Background People with mental health (MH) disorders smoke at higher rates, are more nicotine-dependent and suffer greater morbidity and mortality from smoking-related illnesses than the general population. Helping these people to quit smoking is a public health priority; however, many MH professionals assume that those with mental illness are not motivated to quit.

Objectives  To use predetermined criteria to identify, review critically and evaluate empirically all English language, peer-reviewed data on motivation to quit smoking in MH populations.

Methods  A systematic search was conducted and key data on subject characteristics, measures of motivation and other variables abstracted. χ2 analyses were used to compare motivation between MH and general populations, between in-patients and out-patients and between people with depression and people with psychotic disorders.

Results  Evidence suggests that people with MH disorders are as motivated to quit smoking as the general population, although those with psychotic disorders may be less motivated than individuals with depression. Although readiness to cease smoking was assessed in 14 studies, only two evaluated motivation to quit smoking in in-patient populations.

Conclusions  People with MH disorders are motivated to quit smoking, although more research is needed looking at in-patient populations. The commonly held false belief that people with MH disorders are not motivated to cease smoking means that opportunities to encourage smoking cessation among this disenfranchised group are being missed.

Assessing motivation to quit smoking in people with mental illness: a review

To better understand the US military's global peacekeeping and combat operations, which may expose a growing population of American servicewomen to challenging occupations and environments. Concordance between self-reported and electronic occupation codes for female participants in the Millennium Cohort was measured using kappa statistics. Multivariable logistic regression modeling was used to assess the odds of five self-reported potentially toxic environmental exposures or disturbing experiences among different occupational categories, while adjusting for demographic and military characteristics, including deployment. Self-reported occupations were moderately to highly reliable when compared with electronic occupation data. Active-duty and Reserve/Guard females differentially reported witnessing death or trauma and exposure to chemical or biological warfare, depleted uranium, or pesticides. Findings suggest that self-reported occupation can be used with a high degree of confidence. Occupational...

The occupational role of women in military service: validation of occupation and prevalence of exposures in the Millennium Cohort Study.

Objective: A meta-analysis of 42 studies on tobacco smoking among schizophrenia subjects found an average smoking prevalence of 62% (range=14–88%). Statements are common, however, in the research literature and the media that between 80% and 90% of people with schizophrenia smoke. The purpose of the present paper was therefore to determine if citation bias exists in the over-citation and reportage of studies finding high rates of smoking prevalence in schizophrenia subjects.Methods: Two hypotheses were tested: (i) that studies on the prevalence of smoking in people with schizophrenia reporting high smoking rates would be cited more often than studies reporting lower rates; and (ii) that statements about smoking rates among schizophrenic people on the Internet would report very high rates more often than more realistic, less dramatic rates.Results: A 10% increase in reported prevalence of smoking was associated with a 61% (95% confidence interval (CI)=30–98%) increase in citation rate. Journal impact facto...

Citation bias in reported smoking prevalence in people with schizophrenia.

Witnessing a traumatic event but not directly experiencing it can be psychologically quite damaging. In North America alone, ∼30% of individuals who witness a traumatic event develop post-traumatic stress disorder (PTSD). While effects of direct trauma are evident, consequences of indirect or secondary trauma are often ignored. Also unclear is the role of social support in the consequences of these experiences. The social defeat paradigm, which involves aggressive encounters by a large Long-Evans male rat (resident) towards a smaller Sprague-Dawley male rat (intruder), is considered a rodent model of PTSD. We have modified this model to create a trauma witness model (TWM) and have used our TWM model to also evaluate social support effects. Basically, when an intruder rat is placed into the home cage of a resident rat, it encounters an agonistic behavior resulting in intruder subordination. The socially defeated intruder is designated the SD rat. A second rat, the cage mate of the SD, is positioned to witness the event and is the trauma witnessing (TW) rat. Experiments were performed in two different experimental conditions. In one, the SD and TW rats were cagemates and acclimatized together. Then, one SD rat was subjected to three sessions of social defeat for 7 d. TW rat witnessed these events. After each social defeat exposure, the TW and SD rats were housed together. In the second, the TW and SD rats were housed separately starting after the first defeat. At the end of each protocol, depression-anxiety-like behavior and memory tests were conducted on the SD and TW rats, blood withdrawn and specific organs collected. Witnessing traumatic events led to depression- and anxiety-like behavior and produced memory deficits in TW rats associated with elevated corticosterone levels.

https://www.researchgate.net/profile/Naimesh_Solanki/publication/262788672_Witnessing_traumatic_events_causes_severe_behavioral_impairments_in_rats/links/550b25260cf285564096fe1a.pdf

Witnessing traumatic events causes severe behavioral impairments in rats.

Objective: The aims of this study were to assess mental health workers’ attitudes to addressing tobacco dependence with patients, to identify barriers that may prevent people with mental illness from receiving support, and determine workers’ recommendations for tobacco policy and practice change.Method: Questionnaires were sent to government and non-government mental health services in Adelaide, South Australia. The questionnaires asked workers to rate on a Likert rating scale their attitudes to addressing tobacco use with patients and to respond to qualitative questions about managing tobacco use within mental health services. Quantitative data were analysed using SPSS version 15.0 and qualitative data was coded by three researchers into categories or themes and then analysed.Results: Questionnaires (324) were received from staff across 45 organizations providing clinical and psychosocial services. More than two thirds of the participants felt it was important for mental health services to be involved in...

Mental health workers’ views on addressing tobacco use

1. Most people with mental illnesses have made at least one attempt to quit smoking on their own. 2. Psychiatric diagnosis and degree of nicotine dependence do not appear to be predictive of ability to quit. 3. People with mental illnesses are aware of nicotine replacement therapy (NRT), but do not combine it with a behavioral program, possibly contributing to the higher rates of recidivism in this population. 4. The lack of participation of mental health care providers in promoting smoking cessation is a complex issue.

Margaret A Green

Papers

Smoking reduction & cessation: a hospital based survey of outpatients' attitudes.