RCT of a Motivational Decision Support System for Smokers with SMI

描述(由申请人提供)：高达80%的精神分裂症和分裂情感障碍患者吸烟--这一比例是普通人群的四倍。如此高的吸烟率导致早期死亡，很大程度上是由于与吸烟有关的癌症、肺部疾病和心血管疾病。戒烟疗法是有效的，但这些吸烟者并不使用它们。为了提供一种简单易用、成本效益高的策略来让这群吸烟者接受有效的治疗，我们开发了一个基于网络的单次会议的激励性决策支持系统，我们来谈谈吸烟吧。该系统整合了一些功能，确保那些由于认知障碍和计算机技能低下而无法使用当前网站的人具有高可用性。它提供了引人注目的内容，让用户参与到以证据为基础的戒烟治疗中。在我们的试点工作中，使用该系统的严重精神疾病吸烟者中，近一半(47%)开始了循证戒烟治疗，而接受公共卫生小册子的吸烟者中，这一比例仅为10%。这项拟议的为期三年的研究将在162名患有精神分裂症和分裂情感障碍的吸烟者中进行随机对照试验，最终测试这种非常有希望的基于网络的干预措施，这些吸烟者在社区心理健康治疗中表现稳定。在基线评估之后，参与者将被随机分配使用决策支持系统或计算机化的教育小册子(控制条件)。参与者将在接受干预后三个月和六个月接受评估，以启动和参与循证戒烟治疗、生物确认的戒烟和其他戒烟行为、吸烟行为和结果预期、依赖程度以及戒烟和使用戒烟治疗的意图。分析将评估这个为认知障碍人群设计的系统是否对吸烟者、精神分裂症和具有一系列认知能力的分裂情感障碍有效。如果我们能够证明这一系统是有效的，它将成为一种全面的、基于网络的治疗方法的一部分，以减少精神分裂症患者的吸烟，这将极大地扩大这一人群的戒烟治疗范围。此外，该系统可能成为接触到其他受教育程度和计算机经验较低的弱势吸烟者的典范战略。

DESCRIPTION (provided by applicant): Up to 80% of people with schizophrenia and schizoaffective disorders smoke - a rate that is four times the rate in the general population. This high rate of smoking leads to early mortality due in large part to smoking-related cancers, lung diseases and cardiovascular diseases. Cessation treatments are effective, but these smokers don't use them. In order to provide an easy-to-use, cost-effective strategy to engage this group of smokers into effective treatments, we developed a single-session; web-based, motivational decision support system, Let's Talk About Smoking. The system incorporates features that insure high usability among those who can't use current websites due to cognitive impairments and low computer skills. It provides compelling content that engages users into evidence-based cessation treatments. In our pilot work, almost half (47%) of smokers with severe mental illnesses who used this system initiated evidence-based cessation treatments, compared to only 10% of those who received a public health pamphlet. The proposed three-year study will definitively test this highly promising web-based intervention in a randomized, controlled trial among 162 smokers with schizophrenia and schizoaffective disorders who are stable in community mental health treatment. After baseline assessment, participants will be randomly assigned to use the decision support system or a computerized educational pamphlet (control condition). Participants will be assessed three and six months after receiving the intervention for initiation of and engagement in evidence-based cessation treatment, biologically confirmed abstinence, and other quit behaviors, smoking behaviors and outcome expectancies, level of dependence, and intention to quit and to use cessation treatment. Analyses will assess whether this system, designed for a cognitively impaired population, is effective among smokers schizophrenia and schizoaffective disorders with a range of cognitive abilities. If we are able to show that this system is effective, it will become part of a comprehensive, web-based treatment approach to reduce smoking in people with schizophrenia that can dramatically expand the reach of smoking cessation treatment for this population. Further, this system may become a model strategy to reach other populations of disadvantaged smokers with low education and computer experience.