Caitlin Notley

Postpartum smoking relapse--a thematic synthesis of qualitative studies.

BACKGROUND AND AIMS Many women quit smoking during pregnancy, but relapse after the baby is born. To understand why and identify ways of preventing this, this study reviewed the qualitative literature on womens experience of postpartum smoking relapse. METHODS A systematic review of qualitative studies and process evaluations of trials. We undertook a thematic synthesis of published qualitative data. RESULTS We screened 1336 papers. Twenty-two papers reporting on 16 studies were included, reporting on the views of 1031 postpartum women. Factors affecting relapse and barriers and facilitators to relapse prevention were identified around the key themes of beliefs, social influences, motivation, physiological factors and identity. Womens beliefs about smoking as a means of coping with stress and the need for social support, especially from a partner, emerged as important. Extrinsic motivation to quit during the pregnancy (for the health of the fetus) appeared to be a factor in prompting relapse after the baby was born. During the immediate postpartum period women believed that physiological changes influence cigarette cravings. The stress of caring for a newborn, sleeplessness and adjusting to a new mothering identity were also reported to be important. CONCLUSIONS Among women who quit smoking during pregnancy, those who relapse postpartum talk commonly about no longer needing to protect the baby and the effects of stress. Partner support and a sense of changed identity are cited as factors preventing relapse.

Perception of need and barriers to access: the mental health needs of young people attending a Youth Offending Team in the UK

This study used a mixed methodology with young offenders attending a Youth Offending Service to identify, with regard to mental health problems, perceptions of level of need, experiences of and views on support and perceptions of barriers in accessing services. Between May and September 2008, 44 young offenders completed a questionnaire about their self-reported levels of mental health need, and their behaviour, preferences and evaluation regarding different sources of support and advice for mental health issues. Six young people were interviewed about their experiences and these data were analysed using thematic analysis. Findings showed that these vulnerable young people had a high level of mental health need, and were most likely to seek support from people with whom they had a confiding and long-standing relationship (parents and friends). For these young people, low levels of service use were not the result of a lack of provision, but because there were psychological, social, structural and cultural barriers to accessing those services including issues of understanding, stigma and confidentiality.

Does non-smoker identity following quitting predict long-term abstinence? Evidence from a population survey in England

Aims ‘Categorical self-labels’ (e.g. thinking of oneself as a smoker or non-smoker) are important aspects of identity that can have a fundamental influence on behaviour. To explore the role identity aspects relating to smoking can play in smoking cessation and relapse, this study assessed the prospective associations between taking on a non-smoker identity following quitting and long-term abstinence. Methods A representative sample of 574 ex-smokers in England who quit smoking in the past year was followed-up at three (N = 179) and six months (N = 163). Post-quit identity relating to smoking (‘I still think of myself as a smoker’ or ‘I think of myself as a non-smoker’), and demographic and smoking-related characteristics were assessed at baseline. Self-reported smoking abstinence was assessed at follow-ups. Results Non-smoker identity was reported by 80.3% (95%CI 76.8–83.4) of recent ex-smokers. Younger age (p = 0.017) and longer abstinence (p < 0.001) were independently associated with a post-quit non-smoker identity. After adjusting for covariates, non-smoker identity (p = 0.032) and length of abstinence at baseline (p < 0.001) were associated with continued abstinence at three month follow-up, and baseline length of abstinence (p = 0.003) predicted continued abstinence at six months. Conclusions The majority of people who quit smoking recently consider themselves as non-smokers. Younger people and those who have been abstinent for longer are more likely to take on a non-smoker identity. Ex-smokers who make this mental transition following a quit attempt appear more likely to remain abstinent in the medium term than those who still think of themselves as smokers.

Substance misuse teaching in undergraduate medical education

BackgroundOver 12,000 hospital admissions in the UK result from substance misuse, therefore issues surrounding this need to be addressed early on in a doctor’s training to facilitate their interaction with this client group. Currently, undergraduate medical education includes teaching substance misuse issues, yet how this is formally integrated into the curriculum remains unclear.MethodsSemi-structured interviews with 17 key members of staff responsible for the whole or part of the undergraduate medical curriculum were conducted to identify the methods used to teach substance misuse. Using a previously devised toolkit, 19 curriculum co-ordinators then mapped the actual teaching sessions that addressed substance misuse learning objectives.ResultsSubstance misuse teaching was delivered primarily in psychiatry modules but learning objectives were also found in other areas such as primary care placements and problem-based learning. On average, 53 teaching sessions per medical school focused on bio-psycho-social models of addiction whereas only 23 sessions per medical school focused on professionalism, fitness to practice and students’ own health in relation to substance misuse. Many sessions addressed specific learning objectives relating to the clinical features of substance dependence whereas few focused on iatrogenic addiction.ConclusionsSubstance misuse teaching is now inter-disciplinary and the frequent focus on clinical, psychological and social effects of substance misuse emphasises the bio-psycho-social approach underlying clinical practice. Some areas however are not frequently taught in the formal curriculum and these need to be addressed in future changes to medical education.

Adolescent Awareness and Use of Electronic Cigarettes: A Review of Emerging Trends and Findings

Adult electronic cigarette (e-cigarette) use is increasing globally, and early studies have suggested that similar trends may be observed among the adolescent population, albeit at lower levels. The current literature review presents data collected since 2014 from 21 cross-sectional studies and one cohort study that were all published in English. In particular, it focuses on awareness, ever use, past 30-day use, and regular use of e-cigarettes. The article suggests that adolescents are nearing complete awareness of e-cigarettes. Furthermore, in relation to ever use and past 30-day use, higher prevalence rates continue to be reported across time, especially in the United States. Nonetheless, reported regular use of e-cigarettes remains much lower than past 30-day use, although conclusions are limited due to inconsistencies with measurement and consequent lack of cross-cultural applicability. The majority of studies do not report whether adolescents use non-nicotine e-cigarettes. There is a current absence of longitudinal studies that explore any association between e-cigarettes and tobacco use and little qualitative data that may illuminate how and why adolescents use e-cigarettes. Through addressing these methodological limitations, future research will be able to inform health care and policy more effectively.

Regaining control: the patient experience of supervised compared with unsupervised consumption in opiate substitution treatment.

INTRODUCTION AND AIMS Supervised consumption of opiate substitution treatment is standard practice in the UK yet little is known about the patient experience of this treatment modality. This study aimed to assess the patient experience of receiving supervised compared with unsupervised consumption of methadone or buprenorphine. DESIGN AND METHODS A qualitative study utilising a grounded theory approach to analysis. Participants (29) were theoretically sampled from 293 opioid-dependent patients entering a randomised controlled trial of opiate substitution treatment across four urban and community drug treatment services in England. Multidisciplinary staff were recruited for interviews and focus groups (55). RESULTS Supervised consumption was accepted by patients, despite causing practical limitations and raising issues of privacy and stigma. Patients recognised that establishing a daily routine away from illicit drugs was useful early in treatment. However, having flexibility to move away from supervision was important. Unsupervised patients reported that they ultimately preferred this treatment approach and appreciated the trust and sense of reward that unsupervised treatment bought. Clinicians expressed confidence in supervised prescribing and reduced risk for their patients, but also concern that a minority of individuals may remain inappropriately supervised for lengthy time periods. DISCUSSION AND CONCLUSIONS This study provides an important patient perspective and is the first in-depth qualitative investigation directly comparing supervision with unsupervised treatment to consider both patient and professional perspectives. Overall, our qualitative findings suggest that flexibly timed discontinuation of supervision may have positive benefits.

The needs of problematic drug misusers not in structured treatment - a qualitative study of perceived treatment barriers and recommendations for services

Aims: Little is currently known regarding treatment barriers amongst problematic drug users not in structured treatment. Much previous work accessed samples entering treatment or predates recent service changes. This study sought to access a ‘hard to reach’ out of structured treatment population, exploring reasons for not seeking treatment. Methods: A total of 43 drug users, self-selected as problematic and not currently in structured treatment, were identified via advertising at low-threshold services in Norfolk, and using snowballing methods. Qualitative focus groups and interviews were conducted. Data were thematically analysed aided by NVivo software. Findings: Key reported barriers to treatment are organized around system, social and personal/interpersonal dimensions. Barriers included perception of a long waiting time, stigma, and a perceived lack of understanding. Social barriers relating to localized group membership were particularly important. Conclusions: Identified barriers confirm previous research, sampling a new out of structured treatment rural population. Perceived barriers persist despite recent changes to treatment services. This could be addressed by improved advertising of service expectations and waiting times. Participants suggested, amongst other things, drop in clinics, increased primary care provision and outreach services to capture problematic drug users not in treatment. Simple practices including appointment reminders and flexibility over urine testing may improve treatment retention.

Treatment retention, drug use and social functioning outcomes in those receiving 3 months versus 1 month of supervised opioid maintenance treatment. Results from the Super C randomized controlled trial

AIM Supervised consumption of opioid maintenance treatment (OMT) is standard in many drug centres reducing drug diversion, but is costly. We aimed to determine whether supervised consumption of OMT improved retention and other measures of drug use. DESIGN Pragmatic randomized controlled trial comparing 3 months of daily supervised consumption of OMT with 1 month or less of daily supervised OMT, then daily unsupervised consumption. SETTING Four community drug services in the United Kingdom. PARTICIPANTS A total of 293 opioid-dependent patients entering OMT. MEASUREMENTS PRIMARY OUTCOME retention in treatment at 12 weeks. Secondary: retention at 6 months; illicit drug use [Maudsley Addiction Profile (MAP)]; quality of life (SF-12 and MAP); criminality (MAP); and social functioning. FINDINGS No significant between-group difference was observed for the primary outcome: 69% (100 of 145) supervised and 74% (109 of 148) unsupervised were retained [odds ratio (OR) = 0.74, 95% confidence interval (CI) = 0.43-1.27]. Per protocol survival analysis suggested that supervised patients were less well retained (hazard ratio for retention = 0.71, 95% CI = 0.51-1.00). Illicit opioid use reduced in both groups and, while not statistically significant by intention-to-treat analysis, favoured unsupervised patients in per protocol analysis (odds of positive opioid screen for supervised versus unsupervised = 2.07, 95% CI = 1.05-4.06). Data on criminal activity also favoured unsupervised patients with 21% supervised patients committing crime versus 9% unsupervised (OR = 3.37, 95% CI = 1.28-8.86). CONCLUSIONS There was no evidence of a difference in treatment retention or opioid use rates between patients whose consumption of opioid maintenance treatment was supervised for 3 months daily (except Saturdays) compared with supervision for 1 month. There was some evidence that longer periods of supervised consumption were associated with higher levels of criminality.

Four groups of illicit substance users amongst the adult ‘hidden’ non-problematic community

This paper describes and distinguishes between adult drug users’ perceptions of their own drug use. Focusing on ‘non-problematic’ (non-addicted) users over the age of 25 amongst a non-agency attending population, the paper delineates adult drug users as a group, using qualitative data from a three-year investigation. Interviewees were located utilizing a combination of snowball and opportunistic sampling, gaining privileged access to a hidden network of drug users. Open ended qualitative interviews explored personal histories of substance use over time, covering patterns and perceptions of use. Four distinct groups of adult ‘non-problematic’ users are identified, each having different purposes, approaches to and understandings of their own drug use, and thus experiencing the phenomenon in fundamentally different ways. The identified groups are presented and discussed in terms of furthering research understanding of this group of illicit substance users. Implications for future research are discussed.

Managing chronic rhinosinusitis and respiratory disease: a qualitative study of triggers and interactions

Abstract Objective: The aim of this analysis is to explore views of patients with chronic rhinosinusitis (CRS) about of the aetiology of their respiratory symptoms and the relationship between upper and lower respiratory symptoms. Methods: This study is part of a larger mixed methods study investigating the epidemiology of CRS, which comprises a questionnaire study of patients with CRS and controls and a qualitative study of 21 patients with CRS. Semi structured qualitative interviews were undertaken with these patients; 11 males and 10 females. Twelve patients had asthma. Patients were recruited with a tertiary outpatient rhinology clinic. Interviews were transcribed verbatim and analysed using thematic analysis, using Nvivo software (QSR International, Melbourne, Australia). Several important and recurring themes were highlighted. Results: Patients described many perceived triggering factors and an interaction between upper and lower respiratory tract symptoms. They felt that their symptoms could be managed more holistically. Conclusions: Concerns about triggers of respiratory symptoms and interactions between upper and lower respiratory symptoms are of significant concern to patients. These should be appropriately managed and acknowledged in formal treatment pathways, for example, through the use of combined ENT/respiratory clinics.