Mary F. Brunette

People with serious mental illness (i.e., disabling psychotic, mood, and other disorders) develop chronic medical diseases early in life. This study aimed to examine the effects of integrating primary care into community mental health centers (CMHCs; reverse integrated care) on service use among young adults with serious mental illness who may benefit from early intervention. This retrospective cohort analysis used Medicaid claims of 945 people with serious mental illness (ages 18-40) in CMHC care from 2020 to 2022-315 in reverse integrated care and 630 propensity score matched participants in comparison care (i.e., not reverse integrated care). Logistic regression, adjusted for participant characteristics, enrollment quarter, and past service use, assessed outcomes in the 6 months after enrollment. Participants' mean±SD age was 32.56 ± 7.84 years; 29% had a diagnosis of schizophrenia, 40% had a co-occurring substance use disorder, 33% had a medical emergency department (ED) visit in the 6 months before enrollment, and all were enrolled in CMHC care at baseline. During follow-up, participants in reverse integrated care were more likely to have an outpatient medical visit (65% vs. 58%; adjusted odds ratio [AOR]=1.54, p=0.005) and were less likely to have a medical ED visit (26% vs. 33%; AOR=0.70, p=0.035) than those in comparison care. Integrating primary care into CMHC services may increase access to outpatient medical care and reduce ED visits for medical reasons among young adults with serious mental illness. Future research should confirm these findings, assess longer-term outcomes, and examine implementation facilitators and barriers.

People with serious mental illness (SMI) are more likely to smoke and less likely to quit than the general population. More effective and accessible cessation treatments are needed to promote health and prevent disease in this disparity population. To this end, we optimized a multicomponent health promotion intervention tailored for people with SMI, Breathe Well, Live Well, and conducted a quasi-experimental program evaluation to assess program feasibility and effectiveness compared with a usual care comparison condition consisting of “The 3 As.” Community mental health center staff trained as health coaches delivered eight telehealth Breathe Well, Live Well sessions over 4 months to individuals. Breathe Well, Live Well content included cognitive behavioral therapy (CBT)-based counseling, pharmacotherapy support, incentivized app use (National Cancer Institute’s quitSTART), and social support person coaching. Participants were 170 integrated mental health and primary care service recipients with SMI who smoked daily; 53 Breathe Well, Live Well and 117 comparison participants were enrolled during February 2020 through July 2022. Effectiveness was measured via biologically verified abstinence; feasibility was measured via Breathe Well, Live Well intervention engagement. Participants of Breathe Well, Live Well were about three times more likely to be abstinent at follow-up compared with comparison participants. Among those still smoking, Breathe Well, Live Well participants were about five times more likely to have decreased their daily cigarette consumption by at least half. Intervention engagement was strong for pharmacotherapy, counseling, and incentivized quitSTART app use, indicating that these components were feasible to deliver by community mental health center staff.

An interesting study by Spike et al examined mortality among 83 071 people with an acute psychosis-related hospital admission in New South Wales,

Aim: Young adults with serious mental illness (SMI) have poor physical health and high Emergency Department (ED) and hospital utilization. Integrating primary care into community mental health care may be an important form of early intervention. Methods: Adjusted multivariable regressions assessed changes in self‐reported annual primary care, ED and hospital utilization for 83 young adults with SMI enrolled in integrated care. Results: Participants' mean annual per person utilization changed significantly as follows: primary care visits, from 1.8 to 3.6, p < .001; medical ED visits, from 1.0 to 0.6, p < .01; psychiatric ED visits from 0.6 to 0.2, p < .001; medical inpatient days, from 1.2 to 0.1, p < .001 and psychiatric inpatient days, from 6.3 to 2.6, p < .001. Conclusions: Young adults with SMI receiving integrated care increased primary care and reduced ED and inpatient utilization. Future controlled research is warranted to further assess integrated care for young adults with SMI.

Background and Hypothesis: Up to 43% of people with schizophrenia have a lifetime cannabis use disorder (CUD). Tetrahydrocannabinol (THC) has been shown to exacerbate psychosis in a dose-dependent manner, but little research has assessed its effects on schizophrenia and co-occurring CUD (SCZ-CUD). In this double-dummy, placebo-controlled trial (total n = 130), we hypothesized that a modest dose of THC would worsen cognitive function but not psychosis. Study Design: Effects of single-dose oral THC (15 mg dronabinol) or smoked 3.5% THC cigarettes vs placebo in SCZ-CUD or CUD-only on positive and negative symptoms of schizophrenia (only for SCZ-CUD), cognition, and drug experiences assessed several hours after drug administration. SCZ-only and healthy control participants were also assessed. Study Results: Drug liking was higher in THC groups vs placebo. Neither smoked THC nor oral dronabinol predicted positive or negative symptom subscale scores 2 and 5 h, respectively, after drug exposure in SCZ-CUD participants. The oral dronabinol SCZ-CUD group, but not smoked THC SCZ-CUD group, performed worse than placebo on verbal learning (B = −9.89; 95% CI: −16.06, −3.18; P = .004) and attention (B = −0.61; 95% CI: −1.00, −0.23; P = .002). Every 10-point increment in serum THC + THCC ng/ml was associated with increased negative symptoms (0.40 points; 95% CI: 0.15, 0.65; P = .001; subscale ranges 7–49) and trends were observed for worse positive symptoms and performance in verbal learning, delayed recall, and working memory. Conclusions: In people with SCZ-CUD, a modest single dose of oral THC was associated with worse cognitive functioning without symptom exacerbation several hours after administration, and a THC dose-response effect was seen for negative symptoms.

Recent surveys show rising numbers of young people who report anxiety and depression. Although much attention has focused on mental health of adolescent youth, less attention has been paid to young people as they transition into adulthood. Multiple factors may have contributed to this steady increase: greater exposure to social media, information, and distressing news via personal electronic devices; increased concerns regarding social determinants of health and climate change; and changing social norms due to increased mental health literacy and reduced stigma. The COVID-19 pandemic may have temporarily exacerbated symptoms and impacted treatment availability. Strategies to mitigate causal factors for depression and anxiety in young adults may include education and skills training for cognitive, behavioral, and social coping strategies, as well as healthier use of technology and social media. Policies must support the availability of health insurance and treatment, and clinicians can adapt interventions to encompass the specific concerns and needs of young adults.

James D Sargent, MD, Kathryn C Edwards, PhD, Jennifer Emond, PhD, Susanne Tanski, MD, Kristie A Taylor, PhD, John P Pierce, PhD, Maciej L Goniewicz, PhD PharmD,

Background Research on cigarettes and adult asthma offers mixed findings, perhaps due to overlap with chronic obstructive pulmonary disease (COPD) and inadequate adjustment for other smoke exposures. Associations between other tobacco products, including e-cigarettes, and asthma are also understudied. Research question Using Population Assessment of Tobacco and Health Study waves 2–4 (2014/2015–2016/2017) data, we assessed the relation between tobacco product use and asthma in persons unlikely to have COPD. Study design and methods Prospective study of 10 267 adults aged 18–39 years without COPD diagnoses. Past-month tobacco use at wave 2 was modelled first as combustible versus non-combustible use and second as specific product categories (former, cigarettes, e-cigarettes, cigars, hookah, smokeless tobacco). Outcomes included lifetime asthma prevalence at wave 2, incidence (waves 3 and 4) and Asthma Control Test score (lower=worse). Multivariable regressions adjusted for predictors of asthma, including other smoke exposures: cigarette pack-years, secondhand smoke and marijuana use. Sensitivity analyses examined findings when persons >39 years and those with both COPD and asthma were added, and when smoke exposure adjustments were removed. Results No product, including cigarettes and e-cigarettes, was associated with prevalence or incidence of asthma. Among people with asthma at wave 2, combustible tobacco (beta=−0.86, 95% CI (−1.32 to –0.39)) and cigarettes (beta=−1.14, 95% CI (−1.66 to –0.62)) were associated with worse asthma control. No tobacco product was associated with asthma control over time. In sensitivity analyses, tobacco use became associated with incident asthma as adults >39 years and those with asthma+COPD were added, and as adjustments for other smoke exposures were omitted. Interpretation Although cigarette use was associated with worse asthma control, there were no longitudinal associations between combustible tobacco or e-cigarette use and new onset or worsening asthma in these preliminary analyses. Research on tobacco and asthma should exclude COPD and adjust for smoking history and other smoke exposures.

Aim: Community stakeholder engagement in research (CSER) can improve research relevance and efficiency as well as prevent harmful practices, particularly for vulnerable populations. Despite potential benefits, researchers lack familiarity with CSER methods. Methods: We describe CSER strategies used across the research continuum, including proposal development, study planning and the first years of a comparative effectiveness study of care for pregnant women with opioid use disorder. Results: We highlight successful strategies, grounded in principles of engagement, to establish and maintain stakeholder relationships, foster bidirectional communication and trust and support active participation of women with opioid use disorder in the research process. Conclusion: CSER methods support research with a disenfranchised population. Future work will evaluate the impact of CSER strategies on study outcomes and dissemination.

Aims: People with serious mental illness (SMI) are more likely to develop chronic health conditions and die prematurely. Timely identification of modifiable health risk factors may enable early intervention. We aimed to describe the physical health characteristics and service utilization of young people with SMI.Methods: Young people with SMI enrolled in an integrated community mental health clinic (CMHC) and primary care program were assessed for physical and mental health history and past year service utilization.Results: A total of 122 participants, ages 16–35 (m = 27.0 ± 5.0 years), half male, 78.3% White were assessed. Half smoked cigarettes, half had obesity, almost half (47.5%, n = 56) had hypertension, and about a third had laboratory metabolic abnormalities. The group averaged 10.7 ± 5.1 h of sedentary behavior per day. Obesity was associated with high blood pressure, prediabetes, poor self‐rated health abilities, sedentary behavior and low health satisfaction. Over half had been to the emergency department (ED) for a medical reason (55.0%, n = 66) and 24.6% had been hospitalized for a health condition in the past year. Over half had a lifetime cardiovascular risk score indicating a 50–67% chance of having a cardiovascular event; simply quitting smoking would reduce the number with this risk by almost half. Most physical health diagnoses were not recorded in the CMHC record.Conclusion: Young people with SMI newly enrolled in integrated care had high rates of smoking, obesity, hypertension, and other cardio‐metabolic abnormalities contributing to high risk for future disease. Research is needed to examine appealing, scalable interventions to improve health, reduce unnecessary medical care, and prevent disparate chronic disease in this group.