Medicare was roughly comparable to that in the NIMH study (3) but was more than five times higher than that found in Texas (4). Ethnicity. The most striking patterns of utilization related to ethnicity. Hispanics were estimated to make up 20.8 percent ofthe Californiapopulation in 1985, but our analysis showed that they accounted for only 8.9 percent ofall discharges for mental health, mental retardation, and substance abuse problems (8.5 percent ofpatient days) and 9.2 percent of the discharges for schizophrenia(9.8 percent ofpatient days). In sharp contrast, blacks, who constitute 7.6 percent of California’s population, accounted for 1 1 .9 percent of all discharges for mental health, mental retardation, and substance abuse problems (14. 1 percent of patient days) and 19. 1 percent of the discharges for schizophrenia (24.2 percent ofpatient days). Patient identifiers, zip codes, and longitudinal data for all discharges will make it possible to conduct far more revealing cross-sectional analyses of inpatient care in the future. LAURIE

M.P.A.

CRUMPTON,

CHANDLER

DAVID

STOLP,

WARNER,

PH.D.

PH.D.

Ms. Crumpton, who lives in Austin, is legislative aide to Texas State Rep resentative Lloyd Criss of Galveston. Dr. Stolp is an associate professor and Dr. Warner is a professor at the Lyndon B. Johnson School ofPublic Affairs at the University ofTexas at Austin. References 1. Stolp C, Warner D, Juretic utilization ofmental health, dation,

and

substance

abuse

M: Hospital mental retarservices

in

California an analysis ofpatterns by age, sex, ethnicity, and facility types. Social Science Quarterly 70:687-707, 1989 2. Kiesler C, Sibulkin AA: Mental Hospitalization: Myths and Facts About a National Crisis. Newbury Park, Calif Sage, 1987 3.

Rosenstein derscheid

MJ, RW:

Millazzo-Sayre

U,

Man-

Care of persons with schizophrenin a statistical profile. SchizophreniaBulletin 15:45-58, 1989

4.

Warner D, Crumpton L, Watts G: Financing costs ofcaring for the chronically men-

tally ill in Texas, in Community Care of the Chronically Mentally Ill. Edited by Bojean C, Coleman M, Iscoe 1. Austin, Tex, Hogg Foundation for Mental Health, 1989

Hospital

and Community

Psychiatry

Patients

Why To

the

Editor:

Smoke Most

patients

with

schizophrenia smoke cigarettes regularly ( 1), yet their reasons for doing so have not been reported. Determining why patients with schizophrenia smoke may be a useful first step toward developing suitable cessation programming for them. No doubt, such programs will become increasingly important with the advent ofmore smoking control policies at psychiatric facilities (2). In one ofthe first examinations of this topic, we surveyed all patients with a DSM-III-R diagnosis of schizophrenia at four treatment programs about their smoking habits, reasons for smoking and quitting, withdrawal experiences, and their beliefs about smoking. Brief questionnaires were completed by 59 patients, of whom 1 8 were inpatients and 4 1 were outpatients. The subjects, 55 males and four females, had a mean ± SD age of 36.6 ± 9.4 years. Seventy-eight percent were current smokers, 19 percent were former smokers, and 3 percent had never smoked. Current smokers smoked a mean ± SD of 2 1 .8 ± 14.6 cigarettes per day, had been smoking a mean of 16.4 ± 8.8 years, and had made a mean of 2. 1 ± 2.4 attempts to quit. A substantial proportion of the smokers (37 percent) reported no desire to quit. The majority of our sample reported smoking for the same reasons that nonschizophrenic persons do, desired to quit for similar reasons, experienced typical withdrawal symptoms, and shared the same health beliefs about smoking (3-4). The most prevalent reasons for smoking included relaxation (80 percent), “out ofhabit” (67 percent), and “settling nerves” (52 percent).

The

most

prevalent

reasons

for

wanting to quit smoking among current and former smokers were concerns about health (47 percent), dislike of addiction (39 percent), and desire to save money (37 percent). The most common withdrawal complaints were increased craving for a cigarette (65 percent) and feeling nervous (66 percent). More than 70 percent of smokers and 75 per-

September

1990

Vol. 4 1

No.

cent of nonsmokers believed smoking causes lung cancer, heart disease, and emphysema. Significantly more nonsmokers (38 percent) than smokers (5 percent) were bothered by others smoking around them (x2=9.1, df= 1, p

Why patients smoke.

Medicare was roughly comparable to that in the NIMH study (3) but was more than five times higher than that found in Texas (4). Ethnicity. The most st...
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