Article

Specifying Cigarette Smoking and Quitting among People with Serious Mental Illness

Department of Psychiatry, University of Maryland, Baltimore, Baltimore, Maryland, United States
American Journal on Addictions (Impact Factor: 1.74). 07/2009; 13(2):128-38. DOI: 10.1080/10550490490436000
Source: PubMed

ABSTRACT People with serious mental illnesses (SMI) have a high prevalence of cigarette smoking. Details of their smoking and quitting behaviors are needed to create effective interventions. This study aims to describe the smoking and quitting histories, current behaviors, and motivations of an outpatient sample of smokers with SMI. A structured interview and Breathalyzer assessment were administered to 120 smokers from four diverse mental health settings. Participants' smoking and quitting self-report data are presented in combination with demographic and clinical variables; the results provide implications for smoking cessation, amelioration, and prevention interventions and for future research.

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Available from: Alicia Lucksted, Feb 26, 2015
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    • "A number of studies have described smoking outcome expectancies in smokers with schizophrenia, with most finding that reduction of negative affect was rated the most important positive expectancy (Buckley et al., 2005; Esterberg and Compton, 2005; Forchuk et al., 2002; Solty et al., 2009; but see Carosella et al., 1999) and negative health consequences the most important negative expectancy (Buckley et al., 2005; Carosella et al., 1999; Esterberg and Compton, 2005; Lucksted et al., 2004; Solty et al., 2009). However, the few studies that have directly compared smoking expectancies of smokers with schizophrenia with those of a concurrent sample of smokers without psychiatric illness have reported inconsistent findings. "
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    ABSTRACT: Cigarette smoking expectancies are systematically related to intention to quit smoking in adult smokers without psychiatric illness, but little is known about these relationships in smokers with serious mental illness. In this study, we compared positive and negative smoking expectancies, and examined relationships between expectancies and intention to quit smoking, in smokers with schizophrenia (n=46), smokers with schizoaffective disorder (n=35), and smokers without psychiatric illness (n=71). In all three groups, reduction of negative affect was rated as the most important smoking expectancy and intention to quit smoking was systematically related to concerns about the health effects and social consequences of smoking. Compared to the other groups of smokers, those with schizoaffective disorder were more concerned with social expectancies and with the immediate negative physical effects of smoking. Results of this study suggest that challenging positive smoking expectancies and providing more tailored information about the negative consequences of smoking might increase motivation to quit smoking in smokers with schizophrenia and schizoaffective disorder, as has been found with non-psychiatric smokers.
    Schizophrenia Research 10/2009; 115(2-3):310-6. DOI:10.1016/j.schres.2009.09.032 · 4.43 Impact Factor
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    ABSTRACT: Developing effective models of identifying and managing physical ill health amongst mental health service users has become an increasing concern for psychiatric service providers. This article sets out the general professional and Irish statutory obligations to provide physical health monitoring services for individuals with serious mental illness. Review and summary statements are provided in relation to the currently available guidelines on physical health monitoring. Developing effective models of identifying and managing physical ill health amongst mental health service users has become an increasing concern for psychiatric service providers. Individuals with serious mental illness (SMI – defined as any DSM [Diagnostic and Statistical Manual] mental disorder leading to substantial functional impairment) have higher than expected rates of physical morbidity and mortality in comparison with members of the general popula-tion. Mortality rates are increased across all psychiatric diagnostic categories and treatment settings, 1-5 although patients attending specialist psychiatric services appear to be at particular risk. 1 Excess morbidity and mortality has been reported in relation to cardiovascular, respiratory, endocrine, neurological, gastrointestinal, infective, and malignant aetiol-ogy. 1-4,6,7 Poor physical health is often evident from an early age and contributes to the proven 10%-20% reduction in life expectancy associated with SMI. 5,8 The relationship between mental disorder and poor physi-cal health is complex and a number of factors are likely to exert influence. Most individuals with SMI live relatively unhealthy lifestyles, with evidence suggesting that they smoke more, 9,10 have poorer diets, 10,11 are less physically active, 12 and are more likely to abuse alcohol or drugs 6,7 than population comparators. A greater inherent predisposition to develop metabolic abnormalities 13 coupled with potential metabolic adverse effects of antipsychotic drug treatments 14 may negatively influence physical health. Other adverse drug effects, including those on cardiovascular, endocrine, sexual and neurological health, are also of concern. 15 Individuals with SMI frequently have unidentified or untreated physical disor-ders, 16 are less likely to be aware of or report previously diagnosed medical conditions, 17 and have low compliance rates with medical treatment regimens. 18-20 Studies of healthcare utilisation have reported both higher and lower rates of service use, reflecting the study method-ologies employed. 21-23 Although service use varies according to psychiatric diagnosis and treatment settings, 21,22 those with SMI may be less likely to benefit from certain screening inves-tigations or preventive health programmes and more likely to receive care from accident and emergency departments. 21,23 In addition, a number of studies have highlighted disparities in the level of investigation and quality of treatment provided for physical disorders in individuals with SMI versus compara-tor patients. 24-27 Unsurprisingly, psychiatric and medical co-morbidity is associated with both poorer physical and mental health outcomes. 28-30 Cognisant of the importance of physical health monitoring for individuals with SMI, we set about planning a compre-hensive integrated service for patients attending Navan general adult psychiatric services. In terms of treatment setting, our community-based multidisciplinary team provides psychiatric outpatient and inpatient services to an urban catchment area population of 43,608 (Census 2006). Early development phases included a review of relevant back-ground information and currently available monitoring guidelines, followed by an audit of local practice and resources to document any service shortfalls. Subsequently, specific recommendations for action were published. We have reproduced some of our findings below, in the hope that service providers elsewhere might benefit from our exploratory work.
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    ABSTRACT: Through the use of Coroner's records the research has demonstrated that people who die in residential fires display a number of environmental, demographic and/or behavioural risk characteristics. The current research has been organised into two studies. Study one had two aims with the first aim to develop the Victoria University (VU) Coroner's Accidental Fire Fatality Database. This would then provide a comprehensive record of all adult fire deaths that occurred in Victoria, Australia between January 1998 and February 2005. The second aim was to use this database to examine risk factors for the overall adult accidental fire fatality population (N = 101). Study two focused on the mentally ill and the aim was to examine whether the mentally ill (MI) (n = 55) compared to the non-mentally ill (NMI) (n = 46) exhibited different risk characteristics. Results indicated this fire death population was overrepresented by males, cigarette smokers, the mentally ill, people not in paid employment, and those aged over 80 years when compared to their proportion of the general Victorian population. When relative risk ratios were calculated it was found that the MI group were 7.9 (CI 95% 2.0-31.8) times more likely than the NMI group to have combined alcohol and drugs prior to their death. The MI were 5.9 (CI 95% 1.9-18.4) times more likely to have a history of careless smoking, a 2.2 (CI 95% 1.4-3.5) increased chance of having a cigarette as an ignition factor and were 3.6 (CI 95% 1.7-7.8) times more prone to have been acting abnormally prior to the fire than the NMI group. Future fire safety measures can be improved by taking into account these risk factors to target campaigns or to tailor interventions that have an effect on the most vulnerable in our community in the context of their environment.
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