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Aust N Z J Psychiatry. 2017 Apr;51(4):366-381. doi: 10.1177/0004867417692424. Epub 2017 Feb 14.

Efficacy of a universal smoking cessation intervention initiated in inpatient psychiatry and continued post-discharge: A randomised controlled trial.

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1 The University of Newcastle, Australia, Callaghan, NSW, Australia.
2 Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
3 Hunter New England Population Health, Wallsend, NSW, Australia.
4 Centre for Translational Neuroscience and Mental Health, Calvary Mater Hospital, Waratah, NSW, Australia.
5 National Drug and Alcohol Research Centre, University of New South Wales, Randwick, NSW, Australia.
6 Mental Health and Substance Use Service, Calvary Mater Hospital, Waratah, NSW, Australia.
7 Mental Health Alcohol and Other Drugs Branch, Queensland Health, Fortitude Valley, QLD, Australia.
8 Stanford Prevention Research Center, School of Medicine, Stanford University, Stanford, CA, USA.



Interventions are required to redress the disproportionate tobacco-related health burden experienced by persons with a mental illness. This study aimed to assess the efficacy of a universal smoking cessation intervention initiated within an acute psychiatric inpatient setting and continued post-discharge in reducing smoking prevalence and increasing quitting behaviours.


A randomised controlled trial was undertaken across four psychiatric inpatient facilities in Australia. Participants ( N = 754) were randomised to receive either usual care ( n = 375) or an intervention comprising a brief motivational interview and self-help material while in hospital, followed by a 4-month pharmacological and psychosocial intervention ( n = 379) upon discharge. Primary outcomes assessed at 6 and 12 months post-discharge were 7-day point prevalence and 1-month prolonged smoking abstinence. A number of secondary smoking-related outcomes were also assessed. Subgroup analyses were conducted based on psychiatric diagnosis, baseline readiness to quit and nicotine dependence.


Seven-day point prevalence abstinence was higher for intervention participants (15.8%) than controls (9.3%) at 6 months post-discharge (odds ratio = 1.07, p = 0.04), but not at 12 months (13.4% and 10.0%, respectively; odds ratio = 1.03, p = 0.25). Significant intervention effects were not found on measures of prolonged abstinence at either 6 or 12 months post-discharge. Differential intervention effects for the primary outcomes were not detected for any subgroups. At both 6 and 12 months post-discharge, intervention group participants were significantly more likely to smoke fewer cigarettes per day, have reduced cigarette consumption by ⩾50% and to have made at least one quit attempt, relative to controls.


Universal smoking cessation treatment initiated in inpatient psychiatry and continued post-discharge was efficacious in increasing 7-day point prevalence smoking cessation rates and related quitting behaviours at 6 months post-discharge, with sustained effects on quitting behaviour at 12 months. Further research is required to identify strategies for achieving longer term smoking cessation.


Smoking cessation; inpatient; intervention; mental health services; mental illness

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