Tackling the high rates of cigarette smoking found among people with mental health problems – A novel Randomised Control Trial.

Introduction: Smoking is a cause of over one quarter of cancer deaths in the UK. Smoking prevalence among people with depression (34%) and anxiety (29%) in the UK is over double that found in the general population. This population has been shown to have reduced odds in achieving abstinence despite being as motivated to quit as those without anxiety and depression. Research suggests that quitting smoking can not only improve physical health, but also mental health, with effects similar to those achieved by anti-depressants. Increasing smoking abstinence is therefore a key public health priority. Integrated support for stopping smoking and mental health can increase rates of quitting smoking but is not readily available in the UK. In England, online psychological therapy is offered within Talking Therapies services as a standard treatment for anxiety and depression and could provide a setting where integrated smoking and mental health support is offered. The online setting allows for the potential to reach a larger number of patients, including those not able to attend therapy in person. The current study is an innovative pragmatic, online, randomised control trial to explore the feasibility and acceptability of offering online smoking cessation support embedded into an existing Silvercloud Cognitive Behavioural therapy (CBT) platform.
Methods: Patients referred to online SilverCloud support, who are aged 18+ and smoke regularly are eligible. Consenting participants will be randomly assigned to a control or intervention group. Smokers in the intervention group are supported to stop via online behavioural support and psychoeducation. The smoking support was developed in collaboration with people who smoked and had mental health difficulties. The intervention will address barriers to stopping smoking; with content that is based on behaviour change theory. The control group receive usual care and will receive signposting to stop smoking information at the end of trial. Outcomes measured include the frequency of visits to the smoking cessation modules, any use of smoking medication such as e-cigarettes, and number of attempts to stop smoking.
Results: The trial is recruiting participants from the online Talking Therapy Services situated across a wide geographical area in England. The smoking cessation intervention will be described, in terms of the nature of the behavioural support and psychoeducation provided as well as feasibility measures and quit attempt findings. Discussion: This is the first trial which is investigating the acceptability and feasibility of nesting smoking cessation support into online Talking Therapy Services. This trial will produce important data on the feasibility and acceptability of this approach.