Providing an e-cigarette starter kit for smoking cessation and reduction as adjunct to usual care to smokers with a mental health condition: Findings from the ESCAPE feasibility study

Dimitra Kale, Emma Beard, Anna-Marie Marshall, Jodi Pervin, Qi Wu, Elena Ratschen, Lion Shahab
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Abstract

Background: Smoking rates in the UK have declined steadily over the past decades, masking considerable inequalities, as little change has been observed among people with a mental health condition. This trial sought to assess the feasibility and acceptability of supplying an electronic cigarette (e-cigarette) starter kit for smoking cessation as an adjunct to usual care for smoking cessation, to smokers with a mental health condition treated in the community, to inform a future effectiveness trial. Methods: This randomised controlled feasibility trial, conducted March-December 2022, compared the intervention (e-cigarette starter kit with a corresponding information leaflet and demonstration with Very Brief Advice) with a usual care control at 1-month follow-up. Participants were 18+ years, receiving treatment for any mental health condition in primary or secondary care in three Mental Health Trusts in Yorkshire and one in London, UK. They were also willing to address their smoking through either cessation or reduction of cigarette consumption. The agreed primary outcome measure was feasibility (consent~15% of eligible participants; attrition rate<30%). Acceptability, validated sustained abstinence and at least 50% cigarette consumption reduction at 1-month, were also evaluated and qualitative interviews conducted to further explore acceptability in this population. Results: Feasibility targets were partially met; of 201 eligible participants, 43 (mean age = 45.2, SD = 12.7; 39.5% female) were recruited (21.4%) and randomised (intervention:48.8%, n=21; control:51.2%, n=22). Attrition rate was 37.2% at 1-month follow-up and was higher (45.5%) in the control group. At follow-up (n=27), 93.3% (n=14) in the intervention group and 25.0% (n=3) in the control group reported e-cigarette use. The intervention was well received with minimal negative effects. In intention-to-treat analysis, validated sustained abstinence at 1-month was 2/21 (9.5%) and 0/22 (0%) and at least 50% reduction in cigarette consumption 13/21 (61.9%) and 3/22 (13.6%), for the intervention and control group, respectively. Qualitative analysis of participant interviews (N=5) showed the intervention was broadly acceptable, but they also highlighted areas of improvements for the intervention and trial delivery. Conclusions: Offering an e-cigarette starter kit to smokers with a mental health condition treated in the community was acceptable and largely feasible, with harm reduction outcomes (i.e. switching from cigarette smoking to e-cigarette use and substantial reduction in cigarette consumption) favouring the intervention. The findings of the study will be used to help inform the design of a main trial.
为患有精神疾病的吸烟者提供戒烟和减烟电子烟启动包,作为常规护理的辅助手段:ESCAPE可行性研究结果
背景:过去几十年来,英国的吸烟率持续下降,但却掩盖了相当大的不平等,因为在精神疾病患者中几乎没有观察到任何变化。本试验旨在评估向在社区接受治疗的患有精神疾病的吸烟者提供戒烟用电子烟(电子烟)入门套件作为常规戒烟护理的辅助手段的可行性和可接受性,为未来的有效性试验提供参考:这项随机对照可行性试验于2022年3月至12月进行,在1个月的随访中比较了干预措施(电子烟入门套件及相应的信息宣传单和非常简短的建议示范)和常规护理对照。参与者年龄在 18 岁以上,在英国约克郡的三个心理健康信托机构和伦敦的一个心理健康信托机构接受初级或二级治疗。他们还愿意通过戒烟或减少吸烟量来解决吸烟问题。商定的主要结果衡量标准是可行性(符合条件的参与者中有 15% 表示同意;自然减员率为 30%)。此外,还对可接受性进行了评估,并进行了定性访谈,以进一步探讨该人群的可接受性:部分达到了可行性目标;在 201 名符合条件的参与者中,43 人(平均年龄 = 45.2 岁,SD = 12.7;39.5% 为女性)被招募(21.4%)并被随机分配(干预:48.8%,n=21;对照:51.2%,n=22)。随访 1 个月时的流失率为 37.2%,对照组的流失率更高(45.5%)。在随访中(n=27),干预组93.3%(n=14)和对照组25.0%(n=3)报告使用了电子烟。干预效果良好,负面影响极小。在意向治疗分析中,干预组和对照组在1个月后的有效持续戒烟率分别为2/21(9.5%)和0/22(0%),香烟消费量至少减少50%的分别为13/21(61.9%)和3/22(13.6%)。对参与者访谈(5 人)进行的定性分析显示,干预措施大体上可以接受,但他们也强调了干预措施和试验实施需要改进的地方:结论:向在社区接受治疗的患有精神疾病的吸烟者提供电子烟入门套件是可以接受的,而且在很大程度上是可行的,减少危害的结果(即从吸烟转为使用电子烟以及香烟消费量的大幅减少)有利于该干预措施。研究结果将用于帮助设计一项主要试验。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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