y-QUIT: Smoking Prevalence, Engagement, and Effectiveness of an Individualized Smoking Cessation Intervention in Youth With Severe Mental Illness

Abstract

Introduction: Young people with psychosis are six times more likely to be tobacco smokers than their gender- and age-matched peers. Smoking is a major contributor to the 15-year reduced life expectancy among people experiencing severe mental illness (SMI). There is a lack of evidence-supported interventions for smoking cessation among young people with SMI.Material and Methods: The study comprised two phases and aimed to assess (i) the prevalence of smoking among a community sample of young people with psychotic illness or at high risk of developing psychosis; (ii) the proportion who engaged in the intervention; (iii) the proportion who achieved smoking cessation; and (iv) secondary smoking-related outcomes. In phase one, prevalence of smoking was assessed among young people with psychotic illness or at high risk of developing psychosis attending a community-based youth mental health service between 16/5/2017 and 16/11/2017. In phase two, over a 1-year period, individuals identified as smokers were invited to participate in a 12-week tailored smoking cessation intervention program that included pharmacological treatment, motivational interviewing, and behavioral change techniques. Those unwilling to participate in a full intervention were offered a brief intervention. Participants of the full intervention were assessed at baseline and at week 12 endpoint on: daily cigarettes smoked (self-report), exhaled CO, nicotine dependence, readiness to quit, and confidence to quit.Results: In phase one, smoking prevalence was 48.2% (53 of 110) among clients of the youth mental health service. Smokers were significantly more likely to be male (X2 = 6.41 p = 0.009). During phase two, 41 of 61 eligible clients engaged in a smoking cessation intervention (67.2%). Effectiveness: twenty-one clients participated in a full intervention (34.4%), of whom three (14.3%) received a brief intervention initially and during engagement converted to full intervention. Twenty participants (32.8%) received a brief intervention only. Ten participants in the full intervention (47.6%) and five in the brief intervention (25%) dropped out. Six (28.6% of full intervention) reported smoking cessation verified by CO monitoring. Participants who completed the full intervention (n = 9) reduced number of cigarettes smoked, nicotine dependence, and exhaled CO, while readiness to quit and confidence to quit increased. Pharmacotherapy was predominantly combination NRT (n = 18; 85.7%), varenicline (4.8%), oral NRT only (4.8%), or none (4.8%). No adverse events were reported.Conclusion: This pilot real-world study demonstrates that both screening for smoking and offering an effective smoking cessation intervention are achievable in youth experiencing or at risk of psychosis.

Targeted Intervention to Reduce Smoking among People with Severe Mental Illness: Implementation of a Smoking Cessation Intervention in an Inpatient Mental Health Setting

“…Acknowledging these limitations, these preliminary data show that effective smoking cessation interventions can be delivered to people with severe mental illness on acute inpatient units with no increase in violence. These findings indicate preliminary success and contribute to a growing and much-needed evidence-base for interventions to address the major health inequities faced by people with severe mental illness [2]. Future implementation phases will prioritize effective participatory collaboration with staff to optimize effectiveness of the intervention, and include additional strategies such as brief intervention training and smoking cessation treatments such as varenicline and buproprion, in addition to NRT, which have been shown to be safe and effective in people experiencing severe mental illness [22].…”

“…Smoking prevalence among psychiatric populations varies, with much higher rates among those with severe mental illnesses, such as schizophrenia and psychosis spectrum disorders and bipolar disorder than among the general population [1][2][3]. Despite a steady decline in smoking rates in the general populations of high-income nations, the prevalence of smoking among people with severe mental illness has not reduced over the past several decades [4].…”

Physical health interventions for patients who have experienced a first episode of psychosis: a narrative review

“…One of these was carried out under the KBIM programme, including one nutritionbased article from this initial study (Teasdale et al 2014). There was only one smoking cessation study identified and it was a two-stage non-controlled interventional study (Curtis et al 2018). 'Meals, Mindfulness and Moving forward' (M 3 ) was another multidisciplinary pre-post intervention study (Usher et al 2019).…”

“…It is important to note that a number of studies identified in this review utilised the same intervention programme. Four Australian studies were devised utilising the KBIM programme (Teasdale et al 2014;Curtis et al 2015Curtis et al , 2018Pedley et al 2018). KBIM was a district-wide programme based in Sydney for service users who had experienced a FEP.…”

Cardiometabolic Risk in First Episode Psychosis Patients

“…Long-term smoking cessation remains difficult to achieve and is a continuing challenge for nicotine dependence in any population, not just psychosis (60). Further research is needed to examine whether the SCIMITAR+ intervention could be adapted to be delivered in EIP services with first episode patients where smoking habits and nicotine dependence may be less strongly established and, potentially, its impact might be greater (61,62).…”