Smoking-related health inequalities, tobacco smoking and substance use disorder.

Background: harms induced by tobacco smoking are exceedingly high in addicted populations when compared to the general population. Tailored, intensive and comprehensive treatment strategies are needed. Mental Health Day Hospitals (MHDH) could be a key setting for the implementation, since patients usually attend every day and have the opportunity to receive such interventions.

Methods: we designed a holistic approach to tobacco cessation/reduction in addicted patients attending a MHDH. The intervention was a multicomponent treatment. A brief advice smoking cessation intervention was used for the control group. Patients completed the following measures at baseline and at discharge: number of cigarettes smokes per day, cotinine levels in urine, Fagerström test, Richmond test, State-Trait Anxiety Inventory (STAI), Brief Symptom Infentory-18 (BSI-18) and Montgomery-Asberg Depression Rating Scale (MADRS). We report the descriptive results of the control sample and the comparison between outcome variables at baseline and discharge using the t-student test for related samples.

Results: a total of 63 patients included the mean age was 44.94 (±11.8), 46% female and the most frequent diagnosis was alcohol use disorder (43%). At baseline the mean of cigarettes smokes per day was 21.16; cotinine levels 1845 ng/ml; Fagerström 5.76; Richmond 3.55; STAI 61.78; BSI 23.06 and MDRS mean 18.12. At discharge the mean of cigarettes smokes was 16.44; cotinine levels 1750 ng/ml; Fagerström 5.13; RIchmond 4; STAI 44.92; BSI 13.86 and MDRS mean 9.54. The number of cigarettes, STAI score and BSI score at the discharge were significantly less (p < 0.05).

Conclusions: health inequalities are preventable differences in health outcomes. Reducing health inequalities remains a key goal of public policy. The MHDH is a resource that offers intensive and holistic interventions. The improvement of patients during their admission and the reduction in cigarettes smoked, show that they would benefit from an intensive treatment of smoking cessation.