Marcia G. Hunt

A review of research on smoking behavior in three demographic groups of veterans: women, racial/ethnic minorities, and sexual orientation minorities

ABSTRACT Background: Veterans comprise a large segment of the U.S. population and smoke at high rates. One significant way to reduce healthcare costs and improve the health of veterans is to reduce smoking-related illnesses for smokers who have high smoking rates and/or face disproportionate smoking consequences (e.g. women, racial/ethnic minorities, sexual orientation minorities). Objectives: We reviewed published studies of smoking behavior in three demographic subgroups of veterans – women, racial/ethnic minorities, and sexual orientation minorities – to synthesize current knowledge and identify areas in need of more research. Methods: A MEDLINE search identified papers on smoking and veterans published through 31 December 2014. Results: Twenty-five studies were identified that focused on gender (n = 17), race/ethnicity (n = 6), or sexual orientation (n = 2). Female and sexual orientation minority veterans reported higher rates of smoking than non-veteran women and sexual orientation majority veterans, respectively. Veterans appeared to be offered VA smoking cessation services equally by gender and race. Few studies examined smoking behavior by race/ethnicity or sexual orientation. Little information was identified examining the outcomes of specific smoking treatments for any group. Conclusion: There is a need for more research on all aspects of smoking and quit behavior for women, racial/ethnic minorities, and sexual orientation minority veterans. The high rates of smoking by these groups of veterans suggest that they may benefit from motivational interventions aimed at increasing quit attempts and longer and more intense treatments to maximize outcomes. Learning more about these veterans can help reduce costs for those who experience greater consequences of smoking.

Continuation of Clozapine During Chemotherapy: A Case Report and Review of Literature

Clozapine is an atypical antipsychotic medication that has been shown to bemore effective in the treatment of refractory schizophrenia and the reduction of suicidal behavior in individuals with schizophrenia and schizoaffective disorder than other antipsychotics. Because of the 0.38% annual risk of agranulocytosis associated with clozapine use, prescription requires enrollment in a national registry with submission of complete blood count results before the medication is dispensed. Standard protocols require clozapine discontinuation or increased monitoring or both if absolute neutrophil counts (ANC) go below certain thresholds. Concerns about prolonged clozapine-induced neutropenia arise when patients require chemotherapy for the treatment of malignancy, which frequently induces a predictable but temporary period of neutropenia. We present the case of a patient being treated with clozapine who was diagnosed with lung cancer and who, in collaboration with his psychiatrist and oncologist, decided to continue clozapine during treatment with myelosuppressive chemotherapy.

Who Let the Dogs In? A Pets Policy for a Supported Housing Organization

This article examines the role of pets for individuals with psychiatric disorders who live in supported housing. Using a case study approach, we describe the process of consultation with an integrated, supported housing organization during the assessment, development, and implementation of a policy to allow tenants to keep pets in their apartments. Themes from interviews with adults with psychiatric disabilities who kept pets suggest that pets provide a sense of connectedness, responsibility, and emotional stability. Employees of the organization had differential views about the advisability of people with mental illness keeping pets in their apartments. Implications of our experiences for the promotion of pet ownership for people with psychiatric disorders are discussed.

A Cohort Study of Mortality in Individuals With and Without Schizophrenia After Diagnosis of Lung Cancer

OBJECTIVE Individuals with serious mental illness have increased mortality relative to those without these illnesses. Although cancer is a leading cause of death, few studies have evaluated potential disparities relative to mortality for individuals with serious mental illness who are diagnosed with cancer. In this study, we evaluated mortality after diagnosis of a common malignancy (lung cancer) in a prototypical serious mental illness (schizophrenia). METHODS Using administrative data in the Veterans Affairs system, we identified 34,664 individuals who were diagnosed with lung cancer between October 1, 2001, and September 30, 2005. We conducted a survival analysis comparing individuals with and without ICD-9-CM schizophrenia using data through September 30, 2010. Controlling variables were age, gender, smoking status, marital status, service connection, homelessness status, and presence of a substance use disorder. RESULTS Our results demonstrated significantly poorer survival after lung cancer diagnosis for individuals with schizophrenia compared to those without schizophrenia. The hazard ratio for all-cause mortality associated with schizophrenia was 1.33 (95% CI, 1.22-1.44). CONCLUSIONS Individuals with schizophrenia are at higher risk of death after diagnosis of lung cancer than those without schizophrenia. Future studies should further characterize cause of death, quality of cancer care received, and barriers to care.

A review of research on smoking among United States Veterans with posttraumatic stress disorder (2006–2016)

ABSTRACT Posttraumatic stress disorder (PTSD) is one of the most common psychiatric disorders diagnosed in U.S. veterans. PTSD is associated with high smoking prevalences and difficulty quitting in the general U.S. population. The current study reviewed research on smoking and PTSD in U.S. veteran samples to summarize past research and identify areas in need of additional inquiry. MEDLINE and PsycINFO searches identified papers on smoking in samples of U.S. veterans with PTSD published from January 2006 through December 2016. Thirty-four articles met all of the inclusion criteria: (a) part of the sample consisted of U.S. veterans with PTSD or PTSD symptoms, and (b) the study examined some aspect of smoking behavior. U.S. veterans with PTSD were more likely to report smoking, heavy smoking, nicotine dependence, and late-onset smoking compared to veterans without PTSD. Smoking behaviors (e.g., current smoking, heavy smoking, smoking expectancies) differed by PTSD symptoms and by combat exposure. Smoking cessation feasibility studies examined the integration of smoking treatment into PTSD clinics and found favorable outcomes. Future research on veterans with PTSD would benefit from extending topics beyond rates of smoking to better understand the treatment needs of veterans. Research on smoking-related behaviors can help identify areas to target for interventions.

Treatment Adherence in Late-Life

Publisher Summary Eighty percent of older adults have at least one chronic illness, and 50% have two or more. Adherence to treatment plans for these chronic illnesses is imperative for effective symptom and disease management, as well as for containing health care costs. Adherence behavior is highly variable, dependent on a multiplicity of individual, provider, and system-level factors. This chapter reviews adherence determinants in the context of theoretical models of illness beliefs and behavior change, along with methods and tools for assessing adherence behavior and associated constructs. With life expectancy and chronic illness prevalence increasing, understanding treatment adherence becomes paramount to improving health outcomes and quality of life for older adults, and health care costs for all. Treatment adherence is multi-faceted and not comprehensively conceptualized by any single model. Multiple individual, provider, and systems-level factors must be taken into account to fully understand why older adults may or may not adhere to a treatment plan. Many assessments are available to measure these factors, including those that measure attitudes, beliefs, performance, or behavior, using self-report, observational, electronic, or physiological methods. As with most treatment modalities, however, the relationship between patient and provider appears to be key in maximizing treatment adherence. Consistent with the Recovery model, identifying and working within the patients goals for treatment and for life, which may reflect their socioeconomic status, culture, education, health literacy, cognitive status, and personality, is most likely to lead to adherence to an agreed upon plan.