Integrated Smoking Cessation Treatment for Smokers with Serious Mental Illnesses, Massachusetts, 2017-2020

In the United States, tobacco smoking is associated with significant morbidity and premature mortality for individuals with serious mental illness (SMI) (e.g., schizophrenia, post-traumatic stress disorder, bipolar disorder, major depressive disorder). While many smokers with SMI wish to quit smoking, few are offered advice or treatments with demonstrated effectiveness in reducing tobacco dependence, primarily medication-assisted treatments. The overall aim of this randomized controlled trial was to test the effects of provider education (PE) (i.e. provider-level educational intervention focused on evidence-based smoking cessation treatment for those with SMI) and community health worker (CHW) support on the provision and utilization of smoking cessation treatment to those with SMI, and cessation rates for adults with SMI who smoke or use tobacco over a 2-year period. The objectives of this trial were to:

Examine whether an intervention combining PE and CHW support would increase prescriber provision of advice and assistance to quit smoking, and improve tobacco cessation rates in smokers with SMI compared to usual care/treatment as usual (TAU) and compared to PE-only treatment
Determine the effect of the combined PE+CHW intervention on patient-reported overall health compared to TAU and PE-only treatment

Eligible individuals were recruited from two outpatient psychiatric service providers in the Boston, Massachusetts metropolitan area. Clinics where individuals received services were randomized into either the TAU condition or into the PE condition, where health care providers would receive additional education on first-line medications used to treat tobacco use disorder. Within clinics in the PE arm, individuals were further randomized into the community health worker (CHW) support condition (PE+CHW), where CHWs would assist participants with smoking cessation care access and provide community outreach and education, or no CHW support (PE-only). Enrolled participants (n=1,010) completed surveys on smoking/tobacco use at 3 timepoints: study baseline, 1 year post-randomization, and 2 years post-randomization.
A mixed-methods evaluation of the trial was also conducted post-intervention, using an interactive convergent design. The aims of the evaluation were to identify barriers and facilitators to effective implementation; examine how primary care providers differed by performance and engagement level, and how experiences with the intervention compared across these groups; and identify anticipated barriers to implementing the intervention as discussed by stakeholders. Quantitative outcome and visit data from the trial were used in the evaluation. For the evaluation's qualitative component, interviews were conducted with purposively sampled community health workers, smoker participants, primary care providers, and other stakeholders in policy, payor, and clinical administration. <b>Please note that the qualitative evaluation data are not available for this collection.</b>