Bridging the Hospital Discharge Gap: Pilot Trial of a Digital Smoking Cessation Program for Psychiatric Inpatients

This randomized pilot trial aimed to evaluate the feasibility, acceptability, and preliminary outcomes of a digital smoking cessation intervention (DSCI)-adapted for psychiatric inpatients and designed to bridge the postdischarge treatment gap-and compare the DSCI with brief counseling (BC).

Psychiatric inpatients who were tobacco users were randomly assigned to DSCI or BC and assessed at 1 and 3 months postdischarge. Feasibility was examined via enrollment rates, acceptability was assessed by examining program engagement and satisfaction, and preliminary outcomes were assessed via abstinence outcomes at 1 and 3 months following hospital discharge and via postdischarge smoking cessation treatment use. Potential mechanisms of action (tobacco craving, abstinence self-efficacy, and abstinence motivation) were also evaluated.

Among 218 eligible patients, 27% (N=58) enrolled in the trial. Among DSCI participants with available data (N=31), 84% used at least one intervention component in the month following discharge, with website visits (65%) and community engagement (58%) being most common. At 1-month follow-up, significantly more DSCI participants reported 7-day abstinence compared with BC participants (N=6 vs. N=0, p=0.04). DSCI participants showed significantly greater increases in abstinence motivation from baseline to 1 month (p=0.05), whereas BC participants' motivation decreased. In qualitative interviews, DSCI participants valued the hospital-based orientation to DSCI and found automated text messages helpful for maintaining abstinence goals.

This pilot trial demonstrated promising signals regarding the feasibility, acceptability, and preliminary postdischarge outcomes of a digital intervention for promoting smoking cessation among psychiatric inpatients.