Abstract
Admission to a smoke-free setting presents a unique opportunity to encourage smokers to quit. However, risk of relapse post-discharge is high, and little is known about effective strategies to support smoking cessation following discharge. We aimed to identify interventions that maintain abstinence following a smoke-free stay and determine their effectiveness, as well as the probable effectiveness of behaviour change techniques (BCTs) used in these interventions. Systematic review and meta-analyses of studies of adult smokers aged ≥18years who were temporarily or fully abstinent from smoking to comply with institutional smoke-free policies. Institutions included prison, inpatient mental health, substance misuse or acute hospital settings. A Mantel-Haenszel random-effects meta-analysis of randomized controlled trials (RCTs) was conducted using biochemically verified abstinence (7-day point prevalence or continuous abstinence). BCTs were defined as 'promising' in terms of probable effectiveness (if BCT was present in two or more long-term effective interventions) and feasibility (if BCT was also delivered in ≥25% of all interventions). Thirty-seven studies (intervention n=9041, control n=6195) were included: 23 RCTs (intervention n=6593, control n=5801); three non-randomized trials (intervention n=845, control n=394) and 11 cohort studies (n=1603). Meta-analysis of biochemically verified abstinence at longest follow-up (4weeks-18months) found an overall effect in favour of intervention [risk ratio (RR)=1.27, 95% confidence interval (CI)=1.08-1.49, I2 =42%]. Nine BCTs (including 'pharmacological support', 'goal-setting (behaviour)' and 'social support') were characterized as 'promising' in terms of probable effectiveness and feasibility. A systematic review and meta-analyses indicate that behavioural and pharmacological support is effective in maintaining smoking abstinence following a stay in a smoke-free institution. Several behaviour change techniques may help to maintain smoking abstinence up to 18months post-discharge.
Highlights
IntroductionSmoking prevalence in the general population in England has steadily declined, but recent data indicate that prevalence remains approximately 50% higher among people with mental health conditions in the United Kingdom [2]
Smoking remains a leading cause of mortality and morbidity world-wide [1]
The majority provided sufficient information to allow mixed methods appraisal tool (MMAT) assessment, and were considered as being of high quality. Those lacking the required information included eight randomized controlled trials (RCTs) where it was not possible to ascertain whether the outcome assessors were blinded to the intervention, and one which provided insufficient information in relation to the rate of attrition
Summary
Smoking prevalence in the general population in England has steadily declined, but recent data indicate that prevalence remains approximately 50% higher among people with mental health conditions in the United Kingdom [2]. Smokers with mental health conditions are more likely to experience greater dependence on smoking, and the long-term quit rates among this population are lower [2,3,4,5]. People with mental health conditions are just as motivated to quit as those in the general population [2,6], but are less likely to receive the required support compared to smokers without mental health conditions [3]. Admission to a smoke-free setting presents a unique opportunity to encourage smokers to quit. We aimed to identify interventions that maintain abstinence following a smoke-free stay and determine their effectiveness, as well as the probable effectiveness of behaviour change techniques (BCTs) used in these interventions
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