Background: Persons with a mental disorder smoke at higher rates and suffer disproportionate tobacco-related burden than the general population. An admission to a smoke-free psychiatric hospital - where smokers are required to abstain from smoking with the support of behavioural and pharmacological nicotine dependence treatment - is a unique opportunity to initiate smoking cessation treatment among such smokers.
Aim: To determine if a smoking cessation intervention initiated during a smoke-free psychiatric hospitalisation and continued post-discharge was effective in reducing smoking behaviours among persons with a mental disorder.
Methods: A randomised controlled trial was conducted at an Australian inpatient psychiatric facility with a total smoke-free policy. Participants were 205 patient smokers randomly allocated to a treatment as usual control (n = 101), or a smoking cessation intervention (n = 104) incorporating psychosocial and pharmacological support for four months post-discharge. Follow-up assessments were conducted at one week, two, four and six months post-discharge and included: abstinence from cigarettes, quit attempts, daily cigarette consumption and nicotine dependence.
Results: Seven-day point prevalence abstinence was significantly higher for intervention (11.5%) than control (2%) participants at four months post-discharge (OR = 6.46, p = .01). Participants in the intervention condition reported significantly more quit attempts (F [1,202.5] = 15.23, p = .0001), and lower daily cigarette consumption (F [4, 586] = 6.5, p < .001) and levels of nicotine dependence (F [3, 406] = 8.5, p <.0001) than controls at all follow-up assessments. Use of nicotine replacement therapy was associated with validated abstinence at the four month follow-up (χ2 (3) = 6.8, p = .009).
Conclusions: Post-discharge cessation support was effective in encouraging quit attempts and reducing cigarette consumption up to six months post-discharge. Additional support strategies are required to facilitate longer term cessation benefits for smokers with a mental disorder.