433-8. [PMID: 26711097 DOI: 10.1007/s10597-015-9975-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/08/2015] [Indexed: 10/22/2022]
Abstract
Despite a steady decline in smoking rates in recent decades, individuals with mental illness continue to smoke at disproportionately higher rates than the general population. Adults with mental illness are motivated to quit and quit with rates similar to the general population when evidence-based cessation interventions are used. To build an evidence base for a wellness and cessation curriculum aimed at individuals with mental illness, the Breathe Easy Live Well (BELW) program was pilot tested in two group homes in North Carolina in the spring of 2014. Evaluators conducted pre- and post-implementation site visits and interviews with program instructors to assess outcomes as well as barriers and facilitators to implementation. Qualitative analysis of the data indicated that implementation was successful in both group homes, and the following themes emerged: (1) Training and technical assistance provided throughout implementation was sufficient; (2) Instructors used prior professional experiences and goal setting to facilitate program success and participant engagement; (3) Fostering positive coping strategies contributed to reports of reduced smoking; (4) Curriculum length may be a barrier to recruitment. Additional results included an increased interest among group home residents in more diligently managing mental illness symptoms and one group home moving the designated smoking area out of the direct path of the entrance/exit. Results of this pilot project suggest that BELW could be a potentially useful tool for group home staff to address health and wellness along with smoking cessation among individuals with mental illness.
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Affiliation(s)
- Hannah M Baker
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, CB#7595, Chapel Hill, NC, 27599, USA.
| | - Leah M Ranney
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, CB#7595, Chapel Hill, NC, 27599, USA
| | - Adam O Goldstein
- Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, CB#7595, Chapel Hill, NC, 27599, USA
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18
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Real-world effectiveness of varenicline versus nicotine replacement therapy in patients with and without psychiatric disorders. J Addict Med 2016; 9:169-76. [PMID: 25622124 DOI: 10.1097/adm.0000000000000111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare the effectiveness and safety of varenicline with nicotine replacement therapy (NRT) among smokers with or without psychiatric disorders attending a storefront smoking cessation clinic in an urban addiction and mental health academic health science center. METHODS A retrospective chart review was conducted to compare treatment outcomes, demographics, and clinical characteristics for adult smokers prescribed varenicline (n = 98) or NRT (n = 98) between 2007 and 2010. Subjects were matched 1:1 on age, sex, and year of initial assessment. RESULTS End-of-treatment quit rates were almost twice as high among those prescribed varenicline (33.7%) versus NRT (18.4%) (RR = 1.83, 95% CI = 1.11-3.03, P = 0.02). After adjusting for several baseline and treatment characteristics, varenicline was still significantly more effective than NRT (ARR = 1.71, 95% CI = 1.05-2.79, P = 0.03). History of psychiatric disorder (excluding substance use disorders) and treatment duration were also independent predictors of end-of-treatment quit rates. Nausea was more commonly reported among those using varenicline (13.3% vs 3.1%, P = 0.009). No single neuropsychiatric adverse effect significantly differed between groups; however, overall reporting of any neuropsychiatric effect was somewhat higher in the varenicline group (31.6% vs 20.4%, P = 0.07). There was one incident of suicidal ideation in each medication group. CONCLUSIONS Varenicline seems to be more effective than NRT and as safe in real-world settings among patients with and without a history of psychiatric disorder.
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Korth RM. LDL-Related Intolerance to Glucose, Diastolic Hypertension and Additive Effects of Smoking Were Found with Three Female Study Groups. Health (London) 2016. [DOI: 10.4236/health.2016.83026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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Li Y, Hou CL, Ma XR, Zang Y, Jia FJ, Zhong BL, Lin YQ, Chiu HFK, Ungvari GS, Himelhoch S, Cao XL, Cai MY, Lai KYC, Xiang YT. Smoking and its associations with sociodemographic and clinical characteristics and quality of life in patients with schizophrenia treated in primary care in China. Gen Hosp Psychiatry 2016; 38:79-83. [PMID: 26633862 DOI: 10.1016/j.genhosppsych.2015.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/14/2015] [Accepted: 10/14/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Maintenance treatment for clinically stable patients with schizophrenia is usually provided by Chinese primary care physicians, but no study has investigated smoking rates in this population. This study investigated the rate of smoking and its associations with sociodemographic and clinical characteristics and quality of life (QOL) in patients with schizophrenia treated in primary care in China. METHODS This was a cross-sectional, community-based survey. A total of 621 schizophrenia patients were recruited from 22 primary care services in Guangzhou, China, in 2013. Patients' sociodemographic and clinical characteristics, smoking status, and QOL were recorded. RESULTS The frequency of current smoking was 23.8% in the whole sample; 41.5% for men and 2.5% for women. Multiple logistic regression analysis revealed that male gender, married status, alcohol use, older age at onset, fewer major medical conditions, lower education level and more hospitalizations were independently associated with current smoking. CONCLUSION The frequency of smoking in Chinese schizophrenia patients treated by primary care physicians is lower than most figures reported from Western and Chinese psychiatric settings.
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Affiliation(s)
- Yan Li
- Department of Psychiatry, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Cai-Lan Hou
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China; Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Xin-Rong Ma
- Ningxia Mental Health Center, Ningxia Ning-An Hospital, Ningxia Province, China
| | - Yu Zang
- Shenzhen Key Laboratory for Psychological Healthcare & Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital & Shenzhen Mental Health Center, Shenzhen, China
| | - Fu-Jun Jia
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China.
| | - Bao-Liang Zhong
- Department of Psychiatry, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yong-Qiang Lin
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China
| | - Helen F K Chiu
- Department of Psychiatry, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia/Marian Centre, Perth, Australia; School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Seth Himelhoch
- Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Xiao-Lan Cao
- Shenzhen Key Laboratory for Psychological Healthcare & Shenzhen Institute of Mental Health, Shenzhen Kangning Hospital & Shenzhen Mental Health Center, Shenzhen, China
| | - Mei-Ying Cai
- Guangzhou Yuexiu Center for Disease Control and Prevention, Guangdong Province, China
| | - Kelly Y C Lai
- Department of Psychiatry, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yu-Tao Xiang
- Guangdong Mental Health Center, Guangdong General Hospital & Guangdong Academy of Medical Sciences, Guangdong Province, China.
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Zale EL, Maisto SA, Ditre JW. Anxiety and Depression in Bidirectional Relations Between Pain and Smoking: Implications for Smoking Cessation. Behav Modif 2015; 40:7-28. [PMID: 26467214 DOI: 10.1177/0145445515610744] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Pain and tobacco smoking are highly prevalent and comorbid conditions that impose considerable burdens on individuals and health care systems. A recently proposed reciprocal model suggests that these conditions interact in a bidirectional manner, resulting in greater pain and the maintenance of tobacco addiction. Anxiety and depression are common among smokers in pain and have been identified as central mechanisms of interest. There is emerging evidence that smokers with anxiety/depression may experience more severe pain and functional impairment, greater pain-induced motivation to smoke, and increased sensitivity to pain during periods of smoking abstinence. Based on empirical findings, we hypothesize that these experiences may engender expectations that abstaining from smoking will exacerbate both pain and negative affect, thus eroding self-efficacy for smoking cessation and increasing perceived barriers to quitting. The goal of this narrative review is to examine the role of anxiety/depression in complex pain-smoking relations so as to advance evolving theoretical perspectives and inform the development of tailored interventions.
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Affiliation(s)
| | - Stephen A Maisto
- Syracuse University, NY, USA Syracuse Veterans Affairs Medical Center, NY, USA
| | - Joseph W Ditre
- Syracuse University, NY, USA Syracuse Veterans Affairs Medical Center, NY, USA
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Stubbs B, Vancampfort D, Bobes J, De Hert M, Mitchell AJ. How can we promote smoking cessation in people with schizophrenia in practice? A clinical overview. Acta Psychiatr Scand 2015; 132:122-30. [PMID: 25754402 DOI: 10.1111/acps.12412] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE High rates of smoking and nicotine dependence are associated with increased physical comorbidity and premature death in people with schizophrenia. We conducted a clinical overview to establish how smoking cessation should be promoted in practice. METHOD Systematic clinical review of major electronic databases from inception till November 2014. RESULTS A growing body of evidence supports pharmacological interventions to assist smoking cessation. The most promising evidence is for bupropion with several meta-analyses demonstrating its effectiveness. Currently, there is limited evidence demonstrating the effectiveness of nicotine replacement therapy (NRT) and varenicline, although this is likely to be due to the paucity of research. There are no consistent data to suggest that pharmacological interventions increase adverse events. Behavioural and psychosocial interventions also demonstrate promise, particularly when combined with pharmacotherapy. Careful monitoring of antipsychotic levels (in particular clozapine) is essential, and the promotion of physical activity may be useful to negate potential weight gain and diabetes risk following smoking cessation. CONCLUSION Evidence from systematic reviews and meta-analyses suggests that smoking cessation interventions are effective in people with schizophrenia, although more long-term research is required. Promoting smoking cessation should be given utmost priority in clinical practice, and we offer practical strategies to facilitate this.
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Affiliation(s)
- B Stubbs
- School of Health and Social Care, University of Greenwich, Eltham, London, UK
| | - D Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
| | - J Bobes
- Department of Psychiatry, University of Oviedo - CIBERSAM, Oviedo, Spain
| | - M De Hert
- KU Leuven Department of Neurosciences, UPC KU Leuven, Kortenberg, Belgium
| | - A J Mitchell
- Department of Cancer and Molecular Medicine, University of Leicester, Leicester, UK
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Manzella F, Maloney SE, Taylor GT. Smoking in schizophrenic patients: A critique of the self-medication hypothesis. World J Psychiatry 2015; 5:35-46. [PMID: 25815253 PMCID: PMC4369547 DOI: 10.5498/wjp.v5.i1.35] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 11/27/2014] [Accepted: 01/12/2015] [Indexed: 02/05/2023] Open
Abstract
A common remark among laypeople, and notably also among mental health workers, is that individuals with mental illnesses use drugs as self-medication to allay clinical symptoms and the side effects of drug treatments. Roots of the self-medication concept in psychiatry date back at least to the 1980s. Observations that rates of smokers in schizophrenic patients are multiple times the rates for regular smoking in the general population, as well as those with other disorders, proved particularly tempting for a self-medication explanation. Additional evidence came from experiments with animal models exposed to nicotine and the identification of neurobiological mechanisms suggesting self-medication with smoking is a plausible idea. More recently, results from studies comparing smoking and non-smoking schizophrenic patients have led to the questioning of the self-medication hypothesis. Closer examination of the literature points to the possibility that smoking is less beneficial on schizophrenic symptomology than generally assumed while clearly increasing the risk of cancer and other smoking-related diseases responsible for early mortality. It is a good time to examine the evidence for the self-medication concept as it relates to smoking. Our approach is to focus on data addressing direct or implied predictions of the hypothesis in schizophrenic smokers.
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Abstract
In the United States, the rate of cigarette smoking has significantly declined over the past 2 decades, but much more work is needed, as almost 20% of adults still smoke and smoking continues to be the leading preventable cause of death. Furthermore, rates of smoking in certain subpopulations have remained relatively stable and have historically been neglected in smoking cessation research. Pharmacotherapy (both prescription and over-the-counter) and behavioral support are known to aid cessation, and their combination is more effective than either alone. There are significant barriers to access, use, and adherence, however, especially with pharmacotherapy. Therefore, the purpose of this review is to provide an update and overview of the numerous behavioral approaches that have been used to enhance smoking cessation. The research described can be classified into the type of approach used, the setting in which it is delivered, and the population targeted. Regardless of the classification, all the approaches attempt to provide smokers with the information, motivation, and behavioral skills thought to be necessary for achieving initial cessation and sustained abstinence. Recommendations for future research on behavioral smoking cessation are also included.
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Affiliation(s)
- Joseph T. Ciccolo
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York (JTC)
- Department of Psychiatry and Human Behavior, Centers for Behavioral & Preventive Medicine, Alpert Medical School of Brown University and The Miriam Hospital, Providence, Rhode Island (AMB)
| | - Andrew M. Busch
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York (JTC)
- Department of Psychiatry and Human Behavior, Centers for Behavioral & Preventive Medicine, Alpert Medical School of Brown University and The Miriam Hospital, Providence, Rhode Island (AMB)
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25
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Affiliation(s)
- Erin S. Rogers
- a VA New York Harbor Healthcare System
- b New York University School of Medicine
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Castaldelli-Maia JM, Loreto AR, Carvalho CFC, Frallonardo FP, de Andrade AG. Retention predictors of a smoking treatment provided by a public psychosocial unit in Brazil. Int Rev Psychiatry 2014; 26:515-23. [PMID: 25137119 DOI: 10.3109/09540261.2014.928272] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Psychosocial units in Brazil (CAPS) provide access to mental health and addiction patients, who are not routinely treated for nicotine dependence. The present study analysed predictors of retention of a 6-week treatment provided by a CAPS unit to 367 smokers with a high rate of psychiatric disorders and addictions for the period 2007-2010. Several baseline variables were collected. Retention was defined as the presence of the individual in all four medical consultations and six group sessions. Multivariate discrete time Cox survival regression models were used to test for the outcome of interest. Timetables were used to explore in which moment of the treatment each predictor was important. Time to smoking the first cigarette (TTFC) 5 min or later after waking and nicotine patch use (nicotine replacement therapy, NRT) were associated with retention. The present study supports the importance of the variables TTFC and NRT when used in treatment retention for a sample with a high rate of psychiatric and alcohol disorders. NRT seems to be very important in the beginning of the treatment, probably because of withdrawal symptoms. Individuals currently undergoing psychiatric treatment and with alcohol problems had good retention rates comparable to the other individuals.
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Sumner HM, McQueen A, Scott MJ, Sumner W. Analysis of comments in a petition defending electronic cigarettes. Nicotine Tob Res 2014; 16:1503-11. [PMID: 24827787 DOI: 10.1093/ntr/ntu055] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION A 2009 petition opposing a Food and Drug Administration (FDA) ban on electronic cigarettes (e-cigs) garnered international attention from e-cig users (vapers). Petitioners' comments described the perceived benefits of vaping. METHODS We conducted a qualitative and quantitative analysis of petitioners' comments. A sample of 200 petitioner names was sought in public records. Reviewers identified 13 major themes in a sample of comments, and themes related to current controversies were added. For each theme, software pattern-matching instructions (regular expressions) were developed and were used to scan comments. Agreement between reviewers and software was calculated; theme prevalence and clustering was ascertained. RESULTS A total of 13,414 signatures and 8,285 comments from 50 states and 75 nations were collected in 6 months. Temporal patterns and name matches in public records suggest that most petitioners are authentic. Agreement between reviewers and software was moderate to high (κ = 0.4-0.8). Commonly cited themes were "e-cigs helped me quit" (34%), "a ban would be counterproductive" (15%), and "my health improved with e-cigs" (13%). Two clusters of themes emerged: the first combined comments about smoking cessation, health benefits, and smoking relapse that an e-cig ban would cause; the second combined themes that a "ban would be counterproductive," it would infringe on personal liberties, and it was motivated by government or industrial greed. People who cited mental health issues often mentioned avoiding withdrawal as a benefit of e-cigs. CONCLUSIONS Early e-cig adopters were both frustrated and confused by discussion of a ban. They believed that e-cigs safely delivered nicotine and helped them quit smoking.
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Affiliation(s)
| | - Amy McQueen
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO
| | - Michael John Scott
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO
| | - Walton Sumner
- Division of General Medical Sciences, Washington University School of Medicine, St. Louis, MO
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Ebert L, Malte C, Hamlett-Berry K, Beckham J, McFall M, Saxon A. Use of a learning collaborative to support implementation of integrated care for smoking cessation for veterans with posttraumatic stress disorder. Am J Public Health 2014; 104:1935-42. [PMID: 25208004 DOI: 10.2105/ajph.2013.301776] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We evaluated the feasibility of incorporating integrated care (IC) for smoking cessation into routine treatment for posttraumatic stress disorder (PTSD) at Department of Veterans Affairs (VA) Medical Centers and the utility of the Learning Collaborative (LC) model in facilitating implementation. METHODS We conducted 2 LCs aimed at implementing IC for smoking cessation using multidisciplinary teams comprising 70 staff members from 12 VA PTSD clinics. Using questionnaires, we evaluated providers' perceptions of the LC methodology and the effectiveness and feasibility of routine IC delivery. We assessed number of providers delivering and patients receiving IC using medical record data. RESULTS More than 85% of participating VA staff considered the LC to be an effective training and implementation platform. The majority thought IC effectively addressed an important need and could be delivered in routine PTSD care. All LC participants who planned to deliver IC did so (n=52). Within 12 months of initial training, an additional 46 locally trained providers delivered IC and 395 veterans received IC. CONCLUSIONS The LC model effectively facilitated rapid and broad implementation of IC. Facilitators and barriers to sustained use of IC are unknown and should be identified to understand how best to promote ongoing access to evidence-based treatment for smoking cessation in mental health populations.
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Affiliation(s)
- Lori Ebert
- Lori Ebert is with the Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC. Carol Malte is with the Center of Excellence in Substance Abuse Treatment and Education, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA. Kim Hamlett-Berry is with Clinical Public Health, Department of Veterans Affairs, Washington, DC. Jean Beckham is with the VA Mid-Atlantic Region Mental Illness Research, Education, and Clinical Center, Durham. Miles McFall and Andrew Saxon are with the VA Puget Sound Health Care System, Seattle
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Muirhead L. Cancer risk factors among adults with serious mental illness. Am J Prev Med 2014; 46:S98-103. [PMID: 24512937 DOI: 10.1016/j.amepre.2013.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 10/13/2013] [Accepted: 10/29/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Lisa Muirhead
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia.
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Aubin HJ, Luquiens A, Berlin I. Pharmacotherapy for smoking cessation: pharmacological principles and clinical practice. Br J Clin Pharmacol 2014; 77:324-36. [PMID: 23488726 PMCID: PMC4014023 DOI: 10.1111/bcp.12116] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 02/11/2013] [Indexed: 11/30/2022] Open
Abstract
Strategies for assisting smoking cessation include behavioural counselling to enhance motivation and to support attempts to quit and pharmacological intervention to reduce nicotine reinforcement and withdrawal from nicotine. Three drugs are currently used as first line pharmacotherapy for smoking cessation, nicotine replacement therapy, bupropion and varenicline. Compared with placebo, the drug effect varies from 2.27 (95% CI 2.02, 2.55) for varenicline, 1.69 (95% CI 1.53, 1.85) for bupropion and 1.60 (95% CI 1.53, 1.68) for any form of nicotine replacement therapy. Despite some controversy regarding the safety of bupropion and varenicline, regulatory agencies consider these drugs as having a favourable benefit/risk profile. However, given the high rate of psychiatric comorbidity in dependent smokers, practitioners should closely monitor patients for neuropsychiatric symptoms. Second-line pharmacotherapies include nortriptyline and clonidine. This review also offers an overview of pipeline developments and issues related to smoking cessation in special populations such as persons with psychiatric comorbidity and pregnant and adolescent smokers.
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Affiliation(s)
- Henri-Jean Aubin
- Centre d'enseignement, de recherche, et de traitement des addictions, Hôpital Paul Brousse, Pars-Sud 11 UniversityINSERM U669, 94800, Villejuif, France
| | - Amandine Luquiens
- Centre d'enseignement, de recherche, et de traitement des addictions, Hôpital Paul Brousse, Pars-Sud 11 UniversityINSERM U669, 94800, Villejuif, France
| | - Ivan Berlin
- Département de Pharmacologie, Université P.&M. Curie, Faculté de médecine, Hôpital Pitié-Salpêtrière75013, Paris, France
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Missen RL, Brannelly T, Newton-Howes G. Qualitative exploration of family perspectives of smoke-free mental health and addiction services. Int J Ment Health Nurs 2013; 22:294-303. [PMID: 23066762 DOI: 10.1111/j.1447-0349.2012.00882.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The significant health disparities experienced by people with mental illness indicate the need for mental health service improvement. This qualitative study explored family and whānau (Māori family group) perspectives of smoke-free mental health services. Thematic analysis found that family and whānau identified a number of barriers to the implementation of successful smoke-free policy, including lack of coordination and consistency, and limited, if any, family and whānau inclusion. Family and whānau discussed smoking as a strategy for coping with anxiety and boredom; therefore, the need for other activities and strategies to replace smoking was identified as necessary in effective service delivery. The attitude that mental health service policy should be different from general health policy, due to the experience of mental distress, was also identified. In this paper, we argue that the development and implementation of quality mental health services would be strengthened by involving family and whānau in smoke-free initiatives. Furthermore, the provision of relevant information to family, whānau, and service users would help dispel myths and stigma associated with tobacco and mental health.
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Farr SL, Bish CL. Preconception health among women with frequent mental distress: a population-based study. J Womens Health (Larchmt) 2012; 22:153-8. [PMID: 23268583 DOI: 10.1089/jwh.2012.3722] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We examined the extent to which mental distress may be associated with a woman's preconception health. METHODS We analyzed population-based, self-reported data from the 2005, 2007, and 2009 Behavioral Risk Factor Surveillance System (BRFSS) and limited analyses to 213,137 women aged 18-44 years. Women whose mental health was not good for ≥14 days during the past month were categorized as having frequent mental distress. For 15 preconception health indicators, we used chi-square tests to measure differences in prevalence by mental distress and the average marginal predictions approach to logistic regression to assess associations between mental distress and each preconception health indicator in separate models, adjusted for demographic characteristics. We conducted analyses using SUDAAN software to account for the complex sampling design and used weights to produce unbiased estimates. RESULTS The prevalence of good preconception health for each indicator was higher for women reporting infrequent mental distress (chi-square p value<0.001 for all). The greatest disparities in preconception health between women with infrequent and frequent mental distress, respectively, were adequate social and emotional support (adjusted prevalence ratio [aPR]=1.4, prevalence=83.7% and 54.8%), not smoking (aPR=1.2, 82.3% and 62.4%), adequate fruit and vegetable consumption (aPR=1.2, 26.1% and 21.5%), normal weight (aPR=1.2, 50.4% and 39.0%), and good general health (aPR=1.2, 91.7% and 71.5%). CONCLUSIONS Interventions tailored for women with poor mental health may be needed to target specific preconception health indicators, such as social support, smoking, weight, and nutrition.
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Affiliation(s)
- Sherry L Farr
- Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Filia SL, Baker AL, Kulkarni J, Williams JM. Sequential behavioral treatment of smoking and weight control in bipolar disorder. Transl Behav Med 2012; 2:290-5. [PMID: 24073127 PMCID: PMC3717911 DOI: 10.1007/s13142-012-0111-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
People with severe mental illnesses like schizophrenia and bipolar disorder (BPAD) live significantly shorter lives than people in the general population and most commonly die of cardiovascular disease (CVD). CVD risk behaviors such as smoking are not routinely assessed or assertively treated among people with a severe mental illness. This article provides an illustrative case example of a woman with BPAD who is motivated to quit smoking, despite concerns about weight gain and relapse to depression. It outlines key considerations and describes the patient's experience of participating in a behavioral intervention focussing first on smoking, then diet and physical activity. Clinical challenges encountered during treatment are discussed in the context of relevant literature. These include motivational issues, relapse to depression, medication interactions, weight gain, addressing multiple health behavior change, focussing on a behavioral rather than cognitive approach, collaborating with other health care providers, and gender issues.
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Affiliation(s)
- Sacha L Filia
- />Monash Alfred Psychiatry Research Centre (MAPrc), Monash University, Level 1, Old Baker Building, The Alfred Hospital, PO Box 315, Prahran, VIC 3181 Australia
| | - Amanda L Baker
- />Centre for Brain and Mental Health Research (CBMHR), University of Newcastle, Newcastle, NSW Australia
| | - Jayashri Kulkarni
- />Monash Alfred Psychiatry Research Centre (MAPrc), Monash University, Level 1, Old Baker Building, The Alfred Hospital, PO Box 315, Prahran, VIC 3181 Australia
| | - Jill M Williams
- />Division of Addiction Psychiatry, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ USA
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Filia SL, Gurvich CT, Baker AL, Kulkarni J. Response to Anandarajan et al.: Manic exacerbation induced by nicotine patch. Aust N Z J Psychiatry 2012; 46:484-5. [PMID: 22472771 DOI: 10.1177/0004867412444627] [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: 11/15/2022]
Affiliation(s)
- Sacha L Filia
- Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University, The Alfred Hospital, Melbourne, Australia
| | - Caroline T Gurvich
- Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University, The Alfred Hospital, Melbourne, Australia
| | - Amanda L Baker
- Centre for Brain and Mental Health Research (CBMHR), University of Newcastle, Newcastle, Australia
| | - Jayashri Kulkarni
- Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University, The Alfred Hospital, Melbourne, Australia
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Kelly DL, Raley HG, Lo S, Wright K, Liu F, McMahon RP, Moolchan ET, Feldman S, Richardson CM, Wehring HJ, Heishman SJ. Perception of smoking risks and motivation to quit among nontreatment-seeking smokers with and without schizophrenia. Schizophr Bull 2012; 38:543-51. [PMID: 21041835 PMCID: PMC3330003 DOI: 10.1093/schbul/sbq124] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We examined perceived consequences/benefits of cigarette smoking and motivation for quitting in nontreatment-seeking smokers who had schizophrenia or schizoaffective disorder (N = 100) or had no Axis I psychiatric disorder (normals, N = 100). METHODS Participants completed questionnaires and provided a breath carbon monoxide (CO) sample 10-15 minutes after smoking 1 preferred-brand cigarette. Primary assessments included the Smoking Consequences Questionnaire-Adult, the Reasons for Quitting Scale, and the Stages of Change. RESULTS There were no differences between the schizophrenia and control group in mean age of smoking onset (16.2 ± 5.4 vs 15.6 ± 5.5 y, P = .44), number of cigarettes daily (17.9 ± 11.6 vs 17.0 ± 7.9, P = 0.51), or in breath CO (28.0 ± 14.5 vs 22.9 ± 8.0 ppm, P = .61). Compared with normals, people with schizophrenia report greater stimulation/state enhancement (P < .0001) and social facilitation (P < .004) from smoking. People with schizophrenia had less appreciation of health risks associated with smoking than normal controls (P < .0001) and were less motivated to quit smoking than normal controls (P = .002), even though they were as likely to be in the preparation stage of change. Immediate reinforcement (P = .04) and health concerns (P = .002) were rated lower as motivators for considering quitting smoking in schizophrenia than normals. People with schizophrenia reported greater motivation to stop smoking due to social pressure/rewards than normals (P = .047). CONCLUSIONS This study underscores the degree to which people with schizophrenia perceive the state-enhancing effects of smoking and their lower appreciation for health risks of smoking compared with normal controls.
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Affiliation(s)
- Deanna L. Kelly
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228,To whom correspondence should be addressed; tel: 410-402-6860, fax: 410-402-6038, e-mail:
| | - Heather G. Raley
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Suzanne Lo
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
| | - Katherine Wright
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Fang Liu
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Robert P. McMahon
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | | | - Stephanie Feldman
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Charles M. Richardson
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Heidi J. Wehring
- Maryland Psychiatric Research Center, University of Maryland, Baltimore School of Medicine, Box 21247, Baltimore, MD 21228
| | - Stephen J. Heishman
- Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, Baltimore, MD
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Ahnallen CG, Liverant GI, Gregor KL, Kamholz BW, Levitt JJ, Gulliver SB, Pizzagalli DA, Koneru VK, Kaplan GB. The relationship between reward-based learning and nicotine dependence in smokers with schizophrenia. Psychiatry Res 2012; 196:9-14. [PMID: 22342123 PMCID: PMC3351530 DOI: 10.1016/j.psychres.2011.09.011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2011] [Revised: 07/27/2011] [Accepted: 09/16/2011] [Indexed: 10/28/2022]
Abstract
Cigarette smoking rates remain remarkably high in schizophrenia relative to smoking in other psychiatric groups. Impairments in the reward system may be related to elevated rates of nicotine dependence and lower cessation rates in this psychiatric group. Smokers with schizophrenia and schizoaffective disorder (SWS; n=15; M(age)=54.87, S.D.=6.51, 100% male) and a non-psychiatric control group of smokers (NCL; n=16; M(age)=50.38, S.D.=11.52; 93.8% male) were administered a computerized signal detection task to measure reward-based learning. Performance on the signal detection task was assessed by response bias, discriminability, reaction time, and hit rate. Clinician-assessed and self-reported measures of smoking and psychiatric symptoms were completed. SWS exhibited similar patterns of reward-based learning compared to control smokers. However, decreased reward-based learning was associated with increased levels of nicotine dependence in SWS, but not among control smokers. Nicotine withdrawal and urge to smoke were correlated with anhedonia within the SWS group. Among SWS, reduced reward responsiveness and increased anhedonia were associated with and may contribute to greater co-occurring nicotine dependence. These findings emphasize the importance of targeting reward system functioning in smoking cessation treatment for individuals with schizophrenia.
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Partos TR, Borland R, Siahpush M. Socio-economic disadvantage at the area level poses few direct barriers to smoking cessation for Australian smokers: findings from the International Tobacco Control Australian cohort survey. Drug Alcohol Rev 2012; 31:653-63. [PMID: 22385265 DOI: 10.1111/j.1465-3362.2012.00427.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Area-level indicators of socio-economic variation are frequently included in models of individual health outcomes. Area disadvantage is linearly related to smoking prevalence, but its relation to cessation outcomes is less well understood. AIMS To explore the relationship between area-level disadvantage and prospective data on smoking cessation. DESIGN AND METHODS The Australian cohort of the International Tobacco Control Four-Country Survey (N = 3503) was used to prospectively examine the contribution of area-level socio-economic disadvantage to predicting three important smoking-cessation outcomes: making a quit attempt, achieving 1 month abstinence and achieving 6 month abstinence from smoking, while controlling for individual-level socio-economic indicators and other individual-level covariates related to smoking cessation. RESULTS Only two independent associations were observed between socio-economic disadvantage and cessation outcomes. Area-level disadvantage was related to 1 month abstinence in a non-linear fashion, and the individual experience of smoking-induced deprivation was associated with a lower likelihood of making quit attempts. DISCUSSION Despite the documented higher prevalence of smoking among the more disadvantaged and in more disadvantaged areas, socio-economic disadvantage was not consistently related to making quit attempts, nor to medium-term success. Nevertheless, indirect effects of disadvantage, like its impact on psychological distress, cannot be ruled out, and considering smokers' individual psychosocial circumstances is likely to aid cessation efforts. CONCLUSION Socio-economic disadvantage, particularly at the area level, poses few direct barriers to smoking cessation.
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Tranel D, McNutt A, Bechara A. Smoking cessation after brain damage does not lead to increased depression: implications for understanding the psychiatric complications of varenicline. Cogn Behav Neurol 2012; 25:16-24. [PMID: 22330182 PMCID: PMC3299864 DOI: 10.1097/wnn.0b013e3182492a9c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are concerns that varenicline (Chantix/Champix), a prescription medication used to treat smoking addiction, might cause serious neuropsychiatric side effects, such as depression, self-injurious behavior, and suicide. However, the cause of depression and related symptoms in persons who quit smoking after taking varenicline remains uncertain, because smoking cessation itself can cause such symptoms. METHOD We studied 70 patients with brain lesions: 32 had stopped smoking after suffering their lesion (Quitters) and 38 had kept smoking (Non-Quitters). RESULTS There was no indication of increased depression in the Quitters compared with the Non-Quitters. The 2 groups, which were statistically indistinguishable on demographic and neuropsychological variables, showed the same rates and levels of severity of depression and related symptoms. Moreover, in a subgroup of 16 Quitters who had stopped smoking immediately after their neurological injury in the context of losing their craving to smoke, rates of depression-related symptoms were no higher than in the other Quitters and the Non-Quitters. CONCLUSIONS Smoking cessation did not lead to elevated levels of depression in patients with brain lesions, suggesting that psychiatric complications (particularly depression) observed after varenicline use are caused by the medication rather than the smoking cessation itself.
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Affiliation(s)
- Daniel Tranel
- Department of Neurology, Division of Behavioral Neurology and Cognitive Neuroscience, University of Iowa College of Medicine, Iowa City, IA 52242, USA.
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Rogers E, Sherman SE. State Smoking Cessation Quitlines and Smokers With Mental Illness. J Smok Cessat 2012. [DOI: 10.1375/jsc.5.2.158] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AbstractObjective:State smoking cessation telephone quitlines have become an integral part of the U.S. public health strategy for helping smokers quit. It is unclear whether these quitlines meet the needs of smokers with a mental illness, who have unique challenges during the quitting process and may benefit from more intensive treatment compared to smokers without mental illness. We conducted a needs assessment survey of U.S. state quitlines (N= 51 including Washington DC) to learn how they work with mentally ill callers.Methods:Quitline representatives were asked whether they have, or perform, six services chosen to represent basic elements of treatment access, process and structure for mentally ill smokers.Findings:We had a 96% response rate to our survey. All surveyed quitlines accept calls from mentally ill smokers, and all either train their counsellors in mental health or their counsellors have past mental health training. In addition, all quitlines encourage mentally ill callers to discuss quitting with their regular healthcare providers for safety reasons. However, only eight surveyed quitlines (16%) screen callers for mental illness, few (18%) use specific counselling protocols for mentally ill callers, and even fewer (6%) have self-help materials tailored for the mentally ill.Conclusions:Future studies are needed to analyse these variations in state quitline operations to identify the most effective approaches to providing telephone-based treatment for smokers with mental illness.
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Nonmedication smoking reduction program for inpatients with chronic schizophrenia: a randomized control design study. J Nerv Ment Dis 2012; 200:142-6. [PMID: 22297311 DOI: 10.1097/nmd.0b013e3182438e92] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
People with schizophrenia are more likely to smoke, and to smoke more frequently, than those without schizophrenia. Furthermore, inpatients smoke even more frequently compared with those living in the community. In light of this, we implemented and assessed a smoking reduction intervention using a wide array of behavioral group techniques and methods in chronic hospitalized schizophrenic clients. Using a controlled design, we randomly assigned chronic schizophrenic clients to either a five-session smoking reduction intervention (n = 35) or a waiting list (WL; n = 18). We assessed self-reported smoking behavior, clinical status (Positive and Negative Syndrome Scale, Hamilton Rating Scale for Depression; Clinical Global Impression Scale for Psychosis), subjective quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire-abbreviated version), and weight before and 3 months after the intervention. The intervention successfully reduced the number of cigarettes smoked compared with nonintervention. No clinical worsening or weight gain was observed. Behavioral group-oriented smoking reduction interventions can significantly reduce smoking behavior in hospitalized chronic clients with schizophrenia.
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Aubin HJ, Rollema H, Svensson TH, Winterer G. Smoking, quitting, and psychiatric disease: A review. Neurosci Biobehav Rev 2012; 36:271-84. [DOI: 10.1016/j.neubiorev.2011.06.007] [Citation(s) in RCA: 173] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 06/14/2011] [Accepted: 06/15/2011] [Indexed: 11/25/2022]
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Hou YZ, Xiang YT, Yan F, Ungvari GS, Dickerson F, Chiu HFK, Lai KYC, Lee EHM, Li WY, Li WX, Zhu YL, Dixon LB. Cigarette smoking in community-dwelling patients with schizophrenia in China. J Psychiatr Res 2011; 45:1551-6. [PMID: 21820671 DOI: 10.1016/j.jpsychires.2011.07.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Revised: 07/08/2011] [Accepted: 07/14/2011] [Indexed: 11/30/2022]
Abstract
This study examined the prevalence of cigarette smoking and its socio-demographic and clinical characteristics in Chinese schizophrenia patients. A sample of 540 community-dwelling patients (female/male: 50.4% vs. 49.6%) with schizophrenia was interviewed using standardized assessment instruments. The patients' basic socio-demographic and clinical data including smoking were collected. The prevalence of cigarette smoking was 28.5% in the whole sample, and 53.6% and 4.0% for men and women, respectively. In univariate analyses, male sex, use of first generation antipsychotics (FGAs) and alcohol consumption were significantly associated with smoking. In multiple logistic regression analysis, male sex, alcohol consumption, older age and lower level of education were independently associated with smoking. The prevalence of smoking in Chinese schizophrenia patients is considerably lower than most figures reported from Western settings. The dramatic differences between males and females underscore the influence of cultural norms on smoking.
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Affiliation(s)
- Ye-Zhi Hou
- Beijing Anding Hospital, Capital Medical University, China
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Depression and essential health risk factors in surgical patients in the preoperative anaesthesiological assessment clinic. Eur J Anaesthesiol 2011; 28:733-41. [DOI: 10.1097/eja.0b013e3283478361] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Chacón F, Mora F, Gervás-Ríos A, Gilaberte I. Efficacy of lifestyle interventions in physical health management of patients with severe mental illness. Ann Gen Psychiatry 2011; 10:22. [PMID: 21929761 PMCID: PMC3189180 DOI: 10.1186/1744-859x-10-22] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Accepted: 09/19/2011] [Indexed: 02/08/2023] Open
Abstract
Awareness of the importance of maintaining physical health for patients with severe mental illnesses has recently been on the increase. Although there are several elements contributing to poor physical health among these patients as compared with the general population, risk factors for cardiovascular disease such as smoking, diabetes mellitus, hypertension, dyslipidemia, metabolic syndrome, and obesity are of particular significance due to their relationship with mortality and morbidity. These patients present higher vulnerability to cardiovascular risk factors based on several issues, such as genetic predisposition to certain pathologies, poor eating habits and sedentary lifestyles, high proportions of smokers and drug abusers, less access to regular health care services, and potential adverse events during pharmacological treatment. Nevertheless, there is ample scientific evidence supporting the benefits of lifestyle interventions based on diet and exercise designed to minimize and reduce the negative impact of these risk factors on the physical health of patients with severe mental illnesses.
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Affiliation(s)
| | - Fernando Mora
- Servicio de Psiquiatría, Hospital Infanta Leonor, Madrid, Spain
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Lee JGL, Ranney LM, Goldstein AO, McCullough A, Fulton-Smith SM, Collins NO. Successful implementation of a wellness and tobacco cessation curriculum in psychosocial rehabilitation clubhouses. BMC Public Health 2011. [PMID: 21917179 DOI: 10.1186/1471–2458-11–702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco remains a seemingly intractable problem for individuals living with severe and persistent mental illness. This study evaluated the implementation, technical assistance, and perceived impact of a model curriculum ("Learning About Healthy Living") to promote wellness and motivation to quit tobacco use in psychosocial rehabilitation clubhouses. METHODS We used semi-structured interviews (n = 9) with clubhouse staff (n = 12) and a survey of participating clubhouse members (n = 271) in nine clubhouses. RESULTS Fifty-eight percent of clubhouse participants completed surveys. Results showed tobacco users open to tobacco-free policies (62%) and perceiving more discussions about quitting tobacco with healthcare providers (69%). Analyses of staff interviews and member surveys revealed four key themes: (1) the curriculum was successfully implemented and appreciated; (2) technical assistance kept implementation on track; (3) adding wellness content and interactive components should enhance the curriculum; and, (4) the curriculum advanced other healthful policies and practices. CONCLUSIONS Mental health settings are important locations for implementing programs to address tobacco use. In this real-world implementation of a model curriculum in psychosocial rehabilitation clubhouses, the curriculum tested well, was feasible and well-received, and suggests potential impact on tobacco use outcomes. Revision, dissemination, and a randomized controlled trial evaluation of the model curriculum should now occur.
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Affiliation(s)
- Joseph G L Lee
- Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, CB 7595, 590 Manning Drive, Chapel Hill, North Carolina 27599, USA.
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Lee JGL, Ranney LM, Goldstein AO, McCullough A, Fulton-Smith SM, Collins NO. Successful implementation of a wellness and tobacco cessation curriculum in psychosocial rehabilitation clubhouses. BMC Public Health 2011; 11:702. [PMID: 21917179 PMCID: PMC3184072 DOI: 10.1186/1471-2458-11-702] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Accepted: 09/14/2011] [Indexed: 11/17/2022] Open
Abstract
Background Tobacco remains a seemingly intractable problem for individuals living with severe and persistent mental illness. This study evaluated the implementation, technical assistance, and perceived impact of a model curriculum ("Learning About Healthy Living") to promote wellness and motivation to quit tobacco use in psychosocial rehabilitation clubhouses. Methods We used semi-structured interviews (n = 9) with clubhouse staff (n = 12) and a survey of participating clubhouse members (n = 271) in nine clubhouses. Results Fifty-eight percent of clubhouse participants completed surveys. Results showed tobacco users open to tobacco-free policies (62%) and perceiving more discussions about quitting tobacco with healthcare providers (69%). Analyses of staff interviews and member surveys revealed four key themes: (1) the curriculum was successfully implemented and appreciated; (2) technical assistance kept implementation on track; (3) adding wellness content and interactive components should enhance the curriculum; and, (4) the curriculum advanced other healthful policies and practices. Conclusions Mental health settings are important locations for implementing programs to address tobacco use. In this real-world implementation of a model curriculum in psychosocial rehabilitation clubhouses, the curriculum tested well, was feasible and well-received, and suggests potential impact on tobacco use outcomes. Revision, dissemination, and a randomized controlled trial evaluation of the model curriculum should now occur.
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Affiliation(s)
- Joseph G L Lee
- Tobacco Prevention and Evaluation Program, Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, CB 7595, 590 Manning Drive, Chapel Hill, North Carolina 27599, USA.
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Meszaros ZS, Dimmock JA, Ploutz-Snyder RJ, Abdul-Malak Y, Leontieva L, Canfield K, Batki SL. Predictors of smoking severity in patients with schizophrenia and alcohol use disorders. Am J Addict 2011; 20:462-7. [PMID: 21838846 DOI: 10.1111/j.1521-0391.2011.00150.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The goal of the present study was to identify predictors of smoking severity in patients with schizophrenia and co-occurring alcohol use disorders (AUD). Our hypothesis was that negative symptoms of schizophrenia, severity of depression, male gender, drinking severity, and recreational drug use were associated with increased smoking. Clinical data, including demographic variables, alcohol and substance use severity, psychiatric medications, severity of depression, positive and negative symptoms of schizophrenia were analyzed in a cohort of 90 patients with schizophrenia or schizoaffective disorder and AUD. Eighty-eight percent of participants were smokers, they smoked an average of 15 cigarettes/day. Zero-inflated negative binomial (ZINB) regression analyses demonstrated that alcohol use severity, gender, and severity of negative symptoms were not predictive of the number of cigarettes smoked. Smoking severity was positively related to Caucasian race, psychosis severity (Positive and Negative Syndrome Scale [PANSS] general score), and medications (conventional antipsychotics). Subjects who used recreational drugs smoked less. In summary, severe, treatment resistant schizophrenia, and conventional antipsychotic treatment is associated with heavy smoking in patients with schizophrenia and AUD regardless of gender or alcohol use.
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Counotte DS, Smit AB, Pattij T, Spijker S. Development of the motivational system during adolescence, and its sensitivity to disruption by nicotine. Dev Cogn Neurosci 2011; 1:430-43. [PMID: 22436565 DOI: 10.1016/j.dcn.2011.05.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 05/18/2011] [Accepted: 05/29/2011] [Indexed: 12/18/2022] Open
Abstract
The brain continues to develop during adolescence, and exposure to exogenous substances such as nicotine can exert long-lasting adaptations during this vulnerable period. In order to fully understand how nicotine affects the adolescent brain it is important to understand normal adolescent brain development. This review summarizes human and animal data on brain development, with emphasis on the prefrontal cortex, for its important function in executive control over behavior. Moreover, we discuss how nicotine exposure during adolescence can disrupt brain development bearing long-term consequences on executive cognitive function in adulthood.
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Affiliation(s)
- Danielle S Counotte
- Molecular and Cellular Neurobiology, Center for Neurogenomics & Cognitive Research (CNCR), VU University, The Netherlands.
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Scharf D, Fabian T, Fichter-DeSando C, Douaihy A. Nicotine replacement prescribing trends in a large psychiatric hospital, before and after implementation of a hospital-wide smoking ban. Nicotine Tob Res 2011; 13:466-73. [PMID: 21464201 DOI: 10.1093/ntr/ntr026] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We examined prescribing patterns for nicotine replacement therapies (NRTs) in a large psychiatric hospital, before and after the implementation of a smoking ban. METHOD We extracted 5 years of NRT utilization data from hospital pharmacy records. The ban went into effect on January 1, 2007. Data reflect NRT prescriptions from 2 years before and 3 years after the ban, and N = 30,908 total inpatient hospital admissions. RESULTS The monthly rate of total NRT prescriptions increased after the ban from M = 254.25 (SD = 126.60) doses per month to M = 4,467.52 (SD = 1,785.87) doses per month (>1,700% increase, p < .0001). After the smoking ban, clinicians prescribed higher doses of transdermal (but not oral) NRT (Tukey, p < .0001). Comparisons of NRT prescribing across hospital units tentatively suggested that patients being treated on the substance use disorders unit were prescribed more doses of NRT, as well as higher doses of NRT compared with patients on other units. Analysis of trends over time showed no apparent downward trend for NRT usage during the 3 years following the smoking ban, suggesting that clinicians continued to treat nicotine dependence after smoking was restricted. CONCLUSIONS Clinicians are more likely to identify and treat symptoms of nicotine withdrawal when smoking is restricted. Hospitals should consider monitoring prescriptions for NRT as part of their ongoing quality assurance practices so that patients receive aggressive treatment of nicotine withdrawal symptoms--an essential component of high-quality patient care.
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Affiliation(s)
- Deborah Scharf
- Pharmacy and Therapeutics, Department of Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, PA, USA.
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Arbour-Nicitopoulos KP, Faulkner GE, Cohn TA, Selby P. Smoking cessation in women with severe mental illness: exploring the role of exercise as an adjunct treatment. Arch Psychiatr Nurs 2011; 25:43-52. [PMID: 21251601 DOI: 10.1016/j.apnu.2010.05.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 05/19/2010] [Accepted: 05/30/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the potential role of exercise in smoking cessation in women with severe mental illness (SMI). METHODS Semistructured interviews with 12 women diagnosed with SMI receiving smoking cessation treatment were conducted. RESULTS Participants perceived three roles for exercise in assisting smoking cessation--addressing fears with preexisting chronic health conditions, emotion management and distraction, and weight management. Most participants identified health care providers (HCPs) as needing to play a supportive role in integrating exercise into smoking cessation attempts. CONCLUSION Findings support a potential role for exercise in facilitating smoking cessation among women with SMI. PRACTICE IMPLICATIONS HCPs should consider developing referral links with exercise specialists to facilitate smoking cessation in women with SMI.
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