title: Efficacy of a universal smoking cessation intervention initiated in inpatient psychiatry and continued post-discharge: A randomised controlled trial.
abstract: OBJECTIVE
  Interventions are required to redress the disproportionate tobacco-related health burden experienced by persons with a mental illness. This study aimed to assess the efficacy of a universal smoking cessation intervention initiated within an acute psychiatric inpatient setting and continued post-discharge in reducing smoking prevalence and increasing quitting behaviours.
  
  
  METHODS
  A randomised controlled trial was undertaken across four psychiatric inpatient facilities in Australia. Participants ( N = 754) were randomised to receive either usual care ( n = 375) or an intervention comprising a brief motivational interview and self-help material while in hospital, followed by a 4-month pharmacological and psychosocial intervention ( n = 379) upon discharge. Primary outcomes assessed at 6 and 12 months post-discharge were 7-day point prevalence and 1-month prolonged smoking abstinence. A number of secondary smoking-related outcomes were also assessed. Subgroup analyses were conducted based on psychiatric diagnosis, baseline readiness to quit and nicotine dependence.
  
  
  RESULTS
  Seven-day point prevalence abstinence was higher for intervention participants (15.8%) than controls (9.3%) at 6 months post-discharge (odds ratio = 1.07, p = 0.04), but not at 12 months (13.4% and 10.0%, respectively; odds ratio = 1.03, p = 0.25). Significant intervention effects were not found on measures of prolonged abstinence at either 6 or 12 months post-discharge. Differential intervention effects for the primary outcomes were not detected for any subgroups. At both 6 and 12 months post-discharge, intervention group participants were significantly more likely to smoke fewer cigarettes per day, have reduced cigarette consumption by ⩾50% and to have made at least one quit attempt, relative to controls.
  
  
  CONCLUSIONS
  Universal smoking cessation treatment initiated in inpatient psychiatry and continued post-discharge was efficacious in increasing 7-day point prevalence smoking cessation rates and related quitting behaviours at 6 months post-discharge, with sustained effects on quitting behaviour at 12 months. Further research is required to identify strategies for achieving longer term smoking cessation.
authors.affiliation: 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.|2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
authors.forename: Alexandra P
authors.initials: AP
authors.lastname: Metse
authors.affiliation: 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.|2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.|3 Hunter New England Population Health, Wallsend, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Wiggers
authors.affiliation: 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.|2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.|3 Hunter New England Population Health, Wallsend, NSW, Australia.
authors.forename: Paula
authors.initials: P
authors.lastname: Wye
authors.affiliation: 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.|2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.|3 Hunter New England Population Health, Wallsend, NSW, Australia.
authors.forename: Luke
authors.initials: L
authors.lastname: Wolfenden
authors.affiliation: 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.|2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
authors.forename: Megan
authors.initials: M
authors.lastname: Freund
authors.affiliation: 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.|2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.|4 Centre for Translational Neuroscience and Mental Health, Calvary Mater Hospital, Waratah, NSW, Australia.
authors.forename: Richard
authors.initials: R
authors.lastname: Clancy
authors.affiliation: 5 National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Stockings
authors.affiliation: 6 Mental Health and Substance Use Service, Calvary Mater Hospital, Waratah, NSW, Australia.
authors.forename: Margarett
authors.initials: M
authors.lastname: Terry
authors.affiliation: 7 Mental Health Alcohol and Other Drugs Branch, Queensland Health, Fortitude Valley, QLD, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Allan
authors.affiliation: 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.
authors.forename: Kim
authors.initials: K
authors.lastname: Colyvas
authors.affiliation: 8 Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA, USA.
authors.forename: Judith J
authors.initials: JJ
authors.lastname: Prochaska
authors.affiliation: 1 The University of Newcastle, Australia, Callaghan, NSW, Australia.|2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
authors.forename: Jenny A
authors.initials: JA
authors.lastname: Bowman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002648:Child; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008605:Mental Health Services; D008875:Middle Aged; D010351:Patient Discharge; D012648:Self Care; D012907:Smoking / Q000628:therapy*; D016540:Smoking Cessation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Smoking cessation; inpatient; intervention; mental health services; mental illness