Speaker Name: Dr. Eden Evins
Session Description:
Individuals with serious mental illness (SMI) have a high prevalence of tobacco smoking and early mortality but underutilize smoking cessation medication. Support workers including community health workers (CHWs) are increasingly able to be reimbursed through Medicaid and Medicare. We sought to determine whether CHWs could improve delivery of first-line tobacco cessation treatment and through this mechanism improve abstinence rates in clients with SMI.
Adult who smoked tobacco and received psychiatric rehabilitation through two Greater Boston community agencies were eligible, regardless of readiness to quit smoking. 1,010 enrolled and were randomly assigned to CHW support + PE, PE alone to their primary care doctor, or usual care. 13 CHWs were employed through the agencies, received 80 hours of CHW certification training, a caseload of 35 participants and weekly group clinical supervision. CHWs were tasked with meeting participants in their communities, as often as they were willing, regardless of willingness to discuss, reduce or attempt to quit smoking, and to bring participants who were willing to smoking cessation groups and accompany them to primary care doctor visits.
CHW support, at a mean dose of 30 minutes twice per month over two years, combined with PE, increased tobacco abstinence rates at 2 years compared with PE alone (OR=1.84; 95% CI: 1.04, 3.24) and compared with usual care (OR=2.40; 95% CI: 1.20, 4.79). PE alone did not improve abstinence rates over usual care. Compared with participants assigned to usual care,
those assigned to PE+CHW had greater odds of varenicline use (OR=2.77, 95% CI: 1.61, 4.75), which was associated with
higher year 2 abstinence (OR=1.97, 95% CI: 1.16–3.33). In mediation analyses the CHW intervention also had a direct positive impact on tobacco cessation, independent of varenicline prescribing.
Low barrier CHW tobacco cessation support combined with PE increased tobacco abstinence rates among adults with SMI.
Learning Objectives:
- Participants will identify populations with high burden of tobacco use disorder and tobacco related morbidity and mortality.
- Participants will identify the most effective treatments for smoking cessation for those with serious mental illness
- Participants will identify gaps in treatment provision to people with serious mental illness.
- Participants will identify interventions, including community health worker support, that increase provision of first line tobacco cessation aids to people with serious mental illness.
References:
“Evins AE, Cather C, Maravic MC, Reyering S, Pachas GN, Thorndike AN, Levy DE, Fung V, Fischer MA, Schnitzer KC, Pratt S, Deeb B, Potter K, Schoenfeld DA. A pragmatic cluster randomized trial of provider education and community health worker support for tobacco cessation. Psychiatric Services. 2023 Apr 1;74(4):365-373. doi: 10.1176/appi.ps.20220187 PMID: 36349498.
Foo CYS, Potter K, Nielsen L, Rohila A, Maravic MC, Schnitzer K, Pachas GN, Levy DE, Reyering S, Thorndike AN, Cather C, Evins AE. Implementation of community health worker support for tobacco cessation in those with Serious Mental Illness: A mixed-methods study. Psychiatric Services. 2024. Aug 9:appips20240044. doi: 10.1176/appi.ps.20240044. PMID: 39118574.
Daumit GL, Evins AE, Cather C, Dalcin AT, Dickerson FB, Miller ER, Appel LJ, Jerome GJ, McCann U, Ford D, Charleston JB, Young DR, Gennusa JV, Goldsholl S, Cook C, Fink T, Wang NY. Effect of a tobacco cessation intervention incorporating weight management for adults with serious mental illness: A randomized clinical trial. JAMA Psychiatry. 2023. Sep 1;80(9):895-904. doi: 10.1001/jamapsychiatry.2023.1691. PMID: 37378972. *Co-first authors”
BIO
Dr. Eden Evins is the Cox Family Professor of Psychiatry at Harvard Medical School, founding director of the Center for Addiction Medicine and Center for Comprehensive Healing at Massachusetts General Hospital. She earned her undergraduate degree at the University of Virginia, her MD at the Medical University of South Carolina, and her psychiatry residency at the Harvard-Longwood Program. She conducted fellowships in molecular biology and in clinical and translational research at Harvard hospitals and earned a Master’s in Public Health from the Harvard School of Public Health. She as published over 250 research articles in journals including The Lancet, JAMA, JAMA Psychiatry, Biological Psychiatry, American Journal of Psychiatry, Neuropsychopharmacology. Dr. Evins received three NIH career awards, serves as director of a NIDA funded Addiction Research Fellowship Training Program, has raised over $35 million in extramural funding, and was named one of the Time Top100 in Healthcare in 2026.