Chronic care treatment for smoking cessation in patients with serious mental illness: a pilot randomized trial
Abstract Background Rates of smoking among those with serious mental illness (SMI) are two to three times higher than for the general population. Smoking is rarely addressed in mental health settings. Innovative outreach and treatment strategies are needed to address these disparities. The current s...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-02-01
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| Series: | BMC Psychiatry |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12888-021-03113-5 |
| _version_ | 1828963517446750208 |
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| author | Andrew M. Busch Dawn M. Nederhoff Shira I. Dunsiger Sandra J. Japuntich Michelle Chrastek Melissa Adkins-Hempel Linda M. Rinehart Harry Lando |
| author_facet | Andrew M. Busch Dawn M. Nederhoff Shira I. Dunsiger Sandra J. Japuntich Michelle Chrastek Melissa Adkins-Hempel Linda M. Rinehart Harry Lando |
| author_sort | Andrew M. Busch |
| collection | DOAJ |
| description | Abstract Background Rates of smoking among those with serious mental illness (SMI) are two to three times higher than for the general population. Smoking is rarely addressed in mental health settings. Innovative outreach and treatment strategies are needed to address these disparities. The current study is a pilot study of the feasibility and acceptability of a chronic care model of tobacco cessation treatment implemented in outpatient psychiatry clinics. Methods Participants were recruited from two outpatient psychiatric clinics and randomly assigned to intervention (counseling and nicotine replacement for 8 weeks, plus ongoing proactive outreach calls inviting reengagement in treatment) or control (brief education and referral to the state quit line). Assessments were conducted at 8 weeks (end of initial treatment block) and 6 months (end of window for retreatment). Feasibility was assessed by enrollment rate, treatment engagement, and completion of follow-up assessments. Acceptability was assessed both quantitatively and qualitatively. Preliminary efficacy was assessed by 7-day and 30-day abstinence rates, rate of quit attempts, and cigarettes per day. Psychological health was measured to assess for changes related to treatment group or attempts to quit smoking. Results Nineteen participants were randomized to intervention and 19 to control. Recruitment proved feasible, and high rates of treatment engagement (mean of 4.5 sessions completed in initial treatment block, 89.5% uptake of nicotine replacement) and retention (94.7% of follow-up assessments completed) were observed. Treatment acceptability was high. As anticipated, there were no significant differences in abstinence between groups, but results generally favored the intervention group, including bio-verified 7-day abstinence rates of 21.1% in intervention vs. 17.6% in control and self-reported 30-day abstinence rates of 16.1% in intervention vs. 5.1% in control at 8 weeks. Significantly more intervention participants made at least one quit attempt (94.7% vs 52.6%; OR = 16.20, 95% CI: 1.79–147.01). Cigarettes per day decreased significantly more in the intervention group at 8 weeks (b = − 13.19, SE = 4.88, p = .02). Conclusions It was feasible to recruit and retain SMI patients in a smoking cessation trial in the context of outpatient psychiatry. The novel chronic care model treatment was acceptable to patients and showed promise for efficacy. If efficacious, a chronic care model could be effective at reducing smoking among SMI patients. Trial registration ClinicalTrial.gov #: NCT03822416 (registered January 30th 2019). |
| first_indexed | 2024-12-14T10:29:42Z |
| format | Article |
| id | doaj.art-3f224a2796134e68bf25839f8754ff6c |
| institution | Directory Open Access Journal |
| issn | 1471-244X |
| language | English |
| last_indexed | 2024-12-14T10:29:42Z |
| publishDate | 2021-02-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Psychiatry |
| spelling | doaj.art-3f224a2796134e68bf25839f8754ff6c2022-12-21T23:06:10ZengBMCBMC Psychiatry1471-244X2021-02-0121111310.1186/s12888-021-03113-5Chronic care treatment for smoking cessation in patients with serious mental illness: a pilot randomized trialAndrew M. Busch0Dawn M. Nederhoff1Shira I. Dunsiger2Sandra J. Japuntich3Michelle Chrastek4Melissa Adkins-Hempel5Linda M. Rinehart6Harry Lando7Department of Medicine, Hennepin HealthcareDivision of Epidemiology and Community Health, University of MinnesotaDepartment of Behavioral and Social Sciences, Center for Health Promotion and Health Equity, Brown University, School of Public HealthDepartment of Medicine, Hennepin HealthcareHennepin Healthcare Research InstituteHennepin Healthcare Research InstituteDepartment of Psychiatry & Behavioral Sciences, University of MinnesotaDivision of Epidemiology and Community Health, University of MinnesotaAbstract Background Rates of smoking among those with serious mental illness (SMI) are two to three times higher than for the general population. Smoking is rarely addressed in mental health settings. Innovative outreach and treatment strategies are needed to address these disparities. The current study is a pilot study of the feasibility and acceptability of a chronic care model of tobacco cessation treatment implemented in outpatient psychiatry clinics. Methods Participants were recruited from two outpatient psychiatric clinics and randomly assigned to intervention (counseling and nicotine replacement for 8 weeks, plus ongoing proactive outreach calls inviting reengagement in treatment) or control (brief education and referral to the state quit line). Assessments were conducted at 8 weeks (end of initial treatment block) and 6 months (end of window for retreatment). Feasibility was assessed by enrollment rate, treatment engagement, and completion of follow-up assessments. Acceptability was assessed both quantitatively and qualitatively. Preliminary efficacy was assessed by 7-day and 30-day abstinence rates, rate of quit attempts, and cigarettes per day. Psychological health was measured to assess for changes related to treatment group or attempts to quit smoking. Results Nineteen participants were randomized to intervention and 19 to control. Recruitment proved feasible, and high rates of treatment engagement (mean of 4.5 sessions completed in initial treatment block, 89.5% uptake of nicotine replacement) and retention (94.7% of follow-up assessments completed) were observed. Treatment acceptability was high. As anticipated, there were no significant differences in abstinence between groups, but results generally favored the intervention group, including bio-verified 7-day abstinence rates of 21.1% in intervention vs. 17.6% in control and self-reported 30-day abstinence rates of 16.1% in intervention vs. 5.1% in control at 8 weeks. Significantly more intervention participants made at least one quit attempt (94.7% vs 52.6%; OR = 16.20, 95% CI: 1.79–147.01). Cigarettes per day decreased significantly more in the intervention group at 8 weeks (b = − 13.19, SE = 4.88, p = .02). Conclusions It was feasible to recruit and retain SMI patients in a smoking cessation trial in the context of outpatient psychiatry. The novel chronic care model treatment was acceptable to patients and showed promise for efficacy. If efficacious, a chronic care model could be effective at reducing smoking among SMI patients. Trial registration ClinicalTrial.gov #: NCT03822416 (registered January 30th 2019).https://doi.org/10.1186/s12888-021-03113-5Serious mental illnessSmokingTobacco |
| spellingShingle | Andrew M. Busch Dawn M. Nederhoff Shira I. Dunsiger Sandra J. Japuntich Michelle Chrastek Melissa Adkins-Hempel Linda M. Rinehart Harry Lando Chronic care treatment for smoking cessation in patients with serious mental illness: a pilot randomized trial BMC Psychiatry Serious mental illness Smoking Tobacco |
| title | Chronic care treatment for smoking cessation in patients with serious mental illness: a pilot randomized trial |
| title_full | Chronic care treatment for smoking cessation in patients with serious mental illness: a pilot randomized trial |
| title_fullStr | Chronic care treatment for smoking cessation in patients with serious mental illness: a pilot randomized trial |
| title_full_unstemmed | Chronic care treatment for smoking cessation in patients with serious mental illness: a pilot randomized trial |
| title_short | Chronic care treatment for smoking cessation in patients with serious mental illness: a pilot randomized trial |
| title_sort | chronic care treatment for smoking cessation in patients with serious mental illness a pilot randomized trial |
| topic | Serious mental illness Smoking Tobacco |
| url | https://doi.org/10.1186/s12888-021-03113-5 |
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