Effectiveness of a telephone-based intervention for smoking cessation in patients with severe mental disorders: study protocol for a randomized controlled trial

TOBACCO USE DISORDER AND DUAL DISORDERS Joint statement by the Spanish Psychiatry Society and the Spanish Dual Disorders Society

Tobacco Use Disorder (TUD) is a health problem of the first order in the world population, affecting a vulnerable population, such as people with other mental disorders, whose morbidity and mortality are increased as a result.

Acceptability and participation predictors for a pragmatic randomized controlled trial to test a smoking cessation intervention after discharge from mental health wards

BACKGROUND AND AIM

Hospitalization is an ideal time to promote smoking cessation, but interventions are limited for supporting cessation maintenance after discharge. This study aimed to evaluate the acceptability of participating in a trial that tested the efficacy of an intensive telephone-based intervention for smokers after discharge.

METHODS

Adult smokers admitted to mental health wards of six hospitals were invited to participate in the trial. We studied the study acceptance/decline rates by analyzing the characteristics of participants (e.g., sex, age, psychiatric disorder, smoking pattern) and hospitals (e.g., size, tobacco control implementation). We calculated adjusted odds ratios (aOR) to assess predictors of non-participation.

RESULTS

Of 530 smokers that met the study inclusion criteria, 55.5% (n = 294) agreed to participate. Participant and non-participants were not different in sex, age, or psychiatric diagnosis. Compared to non-participants, participants had made more attempts to quit in the past year (66.1% vs 33.9%; p < 0.001) and reported higher abstinence rates during the hospital stay (66.7% vs. 33.3%; p = 0.05). Participation rates by hospital varied from 30.9% to 82.0% (p < 0.001). Predictors of non-participation were not having attempted to quit in the last year (aOR=2.42; 95%CI: 1.66-3.53) and low level of tobacco control in the hospital (aOR range: 1.79-6.39, p < 0.05).

CONCLUSIONS

A telephone-based intervention to promote smoking cessation after discharge was accepted by half of the smokers with mental health disorders. Smokers that had attempted to quit previously and those that stayed in hospitals with a strong tobacco control policy were more likely to participate in the trial.

Multidisciplinary barriers to addressing tobacco cessation during an inpatient psychiatric hospitalization

Tobacco use and resultant health complications disproportionately impact individuals with psychiatric disorders. Inpatient psychiatric hospitalizations provide an opportunity to initiate tobacco treatment. In this study, electronic medical record review identified demographic and clinical information, smoking status, and tobacco cessation treatment offered for adults hospitalized on two acute, non-smoking psychiatric units in Massachusetts from January 2016 to March 2018. We additionally conducted semi-structured interviews with 15 inpatient nursing, psychiatry, psychology and social work providers regarding their tobacco cessation treatment practices and perceived facilitators and barriers to addressing tobacco use on psychiatric inpatient units. Chart review identified 1099 of 3140 (35%) people admitted reporting daily tobacco smoking. On discharge, 5 (0.005%) of inpatient smokers received a prescription for varenicline, 43 (0.04%) for dual-nicotine replacement therapy, 211 (19.2%) for nicotine patch, and 5 (0.005%) for bupropion. Barriers to inpatient smoking cessation treatment initiation identified in qualitative interviews included: 1) smoking cessation as low priority, 2) smoking cessation as the responsibility of outpatient providers, 3) lack of education about tobacco treatment, and 4) treatment discussions framed as preventing withdrawal. Given the potential to impact a large percentage of psychiatric tobacco users, future interventions should investigate provision of tobacco cessation counseling and pharmacotherapy in inpatient settings, with interventions that take into account the barriers and opportunities presented in this study.

Prevalence and Epidemiological Profile of Smokers in the Psychiatric Population and General Population: Smokers in Psychiatric Population

This study aims to estimate the prevalence of smokers living in Brazil who use outpatient and hospital psychiatric services and outpatient services in primary health care services. It also aims to identify the sociodemographic and clinical factors associated with current smoking in these samples. This is a cross-sectional study with 378 participants from a Brazilian city: P1, persons from the mental health outpatient service; and P2, persons from the psychiatric hospital; P3, general population from the primary healthcare center. A Poisson multiple regression model for current smoking was adjusted. The prevalence of smokers was greater in the psychiatric population than those in the primary health care population (mental health outpatient service = 27%, psychiatric hospital = 60.3%, primary healthcare center = 19%). Current smoking is associated with younger groups (15-29 years old: PRadjusted = 3.35; 30-39 years old: PRadjusted = 2.28), Roman Catholicism (PRadjusted = 1.60), not having a religion (PRadjusted = 2.45), severe psychiatric illness (PRadjusted = 3.04), anxiety disorders/other disorders (PRadjusted = 3.96), and the previous and current use of alcohol (PRadjusted = 2.27 and 2.25, respectively) and illicit substances (PRadjusted = 1.81 and 2.00, respectively). In conclusion, the independent factors associated with current smoking are age, religion, psychiatric diagnosis, and use of alcohol/illicit substances.