Older adults with serious mental illness engagement in a smoking cessation program: A mixed-methods evaluation

Older adults with serious mental illness (SMI) experience substantially reduced life expectancy, with tobacco use contributing significantly to premature mortality. Although many individuals with SMI express interest in quitting smoking, effective and engaging cessation interventions tailored to this population remain limited.

To examine engagement in a group-based smoking cessation intervention among older adults with SMI and explore factors influencing engagement using a mixed-methods approach.

We analyzed data from participants aged ≥ 50 years enrolled in a randomized controlled trial of a 12-week group-based smoking cessation intervention. Quantitative analyses assessed retention, smoking behavior, and readiness to quit. Linear mixed-effects models with random intercepts for participants were used to evaluate changes in outcomes over time. Qualitative data were collected through semi-structured interviews and analyzed using grounded theory methods.

Forty participants with SMI (mean age = 58.0 years, SD = 4.7) were included. Twenty-six participants (65%) completed the 6-week assessment and 22 (55%) completed the full 12-week intervention. Mixed-effects models revealed a significant effect of time on smoking behavior, with cigarettes smoked per week decreasing significantly from baseline to midpoint (B = -38.31, 95% CI [-58.71, -17.90], p < .001) and remaining significantly lower than baseline at the end of the intervention (B = -26.72, 95% CI [-49.01, -4.43], p = .014). Readiness to quit scores did not change significantly over the 12-week period. Nine participants completed qualitative interviews. Analysis identified three interrelated dimensions of engagement: readiness to quit, access to the program, and accountability. Participants emphasized the importance of program structure, peer support, and opportunities to learn and apply cessation strategies in supporting behavior change.

Older adults with SMI demonstrated sustained engagement and significant reductions in smoking during a 12-week group-based cessation intervention. Engagement was facilitated by readiness, program accessibility, and accountability, suggesting that multifaceted interventions addressing both behavioral and contextual factors may improve smoking cessation outcomes in this high-risk population.