Long-term abstinence and predictors of tobacco treatment uptake among hospitalized smokers with serious mental illness enrolled in a smoking cessation trial
- 414 Downloads
Hospital patients with serious mental illness (SMI) have high rates of smoking. There are few post-discharge treatment models available for this population and limited research on their treatment uptake following discharge. This study is a secondary analysis of an RCT that compared multi-session intensive telephone counseling versus referral to state quitline counseling at two safety net hospitals in New York City. For this analysis, we selected all trial participants with a history of schizophrenia, schizoaffective disorder or bipolar disorder (N = 384) and used multivariable logistic regression to compare groups on self-reported 30-day abstinence at 6 months and to identify patient factors associated with use of tobacco treatment. Analyses found no significant group differences in abstinence 6 months (28% quitline vs. 29% intervention, p > 0.05), use of cessation medications (42% quitline vs. 47% intervention, p > 0.05) or receipt of at least one counseling call (47% quitline vs. 42% intervention, p > 0.05). Patients with hazardous drinking (p = 0.04) or perceived good health (p = 0.03) were less likely to use cessation medications. Homeless patients were less likely to use counseling (p = 0.02). Most patients did not use cessation treatment after discharge, and the intensive intervention did not improve abstinence rates over quitline referral. Interventions are needed to improve use of cessation treatment and long-term abstinence in patients with SMI.
KeywordsSmoking Smoking cessation Tobacco Mental health Serious mental illness
This work was supported by a Grant from the National Heart, Lung and Blood Institute (NHLBI) of NIH (#1U01HL105229) and a Hurricane Sandy Supplement (#3U01HL105229-04S1).
Compliance with ethical standards
Conflict of interest
Erin S. Rogers, Rebecca Friedes, Annika Jakes, Ellie Grossman, Alissa Link, and Scott E. Sherman declare that they have no conflict of interest.
Human and animal rights and Informed consent
All procedures were in accordance with the ethical standards of the participating institutions’ research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.
- Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): An effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Archives of Internal Medicine, 158, 1789–1795.CrossRefPubMedGoogle Scholar
- CDC. (2010). Number and rate of discharges from short-stay hospitals and of days of care, with average length of stay and standard error, by selected first-listed diagnostic categories: United States, 2010.Google Scholar
- Consortium, N. A. Q. (2009). Measuring quit rates.Google Scholar
- Evins, A. E., Cather, C., Pratt, S. A., Pachas, G. N., Hoeppner, S. S., Goff, D. C., et al. (2014). Maintenance treatment with varenicline for smoking cessation in patients with schizophrenia and bipolar disorder: A randomized clinical trial. JAMA, 311, 145–154. doi: 10.1001/jama.2013.285113 CrossRefPubMedPubMedCentralGoogle Scholar
- Fiore, M. C., Jaén, C. R., Baker, T. B., et al. (2008a). Treating tobacco use and dependence: 2008 update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service.Google Scholar
- Fiore, M. C., Jaén, C. R., Baker, T. B., et al. (2008b). Treating tobacco use and dependence: 2008 update. Rockville, MD: U.S. Department of Health and Human Services, Public Health Service.Google Scholar
- Goodwin, R. D., Kim, J. H., Weinberger, A. H., Taha, F., Galea, S., & Martins, S. S. (2013). Symptoms of alcohol dependence and smoking initiation and persistence: A longitudinal study among US adults. Drug and Alcohol Dependence, 133, 718–723. doi: 10.1016/j.drugalcdep.2013.08.026 CrossRefPubMedPubMedCentralGoogle Scholar
- Grossman, E., Shelley, D., Braithwaite, R. S., Lobach, I., Goffin, A., Rogers, E., et al. (2012). Effectiveness of smoking-cessation interventions for urban hospital patients: Study protocol for a randomized controlled trial. Trials, 13, 126. doi: 10.1186/1745-6215-13-126 CrossRefPubMedPubMedCentralGoogle Scholar
- McInnes, D. K., Petrakis, B. A., Gifford, A. L., Rao, S. R., Houston, T. K., Asch, S. M., et al. (2014). Retaining homeless veterans in outpatient care: A pilot study of mobile phone text message appointment reminders. American Journal of Public Health, 104, S588–S594. doi: 10.2105/ajph.2014.302061 CrossRefPubMedPubMedCentralGoogle Scholar
- Pattanayak, R. D., Jain, R., & Sagar, R. (2012). Reliability of self-reported tobacco use in bipolar disorder: An exploratory study of euthymic patients visiting a tertiary care hospital in India. [Research Support, Non-U.S. Gov’t]. International Journal of Psychiatry in Medicine, 43, 153–163. doi: 10.2190/PM.43.2.d CrossRefPubMedGoogle Scholar
- Rogers, E., & Sherman, S. (2014). Tobacco use screening and treatment by outpatient psychiatrists before and after release of the American Psychiatric Association treatment guidelines for nicotine dependence. American Journal of Public Health, 104, 90–95. doi: 10.2105/AJPH.2013.301584 CrossRefPubMedPubMedCentralGoogle Scholar
- Rogers, E. S., Smelson, D. A., Gillespie, C. C., Elbel, B., Poole, S., Hagedorn, H. J., et al. (2016). Telephone smoking-cessation counseling for smokers in mental health clinics: A patient-randomized controlled trial. American Journal of Preventive Medicine, 50, 518–527. doi: 10.1016/j.amepre.2015.10.004 CrossRefPubMedGoogle Scholar
- Schroeder, S. A., & Morris, C. D. (2010). Confronting a neglected epidemic: Tobacco cessation for persons with mental illnesses and substance abuse problems. Annual Review of Public Health, 31, 297–314, 291p following 314. doi: 10.1146/annurev.publhealth.012809.103701
- Sherman, S. E., Link, A. R., Rogers, E. S., Krebs, P., Ladapo, J. A., Shelley, D. R., et al. (2016). Smoking-cessation interventions for urban hospital patients: A randomized comparative effectiveness trial. American Journal of Preventive Medicine, 51, 566–577. doi: 10.1016/j.amepre.2016.06.023 CrossRefPubMedGoogle Scholar
- Toll, B. A., Cummings, K. M., O’Malley, S. S., Carlin-Menter, S., McKee, S. A., Hyland, A., et al. (2012). Tobacco quitlines need to assess and intervene with callers’ hazardous drinking. Alcoholism, Clinical and Experimental Research, 36, 1653–1658. doi: 10.1111/j.1530-0277.2012.01767.x CrossRefPubMedPubMedCentralGoogle Scholar
- Toll, B. A., Martino, S., O’Malley, S. S., Fucito, L. M., McKee, S. A., Kahler, C. W., et al. (2015). A randomized trial for hazardous drinking and smoking cessation for callers to a quitline. Journal of Consulting and Clinical Psychology, 83, 445–454. doi: 10.1037/a0038183 CrossRefPubMedGoogle Scholar
- Trinh, N. H., Youn, S. J., Sousa, J., Regan, S., Bedoya, C. A., Chang, T. E., et al. (2011). Using electronic medical records to determine the diagnosis of clinical depression. International Journal of Medical Informatics, 80, 533–540. doi: 10.1016/j.ijmedinf.2011.03.014 CrossRefPubMedPubMedCentralGoogle Scholar
- Ziedonis, D., Hitsman, B., Beckham, J. C., Zvolensky, M., Adler, L. E., Audrain-McGovern, J., et al. (2008). Tobacco use and cessation in psychiatric disorders: National Institute of Mental Health report. Nicotine and Tobacco Research, 10, 1691–1715. doi: 10.1080/14622200802443569 CrossRefPubMedGoogle Scholar