The health impacts of smoking cigarettes are well known and, while the number of smokers in the US has generally declined, rates of smoking among people with mental illness remain higher than those among people without mental illness. People with severe mental illness (SMI) are even more likely to be smokers. Research has shown that combining medication with support programs can help people with SMI who want to quit smoking. Brief motivational interventions can help these smokers get started on the path to quitting, but can these programs make a difference in quitting long term? One NIDILRR--funded study looked at whether a web-based motivational intervention would lead smokers with SMI to engage in any smoking cessation behaviors and start on the path to being smoke-free.
Researchers affiliated with the Rehabilitation Research and Training Center on Psychiatric Disabilities and Co-Occurring Medical Conditions recruited 124 adult smokers with SMI receiving care in a large, urban rehabilitation center who had not tried to quit smoking within the past two months - through either behavioral support or medication treatment. The participants were asked to use a web-based motivational decision support program, made available in the center. The program encouraged participants to quit smoking by using interactive exercises, videos of quit stories, and information about available evidence-based treatments. After completing the web-based program, participants were reminded about the center’s in-person smoking cessation programs and invited to make an appointment to speak with a smoking cessation specialist at the center. The center offers group cessation treatment which participants can join at any time and are encouraged to stay through 12 sessions. In addition to the center’s program, participants were also free to engage in any other treatment programs available to them outside of the center or quit smoking on their own. Cessation medications such as varenicline or nicotine patches were also available by prescription either through the center’s clinic or through the state’s Quitline (800-QuitNow).
Researchers followed up with the participants at two- and six-month intervals after the web-based intervention to see whether they had received the in-person individual or group smoking cessation treatment and/or medication, how many days they were able to stop smoking, and the longest they were able to go without smoking.
The researchers found that, during the six months following the motivational intervention, more than half of the participants reported engaging in some cessation behavior. The findings were as follows:
- 55% of participants reported trying to quit smoking either on their own or using treatment.
- Nearly 40% of participants reported using some form of evidence-based cessation treatment through the clinic.
- Support groups were the most popular treatment option, with 25% of participants attending at least one session.
- Participants attended an average of six sessions per person, half of the recommended treatment.
- Nearly 38% of participants chose a cessation medication and most of those also engaged in a behavioral treatment like the support groups.
- Overall, 60% of participants reported quitting for at least one day.
- 29% of participants reported being able to go at least a week without smoking.
- Participants who had more years of education and those who used some cessation treatment, such as support groups or medication, were more likely to report quitting for at least seven days.
Most of the participants who accessed treatment did so within two months of using the web-based motivational intervention, so the authors recommended that programs and medications should be readily available and accessible to smokers with mental illness who are ready to quit. The authors identified potential barriers to treatment and program access: clinicians and prescribers may lack training on how to provide cessation treatment, have limited knowledge of the overlap of side effects of nicotine withdrawal and the symptoms of mental illness, or may be unsure of the effectiveness and safety of cessation treatment. Insurance coverage may also present a barrier to accessing treatment. According to the authors, most of the study participants were not able to completely quit smoking, which may be because they did not complete the full course of treatment sessions or did not use both a behavioral intervention and a medication. Previous research has shown that it can take up to a year of medication and support for smokers with SMI to successfully quit smoking. The authors recommended that community clinics consider implementation of programs which encourage or provide incentive for engagement and long-term participation in cessation treatment for smokers with SMI.
Since the purpose of the study was to preliminarily demonstrate the ability of a motivational decision support system to spur engaging in quitting behaviors, the researchers did not include a control group who did not receive the motivational intervention. The results of the study did not reveal if smokers with SMI who do not have access to such a system would be more or less likely to sign up for programs to help them quit. According to the authors, the results do show that smokers with SMI can be motivated to quit after just one session with such a system, and the key to success may be easy access to evidence-based treatment and programs in community clinic settings that encourage smokers to stick with those programs for the long term.
To Learn More
The study resulted in a unique medication decision aid for doctors prescribing both psychiatric and smoking cessation medications:
The center also has a podcast on one peer’s journey to quit smoking:
One Woman’s Journey to Quit Smoking and Be Healthier
The step down method helps you deal with nicotine cravings while avoiding the temptation to smoke. Get information and suggestions on how to motivate yourself or someone you love to quit smoking for good!
Additional inspirational quit stories from former smokers with psychiatric disabilities associated with the study are available at:
Find information, tips, texts, and support programs at http://smokefree.gov/
To Learn More About this Study
Ferron, J.C., Devitt, T., McHugo, G.J., Jonikas, J.A., Cook, J.A., and Brunette, M.F. (2016) Abstinence and use of community-based cessation treatment after a motivational intervention among smokers with severe mental illness. Community Mental Health Journal. This article is available from the NARIC collection under Accession Number J73550.