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性障碍患者吸烟，这一比率是普通人群比率的四倍。这种高吸烟率导致过早死亡，主要原因是与吸烟有关的癌症、肺病和心血管疾病。戒烟治疗是有效的，但这些吸烟者不使用它们。为了提供一种易于使用、具有成本效益的策略，使这群吸烟者参与有效的治疗，我们开发了一种单次治疗；基于网络的激励决策支持系统，让我们谈谈吸烟。该系统包含了一些功能，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很高的可用性。它提供了引人注目的内容，吸引用户参与基于证据的戒烟治疗。在我们的试点工作中，使用该系统的患有严重精神疾病的吸烟者中，几乎有一半（47%）开始了基于证据的戒烟治疗，相比之下，只有10%的人接受了公共卫生小册子。这项为期三年的研究将在一项随机对照试验中对162名患有精神分裂症和分裂情感性障碍的吸烟者进行最终测试，这些吸烟者在社区精神健康治疗中表现稳定。基线评估后，参与者将被随机分配使用决策支持系统或计算机化教育小册子（对照条件）。参与者将在接受干预后3个月和6个月接受评估，以开始和参与循证戒烟治疗，生物学上证实的戒烟，以及其他戒烟行为，吸烟行为和结果预期，依赖程度，戒烟和使用戒烟治疗的意图。分析将评估这一为认知障碍人群设计的系统是否对具有一系列认知能力的吸烟者、精神分裂症和分裂情感性障碍有效。如果我们能够证明这个系统是有效的，它将成为一个全面的、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，该系统可能成为一种模式策略，以接触其他受教育程度低和计算机经验不足的弱势吸烟者。

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.