Smoking Cessation and SMI: A systematic review of the literature 

The severe mental illness (SMI) population has a prevalence of smoking about 3 times 
greater than that of the general population and they also tend to smoke more heavily. Smoking-related illness is one of the primary causes of morbidity and mortality in smokers with severe mental illness. Tobacco use among individuals with SMI is financially costly to both themselves and to the society through treating smoking-related diseases. 

Smokers with severe mental illness are just as likely to want to quit as people without mental disorders. However, due to the high levels of tobacco dependence, it is less likely that SMI patients are successful in attempts to stop smoking compared with individuals without mental disorders. The development of tailored smoking cessation and reduction interventions in these patients is crucial. 

Methods: This is a collaborative project between The UK Centre for Tobacco & Alcohol Studies and the University of York. Individuals with severe mental illnesses are typically excluded from large-scale studies of smoking cessation. Therefore, a limited evidence base is available to inform smoking treatment among people with SMI. In light of this, we conducted a systematic review to synthesise existing studies in order to provide further evidence to inform current smoking cessation strategies and inform future research. 

The primary objectives of this study are to: 

1. Carry out a systematic review to identify smoking cessation and reduction interventions in people with severe mental illness. 

2. Review systematically health economic evaluations of smoking cessation and reduction interventions in severe mental illness. 

3. Conduct a detailed costing exercise to evaluate the intervention costs incurred by the provision of each of the interventions considered in the effectiveness review. 

4. Perform meta-analyses to examine the effects of the selected interventions. 

5. Explore the relationship between intervention costs and smoking reduction using meta-regression models. 

Preliminary findings: 
The result of this study suggests that although a very small proportion of SMI patients can quit smoking, most SMI patients are able to reduce their daily cigarette intake. The result shows that the increased intensity of treatment results in greater smoking reduction in this population. The combined use of pharmacologic and behavioural intervention was more effective than single intervention use alone. 

Research Team

Lead: Steve Parrott
Collaborators: Professor Simon Gilbody, Qi Wu, Professor John Britton 

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