Integrated approach to smoking cessation achieved higher quit rates

Incorporating smoking cessation efforts into existing mental health programs may help more people quit smoking, findings published in the Dec. 7 Journal of the American Medical Association suggest.

Miles McFall, PhD, of the Veterans Affairs Puget Sound Health Care System in Seattle, and colleagues compared the efficacy of smoking cessation programs that were referral based vs. those that were part of a comprehensive primary mental health care approach among 943 veterans with post traumatic stress disorder – a group known for high tobacco dependence (45%) and heavy smoking.

The researchers recruited patients from outpatient PTSD clinics at 10 Veterans Affairs medical centers and performed follow up for 18 to 48 months between Nov. 2004 and July 2009.

They found that patients who had smoking cessation treatment delivered by a mental health clinician as part of integrated PTSD care were twice as likely to achieve seven-day and 30-day abstinence than those referred for quitting assistance. Furthermore, patients in the integrated care group attended more cessation sessions and were more likely to use cessation medications.

Verifying abstinence by measuring exhaled carbon monoxide or urine cotinine levels, the researchers determined that 42 patients in the integrated care group (8.9%) had prolonged abstinence at 12 months compared with 21 patients referred to Veterans Affairs smoking cessation clinics (4.5%).  Differences in smoking prevalence between the two groups were greatest at six months:

  • Seven-day abstinence was achieved by 16.5% of the integrated treatment group vs. 7.2% of the referral group.
  • Thirty-day abstinence was achieved by 13.8% of the integrated treatment group vs. 5.9% of the referral group.

“This study by McFall et al represents a major step forward on the path to abating the previously overlooked epidemic of tobacco dependence that has plagued persons with mental illness,” Judith J. Prochaska, PhD, MPH of the University of California, San Francisco wrote in an accompanying editorial.

Previous research has shown that tobacco use is prevalent among individuals with mental illness, and that these individuals have higher rates of tobacco-related morbidity and mortality and a harder time kicking the habit.

“Study findings have further potential to extend to the 10 million individuals in the United States who receive mental health treatment annually, of whom an estimated 41% are smokers,” McFall and colleagues wrote.

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