Efficacy of a universal smoking cessation intervention initiated in inpatient psychiatry and continued post-discharge: A randomised controlled trial

• Published in: Australian and New Zealand journal of psychiatry Vol. 51; no. 4; pp. 366 - 381
• Main Authors: Metse, Alexandra P, Wiggers, John, Wye, Paula, Wolfenden, Luke, Freund, Megan, Clancy, Richard, Stockings, Emily, Terry, Margarett, Allan, John, Colyvas, Kim, Prochaska, Judith J, Bowman, Jenny A
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-04-2017
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Australia; Care; Child; Evaluation; Female; Humans; Inpatients; Male; Mental Disorders - complications; Mental Health Services; Mentally ill; Middle Aged; Nicotine addiction; Patient Discharge; Self Care; Smoking - therapy; Smoking Cessation - methods; Smoking cessation programs; Treatment Outcome; Young Adult; Smoking cessation; mental health services; mental illness; intervention; inpatient
• ISSN: 0004-8674; 1440-1614
• DOI: 10.1177/0004867417692424

Objective:
Interventions are required to redress the disproportionate tobacco-related health burden experienced by persons with a mental illness. This study aimed to assess the efficacy of a universal smoking cessation intervention initiated within an acute psychiatric inpatient setting and continued post-discharge in reducing smoking prevalence and increasing quitting behaviours.
Method:
A randomised controlled trial was undertaken across four psychiatric inpatient facilities in Australia. Participants (N = 754) were randomised to receive either usual care (n = 375) or an intervention comprising a brief motivational interview and self-help material while in hospital, followed by a 4-month pharmacological and psychosocial intervention (n = 379) upon discharge. Primary outcomes assessed at 6 and 12 months post-discharge were 7-day point prevalence and 1-month prolonged smoking abstinence. A number of secondary smoking-related outcomes were also assessed. Subgroup analyses were conducted based on psychiatric diagnosis, baseline readiness to quit and nicotine dependence.
Results:
Seven-day point prevalence abstinence was higher for intervention participants (15.8%) than controls (9.3%) at 6 months post-discharge (odds ratio = 1.07, p = 0.04), but not at 12 months (13.4% and 10.0%, respectively; odds ratio = 1.03, p = 0.25). Significant intervention effects were not found on measures of prolonged abstinence at either 6 or 12 months post-discharge. Differential intervention effects for the primary outcomes were not detected for any subgroups. At both 6 and 12 months post-discharge, intervention group participants were significantly more likely to smoke fewer cigarettes per day, have reduced cigarette consumption by ⩾50% and to have made at least one quit attempt, relative to controls.
Conclusions:
Universal smoking cessation treatment initiated in inpatient psychiatry and continued post-discharge was efficacious in increasing 7-day point prevalence smoking cessation rates and related quitting behaviours at 6 months post-discharge, with sustained effects on quitting behaviour at 12 months. Further research is required to identify strategies for achieving longer term smoking cessation.