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Doctors Fear Asking Mentally Ill to Quit Smoking
But these big smokers are likely to benefit from treatment
People with mental illnesses such as depression and anxiety are the heaviest smokers in the country, but their doctors are afraid to ask them to quit. They assume that if their patients try to quit smoking, their mental disorders will get worse.
That is a myth, according to Brian Hitsman, a tobacco addiction specialist and assistant professor of preventive medicine at Northwestern University Feinberg School of Medicine. He also is a member of the Robert H. Lurie Comprehensive Cancer Center of Northwestern University.
"These doctors and mental health specialists focus on their patients' psychiatric health and lose track of their physical health," said Hitsman, who is a health psychologist. "Tobacco cessation gets a lot of attention, but we leave out a population that smokes the majority of all the cigarettes."
Doctors erroneously believe mental disorders will worsen if they take away a person's tobacco. "Not a single study shows that symptoms get worse," Hitsman said. He examined 13 randomized clinical trials that measured psychiatric symptoms during smoking cessation treatment. Seven studies showed that psychiatric symptoms actually improved during smoking cessation treatment, and six showed no changes.
To help motivate the patient, the counselor highlights the benefits of quitting, the personal costs of smoking and the barriers to cessation success. "It gets the person in a problem-solving mode, at the basis of which is a solid relationship with the counselor," Hitsman said.
Hitsman's colleagues on the paper are Tony George, M.D., professor and chair of addiction psychiatry at the University of Toronto, Taryn Moss, a psychology student at the University of Toronto and Ivan Montoya, M.D., medical director of the division of pharmacotherapies and medical toxicity at the National Institute on Drug Abuse.
Northwestern University 09 09 09
Smoking is a risk factor for active tuberculosis (TB) disease, according to a new study on TB incidence.
While past studies have reported increased mortality among TB patients who smoke, none have been able to specifically examine the direct effect of smoking on active TB incidence using a longitudinal design in a general population. "In this prospective cohort study we found a two-fold increase in the risk of active TB in current smokers compared with never-smokers," said lead author, Hsien-Ho Lin, postdoctoral research fellow from Brigham and Women's Hospital, in Boston.
"To our knowledge this is the first cohort study from a general population that provides evidence on the positive association between tobacco smoking and active TB. Based on results from ours and other studies, policy makers and public health personnel should consider addressing tobacco cessation as part of tuberculosis control. From the perspective of prevention, the target of smoking cessation should aim beyond TB patients to reach high-risk populations who are most likely to benefit from cessation," said Dr. Lin. "Further studies are needed on smoking and TB in different countries and ethnic groups, as well as randomized trials of smoking cessation that look at incident TB as one of the outcomes."
The results are reported in the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
American Thoracic Society 08 09
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