School of Nursing, University of Texas at Austin, Austin.
Department of Psychology, Fordham University, Bronx, New York.
JAMA Psychiatry. 2021 Aug 1;78(8):839-847. doi: 10.1001/jamapsychiatry.2021.0707.
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.
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.
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.
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.
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).
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.
ClinicalTrials.gov Identifier: NCT02204956.
患有严重精神疾病（SMI）的个体吸烟是一个主要的公共卫生问题。在精神病院住院期间进行干预可能提供帮助参与戒烟治疗并促进戒烟成功的机会。
研究多组分、持续护理（SusC）戒烟干预措施在接受住院精神病护理的 SMI 成年人中的有效性。
设计、地点和参与者：Helping HAND 3 随机临床试验比较了 SusC 与常规护理（UC）在每天吸烟且在德克萨斯州奥斯汀的一家医院接受住院精神病护理的 SMI 个体中的疗效。该研究于 2015 年 7 月至 2019 年 8 月进行。
UC 干预措施包括简短的戒烟信息、自我帮助材料和入院护士的建议，并提供在住院期间使用尼古丁替代疗法的机会。SusC 干预措施包括 4 个主要部分，旨在促进患者参与出院后戒烟资源：（1）住院动机咨询；（2）出院时免费提供透皮尼古丁贴片；（3）提供免费的出院后电话戒烟热线、基于文本的和/或基于网络的戒烟咨询，以及（4）出院后自动交互式语音应答电话或短信。
主要结果是在 6 个月随访时通过生物化学验证的 7 天点前戒烟率。次要结果是出院后 1、3 和 6 个月的自我报告戒烟治疗使用情况。
共有 353 名参与者被随机分配，其中 342 名参与者被纳入分析（平均[SD]年龄，35.8[12.3]岁；268 名白人个体[78.4%]；280 名非西班牙裔个体[81.9%]；169 名女性[49.4%]）。他们报告平均每天吸烟（SD）16.9（10.4）支。SusC 组在 6 个月随访时的点前戒烟率显著高于 UC 组（8.9%比 3.5%；调整后的优势比，2.95[95%CI，1.24-6.99]；P=0.01）。需要治疗的人数为 18.5（95%CI，9.6-306.4）。一系列敏感性分析证实了有效性。最后，与 UC 组相比，SusC 组出院后 6 个月内更有可能报告使用戒烟治疗（74.6%比 40.5%；相对风险，1.8[95%CI，1.51-2.25]；P<0.001）。
这项随机临床试验的结果为可扩展的多组分干预措施在促进 SMI 个体出院后戒烟治疗使用和戒烟方面的有效性提供了证据。
ClinicalTrials.gov 标识符：NCT02204956。
