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Three factors influencing physical health in serious mental illness:smoking, health education, and employment

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Author	Nawaz, Saira.
Title	Three factors influencing physical health in serious mental illness:smoking, health education, and employment
Date	2012
Abstract	The confluence of patient, provider, and system level factors contributes to excess mortality due to preventable medical conditions among people with serious mental illness (SMI) compared to the general population. Study one explored how contextual factors influenced beliefs, attitudes, and behaviors of smokers with SMI in three race/ethnicity groups (African American, Latino and White). A thematic analysis of focus group interviews with SMI smokers showed that respondents felt the culture of mental healthcare had a greater influence on normalizing smoking behavior than membership to a particular race/ethnicity group. Compared to White participants, African American and Latino participants relied more heavily on family and friends than mental health providers for advice about quitting compared, and this peer advice led to misinformation about the effectiveness of smoking cessation. Study two examined trends in the provision of health education in office-based visits to psychiatrists from 1995-2009 using the National Ambulatory Medicare Care Survey. To assess change in the extent of involvement of psychiatrists, I used bivariate and multiple logistic methods to compare the provision of health education from 1995-1997 to 2007-2009 for demographic, clinical, and practice-based subgroups. The rate of health education doubled from 6.4% (1995-1997) to 12.1% (2007-2009), with notable increases for visits with diagnosis of schizophrenia and substance abuse disorders, as well as visits with current smokers. Health education appeared to be appropriately targeted to individuals with SMI, patients with comorbid medical illness, and current smokers. Study three explored the relationship between medical conditions, physical functioning, and employment, for social security disability beneficiaries with schizophrenia and affective disorders. Using hierarchical and k-means clustering, I developed a comprehensive measure of physical health that combines medical comorbidity, BMI scores, SF-12 physical scores, and overall general health. The clustering approach produced three clusters (healthiest, moderately healthy, and sickest groups) with predicted variation. Physically healthier individuals were twice as likely to achieve intermediate work outcomes compared to those in the sickest group, but physical health did not appear to be tied to steady work. Study findings inform the adaptation of current mental health services to address the medical and social needs of this vulnerable group.
Description	viii, 139 leaves : ill. ; 28 cm.
Format	application/pdf
Advisor	Drake, Robert E; McHugo, Greg; Olfson, Mark; Carpenter-Song, Elizabeth
College	Dartmouth Institute for Health Policy and Clinical Practice.
Issuing Body	Dartmouth Dissertations are made available through the Dartmouth Digital Library.
Degree	Thesis (Ph.D.)--Dartmouth College.
Copyright	All rights reserved. No part of this book may be reproduced in any form by any electronic or mechanical means without permission in writing from the author.
DOI	http://dx.doi.org/10.1349/ddlp.425

Title	Page 1
Format	application/pdf
Issuing Body	Dartmouth Dissertations are made available through the Dartmouth Digital Library.
Degree	Thesis (Ph.D.)--Dartmouth College.
Full Text	Three factors influencing physical health in serious mental illness: smoking, health education, and employment A Dissertation Presented to the Faculty n partial fulfillment of the requirements for the Ph.D. degree in Health Policy and Clinical Practice, Dartmouth College by Saira Nawaz DARTMOUTH COLLEGE Hanover, New Hampshire May 2012 Dissertation Committee: __________________________ Robert E Drake, M.D., Ph.D. __________________________ Gregory J. McHugo, Ph.D. __________________________ Elizabeth Carpenter-Song, Ph.D. __________________________ Mark Olfson, M.D., M.P.H (external) ____________________ Saira Nawaz, Ph.D,

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