Estudo intervencionista sobre redução do tabagismo na psiquiatria (TABAPSY)
Avaliação de uma intervenção para reduzir o tabagismo entre usuários de saúde mental tratados em psiquiatria ambulatorial
The smoking rate among people with mental disorders is higher than in the general population. Greater exposure to the harmful effects of tobacco partly explains the major inequality in life expectancy observed among people with mental disorders who, depending on the disorder and the study, live 10 to 25 years less than the general population, a gap mainly due to the occurrence of cardiovascular and respiratory pathologies, notably bronchial cancers. However, tobacco reduction actions specifically targeting these people remain insufficiently developed, particularly in psychiatry where this addiction is often banalized and its treatment neglected.
The objective of this study is to evaluate an intervention ('Tabapsy') co-constructed with mental health services users, mental health professionals, and general practitioners and targeting adult patients followed in ambulatory psychiatry. The main objective is to evaluate the effectiveness of the intervention on short-term smoking cessation (cessation for at least 7 days) among regular smokers at 3 months. Secondary objectives include evaluation of its cost-effectiveness and implementation. To this end, a national cluster-randomized controlled study will be carried out, supplemented by qualitative interviews to study the implementation of the intervention.
Visão geral do estudo
Status
Condições
Intervenção / Tratamento
Descrição detalhada
The smoking rate among people with mental disorders is higher than in the general population. Greater exposure to the harmful effects of tobacco partly explains the major inequality in life expectancy observed among people with mental disorders who, depending on the disorder and the study, live 10 to 20 years less than the general population, a gap mainly due to the occurrence of cardiovascular and respiratory pathologies, notably bronchial cancers.
While studies found that people under psychiatric care are as motivated as others to stop smoking, the literature also shows that psychiatric care systems tolerate, underestimate and even encourage smoking among users, despite the fact that psychiatric care, whether at hospital or in an ambulatory setting, is conducive to changes in smoking behaviour and to the implementation of a smoking cessation approach, notably because of anti-smoking regulations in hospitals. In addition, withdrawal symptoms is stronger in this population and smoking cessation would therefore need to be adapted.
Against this backdrop, a smoking cessation intervention ('Tabapsy') was co-constructed with the various stakeholders (users with mental disorders, mental health professionals and general practitioners). Its aim is to encourage and support smoking cessation among people with mental disorders followed in ambulatory psychiatry by medical psychological centers (CMP). It consists of two parts: a campaign to promote smoking cessation within the CMP, and the setting up of an intervention to help people stop smoking. The latter comprises of:
- A general information meeting, to encourage motivation to start smoking cessation;
- An assessment workshop, to evaluate level of dependence using validated tests and establish a personalized cessation program based on the results obtained;
- Five thematic workshops to support cessation, covering 1/ nicotine replacement treatments, electronic cigarettes and other drug treatments available for smoking cessation, 2/ emotional management, 3/ weight gain, 4/ physical activities, and 5/ manual occupations;
- Peer support groups, based on the sharing of experiences, to encourage mutual aid and solidarity between people with mental disorders who are trying to quit smoking.
The intervention also relies on a facilitator specifically recruited to set up the intervention and run the various workshops in the CMP. It is complemented by a website that will contain all the resources and information presented during the meetings/workshops.
The primary objective of the study is to evaluate the effectiveness of the "Tabapsy" intervention on short-term smoking cessation (cessation for at least 7 days) at 3 months among regular smokers followed by adult psychiatric CMPs. Secondary objectives include assessing its cost-effectiveness and implementation.
A cluster-randomized controlled trial will be carried out to evaluate the intervention. The cluster is the "psychiatric sector", i.e., the public care entity responsible for organizing the mental health care of a population within a pre-specified geographical area (including hospital and ambulatory care) in France. A psychiatric sector may include one or multiple CMPs depending on the size of the population it serves. Psychiatric sectors will be randomized into one of two groups (intervention or usual practice).
It will be supplemented by a qualitative study to study the implementation of the intervention.
All regular smokers (at least one cigarette a day) who agree to participate will be asked to complete questionnaires on a WebApp at inclusion, and again at 3 and 6 months. Additional questionnaires will be available in the intervention group. Questions will focus on user characteristics, tobacco consumption, level of nicotine dependence, motivation to quit, use of cessation aids, level of mental and physical well-being, smoking-related knowledge and representations, and in the intervention group, participation in the intervention and satisfaction.
6,250 participants will be included over 12 months, in 22 participating sectors.
Tipo de estudo
Inscrição (Estimado)
Estágio
- Não aplicável
Contactos e Locais
Contato de estudo
- Nome: Jean-Luc ROELANDT, MD
- Número de telefone: +33 3 20 43 71 00
- E-mail: jean-luc.roelandt@ghtpsy-npdc.fr
Locais de estudo
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Armentières, França, 59280
- Concluído
- Public mental health establishment of Lille Metropole (59G16-G17)
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Armentières, França, 59280
- Concluído
- Public mental health establishment of Lille Metropole (59G21)
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Bailleul, França, 59270
- Concluído
- Flanders public mental health establishment (59G05/06)
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Laxou, França, 54520
- Concluído
- Psychotherapeutic center of Nancy (54G02-06)
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Lille, França, 59000
- Retirado
- University Hospital Center of Lille (59G08)
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Nanterre, França, 92014
- Concluído
- Hospital Care Center of Nanterre (92G10)
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Paris, França, 75014
- Concluído
- University Hospital Group Paris Neurosciences & Psychiatry (75G04)
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Rouffach, França, 68250
- Concluído
- Hospital Center of Rouffach (68G02/03)
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Rouffach, França, 68250
- Concluído
- Hospital Center of Rouffach (68G08/09)
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Rouffach, França, 68250
- Concluído
- Hospital Center of Rouffach (Pôle LTD - 68G04/05)
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Saint-Maurice, França, 94410
- Concluído
- Hospitals of Paris Est Val de Marne (94G01)
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Saint-Maurice, França, 94410
- Concluído
- Hospitals of Paris Est Val de Marne (94G16)
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Saint-Maurice, França, 94410
- Concluído
- Hospitals of Paris Est Val de Marne (Paris 11)
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Saint-Maurice, França, 94410
- Concluído
- Hospitals of Paris Est Val de Marne (Paris 12)
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Saint-Maurice, França, 94410
- Concluído
- Hospitals of Paris Est Val de Marne (Paris Centre)
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Saint-Venant, França, 62350
- Concluído
- Public mental health establishment of Val de Lys Artois (62G09)
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Saint-Venant, França, 62350
- Concluído
- Public mental health establishment of Val de Lys Artois (62G12)
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Saint-Venant, França, 62350
- Concluído
- Public mental health establishment of Val de Lys Artois (Pôle du Ternois)
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Étampes, França, 91150
- Recrutamento
- Barthelemy Durand public health establishment (91G05)
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Contato:
- Amina AMRANDI, MD
- Número de telefone: + 33 1 69 46 86 66
- E-mail: amina.amrandi@eps-etampes.fr
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Investigador principal:
- Amina AMRANDI, MD
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Saint-Claude, Guadalupe, 97122
- Recrutamento
- Public mental health establishment of Guadeloupe (96G06)
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Contato:
- Isabelle DELAROZIERE, MD
- Número de telefone: +590 5 90 41 48 68
- E-mail: isabelle.delaroziere@epsm-guadeloupe.fr
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Investigador principal:
- Isabelle DELAROZIERE, MD
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Saint-Claude, Guadalupe, 97122
- Recrutamento
- Public mental health establishment of Guadeloupe (96G01)
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Contato:
- Daniel CAPERET, MD
- Número de telefone: +590 5 90 80 52 62
- E-mail: Daniel.CAPERET@epsm-guadeloupe.fr
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Investigador principal:
- Magloire MPEMBI, MD
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Saint-Paul, Reunião, 97460
- Concluído
- Public mental health establishment of Reunion Island (Pôle Nord)
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Critérios de participação
Critérios de elegibilidade
Idades elegíveis para estudo
Aceita Voluntários Saudáveis
Gêneros Elegíveis para o Estudo
Descrição
Inclusion Criteria:
- Regular smokers (at least one cigarette per day)
- Followed in psychiatric ambulatory care at one of the participating sectors' CMPs
- Adults (18 years or older)
- Covered by the statuary health insurance
- Who gave their informed consent to participate to the study
Exclusion Criteria:
- Users under guardianship or legal protection,
- Psychological state incompatible with completing the questionnaire,
- Persons with no command or understanding of the French language
Plano de estudo
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Prevenção
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
|
Experimental: Intervention arm
Sectors randomized to the intervention group will implement the 'Tabapsy' intervention. |
The Tabapsy intervention consists in a campaign to promote smoking cessation within the CMP, and an intervention to help people stop smoking which comprises of a) A general information meeting; b) An assessment workshop, to evaluate level of dependence using validated tests and establish a personalized cessation program based on the results obtained; c) Five thematic workshops to support cessation, covering 1/ nicotine replacement treatments, electronic cigarettes and other drug treatments available for smoking cessation, 2/ emotional management, 3/ weight gain, 4/ physical activities, and 5/ manual occupations; d) Peer support groups, based on the sharing of experiences, to encourage mutual aid and solidarity between people with mental disorders who are trying to quit smoking. The intervention relies on a facilitator specifically recruited to implement and run the intervention in the CMP. It is complemented by a website that will contain all the resources and information presented dur |
|
Outro: Usual care
Sectors randomized to the control group will continue implementing their usual smoking cessation promotion. |
Usual care corresponds to usual practices regarding smoking cessation activities in participating sectors. Those practices may vary (enquiring whether a patient is a smoker or not, offering smoking cessation if they are or only if the patient asks, etc.) |
O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Short-term smoking cessation
Prazo: 3 months
|
Short-term smoking cessation corresponds to a smoking cessation of at least 7 days, assessed among regular smoker (at least one cigarette a day) included in the study. |
3 months
|
Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Motivation to stop smoking
Prazo: 3 and 6 months
|
The motivation to stop smoking will be assessed using the Q-Mat ("Questionnaire de motivation à l'arrêt du tabac") scale. The computed score ranges from 0 to 20, 20 representing the highest motivation. |
3 and 6 months
|
|
Voluntary quit attempts lasting at least 24 hours in the last 3 months
Prazo: 3 and 6 months
|
Number of voluntary quit attempts assessed both as percentage of users reporting at least one quit attempt and mean number of quit attempts per use |
3 and 6 months
|
|
Voluntary quit attempts lasting at least 7 days in the last 3 months
Prazo: 3 and 6 months
|
Number of voluntary quit attempts assessed both as percentage of users reporting at least one quit attempt and mean number of quit attempts per user. |
3 and 6 months
|
|
Tobacco consumption
Prazo: 3 and 6 months
|
Number of cigarettes smoked per day |
3 and 6 months
|
|
Nicotine dependence
Prazo: 3 and 6 months
|
Nicotine dependence will be measured by the 6-question Fagerström test. |
3 and 6 months
|
|
Short-term smoking cessation
Prazo: 6 months
|
Short-term smoking cessation corresponds to a smoking cessation of at least 7 days, assessed among regular smoker (at least one cigarette a day) included in the study. |
6 months
|
|
Medium-term smoking cessation
Prazo: At 3 and 6 months
|
Medium-term smoking cessation corresponds to a smoking cessation of at least 30 days, assessed among regular smoker (at least one cigarette a day) included in the study. |
At 3 and 6 months
|
|
Use of smoking cessation aids
Prazo: 3 and 6 months
|
Number of participants using smoking cessation aids (nicotine replacement therapy and other smoking cessation medications (varenicline or bupropion), electronic cigarettes, and health professionals, assessed together and separately |
3 and 6 months
|
|
Level of mental well-being
Prazo: 3 and 6 months
|
Level of mental well-being assessed with a visual analog scale ranging from 1 to 10, 10 representing the highest level of mental well-being |
3 and 6 months
|
|
Level of physical well-being
Prazo: 3 and 6 months
|
Level of physical well-being assessed with a visual analog scale ranging from 1 to 10, 10 representing the highest level of physical well-being |
3 and 6 months
|
|
Knowledge and representations surrounding tobacco use
Prazo: 3 and 6 months
|
Knowledge and representations surrounding tobacco use will be assessed using a dedicated questionnaire addressed to all the included population as well as to patients who participated to a given workshop |
3 and 6 months
|
|
Cost-effectiveness (short-term)
Prazo: A 6 months
|
Incremental cost-effectiveness ratio in cost per additional weaning of at least 7 days. |
A 6 months
|
|
Cost-effectiveness (long-term)
Prazo: 6 months
|
Incremental cost-effectiveness ratio in cost per life-year gained over the entire life of users, using extrapolated data and economic modeling (Markov model) to assess lifetime costs and effectiveness 'till all patients in the model are deceased. |
6 months
|
|
Budgetary impact (costs)
Prazo: 5 years after hypothetical generalization
|
Direct costs will be calculated with and without the Tabapsy intervention to assess the budgetary impact of its generalization. |
5 years after hypothetical generalization
|
|
Budgetary impact (health benefits)
Prazo: 5 years after hypothetical generalization
|
The number of users who have stopped smoking for at least 7 days will be calculated with and without the Tabapsy intervention to assess the health gains associated with its generalization. |
5 years after hypothetical generalization
|
|
Implementation
Prazo: 6 months
|
The implementation of the intervention and its components will be assessed using qualitative methods through semi-structured interviews conducted with 25 mental health users et 25 mental health professionnals of the intervention group). |
6 months
|
|
Satisfaction level
Prazo: 3 and 6 months
|
Users who participated in one of the components of the intervention will be asked to rate their satisfaction using a visual analog scale ranging from 0 to 10, with 10 corresponding to the highest satisfaction. |
3 and 6 months
|
Colaboradores e Investigadores
Patrocinador
Colaboradores
Investigadores
- Investigador principal: Jean-Luc ROELANDT, MD, GCS-CCOMS & INSERM ECEVE 1123
- Diretor de estudo: Karine CHEVREUL, MD and Pr of public health, Evaluation and research in health services and policies for vulnerable populations, French National Institute for Health and Medical Research (INSERM ECEVE 11 23)
Datas de registro do estudo
Datas Principais do Estudo
Início do estudo (Real)
Conclusão Primária (Real)
Conclusão do estudo (Estimado)
Datas de inscrição no estudo
Enviado pela primeira vez
Enviado pela primeira vez que atendeu aos critérios de CQ
Primeira postagem (Real)
Atualizações de registro de estudo
Última Atualização Postada (Real)
Última atualização enviada que atendeu aos critérios de controle de qualidade
Última verificação
Mais Informações
Termos relacionados a este estudo
Palavras-chave
Termos MeSH relevantes adicionais
Outros números de identificação do estudo
- 2024-A01474-43
- A19017HS (Outro identificador: Institute for Public Health Research (IRESP))
Plano para dados de participantes individuais (IPD)
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