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SCIMITAR+

People with serious mental health problems such as schizophrenia or bipolar disorder are three to four times more likely to smoke than people in the general population. Smoking contributes to poor health, poverty and early death in people with severe mental ill health (SMI) and people with SMI die on average 20 to 25 years earlier than those without. Smoking makes a significant contribution to this health inequality. Whilst smoking rates are falling in the general population, they have remained unchanged among people who use mental health services. For these reasons, it is clear that conventional approaches to smoking cessation might need to be tailored to people with SMI, to address lower motivation to quit, and to ensure that help is delivered in a way that anticipates the specific difficulties of those with mental illness. A bespoke smoking cessation intervention (BSC) to help people with SMI cut down or quit smoking has been developed by the present team and a pilot trial to test the acceptability of the BSC intervention conducted.

The SCIMITAR pilot successfully recruited and followed up 97 participants and found that the BSC intervention was acceptable to people with SMI. The next stage of this program of research is to carry out a definitive randomised controlled trial. In the SCIMITAR+ trial 400 people will be randomly allocated to either the BSC intervention or usual GP care where they will have access to existing smoking cessation services which are not generally tailored to the needs of people with SMI.

In the SCIMITAR+ trial we will examine whether the BSC intervention works better than existing smoking cessation services in helping people with SMI to quit smoking and compare the cost of the BSC intervention with usual care.

Outputs

Protocol: Peckham, E., Arundel, C., Bailey, D. et al. Smoking Cessation Intervention for Severe Mental Ill Health Trial (SCIMITAR+): study protocol for a randomised controlled trial. Trials 18, 44 (2017). https://doi.org/10.1186/s13063-017-1789-7

Results: Gilbody, S., Peckham, E., Bailey, D., Arundel, C., Heron, P., Crosland, S., Fairhurst, C., Hewitt, C., Li, J., Parrott, S., Bradshaw, T., Horspool, M., Hughes, E., Hughes, T., Ker, S., Leahy, M., McCloud, T., Osborn, D., Reilly, J., ... Vickers, C. (2019). Smoking cessation for people with severe mental illness (SCIMITAR+): a pragmatic randomised controlled trial. The Lancet Psychiatry, 6(5), 379-390. https://doi.org/10.1016/S2215-0366(19)30047-1

HTA Monograph: Peckham E, Arundel C, Bailey D, Crosland S, Fairhurst C, Heron P, et al. A bespoke smoking cessation service compared with treatment as usual for people with severe mental ill health: the SCIMITAR+ RCT. Health Technol Assess 2019;23(50). https://doi.org/10.3310/hta23500

Cost Effectiveness: Li, J., Fairhurst, C., Peckham, E., Bailey, D., Arundel, C., Hewitt, C., Heron, P., Crosland, S., Parrott, S., Gilbody, S., and SCIMITAR+ collaborative (2020) Cost-effectiveness of a specialist smoking cessation package compared with standard smoking cessation services for people with severe mental illness in England: a trial-based economic evaluation from the SCIMITAR+ study. Addiction, 115: 2113–2122. https://doi.org/10.1111/add.15086

Arundel CE, Peckham E, Bailey D, Crosland S, Heron P, Gilbody S. Challenges and solutions to nicotine replacement therapy access: observations from SCIMITAR+. BJPsych Open. 2020;6(6):e120. doi:10.1192/bjo.2020.100

Peckham, E. J., Mishu, M. P., Fairhurst, C. M., Robson, D., Bradshaw, T., Arundel, C. E., Bailey, D., Heron, P. N., Ker, S., & Gilbody, S. (2020). E-cigarette use and associated factors among smokers with severe mental illness. Addictive Behaviors, 108, Article 106456. https://doi.org/10.1016/j.addbeh.2020.106456

Heron P, McCloud T, Arundel C, et al. Standard smoking cessation services in sites participating in the SCIMITAR+ trial for people with severe mental ill health. BJPsych Bulletin. 2020;44(1):6-11. doi:10.1192/bjb.2019.39

Arundel C, Coleman E, Fairhurst C et al. The effectiveness of a contingent financial incentive to improve trial follow up; a randomised study within a trial (SWAT) [version 2; peer review: 2 approved]. F1000Research 2020, 8:1937 (https://doi.org/10.12688/f1000research.21059.2)

Gilbody S, Peckham E, Bailey D, et al. Smoking cessation in severe mental illness: combined long-term quit rates from the UK SCIMITAR trials programme. The British Journal of Psychiatry. 2021;218(2):95-97. doi:10.1192/bjp.2019.192

Peckham, E., Arundel, C., Bailey, D. et al. Successful recruitment to trials: findings from the SCIMITAR+ Trial. Trials 19, 53 (2018). https://doi.org/10.1186/s13063-018-2460-7