Faculty Bibliography

BACKGROUND: Providers and patients are encouraged by reduction in the number of cigarettes smoked, but it is unclear this represents a meaningful outcome. A proactive telephone smoking cessation counseling study in smokers with mental illness examined whether a reduction in number of cigarettes smoked per day (CPD) from baseline to 2 months associated with sustained reduction or abstinence at 6 months. METHODS: Participants (421) from a multi-site VA study evaluating telephone care for VA smokers with mental illness received smoking cessation education, were offered cessation medications and received telephone counseling from the VA or State Quitline. Participants completed a structured assessment upon enrollment, and 2 and 6 months postenrollment. Chi-square analyses examined whether persons who were abstinent or had reduced their CPD by at least 50% by 2 months were more likely to be abstinent or have continued their reduction in smoking at 6 months. RESULTS: 104 participants completed baseline, 2 month and 6 month surveys. 49%(50/104) achieved at least a 50% reduction in CPD by 2 months, 44% (22/50) were abstinent. 50% (26/50) of patients who achieved at least 50%reduction in CPDby 2 months remained at the reduced number of CPD or decreased their CPDmore by 6 months. Patients who reduced CPD by 50%by 2 months were more likely to be abstinent at 6 months compared to patients who had not achieved 50% reduction in CPD by 2 months (44% vs. 19%, OR =3.46, 95%CI 1.43-8.38). Patients who were abstinent by 2months weremore likely to be abstinent at 6 months compared to patients who were not abstinent by 2 months (81% vs. 17%, OR=21.9, 95%CI 6.4-74.5). CONCLUSIONS: Data support short-term harm reduction as a model for long-term abstinence in a mental health population. Referral to smoking cessation counseling and initial harm-reduction steps should be encouraged for patients not ready or able to immediately quit. All smokers, no matter their stage of change, should be offered effective cessation trea!

Introduction: State smoking-cessation telephone Quitlines have become an integral part of the United States' public health strategy for helping smokers quit. It is unclear whether these Quitlines meet the needs of smokers with a mental illness, who have unique challenges during the quitting process and may benefit from more intensive treatment. We conducted a needs assessment survey of U.S. state Quitlines (N= 51, including Washington, D.C.) to learn how they work with mentally ill callers. Methods: Quitline representatives were asked whether they have or perform six services chosen to represent basic elements of treatment access, process, and structure for mentally ill smokers. Results: We had a 96 percent response rate to our inquiries. All surveyed Quitlines accept calls from mentally ill smokers, and all either train their counselors in mental health or their counselors have past mental health training. In addition, all Quitlines encourage mentally ill callers to discuss quitting with their usual care provider for safety reasons. However, only eight sun'eyed Quitlines screen callers for mental illness, nine use specific counseling protocols for mentally ill callers, and only three have self-help materials tailored for the mentally ill. Discussion: Future studies are needed to identify the most effective approaches to providing telephone-based care for smokers with mental illness.

Objective: State smoking cessation telephone quitlines have become an integral part of the U.S. public health strategy for helping smokers quit. It is unclear whether these quitlines meet the needs of smokers with a mental illness, who have unique challenges during the quitting process and may benefit from more intensive treatment compared to smokers without mental illness. We conducted a needs assessment survey of U.S. state quitlines (N=51 including Washington DC) to learn how they work with mentally ill callers. Methods: Quitline representatives were asked whether they have, or perform, six services chosen to represent basic elements of treatment access, process and structure for mentally ill smokers. Findings: We had a 96% response rate to our survey. All surveyed quitlines accept calls from mentally ill smokers, and all either train their counsellors in mental health or their counsellors have past mental health training. In addition, all quitlines encourage mentally ill callers to discuss quitting with their regular healthcare providers for safety reasons. However, only eight surveyed quitlines (16%) screen callers for mental illness, few (18%) use specific counselling protocols for mentally ill callers, and even fewer (6%) have self-help materials tailored for the mentally ill. Conclusions: Future studies are needed to analyse these variations in state quitline operations to identify the most effective approaches to providing telephone-based treatment for smokers with mental illness.

Three experiments assessed how speakers avoid linguistically and nonlinguistically ambiguous expressions. Speakers described target objects (a flying mammal, bat) in contexts including foil objects that caused linguistic (a baseball bat) and nonlinguistic (a larger flying mammal) ambiguity. Speakers sometimes avoided linguistic-ambiguity, and they did so equally regardless of whether they also were about to describe foils. This suggests that comprehension processes can sometimes detect linguistic-ambiguity before producing it. However, once produced, speakers consistently avoided using the same linguistically ambiguous expression again for a different meaning. This suggests that production processes can successfully detect linguistic-ambiguity after-the-fact. Speakers almost always avoided nonlinguistic-ambiguity. Thus, production processes are especially sensitive to nonlinguistic- but not linguistic-ambiguity, with the latter avoided consistently only once it is already articulated.

Diagnostic tests for Alzheimer's disease (AD) involving tropicamide blockade of cholinergic oculomotor functions were examined in AD patients (n=15), Parkinson's disease (PD) patients (n=15), and non-clinical control (NC) participants (n=15). Pupillographic methods were used to measure pupil diameter and pupillary light reflexes after double-blind ocular administration of dilute tropicamide (0.01%) in one eye and saline in the other eye. Changes in pupil size were measured in bright background light and near-darkness. Tropicamide increased pupil diameter to a similar extent in all three groups in light and darkness. Tropicamide also reduced the amplitude and latency of the pupillary light reflex to a similar extent for all three groups. Tropicamide pupillary response tests, therefore, were not sensitive or specific diagnostic tests for AD. Peak constriction amplitude of the pupillary light reflex was significantly reduced in both eyes in AD and PD groups relative to non-clinical controls, but AD and PD groups did not differ significantly. The pupillary light reflex test, therefore, was sensitive to AD, but lacked adequate specificity. Finally, peak constriction amplitude correlated significantly with dementia severity and donepezil treatment may have partially normalized pupillary light reflex abnormalities in AD patients. The pupillary light reflex test, therefore, may index central cholinergic dysfunction associated with disease progression and improvement in cholinergic function associated with pharmacologic treatment response in AD.