Social and environmental factors during the smoking cessation process: The experiences of adults with serious mental illnesses

Introduction: People living with schizophrenia and other serious mental illnesses (SMI) face a disproportionate burden of tobacco-related prevalence and, consequently, tobacco-induced morbidity, in comparison to those without SMI. Social and environmental factors play an important role in the health of people with SMI yet less is known about the role of these factors in smoking cessation interventions for adults with SMI. The purpose of this paper is to analyze the social and environmental factors that contributed to the smoking cessation process among adults with SMI enrolled in a smoking cessation program. Methods: We conducted semi-structured qualitative interviews with 30 adults (mean age 47.0, sd 12.2) living with SMI, upon completion of a 12-week smoking cessation program. Grounded Theory methodology guided data collection and analysis. Results: Participants described what contributed to their success with smoking cessation or reduction and elucidated how social and environmental factors played a role in the process. Two broad categories of the social determinants of smoking cessation evolved from the data: 1) support and belonging; and 2) environment, including both the physical and broader sociopolitical. Discussion/conclusion: Our findings illustrate the importance of including social and environmental contexts in health interventions and serve as a reminder to consider social determinants of health when tailoring interventions to meet the unique needs of people living with SMI. These findings can inform the development of tobacco cessation programs in mental health programs, such as the need to incorporate group-based social support, nature-friendly environments, and social activities in the process of cessation.