Decision support for smoking cessation in young adults with severe mental illness

描述（由申请人提供）：高达77%的患有严重精神疾病（精神分裂症和严重情绪障碍）的美国年轻人吸烟，这一比例比其他年轻人的每日吸烟率高出5倍。由于与吸烟有关的疾病，这一群体的发病率和死亡率非常高。动机干预可以使重度精神分裂症吸烟者戒烟，但尚未在患有重度精神分裂症的年轻过渡年龄成人中进行过测试，他们需要针对其独特特征和需求进行干预。研究人员开发了一种基本的、易于使用的、激励的电子决策支持系统（EDSS），专门为患有重度精神分裂症的吸烟者设计。虽然在中年重度精神分裂症成年人中进行的试点试验提供了有希望的结果，但最近在年轻重度精神分裂症吸烟者中进行的试点工作表明，EDSS虽然具有激励作用，但需要进一步发展。为了满足这一群体对低成本、有效的动机干预措施的需求，我们建议进一步开发并测试我们基于理论的EDSS——该产品将是一种易于使用和实施的基于网络的干预措施，以激励年轻的SMI吸烟者通过有效的戒烟治疗戒烟。这里提出的EDSS发展将基于计划行为理论，该理论指出，可以改变人口特定的信念，态度，社会规范和对健康行为的感知行为控制，以增加意图和行为制定。在第一年，我们将确定阻碍使用戒烟治疗的年轻重度吸烟者的信念。然后，EDSS将通过新的设计、文本、互动练习和视频患者故事来修改以改变这些信念（以及相关的态度、社会规范和感知行为控制）。修订后的EDSS将在年轻重度重度吸烟者中进行实用性实地测试，并根据需要进行改进。在第二年，我们将对60名患有重度精神障碍的年轻吸烟者进行随机对照试验，将EDSS与计算机版的标准戒烟小册子进行比较。分析将评估EDSS的使用是否会导致更多的临床证实的戒烟治疗的开始，以及对治疗信念的改变。这项研究将为R01申请奠定基础，进行一项完整的随机对照试验，以测试修订后的EDSS在激励年轻重度重度吸烟者使用戒烟治疗方面的功效。这种干预的最终目标是延长预期寿命，减轻疾病负担，提高重度精神障碍美国人的生活质量。

DESCRIPTION (provided by applicant): Up to 77% of young Americans with severe mental illnesses (SMI: schizophrenia and severe mood disorders) smoke, a rate that is up to five times higher than the rate of daily smoking in other young adults. This group goes on to experience very high rates of morbidity and mortality due to smoking-related diseases. Motivational interventions can engage SMI smokers into cessation but have not been tested in young, transitional age adults with SMI, who require interventions that address their unique characteristics and needs. The investigators have developed a basic, easy-to-use, motivational electronic decision support system (EDSS) tailored for smokers with SMI. Although pilot testing in middle-aged SMI adults provided promising results, recent pilot work among young SMI smokers indicated that the EDSS, although motivating, required further development. To address the need for low cost, effective motivational interventions for this group, we propose here to further develop and then test our theory-based EDSS -- the product will be an easy-to-use and implement web-based intervention to motivate young SMI smokers to quit with effective cessation treatments. The EDSS development proposed here will be based on the Theory of Planned Behavior, which states that population-specific beliefs, attitudes, social norms, and perceived behavioral control regarding a health behavior can be changed to increase intention and behavior enactment. In Year 1, we will identify the beliefs of young SMI smokers that impede use of cessation treatments. The EDSS will then be revised to change these beliefs (and related attitudes, social norms and perceived behavioral control) with new design, text, interactive exercises, and video patient stories. The revised EDSS will be field-tested for usability among young SMI smokers and improved as needed. In Year 2, we will conduct an RCT among 60 young smokers with SMI psychotic disorders comparing the EDSS to a computerized version of a standard smoking cessation pamphlet. Analyses will assess whether use of the EDSS results in greater clinician-confirmed initiation of cessation treatment, as well as changes in beliefs about treatment. This study will set the stage for an R01 application to conduct a full RCT to test the efficacy of the revised EDSS to motivate young SMI smokers to use cessation treatment. The ultimate goals of this intervention are to extend life expectancy, reduce illness burdens and increase quality of life for Americans with SMI. PUBLIC HEALTH RELEVANCE: Up to 77% of young people with severe mental illnesses (SMI) smoke tobacco. Motivational interventions to engage this disparity group into cessation treatment are needed. This research will further develop and conduct preliminary testing on a tailored, motivational, web-based decision support system for smoking cessation in young adults with SMI. The overall goal is to prevent cancer and other smoking-related disease in this group.