Tobacco cessation with weight loss beneficial for people with serious mental illness: JAMA

Written By : Dr. Kamal Kant Kohli Published On 2023-07-07T20:00:35+05:30 | Updated On 7 July 2023 8:01 PM IST

USA: A comprehensive 18-month smoking cessation intervention has demonstrated promising results in helping people with serious mental illnesses quit smoking, according to a recent study published in JAMA Psychiatry.

"An 18-month intervention with first-line pharmacotherapy and tailored behavioural support for smoking cessation and weight management increased tobacco abstinence without significant weight gain in people with serious mental illness who are interested in quitting smoking within six months," the researchers reported.

Smoking cessation has long been a major public health concern, but recent research has highlighted its even greater urgency for individuals with serious mental illness. The study showed thatthis vulnerable population faces significantly elevated cardiovascular disease risks due to tobacco smoking.

Furthermore, the negative health impacts are amplified by the high prevalence of overweight and obesity often associated with mental health conditions.

The randomized clinical trial, led by Dr. Gail Daumit and her team at the Johns Hopkins University School of Medicine, evaluated the effectiveness of an 18-month tobacco smoking cessation intervention with pharmacologic and behavioural components, including weight management. The study included daily smokers with serious mental illnesses who were not necessarily ready to quit smoking immediately. Participants were randomly assigned to either the intervention or control group based on their willingness to quit smoking within one month or 6 months.

● The primary outcome measured was biochemically validated, 7-day point-prevalence tobacco abstinence at the 18-month mark. The results were remarkable, with a smoking abstinence rate of 26.4% observed in the intervention group compared to only 5.7% in the control group, who received quitline referrals.

The intervention encompassed a multifaceted approach that combined pharmacotherapy, primarily using varenicline or nicotine replacement therapy, with behavioural support. Participants received tailored individual and group counselling for motivation, smoking cessation, relapse prevention, weight management, and support for physical activity. In contrast, the control group received quitline referrals but did not receive the extensive intervention provided to the intervention group.

Significantly, the study found that individuals in the intervention group achieved abstinence without experiencing substantial weight gain, which is often a barrier to smoking cessation, particularly for those with serious mental illness.

The findings indicate a nearly sixfold increase in the odds of achieving smoking abstinence for individuals who received the extended-duration intervention compared to the control group. Interestingly, the readiness to quit smoking within 1 month did not significantly impact the effectiveness of the intervention, suggesting that 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.

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

It is important to note that these findings are based on an 18-month clinical trial, and further research is needed to validate the long-term effectiveness of the intervention. However, the study provides valuable insights into the potential of a comprehensive approach to smoking cessation that addresses the specific needs of individuals with serious mental illness.

Reference: 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

JAMA PsychiatrySmoking cessationSmokingMental Illness

Source : JAMA Psychiatry

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751