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- Title
Tobacco Use, Nicotine Dependence, and Cessation Methods in US Adults With Psychosis.
- Authors
Han, Beth; Aung, Ther W.; Volkow, Nora D.; Silveira, Marushka L.; Kimmel, Heather L.; Blanco, Carlos; Compton, Wilson M.
- Abstract
This cross-sectional study assesses the self-reported use of tobacco products and other substances and related behaviors by adults with and without a history of schizophrenia, schizoaffective disorder, psychosis, or psychotic illness. Key Points: Question: Do prevalence of tobacco product use, severity of nicotine dependence, and cessation methods among community-dwelling adults differ between persons with and without psychosis? Findings: In this cross-sectional study of 29 045 adult participants in the Population Assessment of Tobacco and Health Study, those with psychosis vs those without psychosis had a higher past-month prevalence of any tobacco, cigarette, e-cigarette, and other tobacco product use; a higher past-month prevalence of polytobacco use; higher nicotine dependence scores; and a higher past-year prevalence of making a quit attempt. Meaning: Findings of this study suggest that tobacco cessation interventions tailored for community-dwelling adults with psychosis are urgently needed. Importance: Adults with psychotic disorders have high premature mortality, partly due to the high prevalence of smoking in this population. Yet recent data are lacking on tobacco product use among US adults with a history of psychosis. Objective: To examine the sociodemographic characteristics and behavioral health status; types of tobacco products used; prevalence of use by age, sex, and race and ethnicity; and nicotine dependence severity and smoking cessation methods among community-dwelling adults with vs without psychosis. Design, Setting, and Participants: This cross-sectional study analyzed nationally representative, self-reported, cross-sectional data of adults (aged ≥18 years) who participated in the Wave 5 survey (conducted from December 2018 to November 2019) of the Population Assessment of Tobacco and Health (PATH) Study. Data analyses were conducted between September 2021 and October 2022. Exposure: PATH Study respondents were classified as having lifetime psychosis if they answered yes to whether they had ever received from a clinician (eg, physician, therapist, or other mental health professional) a diagnosis of schizophrenia, schizoaffective disorder, psychosis, or psychotic illness or episode. Main Outcomes and Measures: Use of any and major types of tobacco products, severity of nicotine dependence, and cessation methods. Results: Among the 29 045 community-dwelling adults who participated in the PATH Study (weighted median [IQR] age, 30.0 [22.0-50.0] years; weighted percentage estimates: 14 976 females (51.5%); 16.0% Hispanic, 11.1% non-Hispanic Black, 65.0% non-Hispanic White, and 8.0% non-Hispanic other race and ethnicity [American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and more than 1 race]), 2.9% (95% CI, 2.62%-3.10%) reported receiving a lifetime psychosis diagnosis. Compared with those without psychosis, people with psychosis had a higher adjusted prevalence of past-month any tobacco use (41.3% vs 27.7%; adjusted risk ratio [RR], 1.49 [95% CI, 1.36-1.63]) as well as cigarette smoking, e-cigarette use, and other tobacco product use overall and in most examined subgroups; they also had a higher past-month prevalence of dual cigarette and e-cigarette use (13.5% vs 10.1%; P =.02), polycombustible tobacco use (12.1% vs 8.6%; P =.007), and polycombustible and noncombustible tobacco use (22.1% vs 12.4%; P <.001). Among adults with past-month cigarette use, those with vs without psychosis had a higher adjusted mean nicotine dependence scores overall (54.6 vs 49.5; P <.001) and within the 45-years-or-older (61.7 vs 54.9; P =.002), female (56.9 vs 49.8; P =.001), Hispanic (53.7 vs 40.0; P =.01), and Black (53.4 vs 46.0; P =.005) groups. They were also more likely to make a quit attempt (60.0% vs 54.1%; adjusted RR, 1.11 [95% CI, 1.01-1.21]) and use counseling, a quitline, or a support group for tobacco cessation (5.6% vs 2.5%; adjusted RR, 2.25 [95% CI, 1.21-3.30]). Conclusions and Relevance: In this study, the high prevalence of tobacco use, polytobacco use, and making a quit attempt as well as the severity of nicotine dependence among community-dwelling adults with a history of psychosis highlighted the urgency for tailored tobacco cessation interventions for this population. Such strategies must be evidence-based and age, sex, and race and ethnicity appropriate.
- Subjects
UNITED States; DRUG addiction; SUBSTANCE abuse; SMOKING cessation; PSYCHOSES; PSYCHOLOGY of drug abusers; AGE distribution; NICOTINE; HEALTH status indicators; RACE; SEX distribution; RESEARCH funding; TOBACCO products; SOCIODEMOGRAPHIC factors
- Publication
JAMA Network Open, 2023, Vol 6, Issue 3, pe234995
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.4995