Randomized Controlled Trial of a Novel Smoking Cessation Application Tailored to Individuals with Serious Mental Illness

项目概要/摘要 在患有严重精神疾病的人中，烟草使用率仍然高得惊人， 精神分裂症、躁郁症和复发性抑郁症。吸烟是头号 这一人群中可预防的死亡原因，缩短了患有严重精神疾病的成年人的寿命， 25年，造成3170亿美元的医疗保健支出和间接收入损失和残疾 效益为个人提供更广泛的戒烟干预措施的新颖有效模式 严重精神疾病患者的治疗是非常需要的，并被列为NIH的优先事项。移动的应用程序是一个有前途的 为严重精神疾病患者提供戒烟治疗的方法。尽管有许多应用程序 我们的可行性研究表明， 这些应用程序对这一群体提出了严峻的挑战。基于这项工作，我们开发了学习戒烟， 一个以用户为中心的戒烟应用程序，专为严重精神疾病患者的需求而量身定制。的 app的主要活性成分是一种新的行为治疗方法， 接受和承诺疗法（Acceptance and Commitment Therapy）该应用程序提供有关尼古丁使用的教育 替代疗法和美国临床实践指南的建议，以确保与最佳 临床实践。在最近的一项试点随机对照试验（R 00 DA 037276）中，将学会戒烟与 NCI的QuitGuide，我们证明了：（1）高招聘率和保留率，（2）高水平的用户 参与学习戒烟，（3）进行大型多中心随机对照研究的有效方法 试验，和（4）有希望的戒烟结果。虽然这项发展工作提供了初步的证据， Quit的可用性、可行性和初步疗效，尚需大规模随机对照试验来检验 它在严重精神疾病患者的代表性样本中的疗效。因此，拟议的研究 将：（1）采用随机平行组设计，比较学会戒烟与NCI戒烟指南的疗效， (2)使用严格的方法来评估应用程序参与度和应用程序功效的中介，以及（3）检查 与为普通人群设计的非定制应用程序相比，Learn to Quit的成本效益。的 一项针对严重问题的研究--患有严重精神疾病的人吸烟率高-- 建议测试一个容易获得的戒烟干预的有效性，使用技术与 潜在的高人口水平的影响。

PROJECT SUMMARY/ABSTRACT Tobacco use remains at alarming high rates amongst individuals with serious mental illness, such as schizophrenia spectrum, bipolar, and recurring depressive disorders. Smoking tobacco is the number one preventable cause of death in this population, shortening the lifespan of adults with serious mental illness by 25 years and contributing to $317 billion in healthcare expenditures and indirect loss of earnings and disability benefits. Novel and effective models to deliver wider-reaching smoking cessation interventions to individuals with serious mental illness are highly needed and indicated as a priority for NIH. Mobile apps are a promising method to deliver smoking cessation treatments to people with serious mental illness. Despite numerous apps available to use for people with serious mental illness, our feasibility research has demonstrated that using these apps presents daunting challenges for this population. Based on this work, we developed Learn to Quit, a user-centered smoking cessation app tailored to the needs of individuals with serious mental illness. The app’s main active ingredient is a novel behavioral treatment that has shown promise as a smoking cessation intervention -- Acceptance and Commitment Therapy. The app provides education about the use of nicotine replacement therapy and recommendations from US Clinical Practice Guidelines to ensure alignment with best clinical practices. In a recent pilot randomized controlled trial (R00 DA037276), comparing Learn to Quit versus NCI’s QuitGuide, we demonstrated: (1) high recruitment and retention rates, (2) high levels of user engagement with Learn to Quit, (3) an effective method to conduct a large multi-site randomized controlled trial, and (4) promising cessation outcomes. While this developmental work provides initial evidence of Learn to Quit’s usability, feasibility, and preliminary efficacy, a large scale randomized controlled trial is needed to test its efficacy in a representative sample of patients with serious mental illness. Therefore, the proposed study will: (1) employ a randomized parallel arm design to compare the efficacy of Learn to Quit vs. NCI’s QuitGuide, (2) use rigorous methods to evaluate mediators of app engagement and app efficacy, and (3) examine the cost-effectiveness of Learn to Quit compared to a non-tailored app designed for the general population. The study addresses a serious problem -- high smoking rates among people with serious mental illness -- and proposes to test the efficacy of an easily-accessible smoking cessation intervention, using technology with the potential for high population-level reach.