Prevalance and course of tobacco use among individuals receiving coordinated specialty care for first-episode psychosis.

Abstract

Tobacco use is decreasing among the general population, but persistent use among individuals in treatment for first-episode psychosis (FEP) remains a problem. This study aimed to measure the prevalence and course of tobacco use and explore the associations between tobacco use and clinical outcomes in a FEP sample located in New York State (NYS). Participants (N=870) were from the OnTrackNY system of coordinated specialty care clinics in NYS. Participant data were collected at admission to the program and at every 3 months of follow-up using standardized forms based on reports from clients, client families and chart review. Course of tobacco use was categorized into four groups: no-use, cessation, persistent and initiation over 1year of follow-up. The prevalence of tobacco use was 12.8% at baseline and 19.9% at 1-year follow-up. Only 3.8% of tobacco users stopped by 1year follow-up, and 4.9% initiated use. Urbanicity of clinic location (p <.001); age at admission (p =.044); gender (p =.015); ethnoracial group (p =.007); baseline education/employment status (p =.004); and baseline use of any non-tobacco substances (p <.001), including alcohol (p <.001) and cannabis (p <.001), were associated with tobacco course. Findings suggest an association between tobacco use and reduced improvement in symptoms. Despite a lower prevalence of tobacco use among OnTrack participants than in other comparable samples, tobacco cessation was minimal and more individuals initiated tobacco use than ceased over the course of follow-up. Efforts to implement tobacco cessation interventions in coordinated specialty care are warranted, since tobacco use is associated with poor health outcomes.