Abstract
Background Epidemiological and experimental models have been applied to describe the disproportionately high prevalence of tobacco use in patients with mental illness. This observed association has become a dire public health concern. The main objective of the present study was to examine the provision of tobacco treatment strategies in a community teaching hospital serving a predominantly underserved African American population. Methods The study was designed as a retrospective review of eight hundred and thirty patients admitted to the inpatient psychiatric units. Results 52.2% of the entire cohort described themselves as current smokers. Gender, primary psychiatric diagnosis, and urine toxicology showed significant differences in the tobacco smoking and nontobacco smoking groups (P<0.05). Almost all current tobacco smokers (91.9%) had tobacco cessation counseling during the course of their hospitalization, but only 64% were offered treatments for tobacco dependence. More than half (57.9%) of the 680 participants who had urine toxicology reports were positive for any illicit substance with cannabis and cocaine being the most frequently used (32.4% and 23.2%). Direct logistic regression revealed gender, psychiatric diagnosis, and substance use as the only significant predictors of tobacco smoking among our cohort (P= 0.021, 0.001, and 0.001, respectively). Conclusions Tobacco screening, cessation counseling, and treatment continue to be a challenge in community psychiatric hospitals and need increased focus in the comprehensive management of patients with psychiatric disorders. The strong association between tobacco smoking and other substance use lends itself to the hypothesis that tobacco smoking debut prevention may be an effective public health strategy for addressing illicit drug use.
Highlights
Tobacco use among individuals with mental illness continues to be a subject of increasing scientific inquiry over the last several decades as epidemiologic and experimental literature have attempted to describe and unravel the disproportionate impact of tobacco use disorder in this demographic
Patients’ personal information was deidentified and the following information was extracted from the charts: age, gender, race, the primary psychiatric diagnosis, urine toxicology report, the type of cessation counseling provided, and, the type of intervention provided to the patients such as Nicotine Replacement Therapy (NRT) and nonnicotine medications
Being a retrospective study, we found our choice of urine toxicology, as the index of substance use, to be very useful; a prospective study that assesses other areas of substance use disorder may provide more information about dependence and other patterns of drug use
Summary
Tobacco use among individuals with mental illness continues to be a subject of increasing scientific inquiry over the last several decades as epidemiologic and experimental literature have attempted to describe and unravel the disproportionate impact of tobacco use disorder in this demographic. The Centers for Disease Control and Prevention (CDC) report noted quite succinctly that, among people with “serious psychological distress”, the prevalence of smoking continues to increase significantly. They further stressed the need for population. Epidemiological and experimental models have been applied to describe the disproportionately high prevalence of tobacco use in patients with mental illness. This observed association has become a dire public health concern. Direct logistic regression revealed gender, psychiatric diagnosis, and substance use as the only significant predictors of tobacco smoking among our cohort (P= 0.021, 0.001, and 0.001, respectively). The strong association between tobacco smoking and other substance use lends itself to the hypothesis that tobacco smoking debut prevention may be an effective public health strategy for addressing illicit drug use
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