Smoking and Mental Illness Co-morbidity: Implications for Mortality Outcomes and Treatment Interventions

Smoking and mental illness are leading contributors to mortality and morbidity in the U.S. They are also significantly associated with each other, as people with mental illness smoke at much higher rates compared to the general population. While it is known that people with mental illness have shorter life expectancies than people without, the extent to which this is associated with their increased smoking had previously been unknown. In Chapter 2, I use survival analysis and the National Health Interview Surveys 1997-2009 mortality follow-up data to construct lifetables by smoking and mental health status. I find that at age 40, never smokers with SPD lose approximately 5.3 years of life expectancy compared to current smokers with SPD who lose 14.9. Thus smoking is a primary driver of differences in life expectancy by mental health status. In Chapter 3, I use simulation methods to adjust for recall error in national surveys and produce revised estimates of lifetime prevalence of major depression (MD) in the U.S. I develop a simple compartmental model of MD calibrated to data from the National Survey on Drug Use and Health (NSDUH). I show that over 40% of adults with lifetime MD underreport their histories of depression. After adjusting for recall error, 28.7% and 16.0% of women and men have lifetime MD compared to 15.6% and 9.5% when relying on self-report. In Chapter 4, I develop the first model to evaluate the joint impact of smoking and mental health in the U.S. I calibrate a system dynamics model of smoking and depression comorbidity to NSDUH data 2005-2015 and show that the smoking prevalence disparity by depressive status is projected to widen over time. From 2016 to 2050, women and men with MD are expected to become increasingly more likely to smoke compared to their never depressed counterparts. Adults with current MD represent 6.7% of the adult population, but more than 640,000 smoking-attributable deaths are projected to occur in this group. While the proportion of smoking-attributable deaths among adults with depression is projected to decrease with time, even by 2050 parity with those who have no history of MD would not be achieved. In Chapter 5, I evaluate the health gains associated with smoking cessation interventions that target patients with depression. I simulate the effects of widespread access to cessation treatment and increased utilization of mental health services among smokers with depression. Under a highly optimistic scenario that assumes all patients with depression receive cessation medication from their mental health professionals in 2018, less than 31,400 premature deaths would be avoided by 2050. This represents only about 5% of the nearly 600,000 smoking-attributable deaths that are projected to occur among adults with depression during the same period. Increases in the level of mental health service utilization would offer some additional but marginal health gains. While cessation interventions in mental health settings would reduce the smoking disparity by depression status, the mortality benefits associated with doing so are modest and should be pursued alongside more aggressive tobacco control strategies. This dissertation advances knowledge about the impact of smoking and mental illness comorbidities on population health. It furthermore demonstrates the potential for systems science approaches to inform the epidemiology of behavioral health conditions, assess changes to tobacco use disparities over time, and evaluate the long-term effects of interventions.PHDHealth Services Organization & PolicyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/146111/1/jamietam_1.pd

Intertidal Community Differences Between the Cook Strait and Wellington Harbour

Wellington Harbour which lies near the southern tip of the North Island, New Zealand, exhibits a typical rocky intertidal shoreline with groups of species similar to those found on many temperate rocky coasts around the world. A short distance away, the Cook Strait displays a very different shoreline in community composition compared with Wellington Harbour, most notably a distinct lack of filter feeders. This thesis aims to examine how exactly the community composition is different between the two coasts at a species level and if there are any environmental factors that can explain the differing distributions. Here, a series of field and laboratory experiments aim to examine why certain filter feeders (mussels) are absent from the Cook Strait shore, yet so abundant in Wellington Harbour ... This work indicates that the Cook Strait coastline has lower filter feeder abundances and an overall different community composition than Wellington Harbour. The cause of these differences appears to be bottom up regulation through the lack of food availability (phytoplankton) during winter months in the Cook Strait. The high commercial value of coastal environments in both fisheries and tourism heightens the need to understand these habitats. Unravelling the complex relationships between the seasonal changes in the water column and onshore biota is important for conserving and protecting these essential ecosystems in New Zealand and temperate shores worldwide

A systematic review of transitions between cigarette and smokeless tobacco product use in the United States

Abstract Background Smokeless tobacco use is becoming an increasingly important public health issue in the US and may influence cigarette smoking behavior. Systematic information on transitions between smokeless tobacco and cigarette use in the US is limited. Methods We conducted a systematic review of published literature on transitions between smokeless tobacco and cigarette use in the US. We searched PubMed, Web of Science and EbscoHost databases for all published articles from January 2000 to March 2014 that presented estimates of transitions in US youth and adult study populations over time between at least one of the following tobacco use states: exclusive cigarette smoking, exclusive smokeless tobacco use, dual use of both products, and use of neither product. We excluded non-English language studies, studies published before 2000, clinical trials, controlled cessation programs, and clinical studies or evaluations of smokeless tobacco cessation programs. Results The review identified six studies on US populations published since 2000 with longitudinal data on some or all of the transitions that users can undergo between smokeless tobacco and cigarette use. There was considerable heterogeneity across studies in design and tobacco use definitions. Despite these differences, the existing data indicate that switching behaviors from exclusive smoking to exclusive smokeless tobacco use are limited (adults: 0%-1.4%, adolescents: 0.8%-3.8%) but may be more common from exclusive smokeless tobacco use to exclusive smoking (adults: 0.9%-26.6%, adolescents: 16.6%-25.5%). Among adults, exclusive cigarette smoking was generally stable and consistent (79.7% to 87.6%) over follow-up across studies but less stable in adolescents (46.8%-78.7%). Exclusive smokeless tobacco use was less stable than exclusive cigarette smoking over time (adults: 59.4%-76.6%, adolescents: 26.2%-44.8%). Conclusion This review provides published estimates of the proportions of adults and adolescents transitioning between tobacco use categories from the most recently available studies on longitudinal transitions between smokeless tobacco and cigarettes in the US. These data can be used to track tobacco use behaviors and evaluate their effect on public health; however, the data for these studies were generally collected more than a decade ago. Additional research including nationally representative longitudinal estimates using consistent definitions and designs, would improve understanding of current tobacco transition behaviors.http://deepblue.lib.umich.edu/bitstream/2027.42/110803/1/12889_2015_Article_1594.pd

Modeling smoking-attributable mortality among adults with major depression in the United States

Tobacco-related health disparities disproportionately affect smokers with major depression (MD). Although tobacco simulation models have been applied to general populations, to date they have not considered populations with a comorbid mental health condition. We developed and calibrated a simulation model of smoking and MD comorbidity for the US adult population using the 2005–2018 National Surveys on Drug Use and Health. We use this model to evaluate trends in smoking prevalence, smoking-attributable mortality and life-years lost among adults with MD, and changes in smoking prevalence by mental health status from 2018–2060. The model integrates known interaction effects between smoking initiation and cessation, and MD onset and recurrence. We show that from 2018–2060, smoking prevalence will continue declining among those with current MD. In the absence of intervention, people with MD will be increasingly disproportionately affected by smoking compared to the general population; our model shows that the smoking prevalence ratio between those with current MD and those without a history of MD increases from 1.54 to 2.42 for men and from 1.81 to 2.73 for women during this time period. From 2018–2060, approximately 484,000 smoking-attributable deaths will occur among adults with current MD, leading to 11.3 million life-years lost. Ambitious tobacco control efforts could alter this trajectory. With aggressive public health efforts, up to 264,000 of those premature deaths could be avoided, translating into 7.5 million life years gained. This model can compare the relative health gains across different intervention strategies for smokers with MD

Water and Sanitation in Schools: A Systematic Review of the Health and Educational Outcomes

A systematic review of the literature on the effects of water and sanitation in schools was performed. The goal was to characterize the impacts of water and sanitation inadequacies in the academic environment. Published peer reviewed literature was screened and articles that documented the provision of water and sanitation at schools were considered. Forty-one peer-reviewed papers met the criteria of exploring the effects of the availability of water and/or sanitation facilities in educational establishments. Chosen studies were divided into six fields based on their specific foci: water for drinking, water for handwashing, water for drinking and handwashing, water for sanitation, sanitation for menstruation and combined water and sanitation. The studies provide evidence for an increase in water intake with increased provision of water and increased access to water facilities. Articles also report an increase in absenteeism from schools in developing countries during menses due to inadequate sanitation facilities. Lastly, there is a reported decrease in diarrheal and gastrointestinal diseases with increased access to adequate sanitation facilities in schools. Ensuring ready access to safe drinking water, and hygienic toilets that offer privacy to users has great potential to beneficially impact children’s health. Additional studies that examine the relationship between sanitation provisions in schools are needed to more adequately characterize the impact of water and sanitation on educational achievements

Editorial: Managing for the future: challenges and approaches for disentangling the relative roles of environmental change and fishing in marine ecosystems

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Joint ICES/EUROMARINE: Workshop on common conceptual mapping methodologies (WKCCMM; Outputs from 2021 meeting)

The Joint ICES/EUROMARINE Workshop on Common Conceptual Mapping Methodologies (WKCCMM) aimed to advance approaches to support inter- and transdisciplinary science via qualitative conceptual models to inform Integrated Ecosystem Assessment (IEA) throughout Eu-ropean seas and beyond. The workshop focused on developing a common understanding of conceptual mapping meth-odologies, their key uses and limitations, and processes for effective conceptual modelling with stakeholders for a variety of applications (e.g. developing food-webs, socio-ecological modelling, scoping exercises, rapid/initial management action and/or impact evaluations). Discussion in-volved presentation and discussion of a range of conceptual modelling approaches and contexts through the examination of case studies. These case studies gave rise to a suite of recommenda-tions, including the development of a workflow for IEA, and more generic guidelines and best practice advice for the use of conceptual modelling approaches with stakeholders. Although stakeholders were not able to be included in this workshop, they were very much at the heart of discussions, with the challenges and good practices of stakeholder inclusion addressed. WKCCMM also investigated how the methodologies can be best used to contribute to IEA, and may otherwise be applied throughout the ICES community, including identifying opportunities for cross-collaboration and knowledge transfer within the network.info:eu-repo/semantics/publishedVersio

Towards ecosystem-based management: identifying operational food-web indicators for marine ecosystems

Modern approaches to Ecosystem-Based Management and sustainable use of marine resources must account for the myriad of pressures (interspecies, human and environmental) affecting marine ecosystems. The network of feeding interactions between co-existing species and populations (food webs) are an important aspect of all marine ecosystems and biodiversity. Here we describe and discuss a process to evaluate the selection of operational food-web indicators for use in evaluating marine ecosystem status. This process brought together experts in food-web ecology, marine ecology, and resource management, to identify available indicators that can be used to inform marine management. Standard evaluation criteria (availability and quality of data, conceptual basis, communicability, relevancy to management) were implemented to identify practical food-web indicators ready for operational use and indicators that hold promise for future use in policy and management. The major attributes of the final suite of operational food-web indicators were structure and functioning. Indicators that represent resilience of the marine ecosystem were less developed. Over 60 potential food-web indicators were evaluated and the final selection of operational food-web indicators includes: the primary production required to sustain a fishery, the productivity of seabirds (or charismatic megafauna), zooplankton indicators, primary productivity, integrated trophic indicators, and the biomass of trophic guilds. More efforts should be made to develop thresholds-based reference points for achieving Good Environmental Status. There is also a need for international collaborations to develop indicators that will facilitate management in marine ecosystems used by multiple countries.JRC.D.2-Water and Marine Resource