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Brief Reports   |    
Clinical Management of Tobacco Dependence in Inpatient Psychiatry: Provider Practices and Patient Utilization
Teresa M. Leyro, Ph.D.; Sharon M. Hall, Ph.D.; Norval Hickman, Ph.D., M.P.H.; Romina Kim, B.S.; Stephen E. Hall, M.D.; Judith J. Prochaska, Ph.D., M.P.H.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200574
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Dr. Leyro, Dr. Sharon Hall, and Dr. Stephen Hall are with the Department of Psychiatry, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA 94143 (e-mail: teresa.leyro@ucsf.edu). Dr. Hickman is with the State of California Tobacco-Related Disease Research Program, University of California Office of the President, Oakland. Ms. Kim is with the College of Human Medicine, Michigan State University, East Lansing. Dr. Prochaska is with the Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, California.

Copyright © 2013 by the American Psychiatric Association


Objective  This investigation examined predictors of utilization of nicotine replacement therapy (NRT) during a smoke-free psychiatric hospitalization.

Methods  Smokers (N=324) were recruited from smoke-free adult inpatient psychiatric units. Exploratory analyses examined correlates of NRT provision and utilization.

Results  The prevalence of NRT use was 51% overall and was greater among patients offered NRT on admission (58%) versus later (34%), among patients with more severe depression and nicotine withdrawal, and among those who reported perceptions that NRT decreases nicotine withdrawal, provides a nicotine substitute, and helps with quitting smoking (p<.05, all comparisons). Although the ratio of nicotine patch dose to usual cigarettes per day was 1.2±.7, the ratio was negatively correlated with time to first cigarette (Spearman’s ρ=–.30, p<.01), suggesting potential underdosing of more dependent smokers.

Conclusions  During smoke-free psychiatric hospitalizations, clinical management of nicotine withdrawal may be enhanced by offering patients NRT directly on admission, educating patients on the benefits of NRT, and increasing the dosage for more dependent smokers.

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Table 1Baseline characteristics of smokers in smoke-free adult inpatient psychiatric units of two hospitals
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a Global Assessment of Functioning. Possible scores range from 0 to 100, with higher scores indicating better functioning.

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b Interquartile range 4 and 11

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c Alcohol Use Disorders Identification Test

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d Drug Abuse Screening Test

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e Possible scores range from 0 to 6, with higher scores indicating heavier smoking as indexed by time to first cigarette of the day and daily cigarette consumption.

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f As measured on the Minnesota Nicotine Withdrawal Scale. Possible scores range from 0 to 28, with higher scores indicating greater nicotine withdrawal severity.

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g Interquartile range 1 and 10



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