- Title
- Addressing smoking among persons accessing acute psychiatric services: a need for proactive and universal inervention
- Creator
- Metse, Alexandra Patricia
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2017
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- In a number of high income countries including Australia, persons with a mental illness smoke at rates two to three times greater than the general population. Consequently, this group experience disproportionate levels of preventable tobacco-related morbidity and mortality, and reduced life expectancy of 10 to 25 years. Despite higher levels of nicotine dependence, smokers with a mental illness are motivated to cease smoking and attempt to quit at similar rates to those without a mental illness, however, find it more difficult to do so successfully. The persistently elevated smoking prevalence, in comparison to the steady decline observed among smokers generally over the past two decades, suggests this group has not equally benefited from population-wide smoking cessation interventions, and that the development of tailored interventions is required. Hospitals have been identified as opportune settings to initiate the provision of smoking cessation interventions, particularly following the introduction of smoke-free policies and the associated need to treat patient nicotine dependence. Admission to a general hospital setting has been shown to have a positive impact on smoking and quitting behaviours, with smoking cessation care provided during hospitalisation and post-discharge increasing the likelihood of prolonged cessation. Integrating hospital smoking care with support post-discharge may therefore represent an intervention approach for psychiatric services to contribute to reducing the prevalence of smoking among people with a mental illness. The efficacy of integrating psychiatric inpatient and community-based smoking support has been assessed in a limited number of trials, of which yielded equivocal findings. In addition, due to a paucity of research surrounding smoking and mental illness, little is also known regarding the determinants of quitting behaviour among smokers accessing acute psychiatric services, or their receptivity and uptake of smoking cessation aids following discharge. To address these gaps in the literature, the broad aims of this thesis were to: 1. Assess the quantity and quality of research outputs relating to smoking and mental illness. ; 2. Explore potential determinants of quitting behaviour among persons with a mental illness. ; 3. Evaluate receptivity to, and utilisation of smoking cessation aids offered to smokers upon discharge from an acute psychiatric inpatient facility. ; 4. Examine the efficacy of initiating smoking cessation support during an inpatient psychiatric admission and continuing post-discharge in reducing smoking rates among persons with a mental illness. ; 5. Based on the findings of the studies undertaken to address the above aims, propose recommendations for future research to facilitate smoking cessation for persons accessing psychiatric services. A series of studies were undertaken to address the first four aims. The first was a repeat cross-sectional bibliometric review of peer-reviewed publications focussed on smoking among persons with a mental illness. Three other studies were carried out across four acute psychiatric facilities in one local health district in New South Wales, Australia: a cross sectional descriptive study of 754 inpatient smokers examining environmental and smoking determinants of quitting behaviour, a descriptive study of 378 recently discharged smokers receiving proactive and universal smoking cessation support addressing receptivity and uptake of such support, and a randomised controlled trial of a smoking cessation intervention offered to patients (N = 754) during a psychiatric inpatient admission and continued post-discharge. The findings presented in this thesis have contributed to advancing the field of smoking and mental illness research in a number of areas. First, assessment of the volume and characteristics of peer reviewed publications in the field revealed that research regarding smoking among those with a mental illness has increased over time; however it also revealed more research is needed to inform the development and implementation of effective cessation interventions for this group. Second, among a large and diverse population of psychiatric inpatients who were smokers, a high level of exposure to smoking in the immediate residential environment was identified. Further, quitting behaviours were associated with nicotine dependence, receipt of support to quit from a psychiatrist and residing with another smoker. Third, smokers with a mental illness were found to be receptive to and to utilise offers of evidence-based smoking cessation aids, with those who were older, more nicotine dependent, able to identify as a non-smoker and using smoking cessation aids whilst an inpatient, being more likely to do so. Fourth, integrating psychiatric inpatient smoking care with post-discharge cessation support was found to be efficacious in increasing seven day point prevalence smoking cessation rates and related quitting behaviours at six months post-discharge, with sustained effects on quitting behaviours at 12 months. Overall, this thesis has highlighted the need to develop tailored interventions to reduce the prevalence of smoking among persons with a mental illness. In the development of such interventions, consideration of the identified determinants of quitting behaviour and of cessation aid uptake may increase effectiveness. The final chapter of this thesis proposes recommendations for future research to increase the effectiveness smoking cessation interventions initiated in inpatient psychiatry and continued post-discharge.
- Subject
- smoking; mental illness; inpatient; intervention; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1335573
- Identifier
- uon:27457
- Rights
- Copyright 2017 Alexandra Patricia Metse
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 2 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 129 KB | Adobe Acrobat PDF | View Details Download |