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

Responses to real-world and hypothetical e-cigarette flavor bans among US young adults who use flavored e-cigarettes

Introduction E-cigarette flavor bans could reduce or exacerbate population health harms. To determine how US e-cigarette flavor restrictions might influence tobacco use behavior, this study assesses responses to real-world and hypothetical flavor bans among young adults who use flavored e-cigarettes. Aims and Methods An online, national survey of young adults ages 18–34 who use flavored e-cigarettes was conducted in 2021 (n = 1253), oversampling states affected by e-cigarette flavor restrictions. Participants were asked about their responses to real-world changes in the availability of flavored e-cigarettes. Unaffected participants were asked to predict their responses under a hypothetical federal e-cigarette flavor ban. Results The most common response to real-world changes in flavored e-cigarettes availability was to continue vaping (~80%). Among those who exclusively vaped, 12.5% switched to combustible tobacco. Quitting all forms of tobacco was selected by 5.3% of those exclusively vape versus 4.2% who dual use. Under a hypothetical federal ban, more than half of respondents stated they would continue vaping; 20.9% and 42.5% of those who exclusively vape versus dual use would use combustible tobacco. Quitting all tobacco products was endorsed by 34.5% and 17.2% of those who exclusively vape versus dual use. Conclusions Young adults who vape flavored e-cigarettes have mixed responses to e-cigarette flavor bans. Under both real-world and hypothetical e-cigarette flavor bans, most who use flavored e-cigarettes continue vaping. Under a real-world ban, the second most common response among those who exclusively vape is to switch to smoking; under a hypothetical federal ban, it is to quit all tobacco. Implications This is the first national survey to directly ask young adults who use flavored e-cigarettes about their responses to real-world changes in flavored e-cigarette availability due to state and local flavor restrictions. The survey also asked individuals to predict their responses under a hypothetical federal e-cigarette flavor ban. Most who use flavored e-cigarettes would continue vaping following e-cigarette flavor restrictions, but many would switch to or continue using combustible tobacco, highlighting potential negative public health consequences of these policies. Policymakers must consider the impact of e-cigarette flavor bans on both e-cigarette and cigarette use

Responses to real-world and hypothetical menthol flavor bans among us young adults who smoke menthol cigarettes

Introduction: Menthol cigarette bans have been implemented in some US states and localities, and a federal ban is being proposed by the FDA. This study asks how young adults who use menthol cigarettes respond to changes in menthol cigarette availability. Aims and Methods: An online survey of young adults ages 18–34 who reported smoking menthol cigarettes on ≥7 of 30 days around Thanksgiving 2019 (n = 734), oversampling Massachusetts—the first state with a menthol ban. Participants reported their tobacco use behavior following real-world menthol cigarette bans or predicted their behavior under a hypothetical federal ban. Results: Most respondents who exclusively smoked versus dual used with e-cigarettes continued smoking/using combustible tobacco following real-world bans (95.3% vs. 86.9%), accessing menthol cigarettes from other jurisdictions. Fewer who smoked exclusively responded by using e-cigarettes compared to those who dual used (3.9% vs. 43.7%). Quitting all tobacco use (ie, no smoking, vaping, or any tobacco use) was uncommon for both groups (3.6% vs. 9.0%). Under a hypothetical ban, majorities of those who exclusively smoke and who dual use predicted they would continue smoking (72.2% vs. 71.8%); fewer who smoke exclusively would use e-cigarettes compared to those who dual use (14.7% vs. 41.4%). Those who smoke exclusively were more likely to report quitting all tobacco compared to those who dual use (29.6% vs. 12.4%). Conclusions: Under real-world and hypothetical menthol cigarette bans, most respondents continued smoking. However, more young adults continued smoking following real-world bans, reflecting the limitations of local/state restrictions when menthol cigarettes are available in other jurisdictions. Implications: This survey asked young adults who use menthol cigarettes how they responded to real-world changes in the availability of menthol cigarettes; 89% reported continuing to smoke. Those who smoked exclusively were far less likely to respond by switching to e-cigarettes compared to people who dual used both products. Under a hypothetical federal menthol cigarette ban, 72% of young adults predicted that they would continue smoking. Quitting all tobacco was less common in the real-world scenario compared to the hypothetical ban. Access to menthol cigarettes in other jurisdictions and flavored cigars likely dampen the public health benefit of menthol cigarette bans

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