International Journal of Mental Health Nursing, 2019
Smoke‐free policies in mental health settings are important to protect health but are often imped... more Smoke‐free policies in mental health settings are important to protect health but are often impeded by staff concerns that physical violence may increase. We aimed to address the literature gap about the frequency, nature, and management of physical violence in relation to smoking. We compared the antecedents and containment of smoking‐related incidents of physical violence over a two‐year period, (12 months when an indoor‐only smoke‐free policy was in place, followed by 12 months after a new comprehensive smoke‐free policy was introduced) using incident reports completed by staff in a large mental health organization in London, UK. Sixty‐one smoking‐related incidents occurred during the indoor‐only smoke‐free policy period; 32 smoking‐related incidents occurred during the comprehensive smoke‐free policy. We identified four antecedent categories for physical violence: i) patient request to smoke denied by staff; ii) during a supervised smoking break; iii) staff response to a patient...
Background The poor translation of research findings into routine clinical practice is common in ... more Background The poor translation of research findings into routine clinical practice is common in all areas of healthcare. Having a better understanding of how researchers and clinicians experience engagement in and with research, their working relationships and expectations of each other, may be one way to help to facilitate collaborative partnerships and therefore increase successful translation of research into clinical practice. Aims To explore the views of clinical and research staff about their experiences of working together during research projects and identify the facilitators and barriers. Methods We conducted four focus groups with 18 participants - clinicians, researchers and those with a dual clinical-research role, recruited from one mental health Trust and one university. Data was analysed using thematic analysis. Results Eight themes were identified under the headings of two research questions 1) Barriers and facilitators of either engaging in or with research from th...
Introduction Smoking in pregnancy increases the risk of negative health outcomes. Vaping can be e... more Introduction Smoking in pregnancy increases the risk of negative health outcomes. Vaping can be effective for smoking cessation in nonpregnant populations. We conducted a systematic review of vaping in pregnancy, covering prevalence, patterns of use, reasons for use, smoking cessation, and health effects. Methods Five academic databases were searched on 17 February 2020. Studies reporting prevalence, patterns, reasons, cessation, or health effects of vaping in pregnancy were included; animal and in vitro studies were excluded. A narrative review was used, with risk of bias assessed using Hoy and colleague’s tool, the Newcastle–Ottawa scale, and the Consolidated Criteria for reporting Qualitative Research. Results Twenty-three studies were identified: 11 survey, 7 qualitative, 3 cohort, and 2 secondary analyses of randomized clinical trials. Prevalence of vaping in pregnancy (four studies) was between 1.2% and 7.0% overall, and <1% among nonsmokers. Twelve studies reported pattern...
Smoking disproportionately affects the health and wellbeing of people with mental health conditio... more Smoking disproportionately affects the health and wellbeing of people with mental health conditions. People who use mental health services, who smoke, often want to quit but historically have not been offered a way out of tobacco dependence that is genuinely helpful to them. The aim of this briefing is to guide staff working with mental health service users to: • Minimise discomfort and anxiety to service users who are admitted to smokefree premises and maximise the likelihood of long-term cessation • Support service users to temporarily abstain from smoking and/or to stop smoking during an admission to smokefree premises • Support people in the community and help to prepare service users for admission to a smokefree setting • Support people to co-operate with smokefree policies
Background: Smoking rates in the UK are at an all-time low but this masks considerable inequaliti... more Background: Smoking rates in the UK are at an all-time low but this masks considerable inequalities; prevalence amongst adults who are homeless remains four times higher than the national average. The objective of this trial was to assess the feasibility and effects of supplying free e-cigarette starter kits to smokers accessing homeless centres to inform a possible future larger trial. Methods: In this feasibility cluster trial, four homeless centres in Great Britain were pragmatically allocated to either a Usual Care (UC) or E-Cigarette (EC) arm. Smokers attending the centres were recruited by staff. UC arm participants (N=48) received advice to quit and signposting to the local Stop Smoking Service. EC arm participants (N=32) received an EC starter kit and 4-weeks supply of e-liquid. Outcome measures were recruitment and retention rates, use of ECs, smoking cessation/reduction and completion of measures required for economic evaluation. Results: Eighty (mean age 43 years; 65% mal...
Background Tobacco control strategies have led to an overall decline in smoking; however, a large... more Background Tobacco control strategies have led to an overall decline in smoking; however, a large gap remains between people with and without mental health problems, leading to substantial health inequalities. We aimed to assess mental health status of cigarette smokers and recent ex-smokers in England, and smoking and harm reduction behaviour and quit attempts by mental health status.Methods Data were collected from 5,637 current and 434 recent ex-smokers in 2016/17 in household surveys of representative samples of adults. We calculated weighted prevalence of different indicators of mental health problem: a) ever diagnosis, b) none, moderate or serious past-month distress, c) past-year treatment. We compared weighted smoking status, cigarette type, dependence, motivation to stop smoking, cutting down, use of nicotine replacement therapy or e-cigarettes, short-term abstinence, and quit attempts according to mental health status.Results Among smokers and recent ex-smokers, 35.9% ever...
Background Smoking prevalence among people with psychosis remains high. Providing Very Brief Advi... more Background Smoking prevalence among people with psychosis remains high. Providing Very Brief Advice (VBA) comprising: i) ASK, identifying a patient’s smoking status ii) ADVISE, advising on the best way to stop and iii) ACT (OFFER), offering a referral to specialist smoking cessation support, increases quit attempts in the general population. We assessed whether system-level changes in a UK mental health organisation improved the recording of the provision of ASK, ADVISE, ACT (OFFER) and consent to referral to specialist smoking cessation support (ACT (CONSENT)). Methods We conducted a study using a regression discontinuity design in four psychiatric hospitals with patients who received treatment from an inpatient psychosis service over 52 months (May 2012–September 2016). The system-level changes to facilitate the provision of VBA comprised: A) financially incentivising recording smoking status and offer of support (ASK and ACT (OFFER)); B) introduction of a comprehensive smoke-free...
Tobacco smoking disproportionately affects the health and wellbeing of people who experience a me... more Tobacco smoking disproportionately affects the health and wellbeing of people who experience a mental health condition because of how much they smoke, the way they smoke and for how long they smoke. Although motivated to quit, these smokers experience several challenges such as high levels of tobacco dependence and fewer opportunities to give up. This article describes how common smoking is among people with a mental health condition, its impact and the use of licenced medicines to assist with quitting. It also briefly discusses the role electronic cigarettes can play in helping people with a mental health condition reduce harm from tobacco smoking.
International journal of mental health nursing, 2018
The introduction of smoke-free policies is increasingly common in mental health settings, to impr... more The introduction of smoke-free policies is increasingly common in mental health settings, to improve health. However, a barrier to implementing smoke-free polices is staff concern that violence will increase. We conducted a systematic review comparing the rates of violence before and after the introduction of smoke-free policies in mental health settings. Two authors searched major electronic databases. We included studies reporting the prevalence of violence (verbal and/or physical or combined) before and after the introduction of a smoke-free policy in a mental health, forensic, or addiction setting. We included 11 studies in the review. A narrative synthesis was used to describe the key results of each study. Six studies measured physical violence specifically; four reported a decrease or no change and two reported a short-term increase. Five of these six studies also measured verbal violence; two found an increase, with one of the studies reporting that this increase was tempora...
International Journal of Mental Health Nursing, 2019
Smoke‐free policies in mental health settings are important to protect health but are often imped... more Smoke‐free policies in mental health settings are important to protect health but are often impeded by staff concerns that physical violence may increase. We aimed to address the literature gap about the frequency, nature, and management of physical violence in relation to smoking. We compared the antecedents and containment of smoking‐related incidents of physical violence over a two‐year period, (12 months when an indoor‐only smoke‐free policy was in place, followed by 12 months after a new comprehensive smoke‐free policy was introduced) using incident reports completed by staff in a large mental health organization in London, UK. Sixty‐one smoking‐related incidents occurred during the indoor‐only smoke‐free policy period; 32 smoking‐related incidents occurred during the comprehensive smoke‐free policy. We identified four antecedent categories for physical violence: i) patient request to smoke denied by staff; ii) during a supervised smoking break; iii) staff response to a patient...
Background The poor translation of research findings into routine clinical practice is common in ... more Background The poor translation of research findings into routine clinical practice is common in all areas of healthcare. Having a better understanding of how researchers and clinicians experience engagement in and with research, their working relationships and expectations of each other, may be one way to help to facilitate collaborative partnerships and therefore increase successful translation of research into clinical practice. Aims To explore the views of clinical and research staff about their experiences of working together during research projects and identify the facilitators and barriers. Methods We conducted four focus groups with 18 participants - clinicians, researchers and those with a dual clinical-research role, recruited from one mental health Trust and one university. Data was analysed using thematic analysis. Results Eight themes were identified under the headings of two research questions 1) Barriers and facilitators of either engaging in or with research from th...
Introduction Smoking in pregnancy increases the risk of negative health outcomes. Vaping can be e... more Introduction Smoking in pregnancy increases the risk of negative health outcomes. Vaping can be effective for smoking cessation in nonpregnant populations. We conducted a systematic review of vaping in pregnancy, covering prevalence, patterns of use, reasons for use, smoking cessation, and health effects. Methods Five academic databases were searched on 17 February 2020. Studies reporting prevalence, patterns, reasons, cessation, or health effects of vaping in pregnancy were included; animal and in vitro studies were excluded. A narrative review was used, with risk of bias assessed using Hoy and colleague’s tool, the Newcastle–Ottawa scale, and the Consolidated Criteria for reporting Qualitative Research. Results Twenty-three studies were identified: 11 survey, 7 qualitative, 3 cohort, and 2 secondary analyses of randomized clinical trials. Prevalence of vaping in pregnancy (four studies) was between 1.2% and 7.0% overall, and <1% among nonsmokers. Twelve studies reported pattern...
Smoking disproportionately affects the health and wellbeing of people with mental health conditio... more Smoking disproportionately affects the health and wellbeing of people with mental health conditions. People who use mental health services, who smoke, often want to quit but historically have not been offered a way out of tobacco dependence that is genuinely helpful to them. The aim of this briefing is to guide staff working with mental health service users to: • Minimise discomfort and anxiety to service users who are admitted to smokefree premises and maximise the likelihood of long-term cessation • Support service users to temporarily abstain from smoking and/or to stop smoking during an admission to smokefree premises • Support people in the community and help to prepare service users for admission to a smokefree setting • Support people to co-operate with smokefree policies
Background: Smoking rates in the UK are at an all-time low but this masks considerable inequaliti... more Background: Smoking rates in the UK are at an all-time low but this masks considerable inequalities; prevalence amongst adults who are homeless remains four times higher than the national average. The objective of this trial was to assess the feasibility and effects of supplying free e-cigarette starter kits to smokers accessing homeless centres to inform a possible future larger trial. Methods: In this feasibility cluster trial, four homeless centres in Great Britain were pragmatically allocated to either a Usual Care (UC) or E-Cigarette (EC) arm. Smokers attending the centres were recruited by staff. UC arm participants (N=48) received advice to quit and signposting to the local Stop Smoking Service. EC arm participants (N=32) received an EC starter kit and 4-weeks supply of e-liquid. Outcome measures were recruitment and retention rates, use of ECs, smoking cessation/reduction and completion of measures required for economic evaluation. Results: Eighty (mean age 43 years; 65% mal...
Background Tobacco control strategies have led to an overall decline in smoking; however, a large... more Background Tobacco control strategies have led to an overall decline in smoking; however, a large gap remains between people with and without mental health problems, leading to substantial health inequalities. We aimed to assess mental health status of cigarette smokers and recent ex-smokers in England, and smoking and harm reduction behaviour and quit attempts by mental health status.Methods Data were collected from 5,637 current and 434 recent ex-smokers in 2016/17 in household surveys of representative samples of adults. We calculated weighted prevalence of different indicators of mental health problem: a) ever diagnosis, b) none, moderate or serious past-month distress, c) past-year treatment. We compared weighted smoking status, cigarette type, dependence, motivation to stop smoking, cutting down, use of nicotine replacement therapy or e-cigarettes, short-term abstinence, and quit attempts according to mental health status.Results Among smokers and recent ex-smokers, 35.9% ever...
Background Smoking prevalence among people with psychosis remains high. Providing Very Brief Advi... more Background Smoking prevalence among people with psychosis remains high. Providing Very Brief Advice (VBA) comprising: i) ASK, identifying a patient’s smoking status ii) ADVISE, advising on the best way to stop and iii) ACT (OFFER), offering a referral to specialist smoking cessation support, increases quit attempts in the general population. We assessed whether system-level changes in a UK mental health organisation improved the recording of the provision of ASK, ADVISE, ACT (OFFER) and consent to referral to specialist smoking cessation support (ACT (CONSENT)). Methods We conducted a study using a regression discontinuity design in four psychiatric hospitals with patients who received treatment from an inpatient psychosis service over 52 months (May 2012–September 2016). The system-level changes to facilitate the provision of VBA comprised: A) financially incentivising recording smoking status and offer of support (ASK and ACT (OFFER)); B) introduction of a comprehensive smoke-free...
Tobacco smoking disproportionately affects the health and wellbeing of people who experience a me... more Tobacco smoking disproportionately affects the health and wellbeing of people who experience a mental health condition because of how much they smoke, the way they smoke and for how long they smoke. Although motivated to quit, these smokers experience several challenges such as high levels of tobacco dependence and fewer opportunities to give up. This article describes how common smoking is among people with a mental health condition, its impact and the use of licenced medicines to assist with quitting. It also briefly discusses the role electronic cigarettes can play in helping people with a mental health condition reduce harm from tobacco smoking.
International journal of mental health nursing, 2018
The introduction of smoke-free policies is increasingly common in mental health settings, to impr... more The introduction of smoke-free policies is increasingly common in mental health settings, to improve health. However, a barrier to implementing smoke-free polices is staff concern that violence will increase. We conducted a systematic review comparing the rates of violence before and after the introduction of smoke-free policies in mental health settings. Two authors searched major electronic databases. We included studies reporting the prevalence of violence (verbal and/or physical or combined) before and after the introduction of a smoke-free policy in a mental health, forensic, or addiction setting. We included 11 studies in the review. A narrative synthesis was used to describe the key results of each study. Six studies measured physical violence specifically; four reported a decrease or no change and two reported a short-term increase. Five of these six studies also measured verbal violence; two found an increase, with one of the studies reporting that this increase was tempora...
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