Attitudes towards the integration of smoking cessation into lung cancer screening in the United Kingdom: A qualitative study of individuals eligible to attend

IntroductionThere is limited research exploring how smoking cessation treatment should be implemented into lung cancer screening in the United Kingdom. This study aimed to understand attitudes and preferences regarding the integration of smoking cessation support within lung cancer screening from the perspective of those eligible.MethodsThirty‐one lung cancer screening eligible individuals aged 55–80 years with current or former smoking histories were recruited using community outreach and social media. Two focus groups (three participants each) and 25 individual telephone interviews were conducted. Data were analysed using the framework approach to thematic analysis.ResultsThree themes were generated: (1) bringing lung cancer closer to home, where screening was viewed as providing an opportunity to motivate smoking cessation, depending on perceived personal risk and screening result; (2) a sensitive approach to cessation with the uptake of cessation support considered to be largely dependent on screening practitioners'' communication style and expectations of stigma and (3) creating an equitable service that focuses on ease of access as a key determinant of uptake, where integrating cessation within the screening appointment may sustain increased quit motivation and prevent loss to follow‐up.ConclusionsThe integration of smoking cessation into lung cancer screening was viewed positively by those eligible to attend. Screening appointments providing personalized lung health information may increase cessation motivation. Services should proactively support participants with possible fatalistic views regarding risk and decreased cessation motivation upon receiving a good screening result. To increase engagement in cessation, services need to be person‐centred.Patient or Public ContributionThis study has included patient and public involvement throughout, including input regarding study design, research materials, recruitment strategies and research summaries.     

The availability of LGBT-specific mental health and substance abuse treatment in the United States

ObjectiveTo examine the availability and facility‐level predictors of LGBT‐specific mental health and substance abuse treatment in the United States.Data Sources/Study Setting2016 National Survey of Substance Abuse Treatment Services, 2016 National Mental Health Service Survey, and 2015‐2016 Gallup Daily tracking survey.Study DesignLogistic regression models and average marginal effects were used to identify characteristics of facilities that offer LGBT‐specific programs. Linear regression models were used to estimate the association between the state‐level proportion of LGBT people and the proportion of facilities that offer LGBT‐specific programs.Data Collection/Extraction MethodsSecondary data analysis. Cases with missing values for any predictor were excluded.Principle Findings12.6 percent of mental health and 17.6 percent of substance abuse facilities reported LGBT‐specific programs. Several facility characteristics were statistically associated with the likelihood of mental health and substance abuse facilities providing LGBT‐specific programs, including offering outpatient or residential treatment, private ownership, religious affiliation, and payment type. The proportion of LGBT adults living within each state was statistically associated with state‐level density of LGBT‐specific mental health programs, but not substance abuse programs.ConclusionsFindings suggest limited availability of culturally competent mental health and substance abuse treatment, despite well‐documented need.     

Accessibility and efficiency of mental health services,United Kingdom of Great Britain and Northern Ireland

ProblemMental ill health in the United Kingdom of Great Britain and Northern Ireland has been a major driver of labour market exclusion through sickness absence, reduced productivity and job loss.ApproachA government-supported programme for improving access to psychological therapies was launched in 2008 and expanded across England in 2010. The aim was to provide evidence-based treatments for people with common mental disorders through three principal strategies: (i) routine session-by-session outcome monitoring; (ii) integration with the wider care system; and (iii) delivery of psychological therapies as part of a stepped-care approach.Local settingAccess to effective psychological therapies was previously low in the United Kingdom. In 2010, only about 35% of people with moderately severe mental disorders were in specialist or non-specialist treatment.Relevant changesThe accessibility of quality mental health services has increased, as has the efficiency of the country’s mental health system. The numbers of people entering treatment have increased steadily from 0.43 million in 2012–2013 to 1.09 million in 2018–2019. The recovery rate of patients in treatment increased from 42.8% to 52.1% during 2012–2018. The number of people moved off sick pay and benefits rose from 3683 to 18 039 over the same period.Lessons learntA clinical guideline on psychological therapies is a prerequisite for increasing the accessibility and efficiency of mental health services. An integrated approach allows mental health services to have better reach. Routine collection of patient-level outcome data plays an important role in the value and function of the mental health care system.     

Cigarette smoking behaviors among adults with serious mental illness in a nationally representative sample

PurposeThis study updates nationally representative information on cigarette smoking behaviors among adults with mental illness, particularly serious mental illness (SMI), to serve as a new benchmark for smoking cessation initiatives.MethodsData are from the 2008–2012 National Surveys on Drug Use and Health. Prevalence estimates for past month daily smoking, heavy smoking, mean cigarettes consumed per day, nicotine dependence, past month quit ratio, and proportion of cigarettes consumed are presented by mental illness status.ResultsAdults with SMI were more likely than adults with any mental illness (AMI) but not SMI and adults without mental illness to engage in smoking behaviors. Adults with AMI but not SMI were more likely to engage in all smoking behaviors compared with adults without mental illness. The past month quit ratio was significantly lower among adults with SMI and among adults with AMI but not SMI than among adults without mental illness. Adults with SMI comprised 6.9% of past month smokers but consumed 8.7% of all cigarettes.ConclusionsAdults with mental illness engage in more smoking behaviors and are less likely to quit than adults without mental illness. In this high-risk population, continued efforts to promote smoking cessation are needed.     

The lived experiences of tobacco use, dependence, and cessation: insights and perspectives of people with mental illness

Even as the rate of smoking in the U.S. population overall has decreased dramatically during the last four decades, people with mental illness continue to use tobacco at alarmingly high rates. In the last two years, national initiatives have developed to address smoking within this population, yet there has not been an attempt to understand the perspectives of people with mental illness themselves regarding the role tobacco plays in their lives. This grounded theory study, based on focus group interviews with 26 individuals with various smoking statuses receiving outpatient mental health services, attempted to develop a theory to understand this high prevalence from the perspectives of people with mental illness. The article explores the experiences ofpeople with mental illness related to never smoking, smoking, and quitting; the role of tobacco use for people with mental illness; the other forces that promote or discourage tobacco use; and the tensions and complexities in understanding the "problem" of tobacco use in this population. It concludes by highlighting directions for future research, policy considerations, and the important role social workers can play in addressing this significant cause of health disparities.     

Our roles are not at ease: The work of engaging a youth advisory council in a mental health services delivery organization

ObjectivesThere is growing policy impetus for including youth voices in health services research and health system reform. This article examines the perspectives of professionals in a mental healthcare organization charged with engaging young people as advisors in service transformation.MethodsAn institutional ethnography of a youth mental health services organization in Ontario, Canada, was conducted. Fieldwork consisted of twelve months of observation of meetings, interviews with youth advisors and adult service providers, with subsequent text analysis of engagement training and policy materials. The present article reports data from six adult professionals and related field observations.ResultsService providers’ efforts to engage youth were observed in three areas: a) supporting youth''s development as advisors, b) retaining and deepening youth participation while waiting for organizational change and c) embedding relationships between youth and adults at various levels within the system of care. This work denotes existing tensions between the values and ideals of youth engagement and the everyday demands of services delivery.ConclusionIn this setting, a fundamental dimension of this work consisted of negotiating tensions between the policy enthusiasm for engagement and its realization in a health services context. In describing these contextual challenges, we outline implications for consideration by other youth mental health services. Engagement efforts that are authentic and sustained require resources and flexibility, and leadership commitment to instil service users’ perspectives throughout multiple levels within the organization.     

广州市初中男生尝试戒烟和戒烟成功的影响因素

目的了解初中男生的尝试戒烟率、戒烟成功率及其影响因素。方法用自填式问卷对4658名初中男生进行横断面调查,收集人口学资料、学校情况、有关吸烟与健康的知识和态度以及个人吸烟和戒烟行为等信息。结果初中男生的规律吸烟率为7·6%,68·6%的规律吸烟男生在过去12个月中尝试过戒烟,戒烟成功率为17·2%。前两位的戒烟动机是“吸烟会影响健康”和“有人劝我戒烟”。筛选出4个有统计学意义的影响尝试戒烟的因素,促进戒烟的有“曾经被人劝戒烟”、“健康缘故”、“心情不好时才吸烟”和“父母反对吸烟”等。另外,有2个影响因素与戒烟成功有统计学关联:“曾接触过反烟宣传”能促使戒烟成功,而“经常在校外吸烟”是阻碍因素。结论大部分规律吸烟者尝试过戒烟,但成功率低。应根据青少年的生理和心理特点,整合学校、家庭和社会等多方力量来帮助其成功戒烟。     

Criminal Justice Involvement after Release from Prison following Exposure to Community Mental Health Services among People Who Use Illicit Drugs and Have Mental Illness: a Systematic Review

Illicit drug use and mental illness are common among people in prison and are associated with higher rates of reoffending and reimprisonment. We conducted a systematic review, searching MEDLINE, Embase, and PsycINFO to January 10, 2022, for studies reporting criminal justice involvement following exposure to community mental health services among people released from jail or prison who use illicit drugs and have mental illness. Our search identified 6954 studies; 13 were eligible for inclusion in this review. Studies were separated into three broad categories based on community mental health service type. Eleven of 13 studies reported a reduction in criminal justice involvement among participants exposed to community mental health services compared to a comparison group. Findings indicate a need to expand and improve integration and referral mechanisms linking people to community mental health services after jail or prison release, alongside a need for tailored programs for individuals with complex illicit drug use and mental health morbidities.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11524-022-00635-5.     

Nicotine Dependence More Strongly Correlates with Psychological Distress in Disadvantaged Areas of Kazakhstan than Germany

The aim of this study was to describe the association of current smoking and nicotine dependence with psychological distress in socially disadvantaged urban areas of Germany and Kazakhstan. Random samples of people living in disadvantaged areas of Berlin, Germany, and Almaty, Kazakhstan, were assessed using the General Health Questionnaire with 28 items and the Fagerström Test for Nicotine Dependence. The association of both current smoking and nicotine dependence with psychological distress was assessed for each sample using linear regression analyses and compared between the two samples calculating t-values for the comparison of B-coefficients. Current smoking was equally associated with psychological distress in both countries, whereas the association of nicotine dependence and psychological distress was only seen for the Kazakh sample and significantly stronger than for the German sample. The results could not be explained by social characteristics. Possibly due to the lack of outpatient community mental health services for the treatment of common mental disorders, nicotine dependence was associated with psychological distress in the disadvantaged area of Kazakhstan.     

Smoking Cessation and Quality of Life: Insights From Analysis of Longitudinal Australian Data,an Application for Economic Evaluations

ObjectivesA number of studies have shown an association between smoking habit and quality of life, but these have mainly involved cross-sectional data. This study takes advantage of longitudinal panel data to estimate the effect of the transition from “smoker” to “ex-smoker” status (smoking cessation) on health-related quality of life (HRQoL), measured by SF-36, in an Australian general population sample.MethodsPanel data from 13 waves (2001-2013) of a nationally representative longitudinal survey of Household Income and Labour Dynamics of Australia (HILDA) were used; 1858 respondents (5% of total HILDA sample) who experienced only 1 cessation event in their HILDA life were selected. HRQoL trajectories elicited by SF-36 (0-100 scale, worst to best health) were modeled before and after cessation events using a piecewise (segmented) 2-way fixed-effect linear regression, adopted to capture within-person differences. This enabled measurement of changes of regression slopes and intercept while controlling time-invariant characteristics (eg, country of birth, gender) and time-varying changes in health status.ResultsAnnual pre-post intervention improvements were estimated for the following dimensions: role physical 0.65 (95% CI 0.62-1.24), bodily pain 0.48 (95% CI 0.10-0.86), general health 0.55 (95% CI 0.2-0.9), and the physical component summary score 0.22 (95% CI 0.01-0.04). Immediate effects (discontinuity at the time of cessation) of smoking cessation existed for bodily pain –1.5 (95% CI –2.52 to –0.40) and general health 1.82 (95% CI 1.01-2.62). The effects for mental health domains were not significant.ConclusionsAdjusting for all unmeasured time-invariant confounders and controlling the effect of time, this study revealed the varied effects of smoking cessation on HRQoL; it has positive effect on physical and general health but nonsignificant effect on mental aspects. Preference-based utility measures based on SF-6D capture changes that can be measured in several of the domains of the SF-36.     

Who Would Pay Higher Taxes for Better Mental Health? Results of a Large‐Sample National Choice Experiment

Policy Points

•  Public funding for mental health programs must compete with other funding priorities in limited state budgets.
•  Valuing state‐funded mental health programs in a policy‐relevant context requires consideration of how much benefit from other programs the public is willing to forgo to increase mental health program benefits and how much the public is willing to be taxed for such program benefits.
•  Taxpayer resistance to increased taxes to pay for publicly funded mental health programs and perceived benefits of such programs vary with state population size.
•  In all states, taxpayers seem to support increased public funding for mental health programs such as state Medicaid services, suggesting such programs are underfunded from the perspective of the average taxpayer.

ContextThe direct and indirect impacts of serious mental illness (SMI) on health care systems and communities represents a significant burden. However, the value that community members place on alleviating this burden is not known, and SMI treatment must compete with a long list of other publicly funded priorities. This study defines the value of public mental health interventions as what the public would accept, either in the form of higher taxes or in reductions in nonhealth programs, in return for increases in the number of mental health program beneficiaries.MethodsWe developed and fielded a best‐practice discrete‐choice experiment survey to quantify respondents’ willingness to be taxed for increased spending among several competing programs, including a program for treating severe mental health conditions. A realistic decision frame was used to elicit respondents’ willingness to support expanded state budgets for mental health programs if that expansion required either cuts in the competing publicly financed programs or tax increases. The survey was administered to a general population national sample of 10,000 respondents.FindingsNearly half the respondents in our sample either chose “no budget increase” for all budget scenarios or had preferences that were too disordered to estimate trade‐off values. Including zero values for those respondents, we found that the mean (median) amount that all respondents were willing to be taxed annually for public mental health programs ranged between $156 ($99) per year for large‐population states and $343 ($181) per year for small‐population states. Respondents would accept reductions of between 1.6 and 3.4 beneficiaries in other programs in return for 1 additional mental health program beneficiary.ConclusionsOur results are consistent with findings that a substantial portion of the US public is unwilling to pay higher taxes. Nevertheless, even including the substantial number of respondents who opposed any tax increase, the willingness of both the mean and median respondent to be taxed for mental health program expansions implies that programs providing mental health services such as state Medicaid are underfunded.     

Smoking behaviors among people with disabilities in Korea

BackgroundMost reports concerning smoking behaviors in people with disabilities have been from Western societies; knowledge of smoking behaviors in Asian countries, including Korea, is insufficient.ObjectivesThis study investigates the smoking behaviors of people with a disability compared to the general population in Korea.MethodsWe compared the smoking behaviors of people with a disability with the general population by using datasets from the 2011 National Survey of Disabled People and an age- and sex-matched random sample from the 5th Korean National Health and Nutrition Examination Survey. Random samples of people 18 years of age and older with disabilities (n = 5636) and of the general population were used (n = 5636). The main outcome measures include smoking behaviors by type, severity, and age at disability onset.ResultsPeople with a mental or physical impairment have higher current smoking rates (38.1% and 26.3%, respectively) than the general population (23.3%). In particular, current smokers with psychiatric impairment were more likely to smoke more than 20 cigarettes a day (61.2%). People with a disability, regardless of severity or age at onset, were less likely than the general population to have attempted to quit smoking.ConclusionsSmoking behaviors differed according to the type of disability. These results suggest that interventions for smoking prevention and cessation need to be tailored according to disability characteristics.     

Unplanned admissions to inpatient psychiatric treatment and services received prior to admission

BackgroundInpatient bed numbers are continually being reduced but are not being replaced with adequate alternatives in primary health care. There is a considerable risk that eventually all inpatient treatment will be unplanned, because planned or elective treatments are superseded by urgent needs when capacity is reduced.Aims of the studyTo estimate the rate of unplanned admissions to inpatient psychiatric treatment facilities in Norway and analyse the difference between patients with unplanned and planned admissions regarding services received during the three months prior to admission as well as clinical, demographical and socioeconomic characteristics of patients.MethodUnplanned admissions were defined as all urgent and involuntary admissions including unplanned readmissions. National mapping of inpatients was conducted in all inpatient treatment psychiatric wards in Norway on a specific date in 2012. Binary logit regressions were performed to compare patients who had unplanned admissions with patients who had planned admissions (i.e., the analyses were conditioned on admission to inpatient psychiatric treatment).ResultsPatients with high risk of unplanned admission are suffering from severe mental illness, have low functional level indicated by the need for housing services, high risk for suicide attempt and of being violent, low education and born outside Norway.ConclusionSpecialist mental health services should support the local services in their efforts to prevent unplanned admissions by providing counselling, short inpatient stays, outpatient treatment and ambulatory outpatient psychiatry services.Implications for health policiesThis paper suggests the rate of unplanned admissions as a quality indicator and considers the introduction of economic incentives in the income models at both service levels.     

The Effects of Medicaid Eligibility on Mental Health Services and Out‐of‐Pocket Spending for Mental Health Services

Objective

Millions of low‐income Americans will gain health insurance through Medicaid under the Affordable Care Act. This study assesses the impact of previous Medicaid expansions on mental health services utilization and out‐of‐pocket spending.

Data Sources

Secondary data from the 1998–2011 Medical Expenditure Panel Survey Household Component merged with National Health Interview Survey and state Medicaid eligibility rules data.

Study Design

Instrumental variables regression models were used to estimate the impact of expanded Medicaid eligibility on health insurance coverage, mental health services utilization, and out‐of‐pocket spending for mental health services.

Data Extraction Methods

Person‐year files were constructed including adults ages 21–64 under 300 percent of the Federal Poverty Level.

Principal Findings

Medicaid expansions significantly increased health insurance coverage and reduced out‐of‐pocket spending on mental health services for low‐income adults. Effects of expanded Medicaid eligibility on out‐of‐pocket spending were strongest for adults with psychological distress. Expanding Medicaid eligibility did not significantly increase the use of mental health services.

Conclusions

Previous Medicaid eligibility expansions did not substantially increase mental health service utilization, but they did reduce out‐of‐pocket mental health care spending.     

Impact of the Medicare Shared Savings Program on utilization of mental health and substance use services by eligibility and race/ethnicity

ObjectiveTo assess the impact of the Medicare Shared Savings Program (MSSP) ACOs on mental health and substance use services utilization and racial/ethnic disparities in care for these conditions.Data sourcesFive percent random sample of Medicare claims from 2009 to 2016.Study designWe compared Medicare beneficiaries in MSSP ACOs to non‐MSSP beneficiaries, stratifying analyses by Medicare eligibility (disability vs age 65+). We estimated difference‐in‐difference models of MSSP ACOs on mental health and substance use visits (outpatient and inpatient), medication fills, and adequate care for depression adjusting for age, sex, race/ethnicity, region, and chronic medical and behavioral health conditions. To examine the differential impact of MSSP on our outcomes by race/ethnicity, we used a difference‐in‐difference‐in‐differences (DDD) design.Data collection/extraction methodsNot applicable.Principal findingsMSSP ACOs were associated with small reductions in outpatient mental health (Coeff: −0.012, P < .001) and substance use (Coeff: −0.001, P < .01) visits in the disability population, and in adequate care for depression for both the disability‐ and age‐eligible populations (Coeff: −0.028, P < .001; Coeff: −0.012, P < .001, respectively). MSSP ACO''s were also associated with increases in psychotropic medications (Coeff: 0.007 and Coeff: 0.0213, for disability‐ and age‐eligible populations, respectively, both P < .001) and reductions in inpatient mental health stays (Coeff:‐0.004, P < .001, and Coeff:‐0.0002, P < .01 for disability‐ and age‐eligible populations, respectively) and substance use‐related stays for disability‐eligible populations (Coeff:‐0.0005, P<.05). The MSSP effect on disparities varied depending on type of service.ConclusionsWe found small reductions in outpatient and inpatient stays and in rates of adequate care for depression associated with MSSP ACOs. As MSSP ACOs are placed at more financial risk for population‐based treatment, it will be important to include more robust behavioral health quality measures in their contracts and to monitor disparities in care.     

A review of mental health literacy in Singapore

ABSTRACT

Mental health is a major concern throughout the world. The lifetime prevalence of mental health problems in Singapore for those aged 18 years and above was reported to be 12%. However, studies on mental health literacy are relatively scarce in Singapore. The aim of this paper is to provide a topical review of local studies on mental health literacy, people’s knowledge of, and attitude toward mental illness, and beliefs about mental health treatment. A narrative review of studies on mental health literacy in Singapore covering the period from 1995 to 2016 highlights the findings from various local studies about attitudes toward mental illness, belief about the causes, and help-seeking behavior. Findings revealed that many lay people are unable to recognize different types of mental disorders. Negative attitudes toward mental illness that hinders individuals from seeking professional treatment, and help-seeking, are the common themes that emerge from the findings. Health professionals have differing views about the causes and treatment of mental disorders. Findings also revealed that treatment seeking and attitudes and beliefs toward mental illness are related to mental health literacy. Implications for promoting mental health literacy are provided.     

Long-Term Cost-Effectiveness of Smoking Cessation Interventions in People With Mental Disorders: A Dynamic Decision Analytical Model

ObjectivesPeople with mental disorders are more likely to smoke than the general population. The objective of this study is to develop a decision analytical model that estimates long-term cost-effectiveness of smoking cessation interventions in this population.MethodsA series of Markov models were constructed to estimate average lifetime smoking-attributable inpatient cost and expected quality-adjusted life-years. The model parameters were estimated using a variety of data sources. The model incorporated uncertainty through probabilistic sensitivity analysis using Monte Carlo simulations. It also generated tables presenting incremental cost-effectiveness ratios of the proposed interventions with varying incremental costs and incremental quit rates. We used data from 2 published trials to demonstrate the model’s ability to make projections beyond the observational time frame.ResultsThe average smoker’s smoking-attributable inpatient cost was 3 times higher and health utility was 5% lower than ex-smokers. The intervention in the trial with a statistically insignificant difference in quit rate (19% vs 25%; P=.2) showed a 45% to 49% chance of being cost-effective compared with the control at willingness-to-pay thresholds of £20 000 to £30 000/quality-adjusted life-years. The second trial had a significant outcome (quit rate 35.9% vs 15.6%; P<.001), and the corresponding probability of the intervention being cost-effective was 65%.ConclusionsThis model provides a consistent platform for clinical trials to estimate the potential lifetime cost-effectiveness of smoking cessation interventions for people with mental disorders and could help commissioners direct resources to the most cost-effective programs. However, direct comparisons of results between trials must be interpreted with caution owing to their different designs and settings.