Assessing Tobacco Treatment Engagement in Assertive Community Treatment Programs.

OBJECTIVE: Despite high tobacco use prevalence among those with serious mental illnesses, few Assertive Community Treatment (ACT) programs provide tobacco treatment. Understanding the factors associated with the intentions to engage in tobacco treatment from both provider and consumer perspectives is important. The purpose was to examine ACT providers' intention to provide and consumer intention to engage in tobacco treatment. METHOD: A cross-sectional survey of ACT program providers (N = 51) and consumers (N = 43) from four community mental health centers. Multiple linear regression analyses were used to examine factors associated with the intentions to provide or engage in tobacco treatment from among attitudinal, subjective norms, and perceived behavioral control variables. RESULTS: Providers reported positive attitudes, high degree of perceived behavior control, and high intentions for delivering tobacco treatment, but poor perceptions of subjective norms. These results were like consumers' intentions to engage in tobacco treatment. In regression analysis, only subjective norms and perceived behavior control were significant predictors for providers' intentions to provide tobacco treatment, but there were no significant predictors of consumers' intentions to engage in tobacco treatment. Both providers and consumers endorsed poor implementation of evidence-based tobacco treatment. CONCLUSION: Poor engagement in tobacco treatment within ACT programs indicates the need for policymakers to support tobacco treatment within the services. This finding calls for training of mental and behavioral health providers while supporting tobacco-free initiatives in ACT treatment service settings.

Pilot Study Focused on Knowledge, Attitudes, and Health Access Behaviors of Psychiatric-Mental Health Nurses Regarding Suicide Prevention.

OBJECTIVE: The purpose of this pilot study was to evaluate the effect of a web-based education module on the knowledge, attitudes, and ratings of willingness to access help related to suicide prevention in psychiatric-mental health nurses. METHODS: A quasi-experimental pretest-posttest design was employed. Registered nurses from two academic health center units and a 239-bed Psychiatric Hospital were invited to participate. Scores on knowledge of suicide risk and prevention, attitudes, subjective norms, perceived behavioral control, and intent to seek help upon experiencing suicidal ideations were obtained before and after administering a 25-min web-based training. RESULTS: Twenty-nine participants completed the pre-survey, web-based education module, and post-survey. Significant increases from baseline in the scores on knowledge, attitudes, subjective norms, and intentions related to help-seeking behaviors for nurse suicide prevention were noted. Perceived behavioral control median scores increased but were not statistically significant. More than 40% of the participants reported having experienced suicidal thoughts. CONCLUSIONS: Further study is needed to determine contributors to this higher rate. Understanding the effectiveness of strategies to reduce nurse suicide can provide insights into building better nurse suicide prevention programs.

The Impact of a Nurse-Led Service on Tobacco Treatment Provision Within a Psychiatric Hospital: A Time Series Study.

INTRODUCTION: Psychiatric hospitalization is an opportunity to provide evidence-based tobacco treatment to optimize cessation efforts among people living with mental illnesses (MI). The purpose of this study was to examine the effectiveness of nurse-driven initiatives to enhance tobacco treatment within an inpatient psychiatric setting. AIMS: We assessed the 4-year impact of implementing a nurse-led tobacco treatment service offered to 11,314 inpatients at admissions in a tobacco-free psychiatric facility in Kentucky. METHOD: Through a time-series design, we compared the differences in rates of screening for tobacco use and providing treatment from September to December 2015 (prior to implementing the nurse-led tobacco treatment services) to each subsequent year in a 4-year period (2016-2019). RESULTS: Approximately 60.0% of inpatients were persons using tobacco during the assessment period. Although there were no changes in tobacco use prevalence over the 4-year evaluation duration, there were significant increases in the provision of practical counseling and Food and Drug Administration-approved nicotine replacement therapies for persons using tobacco. CONCLUSIONS: Our findings support the effectiveness of implementing tobacco treatment programs at the organizational level. Psychiatric hospitalizations provide an opportunity to optimize nurse-driven efforts to deliver tobacco treatment to people with MI. Similar models of nurse-led tobacco treatment services can be adopted within inpatient and other mental and behavioral health settings.

The Impact of Psychiatric Disorder Diagnosis on Motivation to Quit and Stage of Change Among Patients at a Hospital-Based Outpatient Smoking Cessation Clinic.

OBJECTIVE: Smoking is among the greatest international public health concerns, causing excessive levels of preventable premature death, disability, and economic costs. The prevalence of tobacco use among people with psychiatric disorders (PDs) remains persistently high relative to the general population, highlighting the need to improve smoking cessation (SC) strategies in this group. We aimed to assess the associations between having a PD and baseline motivation to quit (MtQ) smoking and Prochaska's stage of change (SoC), two clinically important metrics linked to SC outcomes. Methods: This retrospective chart review included patients who completed a baseline visit at a hospital-based outpatient SC clinic (N = 896). Multivariate hierarchical logistic and linear regression models were developed to assess variables associated with MtQ (importance and confidence in quitting) and SoC, primarily PD category (externalizing, internalizing, externalizing/internalizing, psychotic or no PD) and secondarily, demographics, physical health history, and tobacco use/dependence metrics. Results: The variables negatively associated with MtQ were female sex (p = .011), older age (p = .038), deriving income from social assistance (p < .001), and age at smoking initiation (p = .005), whereas ≥ 1 quit attempt in the past year predicted higher MtQ (p < .0001). Being in the preparative/action SoC (versus the pre-contemplative/contemplative) was associated with income from social assistance (OR 0.39, p = .001), more daily cigarettes smoked (OR 0.98, p = .005) and ≥ 1 past-year quit attempt (OR 1.69, p = .013). Conclusions: Having a PD was not associated with either MtQ or SoC. Deriving income from social assistance predicted lower MtQ and SoC. Having made ≥ 1 quit attempt in the past year was associated with higher MtQ and SoC. Our study suggests that people with PDs are as motivated to quit smoking and ready for change as people without PDs, and smoking cessation efforts should be amplified in this group to address the disproportionately high level of tobacco use, especially because having at least one quit attempt may enhance MtQ and SoC.

Quit and win contests in community-dwelling mental and behavioral health populations: A systematic review and pilot feasibility findings.

BACKGROUND: People with mental illnesses (MI) benefit from incentives to promote tobacco cessation. "Quit and Win" contests are community-based approaches that incentivize cessation. However, little is known about "Quit and Win" contest effectiveness among people with MI. AIM: To examine the utility of "Quit and Win" contests among people with MI. METHOD: This study had two phases: (a) a systematic literature review to explore the potential effectiveness of "Quit and Win" contests for people with MI and (b) a pilot feasibility study of implementing a "Quit and Win" contest among people with MI from a community mental health program (CMHP). RESULTS: In phase 1, no reviewed study specifically included people with MI in their sample. Of the four cohort and five randomized controlled studies in the review, the mean reported participant quit rates at the end of "Quit and Win" contests were 76.8% and 28.3%, respectively. In phase 2, within a CMHP, four out of seven participants completed a "Quit and Win" contest, and one individual achieved cessation. CONCLUSION: People with MI may benefit from incentive-based tobacco cessation programs. Implementing a "Quit and Win" contests within a CMHP is important and requires more studies to determine feasibility and effectiveness.

Correlates of post-traumatic growth among nursing professionals: A cross-sectional analysis.

AIMS: Among nursing professionals, our aims were to examine (a) self-reported traumatic experiences, (b) differences in post-traumatic growth (i.e. positive psychological growth after experiencing a traumatic event) by nursing professional level and (c) demographic, work-related, behavioural and traumatic experience covariates of post-traumatic growth. BACKGROUND: Trauma experience among nursing professionals is higher than observed in the general population. Due to the nature of their work environment, workplace trauma rates are particularly alarming. Understanding post-traumatic growth among nursing professionals may guide interventions to enhance well-being. METHOD: A secondary analysis of cross-sectional survey data from nursing professionals (N = 299). Demographic, work-related, behavioural, trauma experience categories and post-traumatic growth variables were examined. RESULTS: Advanced practice nurses and clinical nurses reported higher rates of workplace trauma, as compared to nursing assistants. Higher post-traumatic growth scores were associated with having a postgraduate degree, serving the paediatric population and lower frequency of alcohol use. Lower post-traumatic growth scores were associated with being married/widowed, being an advanced practice provider or clinical nurse, working in the intensive care unit and reporting workplace, family/personal stress and undisclosed trauma. CONCLUSIONS: Nursing professionals have several demographic, work-related, behavioural and traumatic experience-related variables associated with and that explain variances in post-traumatic growth. IMPLICATION FOR NURSING MANAGEMENT: Targeted screening and individualized treatment based on nursing professional level should be considered to support trauma recovery and post-traumatic growth.

Nursing Staff Attitude, Subjective Norms, Perceived Behavior Control, and Intention to Provide Tobacco Treatment in a Psychiatric Hospital.

BACKGROUND: Although the nursing staff is fundamental in assisting individuals with mental illnesses (MI) to stop tobacco use, they often have mixed feelings about providing tobacco treatment (TT) services to people with MI in inpatient psychiatric settings. OBJECTIVE: Therefore, this study aimed to understand factors associated with nursing staff's intentions to provide TT interventions for individuals diagnosed with MI in a psychiatric facility using the constructs of the theory of planned behavior (TPB). METHOD: Secondary data analysis was performed using cross-sectional data collected from 98 nursing staff who worked in a state inpatient psychiatric facility. A 15-item questionnaire was used to assess nursing staff intentions to provide TT services based on TPB constructs, including attitudes (four items), subjective norms (four items), perceived behavioral controls (four items), and intentions (three items) toward providing TT. The mean scores of each subscale ranged from 1 to 7. A logistic regression analysis was used to examine the relationship between TBP constructs and nursing staff intentions to provide TT for people with MI. RESULTS: Nursing staff had an acceptable mean score in the intentions subscale (4.34 ± 2.01). Only two constructs of TPB explained nursing staff intentions to provide TT: subjective norms (OR = 2.14, 95% CI [1.46, 3.13]) and perceived behavioral control (OR = 2.33, 95% CI [1.32, 4.12]). CONCLUSIONS: The constructs of the TPB, the subjective norms, and the perceived behavior control were able to predict nurses' intentions to provide TT for inpatients in a psychiatric setting. Accordingly, we suggest implementing policies that make TT a normative practice while supporting the confidence and competence of nurses to deliver TT in psychiatric facilities.

Compassion Satisfaction, Burnout, and Secondary Traumatic Stress Among Nursing Staff at an Academic Medical Center: A Cross-Sectional Analysis.

BACKGROUND: Although several studies have recently described compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) in nurses, few to date have examined these issues across nursing specialties. Such examination is needed to inform future nursing-subspecialty tailored interventions. AIMS: To examine (1) differences in CS, BO, and STS across nursing specialties and (2) differences associated with demographic, work-related, and behavioral factors among nurses. METHOD: A secondary analysis of survey responses from nurses (N = 350) at an academic medical center. Demographic, behavioral, work-related, and professional quality of life variables were analyzed using hierarchical regression analyses. RESULTS: CS, BO, and STS scores significantly varied across specialties with emergency nurses experiencing significantly elevated rates of BO and STS, and lowest rates of CS; scores were also differentially associated with demographic, work-related, behavioral, and workplace violence variables. CONCLUSIONS: Key differences in CS, BO, and STS by nursing specialty suggests the importance of tailoring BO and STS mitigative interventions. BO and STS risk factors should be assessed in nurses (e.g., behavioral health problems and poor sleep quality) and specialty-specific interventions (e.g., reducing workplace violence exposure in emergency settings) may be considered to improve CS while reducing BO and STS among nurses.

From twisting to settling down as a nurse in China: a qualitative study of the commitment to nursing as a career.

BACKGROUND: The nurse workforce shortage, partially caused by high work turnover, is an important factor influencing the quality of patient care. Because previous studies concerning Chinese nurse work turnover were predominantly quantitative, they lacked insight into the challenges faced by nurses as they transition from university to their career. A successful transition can result in new nurses' commitment to the career. As such, this study sought to understand how new nurses commit to the career, and focused on identifying facilitators and barriers to such commitment. METHODS: This was a qualitative study using a grounded theory design. Through purposive sampling, clinical nurses were recruited from hospitals in Western China to participate in semi-structured interviews. The data was analyzed through coding to develop categories and themes. RESULTS: Theoretical saturation was achieved after interviewing 25 participants. The data revealed the 'zigzag journey' of committing to the nursing career. The emerging core theme was "getting settled", indicating that new nurses needed to acclimate to the work reality in the nursing career. By analyzing the data provided by the participants, the researchers concluded that the journey to getting settled in nursing compassed four stages:1) "sailing out with mixed feelings", 2) "contemplating to leave", 3) "struggling to stay", and 4) "accepting the role". For most participants, nursing was described as a way to earn a living for their family, not as a career about which they felt passionate. CONCLUSIONS: Committing to the nursing career is a complicated long-term process. There seems to be a lack of passion for nursing among the Chinese clinical nurses participating in this study. Thus, the nurses may need continued support at different career stages to enhance their ability to remain a nurse for more than economic reasons.

Reasons for Tobacco Use and Perceived Tobacco-Related Health Risks in an Inpatient Psychiatric Population.

People with mental illness (MI) have a disproportionate tobacco-related disease burden and mortality. Tobacco-use rates in people with MI are nearly twice that of the general population. Reasons for tobacco-use in this population may be a result of diminished tobacco-related disease risk perceptions. The purpose of this study was to examine the reasons for tobacco-use and perceived tobacco-related health risks among psychiatric inpatients. A correlational design was employed to survey a convenient sample of 137 patients from a psychiatric facility in central Kentucky. Information obtained from participants included demographics, psychiatric diagnoses, tobacco-use and exposure history, medical illness history, reasons for tobacco-use, and tobacco-related illness risk perceptions. The primary reasons participants endorsed for tobacco-use were for stress reduction, followed by addiction, then boredom, psychiatric symptom control, social, and negative mood. In addition, about 72% of participants used tobacco to cope with MI symptoms and 52% to manage the side effects of their medications. Participants were most likely to endorse that tobacco-use caused lung disease (83.2%), heart disease (79.6%), cancer (77.4%), and premature mortality (79.6%) but were less likely to admit that it may cause addiction to other drugs (39.4%) or MI (23.4%). Given the high endorsement of tobacco-use for stress reduction and psychiatric symptom control, it is important for mental health nurses to properly educate consumers on tobacco addiction and evidence of its effects on mental health. Strategies to incorporate our study findings into routine mental health services may address the tobacco-use disparities experienced by people with MI.

Assessing opinions and barriers to providing evidence-based tobacco treatment among health care providers within an in-patient psychiatric facility.

Background: Tobacco-related morbidity and mortality is high among people with mental illnesses (PMI); yet tobacco treatment (TT) is often not provided by mental health care providers (MHPs). Studies that examine barriers to TT for people with MI are critical in addressing this disparity.Aims: To determine factors associated with MHPs' opinions of, self-efficacy in, barriers to and training needs for providing TT by job role.Methods: 205 MHPs in a psychiatric facility were surveyed using a standardized questionnaire on demographics and opinions, self-efficacy, barriers and needs to providing TT. Descriptive and multivariate regression analyses examined factors associated with the main outcomes.Results: MHP's gave high ratings to both the appropriateness of delivering evidence-based TT and their confidence in providing TT medications. In regards to perceived barriers to providing TT, MHP's further endorsed that patients should be provided nicotine replacement therapy and be motivated to engage in TT. Key needs were for training in cessation counseling, cessation materials and community support for TT.Conclusions: Based on our findings, future studies are needed to address providers' biases and concerns, eliminate system-barriers and determine effective provider training. Moreover, these findings may guide research, practice and policies toward enhancing TT in PMI.

Patterns of tobacco use among smokers prior to hospitalization for an acute cardiac event: Use of combusted and non-combusted products.

Use of tobacco products before or after a cardiac event increases risk of morbidity and mortality. Unlike cigarette smoking, which is generally screened in the healthcare system, identifying the use of other tobacco products remains virtually unexplored. This study aimed at characterizing the use of other non-combusted tobacco products in addition to combusted products among cardiac patients and identifying a profile of patients who are more likely to use non-combusted products. Patients (N = 168) hospitalized for a coronary event who reported being current cigarette smokers completed a survey querying sociodemographics, cardiac diagnoses, use of other tobacco products, and perceptions towards these products. Classification and regression tree (CART) analysis was used to identify which interrelationships of participants characteristics led to profiles of smoking cardiac patients more likely to also be using non-combusted tobacco products. Results showed that non-combusted tobacco product use ranged from 0% to 47% depending on patient characteristic combinations. Younger age and lower perception that cigarette smoking is responsible for their cardiac condition were the strongest predictive factors for use of non-combusted products. Tobacco product use among cardiac patients extends beyond combusted products (13.7% non-combusted product use), and consequently, screening in health care settings should be expanded to encompass other tobacco product use. This study also characterizes patients likely to be using non-combusted products in addition to combusted, a group at high-risk due to their multiple product use, but also a group that may be amenable to harm reduction approaches and evidence-based tobacco treatment strategies.

Factors Associated with the Initial Sensations of Smoking among Smokers with Mental Illness.

People with mental illnesses (MI) have a disproportionate smoking prevalence and associated disease burden. Smoking initiation among people with MI is poorly understood. However, the sensations experienced during smoking initiation predict continued smoking and nicotine dependence. Yet, few studies have examined the initial experiences of smoking among people with MI. Thus, the aim of this study was to explore factors associated with the initial sensations of smoking in people with MI. Smokers in an inpatient psychiatric facility (n = 123) were surveyed. Data obtained included information on demographics, smoking and secondhand smoke (SHS) exposure, psychiatric diagnoses, and sensations of initial smoking. Spearman correlations explored associations among initial smoking sensation variables; and binary logistic regression analyses examined the associations between study variables and groupings derived from initial sensations (i.e., "pleasant + buzz," "unpleasant + buzz," and "all" sensations). The most frequently reported initial smoking sensation was feeling dizzy (87%) and there were low to moderate correlations between unpleasant (e.g., cough, sick, nervous) and pleasant (e.g., good, relaxed) sensations. In logistic regression analyses, having higher perceived SHS exposure was significantly associated with the "pleasant + buzz" sensation grouping; and lower past week SHS exposure was associated with the "unpleasant + buzz" sensation grouping; but, no variables were associated with "all" sensation group. Initial smoking sensations are an uncharted avenue of exploration in understanding smoking initiation among people with MI. SHS exposure may be an important factor associated with the report of both unpleasant and pleasant initial sensations. Future studies are needed to further explore initial sensations in relation to the context of smoking initiation among people with MI.

Which Types of Tobacco Treatment Interventions Work for People with Schizophrenia? Provider and Mental Health Consumer Perspectives.

People with schizophrenia and other psychotic disorders (PWS) consume tobacco at high rates, resulting in disproportionate tobacco-related morbidity and mortality. Conventional tobacco treatment (TT) approaches may not adequately address unique affective, cognitive, and social challenges of PWS during cessation. This study sought to obtain provider and mental health consumer perspectives on effective, desirable, applicable, and acceptable components of TT for PWS. This convergent mixed-method study used structured interviews and a cross-sectional survey to obtain data. Eighteen mental health consumers and six mental health providers were engaged in face-to-face or telephone interviews. The qualitative data were analyzed using content analysis and theme identification and descriptive statistics were used for the analysis of quantitative data. In the qualitative analysis, consumers endorsed education, counseling, social support, and pharmacotherapy as key TT components. Consumers further stressed the need for flexible interventions that are available at any point in a quit attempt. Both providers and consumers endorsed targeting TT interventions to consider learning needs, potential cognitive issues, and motivation for behavioral change. Providers encouraged a recovery-driven TT framework with peer support and health promotion activities. Quantitative findings mirrored the qualitative findings with support sessions, relapse prevention, and skills training having the highest desirability, applicability, and acceptability TT component scores. Providers and consumers agreed on components of an effective TT program targeted to PWS. Given these findings, it is crucial to further investigate successful TT approaches for PWS and to test whether targeted or tailored programs are more effective than conventional approaches.

The effect of implementing a tobacco treatment service on adherence to evidence-based practice in an inpatient state-owned psychiatric hospital.

BACKGROUND AND OBJECTIVES: The Centers for Medicare and Medicaid Services (CMS) requires reporting of specific tobacco treatment (TT) measures. We examined compliance to these measures before and after initiation of a specialized TT service in a state-psychiatric hospital. METHODS: Using a retrospective analysis, patient records (N = 3669) were examined, using one-way ANOVAs, for changes in rates of tobacco use screening and treatment between September-December 2015 (pre-implementation of CMS requirements), and January-April, May-August, and September-December 2016 (post-implementation of the CMS requirements). RESULTS: We found significant increases, between Sep-Dec 2015 and Sep-Dec 2016, in the rates of tobacco use screening (93.4-95.3%, F [3, 12] = 7.39, p = .005), offering TT counseling (68.1-76.5%, F [1] = 18.59, p = .001) and medications (71.7-76.5%, F [1] = 5.86, p = .032). CONCLUSIONS AND SIGNIFICANCE: Our findings can provide guidance to enhance compliance with TT measures in psychiatric settings. (Am J Addict 2018;XX:1-4).

A Retrospective Analysis of the Outcomes of Smoking Cessation Pharmacotherapy Among Persons With Mental Health and Substance Use Disorders.

OBJECTIVES: It is common practice to individualize smoking cessation pharmacotherapy based on clinical judgment and patient response. However, little has been documented about the use and outcomes of smoking cessation pharmacotherapy in real-world settings. This study examines factors associated with using smoking cessation pharmacotherapy and related outcomes among smokers with psychiatric and/or substance use disorders who completed an intensive tobacco treatment program within mental health and addiction services settings in Vancouver, Canada. METHODS: A retrospective analysis was used to examine combined program participation data (N = 889) from two tobacco treatment programs (i.e., the Tobacco Dependence Clinic and the Butt Out group) between September 2007 and July 2013. Changes in smoking cessation pharmacotherapy from the initial to final treatment and seven-day point prevalence of smoking abstinence (verified by expired carbon monoxide) were assessed at the end of treatment. RESULTS: During treatment, 60% of participants remained on the initial pharmacotherapy plan, 30% received adjunctive treatment, and 10% had treatment plans that were switched. Those whose pharmacotherapy was switched had higher cigarette consumption and nicotine dependence at baseline and were less likely to have a psychiatric disorder history. When comparing between pharmacotherapy groups, individuals who switched medications were less likely to achieve abstinence at the end of treatment as compared to those whose medication treatment plans remained the same or who received adjunctive treatment (unchanged = 36.8%, adjunctive = 38.1% vs. switched = 20.9%, χ2 = 9.59, df = 2, p = .008). In multivariate regression analysis, switching pharmacotherapy was associated with lower smoking cessation (OR = .33, 95% CI [.17, .63]) and significantly mediated the effectiveness of pharmacotherapy. As there were differences in medication switching rates at the clinical level, there were limitations in assessing the impact of mental illness or substance use disorder variables. CONCLUSIONS: At least 40% of individuals may have their smoking cessation pharmacotherapy plan changed during treatment. Switching pharmacotherapy may indicate a subgroup of smokers characterized by greater challenges in smoking cessation. Our findings may enhance algorithms for using smoking cessation pharmacotherapy in clinical practice and provide directions for future research in treating tobacco use disorder among individuals with mental health and substance use disorders.

Factors Associated With Staff Engagement in Patients' Tobacco Treatment in a State Psychiatric Facility.

BACKGROUND: Persons with mental illnesses (MI) who use tobacco are likely to experience poorer physical health and worsened psychiatric symptomology as compared to their non-tobacco-using counterparts. Therefore, engaging them in treatment is an important aspect of evidence-based care. OBJECTIVE: To use the theory of planned behavior to examine factors associated with intentions to provide and the provision of evidence-based tobacco treatment. DESIGN: This study is based on a cross-sectional analysis of survey data from 195 staff at a state psychiatric hospital. RESULTS: When controlling for demographic variables, attitudes, subjective norms, and perceived behavioral control toward providing tobacco treatment were associated with intentions to provide tobacco treatment, but only subjective norms and perceived behavioral control were associated with reported provision of evidence-based tobacco treatment. CONCLUSIONS: Understanding factors that influence provider delivery of tobacco treatment can better determine strategies to reduce the disproportionate tobacco use and related illnesses in behavioral health settings.

Gender, smoking and tobacco reduction and cessation: a scoping review.

Considerations of how gender-related factors influence smoking first appeared over 20 years ago in the work of critical and feminist scholars. This scholarship highlighted the need to consider the social and cultural context of women's tobacco use and the relationships between smoking and gender inequity. Parallel research on men's smoking and masculinities has only recently emerged with some attention being given to gender influences on men's tobacco use. Since that time, a multidisciplinary literature addressing women and men's tobacco use has spanned the social, psychological and medical sciences. To incorporate these gender-related factors into tobacco reduction and cessation interventions, our research team identified the need to clarify the current theoretical and methodological interpretations of gender within the context of tobacco research. To address this need a scoping review of the published literature was conducted focussing on tobacco reduction and cessation from the perspective of three aspects of gender: gender roles, gender identities, and gender relations. Findings of the review indicate that there is a need for greater clarity on how researchers define and conceptualize gender and its significance for tobacco control. Patterns and anomalies in the literature are described to guide the future development of interventions that are gender-sensitive and gender-specific. Three principles for including gender-related factors in tobacco reduction and cessation interventions were identified: a) the need to build upon solid conceptualizations of gender, b) the importance of including components that comprehensively address gender-related influences, and c) the importance of promoting gender equity and healthy gender norms, roles and relations.

Smoking cessation outcomes and predictors among individuals with co-occurring substance use and/or psychiatric disorders.

OBJECTIVE: Individuals with substance use and psychiatric disorders have a high prevalence of tobacco use disorders and are disproportionately affected by tobacco-related morbidity and mortality. However, it is unclear how having co-occurring disorders affects tobacco cessation. Our aim was to examine smoking cessation outcomes and relevant predictors of smoking cessation among smokers with substance use and/or psychiatric disorders. METHODS: Data from medical records of 674 participants in a tobacco treatment program within mental health and addictions services in Vancouver, Canada, were analyzed. The 26-week treatment program included an 8-week structured behavioral counseling group, an 18-week support group, and 26 weeks of no-cost pharmacotherapy. Information on demographics, tobacco use and history, type of pharmacotherapy received, nicotine dependence, importance of and confidence in quitting smoking, expired carbon monoxide level, substance use and psychiatric disorder history, and total program visits were gathered. RESULTS: Approximately 67% (n = 449) of participants had co-occurring substance use and psychiatric disorders, while 20% (n = 136) had substance use disorder only, 10% (n = 67) had psychiatric disorder only, and 3% (n = 22) had tobacco dependence only. Rates of tobacco cessation (i.e., 7-day point prevalence of abstinence verified by expired carbon monoxide of ≤8 ppm) by group in the 522 people who completed treatment were as follows: 38.2% for those with co-occurring disorders, 47.1% for those with tobacco dependence only, 47.1% for those with substance use disorder only, and 41.8% for those with psychiatric disorder only. Length of treatment was a significant predictor of smoking cessation for those with co-occurring disorders and substance use disorder only. In the final stratified multivariate analysis, for individuals with co-occurring disorders, having an opiate use disorder (as compared to an alcohol use disorder) and higher nicotine dependence scores at baseline were predictive of poor cessation outcomes, while greater length of treatment was predictive of successful smoking cessation. CONCLUSIONS: Tobacco cessation treatment for individuals with co-occurring substance use and psychiatric disorders is likely to be as effective as for smokers with either disorder alone. Treatment duration predicts success among these smokers so strategies to enhance engagement and retention are needed.

Correlates of secondhand tobacco smoke exposure among individuals with a history of substance use and/or psychiatric disorders participating in a tobacco treatment program in Vancouver, Canada.

Individuals with substance use (SUD) and/or psychiatric disorders (PD) are disproportionately affected by tobacco use; yet, little is known about secondhand tobacco smoke (SHS) exposure in these populations. An analysis of existing data examined SHS exposure among 497 smokers in community clinics in Vancouver, Canada. Seventy-percent of the participants reported SHS exposure. In sex-stratified multivariate logistic regression analyses correlates of SHS exposure among women were not having a history of using evidence-based smoking cessation treatment and using a single substance (as compared to a polysubstance use history); whereas among men, a history of a respiratory illness and higher nicotine dependence were associated with SHS exposure. Despite limitations about the measures of SHS exposure used in the study, these findings suggest a need to further determine the risks associated with SHS exposure and tobacco use among individuals with SUD and/or PD within mental health and addictions treatment settings.