Department of Addictions,Institute of Psychiatry, Psychology and Neuroscience,King's College London,London,UK.
Psychol Med. 2018 Mar;48(4):669-678. doi: 10.1017/S0033291717002021. Epub 2017 Aug 7.
Smoking prevalence is doubled among people with mental health problems and reaches 80% in inpatient, substance misuse and prison settings, widening inequalities in morbidity and mortality. As more institutions become smoke-free but most smokers relapse immediately post-discharge, we aimed to review interventions to maintain abstinence post-discharge.
MEDLINE, EMBASE, PsycINFO, CINAHL and Web of Science were searched from inception to May 2016 and randomised controlled trials (RCTs) and cohort studies conducted with adult smokers in prison, inpatient mental health or substance use treatment included. Risk of bias (study quality) was rated using the Effective Public Health Practice Project Tool. Behaviour change techniques (BCTs) were coded from published papers and manuals using a published taxonomy. Mantel-Haenszel random effects meta-analyses of RCTs used biochemically verified point-prevalence smoking abstinence at (a) longest and (b) 6-month follow-up.
Five RCTs (n = 416 intervention, n = 415 control) and five cohort studies (n = 471) included. Regarding study quality, four RCTs were rated strong, one moderate; one cohort study was rated strong, one moderate and three weak. Most common BCTs were pharmacotherapy (n = 8 nicotine replacement therapy, n = 1 clonidine), problem solving, social support, and elicitation of pros and cons (each n = 6); papers reported fewer techniques than manuals. Meta-analyses found effects in favour of intervention [(a) risk ratio (RR) = 2.06, 95% confidence interval (CI) 1.30-3.27; (b) RR = 1.86, 95% CI 1.04-3.31].
Medication and/or behavioural support can help maintain smoking abstinence beyond discharge from smoke-free institutions with high mental health comorbidity. However, the small evidence base tested few different interventions and reporting of behavioural interventions is often imprecise.
精神健康问题患者的吸烟率是普通人群的两倍，在住院患者、药物滥用者和监狱囚犯中，这一比例高达 80%，这进一步扩大了发病率和死亡率方面的不平等。由于越来越多的机构实行禁烟，但大多数吸烟者在出院后立即复吸，我们旨在回顾在出院后保持戒烟状态的干预措施。
从建库起至 2016 年 5 月，我们检索了 MEDLINE、EMBASE、PsycINFO、CINAHL 和 Web of Science，并纳入了在监狱、住院精神健康或物质使用治疗中成年吸烟者开展的随机对照试验（RCT）和队列研究。使用有效公共卫生实践项目工具评价了偏倚风险（研究质量）。从已发表的论文和手册中使用已发表的分类法对行为改变技术（BCT）进行编码。使用生化验证的点吸烟率来对 RCT 的最长和（b）6 个月随访进行 Mantel-Haenszel 随机效应荟萃分析。
纳入了 5 项 RCT（n = 416 例干预，n = 415 例对照）和 5 项队列研究（n = 471）。关于研究质量，4 项 RCT 被评为强，1 项为中；1 项队列研究被评为强，1 项为中，3 项为弱。最常见的 BCT 是药物治疗（n = 8 项尼古丁替代疗法，n = 1 项可乐定）、解决问题、社会支持和正反两面利弊分析（每项 n = 6）；论文报道的技术比手册少。荟萃分析发现干预措施有效果[（a）风险比（RR）= 2.06，95%置信区间（CI）1.30-3.27；（b）RR = 1.86，95% CI 1.04-3.31]。
药物治疗和/或行为支持可以帮助在高精神健康共病的禁烟机构出院后保持戒烟状态。然而，证据基础较小，测试了几种不同的干预措施，行为干预措施的报告通常不够精确。
