Factors related to cigarette smoking and intent to quit among adolescent inpatients with psychiatric and substance use disorders

[Implementation of Tobacco Control Strategies in Psychiatric Institutions for Children and Adolescents: an Online Survey of Leading Staff Members]

OBJECTIVE

Tobacco control measures are relevant also in child and adolescent psychiatric institutions and their implementation in Germany will be assessed in this study.

METHODS

In an online survey, n=78 leading staff members responded to standardized questions assessing how smoking in patients was dealt in such institutions.

RESULTS

The majority of institutions (70-87%) had smoking bans in the psychiatric clinic buildings and premises. Depending on the type of psychiatric ward, exceptions were in place in the form of a designated smoking area (38%), smoking pavilion (19%), or when patients suffered from certain mental disorders (28%). Documentation of violations of the ban varied with the type of ward (30-79%), while in most cases violations led to consequences (84-93%) including confiscation of smoking utilities (42-63%) or a curfew (25-38%). Smoking cessation aids were reported by 78% of the institutions, most often as consultations (64%). Pharmacological treatments for smoking were provided in inpatient wards (71-83%). One in two institutions documented the result of cessation attempts (54%). Smoking-related working groups (14%) or the use of standardized diagnostic instruments (0-4%) were much less frequently reported.

DISCUSSION

We provide a first look at tobacco control policy measures in child and adolescent psychiatric institutions on a national scale. This allows us to derive future areas for tobacco control.

Tobacco Screening and Use in Hospitalized Adolescents at a Children's Hospital

OBJECTIVES

With this study, we aim to evaluate inpatient adolescent screening for tobacco, as well as the relationship between tobacco and other substance use, tobacco types used, and cessation interventions.

METHODS

A retrospective chart review of inpatient hospital admissions of adolescents aged ≥13 years to a tertiary care, freestanding, urban children's hospital in 2018 was performed. Tobacco use-related variables were entered into a multiple logistic regression model in which the adjusted odds ratios were determined. Variables found to be significant in bivariate analysis were included as covariates in the model by using SAS 9.4 software (SAS Institute, Inc, Cary, NC).

RESULTS

There were 4412 admissions of adolescents aged ≥13 years during the study period, of which 370 (8.4%) adolescents were screened for tobacco use by physicians. Significant factors associated with being screened included age 16 to 18 years, white race, and admission to the pediatric hospital medicine service. There were 93 (25.1%) tobacco users identified, of whom the majority reported concomitant caretaker use (78.6%), alcohol use (52.7%), and marijuana use (70.8%). The most commonly reported tobacco type used was cigarettes at 50.5%. Cessation intervention was documented in 8 tobacco users.

CONCLUSIONS

Tobacco use screening of hospitalized adolescents aged ≥13 years was performed infrequently and was not standardized among physicians. Tobacco use was identified in 25.1% of those screened, and cessation interventions were inconsistently performed. This study suggests a need for universal, standardized tobacco use screening in inpatient adolescents and identifies a missed opportunity for treatment of tobacco dependence.

Quality Improvement Project to Improve Screening for Tobacco Use in Adolescent Inpatients at a Children's Hospital

Tobacco use begins in adolescence for the majority of smokers. The purpose of this study was to increase screening and reporting of tobacco use in hospitalized adolescents at a tertiary care children’s hospital. We completed a nursing focus group to understand challenges and completed four iterative Plan-Do-Study-Act cycles, which included: (1) in-person nursing education regarding tobacco use screening, (2) addition of an e-cigarette-specific screening question, (3) the creation and dissemination of an educational video for nursing, and (4) adding the video as a mandatory component of nursing orientation. Run charts of the percentage of patients screened who reported tobacco use were created. Absolute counts of tobacco products used were also captured. From January 2016 to September 2018, 12,999 patients ≥13 years of age were admitted to the hospital. At baseline, 90.1% of patients were screened and 4.8% reported tobacco use. While the absolute number of adolescents reporting e-cigarette use increased from zero patients per month at baseline to five, the percentage of patients screened and reporting tobacco use was unchanged; the majority of e-cigarette users reported use of other tobacco products. This study demonstrates that adding e-cigarettes to screening increases reporting and suggests systems level changes are needed to improve tobacco use reporting.