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1.
J Community Health ; 48(4): 606-615, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36802004

RESUMO

People who are homeless disproportionately experience the burdens of chronic disease, have limited access to preventive care, and may be less trusting of healthcare agencies. The Collective Impact Project created and evaluated an innovative model designed to increase chronic disease screening and referral to healthcare and public health services. Trained Peer Navigators (PNs), who were paid staff with lived experiences similar to the clients served, were embedded in five agencies serving people experiencing homelessness or at risk for homelessness. Over two years, PNs engaged 1071 individuals. Of those, 823 were screened for chronic diseases and 429 were referred to healthcare services. Alongside screening and referrals, the project demonstrated the value of convening a coalition of community stakeholders, experts, and resources to identify service gaps and how PN functions might complement existing staffing roles. Project findings add to a growing literature documenting unique PN roles that potentially reduce health inequities.


Assuntos
Pessoas Mal Alojadas , Humanos , Grupo Associado , Serviços de Saúde , Acessibilidade aos Serviços de Saúde , Doença Crônica
2.
Depress Anxiety ; 39(5): 429-440, 2022 05.
Artigo em Inglês | MEDLINE | ID: mdl-35535436

RESUMO

IMPORTANCE: Improving treatment outcomes for smokers with major depressive disorder (MDD) can have significant public health implications. OBJECTIVE: To evaluate the safety and efficacy of smoking cessation pharmacotherapy among smokers with MDD. DESIGN: Secondary analysis of a randomized, double-blind, active- (nicotine patch) and placebo-controlled trial of 12 weeks of either varenicline or bupropion with a 12-week follow-up. PARTICIPANTS: Community volunteers 18-75 years of age; smoke 10+ cigarettes/day; with clinically stable MDD (N = 2635) or no psychiatric disorder (N = 4028), from 140 sites in 16 countries. INTERVENTION: Twelve weeks of pharmacotherapy (placebo [PLA], nicotine replacement therapy [NRT], bupropion [BUP], varenicline [VAR]) plus brief cessation counseling. MEASURE(S): Primary safety outcome: the occurrence of ≥1 treatment-emergent, moderate to severe neuropsychiatric adverse event (NPSAE). Primary efficacy outcome: biochemically confirmed continuous abstinence (CA) during the final 4 weeks of treatment (Weeks 9-12). RESULTS: A total of 6653 participants (56% female; 39% MDD) ~47 years old. Risk of NPSAEs did not differ by medication for MDD. MDD had higher risk (p < .0001) for NPSAEs than the NPC. Efficacy (6653; intent-to-treat): CA rates for MDD versus NPC respectively were 31.2% versus 38.0% VAR; 23.0% versus 26.1% BUP; 22.6% versus 26.4% NRT; and 13.4% versus 13.7% PLA but no differential treatment effect was noted within the cohorts. All active treatments differed from PLA but VAR showed the largest effect. CONCLUSIONS: Results suggest that for MDD smokers, inclusive of those with recurrent episode, varenicline plus counseling may be the best pharmacological option for the treatment of smoking given its greater efficacy effect size and similar risk of NPSAEs. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01456936. https://clinicaltrials.gov/ct2/show/NCT01456936.


Assuntos
Transtorno Depressivo Maior , Abandono do Hábito de Fumar , Bupropiona/efeitos adversos , Depressão , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Poliésteres , Fumantes , Abandono do Hábito de Fumar/psicologia , Dispositivos para o Abandono do Uso de Tabaco/efeitos adversos , Resultado do Tratamento , Vareniclina/efeitos adversos
3.
Ecol Food Nutr ; 61(2): 235-249, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34597194

RESUMO

Palauan foodways have changed significantly over the last 100 years. Current nutritional norms in Palau have led to increased prevalence of nutrition-based noncommunicable disease. While generational change in Palauan foodways in the decades immediately following World War II has been documented, less attention has been paid to change since national independence. Parents, teachers, and students at Palauan elementary schools participated in focus groups designed to advance understanding of the current state of Palauan nutrition across generations at home, school, and elsewhere (including after-school snacks and ritual events). We document these perspectives and share Palauan ideas for improving local nutrition.


Assuntos
Doenças não Transmissíveis , Fatores Etários , Humanos , Palau/epidemiologia , Prevalência , Instituições Acadêmicas
4.
Health Promot Pract ; 18(4): 554-560, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28125916

RESUMO

We assessed changes in patient census, smoking prevalence, and intention to remain abstinent associated with the voluntary enactment of a campus-wide tobacco-free policy in a for-profit residential addictions treatment center. Employing nationally recognized tobacco-free policy strategies, steps toward implementation were tailored to addictions treatment settings. Census data and survey of client tobacco use data were collected for 1 year before the policy began and for 1 year following the policy. Average daily census increased for both the inpatient and extended residential treatment programs after enactment of the tobacco-free policy. Number of tobacco users admitted to treatment increased significantly, while the number of tobacco users who left treatment early did not significantly change. In addition to reducing smoking, the policy was associated with a significant increase of patients reporting the intention to remain abstinent after discharge. Contrary to common concern, a tobacco-free policy implemented in an inpatient residential addictions treatment setting did not negatively affect census rates. This study suggests potential clinical and organizational benefits for campus-wide tobacco-free policies.


Assuntos
Pacientes Internados , Política Antifumo , Centros de Tratamento de Abuso de Substâncias/organização & administração , Feminino , Humanos , Intenção , Masculino , Avaliação de Programas e Projetos de Saúde , Abandono do Hábito de Fumar/psicologia , Centros de Tratamento de Abuso de Substâncias/normas
5.
Nicotine Tob Res ; 18(11): 2124-2129, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27613942

RESUMO

BACKGROUND: American Indians and Alaska Natives (AI/AN) have the highest smoking prevalence (29.2%) of any other racial/ethnic group in the United States and lower quit rates. Comprehensive health care services, including commercial tobacco cessation treatments, are difficult to access for many AI/AN individuals due to poverty, the rural distribution of tribal territories, cultural barriers and the lack of funding for these programs. Due, in part, to these health care gaps, AI/AN communities are disproportionally affected by nicotine dependence and associated chronic medical and psychiatric conditions. METHODS: We report on data from National Jewish Health that provides telephonic tobacco cessation services for 14 states in the United States. We examine how AI/AN callers who were predominately AI callers differ from their counterparts (i.e., callers identifying as other ethnic groups) in terms of demographic characteristics, commercial tobacco use history, rates of emotional or mental health issues, and rates of chronic illness. RESULTS: Findings from the quitline analyses show a higher rate of preadolescent onset of commercial tobacco use in the AI/AN callers. AI/AN callers are also more likely to live with another commercial tobacco user. Results demonstrate that AI/AN callers are disproportionately impacted by mental health challenges, including high levels of stress, anxiety, and depression. Similarly, AI/AN callers report more chronic medical issues including diseases of the lungs and cardiovascular system. CONCLUSIONS: These findings stress the critical need for tailored efforts to better reach AI/AN commercial tobacco users who are considering treatment, in order to make meaningful gains in commercial tobacco cessation for this vulnerable population. IMPLICATIONS: These findings demonstrate the disproportionate impact of commercial tobacco use on the AI/AN population who utilizes quitline services. These data stress the critical need for tailored efforts to better reach AI/AN commercial tobacco users who are considering treatment, in order to make meaningful gains in commercial tobacco cessation for this vulnerable population.


Assuntos
Disparidades em Assistência à Saúde , Linhas Diretas/estatística & dados numéricos , Abandono do Hábito de Fumar/métodos , Fumar/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Alaska/epidemiologia , Feminino , Humanos , Indígenas Norte-Americanos , Pessoa de Meia-Idade , Fumar/etnologia , Prevenção do Hábito de Fumar , Estados Unidos/epidemiologia , Adulto Jovem
6.
Nicotine Tob Res ; 17(8): 924-30, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26180216

RESUMO

INTRODUCTION: Tobacco cessation quitlines are generally effective in assisting smokers who want to quit. However, up to half of quitline callers report a history of mental health conditions and/or recent emotional challenges (MH+), and there has been little study of cessation outcomes for this population. Moreover, evidence suggests that callers who expect their MH+ to interfere with quit attempts have less success with quitting. This study compares rates of quitting among MH+ callers and callers with no mental health conditions or recent emotional challenges (MH-). It also compares rates of quitting between those who felt that mental health issues would interfere with their quit attempt (MHIQ+) and those who did not (MHIQ-). METHODS: National Jewish Health collected telephone data from 6 state quitlines. Participants received up to 5 coaching sessions and up to 8 weeks of nicotine replacement therapy. Smoking status was assessed during 3-month and 6-month post-intervention calls in a subset of participants (n = 4,960) for whom follow-up interviews were completed. RESULTS: Participation in follow-up interviews was not significantly different between callers with MH+ and those without MH- (p = .13). However, at follow-up MH+ participants were less likely to report a successful quit compared with MH- (3-month: 31% vs. 43%; 6-month: 33% vs. 43%; both p < .001). Among MH+ participants, those reporting MHIQ+ were significantly less likely to quit compared with those who were MHIQ- (3-month: 24% vs. 34%; 6-month: 26% vs. 35%; both p ≤ .001). CONCLUSIONS: These findings highlight the importance of evaluating both the mental health status of individuals seeking support for smoking cessation as well as the individuals' expectations for success, because they may need more tailored intervention to ensure the potential for better compared with outcomes.


Assuntos
Nível de Saúde , Linhas Diretas/tendências , Saúde Mental/tendências , Abandono do Hábito de Fumar/métodos , Fumar/terapia , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fumar/epidemiologia , Fumar/psicologia , Abandono do Hábito de Fumar/psicologia , Tabagismo/epidemiologia , Tabagismo/psicologia , Tabagismo/terapia , Resultado do Tratamento , Estados Unidos/epidemiologia
7.
Prev Chronic Dis ; 12: E13, 2015 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-25654218

RESUMO

The California Tobacco Control Program (CTCP) administered 4 regional trainings in 2012 to staffers at CTCP-funded projects, tobacco control coalitions, several county departments of mental health and alcohol and drug, and administrators and providers from behavioral health care facilities. These trainings focused on the special tobacco use cessation needs and opportunities for cessation among persons with mental illness or substance abuse disorders, and they provided information about cessation and smoke-free policies. CTCP surveyed county and private behavioral health care programs to assess their readiness for adopting tobacco control strategies at treatment facilities. Between baseline and follow-up we found a decrease in the proportion of organizations at the precontemplation or contemplation stages of change and twice as many organizations at the action and maintenance stages of change. Significant obstacles remain to implementing policy: many agencies have concerns about going tobacco-free. But significant progress has been made, as evidenced by new policies and a growing number of tobacco-free coalitions consisting of public health agencies, behavioral health care agencies, and local hospitals.


Assuntos
Política de Saúde , Transtornos Mentais/epidemiologia , Política Organizacional , Política Antifumo/legislação & jurisprudência , Abandono do Hábito de Fumar/legislação & jurisprudência , Fumar/epidemiologia , Poluição por Fumaça de Tabaco/efeitos adversos , California/epidemiologia , Comportamento Cooperativo , Humanos , Transtornos Mentais/etiologia , Saúde Mental , Prevalência , Estudos Retrospectivos , Prevenção do Hábito de Fumar , Poluição por Fumaça de Tabaco/legislação & jurisprudência
8.
Ann Intern Med ; 159(6): 390-400, 2013 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-24042367

RESUMO

UNLABELLED: Chinese translation BACKGROUND: Depression is overrepresented in smokers. OBJECTIVE: To evaluate smoking abstinence and changes in mood and anxiety levels in smokers with depression treated with varenicline versus placebo. DESIGN: Phase 4, multicenter, parallel, 1:1 allocation, double-blind, randomization trial. Randomization, stratified by antidepressant use and depression score at baseline, was blocked in sizes of 4. (ClinicalTrials.gov: NCT01078298). SETTING: 38 centers in 8 countries. PARTICIPANTS: 525 adult smokers with stably treated current or past major depression and no recent cardiovascular events. INTERVENTION: Varenicline, 1 mg twice daily, or placebo for 12 weeks, with 40-week nontreatment follow-up. MEASUREMENTS: Primary outcome was carbon monoxide-confirmed continuous abstinence rate (CAR) for weeks 9 to 12. Other outcomes included CARs assessed during nontreatment follow-up and ratings of mood, anxiety, and suicidal ideation or behavior. RESULTS: 68.4% versus 66.5% of the varenicline and placebo groups, respectively, completed the study. Varenicline-treated participants had higher CARs versus placebo at weeks 9 to 12 (35.9% vs. 15.6%; odds ratio [OR], 3.35 [95% CI, 2.16 to 5.21]; P < 0.001), 9 to 24 (25.0% vs. 12.3%; OR, 2.53 [CI, 1.56 to 4.10]; P < 0.001), and 9 to 52 (20.3% vs. 10.4%; OR, 2.36 [CI, 1.40 to 3.98]; P = 0.001). There were no clinically relevant differences between groups in suicidal ideation or behavior and no overall worsening of depression or anxiety in either group. The most frequent adverse event was nausea (varenicline, 27.0%; placebo, 10.4%). Two varenicline-group participants died during the nontreatment phase. LIMITATIONS: Some data were missing, and power to detect differences between groups was low in rare events. Smokers with untreated depression, with co-occurring psychiatric conditions, or receiving mood stabilizers and antipsychotics were not included. CONCLUSION: Varenicline increased smoking cessation in smokers with stably treated current or past depression without exacerbating depression or anxiety. PRIMARY FUNDING SOURCE: Pfizer.


Assuntos
Benzazepinas/uso terapêutico , Transtorno Depressivo Maior/complicações , Agonistas Nicotínicos/uso terapêutico , Quinoxalinas/uso terapêutico , Abandono do Hábito de Fumar/métodos , Abandono do Hábito de Fumar/psicologia , Adolescente , Adulto , Idoso , Antidepressivos/uso terapêutico , Ansiedade , Benzazepinas/efeitos adversos , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Maior/psicologia , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Agonistas Nicotínicos/efeitos adversos , Quinoxalinas/efeitos adversos , Ideação Suicida , Resultado do Tratamento , Vareniclina , Adulto Jovem
9.
Tob Use Insights ; 16: 1179173X231168511, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37051590

RESUMO

Background: Despite the vast human and economic costs associated with tobacco use among U.S. inmates, smoking remains a largely ignored public health epidemic. Incarcerated individuals smoke at 3 to 4 times the rate of the general population and face tobacco-related health disparities. Purpose: This paper reports results from a single arm, pre/post pilot study designed to test the feasibility and initial effectiveness of an inmate-administered group tobacco cessation intervention within a men's pre-release program run by the Arizona Department of Corrections. Methods: Corrections staff and inmate peer mentors were trained in the DIMENSIONS: Tobacco Free Program, a manualized 6-session tobacco cessation group curriculum. Group sessions used evidence-based interventions for assisting inmates develop skills to live tobacco and nicotine free. In 2019-2020, 39 men who reported tobacco use voluntarily participated in one of three cessation groups. Wilcoxen signed-rank tests evaluated changes across group sessions in frequency of tobacco use and attitudes about nicotine-free living post release. Results: Most participants attended all six group sessions (79%) and made one or more quit attempts (78%). Overall, 24% of the sample reported quitting tobacco, and significant reductions in tobacco use were reported after only two sessions. Participants further reported significant positive changes in knowledge, plans, support, and confidence to live tobacco-free lives post-release. Conclusions: To our knowledge, this is the first study to demonstrate that, with minimal investment, implementation of an evidence-based, peer-led tobacco free program is feasible and effective within an incarcerated population uniquely vulnerable to the burden of tobacco.

10.
Cancer Cell ; 2(6): 473-83, 2002 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-12498716

RESUMO

Id proteins are helix-loop-helix transcription factors that regulate tumor angiogenesis. In order to identify downstream effectors of Id1 involved in the regulation of angiogenesis, we performed PCR-select subtractive hybridization on wild-type and Id1 knockout mouse embryo fibroblasts (MEFs). Here we demonstrate that thrombospondin-1 (TSP-1), a potent inhibitor of angiogenesis, is a target of transcriptional repression by Id1. We also show that Id1-null MEFs secrete an inhibitor of endothelial cell migration, which is completely inactivated by depletion of TSP-1. Furthermore, in vivo studies revealed decreased neovascularization in matrigel assays in Id1-null mice compared to their wild-type littermates. This decrease was completely reversed by a TSP-1 neutralizing antibody. We conclude that TSP-1 is a major target for Id1 effects on angiogenesis.


Assuntos
Regulação da Expressão Gênica , Neovascularização Patológica/genética , Proteínas Repressoras , Trombospondina 1/genética , Fatores de Transcrição/fisiologia , Animais , Bovinos , Movimento Celular/efeitos dos fármacos , Células Cultivadas , Elementos E-Box , Embrião de Mamíferos , Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/metabolismo , Fibroblastos/fisiologia , Humanos , Imuno-Histoquímica , Proteína 1 Inibidora de Diferenciação , Camundongos , Camundongos Knockout , Reação em Cadeia da Polimerase , Regiões Promotoras Genéticas , Trombospondina 1/antagonistas & inibidores , Trombospondina 1/biossíntese , Trombospondina 1/farmacologia , Fatores de Transcrição/deficiência , Transcrição Gênica , Regulação para Cima
11.
J Behav Med ; 35(2): 139-48, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21479646

RESUMO

Despite an abundance of literature documenting the prevalence and dangers of youth tobacco use, there is a relative dearth of literature in the area of effective cessation treatments for youth (Fiore et al. in Clinical tobacco guideline: treating tobacco use and dependence, 2008). Additionally, although it has been widely accepted that mental illness is highly correlated with tobacco use and dependence, little research has been done to support prevention and cessation efforts for youth with mental illnesses. This paper summarizes the literature on tobacco use and cessation in youth, with a focus on describing the existing knowledge base for youth with mental illnesses.


Assuntos
Transtornos Mentais/epidemiologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Fumar/epidemiologia , Tabagismo/epidemiologia , Adolescente , Humanos , Prevalência , Prevenção do Hábito de Fumar , Tabagismo/prevenção & controle , Adulto Jovem
12.
PLoS One ; 17(12): e0278611, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36477160

RESUMO

The coronavirus disease 2019 (COVID-19) first came to the Unites States in January 2020. Though adult and pediatric vaccines became available to the public, vaccine uptake among youth and particularly younger children has been gradual. This explanatory study aimed to better understand parents' attitudes and beliefs of the pediatric COVID-19 vaccine and the barriers and facilitators to vaccine uptake in a rural community through a brief, online demographic survey, and in-depth qualitative interviews. Forty-one in depth interviews were conducted with parents (31-English and 10-Spanish-speaking) residing in rural and frontier counties in Colorado between September 2021 and February 2022. Six emergent themes related to COVID-19 pediatric vaccine uptake were identified among the population. These themes spanned the three levels of influence in the Social Ecological Model (individual, interpersonal, and community levels). The six themes were identified as such; 1) Vaccine accessibility was associated with pediatric COVID vaccine uptake in rural communities, 2) Previous pediatric vaccine behaviors were not associated with COVID-19 pediatric vaccine uptake, 3) Perceived health status of a child or family member influenced pediatric COVID-19 vaccine uptake, 4) COVID-19 health seeking behaviors, like COVID pediatric vaccine uptake, are influenced by an individual's prosocial or individualistic perspectives, 5) Child autonomy and "age of consent" frames vaccine decision making behaviors in parents, and lastly 6) Social networks impacted COVID-19 pediatric vaccine decision making. These findings inform next steps for COVID-19 pediatric vaccine uptake including targeted and tailored messaging for communities (cues to actions), engaging youth stakeholders, and identifying trusted sources to build rapport and trust between health professionals and community members. The growing vaccine hesitancy among parents has serious implications for disease eradication and future viral outbreaks. Understanding the perceived barriers and facilitators to pediatric vaccine uptake is important to maintain the health of our youth and communities.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Humanos , Criança , Adolescente , População Rural , COVID-19/epidemiologia , COVID-19/prevenção & controle , Família , Pais
13.
Community Ment Health J ; 47(6): 694-702, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-21556784

RESUMO

Persons with mental illnesses use tobacco at significantly higher and heavier rates than the general population, and suffer greater tobacco- related morbidity and mortality. However, there are few existing tobacco cessation interventions for these individuals. This study examined two tobacco cessation interventions, a telephonic quitline intervention (counseling and nicotine replacement therapy) and a community-based group counseling intervention with adults currently receiving community mental health services. At 6-month follow-up, both groups demonstrated significantly reduced tobacco use, but participants who received both quitline services and the group counseling intervention were significantly more likely to have a 50% tobacco use reduction. Across groups, the overall intent-to-treat cessation rate was 7%. Tobacco dependence, depression symptoms, and psychotic symptoms decreased significantly for all treatment groups, while health and mental health functioning increased. Findings suggest that common community tobacco cessation services are effective for this population.


Assuntos
Redes Comunitárias , Promoção da Saúde/métodos , Transtornos Mentais/complicações , Abandono do Hábito de Fumar , Tabagismo/complicações , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Tabagismo/terapia , Estados Unidos , Adulto Jovem
14.
Am J Prev Med ; 60(3 Suppl 2): S163-S171, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33663704

RESUMO

INTRODUCTION: The general efficacy of quitlines has been widely demonstrated, but uncertainty exists regarding how quitlines might best intervene for persons with mental health conditions. A total of 1 in 5 people in the U.S. has a diagnosable psychiatric disorder. These individuals smoke at 2‒4 times the rate of smoking among those without a mental health condition and face high rates of related death and disability. About half of quitline callers self-report a mental health condition, but until recently, quitline protocols tailored to these smokers did not exist. METHODS: This paper provides initial results for tailored mental health programs from the largest quitline providers in the U.S., Optum and National Jewish Health. From 2017 to 2018, cohorts of callers with a mental health condition who enrolled in tailored programs were compared with cohorts with a mental health condition who received standard care. Both mental health programs offered participants additional calls, longer duration of combination nicotine-replacement therapy, and attention to mental health issues. Analyses were conducted in 2018-2019. RESULTS: Findings suggest that callers with a mental health condition benefit from both standard care and tailored mental health services. Tailored programming did well in engaging people with mental health conditions. At the same time, there were no significant differences in abstinence rates when comparing mental health programs with standard care. Mental health cohorts did receive significantly greater service durations, more counseling calls, and longer nicotine-replacement therapy duration. CONCLUSIONS: Tailored mental health quitline programs present a promising framework for testing the services that address psychiatric symptoms as well as other frequent population characteristics such as chronic illness. Implications for increasing reach to the often underserved population with a mental health condition are discussed.


Assuntos
Saúde Mental , Abandono do Hábito de Fumar , Aconselhamento , Estudos de Viabilidade , Linhas Diretas , Humanos , Dispositivos para o Abandono do Uso de Tabaco
15.
Annu Rev Public Health ; 31: 297-314 1p following 314, 2010.
Artigo em Inglês | MEDLINE | ID: mdl-20001818

RESUMO

Tobacco use exerts a huge toll on persons with mental illnesses and substance abuse disorders, accounting for 200,000 of the annual 443,000 annual tobacco-related deaths in the United States. Persons with chronic mental illness die 25 years earlier than the general population does, and smoking is the major contributor to that premature mortality. This population consumes 44% of all cigarettes, reflecting very high prevalence rates plus heavy smoking by users. The pattern reflects a combination of biological, psychosocial, cultural, and tobacco industry-related factors. Although provider and patient perspectives are changing, smoking has been a historically accepted part of behavioral health settings. Additional harm results from the economic burden imposed by purchasing cigarettes and enduring the stigma attached to smoking. Tailored treatment for this population involves standard cessation treatments including counseling, medications, and telephone quitlines. Further progress depends on clinician and patient education, expanded access to treatment, and the resolution of existing knowledge gaps.


Assuntos
Transtornos Mentais/epidemiologia , Abandono do Hábito de Fumar , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Feminino , Órgãos Governamentais , Promoção da Saúde/organização & administração , Humanos , Masculino , Serviços de Saúde Mental , Prisões , Fumar/tratamento farmacológico , Fumar/epidemiologia , Centros de Tratamento de Abuso de Substâncias , Estados Unidos/epidemiologia
16.
J Behav Health Serv Res ; 47(4): 601-613, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32495248

RESUMO

The U.S. is in the midst of an opioid epidemic. At the same time, tobacco use remains the leading cause of preventable death and disability. While the shared biological underpinnings of nicotine and opioid addiction are well established, clinical implications for co-treatment of these two substance use disorders has not been emphasized in the literature, nor have researchers, clinicians, and policy makers adequately outlined pathways for incorporating co-treatment into existing clinical workflows. The current brief review characterizes the metabolic and neural mechanisms which mediate co-use of nicotine and opioids, and then outlines clinical and policy implications for concurrently addressing these two deadly epidemics. Screening, assessment, medication-assisted treatment (MAT), and tobacco-free policy are discussed. The evidence suggests that clinical care and policies that facilitate co-treatment are an expedient means of delivering healthcare to individuals that result in better health for the population while also meeting patients' substance abuse disorder recovery goals.


Assuntos
Analgésicos Opioides/efeitos adversos , Nicotina/efeitos adversos , Agonistas Nicotínicos/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/reabilitação , Tabagismo/reabilitação , Analgésicos Opioides/uso terapêutico , Comportamento Aditivo , Política de Saúde , Humanos , Nicotina/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/psicologia , Padrão de Cuidado , Tabagismo/psicologia
17.
Bipolar Disord ; 11(8): 876-84, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19922556

RESUMO

OBJECTIVES: Few studies have addressed the physical and mental health effects of caring for a family member with bipolar disorder. This study examined whether caregivers' health is associated with changes in suicidal ideation and depressive symptoms among bipolar patients observed over one year. METHODS: Patients (N = 500) participating in the Systematic Treatment Enhancement Program for Bipolar Disorder and their primary caregivers (N = 500, including 188 parental and 182 spousal caregivers) were evaluated for up to one year as part of a naturalistic observational study. Caregivers' perceptions of their own physical health were evaluated using the general health scale from the Medical Outcomes Study 36-item Short-Form Health Survey. Caregivers' depression was evaluated using the Center for Epidemiological Studies of Depression Scale. RESULTS: Caregivers of patients who had increasing suicidal ideation over time reported worsening health over time compared to caregivers of patients whose suicidal ideation decreased or stayed the same. Caregivers of patients who had more suicidal ideation and depressive symptoms reported more depressed mood over a one-year reporting period than caregivers of patients with less suicidal ideation or depression. The pattern of findings was consistent across parent caregivers and spousal caregivers. CONCLUSIONS: Caregivers, rightly concerned about patients becoming suicidal or depressed, may try to care for the patient at the expense of their own health and well-being. Treatments that focus on the health of caregivers must be developed and tested.


Assuntos
Transtorno Bipolar/complicações , Transtorno Bipolar/psicologia , Cuidadores/psicologia , Depressão/etiologia , Depressão/psicologia , Suicídio/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Lista de Checagem/métodos , Saúde da Família , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Observação , Valor Preditivo dos Testes , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Autoimagem , Suicídio/estatística & dados numéricos , Fatores de Tempo , Adulto Jovem
18.
Psychiatr Rehabil J ; 32(4): 276-84, 2009.
Artigo em Inglês | MEDLINE | ID: mdl-19346206

RESUMO

OBJECTIVES: Forty-one percent (41%) of persons in the U.S. who reported having recent mental illnesses also smoke cigarettes. Tobacco use among this population is associated with up to 25 less years of life and excess medical comorbidity compared to the general population. While research demonstrates that tobacco interventions can be effective for persons with mental illnesses, they are not commonly utilized in clinical practice. The current study explored how to adapt evidence-based tobacco cessation interventions to meet the unique physiological, psychological, and social challenges facing persons with mental illnesses. METHODS: Ten focus groups were conducted utilizing a semi-structured discussion; 5 for adult mental health consumers (n = 62) and 5 with mental health clinicians and administrators (n = 22). Content analysis was used to organize themes into categories. RESULTS: Five thematic categories were found: (1) Barriers to treatment, (2) Resources and infrastructure, (3) Negative influences on smoking behavior, (4) Knowledge deficits, and (5) Treatment needs. CONCLUSIONS: These findings are instructive in developing appropriate tobacco cessation services for this population. Specifically, these data have been incorporated into a mental health provider toolkit for smoking cessation and have informed the development of a tobacco cessation intervention study.


Assuntos
Transtornos Mentais/complicações , Serviços de Saúde Mental , Abandono do Hábito de Fumar/métodos , Tabagismo/terapia , Adolescente , Adulto , Estudos de Coortes , Colorado , Grupos Focais , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Transtornos Mentais/psicologia , Avaliação das Necessidades , Planejamento de Assistência ao Paciente , Educação de Pacientes como Assunto/métodos , Guias de Prática Clínica como Assunto , Desenvolvimento de Programas/métodos , Qualidade de Vida , Abandono do Hábito de Fumar/psicologia , Tabagismo/complicações , Tabagismo/psicologia , Adulto Jovem
20.
Mol Cancer Ther ; 17(5): 1024-1038, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29545330

RESUMO

Ligation of OX40 (CD134, TNFRSF4) on activated T cells by its natural ligand (OX40L, CD252, TNFSF4) enhances cellular survival, proliferation, and effector functions such as cytokine release and cellular cytotoxicity. We engineered a recombinant human OX40L IgG4P Fc fusion protein termed MEDI6383 that assembles into a hexameric structure and exerts potent agonist activity following engagement of OX40. MEDI6383 displayed solution-phase agonist activity that was enhanced when the fusion protein was clustered by Fc gamma receptors (FcγRs) on the surface of adjacent cells. The resulting costimulation of OX40 on T cells induced NFκB promoter activity in OX40-expressing T cells and induced Th1-type cytokine production, proliferation, and resistance to regulatory T cell (Treg)-mediated suppression. MEDI6383 enhanced the cytolytic activity of tumor-reactive T cells and reduced tumor growth in the context of an alloreactive human T cell:tumor cell admix model in immunocompromised mice. Consistent with the role of OX40 costimulation in the expansion of memory T cells, MEDI6383 administered to healthy nonhuman primates elicited peripheral blood CD4 and CD8 central and effector memory T-cell proliferation as well as B-cell proliferation. Together, these results suggest that OX40 agonism has the potential to enhance antitumor immunity in human malignancies. Mol Cancer Ther; 17(5); 1024-38. ©2018 AACR.


Assuntos
Fragmentos Fc das Imunoglobulinas/imunologia , Imunoglobulina G/imunologia , Ligante OX40/imunologia , Proteínas Recombinantes de Fusão/imunologia , Animais , Linhagem Celular Tumoral , Citocinas/imunologia , Citocinas/metabolismo , Citotoxicidade Imunológica/efeitos dos fármacos , Citotoxicidade Imunológica/imunologia , Feminino , Células HEK293 , Humanos , Fragmentos Fc das Imunoglobulinas/genética , Fragmentos Fc das Imunoglobulinas/metabolismo , Imunoglobulina G/genética , Imunoglobulina G/metabolismo , Ativação Linfocitária/efeitos dos fármacos , Ativação Linfocitária/imunologia , Macaca mulatta , Ligante OX40/genética , Ligante OX40/metabolismo , Multimerização Proteica/imunologia , Receptores OX40/agonistas , Receptores OX40/imunologia , Receptores OX40/metabolismo , Proteínas Recombinantes de Fusão/química , Proteínas Recombinantes de Fusão/farmacologia , Linfócitos T/imunologia , Linfócitos T/metabolismo , Linfócitos T Reguladores/imunologia , Linfócitos T Reguladores/metabolismo
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