Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA 94305–5411, USA.
Nicotine Tob Res. 2013 Aug;15(8):1427-35. doi: 10.1093/ntr/nts343. Epub 2013 Jan 15.
Youth with psychiatric disorders are at increased risk of tobacco use. Outpatient mental health settings have received little investigation for delivering tobacco treatment. This study obtained formative data to guide development of a tobacco cessation program for transitional age youth with co-occurring psychiatric disorders with a focus on outpatient mental health settings.
Applying qualitative methods, we analyzed transcripts from interviews with 14 mental health clients (aged 16-23) and 8 mental health providers.
The youth identified internal (nicotine addiction and mood), social, parental, and media influences to their use of tobacco. Providers' viewed youth tobacco use as a normative developmental process, closely tied to management of psychiatric symptoms, supported by parents, and of lower priority relative to youth alcohol and illicit drug use. Youth and providers believed that clinicians can do more to address tobacco use in practice and emphasized nonjudgmental support and nondirective approaches. Top recommended quitting strategies, however, differed notably for the youth (cold turkey, support from friends, physical activity, hobbies) and providers (cessation pharmacotherapy, cessation groups, treatment referrals).
Mental health providers' greater prioritization of other substances and view of youth smoking as developmentally normative and a coping strategy for psychopathology are likely contributing to the general lack of attention to tobacco use currently. Integrating care within mental health settings would serve to reach youth in an arena where clinical rapport is already established, and study findings suggest receptivity for system improvements. Of consideration, however, is the apparent disconnect between provider and youth recommended strategies for supporting cessation.
患有精神疾病的年轻人使用烟草的风险增加。门诊心理健康机构在提供烟草治疗方面受到的关注较少。本研究获得了形成性数据，以指导为同时患有精神疾病的过渡年龄青年开发一个针对门诊心理健康环境的戒烟计划。
应用定性方法，我们分析了 14 名心理健康患者（年龄在 16-23 岁之间）和 8 名心理健康提供者的访谈记录。
这些年轻人将内在因素（尼古丁成瘾和情绪）、社会、父母和媒体对他们吸烟的影响。提供者将青年烟草使用视为与管理精神症状密切相关的规范发展过程，得到父母的支持，相对于青年饮酒和非法药物使用的优先级较低。青年和提供者认为，临床医生在实践中可以做更多的工作来解决烟草使用问题，并强调非评判性支持和非指导性方法。然而，推荐的戒烟策略在年轻人（突然戒烟、朋友支持、体育活动、爱好）和提供者（戒烟药物治疗、戒烟小组、治疗转介）之间有明显的不同。
心理健康提供者更优先考虑其他物质，将青年吸烟视为发展规范和精神病理学的应对策略，这可能是导致目前对烟草使用普遍关注不足的原因。在心理健康机构中整合护理将有助于在已经建立临床关系的领域中接触到年轻人，并表明对系统改进的接受度。然而，需要考虑的是，提供者和年轻人推荐的支持戒烟策略之间明显脱节。
