ORIGINAL RESEARCH Utilization of Evidence-Based Smoking Cessation Treatments by Psychiatric Inpatient Smokers With Depression David R. Strong, PhD, Lisa Uebelacker, PhD, Kathryn Fokas, BS, Jennifer Saritelli, BA, Stephen Matsko, BA, Ana M. Abrantes, PhD, and Yael Schonbrun, PhD Objectives. Although smoking is a major health issue among de- pressed psychiatric inpatients and interest in quitting is high, suc- cessful quit rates remain low among this population. We sought to understand preferences that depressed inpatient smokers may have for cessation treatments. Methods. Eighty smokers (60% women, mean age 38.75 ± 11.20) with major depressive disorder and nicotine dependence receiving psychiatric inpatient services provided information on current de- pressive symptoms, smoking status and nicotine dependence, quit attempts, perceived barriers to quitting, and smoking consequences. Results. Almost half (46%) of participants endorsed a past-year quit attempt. Emotional barriers to quitting were uniquely associated with fewer past-year quit attempts, and depression severity was related to greater emotional barriers to quitting. Nicotine dependence severity was related to a variety of emotional, financial, weight concern, and self-efficacy barriers, but only weight gain concern was associated with decreased odds of making a past-year quit attempt. The num- ber of lifetime quit attempts was positively associated with negative smoking consequences. With regard to interest in smoking cessation treatment, 86% and 92% of smokers reported a willingness to try be- havioral counseling and nicotine replacement products, respectively, but fewer smokers reported a willingness to try medication, print or Web-based materials, or an unaided quit attempt. Conclusions. Although half of our sample reported recent quit at- tempts, many people did not make an attempt using an evidence- based treatment. On the basis of consumer preferences identified herein, clinical recommendations for reinforcing the use of evidence- From the Department of Family and Preventive Medicine (DRS), University of California, San Diego; Alpert Medical School of Brown University (LU, AMA, YS), Providence, RI; and Butler Hospital (LU, KF, JS, SM, AMA, YS), Providence, RI. Received for publication October 29, 2013; accepted August 3, 2013. Supported by a Research Scholar Award from the American Cancer Society (RSGPB-08-145-01-CPPB). All authors have no conflicts of interest to declare. Send correspondence and reprint requests to David R. Strong, PhD, Department of Family and Preventive Medicine, University of Califor- nia, San Diego, 9500 Gilman Drive 0813, La Jolla, CA 92093. E-mail: dstrong@ucsd.edu. Copyright C  2014 American Society of Addiction Medicine ISSN: 1932-0620/14/0802-0077 DOI: 10.1097/ADM.0000000000000027 based smoking cessation treatments for depressed psychiatric inpa- tient smokers are provided. Key Words: depression, inpatient treatment, smoking cessation (J Addict Med 2014;8: 77–83) T obacco-related disease contributes substantially to the in- creased risk of morbidity and mortality seen in those with severe psychiatric illness (Colton and Manderscheid, 2006). Rates of smoking among individuals with major depressive disorder (MDD) are nearly 3 times that of the general popu- lation, and 4 times higher among individuals receiving inpa- tient care for MDD (Lasser et al., 2000; Kessler et al., 2005). Despite these high smoking rates and co-occurring mental disorders, 65% of psychiatric inpatients express an intention to quit smoking (Prochaska et al., 2006), similar to general population smokers (Hall and Prochaska, 2009). However, de- pressed smokers have fewer lifetime quit attempts and are less likely to successfully quit than other smokers (Hagman et al., 2008; Strong et al., 2010). A 2008 Institute of Medicine (2007) report concluded that more effort was needed to inte- grate promotion of quitting and facilitation of evidence-based treatments (EBT) for cessation into health care systems. Psy- chiatric service providers could serve a key role in decreas- ing the disproportionate smoking-related health consequences among individuals with depression. In the United States, 41% of state psychiatric hospitals have implemented complete smoking bans (Lane et al., 2009). Given the importance of addressing psychiatric patients’ high rates of smoking, a smoke-free hospital stay can provide an ideal opportunity to quit (Shmueli et al., 2007; Prochaska, 2009). Prochaska (2009) argues that mental health profession- als are well-equipped to treat tobacco dependence, as they can blend behavioral and pharmacological treatments, an effective combination for outpatient smokers (Fiore et al., 2008). Fur- thermore, several studies have found no evidence that smoking abstinence adversely affects patients’ mental health or behav- ior on inpatient units (Lawn and Pols, 2005; Prochaska et al., 2008). In contrast, Prochaska (2009, 2011) claims that failure to address tobacco use during inpatient treatment is harmful for patients’ overall health and treatment outcomes. Moreover, smoking abstinence may support recovery from other addic- tions (Prochaska et al., 2004). Copyright © 2014 American Society of Addiction Medicine. Unauthorized reproduction of this article is prohibited. J Addict Med  Volume 8, Number 2, March/April 2014 77