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      Cigarette smoking among psychiatric patients in Brazil Translated title: Tabaquismo entre los pacientes psiquiátricos en Brasil Translated title: Tabagismo entre pacientes psiquiátricos no Brasil

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          Abstract

          The aim of this study was to estimate tobacco smoking prevalence among psychiatric patients attended in care facilities in Brazil and assess associated factors. A cross-sectional multicenter study was conducted of psychiatric patients (N = 2,475) selected from 26 care facilities. Current and ex-smokers were compared to those who had never smoked. Odds ratios were estimated using logistic regression. The current and past smoking prevalence rates were 52.7% and 18.9%, respectively. Being male, aged 40 years or over, drug and alcohol use, unprotected sex and a history of physical violence were factors associated with both current and past smoking, while a low education level (≤ 8 years of schooling), history of homelessness, not practicing a religion, current or previous psychiatric hospitalization, and main psychiatric diagnosis substance use disorders, were factors only associated with current smoking. Tobacco smoking prevalence among this population was high and was higher than the rate in the general population. Appropriate interventions and smoking prevention policies should be incorporated into mental health services.

          Translated abstract

          El objetivo del estudio fue estimar la prevalencia y los factores asociados con el tabaquismo entre los pacientes psiquiátricos en Brasil. Un estudio transversal multicéntrico fue realizado en 2.475 pacientes con trastorno mental, seleccionados de 26 servicios de salud. Los fumadores y los exfumadores fueron comparados con aquellos que nunca habían fumado. Las odds ratios se calcularon mediante regresión logística. La prevalencia de fumadores y ex fumadores fue un 52,7% y un 18,9%, respectivamente. Hombre, edad 40+ años, uso de las drogas y alcohol, sexo sin protección, e historia de agresión física se asociaron con fumadores y ex fumadores. Escolaridad ≤ 8 años, estar sin hogar, no practicar ninguna religión, hospitalización psiquiátrica actual o anterior, y trastornos por uso de sustancias, así como el diagnóstico psiquiátrico primario, se asociaron únicamente con el tabaquismo actual. La prevalencia de tabaquismo en esta población fue alta y superior a la de la población general de Brasil. Se deben adoptar políticas de intervención y prevención del tabaquismo por parte de los servicios de salud mental.

          Translated abstract

          O objetivo do estudo foi estimar a prevalência e os fatores associados com o tabagismo entre pacientes psiquiátricos no Brasil. Estudo multicêntrico de corte transversal foi conduzido com 2.475 pacientes com transtorno mental, selecionados de 26 serviços. Fumantes e ex-fumantes foram comparados com aqueles que nunca fumaram. Odds ratios foram estimados por meio de regressão logística. As prevalências de fumantes e ex-fumantes foram 52,7% e 18,9%, respectivamente. Sexo masculino, idade 40+ anos, uso de drogas e álcool, prática de sexo desprotegido e histórico de agressão física estiveram associados tanto com fumantes quanto com ex-fumantes. Já a escolaridade ≤ 8 anos, história de ter morado na rua, não ter prática religiosa, internação psiquiátrica atual ou anterior, e transtorno por uso de substâncias como diagnóstico psiquiátrico principal foram associados somente ao tabagismo atual. A prevalência de tabagismo nessa população foi alta e maior do que para a população geral brasileira. Políticas de intervenção e prevenção do tabagismo devem ser adotadas pelos serviços de saúde mental.

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          Causes of the excess mortality of schizophrenia.

          The excess mortality of schizophrenia is well recognised, but its precise causes are not well understood. To measure the standardised mortality ratio (SMR) and examine the reasons for any excess mortality in a community cohort with schizophrenia. We carried out a 13-year follow-up of 370 patients with schizophrenia, identifying those who died and their circumstances. Ninety-six per cent of the cohort was traced. There were 79 deaths. The SMRs for all causes (298), for natural (232) and for unnatural causes (1273), were significantly higher than those to be expected in the general population, as were the SMRs for disease of the circulatory, digestive, endocrine, nervous and respiratory systems, suicide and undetermined death. Smoking-related fatal disease was more prominent than in the general population. Some of the excess mortality of schizophrenia could be lessened by reducing patients' smoking and exposure to other environmental risk factors and by improving the management of medical disease, mood disturbance and psychosis.
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            Smoking and mental illness: results from population surveys in Australia and the United States

            Background Smoking has been associated with a range of mental disorders including schizophrenia, anxiety disorders and depression. People with mental illness have high rates of morbidity and mortality from smoking related illnesses such as cardiovascular disease, respiratory diseases and cancer. As many people who meet diagnostic criteria for mental disorders do not seek treatment for these conditions, we sought to investigate the relationship between mental illness and smoking in recent population-wide surveys. Methods Survey data from the US National Comorbidity Survey-Replication conducted in 2001–2003, the 2007 Australian Survey of Mental Health and Wellbeing, and the 2007 US National Health Interview Survey were used to investigate the relationship between current smoking, ICD-10 mental disorders and non-specific psychological distress. Population weighted estimates of smoking rates by disorder, and mental disorder rates by smoking status were calculated. Results In both the US and Australia, adults who met ICD-10 criteria for mental disorders in the 12 months prior to the survey smoked at almost twice the rate of adults without mental disorders. While approximately 20% of the adult population had 12-month mental disorders, among adult smokers approximately one-third had a 12-month mental disorder – 31.7% in the US (95% CI: 29.5%–33.8%) and 32.4% in Australia (95% CI: 29.5%–35.3%). Female smokers had higher rates of mental disorders than male smokers, and younger smokers had considerably higher rates than older smokers. The majority of mentally ill smokers were not in contact with mental health services, but their rate of smoking was not different from that of mentally ill smokers who had accessed services for their mental health problem. Smokers with high levels of psychological distress smoked a higher average number of cigarettes per day. Conclusion Mental illness is associated with both higher rates of smoking and higher levels of smoking among smokers. Further, a significant proportion of smokers have mental illness. Strategies that address smoking in mental illness, and mental illness among smokers would seem to be important directions for tobacco control. As the majority of smokers with mental illness are not in contact with mental health services for their condition, strategies to address mental illness should be included as part of population health-based mental health and tobacco control efforts.
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              Vigitel Brasil 2011: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico

              (2012)
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                csp
                Cadernos de Saúde Pública
                Cad. Saúde Pública
                Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz (Rio de Janeiro )
                1678-4464
                June 2014
                : 30
                : 6
                : 1195-1206
                Affiliations
                [1 ] Universidade Federal de Minas Gerais Brazil
                [2 ] Universidade Federal de São João del-Rei Brazil
                [3 ] Columbia University United States
                Article
                S0102-311X2014000601195
                10.1590/0102-311X00027113
                04053314-6733-4f46-856a-a901362ca465

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Brazil

                Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=0102-311X&lng=en
                Categories
                Health Policy & Services

                Public health
                Smoking,Mental Health,Risk Factors,Hábito de Fumar,Salud Mental,Factores de Riesgo,Saúde Mental,Fatores de Risco

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