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Smoking Cessation Care in State-Operated or State-Supported Psychiatric Hospitals: From Policy to Practice
Glorimar Ortiz, M.S.; Lucille Schacht, Ph.D.; G. Michael Lane, Jr., M.A., M.P.H.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200290
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The authors are affiliated with the National Association of State Mental Health Program Directors Research Institute, Inc., 3141 Fairview Park Dr., Suite 650, Falls Church, VA 22042 (e-mail: glorimar.ortiz@nri-inc.org).

Copyright © 2013 by the American Psychiatric Association


Objectives  The aims of this study were to identify changes in smoking policies and their implementation and to determine the level of smoking cessation care provided at state-operated or state-supported psychiatric inpatient hospitals.

Methods  Hospitals were surveyed in 2008 (N=219) and 2011 (N=206) about their smoking policies and practices, and changes in specific policies and practices, such as staff specialty training about smoking cessation care, assessment at intake, provision of smoking cessation treatment and education, and aftercare planning, were examined. Smoking cessation care was categorized as best, good, average, or poor.

Results  The survey was completed in both 2008 and 2011 by 108 hospitals. The number of hospitals prohibiting smoking rose by 73%, from 48% in 2008 to 83% in 2011. The provision of specialty training to staff did not significantly improve. Nearly all hospitals assessed smoking status at admission, and nicotine replacement therapy was provided by more hospitals than any other treatment in both 2008 and 2011. The number of hospitals providing no follow-up of smoking cessation care after discharge dropped significantly, from 64% to 41%, and significantly more provided good versus average smoking cessation care.

Conclusions  Analysis of smoking policies at state-operated or state-supported psychiatric inpatient hospitals found significant movement in adopting nonsmoking policies and some increase in active treatment, notably wellness counseling. Educational resources have not reached full penetration, and continuum of care activities are also lagging behind. Additional resources and staff training may be needed to continue to address smoking cessation both during and after hospitalization.

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Table 1Characteristics of 108 state-operated or state-supported psychiatric hospitalsa
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a Data are from a survey of smoking policies and practices completed by hospitals in 2008 and 2011.

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b Hospitals could serve more than one type of population. No hospital served only youth populations.

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c Hospitals serving forensic and geriatric populations were not included.

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Table 2Specialty training in smoking cessation care provided to staff at 108 inpatient psychiatric hospitalsa
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a Data were missing for one hospital in 2008.

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Table 3Smoking cessation care provided by 108 inpatient psychiatric hospitals
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a Nicotine replacement therapy (NRT) includes patch, lozenge, inhaler, gum, and spray.

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b Includes Chantix (varenicline), Zyban/Wellbutrin (bupropion), and other pharmacotherapy

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c Includes educational pamphlets, referral to quit lines, peer support, and referral to smoking Web sites

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d Includes group sessions, individual sessions with clinical staff, and healthy lifestyle counseling



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