Rapid Fire Session 2014 World Cancer Congress

Impact of a post-discharge smoking cessation intervention for smokers admitted to a smoke-free psychiatric hospital: A randomised controlled trial  (#360)

Emily A. Stockings 1 2 , Jenny A. Bowman 1 2 , Amanda L. Baker 2 3 , Margarett Terry 4 , Richard Clancy 2 3 , Paula M. Wye 5 , Jenny Knight 5 , Lyndell H. Moore 1 , Maree F. Adams 1 , Kim Colyvas 6 , John H. Wiggers 2 5 7
  1. School of Psychology, University of Newcastle, Callaghan, NSW, Australia
  2. Hunter Medical Research Institute (HMRI), New Lambton Heights, NSW, Australia
  3. Centre for Translational Neuroscience and Mental Health (CTNMH), University of Newcastle, Waratah, NSW, Australia
  4. Mental Health and Substance Use Service (MHSUS), Hunter New England Health, Waratah, NSW, Australia
  5. Hunter New England Population Health (HNEPH), Wallsend, NSW, Australia
  6. School of Mathematics and Physical Sciences, University of Newcastle, Callaghan, NSW, Australia
  7. School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia

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.