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Vulnerable Populations

Smoking is much more common among vulnerable populations in society. We have a number of projects which aim to reduce smoking among these vulnerable populations. 

Smokers with mental health problems 

Cessation in smokers with mental health problems 

Dr Leonie Brose secured a three-year fellowship funded by Cancer Research UK/BUPA Foundation to assess smoking and smoking cessation in those with mental health problems. This fellowship is making use of existing clinical datasets and includes collaborations on surveys of the general population and healthcare professionals. It also includes a feasibility study to reduce relapse among smokers who have successfully stopped whilst in mental health settings with smoke-free policies. PhD student Mr Erikas Simonavicius also contributes to this and other related projects.  

Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London Psychosis Theme 

Professor Ann McNeill leads the CLAHRC South London Psychosis Theme, with an aim to improve the physical health of people with psychosis, and Dr Debbie Robson leads the smoking component of this research, and Rosemary Padley, Research Manager, provides business management support to the CLAHRC South London Psychosis team. 

In this project we played a key role in the development of our partner mental health Trust, the South London & Maudsley NHS Foundation Trust’s (SLaM) comprehensive smoke-free policy and wrote the Trust’s Tobacco Dependence Treatment Guidelines and Electronic Cigarette Policy. SLaM was an early implementer of the NICE guidelines for smoking cessation in secondary care and the second mental health Trust in the UK to implement a comprehensive smoke-free policy. The implementation of the smoke-free policy so far has attracted a great deal of interest nationally receiving a Helping Smokers Quit Award with KHP colleagues and Dr Debbie Robson being involved in Public Health England video and roadshows.  

Treatments to support the implementation of NICE PH48: Smoking cessation in secondary care 

Our research, led by Dr Debbie Robson and colleagues across SLaM and the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), utilises electronic patient records and Trust audits to assess the impact of the smoke-free policy on service user smoking and mental health, as well as addressing concerns raised through qualitative research by mental health professionals ahead of policy implementation.  

Current projects focus on: 

  1. Evaluating the provision of very brief advice for smoking cessation for people with psychosis who have a hospital stay.
  2. The provision of tobacco-dependence treatment during an inpatient admission: effect on uptake of support and outcome on temporary abstinence, smoking reduction and quitting.
  3. Evaluating the impact of the policy on violence (which is one of the main concerns mental health professionals have about smoke-free policies) with Miss Gilda Spaducci, Duncan Stewart (University of York) and Lisa Szatskowki (Nottingham University). 
  4. A systematic review of smoke-free policies in mental health settings and violence (Miss Gilda Spaducci, Brendon Stubbs, Health Services and Population Research (HSPR) and Duncan Stewart (University of York). 

Other components of the CLAHRC South London Psychosis Theme include the evaluation of a physical activity (walking) intervention, the production and evaluation of a physical health plan for service users and peer support for service users transferring from secondary to primary healthcare (led by Fiona Gaughran South London and Maudsley NHS Trust (SLaM) and Julie Williams Health Services and Population Research (HSPR). 

Electronic cigarette usage in mental health settings 

We have a number of projects exploring the use of electronic cigarettes in smokers with mental health problems: 

  1. Dr Debbie Robson is co-supervising a PhD student, Pasquale Caponnetto, with lead supervisor Professor Linda Bauld at the University of Stirling. The PhD projects include a qualitative study exploring the experiences of people with schizophrenia, tobacco smoking and use of electronic cigarettes, and an observational study of the role of electronic cigarettes on smoking displacement in smokers with schizophrenia.
  2. Professor Ann McNeill is co-supervising a PhD student, Charlie Smith, with lead supervisor Dr Lion Shahab (University College London, UCL). This studentship is exploring the potential benefits of electronic cigarettes in mental health settings using a mixture of both qualitative and quantitative research. 
  3. Professor Ann McNeill is a co-investigator of a pilot study on the use and safety of electronic cigarettes in people with mental illness (APUS-ecig) led by Dr Rocio Iglesias in the Psychosis department. 

Smokers who misuse other substances 

Cessation in smokers using other substances 

Former PhD student Dr Tom Ainscough conducted research on contingency management interventions to help smokers who are in treatment for opiate addiction to stop smoking. The PhD included a systematic review of CM interventions in the substance misuse field and a pilot study with smokers in opiate treatment. 

We are also working with colleagues in South London and Maudsley NHS Foundation Trust (SLaM), the Lambeth Addiction Treatment Consortium and Lambeth Stop Smoking Service to audit the outcome of tobacco dependence treatment with service user who are also receiving treatment for other substances. Treatment includes both stop smoking medication and/or electronic cigarettes. 

Research with Florence Nightingale Nursing Department 

Dr Maria Duaso carried out qualitative research with health professionals working with people misusing other substances. 

Ms Hannah Walsh is carrying out a PhD to explore smoking and cannabis use. The PhD will involve qualitative research with service users and the development and pilot testing of a new cannabis/smoking intervention.