Providing Aid To People With Serious Mental Illness To Quit Smoking
A recent study "Effect of a Tobacco Cessation Intervention Incorporating Weight Management for Adults With Serious Mental Illness" published in JAMA Psychiatry and funded by the National Institute of Mental Health talks about an 18-month community-based tobacco smoking cessation intervention developed by Gail Daumit, A. Eden Evins, Corinne Cather and colleagues.
Individuals who suffer from serious mental illnesses (SMI) like schizophrenia, bipolar disorder, and major depression, often encounter significant physical health obstacles. For example, those with SMI are twice as likely to die from cardiovascular disease than those without. Moreover, this group has high rates of tobacco smoking.
Despite smoking being the primary preventable reason for death in people with SMI, they are less likely to receive smoking cessation treatment compared to their counterparts. Even when they receive treatment, it often neglects the potential for weight gain. People commonly experience weight gain when they quit smoking, and people with SMI have a higher risk of developing obesity. The detrimental effects of tobacco use, cardiovascular disease, and obesity on people with SMI highlight the pressing need for scalable interventions that address these multiple health concerns.
To be eligible to participate in the study, individuals had to be diagnosed with a serious mental illness, smoke tobacco daily, and express a willingness to attempt smoking cessation within six months.
Before the study, all participants were asked about their readiness to quit smoking within six months, differentiating between being ready to quit within one month versus not being ready to quit within one month. The participants were then randomly assigned to either an intervention group or a control group that did not receive any intervention.
Participants in the intervention group, who reported not being ready to quit smoking within a month, were enrolled in a 4-week motivational enhancement group. This group was specifically designed to increase their motivation to quit smoking. On the other hand, those participants who reported being ready to quit smoking within a month were enrolled in a 7-week behavioural smoking cessation group. Participants were allowed to repeat groups as many times as necessary or switch between the groups if their readiness to quit smoking changed. Additionally, participants were offered smoking cessation medication, regardless of their initial interest in quitting. Lastly, those participants who successfully quit smoking and maintained smoking abstinence for at least a week were encouraged to attend ongoing relapse prevention groups and continue using smoking cessation medication.
During the smoking cessation and weight management sessions, researchers provided both group and individual participants with useful information about the benefits and effective methods of quitting smoking, helping them to identify smoking triggers and more. Additionally, participants in the intervention group were given access to group exercise classes and incentives for participating in the program, including small monetary compensation for group attendance and medallions to commemorate the achievement of health milestones.
According to the research, after 18 months, 26.4 per cent of people in the intervention group managed to quit smoking as compared to only 5.7 per cent of people in the control group. Furthermore, participants in the intervention group were more likely to quit smoking at 6, 12, and 15 months compared to the control group. Interestingly, the ability to quit smoking at 18 months was not significantly influenced by the participants' readiness to quit, psychiatric diagnosis, sex, or race.
Moreover, the study revealed that the intervention group experienced a significant decrease of 12.7 per cent in their 10-year risk for cardiovascular events, while the control group experienced an increase of 3.6 per cent in the same risk factor. However, no significant difference was observed in weight change between the intervention (+0.2 kg) and control (-1.4 kg) groups.
The results of the study suggest that providing extended smoking cessation support to people with SMI can be effective at reducing smoking and improving cardiovascular health—even if people report they are not ready to quit smoking right away. The researchers suggest that making evidence-based smoking cessation programs with medication and counselling more available to people with SMI could help reduce disparities in tobacco-related mortality seen between people with SMI and the general population.
