Effectiveness of a Smoking Cessation Intervention in a Mental Health Day Hospital

Study Overview
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Brief Summary
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Background: Nicotine contained in tobacco is highly addictive and tobacco use is a major risk factor for cardiovascular and respiratory diseases. Every year, more than 8 million people die from tobacco use. Smoking-related mortality is significantly higher in people with serious mental illness. Is estimated that half of all deaths among individuals with mental illnesses are attributable to tobacco use. People with serious mental illness have greater daily tobacco consumption, nicotine dependence, and smoking relapse. While significant progress has been made in reducing tobacco use within the general population, rates of tobacco use remain high among individuals with mental illness. Smoking cessation often requires numerous attempts by these people. Thus, smokers with mental health illnesses may find it more difficult to quit, although highly motivated to quit. Smoking cessation during hospitalization (total or partial) is cost-effective, as it reduces hospital readmissions, and mortality, and improves smokers' quality of life. Available quitting aids are both safe and effective in supporting cessation in tobacco users with mental illness and stopping smoking is associated with an improvement in mental health. The investigators aimed to evaluate the feasibility and efficacy of adding an intensive smoking intervention to the usual treatment for patients with psychiatric disorders attending a day hospital of a tertiary hospital.

Detailed Description
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The investigators will perform a quasi-experimental, longitudinal, and prospective study in the mental health day hospital of the Hospital Clinic of Barcelona. Adults attending the day hospital and willing to participate, under informed consent, will be invited to participate. Consecutive eligible individuals will be recruited and will be assigned to two groups, the control group, and the experimental group. Initially, patients will be recruited for the control group, once the control group is completed the experimental group will begin. An assessment will be conducted at baseline (admission) and in the discharge. Sociodemographic and clinical data will be obtained.

Official Title
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Effectiveness of a Smoking Cessation Intervention in a Mental Health Day Hospital

Conditions
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Tobacco Use Disorder, Smoking Cessation, Mental Disorder

Intervention / Treatment
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* Behavioral: Smoking cessation program
* Behavioral: Placebo Comparator: Brief Counselling


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Mental health day hospital inpatient. Smoker of at least 1 cigarette per day, electronic cigarette, or heated tobacco product daily for at least 1 month. Individuals who accept to participate in the study and give informed consent. Exclusion Criteria: Cognitive impairment, dementia, or brain damage. Medically unstable. Explicitly demanding tobacco treatment. Trying to quit smoking using another intervention. Insufficient comprehension skills in Spanish or Catalan.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Non-Randomized
Intervention Model: Sequential Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Experimental: Intervention Group<br>Participants in the intervention group will receive an intensive motivational intervention with individual and group treatment for smoking cessation. The treatment, provided by trained professionals, will include psychological, psycho-educational support and pharmacological treatment advice. | Behavioral: Smoking cessation program<br>* Participants will receive intensive treatment for smoking cessation during day hospital admission. The intervention is carried out individually and in an open-ended group. The treatment, provided by trained and multidisciplinary professionals (nursing, psychiatry, psychologist, occupational therapist, social work), includes psychological, psycho-educational support, and pharmacological treatment advice. The group intervention takes place once a week and is divided into six structured sessions that are repeated. Sessions include nicotine addiction and withdrawal, health consequences, benefits of quitting, motivation for change, triggers, coping responses, social support, decision making, pharmacological treatment advice and healthy lifestyle habits.<br>|
| Placebo Comparator: Placebo Comparator: Brief Counselling<br>Participants in the placebo group will receive a brief intervention for smoking cessation. | Behavioral: Placebo Comparator: Brief Counselling<br>* Participants will receive brief counseling on smoking cessation during their hospital stay. This brief intervention is based on motivational techniques to increase motivation to reduce tobacco use or to initiate treatment.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Tobacco use changes from baseline to post-intervention | Number of cigarettes smoked in past 24 hours. | An average of 2 months | 
| Motivation to quit smoking changes from baseline to post-intervention | Individuals will be assessed with the Richmond test. | An average of 2 months | 
| Cotinine levels in urine changes from baseline to post-intervention | Urine cotinine levels | An average of 2 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Nicotine dependence changes from baseline to post-intervention | Change of self reported tobacco dependence using Fagerström Test for Nicotine Dependence. | An average of 2 months | 
| Self-efficacy to quit smoking changes from baseline to post-intervention | Change of self reported self-efficacy (using a Likert scale from 0 to 10). Minimum value: 0. Maximum value: 10. Higher scores indicate more self-efficacy to quit smoking. | An average of 2 months | 
| Smoking knowledge changes from baseline to post-intervention | Changes in smoking knowledge obtained through a knowledge questionnaire developed by the researchers. | An average of 2 months | 
| Trait and state anxiety changes from baseline to post-intervention | Changes in anxiety obtained through the State-Trait Anxiety Inventory. Minimum value: 20. Maximum value: 80. Higher scores indicate greater anxiety. | An average of 2 months | 
| Depressive symptoms changes from baseline to post-intervention | Changes in depressive symptoms obtained through the Montgomery and Asberg Depression. Minimum value: 0 Maximum value: 60. A score of less than 10 points indicate the absence of depressive disorder. | An average of 2 months | 
| Self-reported clinically relevant psychological symptoms changes from baseline to post-intervention | Changes in self-reported clinically relevant psychological symptoms through the Brief Symptom Inventory. Minimum value: 0. Maximum value: 72. Higher scores indicate higher levels of psychological distress. | An average of 2 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Motivational Interviewing, Group Counseling