Sustained Care Smoking Cessation Intervention for Individuals Hospitalized for Psychiatric Disorders: The Helping HAND 3 Randomized Clinical Trial
Open accessAbstract
Importance: Smoking among individuals with serious mental illness (SMI) represents a major public health problem. Intervening during a psychiatric hospital stay may provide an opportunity to aid engagement in smoking cessation treatment and facilitate success in quitting. Objective: To examine the effectiveness of a multicomponent, sustained care (SusC) smoking cessation intervention in adults with SMI receiving inpatient psychiatric care. Design, Setting, and Participants: The Helping HAND 3 randomized clinical trial compared SusC with usual care (UC) among individuals with SMI who smoked daily and were receiving inpatient psychiatric care in Austin, Texas, in a single hospital. The study was conducted from July 2015 through August 2019. Interventions: The UC intervention involved brief smoking cessation information, self-help materials and advice from the admitting nurse, and an offer to provide nicotine replacement therapy during hospitalization. The SusC intervention included 4 main components designed to facilitate patient engagement with postdischarge smoking cessation resources: (1) inpatient motivational counseling; (2) free transdermal nicotine patches on discharge; (3) an offer of free postdischarge telephone quitline, text-based, and/or web-based smoking cessation counseling, and (4) postdischarge automated interactive voice response calls or text messages. Main Outcomes and Measures: The primary outcome was biochemically verified 7-day point-prevalence abstinence at 6-month follow-up. A secondary outcome was self-reported smoking cessation treatment use at 1, 3, and 6 months after discharge. Results: A total of 353 participants were randomized, of whom 342 were included in analyses (mean [SD] age, 35.8 [12.3] years; 268 White individuals [78.4%]; 280 non-Hispanic individuals [81.9%]; 169 women [49.4%]). They reported smoking a mean (SD) of 16.9 (10.4) cigarettes per day. Participants in the SusC group evidenced significantly higher 6-month follow-up point-prevalence abstinence rates than those in the UC group (8.9% vs 3.5%; adjusted odds ratio, 2.95 [95% CI, 1.24-6.99]; P = .01). The number needed to treat was 18.5 (95% CI, 9.6-306.4). A series of sensitivity analyses confirmed effectiveness. Finally, participants in the SusC group were significantly more likely to report using smoking cessation treatment over the 6 months postdischarge compared with participants in the UC group (74.6% vs 40.5%; relative risk, 1.8 [95% CI, 1.51-2.25]; P < .001). Conclusions and Relevance: The findings of this randomized clinical trial provide evidence for the effectiveness of a scalable, multicomponent intervention in promoting smoking cessation treatment use and smoking abstinence in individuals with SMI following hospital discharge. Trial Registration: ClinicalTrials.gov Identifier: NCT02204956.
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Tobacco smoking is recognized as a major factor contributing to the lower life expectancy of persons with mental disorders.
“Tobacco smoking is recognized as a major factor contributing to the lower life expectancy of persons with mental disorders 134,135 .”
From Substance use disorders: a comprehensive update of classification, epidemiology, neurobiology, clinical aspects, treatment and prevention (2023) · cites this paper as [134]
The opening passage says cigarette smoking is an important modifiable risk factor for excess mortality in people with serious mental illness, who have shorter lifespans than the general population. The citing sentence extends that point to people with mental disorders generally, a broader group than the source specifies. (LLM, conf=0.83)
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- Authors
- Brown, R. A., Minami, H., Hecht, J., Kahler, C. W., Price, L. H., Kjome, K. L., Bloom, E. L., Levy, D. E., Carpenter, K. M., Smith, A., Smits, J. A. J., & Rigotti, N. A.
- Affiliations
- The University of Texas at Austin (US)
- Fordham University (US)
- Brown University (US)
- Harvard University (US)
- Optum (United States) (US)
- Corresponding author
- Brown, Richard A.
- ORCID
- Venue
- JAMA Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2021-08-01
- Volume
- 78
- Issue
- 8
- Pages
- 839
- ISSN
- 2168-622X (ISSN-L)
- PMC
- PMC8100915
- OpenAlex
- W3158966543
- Cited by
- 26
- References
- 43
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 4 · 2023: 4 · 2022: 6 · 2021: 2
- FWCI
- 2.51
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JAMA Psychiatry (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R01MH104562)
- National Institute on Drug Abuse (K23DA035288)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- smoking cessation, severe mental illness, psychiatric hospitalization, nicotine replacement therapy, nicotine patch, telephone quitline, automated text messaging, interactive voice response, motivational counseling, smoking abstinence, post-discharge follow-up, usual care comparison, number needed to treat
- MeSH terms
- Cigarette Smoking, Adult, Aftercare, Mental Disorders, Combined Modality Therapy, Counseling, Female, Follow-Up Studies, Hospitals, Psychiatric, Humans, Inpatients, Male, Middle Aged, Comorbidity, Smoking Cessation, Outcome Assessment, Health Care, Young Adult, Tobacco Use Cessation Devices, Motivational Interviewing
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