Efficacy of initiating tobacco dependence treatment in inpatient psychiatry: a randomized controlled trial.
OBJECTIVE
We evaluated the efficacy of a motivational tobacco cessation treatment combined with nicotine replacement relative to usual care initiated in inpatient psychiatry.


METHODS
We randomized participants (n = 224; 79% recruitment rate) recruited from a locked acute psychiatry unit with a 100% smoking ban to intervention or usual care. Prior to hospitalization, participants averaged 19 (SD = 12) cigarettes per day; only 16% intended to quit smoking in the next 30 days. Results. Verified smoking 7-day point prevalence abstinence was significantly higher for intervention than usual care at month 3 (13.9% vs 3.2%), 6 (14.4% vs 6.5%), 12 (19.4% vs 10.9%), and 18 (20.0% vs 7.7%; odds ratio [OR] = 3.15; 95% confidence interval [CI] = 1.22, 8.14; P = .018; retention > 80%). Psychiatric measures did not predict abstinence; measures of motivation and tobacco dependence did. The usual care group had a significantly greater likelihood than the intervention group of psychiatric rehospitalization (adjusted OR = 1.92; 95% CI = 1.06, 3.49).


CONCLUSIONS
The findings support initiation of motivationally tailored tobacco cessation treatment during acute psychiatric hospitalization. Psychiatric severity did not moderate treatment efficacy, and cessation treatment appeared to decrease rehospitalization risk, perhaps by providing broader therapeutic benefit.
At the time of the study, the authors were with the Department of Psychiatry, University of California, San Francisco.
Judith J
JJ
Prochaska
Stephen E
SE
Hall
Kevin
K
Delucchi
Sharon M
SM
Hall
D000328:Adult; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D010349:Patient Compliance / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011567:Psychiatric Department, Hospital; D016540:Smoking Cessation / Q000379:methods*; D016896:Treatment Outcome