School of Nursing, University of British Columbia, T201 - 2211 Wesbrook Mall, Vancouver, BC, Canada.
BMC Psychiatry. 2010 Nov 30;10:101. doi: 10.1186/1471-244X-10-101.
In many countries, smoking remains the leading preventable cause of death. In North America, reductions in population smoking levels are stabilising and, in recent years, those involved in tobacco control programming have turned their attention to particular segments of society that are at greatest risk for tobacco use. One such group is people with mental illness. A picture of tobacco use patterns among those with mental illness is beginning to emerge; however, there are several unanswered questions. In particular, most studies have been limited to particular in-patient groups. In addition, while it is recognised that men and women differ in relation to their reasons for smoking, levels of addiction to nicotine, and difficulties with cessation, these sex and gender differences have not been fully explored in psychiatric populations.
Community residents with serious mental illness were surveyed to describe their patterns of tobacco use and to develop a gender-specific profile of their smoking status and its predictors.
Of 729 respondents, almost one half (46.8%) were current tobacco users with high nicotine dependence levels. They spent a majority of their income on tobacco, and reported using smoking to cope with their psychiatric symptoms. Current smokers, compared with non-smokers, were more likely to be: diagnosed with a schizophrenia spectrum disorder (rather than a mood disorder); male; relatively young; not a member of a racialised group (e.g., Aboriginal, Asian, South Asian, Black); poorly educated; separated or divorced; housed in a residential facility, shelter, or on the street; receiving social assistance; and reporting co-morbid substance use. There is evidence of a gender interaction with these factors; in the gender-specific multivariate logistic regression models, schizophrenia spectrum disorder versus mood disorder was not predictive of women's smoking, nor was education, marital status or cocaine use. Women, and not men, however, were more likely to be smokers if they were young and living in a residential facility.
For men only, the presence of schizophrenia spectrum disorder is a risk factor for tobacco use. Other factors, of a social nature, contribute to the risk of smoking for both men and women with serious mental illness. The findings suggest that important social determinants of smoking are "gendered" in this population, thus tobacco control and smoking cessation programming should be gender sensitive.
在许多国家，吸烟仍是可预防的主要死因。在北美，人口吸烟水平的下降趋势正在趋于稳定，近年来，参与烟草控制规划的人员将注意力转向了烟草使用风险最高的特定社会群体。其中一个群体是患有精神疾病的人。开始出现患有精神疾病的人吸烟模式的图片；然而，仍有几个未解答的问题。特别是，大多数研究仅限于特定的住院群体。此外，尽管人们认识到男性和女性在吸烟原因、尼古丁成瘾程度和戒烟困难方面存在差异，但这些性别差异在精神科人群中并未得到充分探讨。
对社区中有严重精神疾病的居民进行调查，以描述他们的吸烟模式，并制定他们吸烟状况及其预测因素的性别特征。
在 729 名受访者中，近一半（46.8%）是当前有较高尼古丁依赖水平的烟草使用者。他们将大部分收入用于购买烟草，并报告说使用吸烟来应对精神症状。与不吸烟者相比，当前吸烟者更有可能：被诊断为精神分裂症谱系障碍（而非心境障碍）；男性；相对年轻；不属于种族化群体（例如，原住民、亚洲人、南亚人、黑人）；受教育程度较低；离婚或分居；居住在住所、避难所或街头；领取社会援助；并报告同时存在物质使用障碍。有证据表明这些因素与性别存在相互作用；在性别特异性多变量逻辑回归模型中，精神分裂症谱系障碍与心境障碍都不能预测女性吸烟，教育、婚姻状况或可卡因使用也不能预测女性吸烟。然而，年轻且居住在住所的女性更有可能成为吸烟者，而不是男性。
仅对男性而言，精神分裂症谱系障碍的存在是吸烟的危险因素。其他社会因素也增加了患有严重精神疾病的男性和女性吸烟的风险。研究结果表明，在这一人群中，吸烟的重要社会决定因素具有“性别”特征，因此烟草控制和戒烟规划应具有性别敏感性。
