Cigarette Smoking as a Risk Factor for Greater Psychiatric Symptom Severity across Serious Mental Illnesses: A Secondary Analysis of Three Nationally-Representative NIH Datasets

项目摘要 在过去的50年里，美国的吸烟率从20世纪60年代的42%下降到14%，下降了三分之二 目前。吸烟预防运动，如烟草产品中心领导的运动，包括 多媒体教育节目和香烟包装上的健康警告标签，非常有效 并在这一削减中发挥了关键作用。然而，在某些弱势群体中，吸烟率仍然很高。 亚群(如青年、少数族裔、男女同性恋、双性恋和变性者)和禁烟方案现在的目标是预防吸烟 向这些亚群发起运动。一个尚未成为目标的弱势群体是 患有严重精神疾病(SMI)的人，如双相情感障碍(BD)、精神分裂症(SCZ)和 抑郁症(MDD)。每5个美国人中就有1人受到SMI的影响，SMI患者的患病人数是美国人的两倍 吸烟的可能性与没有SMI的人一样。因此，40%的香烟是由患有 SMIS。长期以来，教育活动一直被用来接触到患有SMI的人，并在 提高治疗率，减少自杀行为。鉴于他们的成功，没有吸烟者 针对SMI人群的预防运动令人震惊。设计一个成功的 Campaign正在为与SMI产生共鸣的消息传递建立科学基础 亚群。关注吸烟对心理健康的影响是一个合乎逻辑的选择。患有自闭症的人 通常他们一生中有15%-25%的时间是有症状的，症状令人痛苦，导致角色障碍， 病情严重时需要住院治疗。我们将进行迄今最严格的调查，以确定 吸烟是SMI患者精神症状严重程度更高的风险因素，具体有三个目标： SA1：确定吸烟是否是患有以下疾病的人发病时间增加的危险因素 SMIS。我们假设BD吸烟者会比BD吸烟者花更多的时间在情绪发作(抑郁+躁狂)上 非吸烟者，SCZ吸烟者会花更多的时间在精神病发作上，MDD吸烟者会花更多的时间 抑郁发作中的时间。SA2：确定吸烟是否是导致时间延长的危险因素 所有SMI患者都患有抑郁症。抑郁症是最常见的由吸烟引起的精神综合症， 患有BD、SCZ和MDD的人都容易患抑郁症。SA1的另一种假设是 吸烟有一种特殊的抑郁作用，在所有三个SMI中，吸烟者将花费更多的时间在 与非吸烟者相比，抑郁发作更明显。SA3：确定人内吸烟变化的预测因素 行为(开始、戒烟、旧病复发)。我们假设吸烟者的精神症状较轻 戒烟严重的人更有可能戒烟，而戒烟者的症状随后会增加 将更有可能再次吸烟。拟议的项目将推动烟草监管科学和 通过为针对以下目标的禁烟运动建立科学基础来保护公众健康 自闭症患者--可以说是受吸烟危害最大的弱势群体。

PROJECT ABSTRACT Over the past 50 years, the US smoking rate was reduced by two-thirds from 42% in the 1960s to 14% currently. Smoking prevention campaigns, such as those led by the Center for Tobacco Products, include multimedia educational programs and health warning labels on cigarette packaging, which are highly effective and played a key role in this reduction. However, smoking rates remain high in certain vulnerable subpopulations (e.g. youth, minorities, LGBTQ people) and the CTP is now targeting smoking prevention campaigns to these subpopulations. One vulnerable subpopulation that has not yet been targeted is people with serious mental illnesses (SMIs) such as bipolar disorder (BD), schizophrenia (SCZ), and major depressive disorder (MDD). SMIs affect more than 1 in 5 Americans and people with SMIs are twice as likely to smoke as people without SMIs. Accordingly 40% of all cigarettes are smoked by people with SMIs. Education campaigns have long been used to reach people with SMIs and have been successful in increasing treatment rates and reducing suicidal behavior. In light of their success, the lack of a smoking prevention campaign targeted to the SMI subpopulation is striking. The first step in designing a successful campaign is establishing the scientific foundation for messaging that will resonate with the SMI subpopulation. Focusing on the mental health consequences of smoking is a logical choice. People with SMIs typically spend 15%-25% of their lives symptomatic, and symptoms are distressing, cause role impairment, and when severe require hospitalization. We will conduct the most rigorous investigation yet done on whether smoking is a risk factor for greater psychiatric symptom severity in people with SMIs, using three specific aims: SA1: Determine whether smoking is a risk factor for increased time in illness episodes in people with SMIs. We hypothesize that BD smokers will spend more time in mood episodes (depression+mania) than BD non-smokers, SCZ smokers will spend more time in psychotic episodes, and MDD smokers will spend more time in depressive episodes. SA2: Determine whether smoking is a risk factor for increased time in depression across SMIs. Depression is the psychiatric syndrome most commonly attributed to smoking, and people with BD, SCZ, and MDD are all vulnerable to depression. An alternate hypothesis to SA1 is that smoking has a specific depressogenic effect and that across all three SMIs smokers will spend more time in depressive episodes than non-smokers. SA3: Determine predictors of within-person changes in smoking behavior (initiating, quitting, relapsing). We hypothesize that smokers with lower psychiatric symptom severity will be more likely to quit smoking, while quitters who experience a subsequent increase in symptoms will be more likely to relapse into smoking. The proposed project will advance tobacco regulatory science and protect public health by establishing the scientific foundation for a smoking prevention campaign targeted to people with SMIs - arguably the vulnerable subpopulation most harmed by smoking.