An Integrated Approach to Smoking Cessation in SMI

描述（由申请人提供）：本申请是为了响应PA-05-019，精神障碍患者的健康行为改变。与探索性研究资助的重点一致（从干预发展到服务：探索性研究资助，2006年3月，PAR-06-248），本R34申请的重点是开发、试点测试和评估一种创新性干预措施的可行性、耐耐性、可接受性和安全性，用于参加精神康复计划（PRPs）的重度精神障碍患者戒烟。PRP是有吸引力的戒烟计划的地点，因为参加他们的患者精神稳定，出席频率更高，就诊时间比门诊就诊时间更长，并且计划的重点是帮助改善患者的长期健康和全面康复。与R34指南一致，我们将：(a)基于理论和实证研究概念化干预（阶段1）；(b)发展和规范干预（第二阶段）；(c)在小规模随机试验中对干预措施进行先导试验（第三阶段）。我们将首先对PRP的工作人员进行关于重度精神分裂症患者戒烟的教育和培训，以改变治疗环境，促进戒烟作为精神健康治疗的目标，支持患者减少或戒烟的努力，并为PRP的不吸烟提供一致的，具体的加强。然后，我们将开发和试点测试一种针对重度精神分裂症患者戒烟的新型多方面行为干预，包括：(1)强调动机增强、技能培训、教育和复发预防的行为组干预；(2)应急管理与财政激励，以加强团体出勤和减少吸烟；(3)支持使用安非他酮或尼古丁替代疗法，并与患者的精神病学护理相结合；(4)戒烟护理协调，旨在提高治疗参与度和坚持度。我们的具体目标是：(1)开发针对重度精神障碍患者的多方面戒烟行为干预的干预材料，并检查干预的可行性、可接受性和安全性。(2)测量治疗后和治疗后3个月对戒烟率、戒烟尝试次数、戒烟意向和吸烟率的影响。次要目的是：(1)研究态度、认知规范和自我效能的变化与吸烟结果之间的关系；(2)检查吸烟结果与症状之间的关系。尽管人们普遍认识到吸烟对健康的破坏性影响，以及重度精神分裂症患者的吸烟率异常高，但重度精神分裂症患者的吸烟并没有得到应有的充分和紧迫的关注。考虑到重度精神障碍患者吸烟率的上升，我们为开发和测试一种创新的、基于广泛的戒烟计划所做的努力，该计划是为适应这种多重残疾人群的需要而量身定制的，具有重大的成本、健康和护理质量影响。在精神康复项目的背景下整合戒烟也将为解决尼古丁成瘾提供新的背景，进一步提高研究的公共卫生意义。

DESCRIPTION (provided by applicant): This application is in response to PA-05-019, Health Behavior Change in People with Mental Disorders. Consistent with the focus of Exploratory Research Grants (From Intervention Development to Service: Exploratory Research Grants, March 2006, PAR-06-248), this R34 application is focused on developing, pilot testing, and evaluating the feasibility, tolerability, acceptability, and safety of an innovative intervention for smoking cessation in people with SMI attending psychiatric rehabilitation programs (PRPs). PRP's are attractive sites for smoking cessation programs because the patients who attend them are stable psychiatrically, attendance is more frequent, visits are longer than outpatient clinic visits, and programming is focused on helping to improve patients' long-term health and overall recovery. Consistent with the R34 guidelines, we will: (a) conceptualize an intervention based on theory and empirical research (Stage 1); (b) develop and standardize the intervention (Stage 2); and (c) pilot test the intervention in a small-scale randomized trial (Stage 3). We will first educate and train PRP staff regarding smoking cessation in SMI in order to change the treatment environment to promote smoking cessation as a goal of mental health treatment, support patients' efforts to reduce or quit smoking, and to provide consistent, concrete reinforcement for not smoking at the PRP. We will then develop and pilot test a novel multifaceted behavioral intervention for smoking cessation in SMI patients that will include: (1) A behavioral group intervention emphasizing motivational enhancement, skills training, education, and relapse prevention; (2) Contingency management with financial incentives to reinforce group attendance and reductions in smoking; (3) Supported use of Bupropion or nicotine replacement therapy that is integrated with patients' psychiatric care; and (4) Smoking cessation care coordination aimed at increasing treatment engagement and retention. Our specific aims are: (1) Develop intervention materials for a multifaceted behavioral intervention for smoking cessation designed for people with SMI, and examine the feasibility, acceptability, and safety of the intervention. (2) Measure the effects at post-treatment and 3-months post-treatment on rates of smoking cessation, number of quit attempts, intention to quit smoking, and rates of smoking reduction. Secondary Aims are: (1) Examine the relationship between changes in attitudes, perceived norms, and self-efficacy with smoking outcomes; and (2) Examine the relationship between smoking outcomes and symptoms. Despite widespread recognition of the devastating health effects of smoking and the extraordinarily high rates of smoking in people SMI, smoking in SMI has not received the full and urgent attention that it deserves. Given the elevated rates of smoking among patients with SMI, our efforts to develop and test an innovative, broad- based smoking cessation program that is tailored to the needs of this multi-handicapped population carry significant cost, health, and quality of care implications. Integration of smoking cessation within the context of psychiatric rehabilitation programs will also provide a new context for addressing nicotine addiction, further enhancing the public health significance of the research.