Cigarette smoking among patients with mental retardation and mental illness

Substance use among individuals with intellectual disabilities living independently in Flanders

BACKGROUND

Over the past decades, there has been increased scientific and clinical interest in substance use among individuals with intellectual disabilities (ID). Despite raised interest and awareness in the topic, lack of supportive data on prevalence and risk factors highlights the need for ongoing research. The aims of this cross-sectional multicenter study were to examine the nature and extent of substance use in individuals with ID living independently, to investigate group differences in substance use and related problems, and to explore the role of substance-related knowledge and attitudes in substance use behaviors.

METHOD

Participants were 123 individuals with mild to moderate ID receiving support from independent living services. Data were gathered by means of a structured interview strategy (i.e. the Substance Use and Misuse in Intellectual Disability-Questionnaire; SumID-Q).

RESULTS

Findings revealed that rates of lifetime use of licit and illicit substances were higher than those found in earlier studies among individuals with ID and the general population. While cannabis use was the only illicit substance reported, current tobacco and alcohol use were shown to be highly prevalent (48%-45.5%). Rates for the latter were similar to earlier studies among community samples of individuals with ID. In contrast to our hypotheses, few group differences in substance use behaviors were observed. Male gender was associated with age of onset of alcohol and tobacco use and tobacco use-related problems, while younger age was found to be associated with lifetime use of cannabis. No evidence was found regarding the role of knowledge; however, smokers and alcohol users rated tobacco and alcohol use more positively.

CONCLUSION

This study demonstrated that individuals with ID living independently use a wide range of licit and illicit substances and present divergent levels and patterns of substance use. Notwithstanding the role of personal choice in substance use, more research is needed to better understand the nature and extent of substance use and related problems, as well as the role of substance-related knowledge and attitudes in individuals with ID.

The Impact of Preexisting Mental Health Disorders on the Diagnosis, Treatment, and Survival among Lung Cancer Patients in the U.S. Military Health System

BACKGROUND

Higher cancer-related mortality has been observed among people with mental health disorders than in the general population. Both delay in diagnosis and inadequate treatment due to health care access have been found to explain the higher mortality. The U.S. Military Health System (MHS), in which all beneficiaries have equal access to health care, provides an ideal system to study this disparity where there are no or minimal barriers to health care access. This study assessed preexisting mental health disorders and stage at diagnosis, receipt of cancer treatment, and overall survival among patients with non-small cell lung cancer (NSCLC) in the U.S. MHS.

METHODS

The study used data from the linked database from the Department of Defense's Central Cancer Registry and the MHS Data Repository (MDR). The study subjects included 5,054 patients with histologically confirmed primary NSCLC diagnosed between 1998 and 2007.

RESULTS

Patients with a preexisting mental disorder did not present with more advanced disease at diagnosis than those without. There were no significant differences in receiving cancer treatments between the two groups. However, patients with a mental health disorder had a higher mortality than those without [adjusted HR, 1.11; 95% confidence interval (CI), 1.03-1.20].

CONCLUSIONS

Poor survival in NSCLC in patients with a preexisting mental health disorder is not necessarily associated with delay in diagnosis and/or inadequate cancer treatment.

IMPACT

This study contributes to the current understanding that health care access may not be sufficient to explain the poor survival among patients with NSCLC with preexisting mental health disorders. Cancer Epidemiol Biomarkers Prev; 25(12); 1564-71. ©2016 AACR.

Challenges in Diagnosis and Treatment of Lung Cancer in People with Intellectual Disabilities: Current State of Knowledge

As the life expectancy of people with intellectual disability (ID) has progressed, they have become similarly at risk of cancer as individuals of the general population. Epidemiological studies indicate a reduced incidence and mortality from lung cancer in the total population of persons with ID. However, the pattern is heterogeneous and the risk is strongly correlated with the impairment level; persons with mild intellectual impairment have higher cancer risk, and this subgroup also has the highest tobacco consumption (the major risk factor for lung cancer) compared to individuals with more severe impairment. Clinical presentation of lung cancer in persons with ID is often atypical, with symptoms frequently hidden by the mental state and communication impairments. Treatment can be impeded by incomplete understanding and lack of cooperation on the part of the patient; nevertheless, general principles for treating lung cancer must be applied to persons with ID. Early diagnosis and implementation of an adapted treatment plan may result in lung cancer outcomes similar to those of individuals in the general population. Physicians facing the difficult task of treating lung cancer in persons with ID are called to carry out their mission of care in a responsible, free, and creative way.

Gesundheitsförderung von Menschen mit intellektueller Behinderung

Zahlreiche Publikationen belegen, dass die Gesundheit von Menschen mit intellektueller Behinderung (IB) für Krankheiten und Störungen anfälliger ist als die der Allgemeinbevölkerung. Zudem sind bestimmte Risikoverhaltensweisen (z. B. schlechte Ernährung und wenig Bewegung) häufiger bei dieser Personengruppe zu finden. Trotz der sensibleren Gesundheitssituation steht die gesundheitspsychologische Forschung für Menschen mit IB noch am Anfang. Für diesen Überblicksartikel wurde Fachliteratur über Menschen mit IB nach gesundheitspsychologischen Konzeptionen durchsucht und bestehende Forschungsarbeiten analysiert. Des Weiteren wurden rezente Gesundheitsmodelle sowie Kontinuitäts- und Stadienmodelle für die Allgemeinbevölkerung und ihre einzelnen Bestandteile hinsichtlich ihrer Übertragbarkeit auf diese spezielle Population untersucht. Eine Generalisierung von Gesundheitsmodellen der Allgemeinbevölkerung auf die Gruppe von Menschen mit IB erscheint aus verschiedenen Gründen problematisch. So erweist sich z. B. die Erfassung einzelner Bestandteile durch ihre Abstraktheit als zu komplex für Menschen mit IB. Dieses und ähnliche Forschungshindernisse werden in diesem Artikel besprochen. Diese genaue Analyse hilft jedoch notwendige Kriterien für die Entwicklung eines theoretischen Gesundheitsmodells speziell für Menschen mit IB zu erstellen. Schlussendlich werden relevante Modellbausteine für Menschen mit IB, die auf den präsentierten Forschungsergebnissen aufbauen, vorgestellt und diskutiert. Schließlich werden zukünftige Forschungsfragen erörtert.

Substance abuse among individuals with intellectual disabilities

Individuals with disabilities are a growing population that confronts multiple disadvantages from social and environmental determinants of health. In particular, the 7-8 million people in the U.S. with an intellectual disability (ID) suffer disproportionately from substance use problems, largely because of a lack of empirical evidence to inform prevention and treatment efforts for them. Although available research could inform future research efforts, studies are scattered across disciplines with the last review synthesizing findings written more than five years ago. To consider more recent findings with earlier works, PubMed, PsychINFO, and Google Scholar were searched and produced 37 peer-reviewed texts across multiple disciplines, 15 from 2006 or later. While the prevalence of alcohol and illicit drug use in this population are low, the risk of having a substance-related problem among ID substance users is comparatively high. Gaps in the research and population subgroups that warrant special attention are identified, such as individuals with borderline and mild ID, individuals with co-occurring mental illness, and individuals who are incarcerated. Compared with substance abusers without ID, ID substance abusers are less likely to receive substance abuse treatment or remain in treatment. Research is needed to better gauge the magnitude of substance use problems, identify prevention strategies, and specify treatment components that meet the unique needs of individuals with ID.

Effects of a mindfulness-based smoking cessation program for an adult with mild intellectual disability

Smoking is a major risk factor for a number of health conditions and many smokers find it difficult to quit smoking without specific interventions. We developed and used a mindfulness-based smoking cessation program with a 31-year-old man with mild intellectual disabilities who had been a smoker for 17 years. The mindfulness-based smoking cessation program consisted of three components: intention, mindful observation of thoughts, and Meditation on the Soles of the Feet. A changing-criterion analysis showed that this man was able to fade his cigarette smoking from 12 at baseline to 0 within 3 months, and maintain this for a year. Follow-up data, collected every 3 months following the maintenance period, showed he was able to abstain from smoking for 3 years. Our study suggests that this mindfulness-based smoking cessation program merits further investigation.

Tobacco use among individuals with intellectual or developmental disabilities: a brief review

Tobacco use is the leading preventable cause of death in the United States. Although few tobacco control efforts target individuals with intellectual and/or developmental disabilities, this population may be especially vulnerable to the deleterious effects of tobacco use and dependence. Individuals with intellectual and developmental disabilities suffer from the health, financial, and stigmatizing effects of tobacco use. The present review examined the current literature with respect to the prevalence and patterns of tobacco use in individuals with intellectual and developmental disabilities, the importance of addressing tobacco use in these smokers, and policies surrounding tobacco use in this population. Suggestions for additional avenues of inquiry as well as modifications to current cessation treatments are proposed.

Audit of cardiovascular disease risk factors among supported adults with intellectual disability attending an ageing clinic

BACKGROUND

Little is known about the cardiovascular disease (CVD) risk factor profile for older adults with intellectual disability (ID). As many CVD risk factors are treatable by lifestyle changes, confirmation of the risk factor profile for older adults with ID could substantially impact upon preventive health practices for this group.

METHOD

Medical charts of all adults aged 40 years or over attending a specialised ageing clinic for adults with ID between January 2002 and June 2005 were reviewed.

RESULTS

Overall, 155 adults' charts were reviewed and 8 (5%) had diagnosed CVD. Risk factor assessments found 18% with hypertension (of 73% checked), 8% with elevated glucose (of 97% checked), 27% with elevated total cholesterol (of 94% checked), 70% overweight or obese (of 55% checked), 11% current or ex-smokers (100% checked), and 96% with inadequate daily exercise (100% checked). Only the prevalence of hypertension and smoking increased significantly with age.

CONCLUSION

Apart from lack of exercise (which was much more prevalent than for the general population) and overweight or obesity, the overall CVD risk factor profile of supported older adults with ID appears generally more favourable compared to the age-matched general population, although the occurrence of all risk factors is still common. Healthy lifestyle programs for this population should focus on implementation of exercise and nutrition strategies.

Prevalence and influences on self-reported smoking among adolescents with mild learning disabilities, attention deficit hyperactivity disorder, and their typically developing peers

Many adolescents take up the smoking habit despite its well-documented adverse health effects. This study explores the prevalence and influences on smoking among 89 adolescents with mild learning disabilities, 108 with attention deficit hyperactivity disorder (ADHD), and 124 typically developing peers aged 12-16 years. All the participants were attending mainstream secondary schools and they were asked to complete a self-report questionnaire on smoking. It was found that adolescents with ADHD smoked more than adolescents with mild learning disabilities, who in turned smoked more than adolescents not diagnosed with any disability. More adolescents with ADHD reported that the majority of their friends smoked and they were less well informed about the health effects of smoking. No differences were identified between the three groups in terms of the smoking behaviour of their parents and the perceived attitudes of their parents and friends towards smoking. Findings are discussed and suggestions are made for further research.

A review of substance use research among those with mental retardation

This article reviews research conducted on the cigarette, alcohol, and illicit drug use of adolescents and adults with mental retardation (MR). The majority of the research related to substance use conducted on this population has been limited to surveys. Overall, results of these studies suggest that, although substance use is slightly lower among those with MR than among nondisabled comparison groups, it is nonetheless a problem for many individuals. This research is reviewed and a discussion of both the general and specific flaws of these studies follows. Further, the examination of education, prevention, and treatment programs for this population has been overlooked, indicating that individuals with MR are likely not receiving the services most appropriate for them. The article concludes with a discussion of several topics that need to be addressed in future studies, including research on potential best practices in the overlooked areas of substance abuse interventions.

Identification and treatment of patients with nicotine problems in routine clinical psychiatry practice

The aim of this study is to assess the rates of nicotine problems diagnosed by psychiatrists, the characteristics of psychiatric patients who smoke, and the services provided to them in routine psychiatric practice. Data were obtained by asking psychiatrists participating in the American Psychiatric Institute for Psychiatric Research and Education's Practice Research Network to complete a self-administered questionnaire to provide detailed sociodemographic, clinical, and health plan information on three of their patients seen during routine clinical practice. A total of 615 psychiatrists provided information on 1,843 patients, of which 280 (16.6%) were reported to have a current nicotine problem. Of these, 9.1% were reported to receive treatment for nicotine dependence. Patients with nicotine problems were significantly more likely to be males, divorced or separated, disabled, and uninsured, and have fewer years of education. They also had significantly more co-morbid psychiatric disorders, particularly schizophrenia or alcohol/substance use disorders; a lower Global Assessment Functioning score; and poorer treatment compliance than their counterparts. The results suggest a very low rate of identification and treatment of nicotine problems among patients treated by psychiatrists, even though psychiatric patients who smoke seem to have more clinical and psychosocial stressors and more severe psychiatric problems than those who do not smoke. Programs should be developed to raise the awareness and ability of psychiatrists to diagnose and treat patients with nicotine problems, with a particular emphasis on the increased medical and psychosocial needs of psychiatric patients who smoke.

A meta-analysis of worldwide studies demonstrates an association between schizophrenia and tobacco smoking behaviors

A meta-analysis of worldwide studies, found by a 10-year literature follow-up and/or by searching PubMed, was performed. Forty-two studies across 20 nations consistently demonstrated an association between schizophrenia and current smoking (weighted average odds ratio, OR=5.9; 95% confidence interval, CI 4.9--5.7). In 32 male studies across 18 nations, the weighted average OR was 7.2 (CI, 6.1--8.3). In 25 female studies across 15 nations, the weighted average OR was 3.3 (CI, 3.0--3.6). The association between schizophrenia and current smoking remained after using severe mentally ill controls (18 studies across 9 countries, weighted average OR was 1.9, CI 1.7--2.1) and controlling for other variables (3 studies, adjusted ORs ranged 2-3). Heavy smoking (6 studies across 4 countries, ORs ranged 1.9--6.4) and high nicotine dependence were more frequent in smokers with schizophrenia versus the general population. There was no consistent evidence that heavy smoking or high nicotine dependence was more frequent in smokers with schizophrenia versus severe mentally ill controls. Cessation rates were lower in schizophrenia smokers versus the general population. Schizophrenia patients had a higher prevalence of ever smoking than the general population (9 studies across 6 countries, weighted average OR=3.1, CI 2.4--3.8) and than severe mentally ill patients (5 studies across 5 countries, OR=2.0, CI 1.6--2.4). Moreover, in two studies adjusting for confounders schizophrenia patients had an increased risk of starting daily smoking than controls. Thus, people who are going to develop schizophrenia have risk factors that make them more vulnerable to start smoking.

Drug and alcohol use among patients with schizophrenia and related psychoses: levels and consequences

Patients with schizophrenia and related psychoses frequently use, abuse and become dependent on psychoactive substances. Local surveys indicate differences in both types and patterns of substances used. A cross-sectional survey was conducted to document abuse in 207 successive outpatients presenting to a psychiatric continuing care facility in a large Canadian city. Nicotine, alcohol and cannabis were the most frequently abused substances in the cohort. Excluding nicotine, 44.9% met criteria for lifetime and 14.0% for current abuse/dependence. Cocaine, heroin, hallucinogen, amphetamine, and inhalant use were rarely reported. Patients with current substance abuse/dependence and a psychotic disorder (dual diagnosis, DD) had significantly higher Positive and Negative Symptom Scale (PANSS) positive scores than lifetime-DD or those with a single diagnosis (SD). Significantly more current-DD (69.0%) patients were depressed (HAM-D score > or =12) compared to SD (45.6%). Furthermore, current-DD (27.6%) patients were more likely than SD (4.5%) to be medication non-compliant. Patients with current-DD were more likely to smoke cigarettes (88.9%) compared to those with SD (49.6%) and they had significantly longer histories of cigarette smoking (19.1 for DD vs. 11.5 years for SD). The smoking behavior of the DD population is discussed in terms of enhanced risk for alcohol abuse, as well as effects on antipsychotic blood levels and metabolism.

Smoking prevalence and knowledge of associated risks in adult attenders at day centres for people with learning disabilities

BACKGROUND

Increased longevity among people with learning disabilities is accompanied by an increase in morbidity. A possible explanation is that living in the community and a move to greater independence may bring higher health risks through obesity and smoking. The study aimed to see if rates of smoking have increased from earlier published rates and to ascertain the awareness of the risks of smoking among people with learning disabilities.

METHODS

A total of 435 people attending four social services day centres in a large urban area were assisted to complete a questionnaire.

RESULTS

Twenty-seven (6.2%) reported that they currently smoked. Those with mild disabilities were much more likely to smoke than those with more severe disabilities and they also reported smoking more heavily. For those with mild levels of learning disability, a higher than expected proportion living in hospital and staffed housing smoked, a lower proportion living with parents smoked but for those living independently the proportion who smoked was no higher than expected. Smokers were more knowledgeable about the risks than non-smokers even if the level of learning disability was controlled for. Only a third of smokers were concerned about the risks.

CONCLUSIONS

The study provides no evidence that rates of smoking are increasing among people with learning disabilities nor that those living independently were more likely to smoke. Knowledge of health risks is poor across the group, but higher among the smokers who were unlikely to express concern about the risks. This may indicate that more support may be needed along with health education in this group.

Shaping exhale durations for breath CO detection for men with mild mental retardation

Roll, Higgins, and Badger (1996) used a carbon monoxide (CO) detector to determine whether participants smoked in a smoking-cessation study. We sought to replicate their work with adults with mild mental retardation. However, verbal instructions were inadequate to establish stable exhalations of sufficient durations for reliable and accurate CO evaluation. This report describes a shaping procedure that enabled 3 of 4 participants to achieve 20-s exhalation durations.

Substance use in individuals with mental retardation

Alcohol and drug use among individuals with mental retardation (MR) has received little empirical attention. Two studies are reported: In Study 1, individuals (n = 122) with MR were surveyed regarding their personality characteristics, alcohol and drug use, and skills to avoid substance abuse. Results indicate that although the majority of participants did not drink alcohol, among those who did, the ratio of misusers to users was nearly 1:1. In addition, misusers were deficient in specific skill areas. In Study 2, participants (n = 84) were randomly assigned to receive a prevention program in either (a) assertiveness building, (b) modeling and social inference, or (c) a delayed treatment, control condition. Results suggest that each program, at least in the short-term, improved substance knowledge and enhanced skills. Overall, these results suggest that substance use interventions focused toward individuals with MR may be beneficial.