Published online Jul 19, 2026. doi: 10.5498/wjp.118770
Revised: February 14, 2026
Accepted: April 1, 2026
Published online: July 19, 2026
Processing time: 171 Days and 1.9 Hours
Smoking prevalence remains disproportionately high among individuals with severe mental illness, contributing to excess morbidity and mortality. Despite this burden, rigorously designed intervention studies targeting smoking cessation in this population are limited. The literature reveals a lack of randomized controlled trials investigating the effectiveness of nurse-led smoking cessation interventions among individuals with severe mental illness. This study was designed to eva
To assess the effectiveness of smoking cessation training in patients at a comm
This randomized controlled trial was conducted in a community mental health center between February and August 2025. Sixty-eight participants were assigned to intervention (n = 34) and control (n = 34) groups. The intervention was an eight-session group smoking cessation program delivered over four weeks. Data were collected using the Fagerström Test for Nicotine Dependence and the Smoking Self-Efficacy Questionnaire. Statistical analyses included two-way repeated measures analysis of variance for group × time effects, χ2 and independent samples t-tests.
Significant group × time interaction effects were observed for Fagerström Test for Nicotine Dependence, Smoking Self-Efficacy Questionnaire, and cigarettes smoked per day (P < 0.01). Post hoc analyses demonstrated that reductions in nicotine dependence and increases in smoking self-efficacy were evident immediately after the intervention and remained significant at the 1-month follow-up, whereas reductions in cigarette consumption were significant only immediately after the intervention. Between-group differences were no longer statistically significant at the 3-month follow-up.
Nurse-led smoking cessation programs resulted in significant short-term reductions in nicotine dependence and cigarette use, and increased self-efficacy; however, these gains were not maintained at 3-month follow-up.
Core Tip: Studies have consistently shown that smoking is a major public health concern among individuals with severe mental illness. The literature suggests that randomized controlled trials examining smoking cessation interventions, particularly nurse-led interventions, remain limited. This study demonstrated that nurse-led smoking cessation training delivered to individuals with severe mental illness registered in a community mental health center was effective in reducing nicotine dependence and daily cigarette consumption and in increasing smoking cessation self-efficacy. The results indicate that a nurse-delivered program can generate meaningful short-term improvements both in dependence levels and in individuals’ confidence in their ability to quit smoking.
- Citation: Öztürk Z, Tozoğlu EÖ, Metin A, Uludağ E, Sayım E. Effectiveness of smoking cessation training in patients at a community mental health center. World J Psychiatry 2026; 16(7): 118770
- URL: https://www.wjgnet.com/2220-3206/full/v16/i7/118770.htm
- DOI: https://dx.doi.org/10.5498/wjp.118770
Nicotine, the main component of tobacco, is one of the most addictive substances[1,2]. Each year, more than eight million people worldwide die from causes related to tobacco addiction[3]. Although tobacco dependence has declined over the past quarter century due to efforts to reduce addiction, it continues to affect one in five adults and remains among the leading preventable causes of death[4]. Tobacco dependence is particularly common among individuals with severe mental disorders, occurring at much higher rates compared to the general population[5-7]. Studies have shown that tobacco dependence, which may be used as a coping mechanism for negative stress in severe mental illness, can lead to serious consequences[5,8,9].
Smoking is among the major factors that increase the incidence of cardiovascular and respiratory diseases and various cancers in individuals with severe mental disorders[8,10]. Among individuals predisposed to psychosis, early tobacco use has been reported to increase the likelihood of developing psychotic symptoms later in life[11]. Tobacco dependence may also reduce the effectiveness of certain medications used in psychotic disorders, leading to the need for higher doses[7]. Deaths related to tobacco dependence are cited as one of the main reasons why people with severe mental health problems have an average life expectancy 15-20 years shorter than the general population[7]. Tobacco use also reduces patients’ quality of life and disrupts their social relationships[6]. Considering all these negative consequences of tobacco dependence, smoking cessation interventions in this group are of great importance[12,13].
A study by Siru et al[14] reported that individuals with mental illness who smoke have similar motivation to quit as those without mental illness. It is thought that similar biopsychosocial mechanisms play a role in smoking initiation and maintenance behaviors among individuals with severe mental illness as in those with other psychiatric disorders[12]. Furthermore, it has been stated that smoking cessation interventions proven effective in individuals without mental illness may also be effective in those with mental disorders[14]. Nurses constitute the largest group of health professionals and, as those who spend the most time with patients, play an active role in smoking cessation interventions[15-17]. It is emphasized that nurses should be at the forefront of the fight against tobacco addiction[16]. It is also highlighted that nurses should play an active role in smoking prevention and cessation in all settings where they provide care[16,17].
The literature demonstrates that smoking is a serious problem among individuals with severe mental illness; however, smoking cessation intervention studies conducted in this population remain quite limited[18-21]. Himelhoch et al[21] examined evidence-based smoking cessation practices in nine community mental health centers and reported that mental health teams did not consistently implement evidence-based interventions. The literature also reveals a lack of rando
H01: There is no difference between the intervention and control groups in changes in nicotine dependence over time.
H11: There is a difference between the intervention and control groups in changes in nicotine dependence over time.
H02: There is no difference between the intervention and control groups in changes in the number of cigarettes smoked per day over time.
H12: There is a difference between the intervention and control groups in changes in the number of cigarettes smoked per day over time.
H03: There is no difference between the intervention and control groups in changes in smoking cessation self-efficacy over time.
H13: There is a difference between the intervention and control groups in changes in smoking cessation self-efficacy over time.
The study was conducted as a randomized controlled trial with patients registered at a community mental health center between February 2025 and August 2025. The population of the study consisted of individuals with severe mental illness who were registered at the Community Mental Health Center where the research was conducted, met the inclusion criteria, and voluntarily agreed to participate in the study. This study was conducted using the CONSORT 2010 checklist and flowchart as a basis for reporting randomized controlled trials.
Inclusion criteria including: (1) Being registered at the Community Mental Health Center; (2) Being in the remission period (the period in which the patient’s treatment in the clinic has been completed, no active symptoms are observed, and insight has developed); (3) Smoking at least one cigarette per day regularly; (4) Being open to communication and cooperation; (5) Being over 18 years of age; and (6) Volunteering to participate in the study.
The study initially included 76 individuals after excluding those who did not meet the inclusion criteria or declined to participate. Eligible participants were randomly assigned to two groups using a simple random number table, and the first group drawn by lot was designated as the intervention group. During the study, four participants from both the intervention and control groups withdrew. The study was completed with a total of 68 participants, consisting of 34 in the intervention group and 34 in the control group. To determine whether the sample size was adequate, an a priori power analysis was conducted using G*Power 3.1.9.7. Based on an effect size of 0.50, an alpha level of 0.05, and a target power of 0.80, the minimum required sample size was calculated as 68 participants[22]. The final sample met this requirement, indicating adequate statistical power (Figure 1).
The study data were collected using the Personal Information Form, the Fagerström Test for Nicotine Dependence (FTND), and the Self-Efficacy Questionnaire (SEQ).
This form, prepared by the researchers, includes sociodemographic information.
Developed by Heatherton et al[23] in 1991. The Turkish validity and reliability study of the scale was conducted by Uysal et al[24] in 2004. The FTND is a self-report scale used to assess individuals’ risk of physical dependence on nicotine, as well as the level and severity of their addiction. It consists of six items scored on dichotomous (0-1) and four-point Likert-type (0-3) scales. The total score ranges from 0 to 10. According to the total score, 0-2 points indicate “very low dependence”, 3-4 points indicate “low dependence”, 5 points indicate “moderate dependence”, 6-7 points indicate “high dependence”, and 8-10 points indicate “very high dependence”[24].
Developed by Nicki et al[25] in 1984. Based on social learning theories, the concept is related to an individual’s belief in their ability to perform a desired behavior, and enhancing such beliefs is often utilized in smoking cessation studies[25,26]. The validity and reliability study of the SEQ in Turkish was conducted by Karanci[26]. The questionnaire consists of 25 items. Each item is rated on a five-point scale ranging from “Not at all confident: 1” to “Completely confident: 5”. The total score ranges between 25 and 125. A higher score indicates a stronger belief in one’s ability to quit smoking. Accordingly, as the total score increases, the individual’s confidence in quitting smoking also increases[26].
The study included both primary and secondary outcome measures. The primary outcomes were the change in nicotine dependence, assessed using the FTND, and the change in the number of cigarettes smoked per day. The secondary outcome was smoking cessation self-efficacy, measured using the smoking SEQ. All outcomes were assessed at baseline, immediately after the intervention, at the 1-month follow-up, and at the 3-month follow-up.
In the study, the training content was developed based on the literature and refined through expert consultation, then compiled into a booklet to enhance the permanence of the education[13,15,20,21,27-29]. Subsequently, the experimental and control groups were determined using randomization, and pretests were administered to both groups. The experimental group participated in a smoking cessation education program consisting of 8 sessions conducted twice a week for 4 weeks, with each session lasting approximately 45-50 minutes. At the beginning of each session, the previous session was reviewed to reinforce learning and ensure continuity, and feedback was obtained from participants.
Intervention delivery was standardized using a researcher-developed structured training manual that defined the content and sequence of each session. To ensure consistency, all sessions were conducted by the project coordinator and corresponding author, a trained nurse holding a doctoral degree in psychiatric nursing. The intervention followed a study-specific protocol, and adherence to the program structure was monitored throughout the study to maintain inter
Posttests were administered to participants in both the experimental and control groups at the end of the intervention. To evaluate the persistence of the education, follow-up assessments were conducted after the intervention period. Smoking cessation education and the educational booklet were offered to voluntary participants in the control group after completion of the study.
Session 1 (preparation session): (1) Introductions; (2) Providing information about the program; (3) Establishing group rules; (4) Sharing participants’ experiences and expectations; and (5) Applying the questionnaires used in the study.
Session 2 (understanding smoking addiction): (1) Reasons for smoking; (2) Types of smoking addiction; (3) Harms of smoking; (4) Mechanism of nicotine’s effect; and (5) Management of nicotine withdrawal and withdrawal symptoms.
Session 3 (the process of quitting smoking): (1) Factors affecting smoking cessation (2) Methods of quitting smoking; and (3) Stages of smoking cessation.
Session 4 (cognitive restructuring in smoking addiction): (1) Importance of cognitive preparation for smoking cessation; (2) Explanation of the 3D model (thought-emotion-behavior); (3) Cognitive distortions related to smoking; and (4) Exp
Session 5 (activating social support systems in smoking addiction): (1) Discussion on the role of the social environment in smoking cessation; (2) Evaluation of social support resources; and (3) Discussion on ways to create a continuous sense of belonging in the community and through the internet (associations, various online sites, and groups).
Session 6 (developing problem-solving skills in smoking addiction): (1) Explanation of problem-solving methods in smoking addiction; (2) Explanation of problem-solving methods in overcoming barriers to quitting smoking; (3) Identification of personal strengths that support smoking cessation; and (4) Explanation of ways to enhance self-efficacy for smoking cessation.
Session 7 (strengthening coping in smoking addiction): (1) The impact of stress on smoking cessation and relapse; (2) Explanation of stress symptoms observed during the quitting process; (3) Teaching stress management techniques; (4) Implementation of a proper breathing exercise; and (5) Practice of mental imagery.
Session 8 (evaluation): (1) Brief summary of the sessions (reinforcement of learning); (2) Evaluation of experiences throughout the program; (3) Program evaluation and obtaining feedback (from where to where); (4) Distribution of educational booklets prepared to enhance the permanence of the training; (5) Applying the questionnaires used in the study; and (6) Completion of the program.
The data were coded and analyzed using SPSS version 29. Descriptive statistics included means, frequencies, and percentage distributions. Group differences in categorical variables were examined using the χ2 test, and independent samples t-tests were used for continuous baseline comparisons. A two-way repeated-measures analysis of variance (ANOVA) was conducted to evaluate group × time interaction effects.
Ethical approval for the study was obtained from the Erzurum Technical University Scientific Research and Publication Ethics Committee, approval No. 15/6. Informed verbal and written consent were obtained from all participants, and all procedures were conducted in accordance with the principles of the Declaration of Helsinki.
The findings of the study, which was conducted to examine the effectiveness of smoking cessation training among patients registered at the community mental health center, are presented below.
Table 1 presents the comparative socio-demographic characteristics of the participants in the study. It was determined that 76.5% of the individuals in the experimental group were male, 67.6% were single, 73.5% were diagnosed with schizophrenia and other psychotic disorders, 47.1% had an income lower than their expenses, 35.3% were secondary school graduates, and 67.6% were unemployed. In the control group, 67.6% of the individuals were male, 79.4% were single, 76.5% were diagnosed with schizophrenia and other psychotic disorders, 50% had an income equal to their expenses, 44.1% were secondary school graduates, and 64.7% were unemployed. The mean age of the individuals in the experimental group was 40.32 ± 9.15, and the mean number of years of smoking was 23.71 ± 9.86. The mean age of the individuals in the control group was 41.06 ± 8.71, and the mean number of years of smoking was 23.68 ± 8.78. It was found that there was no significant difference between the groups in terms of socio-demographic characteristics, indicating that they were similar (P > 0.05).
| Characteristics | Experimental group (n = 34) | Control group (n = 34) | Test value and significance | ||
| Gender | |||||
| Female | 8 | 23.5 | 11 | 32.4 | χ2 = 0.292, P = 0.589 |
| Male | 26 | 76.5 | 23 | 67.6 | |
| Marital status | |||||
| Single | 23 | 67.6 | 27 | 79.4 | χ2 = 0.680, P = 0.410 |
| Married | 11 | 32.4 | 7 | 20.6 | |
| Diagnosis | |||||
| Bipolar disorders | 9 | 26.5 | 8 | 23.5 | χ2 = 0.000, P = 1.000 |
| Schizophrenia and other psychotic disorders | 25 | 73.5 | 26 | 76.5 | |
| Income status | |||||
| Income less than expenses | 16 | 47.1 | 10 | 29.4 | χ2 = 2.455, P = 0.336 |
| Income equal to expenses | 14 | 41.2 | 17 | 50.0 | |
| Income more than expenses | 4 | 11.7 | 7 | 20.6 | |
| Educational status | |||||
| Literate | 8 | 23.5 | 6 | 17.6 | χ2 = 1.363, P = 0.739 |
| Primary education | 10 | 29.4 | 11 | 32.4 | |
| Secondary education | 12 | 35.3 | 15 | 44.1 | |
| Bachelor’s degree | 4 | 11.8 | 2 | 5.9 | |
| Employment status | |||||
| Unemployed | 23 | 67.6 | 22 | 64.7 | χ2 = 0.216, P = 1.000 |
| Employed | 7 | 20.6 | 7 | 20.6 | |
| Retired | 4 | 11.8 | 5 | 14.7 | |
| Age | 40.32 ± 9.15 | 41.06 ± 8.71 | t = -0.339, P = 0.735 | ||
| Years of smoking | 23.71 ± 9.86 | 23.68 ± 8.78 | t = 0.013, P = 0.990 | ||
Table 2 presents binary smoking status derived from cigarettes per day (CPD) (abstinent: CPD = 0; smoking: CPD > 0) across time by group. At pretest, all participants in both groups were classified as smoking (100%). At posttest, abstinence was observed in 6/34 (17.6%) participants in the experimental group and 0/34 (0%) in the control group. At the 1-month follow-up, abstinence rates were 5/34 (14.7%) vs 0/34 (0%), and at the 3-month follow-up, 4/34 (11.8%) vs 0/34 (0%). Overall, abstinence was observed only in the experimental group and declined over follow-up.
| Time point | Cigarettes/day | Experimental group | Control group |
| Pretest | 0 | 0 (0) | 0 (0) |
| 1-10 | 3 (8.8) | 4 (11.8) | |
| 11-20 | 10 (29.4) | 11 (32.4) | |
| 21-30 | 10 (29.4) | 8 (23.5) | |
| ≥ 31 | 11 (32.4) | 11 (32.4) | |
| Posttest | 0 | 6 (17.6) | 0 (0) |
| 1-10 | 4 (11.8) | 3 (8.8) | |
| 11-20 | 11 (32.4) | 11 (32.4) | |
| 21-30 | 9 (26.5) | 11 (32.4) | |
| ≥ 31 | 4 (11.8) | 9 (26.5) | |
| 1st follow-up | 0 | 5 (14.7) | 0 (0) |
| 1-10 | 4 (11.8) | 3 (8.8) | |
| 11-20 | 9 (26.5) | 10 (29.4) | |
| 21-30 | 10 (29.4) | 12 (35.3) | |
| ≥ 31 | 6 (17.6) | 9 (26.5) | |
| 2nd follow-up | 0 | 4 (11.8) | 0 (0) |
| 1-10 | 4 (11.8) | 3 (8.8) | |
| 11-20 | 9 (26.5) | 11 (32.4) | |
| 21-30 | 10 (29.4) | 10 (29.4) | |
| ≥ 31 | 7 (20.6) | 10 (29.4) |
Table 3 presents the results of the two-way repeated measures ANOVA for FTND, SEQ, and CPD. Sphericity was assessed using Mauchly’s test. For FTND, the sphericity assumption was violated [Mauchly’s W = 0.341, χ2 (5) = 69.707, P < 0.001]; therefore, Greenhouse-Geisser (GG) corrected results are reported. For SEQ, sphericity was also violated [Mauchly’s W = 0.578, χ2 (5) = 35.456, P < 0.001], and GG-corrected results are reported. For CPD, sphericity was not violated [Mauchly’s W = 0.905, χ2 (5) = 6.473, P = 0.263]; therefore, sphericity-assumed results are reported.
| Time point | Experimental group | Control group | Time | Group | Group × time |
| FTND | F = 8.36 | F = 3.95 | F = 3.21 | ||
| Pretest1 | 6.76 ± 1.39 | 6.91 ± 1.71 | P = 0.001 | P = 0.051 | P = 0.049 |
| Posttest2 | 5.03 ± 2.90 | 6.56 ± 1.89 | η2 = 0.112 | η2 = 0.057 | η2 = 0.046 |
| 1st follow-up3 | 5.41 ± 2.85 | 6.47 ± 1.89 | Post hoc: 1 > 2, 1 > 3 | ||
| 2nd follow-up4 | 5.59 ± 2.79 | 6.59 ± 2.03 | |||
| CPD | F = 3.40 | F = 2.69 | F = 3.72 | ||
| Pretest1 | 23.29 ± 8.98 | 22.82 ± 9.62 | P = 0.019 | P = 0.106 | P = 0.012 |
| Posttest2 | 16.15 ± 10.82 | 23.15 ± 9.37 | η2 = 0.049 | η2 =0.053 | |
| 1st follow-up3 | 18.24 ± 12.20 | 22.3 ± 9.06 | Post hoc: 1 > 2 | ||
| 2nd follow-up4 | 19.68 ± 11.70 | 22.53 ± 9.61 | |||
| SEQ | F = 14.72 | F = 5.63 | F = 22.41 | ||
| Pretest1 | 50.59 ± 20.36 | 51.50 ± 16.48 | P < 0.001 | P = 0.021 | P < 0.001 |
| Posttest2 | 69.74 ± 19.24 | 49.47 ± 13.65 | η2 = 0.182 | η2 = 0.079 | η2 = 0.254 |
| 1st follow-up3 | 60.59 ± 20.41 | 50.26 ± 15.26 | Post hoc: 1 < 2, 1 < 3, 2 > 3, 2 > 4 | ||
| 2nd follow-up4 | 58.62 ± 19.72 | 50.38 ± 15.24 | |||
A two-way repeated measures ANOVA indicated a significant group × time interaction for FTND scores, F (1.791, 118.192) = 3.21, P = 0.049, partial η2 = 0.046 (GG-corrected). Bonferroni-adjusted pairwise comparisons across time points based on estimated marginal means for the main effect of Time (collapsed across groups) showed that FTND scores at posttest and 1-month follow-up were significantly lower than pretest scores (1 > 2, 1 > 3), whereas the pretest to 3-month follow-up difference was not statistically significant. In the experimental group, mean FTND scores decreased immediately after the intervention and remained numerically below baseline at follow-up, although the reduction at 3 months did not reach statistical significance. The control group showed no statistically meaningful change across measurement points.
For cigarettes smoked per day, a significant group × time interaction was observed, F (3, 198) = 3.72, P = 0.012, partial η2 = 0.053 (sphericity assumed). Bonferroni-adjusted pairwise comparisons across time points based on estimated marginal means for the main effect of time (collapsed across groups) indicated that cigarette consumption at posttest was significantly lower than at pretest (1 > 2), while differences involving follow-up assessments were not statistically significant. In the experimental group, cigarette consumption decreased immediately after the intervention and remained numerically below baseline at both follow-up assessments. The control group exhibited no statistically meaningful change over time.
A significant group × time interaction effect was also observed for SEQ scores, F (2.315, 152.780) = 22.41, P < 0.001, partial η2 = 0.254 (GG-corrected), representing a large interaction effect. Bonferroni-adjusted pairwise comparisons across time points based on estimated marginal means for the main effect of Time (collapsed across groups) showed that SEQ scores increased significantly from pretest to posttest and 1-month follow-up (1 < 2, 1 < 3), and that posttest scores were significantly higher than both follow-up measurements (2 > 3, 2 > 4). This pattern indicates an immediate increase following the intervention, followed by a partial decline over time, although scores remained above baseline. SEQ scores in the control group remained stable across all measurement points.
Effect size interpretation based on conventional benchmarks suggested a small-to-moderate interaction effect for FTND and CPD, and a large effect for SEQ[30].
Studies have consistently shown that smoking is a major public health concern among individuals with severe mental illness, yet intervention studies targeting smoking cessation in this population remain relatively limited. The literature also suggests that randomized controlled trials examining smoking cessation interventions, particularly nurse-led interventions, remain limited. The present study was conducted to address this gap by evaluating the effectiveness of structured smoking cessation training delivered in a community mental health center.
It was determined that, prior to the intervention, participants in both groups exhibited high levels of nicotine dependence, high daily cigarette consumption, and low smoking cessation self-efficacy. Mahamud Isse[31] reported that the prevalence of smoking among individuals with mental illness ranged between 50% and 85%, and that these individuals were significantly less likely to quit smoking compared to the general population. Similarly, Khanna et al[28] found that individuals with serious mental illness were more likely to smoke and had higher levels of dependence compared to the general population. Dickerson et al[32] reported that the smoking rates among individuals with mental illnesses such as schizophrenia and bipolar disorder remained disproportionately high compared to the general population due to various cognitive, emotional, and systemic barriers to cessation support. These results are consistent with the findings of the present study.
In this study, smoking cessation training provided to patients registered at the community mental health center reduced nicotine dependence, decreased daily cigarette consumption, and increased self-efficacy for quitting smoking in the intervention group. During the one-month follow-up, the decrease in nicotine dependence and the increase in smoking cessation self-efficacy remained significant, while the decrease in cigarette consumption did not persist in the follow-up measurements. At the three-month follow-up, the differences between the groups in terms of nicotine dependence, cigarette consumption, and self-efficacy were no longer statistically significant. Effect size estimates revealed small to moderate effects for nicotine dependence and cigarette consumption, and a large effect for self-efficacy; this suggests that the intervention provided measurable improvements that gradually weakened over time.
This study determined that the nurse-based smoking cessation training applied to the experimental group reduced the levels of nicotine dependence and the number of cigarettes smoked daily among individuals with severe mental disorders, and increased their self-efficacy levels regarding quitting smoking. In the follow-up study conducted one month after the intervention, the decrease in nicotine dependence and self-efficacy for quitting smoking was significant. In contrast, the decrease in the number of cigarettes smoked daily was not significant. In the follow-ups conducted three months later, nicotine dependence, the number of cigarettes smoked daily, and self-efficacy levels were found to be no different from those of the control group. In conclusion, smoking cessation training resulted in improvements that gradually diminished over time. Small-to-medium effect sizes were observed for nicotine dependence and cigarette consumption, while large effect sizes were observed for self-efficacy. The literature indicates that randomized controlled trials evaluating nurse-led smoking cessation interventions in individuals with severe mental illness are limited. Current evidence suggests that interventions effective in the general population can achieve similar success in individuals with severe mental illness[19,20]. Lappin et al[13] demonstrated the feasibility of evidence-based smoking cessation interventions in psychiatric care settings for individuals receiving mental health services, and these findings support the current study.
In this study, the percentage of participants who reported quitting smoking immediately after receiving nurse-based smoking cessation education in the experimental group was 17.6%, but this decreased to 14.7% at 1 month and 11.8% at 3 months. Although nicotine dependence, daily cigarette consumption, and self-efficacy levels did not show significant changes in the third-month follow-up, the percentage of participants who reported quitting smoking demonstrates that nurse-based smoking cessation education may support short-term smoking cessation among individuals with severe mental illness. Banham and Gilbody[19] reported that most smoking cessation interventions implemented in individuals with mental illness provided moderate short-term benefits but weaker long-term outcomes. Garcia-Portilla et al[20] showed that multi-component cessation programs were effective in the short term, but that cessation rates declined over time. Busch et al[33] reported that smoking cessation training based on the chronic care model had a strong effect in reducing the number of cigarettes smoked daily by individuals with serious mental illness, but that this effect diminished over time. Bennett et al[34] found that their psychosocial smoking cessation intervention for individuals diagnosed with serious mental illness reduced nicotine dependence and cigarette consumption in the short term but failed to sustain this effect in the long term. In the three-month follow-up studies conducted in this study, the preservation of the direction of change despite the decreasing effect in the experimental group indicates that the intervention had a short-term effect that weakened over time. This may be related to the absence of reinforcement sessions in the study, the severity of symptoms in severe mental disorders, the chronic and recurrent nature of nicotine addiction, and the lack of integration of pharmacotherapy into the intervention. These findings are consistent with the current study and suggest that smoking cessation interventions are effective in the short term but difficult to sustain in the long term in individuals with severe mental illness.
The study has several limitations that should be considered when interpreting the findings. First, the study was conducted in a single community mental health center, which may limit the generalizability of the results to other clinical settings and populations. Second, all outcomes were assessed using self-report measures, which may be subject to reporting bias and social desirability effects. In addition, smoking cessation status was not verified using biochemical indicators, representing a lack of objective behavioral outcome data. The relatively small sample size may have limited statistical power, particularly for detecting sustained effects at the 3-month follow-up. Furthermore, all participants were in remission at the time of the study; therefore, the findings may not be generalizable to individuals experiencing acute phases of severe mental illness.
Nurse-led smoking cessation programs resulted in significant short-term reductions in nicotine dependence and cigarette use, and increased self-efficacy; however, these gains were not maintained at 3-month follow-up. These findings are particularly important given that nurse-led smoking cessation interventions in this population remain limited in the literature. The results indicate that a nurse-delivered program can generate meaningful short-term improvements both in dependence levels and in individuals’ confidence in their ability to quit smoking. In light of these findings, systematically integrating nurse-led smoking cessation programs into routine nursing care and reinforcing them with structured follow-up support is recommended to sustain treatment gains.
The authors are grateful to all the study participants for their cooperation in this study.
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