Smoking rates among individuals with psychiatric disorders are disproportionately higher than the general population. In fact, these individuals are estimated to consume almost half (44.3%) of all cigarettes smoked in the U.S. and have lifespans 25 - 32 years shorter than the general population. In 2011, 1.8 million U.S. adults, including 7.2% of adults with severe mental illness (SMI), received inpatient psychiatric treatment. The majority of psychiatric hospitals ban smoking on hospital grounds, thus providing an opportunity for inpatients to experience abstinence. Yet smokers in inpatient psychiatric settings are infrequently provided with referrals for cessation treatment on discharge (<1 %) and most resume smoking upon discharge. Therefore, the integration of effective cessation interventions within the current mental health treatment system is a public health priority. We have recently described and have now completed a comparative effectiveness trial in hospitalized medical patients, comparing Standard Care to an Extended Care smoking intervention that provided up to 3 months of smoking cessation medication at no cost to patients and 5 proactive, computerized telephone calls during which patients could request to receive a call back from a live counselor. This Extended Care service demonstrated clinical effectiveness, yielding significantly greater biochemically-verified, point prevalence abstinence relative to Standard Care, 6 months after hospital discharge. The overall objective of this project is to adapt this Extended Care (ExC) model to smokers with SMI engaged in a psychiatric hospitalization and to conduct a randomized, pragmatic effectiveness trial designed to assess the benefit of this adapted ExC in real-world practice. We will test the hypothesis that, among smokers with SMI in inpatient psychiatric treatment (n = 422), ExC will result in significantly greater rates of cotinine- validated, 7-day point prevalence abstinence at 6- and 12-months compared to a group that receives Brief Education (BE) about smoking cessation. Furthermore, we hypothesize that a higher proportion of ExC vs. BE patients will use evidence-based smoking cessation treatment (counseling and pharmacotherapy) in the month after discharge. We will also explore the effect of ExC on health and health care utilization in the 12 months post-discharge (psychiatric symptoms, psychiatric and medical hospital readmissions and emergency room visits) and the effectiveness of ExC on smoking abstinence in patient diagnostic subgroups. The expected outcome of this project is a demonstration of the effectiveness of an Extended Care intervention for smoking cessation in individuals with SMI following psychiatric hospitalization. Future studies could extend these findings to individuals with SMI receiving outpatient psychiatric treatment or psychotherapy. Overall, this research would have a significant positive public health impact that will move us closer to the long- term goal of dissemination and integration of the Extended Care model to increase smoking cessation and decrease smoking related morbidity and mortality in people with severe mental illness.
Given the disproportionately high rates of smoking and smoking-related morbidity and mortality among people with severe mental illness (SMI), the integration of effective smoking cessation interventions into psychiatric treatment settings is a public health priority. This pragmatic effectiveness trial will examine whether an Extended Care service intervention that has been successfully implemented for smoking cessation in medical hospitals for the general population, can be adapted and shown to be effective for smokers with SMI engaged in a psychiatric hospitalization. We expect that as a result of this study, we will have demonstrated the effectiveness of an Extended Care intervention for smoking cessation in individuals with SMI following psychiatric hospitalization which will have a significant positive public health impact that will move us closer to the long-term goal of dissemination and integration of effective, practical interventions to increase smoking cessation and decrease smoking related morbidity and mortality in people with severe mental illness.
