Evaluation of the CHOICES program of peer-to-peer tobacco education and advocacy.

CHOICES is a consumer driven program for addressing tobacco in people with mental illness that employs mental health peer counselors. Since 2005, CHOICES has conducted over 298 community visits reaching more than 10,000 smokers with mental illness (about 2500/year). A telephone based outcome study was conducted in 102 outpatient smokers who received a CHOICES peer-to-peer session. At 1-month follow up participants (N = 86; 84%) reported smoking an average of 13 cigarettes per day which was significantly reduced from a baseline of 19 (P < 0.001). Twenty-five individuals (29%) tried to quit smoking in the month after the peer session and another 47 (55%) reduced their smoking. Feedback from smokers about the program was positive. Most (N = 59, 71%) said it was a lot easier to talk with a consumer about smoking compared to their psychiatrist or staff. Peer-to-peer communication about tobacco use can be effective to increase awareness and change smoking behaviors.

Higher serum caffeine in smokers with schizophrenia compared to smoking controls.

Previous studies of high dietary caffeine intake in individuals with schizophrenia have not demonstrated biological evidence of higher intake or controlled smoking behavior. This study aimed to examine differences in serum caffeine levels in 104 smokers with schizophrenia/schizoaffective disorder (SCZ/SA) and compare them to 63 smokers without any mental illness (CON). Since we were interested in measuring caffeine levels, we excluded all non-caffeine users from the study. Blood draws were standardized to occur at mid-day on a usual smoking day. The mean serum caffeine level was significantly higher for SCZ/SA group compared to CON (2722 ng/mL vs. 1122 ng/mL; p<0.001). This trend persisted in subsets of smokers who smoked less than 20 cigarettes per day (CPD; 2052 ng/mL vs. 587 ng/mL; p<0.05), 20-30 CPD (2743 ng/mL vs. 1170 ng/mL; p<0.001) or more than 30 CPD (3430 ng/mL vs. 1834 ng/mL; NSS). Linear backward stepwise regression analyses including demographic and smoking variables revealed that having a diagnosis of SCZ/SA (compared to CON) significantly predicted serum caffeine level (B=1528.2; p<0.001). In addition, SCZ/SA group had two times greater serum caffeine levels as compared to CON with similar smoking behavior. Clinical effects of smoking and caffeine intake are important and may complicate the interpretation of schizophrenia symptoms and antipsychotic medication side effects, thus warranting further research.

Training psychiatrists and advanced practice nurses to treat tobacco dependence.

The lack of availability of continuing medical education programs on tobacco dependence for psychiatrists and psychiatric nurses is profound. We developed a 2-day curriculum delivered in November 2006 and March 2007 to 71 participants. Ninety-three percent ( n = 66) completed a pretest/posttest, and 91% (n = 65) completed the attitudes and beliefs survey. Scores on the pretest were low (M = 47% correct). Paired t tests found significant increases in raw scores from 6.7 to 13.6, t(65) = -22.8, p < .0001. More than 90% of psychiatrists and nurses indicated that motivating and helping patients to stop smoking and discussing smoking behavior were part of their professional role. Although 80% reported that they usually ask about smoking status, fewer reported recommending nicotine replacement (34%), prescribing pharmacotherapy (29%), or referring smokers to a telephone quit line (26%). Trainings are repeated twice a year because of ongoing demand. Further follow-up should evaluate changes in practices after training.