A Web-Based Tobacco Cessation Treatment for Veterans with Mental Health Disorders

项目摘要 与普通人群相比，患有精神疾病的退伍军人吸烟率很高 (32%-68%对一般人群的15%）和低终身戒烟率（17-33%对一般人群的43%）。 人口）。因此，患有心理健康障碍的退伍军人面临着严重健康问题的高风险。 问题和身体机能不良。平均而言，患有心理健康疾病的退伍军人将失去25年 他们的生活由于吸烟有关的原因。此外，患有精神疾病的退伍军人吸烟 严重干扰他们的心理健康和社会功能（例如，影响到人际关系工作 娱乐活动），但目前的治疗错过了帮助退伍军人改善这些生活领域的机会 功能此外，没有广泛提供的VA专用戒烟网站，这是一个 为退伍军人提供的服务有很大差距。 SPiRE项目的目标是调整和评估现有的有效的基于网络的烟草 为患有精神疾病的退伍军人提供戒烟计划。基于Web的接受和承诺 治疗（ACT）是一种新的有效的戒烟治疗模式。本干预使用 接受和承诺疗法（ACT）的戒烟原则，一个基于证据的烟草 一种停止方法，专注于使用接受，正念和对价值观的承诺，以帮助 退伍军人克服戒烟和实现生活目标的情感障碍。基于Web的ACT 戒烟干预，WebQuit是：（1）有效的基于网络的戒烟干预， 一般人群吸烟者（3个月时为23%-24%）;和（2）临床上吸烟者高度接受 创伤后应激障碍的重要症状然而，这一基于网络的计划并没有适应的具体需求， 有精神疾病的退伍军人。有针对性的节目内容，以解决各种精神症状- 相关的吸烟诱因，退伍军人文化，往往鼓励吸烟，和穷人的生活功能， 退伍军人是必要的，以解决这些普遍的动机吸烟的退伍军人与心理健康 紊乱拟议的治疗，Vet WebQuit，是一种针对退伍军人的基于网络的ACT干预， 心理健康障碍，专门针对心理健康障碍戒烟，退伍军人文化， 吸烟，以及与烟草使用和精神健康障碍相关的功能低下。 拟议的SPiRE将涉及几个目标：1）调整现有的，有效的，有针对性的基于Web的 对患有精神健康障碍的退伍军人进行戒烟干预（Vet WebQuit），使用的数据来自 资深焦点小组; 2）通过迭代可用性测试优化Vet WebQuit的可用性（n=20），以及3）准备 Vet WebQuit的最终版本，用于未来更大规模的随机对照试验的拨款申请。 干预该试点项目在三个关键方面具有重要意义和创新性：（1）它采用了一种有前途的新方法， 治疗方法（即，接受，正念，基于价值观的生活），以解决低戒烟率的问题， 有精神健康障碍的退伍军人;（2）这种基于网络的干预可能具有成本效益，并且易于 传播;（3）对改善退伍军人的功能和生活质量的关注有很大不同 比标准的基于网络的烟草治疗更有效。该试点项目的结果将为制定一项 Vet WebQuit与www.example.com的随机临床试验Smokefree.gov是最广泛推广的基于网络的 VHA和美国的戒烟计划。

PROJECT SUMMARY Compared to the general population, Veterans with mental health disorders have high rates of smoking (32%-68% vs. 15% in the general population) and low lifetime quit rates (17-33% vs. 43% in the general population). As a result, Veterans with mental health disorders are at high risk of developing severe health problems and poor physical functioning. On average, Veterans with mental health disorders will lose 25 years of their life due to smoking-related causes. In addition, smoking by Veterans with mental health disorders substantially interferes with their mental health and social functioning (e.g., interferes with relationships, work, recreational activities), but current treatments miss the opportunity to help Veterans improve these areas of life functioning. In addition, there is no widely available VA-specific tobacco cessation website, which is a substantial gap in services for Veterans. The goal of this SPiRE project is to adapt and evaluate an existing and effective web-based tobacco cessation program for Veterans with mental health disorders. Web-based Acceptance and Commitment Therapy (ACT) is a new and effective model of smoking cessation treatment. This intervention uses the principles of Acceptance and Commitment Therapy (ACT) for tobacco cessation, an evidence-based tobacco cessation approach which focuses on the use of acceptance, mindfulness, and a commitment to values to help Veterans overcome emotional obstacles to quitting tobacco and achieving life goals. A web-based ACT smoking cessation intervention, WebQuit is: (1) an efficacious web-based smoking cessation intervention for general population smokers (23%-24% at 3 months); and (2) highly acceptable to smokers with clinically significant symptoms of PTSD. However, this web-based program has not adapted to the specific needs of Veterans with mental health disorders. Targeting program content to address a variety of psychiatric symptom- related smoking triggers, the Veteran culture that often encourages smoking, and poor life functioning for Veterans is necessary to address these prevalent motives for smoking in Veterans with mental health disorders. The proposed treatment, Vet WebQuit, is a targeted web-based ACT intervention for Veterans with mental health disorders that specifically targets mental health obstacles to quitting, the Veteran culture of smoking, and poor functioning associated with tobacco use and mental health disorders. The proposed SPiRE will involve several aims: 1) Adapt an existing, effective, and targeted web-based tobacco cessation intervention for Veterans with mental health disorders (Vet WebQuit), using data from Veteran focus groups; 2) Optimize usability of Vet WebQuit via iterative usability testing (n=20), and 3) Prepare a final version of Vet WebQuit for a future grant application of a larger randomized controlled trial of this intervention. This pilot project is significant and innovative in three key respects: (1) it applies a promising new treatment approach (i.e., acceptance, mindfulness, values-based living) to the problem of low quit rates among Veterans with mental health disorders; (2) this web-based intervention is potentially cost-effective and easy to disseminate; and (3) the focus on improving Veterans' functioning and quality of life is substantially different than standard web-based tobacco treatments. Results from this pilot project will inform the development of a randomized clinical trial of Vet WebQuit vs. Smokefree.gov, one of the most widely promoted web-based tobacco cessation programs in VHA and in the United States.