This study was a correlational study that aimed to examine the direct and indirect associations between the predictors of smoking cessation and smoking status in smokers with schizophrenia. In addition, attempts to quit smoking were found to have a significant negative direct effect on smoking status (ß = -.46). 133 Table 15 Possible range, actual range, mean, standard deviation (SD), skewness and kurtosis of quit attempts.
134 Table 16 Possible range, actual range, mean, standard deviation (SD), skewness, and kurtosis of smoking status.
INTRODUCTION
Smokers with schizophrenia need an effective smoking cessation intervention delivered by mental health professionals who encourage them to try to quit. Therefore, in this study, the possible factors that influenced the smoking cessation attempt and smoking status in smokers with schizophrenia were reviewed. To identify the predictors of quit attempts and smoking status in smokers with schizophrenia.
Rationale: Smoking cessation intervention is the single predictor of smoking cessation attempts and smoking status in smokers with schizophrenia.
LITERATURE REVIEW
Overview of smokers with schizophrenias
From previous research by Amanda Baker et al. 2007) investigated the characteristics of 298 community-dwelling smokers with psychotic disorder (56.7% with schizophrenia). Research has shown that socioeconomic and environmental factors are important for a high percentage of schizophrenics who smoke (Hughes et al. 1986). In addition, nicotine helps alleviate some of the negative symptoms of schizophrenia (Patkar et al., 2002).
Smoking has also been associated with positive improvement symptoms such as hallucinations and delusions (Smith et al., 2002).
Smoking cessation services for smokers with schizophrenia
Although patients can be referred to specialists within the NHS smoking cessation service, it would make the most sense to integrate and co-ordinate smoking cessation services within mental health where people with more severe mental illness are treated. This is important as existing smoke-free policies in mental health settings appear to have had little effect on smoking cessation in the long term, possibly in part due to poor coordination between inpatient and outpatient services and smoking cessation services. 2010) assessed the attitudes of mental health professionals towards the treatment of tobacco dependence and found that more than two-thirds of participants felt it was important for mental health services to be involved in helping patients to quit smoking; however, only 26% said they raised the issue of tobacco use with patients. Psychiatric units should be an integral part of a more health-promoting culture in the mental health setting by providing important smoking cessation activities throughout the day that go beyond therapeutic settings.
Baker, Richmond, Haile et al. 2006) conducted a randomized controlled trial of a smoking cessation intervention among people with psychotic disorder.
Mental health nurse’s role in smoking cessation among smokers with
Screening for tobacco use and addiction is one of the most important first steps for mental health professionals in treating their patients' tobacco addiction.
Quit attempt
Several authors stated that a quit attempt, defined as a smoker's self-reported successful cessation of smoking for at least 24 hours. In this study, a quit attempt refers to abstinence from smoking for 24 hours in the past 30 days. Several of the authors cited above noted that quit attempts can be measured by asking smokers to report the number of quit attempts and to have smokers try to quit for at least 24 hours.
In this study, quit attempts were measured by the self-report questionnaire for smokers with schizophrenia who quit smoking at least 24 hours, 7 days after.
Smoking status
"Current smoker" is someone who has smoked more than 100 cigarettes in their lifetime and currently smokes at least monthly. In this study, smoking status is defined as the number of cigarettes smoked per day by smokers with schizophrenia one month after hospital discharge. In this study, researcher smoking status was measured by self-report of smokers with schizophrenia for one month after hospital discharge.
Smoking status was measured by the number of cigarettes smoked per day one month after discharge.
Factors related to quit attempt and smoking status in smokers with
Motivation to quit is defined as smokers' desire or energy to be persistently interested in quitting smoking, stimulated by intrinsic motivation and extrinsic motivation. Motivation to quit is defined as the desire of smokers with schizophrenia to be interested in quitting smoking, stimulated by intrinsic and extrinsic forces. In this study, motivation to quit is defined as schizophrenic smokers' desire to be interested in quitting smoking, stimulated by intrinsic and extrinsic forces.
The sources of motivation to quit smoking in smokers with schizophrenia are intrinsic (intrinsic) motivation, which is health concern and self-control, and extrinsic (extrinsic) motivation, which is immediate reinforcement and social influence. There are existing instruments that have been used to measure motivation to quit smoking in the general population and the psychiatric population. In this study, motivation to quit smoking refers to smokers with schizophrenia's desire to quit smoking, influenced by intrinsic motivation and extrinsic motivation.
Participants with higher levels of nicotine dependence were less able to quit smoking successfully within 24 hours. In this study, readiness to quit smoking is defined as smokers with schizophrenia thinking or planning to change behavior from smoking to quitting smoking. Assessment of readiness to quit smoking in general was created using the readiness ruler (Rollnick, Miller, & Butler, 2008).
Details of the instruments used to measure readiness to quit are as follows: In this study, The Readiness to Quit Ladder, developed from Abrams, Boutwell et al. 1991) was used to measure readiness to quit smoking in smokers with schizophrenia.
Research related in factors influencing the quit attempt and smoking status
Smokers who received advice from health care providers to quit smoking in the past 12 months were more likely to report a quit attempt during the same time period (AOR. Both the number of days smoked and the amount of smoking in the previous 30 days was associated with lower odds of a 12-month quit attempt Compared to participants with lower levels of nicotine dependence, smokers with moderate and severe dependence were more likely to have reported at least one attempt to quit smoking in their lifetime (AOR and AOR, respectively).
Receipt of health care provider advice to quit smoking in the past 12 months was associated with increased odds of a lifetime quit attempt (AOR. Finally, the odds of a lifetime quit attempt were inversely related to the number of cigarettes smoked in the past 30 days.2010) investigated whether measures of motivation to quit have different predictive relationships with quit attempts and the maintenance of those attempts. The result revealed that the factors related to the attempt to quit smoking showed that male participants were 20% less likely than females to make an attempt to quit smoking (odds ratio [OR confidence interval [CI.
Higher levels of nicotine dependence as measured by the baseline FTND score were associated with lower likelihood of a quit attempt (OR CI. Results showed that lower nicotine dependence (modified Fagerström Tolerance Questionnaire [mFTQ]), higher Behavioral Inhibition System score and lower baseline heart rate were predictive of SQA in both the univariate and the multivariate models.2010) assessed effect of clinic advice and patient readiness to quit on quit attempt in hospitalized smokers. Those who were prepared and given advice to quit were more likely to make a quit attempt and report abstinence than those who were less prepared.
They conducted logistic regression analyzes to examine how the intermediate association and smoking-related variables influenced a quit attempt. Smokers exposed to smoke at home monthly or less frequently were more likely to have attempted to quit (OR=1.80, 95% CI) than those exposed on a daily basis.
METHODOLOGY
The summary of the measure is presented in Table 3. 3) The Alcohol Use Disorders Identification Test (AUDIT). The summary of the measurement is presented in Table 3. 4) The Fagerstrom Test for Nicotine Dependence (FTND). The summary of the measure is presented in Table 3. 5) The Scale for Quitting (RFQ).
A summary of the measure is presented in Table 3. 7) Positive Symptom Rating Scale (PSRS). A summary of the measure is presented in Table 3. 9) Calgary Depression Scale for Schizophrenia (CDSS). A summary of the measure is presented in Table 3. 10) Intensity of the smoking cessation intervention questionnaire.
In this study, the content validity index of the intensity of smoking cessation intervention questionnaire was 1.00 in both scale-content validity index (S-CVI) and item content validity index (I-CVI). In this study, the reliability of the Intensity of Smoking cessation intervention questionnaire was determined by considering internal consistency analysis using Cronbach's alpha coefficient. The quit attempt questionnaire from Rojnawee (2014) was modified to fit this study by changing the time period from "past 12 months" to "seven days after hospital discharge" Therefore the question was "How many times within seven days after hospital admission" . discharge have you stopped smoking for 24 hours or longer?”.
The effects of independent variables on quit attempt and smoking status in smokers with schizophrenia were presented, and the findings are described below. Finally, all predictor variables in the model explained approximately 45% (R2 = 0.45) of the variance in quit attempt and smoking status in smokers with schizophrenia. Intensity of the smoking cessation intervention had a significant positive indirect effect on quit attempt via willingness to quit (ß= .14, p < .05) and had a nonsignificant positive indirect effect on quit attempt via motivation to quit (ß= .02, p > 0.05). This part did not support this hypothesis. An explanation for this finding, which did not support the hypothesis, is that approximately 60% of the subjects reported that they had not received a smoking cessation intervention, which could have accounted for the variance of this variable.
This finding does not support this hypothesis. The unexpected results may be explained by the fact that the period measuring nicotine level, positive symptoms, and negative symptoms were asked during hospitalization and before the smokers with schizophrenia were discharged from the hospital. Furthermore, the intensity of the smoking cessation intervention influenced the attempt to quit smoking through willingness to quit smoking. The pre-contemplation phase (do not intend to quit smoking in the future, usually measured as . the next 6 months), assess readiness to quit smoking and provide information about the effect of smoking on health.
RESULTS
DISCUSSION, IMPLICATIONS, AND RECOMMENDATIONS
