Smoking Cessation Following Psychiatric Hospitalization

Smoking rates among individuals with psychiatric disorders are disproportionately higher than
the general population. The majority of psychiatric hospitals ban smoking on hospital
grounds, thus providing an opportunity for inpatients to experience abstinence. Yet smokers
in inpatient psychiatric settings are infrequently provided with referrals for cessation
treatment on discharge (< 1 %) and most resume smoking upon discharge. Therefore, the
integration of effective cessation interventions within the current mental health treatment
system is a public health priority.

The overall objective of this project is to adapt a Sustained Care (SusC) model to smokers
with severe mental illness (SMI) engaged in a psychiatric hospitalization and to conduct a
randomized, pragmatic effectiveness trial designed to assess the benefit of this adapted SusC
intervention in real-world practice. We will test the hypothesis that, among smokers with SMI
in inpatient psychiatric treatment (n = 422), SusC will result in significantly greater rates
of cotinine-validated, 7-day point prevalence abstinence at 6- and 12-months compared to a
group that receives Usual Care (UC) about smoking cessation. Furthermore, we hypothesize that
a higher proportion of SusC vs. UC patients will use evidence-based smoking cessation
treatment (counseling and pharmacotherapy) in the month after discharge. We will also explore
the effect of SusC on health and health care utilization in the 12 months post-discharge
(psychiatric symptoms, psychiatric and medical hospital readmissions and emergency room
visits) and the effectiveness of SusC on smoking abstinence in patient diagnostic subgroups.

The expected outcome of this project is a demonstration of the effectiveness of a Sustained
Care intervention for smoking cessation in individuals with severe mental illness (SMI)
following psychiatric hospitalization. Future studies could extend these findings to
individuals with SMI receiving outpatient psychiatric treatment or psychotherapy. Overall,
this research would have a significant positive public health impact that will move us closer
to the long-term goal of dissemination and integration of the Sustained Care model to
increase smoking cessation and decrease smoking related morbidity and mortality in people
with severe mental illness.