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      Gender-specific profiles of tobacco use among non-institutionalized people with serious mental illness

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          Abstract

          Background

          In many countries, smoking remains the leading preventable cause of death. In North America, reductions in population smoking levels are stabilising and, in recent years, those involved in tobacco control programming have turned their attention to particular segments of society that are at greatest risk for tobacco use. One such group is people with mental illness. A picture of tobacco use patterns among those with mental illness is beginning to emerge; however, there are several unanswered questions. In particular, most studies have been limited to particular in-patient groups. In addition, while it is recognised that men and women differ in relation to their reasons for smoking, levels of addiction to nicotine, and difficulties with cessation, these sex and gender differences have not been fully explored in psychiatric populations.

          Methods

          Community residents with serious mental illness were surveyed to describe their patterns of tobacco use and to develop a gender-specific profile of their smoking status and its predictors.

          Results

          Of 729 respondents, almost one half (46.8%) were current tobacco users with high nicotine dependence levels. They spent a majority of their income on tobacco, and reported using smoking to cope with their psychiatric symptoms. Current smokers, compared with non-smokers, were more likely to be: diagnosed with a schizophrenia spectrum disorder (rather than a mood disorder); male; relatively young; not a member of a racialised group (e.g., Aboriginal, Asian, South Asian, Black); poorly educated; separated or divorced; housed in a residential facility, shelter, or on the street; receiving social assistance; and reporting co-morbid substance use. There is evidence of a gender interaction with these factors; in the gender-specific multivariate logistic regression models, schizophrenia spectrum disorder versus mood disorder was not predictive of women's smoking, nor was education, marital status or cocaine use. Women, and not men, however, were more likely to be smokers if they were young and living in a residential facility.

          Conclusion

          For men only, the presence of schizophrenia spectrum disorder is a risk factor for tobacco use. Other factors, of a social nature, contribute to the risk of smoking for both men and women with serious mental illness. The findings suggest that important social determinants of smoking are "gendered" in this population, thus tobacco control and smoking cessation programming should be gender sensitive.

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          Most cited references 35

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          Measuring degree of physical dependence to tobacco smoking with reference to individualization of treatment.

           K Fagerström (1977)
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            Prevalence of smoking among psychiatric outpatients.

            The prevalence of smoking among psychiatric outpatients (N = 277) was significantly higher than among either local or national population-based samples (N = 1,440 and 17,000) (52% versus 30% and 33%). The higher prevalence was not associated with the age, sex, marital status, socioeconomic status, alcohol use, coffee use, or institutionalization of the psychiatric patients. Smoking was especially prevalent among patients with schizophrenia (88%) or mania (70%) and among the more severely ill patients. Hypotheses about why psychiatric patients are more likely to smoke and why they do not have a high rate of smoking-induced illnesses are presented.
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              Addressing tobacco among individuals with a mental illness or an addiction.

              Tobacco dependence among individuals with a mental illness or an addiction is a tremendous problem that goes largely ignored. Studies of genetics, neuroimaging, and nicotinic receptors support a neurobiological link between tobacco use and alcohol dependence, drug dependence, schizophrenia, depression, attention-deficit hyperactivity disorder (ADHD), and anxiety disorders. This paper summarizes the recent literature on this topic and discusses how treatment for tobacco can no longer be ignored in mental-health and addiction-treatment settings. More research is needed as well as a national organized effort to address tobacco in this large segment of smokers.
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                Author and article information

                Journal
                BMC Psychiatry
                BMC Psychiatry
                BioMed Central
                1471-244X
                2010
                30 November 2010
                : 10
                : 101
                Affiliations
                [1 ]School of Nursing, University of British Columbia, T201 - 2211 Wesbrook Mall, Vancouver, BC, Canada V6T 2B5
                [2 ]BC Centre of Excellence for Women's Health, E311 - 4500 Oak Street, Box 48, Vancouver, BC, Canada V6H 3N1
                [3 ]BC Mental Health & Addictions Research Institute, A3-113, 938 W. 28th Avenue, Vancouver, BC, Canada V5Z 4H4
                [4 ]Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia Okanagan, 3333 University Way, Kelowna, BC Canada, V1V 1V7
                [5 ]Cancer Nursing Research, Faculty of Nursing, University of Manitoba, Canada, Room 487 Helen Glass Centre for Nursing, 89 Curry Place, Winnipeg, Manitoba, R3T 2N2
                Article
                1471-244X-10-101
                10.1186/1471-244X-10-101
                3002315
                21118563
                Copyright ©2010 Johnson et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Research Article

                Clinical Psychology & Psychiatry

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