Quitline nurses' experiences in providing telephone-based smoking cessation help to mental health patients: A mixed methods study.

WHAT IS KNOWN ON THE SUBJECT?: Quitlines are known to be effective in helping people quit smoking, including those with mental health conditions. It is particularly important to address smoking in this population as the prevalence of smoking ranges from 40% to 75%. However, professionals working in quitlines often face barriers due to their limited training and resources to effectively support these smokers quit, especially if they are not mental health professionals. Therefore, training programmes should be developed to enhance their knowledge and skills in providing smoking cessation support to this vulnerable population. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The '061 QUIT-MENTAL study' evaluated the efficacy of a proactive telephone-based intervention for smoking cessation among smokers with severe mental health disorders. Conducted through a quitline service in Catalonia, Spain, the study focused on training non-mental health specialized nurses and other health professionals to provide evidence-based interventions for promoting smoking cessation among individuals with mental health disorders. The objective of this study is to assess the changes in nurses' knowledge and readiness to treat smokers with mental health conditions, while also capturing their insights and perceptions regarding the facilitators and barriers to providing smoking cessation interventions. The training and insights of the nurses were integral to conducting this research and providing valuable information for the future sustainability of such interventions. This is particularly important as quitlines hold the potential to offer cessation support to these patients at the community level. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: While the training programme was successful in improving non-mental health specialized nurses' knowledge and motivation skills to help patients with mental health disorders quit smoking, they encountered obstacles in delivering this intervention over the phone. These difficulties were mainly due to challenges in reaching participants and delivering the intervention as detailed in the protocol. The study highlights the need of reducing barriers for providers in attending to these patients, particularly if they are non-mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco-related diseases among this population. ABSTRACT: Introduction The viewpoint of those who implement a programme for the first time is crucial for understanding its impact and ensuring its long-term viability. The 061 QUIT-MENTAL study was a pragmatic randomized controlled trial evaluating a proactive telephone-based intervention addressed to mental health patients conducted by non-psychiatric specialized nurses. Aim We assessed nurses' knowledge of smoking cessation interventions addressed to this population before and after receiving training and their insights after delivering the intervention. Method Mixed methods study: (1) Pre-post evaluation to assess self-reported knowledge, self-efficacy and opinions about smoking cessation. (2) In-depth interviews with key nurses to ascertain their perceptions regarding the impact of the training received in delivering the study intervention. Results The training enhanced nurses' knowledge of psychological and pharmacological resources to aid these patients, as well as their ability to increase their motivation to quit. However, nurses reported difficulties in delivering population-based interventions to individuals with mental health disorders. These challenges primarily arose from participants being hard to reach, exhibiting low motivation to quit, struggling to comprehend instructions or follow recommendations, and nurses feeling unsure about their capacity to assist individuals with mental illnesses in quitting, despite the training they received. Discussion Despite the training and protocol designed to facilitate the delivery of the intervention, nurses faced difficulties in providing population-based interventions to individuals with mental health disorders. Implications for Practice Future quitline programmes aimed at the population with mental health disorders should strive to reduce barriers for providers in attending to these patients, particularly if they are non-mental health specialized professionals. By minimizing the stigmatization associated with caring for mentally ill individuals and promoting coordination with specialists, innovative approaches may be introduced to alleviate the burden of tobacco-related diseases among this population.

Acceptability and participation predictors for a pragmatic randomized controlled trial to test a smoking cessation intervention after discharge from mental health wards.

BACKGROUND AND AIM: Hospitalization is an ideal time to promote smoking cessation, but interventions are limited for supporting cessation maintenance after discharge. This study aimed to evaluate the acceptability of participating in a trial that tested the efficacy of an intensive telephone-based intervention for smokers after discharge. METHODS: Adult smokers admitted to mental health wards of six hospitals were invited to participate in the trial. We studied the study acceptance/decline rates by analyzing the characteristics of participants (e.g., sex, age, psychiatric disorder, smoking pattern) and hospitals (e.g., size, tobacco control implementation). We calculated adjusted odds ratios (aOR) to assess predictors of non-participation. RESULTS: Of 530 smokers that met the study inclusion criteria, 55.5% (n = 294) agreed to participate. Participant and non-participants were not different in sex, age, or psychiatric diagnosis. Compared to non-participants, participants had made more attempts to quit in the past year (66.1% vs 33.9%; p < 0.001) and reported higher abstinence rates during the hospital stay (66.7% vs. 33.3%; p = 0.05). Participation rates by hospital varied from 30.9% to 82.0% (p < 0.001). Predictors of non-participation were not having attempted to quit in the last year (aOR=2.42; 95%CI: 1.66-3.53) and low level of tobacco control in the hospital (aOR range: 1.79-6.39, p < 0.05). CONCLUSIONS: A telephone-based intervention to promote smoking cessation after discharge was accepted by half of the smokers with mental health disorders. Smokers that had attempted to quit previously and those that stayed in hospitals with a strong tobacco control policy were more likely to participate in the trial.

Effectiveness of a telephone-based intervention for smoking cessation in patients with severe mental disorders: study protocol for a randomized controlled trial.

BACKGROUND: Up to 75% of inpatients with mental disorders smoke, and their life expectancy is decreased by up to 25 years compared to the general population. Hospitalized patients without monitoring after discharge quickly return to prehospitalization levels of tobacco use. The aim of the 061 QuitMental study is to assess the effectiveness of a multicomponent and motivational telephone-based intervention to stop smoking through a quitline addressed to smokers discharged from mental health hospital wards. METHODS: A pragmatic randomized controlled trial, single blinded, will include 2:1 allocation to the intervention group (IG) and the control group (CG). The IG will receive telephone assistance to quit smoking (including psychological and psychoeducational support, and pharmacological treatment advice if required) proactively for 12 months, and the CG will receive only brief advice after discharge. The sample size, calculated with an expected difference of 15 points on smoking abstinence between groups (IG, 20% and CG, 5%), α = 0.05, ß = 0.10, and 20% loss, will be 334 participants (IG) and 176 participants (CG). Participants are adult smokers discharged from psychiatric units of five acute hospitals. Measurements include dependent variables (self-reported 7-day point prevalence smoking abstinence (carbon monoxide verified), duration of abstinence, number of quit attempts, motivation, and self-efficacy to quit) and independent variables (age, sex, and psychiatric diagnoses). In data analysis, IG and CG data will be compared at 48 h and 1, 6, and 12 months post discharge. Multivariate logistic regression (odds ratio; 95% confidence interval) of dependent variables adjusted for potential confounding variables will be performed. The number needed to treat to achieve one abstinence outcome will be calculated. We will compare the abstinence rate of enrolled patients between groups. DISCUSSION: This trial evaluates an innovative format of a quitline for smokers with severe mental disorders regardless of their motivation to quit. If effective, the pragmatic nature of the study will permit transfer to routine clinical practice in the National Health System. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03230955 . Registered on 24 July 2017.

Violence among illicit drug users recruited in drug treatment facilities. / Violencia en consumidores de drogas ilícitas reclutados en centros específicos de tratamiento.

Illicit drug use is known to be associated with injuries resulting from violence. This study aims to estimate the prevalence of violence, for the last 12 months, in illicit drug users and study the victim-offender overlap, separately by sex. Persons using illicit drugs (502) were recruited in drug treatment facilities. Violence was assessed using four questions for victim and one for perpetrator in the last 12 months. Associations between violence and socio-demographic, substance use, crime and illegal drug market aspects were examined with Poisson regression models. Victimization was reported by 49.6% men and 54.7% women; offending by 36.5% and 27.6%, respectively. Higher prevalence ratios of both victim and offender were observed among participants with marginal income generation activities and alcohol risk use. Victimization was more likely in women using parenteral route and among men with early illegal drug use, illegal polydrug use or history of imprisonment. Offending was more likely among men reporting psychological treatment, early illegal drug use, illegal polydrug use or past imprisonment, and women reporting early illegal drug use or trafficking. Thus, a high prevalence of violence (both victimization and perpetration) was found in illicit drug users, especially among those involved in market activities and crime. Drug treatment facilities should consider assessing for history and signs of violence and promote community health strategies.

El uso ilícito de drogas se ha asociado a lesiones producidas por violencia. Nuestro objetivo es estimar en usuarios de drogas ilícitas, la prevalencia de violencia en los últimos 12 meses y estudiar la superposición víctima-agresor. Se reclutaron personas consumidoras de drogas ilícitas (502) en centros de tratamiento de drogas. La violencia se evaluó mediante cuatro preguntas sobre victimización y una sobre agresión referidas a los últimos 12 meses. Las asociaciones entre violencia y aspectos sociodemográficos, consumo de sustancias, delincuencia y mercado de drogas ilegales se analizaron con modelos de regresión de Poisson. El 49,6% de los hombres y el 54,7% de las mujeres reportaron victimización; la agresión un 36,5% y 27,6%, respectivamente. Se observaron prevalencias elevadas de víctima y de ofensor entre los participantes con actividades marginales de generación de ingresos y con uso de riesgo de alcohol. La victimización fue más probable en las mujeres que usaban vía parenteral y entre los hombres con consumo precoz de drogas ilegales, policonsumo de drogas ilegales y antecedentes penitenciarios. La agresión fue más probable entre los hombres receptores de tratamiento psicológico, consumo precoz de drogas ilegales, policonsumo de drogas ilegales y antecedentes penitenciarios, y entre las mujeres, aquellas que reportaron consumo precoz de drogas ilegales y que habían traficado. Se encontró una alta prevalencia de violencia en los usuarios de drogas ilícitas, especialmente entre aquellos involucrados en actividades de mercado y delincuencia. Los centros de tratamiento de drogas deberían considerar evaluar los antecedentes y los signos de violencia, y promover estrategias de salud comunitaria.

Suicidal behaviours in male and female users of illicit drugs recruited in drug treatment facilities / Conductas suicidas en hombres y mujeres consumidores de sustancias ilícitas reclutados en centros de tratamiento para la drogodependenci

Objective: We assessed prevalence of suicidal ideation and plans among illicit drug users and their association with contextual factors, by gender. Methods: Cross-sectional study. In a sample of 511 illicit drug users recruited during spring 2012 in drug treatment and prevention facilities in Catalonia (Spain), the prevalence of suicidal ideation/plans in the last 12 months was assessed. Poisson regression was used to examine associations between suicidal ideation/plans and various factors (socio-demographic, psychological, illegal drug market activities and marginal income generation activities, which included any reported sex work, stealing, peddling, begging or borrowing on credit from a dealer). Results: The average age was 37.9 years (standard deviation: 8.62); 76.3% were men. Suicidal ideation/plans were reported by 30.8% of men and 38.8% of women, with no significant differences by age or gender. Recent aggression (male prevalence ratio [PR]=2.2; female PR=1.4), psychological treatment (male PR=1.2; female PR=1.3) and illegal/marginal income generation activities (male PR=1.5; female PR=1.1) were associated with suicidal ideation/plans. Men who trafficked were more likely to have suicidal ideation/plans (PR=1.3), while prison history was positive for women (PR=1.8) and negative for men (PR=0.7). Conclusions: Prevalence of suicidal ideation/plans was high among illicit drug users recruited from healthcare facilities. Besides psychological variables, participation in illegal market activities and crime ought to be considered in drug users’ suicidal prevention. Suicide risk needs to be evaluated in drug treatment facilities and psychological status and context contemplated (AU)

Objetivo: Se evaluó la prevalencia de ideación y de planes suicidas entre los/las consumidores/as de drogas ilícitas y su asociación con factores contextuales, por sexo. Métodos: Estudio transversal. En una muestra de 511 consumidores/as de drogas ilícitas, reclutados/as durante la primavera de 2012 en centros de tratamiento y preventivos de Cataluña, se evaluó la presencia de ideación o plan suicida en los últimos 12 meses. Se utilizó una regresión de Poisson para examinar las asociaciones entre la ideación o el plan suicida y diversos factores (sociodemográficos, psicológicos, mercado de drogas y actividades marginales de generación de ingresos, considerándose trabajo sexual, robo, venta ambulante, mendicidad o endeudamiento con un traficante). Resultados: La edad media fue de 37,9 años (desviación estándar: 8,62). El 76,3% eran hombres. El 30,8% de los hombres y el 38,8% de las mujeres reportaron ideación o plan suicida, sin diferencias significativas por sexo y edad. La agresión reciente (razón de prevalencia [PR] hombres=2,2, PR mujeres=1,4), el tratamiento psicológico (PR hombres=1,2, PR mujeres=1,3) y las actividades ilegales o marginales de generación de ingresos (PR hombres=1,5, PR mujeres=1,1) se asociaron a la ideación o plan suicida. Los hombres que traficaban eran más propensos a tener ideación o plan suicida (PR=1,3), mientras que la prisión lo fue positivamente para las mujeres (RP=1,8) y negativamente para los hombres (PR=0,7). Discusión: La prevalencia de ideación o plan suicida fue alta entre los/las consumidores/as de drogas ilícitas reclutados/as en centros sanitarios. El estado psicológico, la participación en actividades de mercado y el crimen deben considerarse especialmente para la prevención del suicidio. El riesgo de suicidio debe ser evaluado en los centros de tratamiento de drogas, contemplando el estado psicológico y el contexto (AU)

Suicidal behaviours in male and female users of illicit drugs recruited in drug treatment facilities.

OBJECTIVE: We assessed prevalence of suicidal ideation and plans among illicit drug users and their association with contextual factors, by gender. METHODS: Cross-sectional study. In a sample of 511 illicit drug users recruited during spring 2012 in drug treatment and prevention facilities in Catalonia (Spain), the prevalence of suicidal ideation/plans in the last 12 months was assessed. Poisson regression was used to examine associations between suicidal ideation/plans and various factors (socio-demographic, psychological, illegal drug market activities and marginal income generation activities, which included any reported sex work, stealing, peddling, begging or borrowing on credit from a dealer). RESULTS: The average age was 37.9 years (standard deviation: 8.62); 76.3% were men. Suicidal ideation/plans were reported by 30.8% of men and 38.8% of women, with no significant differences by age or gender. Recent aggression (male prevalence ratio [PR]=2.2; female PR=1.4), psychological treatment (male PR=1.2; female PR=1.3) and illegal/marginal income generation activities (male PR=1.5; female PR=1.1) were associated with suicidal ideation/plans. Men who trafficked were more likely to have suicidal ideation/plans (PR=1.3), while prison history was positive for women (PR=1.8) and negative for men (PR=0.7). CONCLUSIONS: Prevalence of suicidal ideation/plans was high among illicit drug users recruited from healthcare facilities. Besides psychological variables, participation in illegal market activities and crime ought to be considered in drug users' suicidal prevention. Suicide risk needs to be evaluated in drug treatment facilities and psychological status and context contemplated.

Internet use and suicidal behaviors: internet as a threat or opportunity?

BACKGROUND: Suicidal behavior is a common and severe health problem around the world. Internet use has been related to an increase in suicidal behaviors, but few studies have focused on the potential benefits of Internet use for preventing self-harm and suicide. MATERIALS AND METHODS: We reviewed the existing literature on the relationship between suicide and Internet use. RESULTS: The accessibility of suicide-related information on the Internet seems to have an impact on the incidence of suicide behaviors. However, the Internet is useful for linking people who feel lonely or isolated, and it provides access to suicide prevention information and resources. The Internet can influence vulnerable people to attempt suicide, but it can also be used to prevent self-harm and suicide. CONCLUSIONS: We propose some efforts that can be made in this preventive line.

[Social and health impact of Institutes of Legal Medicine in Spain: beyond justice]. / La proyección social y sanitaria de los Institutos de Medicina Legal en España: más allá de la justicia.

The main mission of Spanish Institutes of Legal Medicine (ILMs) is to serve the justice system. We review the potential broader role of the work done by ILMs, with an emphasis on forensic pathology. The relevance of forensic information to increase the quality of mortality statistics is highlighted, taking into account the persistence of the low validity of the external causes of death in the Mortality Register that was already detected more than a decade ago. The new statistical form and reporting system for the deaths under ILMs jurisdiction, as introduced by the Spanish Instituto Nacional de Estadística in 2009, are also described. The IMLs role in the investigation of the following mortality causes and of their determinants is reviewed in detail: traffic accidents, suicide, drugs of abuse, child deaths and sudden deaths. We conclude that an important public role of IMLs is emerging beyond their valuable service to the justice system, mainly through the gathering of data critical to assess and prevent several medical and public health and safety issues of great social impact and through their participation in epidemiologic research and surveillance.

La proyección social y sanitaria de los Institutos de Medicina Legal en España: más allá de la justicia / Social and health impact of Institutes of Legal Medicine in Spain: beyond justice

Los Institutos de Medicina Legal (IML) en España tienen como misión principal auxiliar a la administración de justicia. La presente revisión analiza la potencialidad de la información de los IML centrada en el campo de la patología forense. Se destaca la importancia de dicha información para mejorar la validez de las estadísticas de mortalidad en las defunciones con intervención judicial, especialmente la persistencia de la escasa validez de estas, ya detectada hace más de una década. Se describe también el documento estadístico y el sistema de declaración de las defunciones con intervención judicial introducidos en 2009 por el Instituto Nacional de Estadística. Se profundiza en el papel de los IML en el conocimiento de la mortalidad y algunos determinantes de ciertas causas de muerte: las debidas a lesiones por tráfico, suicidio, por reacción aguda a drogas de abuso, así como las muertes infantiles y la muerte súbita. Se concluye que la relevancia social y sanitaria de los IML se proyecta más allá de su valioso auxilio a la justicia, ya que brinda un gran servicio a la sociedad y aporta información indispensable para el conocimiento y abordaje de problemas de salud pública relativos a cuestiones de gran impacto social y sanitario (AU)

The main mission of Spanish Institutes of Legal Medicine (ILMs) is to serve the justice system. We review the potential broader role of the work done by ILMs, with an emphasis on forensic pathology. The relevance of forensic information to increase the quality of mortality statistics is highlighted, taking into account the persistence of the low validity of the external causes of death in the Mortality Register that was already detected more than a decade ago. The new statistical form and reporting system for the deaths under ILMs jurisdiction, as introduced by the Spanish Instituto Nacional de Estadística in 2009, are also described. The IMLs role in the investigation of the following mortality causes and of their determinants is reviewed in detail: traffic accidents, suicide, drugs of abuse, child deaths and sudden deaths. We conclude that an important public role of IMLs is emerging beyond their valuable service to the justice system, mainly through the gathering of data critical to assess and prevent several medical and public health and safety issues of great social impact and through their participation in epidemiologic research and surveillance (AU)

[Definition of hospital discharge, serious injury and death from traffic injuries]. / Definición de alta hospitalaria, lesión grave y muerte por lesiones por tráfico.

Road traffic injury surveillance involves methodological difficulties due, among other reasons, to the lack of consensus criteria for case definition. Police records have usually been the main source of information for monitoring traffic injuries, while health system data has hardly been used. Police records usually include comprehensive information on the characteristics of the crash, but often underreport injury cases and do not collect reliable information on the severity of injuries. However, statistics on severe traffic injuries have been based almost exclusively on police data. The aim of this paper is to propose criteria based on medical records to define: a) "Hospital discharge for traffic injuries", b) "Person with severe traffic injury", and c) "Death from traffic injuries" in order to homogenize the use of these sources.

Parte judicial de lesiones: de la tradición a la prevención / Mandatory injury report: From tradition to prevention

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[Healthy eating support groups on Facebook: content and features]. / Grupos sobre alimentación saludable en Facebook: características y contenidos.

OBJECTIVE: To determine the features and use of groups related to healthy eating on Facebook. METHOD: We carried out a cross-sectional study through the Internet. Using the API on Facebook, we included open groups related to healthy eating in the Spanish language. The variables studied were name, description, category, the number and gender of users, date of creation, number of posts, content of the first 20 posts, and the most recent update. RESULTS: We selected 281 open groups for inclusion in the study. Of these, 125 were excluded because the content was unrelated to healthy eating. Finally 156 groups were studied with 14,619 users (10,373 women [71%] and 3,919 men [26.8%]). Dietary products were promoted by 40% of the groups. CONCLUSIONS: Facebook is used as a means of communication and for sharing health information. Because many of these groups promote dietary products, their usefulness for health education is doubtful. Health organizations should participate in social media.

The choice of screening instrument matters: the case of problematic cannabis use screening in spanish population of adolescents.

The aim of this study was to examine the feasibility of problem cannabis use screening instruments administration within wide school surveys, their psychometric properties, overlaps, and relationships with other variables. Students from 7 Spanish regions, aged 14-18, who attended secondary schools were sampled by two-stage cluster sampling (net sample 14,589). Standardized, anonymous questionnaire including DSM-IV cannabis abuse criteria, Cannabis Abuse Screening Test (CAST), and Severity of Dependence Scale (SDS) was self-completed with paper and pencil in the selected classrooms. Data was analysed using classical psychometric theory, bivariate tests, and multinomial logistic regression analysis. Not responding to instruments' items (10.5-12.3%) was associated with reporting less frequent cannabis use. The instruments overlapped partially, with 16.1% of positives being positive on all three. SDS was more likely to identify younger users with lower frequency of use who thought habitual cannabis use posed a considerable problem. CAST positivity was associated with frequent cannabis use and related problems. It is feasible to use short psychometric scales in wide school surveys, but one must carefully choose the screening instrument, as different instruments identify different groups of users. These may correspond to different types of problematic cannabis use; however, measurement bias seems to play a role too.

Substance use among non-fatally injured patients attended at emergency departments in Spain.

AIMS: To describe the prevalence of recent use of alcohol, medication, and illegal drugs among patients who attended emergency departments (EDs) as a result of suffering an injury due to any external mechanism and to identify factors associated with alcohol and drug use. METHODS: A cross-sectional study was conducted in eight university hospitals in Spain. Participants were adult patients admitted to a trauma ED. Oral fluid was used to test for psychoactive substances analyzed by gas chromatography-mass spectrometry. Socio-demographic data and information on circumstances of the injury were collected through interviews. RESULTS: The analysis included 1579 patients admitted to the EDs (56.4% men). Among young people (< 40 years), 21.4% of men and 8.5% of women were positive for any illegal substance, primarily cannabinoids or cocaine; 24.7% of men and 14.8% of women were positive for alcohol. Among patients > or = 40 years, 7.4% of men and 1.6% of women were positive for any illegal substance, and 16.3% and 11.0% respectively for alcohol. Prevalence of substance detected varied across mechanism of injury, gender and age group. Night-time injury was associated with substance use. CONCLUSIONS: A high proportion of injured patients who were treated in an EDs tested positive for psychoactive drugs. Routine testing at trauma departments would maximize the identification of patients who may benefit from referral to specialized addiction treatment centers, or brief interventions.

Problematic heroin use incidence trends in Spain.

AIMS: To estimate the annual incidence of heroin use in Spain. PARTICIPANTS AND DESIGN: Data on individuals' year of first heroin use (from 1971 to 2005), year of first heroin treatment between 1991 and 2005 and most frequent route of heroin administration when presenting to treatment were obtained from the Spanish Drug Observatory Register and used to calculate the delay between onset and treatment. By using a log-linear model approach it was possible to correct for missing observations (heroin users who presented for treatment before 1991 and those who had still not presented by the end of 2005) and to estimate heroin incidence over time. FINDINGS: The estimated incidence of problematic heroin use in the population aged 15-44 peaked at 190 per 100,000 in 1980--after rising rapidly from less than 40 per 100,000 in 1971--and fell subsequently to about 8 per 100,000 in 2005. On average, incidence was five times higher in men. Injecting heroin incidence peaked and declined rapidly from 1980; as heroin smoking did not decline as rapidly, from 1985 onwards its estimated incidence has remained above that of heroin injecting. The delay between starting heroin use and entering treatment had a median of 3 years. CONCLUSIONS: We demonstrate the utility of a method to estimate heroin incidence from analysis of observed trends in presentations at specialist drug treatment facilities. The estimates suggest that incidence of heroin use, especially injecting, has fallen since 1980 and is now lower than in the early 1970s.