Thursday, May 6, 2021

Sustained Model May Be Effective for Smoking Cessation in Psychiatric Patients

A hospital-based smoking cessation intervention that involves motivational counseling and post-discharge follow-up helps patients maintain abstinence longer than usual care, according to a study published Wednesday in JAMA Psychiatry.

“Individuals with serious mental illness (SMI) smoke cigarettes at disproportionately higher rates, are more likely to smoke heavily, and have lower cessation rates than the general population,” wrote Richard A. Brown, Ph.D., of the University of Texas at Austin; Nancy Rigotti, M.D., of Harvard Medical School; and colleagues. “These findings, if replicated, provide a scalable approach to achieving sustained smoking cessation in patients with SMI following a psychiatric hospital stay.”

Brown, Rigotti, and colleagues conducted a clinical trial involving 342 participants aged 18 and older receiving inpatient treatment for SMI who smoked at least five cigarettes per day when not hospitalized. Participants’ diagnoses included depressive, anxiety, bipolar, psychotic, and personality disorders, among others. The participants were randomly assigned to one of two interventions: usual care or sustained care.

Patients assigned to the usual care group received five to 10 minutes of smoking cessation information and advice from the admitting nurse, self-help materials, and an offer of nicotine replacement therapy to use after discharge. Those in the sustained care group received a single 40-minute motivational interview tailored for patients with SMI provided by a smoking cessation counselor; four weeks of free transdermal nicotine patches upon discharge; access to free telephone-, text-, or web-based cessation counseling after discharge provided by a counselor trained to work with callers with psychiatric diagnoses; and enrollment in an automated, interactive voice response telephone system that asked participants about their smoking and intentions to quit following discharge.

The participants in both groups were asked about their use of smoking cessation treatment (smoking counseling and/or pharmacological interventions) at one, three, and six months after hospital discharge. At the six-month follow-up, participants were also asked about smoking in the past seven days; smoking status was also biochemically verified. Participants reported smoking an average of 17 cigarettes per day prior to hospitalization. At the six-month follow-up, those in the sustained care group had significantly higher rates of seven-day abstinence compared with the participants who received usual care (8.9% vs. 3.5%). Participants in the sustained care group were also significantly more likely to report using smoking cessation treatment over the six months following their hospitalization compared with those in the usual care group (74.6% vs. 40.5%).

“These findings are notable, given that two-thirds of this sample could be considered economically disadvantaged (with household annual incomes less than $25,000), in addition to having SMI,” the authors wrote. “Both of these factors are associated with higher smoking rates and less success at quitting.

“Our findings suggest that combining this evidenced-based, client-centered counseling approach with automated, proactive resources, such as [interactive voice response], text messaging, and other technology-assisted interventions … increases the likelihood of successful attempts at quitting,” the authors continued.

For related information, see the Psychiatric News article “Psychiatrists Can Do More to Help Patients Quit Smoking.”

(Image: iStock/Sezeryadigar)

Don't miss out! To learn about newly posted articles in Psychiatric News, please sign up here.


The content of Psychiatric News does not necessarily reflect the views of APA or the editors. Unless so stated, neither Psychiatric News nor APA guarantees, warrants, or endorses information or advertising in this newspaper. Clinical opinions are not peer reviewed and thus should be independently verified.