Extended-Duration Smoking Cessation Shows Promise for Adults with Serious Mental Illness

Gail Daumit, MD, MHS

Credit: Johns Hopkins University School of Medicine

Smoking cessation has long been a major public health concern, but its urgency is even more pronounced for individuals with serious mental illness, according to new research which stated this vulnerable population faces significantly elevated cardiovascular disease risks due to tobacco smoking.¹

Additionally, poor impacts on health are further magnified by the high prevalence of overweight and obesity often associated with mental health conditions. Previous suggested that incorporating twice-daily 1 mg varenicline into smoking cessation programs for patients with type 2 diabetes (T2D) can lead to prolonged abstinence without serious adverse events.²

In this investigation, a multifaceted intervention approach was evaluated. At the 18-month mark, investigators observed more than a quarter of the intervention group had successfully quit smoking, compared with less than 6% of the control group.¹

The randomized clinical trial was conducted by Gail Daumit, MD, MHS, Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, and investigators, who sought to determine the effectiveness of an 18-month tobacco smoking cessation intervention with pharmacologic and behavioral components, including weight management, in adults with serious mental illness who were not necessarily ready to quit smoking right away.

Adults with serious mental illness who were daily smokers were included in the trial (July 2016 - March 2020). The participants were randomly assigned to either the intervention or control group. Their willingness to quit smoking immediately within 1 month, or within 6 months was used as a stratification criterion.

Biochemically validated, 7-day point-prevalence tobacco abstinence at the 18-month mark was the primary outcome measured. The data provided promising results, yielding a smoking abstinence rate of 26.4% in the intervention group at 18 months.

Those in the intervention group received the extended-duration treatment and demonstrated significant improvement without experiencing substantial weight gain. In contrast, only 5.7% of the control group, who received quitline referrals, achieved abstinence during the same period.

The intervention consisted of a comprehensive approach that combined pharmacotherapy and behavioral support. Participants received pharmacotherapy primarily in the form of varenicline, dual-form nicotine replacement, or a combination of both.

They also underwent tailored individual and group counseling for motivational enhancement, smoking cessation and relapse prevention, weight management counseling, and support for physical activity. Alternatively, the control group received quitline referrals but did not receive the extensive intervention provided to the intervention group.

Findings demonstrated a remarkable difference in smoking abstinence rates between the 2 groups, the study stated. These findings indicated a nearly sixfold increase in the odds of achieving abstinence for individuals who received the extended-duration intervention.

Investigators noted the readiness to quit smoking within 1 month did not significantly modify the effectiveness of the intervention on smoking abstinence. This suggests the extended-duration treatment may benefit individuals who are not yet prepared to quit immediately but express interest in doing so within a relatively short time frame.

Equally important, individuals in the intervention group did not experience significant weight gain compared with the control group. This outcome is crucial, as weight gain often poses a barrier to smoking cessation for many individuals, particularly those with serious mental illness.

The implications of these findings are substantial for individuals with serious mental illness who face elevated smoking rates and heightened cardiovascular risks. By supporting the implementation of extended-duration tobacco cessation treatment, health professionals can effectively reduce smoking rates and mitigate cardiovascular disease risk in this vulnerable population, according to the study.

References:

1. Daumit GL, Evins AE, Cather C, et al. Effect of a Tobacco Cessation Intervention Incorporating Weight Management for Adults With Serious Mental Illness: A Randomized Clinical Trial. JAMA Psychiatry. Published online June 28, 2023. doi:10.1001/jamapsychiatry.2023.1691
2. Iapoce C. Varenicline Use Benefits Smoking Cessation in Patients with Type 2 Diabetes. HCPLive. June 30, 2022. https://www.hcplive.com/view/varenicline-use-benefits-smoking-cessation-type-2-diabetes