Smoking Cessation The objective of this literature review is to scrutinize literature about smoking cessation in people with mental health the group diagnosed as having severe mental health problems. The review will begin by examining the extent of smoking within along with the quantity of cigarettes that are consumed by individuals experiencing from bipolar/schizophrenia and by people with psychiatric challenges during the period between 1999 and 2011. Secondly, it will determine the extent to which cigarette smokers with signs of poor psychological health get smoking cessation interventions in primary healthcare consultations relative to those without. Lastly, it will evaluate the barriers, willingness, and resources to use evidence-based interventions in people with mental health challenges. The review takes into consideration three research studies. According to Carosella et al. (2010), smoking is the largest main cause of ill-health and early deaths in the United Kingdom. Smoking accounts for more than 80, 000 deaths in England in 2010 (Romeri et al. 2015). Himelhoch et al. (2014) note that following the fall in the prevalence of smoking in UK in the recent past, a number of studies have revealed that mortality as a result of smoking related illnesses/diseases has significantly fallen. Nonetheless, according to research that was done by Jarvis and Wardle (2016) on smoking and its effect on human being’s social status, it was established that the fall in incidence of deaths as a result of smoking in UK in the recent past conceals significantly social as well as other inequalities. Similarly, in another study that was conducted by Stead et al. (2012), it was revealed that smoking is the greatest cause of preventable deaths among the inhabitants of United States, an argument supported by Himelhoch et al. (2014). The study substantiates this by pointing out that smoking has a high relationship with heart diseases and lung cancer besides the fact that it causes problems like obesity and diabetes, (Grant et al. 2014). There is a lot of literature about interventions that should be employed to help curb the smoking of cigarettes. Nonetheless, there is little literature that correlates smoking cessation interventions to effects of smoking on people who are mentally ill. It is, therefore, justifiable that more study be done on the correlation. To understand more about the correlation, this review considers different studies that were conducted regarding smoking and mental illness. The studies conducted by Dickerson et al. (2014) which was aimed at determining the prevalence of smoking as well as quantities of cigarettes that are consumed by people experiencing from bipolar/schizophrenia disorder along with those who do not have psychiatric disorder during the period between 1999 and 2011. 991 participants with bipolar, schizophrenia, or without mental illness gave information regarding their smoking when they were being recruited for the research, (Dickerson et al. 2014) dissimilarities among persons as well as trends over time for new enrollees were evaluated by use of multivariate models. Additionally, regression analyses were employed to help compare between bipolar and schizophrenia disorder groups, (Dickerson et al. 2014). (Dickerson et al. 2014) used a qualitative research methodology to help determine the prevalence of smoking as well as quantities of cigarettes that are consumed by people suffering from bipolar/schizophrenia disorder along with those who do not have psychiatric disorder during the period between 1999 and 201. According to Bell and Waters (2014), qualitative research, utilizing open-ended questionnaires, structured as well as unstructured observations, and past records of the patients, is descriptive and gives room to people to express their individual thoughts in unstructured manners during the process of conducting interviews. Nevertheless, the methodology can be difficult to work with especially when replication of results is required besides the fact that the technique lacks transparency, (Bell & Waters 2014). The researchers diagnosed each of the respondents with mental disorder by use of a broad and certified psychiatrist based on DSM-IV Axis I Disorders’ Structured Clinical Interview (Dickerson et al. 2014). The participants who never had mental illnesses were screened by the use of DSM-IV Axis I Disorders Non-Patient Edition’s Structured Clinical Interview (Dickerson et al. 2014). All respondents gave written informed permission, and the researches were sanctioned by the Sheppard Pratt Institutional Review Board (Dickerson et al. 2014). This action was in accordance with the British Psychological Society ethics guidelines that states that the Code of Ethics requires that no code should replace the necessity of psychologists to employ their ethical and professional judgement when dealing with human beings, (Bell & Waters 2014). The result of the study by Dickerson et al. (2014 revealed that there are significant differences in the prevalence of cigarette smoking as well as in the amount of cigarettes that are consumed among people diagnosed with schizophrenia and dipolar. Generally, 44% of those experiencing from bipolar disorder, 64% of those experiencing from schizophrenia, and 19% of the participants who are not suffering from any mental illness said that they were still smoking, (Dickerson et al. 2014). The researchers noted that these discrepancies remained relatively the same from 1999 to 2011, and that there were no statistically substantial time patterns in cigarette consumption as well as smoking even after modifications for demographic covariates were made, (Dickerson et al. 2014). They also found out that among the participants who had mental illness, cigarette consumption and smoking were considerably associated with a past record of longer durations of illness, substance abuse, less education, Caucasian race, along with schizophrenia diagnosis yet not with mental sign severity (Daumit et al. 2010). From their study, Dickerson et al. (2014) concluded that the prevalence of smoking alarmingly remained high among people with bipolar and schizophrenia disorder in unchanging mental environments. For this reason, the researchers suggested that concerted determinations are needed urgently to help promote smoking cessation among the groups. The second study regarding smoking is that which was done by Szatkowski and McNeill (2013), which was aimed at quantifying the degree to which cigarette smokers with signs of poor health conditions get smoking cessation support in primary healthcare consultations relative to those who do not have. The research employed a cross-sectional type of study in a database containing information regarding primary healthcare medical past records of people. 495 common practices within the United Kingdom donating data to THIN (The Health Improvement Network) database, 2 493 085 participants (patients) who were aged sixteen years and above were registered with one THIN practice between 1 July 2009 and 30 June 2010 (Szatkowski & McNeill 2013). The researchers used patients’ unique number in addition to registration numbers to extract the relevant information from THIN. They identified patients who exhibited signs of poor psychological mental health in two main ways: red codes helped in identifying patients who had a diagnosis of any one or extra specified psychological health illness during the year of interest (Szatkowski & McNeill 2013) and Consultation file fond within THIN to ascertain the number of exceptional days during which each of the patients contacted a worker at the primary healthcare staff. The results indicated that of 32 154 smokers (50.6%) with a psychological health diagnosis as well as 49.3% of 96 285 smokers who approved a psychoactive prescription had a history of smoking cessation advice, more than the frequency of advice recording in cigarette smokers short of these indicators (33.4%) (Szatkowski & McNeill 2013). Similarly, smoking cessation medication recommending was also higher 11.2% among cigarette smokers with any kind of mental health diagnosis along with the finding that 11.0% of smokers who approved psychoactive treatment obtained a prescription, relative to 6.73% of cigarette smokers short of these indicators (95%) (Szatkowski & McNeill 2013). Additionally, the study found that smoking cessation assistance was provided in lower quantities of consultations for cigarette smokers who exhibited signs of poor psychological health as compared to those without. From the study, it can be clearly stated that smoking cessation interventions can help reduce the high prevalence of smoking cessation among the mentally ill people. From the study, Szatkowski and McNeill (2013) concluded that Nearly half of cigarettes smokers with signs of poor psychological heath status get pieces of advice from primary healthcare staff to help them quit smoking during primary healthcare consultations in the U.K. Additionally, one out of ten patients get a smoking cessation prescription (Szatkowski & McNeill 2013). However, the study established that interventions were lower per every consultation for cigarette smokers who had psychological health signs relative to cigarette smokers who did not have psychological health signs, (Szatkowski & McNeill 2013). The study argues that owing to the burden of dependence on nicotine among people with mental disease along with the fact that dependence on nicotine remains some of the leading cause of disability, death, and disease in the U.S. (Siru et al. 2015),the American Psychiatric Association’s Practice Guideline for the Treatment of Patients With Substance Use Disorders (Reid et al. 2017), Public Health Service (PHS) 2008 guidelines (Stead et al. 2012),the American Psychiatric Association’s Practice Guideline for the Treatment of Patients With Substance Use Disorders (Miller et al. 2014), and National Institutes of Health agreement declarations (Carosella et al. 2010), all strongly recommend that cigarette smokers who have mental disease receive a similar evidence-based cigarette smoking cessation medications just as general smokers. Kelly et al. (2011) point out that this key since the study suggests that cigarette smokers who have mental health issue are equally motivated to quit the tendency to smoke just as the general smokers, an argument supported by Grant et al. (2014). In general, the study establishes that evidence-based cigarette smoking interventions are highly recommended and very critical for enhancing the health of cigarette smokers who have mental disease. This is in agreement with Stead et al. (2012)’s position that inconsistent and poor quality of medical care are strongly related to the high mortality that is observed among people with mental disease. As such, community mental healthcare facilities are increasingly being invited to offer elementary screening as well as medical and preventive services for all the patients that they attend to (Reid et al. 2017). Regrettably, smoking cessation interventions are hardly employed in mental healthcare facilities. The third study was conducted by Himelhoch et al. (2014). This study was aimed at evaluating the barriers, willingness, and resources that should use proof-based interventions within psychological environments (Himelhoch et al. 2014). A total of 95 participants were involved during this research (Himelhoch et al. 2014). To realize this, a survey was conducted on clinicians from nine different community psychological environments within four counties of Maryland (Himelhoch et al. 2014). The questionnaire, the Evidence-Based Practice Attitude Scale, was used to evaluate barriers, utilization, and availability of smoking cessation treatment and assessment, including clinicians’ willingness to employ evidence-based practices. They equally employed interviews on some of the clinicians. Interviews were on the basis of face-to-face with the clinicians and were lasting approximately one hour (Szatkowski & McNeill 2013). The face-to-face interview was preferred because, as noted by Szolnoki & Hoffmann (2013), it has high probability of giving accurate results and sufficient screening during the interview hence likely to give very detailed data. Additionally, a face-to-face interview has the ability to capture non-verbal language expressed by interviewees like body language, gestures, and facial expressions which enhance the interviewer’s ability to comprehend, interpret, and relate better with interviewees without any biasness, (Zhang et al. 2017). Himelhoch et al. (2014) found out that of the 95 participants who were involved in the study, most of them (84%) were full-time workers with those having master’s degree qualification being 56%. The majority of the participants (94%) were former cigarette smokers and or non-smokers (Himelhoch et al. 2014) while 42% of the clinicians admitted that they had inquired from their patients regarding cigarette smoking (Himelhoch et al. 2014). Similarly, 33% of the clinicians assisted or advised their patients with smoking problem while only 10% reported that they had given referrals to cigar smokers to mobile phone quit lines (Himelhoch et al. 2014). 26% reported that they were confident regarding their capability to offer cigarette smoking cessation counseling (Himelhoch et al. 2014). In the same light, the study established that the main barrier/hindrance to the provision of cessation psychoanalysis was the commonplace belief that smoking patients were uninterested in quitting smoking, contributing to 77% (Himelhoch et al. 2014). Averagely, the research established that clinicians had a great willingness to incorporate proof-based cigarette smoking cessation interventions in case they were offered apt coaching. From these findings, the study concluded that psychological health clinicians who worked in community psychological health environments were inconsistently offering proof-based cigarette smoking cessation interventions (Gill & Bennett 2017). Similarly, they concluded that barriers/hindrances seem to be changeable through education and training. To conclude, it is clear that people with mental illness be motivated to quit smoking. From the foregoing literature, it is clearly highlighted that smoking has a number of health implications on smokers. Smoking has a high relationship with heart diseases and lung cancer. Besides, smoking causes health challenges/implications like obesity and diabetes which are akin to several lifestyle diseases like asthma, high blood pressure, and heart failure condition. Similarly, some studies have established that smoking has extra serious psychiatric symptoms, as well as more health comorbidities. Additionally, high rates of smoking has been associated with is linked to greater mortality and morbidity. Smoking also contributes to the high rates of mortality and morbidity among persons with mental illness, especially schizophrenia along with other severe mental diseases. Smoking also leads to a number of lifestyle and chronic diseases that increase healthcare costs for people, especially the mentally challenged ones. As such, by people with mental illness quitting smoking, they will increase their morbidity and mortality by minimizing their chances of experiencing from diseases like lung cancer, obesity, asthma, high blood pressure, and heart failure. Similarly, mentally ill people will be able to reduce their chances of suffering other mental diseases that are associated with smoking tobacco. In the same light, their medical healthcare to the NHS costs will significantly be reduced.   List of References Bell, J, Waters, S 2014, Doing your research project: a guide for first-time researchers. 6th ed. Maidenhead, McGraw-Hill Education, Retrieved from http://0-search.ebscohost.com.wam.city.ac.uk/login.aspx?direct=true&scope=site&db=nle bk&db=nlabk&AN=937946 on April 3, 2017. Carosella, AM, Ossip-Klein, DJ, & Owens, CA 2010, ‘Smoking attitudes, beliefs, and readiness to change among acute and long term care in patients with psychiatric diagnoses’, Addictive Behaviors, vol. 24, no. 7, pp. 331-344. Daumit, GL, Anthony, CB, & Ford, DE 2010, ‘Pattern of mortality in a sample of Maryland residents with severe mental illness’, Psychiatry Research, vol. 176, no. 6, pp. 242-245. Dickerson, F, Stallings, CR, Origoni, AE, Vaughan, C,Khushalani, S, Schroeder, J, & Yolken, RH 2014, ‘Cigarette Smoking Among Persons With Schizophrenia or Bipolar Disorder in Routine Clinical Settings, 1999–2011’, The American Psychiatric Journal, vol. 64, no. 1, pp. 44-50. Gill, BS, & Bennett, DL 2017, ‘Addiction professionals’ attitudes regarding treatment of nicotine dependence’, Journal of Substance Abuse Treatment, vol. 19, no. 3, pp. 317-318. Himelhoch, S,Riddle, J, & Goldman, HH 2014, ‘Barriers to Implementing Evidence-Based Smoking Cessation Practices in Nine Community Mental Health Sites’, Psychiatric Services Journal, vol. 65, no. 1, pp. 75-80. Jarvis, MJ, & Wardle, J 2016, ‘Social patterning of individual health behaviours: the case of cigarette smoking. In: Marmot M., Wilkinson R., editors. Social Determinants of Health. Oxford: Oxford Oxford University Press, pp. 224-37. Kelly, DL, McMahon, RP, & Wehring, HJ 2011, ‘Cigarette smoking and mortality risk in people with schizophrenia’, Schizophrenia Bulletin, vol. 37, no. 1, pp. 832–838. Miller, BJ, Paschall, CB, & Svendsen, DP 2014, ‘Mortality and medical comorbidity among patients with serious mental illness’, Psychiatric Services, vol. 57, no. 9, pp. 1482-1487. Reid, MS, Fallon, B, & Sonne, S 2017, ‘ Implementation of a smoking cessation treatment study at substance abuse rehabilitation programs: smoking behavior and treatment feasibility across varied community-based outpatient programs’, Journal of Addiction Medicine, vol. 13, no.1 pp. 154-160. Romeri, E, Baker, A, & Griffiths, C 2015, ‘Mortality by deprivation and cause of death in England and Wales, 1999–2003’, Health Stat Q vol. 32, no. 1, pp. 19-34. Siru, R, Hulse, GK, & Tait, RJ 2015, ‘Assessing motivation to quit smoking in people with mental illness: a review’, Addiction, vol. 104, no. 11, pp. 719-733. Stead, LF, Perera, R, Bullen, C, Mant, D, Hartmann-Boyce, J, & Cahill, K 2012, ‘Nicotine replacement therapy for smoking cessation’, Cochrane Database Syst Rev, vol. 11, no. 2, 146. Szatkowski, L, & McNeill, N 2013, ‘The delivery of smoking cessation interventions to primary care patients with mental health problems’, Addiction, vol. 108, no. 2, pp. 1487–1494. Szolnoki, G, & Hoffmann, D 2013, 'Online, face-to-face and telephone surveys—Comparing different sampling methods in wine consumer research', Wine Economics and Policy, vol. 2, pp. 57-66. Zhang, X, Kuchinke, L, Woud, ML, Velten, J, & Margraf, J 2017, 'Survey method matters: Online/offline questionnaires and face-to-face or telephone interviews differ', Computers in Human Behaviour, vol. 71, pp. 172-180.