Effect of a group tobacco cessation behavioral intervention among patients with mental illness in Kenya: Results from a controlled clinical trial

Abstract

Introduction Individuals with mental disorders are more susceptible to initiating and sustaining tobacco use; unfortunately, most do not get support to quit. Group behavioral counselling, an effective low-cost strategy for cessation has been shown to be effective, yet has not been studied among this population in Kenya. Methods Mentally ill tobacco users at Mathari Referral and Teaching Hospital’s Clinic for Substance Abuse Treatment in Nairobi, were recruited from September 2017 to March 2019. Participants were allocated into intervention and control groups (1:1). Intervention group participants met in groups of 10 over a 24-week period to participate in group behavioral counselling sessions using a structured curriculum to promote cessation. Control group participants received usual care. The primary outcome was tobacco cessation at 24 weeks measured through salivary cotinine strips. Secondary outcomes included self-reported number of cigarettes/sticks used daily and health-related quality of life (HRQOL), using the WHOQOL Brief Questionnaire at 24 weeks. Between-group event rates were compared using Cox proportional hazards models, while differences in HRQOL scores were analyzed using paired t-tests. Results Participants’ mean age was 35 (SD=9) years, 87% were male, and 42% had completed secondary education. Over half (65%) had substance use disorders (diagnosed) and 15% had major depressive disorders. Most participants (94%) used cigarettes at baseline and participants smoked for a mean of 13 (SD=11) years with an average of 14 (SD=7) sticks daily. Intervention group participants reported a higher cessation rate (15.2% vs 0%, p=0.02 at week 12, and 9.1% vs 0%, p=0.10 at week 24), with a lower number of sticks smoked (97% vs 58.6%, p<0.0001) compared with control group participants at 24 weeks follow-up. Intervention group participants reported higher change in HRQOL scores compared to control participants in physical (30.6% vs 10.4%: OR=3.79; 95% CI: 1.25–11.48) and environmental domains (34.7% vs 8.3%: OR=5.84; 95% CI: 1.79–19.03) at end of study. Conclusions The group behavioral intervention among tobacco using Kenyans with mental illness led to improved tobacco cessation outcomes.

Keywords

• smoking cessation
• smoking reduction
• group behavioral therapy
• mental illness