Experiences Using Family or Peer Support for Smoking Cessation and Considerations for Support Interventions: A Qualitative Study in Persons With Mental Health Conditions.

Background: The current study aimed to understand how people with mental health conditions who currently smoke or recently quit engaged with family members or peers when quitting and assessed interest in involving family or peers in cessation interventions. Methods: Adults with mental health conditions who smoke or had quit within the past 5 years were recruited from publicly funded mental health programs (N = 24). We conducted virtual qualitative interviews between November 2020 and August 2021 and analyzed the data using the rapid thematic analytic approach. Results: Most participants were men (62%), and 71% were current smokers. We found that: having family/peers who were interested in quitting presented communal quitting opportunities, communication that facilitated quitting tended to be encouraging, and strong relationships with family members increased willingness to involve them in cessation interventions. But family or peer support was less helpful for individuals who were not ready to quit. Conclusion: Training family and peers to engage in supportive behaviors may promote cessation in this population. Cessation interventions may benefit from recruiting support partners who share a strong relationship with the smoker.

Use of a Rapid Qualitative Method to Inform the Development of a Text Messaging Intervention for People With Serious Mental Illness Who Smoke: Formative Research Study.

BACKGROUND: People with serious mental illness are disproportionately affected by smoking and face barriers to accessing smoking cessation treatments in mental health treatment settings. Text-based interventions are cost-effective and represent a widely accessible approach to providing smoking cessation support. OBJECTIVE: We aimed to identify key factors for adapting text-based cessation interventions for people with serious mental illness who smoke. METHODS: We recruited 24 adults from mental health programs who had a serious mental illness and currently smoked cigarettes or had quit smoking within the past 5 years. We then conducted virtual qualitative interviews between November 2020 and August 2021. Data were analyzed using the rapid thematic analytic approach. RESULTS: We identified the following 3 major themes: (1) interplay between smoking and having a serious mental illness, (2) social contextual factors of smoking in adults with serious mental illness, and (3) smoking and quitting behaviors similar to the general population. Participants reported barriers and facilitators to quitting across the 3 themes. Within the "interplay between smoking and having a serious mental illness" theme, barriers included smoking to manage stress and mental health symptoms, and facilitators to quitting included the awareness of the harm of smoking on mental health and patient-provider discussions on smoking and mental health. In the "social contextual factors of smoking in adults with serious mental illness" theme, barriers included high social acceptability of smoking among peers. Positive support and the combined social stigma of smoking and having a mental health condition outside of peer groups motivated individuals to quit. Some participants indicated that low exposure to other smokers during the COVID-19 pandemic helped them to engage in cessation efforts. In the "smoking and quitting behaviors similar to the general population" theme, barriers included smoking after eating, having coffee, drinking alcohol, and experiencing negative social support, and facilitators included health concerns, improvement in the general quality of life, and use of evidence-based tobacco treatments when available. CONCLUSIONS: People with serious mental illness often smoke to cope with intense emotional states, manage mental health symptoms, or maintain social bonds. Text message content emphasizing equally effective and less harmful ways for stress reduction and mental health symptom management may improve quit rates in individuals with serious mental illness.

A Challenging Yet Motivating Journey: The Experiences of Young Adult Parents With Serious Mental Health Conditions in the USA.

In recent decades the average age of becoming a parent has increased, the rate of teen pregnancies has decreased, and a new developmental period of emerging adulthood is marked by diverse pathways into adulthood. Today, those who become parents in young adulthood (18-24 years old) and their children may be vulnerable to poor outcomes observed in teen parents (13-19 years old) of previous generations. Young adults with serious mental health conditions (SMHC) who encounter additional challenges navigating young adulthood and tend to parent earlier than their peers may be at particularly increased risk of poor outcomes. To date, little research has been done to understand the experiences of young adult parents, especially those with SMHC. This study describes themes from qualitative interviews with 18 young adults with SMHC in the United States who became parents before the age of 25. Life story narrative interviews, conducted mostly by young adults with lived experience, asked participants to describe their parenting and mental health experiences and their school, training, and work experiences. Participants described the challenges of simultaneously parenting young children and managing a mental health condition, experiences of discrimination, and fear of future discrimination related to their mental health condition. However, parents also expressed that their children motivated them to maintain recovery and build a good life for their family. This is the first study to qualitatively explore the experiences of young adult parents with SMHC. While many of these findings align with prior qualitative research on mothers with mental illness, by exclusively focusing on individuals who become parents earlier than their peers and including father experiences, this research adds to our understanding of how individuals simultaneously navigate parenting and managing a serious mental health condition. These findings should inform larger-scale research studies on the experiences and outcomes of young adults with SMHC who become parents in their late teens or early twenties. A better understanding of their experiences should inform public mental health services that incorporate parenting as an important element of an individual's personal recovery model.

Evaluating Educational and Employment Services for Young People With Psychiatric Conditions: A Systematic Review.

OBJECTIVE: The authors conducted a systematic review of studies evaluating vocational interventions for young people with psychiatric conditions to determine the extent to which services were adapted for young people and whether services promoted gains in postsecondary education and employment. METHODS: Five databases (PubMed, PsycINFO, Web of Science, Academic Search Premier, and ERIC) were searched. Sources eligible for inclusion were controlled studies published between 2000 and mid-2020 that evaluated a vocational intervention and examined postsecondary educational or employment outcomes for youths or young adults (ages 14-35 years) with psychiatric conditions. RESULTS: Ten studies met the inclusion criteria. Several of the studies evaluated services that were adapted for young people, including through the incorporation of educational supports. The most consistent finding was that services based on the individual placement and support (IPS) model improved employment outcomes more effectively than did comparison approaches and treatment as usual. Fewer studies assessed educational outcomes, and they yielded mixed results; however, recent findings from a controlled trial indicate that an enhanced IPS intervention that included well-specified supported education and skills training led to significantly superior outcomes in both education and employment. CONCLUSIONS: These results provide support for the efficacy of IPS-based services to improve employment outcomes among young people with psychiatric conditions and suggest that adapting IPS to include comprehensive educational supports and skills training may be important for efforts to improve postsecondary educational outcomes. Additional well-controlled intervention studies that examine educational and longer-term outcomes should further inform the development and delivery of vocational services for this population.