Tobacco Use, Nicotine Dependence, and Cessation Methods in US Adults With Psychosis.

Importance: Adults with psychotic disorders have high premature mortality, partly due to the high prevalence of smoking in this population. Yet recent data are lacking on tobacco product use among US adults with a history of psychosis. Objective: To examine the sociodemographic characteristics and behavioral health status; types of tobacco products used; prevalence of use by age, sex, and race and ethnicity; and nicotine dependence severity and smoking cessation methods among community-dwelling adults with vs without psychosis. Design, Setting, and Participants: This cross-sectional study analyzed nationally representative, self-reported, cross-sectional data of adults (aged ≥18 years) who participated in the Wave 5 survey (conducted from December 2018 to November 2019) of the Population Assessment of Tobacco and Health (PATH) Study. Data analyses were conducted between September 2021 and October 2022. Exposure: PATH Study respondents were classified as having lifetime psychosis if they answered yes to whether they had ever received from a clinician (eg, physician, therapist, or other mental health professional) a diagnosis of schizophrenia, schizoaffective disorder, psychosis, or psychotic illness or episode. Main Outcomes and Measures: Use of any and major types of tobacco products, severity of nicotine dependence, and cessation methods. Results: Among the 29 045 community-dwelling adults who participated in the PATH Study (weighted median [IQR] age, 30.0 [22.0-50.0] years; weighted percentage estimates: 14 976 females (51.5%); 16.0% Hispanic, 11.1% non-Hispanic Black, 65.0% non-Hispanic White, and 8.0% non-Hispanic other race and ethnicity [American Indian or Alaska Native, Asian, Native Hawaiian or other Pacific Islander, and more than 1 race]), 2.9% (95% CI, 2.62%-3.10%) reported receiving a lifetime psychosis diagnosis. Compared with those without psychosis, people with psychosis had a higher adjusted prevalence of past-month any tobacco use (41.3% vs 27.7%; adjusted risk ratio [RR], 1.49 [95% CI, 1.36-1.63]) as well as cigarette smoking, e-cigarette use, and other tobacco product use overall and in most examined subgroups; they also had a higher past-month prevalence of dual cigarette and e-cigarette use (13.5% vs 10.1%; P = .02), polycombustible tobacco use (12.1% vs 8.6%; P = .007), and polycombustible and noncombustible tobacco use (22.1% vs 12.4%; P < .001). Among adults with past-month cigarette use, those with vs without psychosis had a higher adjusted mean nicotine dependence scores overall (54.6 vs 49.5; P < .001) and within the 45-years-or-older (61.7 vs 54.9; P = .002), female (56.9 vs 49.8; P = .001), Hispanic (53.7 vs 40.0; P = .01), and Black (53.4 vs 46.0; P = .005) groups. They were also more likely to make a quit attempt (60.0% vs 54.1%; adjusted RR, 1.11 [95% CI, 1.01-1.21]) and use counseling, a quitline, or a support group for tobacco cessation (5.6% vs 2.5%; adjusted RR, 2.25 [95% CI, 1.21-3.30]). Conclusions and Relevance: In this study, the high prevalence of tobacco use, polytobacco use, and making a quit attempt as well as the severity of nicotine dependence among community-dwelling adults with a history of psychosis highlighted the urgency for tailored tobacco cessation interventions for this population. Such strategies must be evidence-based and age, sex, and race and ethnicity appropriate.

Effect on blood pressure and eye health symptoms in a climate-financed randomized cookstove intervention study in rural India.

BACKGROUND: Air pollution from cooking with solid fuels is a potentially modifiable risk factor for increased blood pressure and may lead to eye irritation. OBJECTIVES: To evaluate whether a climate motivated cookstove intervention reduced blood pressure and eye irritation symptoms in Indian women. METHODS: Households using traditional stoves were randomized to receive a rocket stove or continue using traditional stoves. Systolic (SBP) and diastolic blood pressure (DBP), and self-reported eye symptoms were measured twice, pre-intervention and at least 124 days post-intervention in women > 25 years old in control (N = 111) and intervention (N = 111) groups in rural Karnataka, India. Daily (24-h) fine particle (PM2.5) mass and absorbance (Abs) were measured in cooking areas at each visit. Mixed-effect models were used to estimate before-and-after differences in SBP, DBP and eye symptoms. RESULTS: We observed a lower SBP (-2.0 (-4.5, 0.5) mmHg) and DBP (-1.1 (-2.9, 0.6) mmHg) among exclusive users of intervention stove, although confidence intervals included zero. Stacking or mixed use of intervention and traditional stoves contributed to a small increase in SBP 2.6 (-0.4, 5.7) mmHg) and DBP (1.2 (-0.9, 3.3) mmHg). Exclusive and mixed stove users experienced higher post-intervention reductions, on average, in self-reported eye irritation symptoms for burning sensation in eyes, and eyes look red often compared to control. Median air pollutant concentrations increased post-intervention in all stove groups, with the lowest median PM2.5 increase in the exclusive intervention stove group. CONCLUSIONS: Health benefits were limited due to stacking and lower-than-predicted efficiency of the intervention stove in the field. Stove adoption and use behavior, in addition to stove technology, affects achievement of health co-benefits. Carbon-financing schemes need to align with international guidelines that have been set based on health outcomes to maximize health co-benefits from cookstove interventions.

Health and Climate-Relevant Pollutant Concentrations from a Carbon-Finance Approved Cookstove Intervention in Rural India.

Efforts to introduce more efficient stoves increasingly leverage carbon-finance to scale up dissemination of interventions. We conducted a randomized intervention study to evaluate a Clean Development Mechanism approved stove replacement impact on fuelwood usage, and climate and health-relevant air pollutants. We randomly assigned 187 households to either receive the intervention or to continue using traditional stoves. Measurements of fine particulate matter (PM2.5) and absorbance were conducted in cooking areas, village center and at upwind background site. There were minor and overlapping seasonal differences (post- minus preintervention change) between control and intervention groups for median (95% CI) fuel use (-0.60 (-1.02, -0.22) vs -0.52 (-1.07, 0.00) kg day(-1)), and 24 h absorbance (35 (18, 60) vs 36 (22, 50) × 10(-6) m(-1)); for 24 h PM2.5, there was a higher (139 (61,229) vs 73(-6, 156) µg m(-3))) increase in control compared to intervention homes between the two seasons. Forty percent of the intervention homes continued using traditional stoves. For intervention homes, absorbance-to-mass ratios suggest a higher proportion of black carbon in PM2.5 emitted from intervention compared with traditional stoves. Absent of field-based evaluation, stove interventions may be pursued that fail to realize expected carbon reductions or anticipated health and climate cobenefits.