An integrated smoking intervention for mental health patients: a randomised controlled trialJenny Bowman: Jacqueline Bailey

Introduction Interventions with a potential population health impact are required to redress the disproportionate tobacco-related health burden experienced by persons with a mental illness. The efficacy of a smoking cessation intervention initiated within an acute psychiatric inpatient setting and continued post-discharge was assessed. Methods A two-arm, parallel group simple 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 a 4-month multimodal smoking cessation intervention (comprising pharmacological and behavioural strategies; n = 379), upon discharge. Outcomes assessed at 6 and 12 months post-discharge were: 7-day point prevalence smoking abstinence (primary outcome); daily cigarette consumption, number and duration of quit attempts, nicotine dependence and readiness to quit (secondary outcomes). Results Abstinence rates were higher for intervention participants (16.9%) than controls (9.5%) at 6 months post discharge (OR 1.07, p = 0.03), but not at 12 months (OR 1.02, p = 0.46). At both 6 and 12 months post-discharge, intervention group participants were smoking fewer cigarettes per day (p = 0.005), were more likely to have reduced their cigarette consumption by at least 50% (p = 0.02), and to have attempted to quit one (p = 0.001) or more (p = 0.002) times, relative to controls. Conclusions Provision of 4 months of multimodal cessation support to all smokers following discharge from a psychiatric inpatient facility resulted in greater abstinence in the short term. Additional research is required to identify strategies for further promoting quitting behaviours and ultimately achieving sustained smoking cessation among persons with a mental illness. Key message: - The integrated intervention had positive and sustained effects on quitting behaviours, however only temporarily increased abstinence rates