Publications

Smoking among patients with mental illness is a major and underappreciated public health problem. The case of Ms G, a 51-year-old woman with bipolar disorder who wishes to quit smoking, illustrates the importance and feasibility of smoking cessation in patients with psychiatric disorders. Persons with chronic mental illness and/or substance abuse constitute 22% of the US population yet are estimated to consume 44% of cigarettes. As many as 200,000 of the 435,000 annual deaths related to smoking in the United States are estimated to occur in this population. On average, patients with mental illness die 25 years earlier than the general population, and smoking is a major contributor to these premature deaths. In the past, mental health clinicians have tended not to address smoking cessation with their patients, but increasing evidence suggests that such reticence is unwarranted, as smoking cessation in this population is feasible. The approach to cessation should include standard interventions of counseling and pharmacotherapy, for which substantial evidence of efficacy exists in patients with and without mental illness. If patients with mental illness are to achieve wellness, smoking cessation must be an integral component of their treatment regimen.

Systolic heart failure is a major problem for Americans today, with 550,000 new cases diagnosed per year, and ultimately contributes to 287,000 deaths annually. While pharmacologic therapy has drastically improved outcomes in patients with systolic heart failure, hospitalizations from systolic heart failure continue to increase and remain a major cost burden. In response to this unmet need, recent years have seen dramatic improvements in device-based therapy targeting one cause of systolic dysfunction: dyssynchronous ventricular contraction. Cardiac resynchronization therapy aims to restore mechanical synchrony by electrically activating the heart in a synchronized manner. This review summarizes the rationale for cardiac resynchronization therapy, evidence for its use, current guidelines, and ongoing and future directions for research.

We describe correlates of drug use-consequences related variables (addiction concern, problem consequences, and drinking alcohol/using drugs while driving) among two samples of high school students, one in the Russian Federation (n = 365), and one in the United States (n = 965). The correlates used in the analyses are based on the Theory of Triadic Influence, which organizes predictors of adolescent substance misuse into intrapersonal (e.g., depression), cultural/attitudinal (e.g., perceived harmfulness of drug use), and interpersonal (friend and family drug use) types of influence. We examined measures from each type of influence, along with drug use (cigarette and alcohol use) as correlates. Overall, correlates from each of the types of influence were significant predictors of substance use consequences variables in both samples. The most consistent predictors of consequences across countries were depression, perceived harmfulness of drug use, family substance abuser, friends' substance use, and last 30-day cigarette use. These results suggest that the Theory of Triadic Influence is relevant to both countries. We speculate that drug prevention efforts may share common features among some U.S. and Russian youth populations.