JMIR Publications

ABSTRACT

Background:

People with serious mental illness are disproportionately affected by smoking and face barriers to accessing smoking cessation treatment in mental health treatment settings. Text-based interventions are cost effective and widely accessible approach to providing smoking cessation support.

Objective:

We aimed to identify key factors for adapting text-based cessation interventions for people with serious mental illnesses who smoke.

Methods:

We recruited 24 adults from mental health programs who had a serious mental illness and currently smoked cigarettes or had quit smoking within the past five years. We then conducted virtual qualitative interviews between November 2020 and August 2021. Data were analyzed using the rapid thematic analytic approach.

Results:

We identified three major themes: 1) interplay between smoking and having a serious mental illness, 2) social contextual factors of smoking in adults with serious mental illness, and 3) smoking and quitting behaviors similar to the general population. Participants reported both barriers and facilitators to quitting smoking across the three themes. Within the ‘interplay between smoking and having a serious mental illness’ theme, barriers included smoking to manage stress and mental health symptoms. Facilitators to quitting included the awareness of the harm of smoking on mental health. In the ‘social contextual factors of smoking in adults with serious mental illness’ theme, barriers included high social acceptability of smoking among peers. Facilitators included positive support from others and the social stigma of smoking outside peer groups. Some participants also indicated that low exposure to other smokers during the COVID-19 pandemic helped them to engage in cessation efforts. In the ‘smoking and quitting behaviors similar to the general population’ theme, barriers included smoking after eating, having coffee, drinking alcohol, and experiencing negative social support. Facilitators included health concerns and improvement in the general quality of life and using evidence-based tobacco treatments when available.

Conclusions:

We found that people with serious mental illness often smoke to cope with intense emotional states, manage mental health symptoms, or maintain social bonds. Emphasizing equally effective and less harmful ways for stress reduction and mental health symptom management may provide targeted text-based cessation interventions.