RCT of a Motivational Decision Support System for Smokers with SMI

描述（由申请人提供）：高达80%的精神分裂症和情感性精神障碍患者吸烟-这一比例是普通人群的四倍。吸烟率高导致过早死亡，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。为了提供一个易于使用的，具有成本效益的策略，使这组吸烟者进入有效的治疗，我们开发了一个单一的会议，基于网络的，动机决策支持系统，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的高可用性。它提供了令人信服的内容，使用户参与循证戒烟治疗。在我们的试点工作中，几乎一半（47%）使用该系统的严重精神疾病吸烟者开始了循证戒烟治疗，而只有10%的人收到了公共卫生小册子。这项为期三年的研究将在一项随机对照试验中明确测试这种非常有前途的基于网络的干预措施，该试验在162名患有精神分裂症和情感障碍的吸烟者中进行，这些人在社区心理健康治疗中保持稳定。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的教育小册子（控制条件）。参与者将在接受干预后3个月和6个月进行评估，以启动和参与循证戒烟治疗，生物学证实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。分析将评估这种为认知受损人群设计的系统是否对具有一系列认知能力的吸烟者、精神分裂症和情感障碍有效。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，可以大大扩大戒烟治疗的范围。此外，这一系统可能成为一种模式战略，以达到其他人口的弱势吸烟者与低教育和计算机经验。

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.