The effect of a restricted smoking policy on motivation to quit smoking in psychiatric patients

The impact of a smoke-free psychiatric hospitalization on patient smoking outcomes: a systematic review

OBJECTIVE

Smoke-free policies have been introduced in inpatient psychiatric facilities in most developed nations. Such a period of supported abstinence during hospitalization may impact smoking behaviours post discharge, yet little quantitative evidence exists. The aim of this review was to provide the first synthesis of the research evidence examining the impact of a smoke-free psychiatric hospitalization on patients' smoking-related behaviours, motivation, and beliefs.

METHODS

We conducted a systematic review of electronic databases PubMed, MEDLINE, PsycINFO, and EMBASE from inception to June 2013. Studies were included if they were conducted in an inpatient psychiatric facility with a smoke-free policy and if they examined any change in patients' smoking-related behaviours, motivation, or beliefs either during admission, post discharge, or both. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias Tool.

RESULTS

Fourteen studies were included in the review. Of the four studies that assessed change in smoking from admission to post discharge, two indicated a significant decline in cigarette consumption up to 3 months post discharge. Positive changes in motivation to quit and beliefs about quitting ability were identified in two studies. One study reported an increase in the rate of quit attempts and one reported a decline in nicotine dependence levels.

CONCLUSIONS

A smoke-free psychiatric hospitalization may have a positive impact on patients' smoking-related behaviours, motivation, and beliefs, both during admission and up to 3 months post discharge. Further controlled studies with more rigorous designs are required to confirm this potential.

Smoking attitudes, behaviour and nicotine dependence among mental health acute inpatients: an exploratory study

BACKGROUND

In 2008, mental health units in England went smoke-free by law. This study explores inpatients' experience with a smoke-free policy, their smoking behaviour, dependence, withdrawal and related issues.

MATERIAL

Semi-structured interviews in a criterion sample of 15 inpatient smokers.

DISCUSSION

Patients generally approved of the smoke-free policy, provided they could smoke outside. Most participants had changed their smoking behaviour following admission. Most had little knowledge of nicotine dependence, reported a lack of structured support for smoking cessation, and a general interest in this being made available. Nicotine dependence was reportedly lower in the ward than in the home setting.

CONCLUSIONS

More structured support is needed to ensure that opportunities for health promotion in a vulnerable population are not being missed.

Acceptability and impact of a partial smoking ban followed by a total smoking ban in a psychiatric hospital

OBJECTIVE

To assess the impact of a partial smoking ban followed by a total smoking ban in a psychiatric hospital in Switzerland.

METHODS

In 2003, smoking was allowed everywhere in psychiatric units. In 2004, smoking was prohibited everywhere except in smoking rooms. In 2006, smoking rooms were removed and smoking was totally prohibited indoors. Patients and staff were surveyed in 2003 (n=106), 2004 (n=108), 2005 (n=119) and 2006 (n=134).

RESULTS

Exposure to environmental tobacco smoke (ETS) decreased after the partial ban and further decreased after the total ban. Among patients, after the total ban, more smokers attempted to quit smoking (18%) relative to before the total ban (2%, odds ratio=10.1, p=0.01). More smokers said that hospital staff gave them nicotine replacement products after the total ban (52%), compared with before (13%, odds ratio=7.6, p<0.001). Many participants (55%) commented that the total ban was too strict, and most (64%) preferred the partial ban.

CONCLUSIONS

The partial ban decreased exposure to ETS and the total ban further improved the situation and increased the proportion of smokers who attempted to quit smoking and received nicotine medications. The total ban was loosely enforced and was overall acceptable, but most participants preferred a partial ban.

A game for smokers: a preliminary naturalistic trial in a psychiatric hospital

OBJECTIVE

"Pick-Klop" is a game based on cognitive behavioral therapy. It aims to change smokers' attitudes towards tobacco addiction. This study tests the feasibility and the impact of one brief session of the intervention in a naturalistic setting within a psychiatric hospital.

METHOD

Fifty-one smokers were recruited during their stay in a psychiatric hospital with a prohibitive smoking policy. They were assessed pre- and post-treatment with visual analogue scales designed to evaluate their intention to stop smoking.

RESULTS

All patients completed the intervention. The outcome shows that the intention to stop smoking becomes significantly stronger after the intervention.

CONCLUSION

This pilot study supports the feasibility and the effectiveness of the "Pick-Klop" game in a psychiatric hospital setting. The game seems to improve the intention to quit smoking. The data, however, should be confirmed by a controlled trial. Moreover, follow-up studies are needed to examine the potential impact of the game on smoking cessation attempts.

PRACTICAL IMPLICATIONS

The game seems to be a useful and simple tool for education about smoking in a psychiatric hospital setting.