Enhancing Provider Delivery of Tobacco Treatment Within the Inpatient Psychiatric Setting

People with mental illnesses (MI) smoke at higher rates than the general population. However, few mental health providers (MHPs) deliver tobacco treatment to patients with MI especially within inpatient psychiatric settings. According to evidence, fewer than half of MHPs in the US mental and behavioral health settings provide the recommended evidence-based tobacco treatment interventions to their clients with MI. This paper uses the theory of planned behavior to examine factors associated with provider intentions to deliver and their experiences in providing evidence-based tobacco treatment to clients with MI. Data were obtained from a cross-sectional survey of 219 providers in a state psychiatric hospital in Kentucky. Attitudes, subjective norms, and perceived behavioral control were associated with providers’ intentions to deliver tobacco treatment when controlling for demographic and work-related variables. However, only profession, subjective norms, and attitudes were associated with reported provision of evidence-based tobacco treatment. Given the underuse of routine tobacco treatment for this vulnerable population, understanding factors influencing provider delivery of tobacco treatment is needed to guide strategies for reducing the disproportionate rates of tobacco use and related burden among people with MI.

The Psychometric Properties of the Minnesota Tobacco Withdrawal Scale Among Patients with Mental Illness

Background and Objectives:

Approximately 65% of psychiatric inpatients experience moderate-to-severe nicotine withdrawal (NW), a set of symptoms appearing within 24 hr after an abrupt cessation or reduction of use of tobacco-containing products in those using nicotine daily for at least a couple of weeks. The Minnesota Tobacco Withdrawal Scale (MTWS) is a widely used instrument for detecting NW. However, the psychometric properties of the MTWS have not previously been examined among patients with serious mental illness (SMI) undergoing tobacco-free hospitalization. The objective of this study was to examine the validity and reliability of the MTWS among patients with SMI during tobacco-free psychiatric hospitalization.



Reliability was tested by examining Cronbach’s α and item analysis. Validity was examined through hypothesis testing and exploratory factor analysis (N = 255).



The reliability analysis yielded a Cronbach’s α coefficient of .763, an inter-item correlations coefficient of .393, and item-total correlations between .291 and .691. Hypothesis testing confirmed the construct validity of the MTWS, and an exploratory factor analysis yielded a unidimensional scale.



The MTWS demonstrated adequate reliable and valid psychometric properties for measuring NW among patients with SMI. Nurses and other health-care professionals may use this instrument in clinical practice to identify patients with SMI experiencing NW. The MTWS is psychometrically sound for capturing NW during tobacco-free psychiatric hospitalization. Future research should examine the efficacy of the MTWS in measuring NW in this population over an extended period of hospitalization.

Factors associated with tobacco cessation attempts among inpatients in a psychiatric hospital


Several effective evidence-based tobacco treatment approaches can optimize cessation attempts; however, little is known about the utilization of such strategies by people with mental illnesses (MI) during their cessation attempts.


To examine methods used during and factors associated with tobacco cessation attempts among people with MI.


Self-administered cross-sectional survey data were obtained from 132 tobacco using inpatients from a psychiatric facility in Kentucky, USA.


Our study found ‘cold turkey’ as the most reported method by inpatient tobacco users with MI in their prior cessation attempts regardless of the psychiatric diagnosis category. Multivariate logistic regression found ethnicity (OR 26.1; 95% CI 2.9–237.1), age at 1st smoke (OR 1.1; 95% CI 1.0–1.1), importance to quit (OR 1.2; 95% CI 1.0–1.4), and receipt of brief tobacco treatment interventions (OR 1.1; 95% CI 1.0–1.3) significantly associated with quit attempt in the past year.


Despite the existence of various evidence-based approaches to enhance tobacco cessation among people with MI, ‘cold-turkey’ was the most preferred method in this sample. In addition, this study highlighted ethnicity, importance to quit, age at 1st smoke, and receipt of brief interventions as important factors to consider when tailoring tobacco cessation in this population. Though ethnicity is a non-modifiable factor, an informed provider may intervene skillfully by addressing socio-cultural barriers specific to an ethnic group. Lower ratings on the motivation ruler and early age of smoking initiation could also inform providers when using motivational interviewing and other evidence-based tobacco-cessation approaches.

Engaging clients with mental illnesses and behavioral health challenges in tobacco treatment


People living with mental illness have higher tobacco use rates and are disproportionately affected by tobacco-related illness and death. In fact, smoking is the leading cause of death in individuals with mental illness and substance use disorders. Yet smokers with mental illness have low success with traditional tobacco treatment programs. Behavioral health care providers need to be more aggressive in offering tobacco use treatment in these populations. The following video gives more background on this population and discusses how to adapt tobacco treatment programs to help those with mental disorders (about 18% of the US population). Many in this population use tobacco to affect their mood often when bored, needing to concentrate, or wanting momentary stress relief. In fact, some mental health facilities actually encourage nicotine use. But early tobacco use may actually cause psychosis or other mental illness and the tar from cigarettes can counteract the effectiveness of mental illness medication (I.e. antipsychotics, antidepressants, mood stabilizers, etc.). Smoking cessation could help the medications treating mental illness to be more effective. For these reasons and many more, the BH WELL team is passionate about changing the norm of nicotine addiction within mental health settings.


Video Citations

BH WELL Receives Funding to Assess Impact of Long-Acting Injectables on Psychiatric Treatment Outcomes

Please join us in congratulating Zim Okoli, PhD, MPH, MSN, RN, CTTS for his success in receiving a two year $383,440 State of Kentucky Department of Medicaid award entitled, "Assessing the Impact of Long-Acting Injectables (LAIs) on Psychiatric Treatment Outcomes Among Medicaid Recipients". As many of you are aware, people with severe mental illnesses, such as schizophrenia, face many challenges related to accessing community mental health services and adherence to medication regimen.

6 Ways Occupational Therapists Can Support People Living with Mental Illnesses

Occupational therapists work to help individuals improve everyday life skills so that they can better participate in home, school, work or wherever they may be. Many people know occupational therapists help children with disabilities or adults recovering from injury. BUT did you know that occupational therapists also help people living with mental illnesses?

Patient-Centered Care Helps Overcome Mental Illness and Tobacco Use

Dr. Zim Okoli is featured in the Lexington Herald-Leader and UKNOW discussing a central focus of his research on patients with mental illness and nicotine use. He highlights the need to have a patient-centered care approach. Read the full 2015 article, “Patient-Centered Care Helps Overcome Mental Illness and Tobacco Use."