An Integrated Approach to Smoking Cessation in SMI

描述(申请人提供)：本申请是对PA-05-019《精神障碍患者的健康行为改变》的回应。与探索性研究资助的重点一致(从干预开发到服务：探索性研究资助，2006年3月，PAR-06-248)，这项R34应用专注于开发、试点测试和评估参加精神康复计划(PRPS)的SMI患者戒烟的创新干预的可行性、耐受性、可接受性和安全性。PRP戒烟计划是有吸引力的地点，因为参加戒烟计划的患者精神状态稳定，就诊频率更高，就诊时间比门诊更长，计划的重点是帮助患者改善长期健康和整体康复。根据R34指南，我们将：(A)在理论和实证研究的基础上对干预措施进行概念化(阶段1)；(B)制定干预措施并使其标准化(阶段2)；(C)在小规模随机试验中对干预措施进行试点测试(阶段3)。我们将首先在SMI对PRP工作人员进行戒烟教育和培训，以改变治疗环境，将戒烟作为心理健康治疗的目标，支持患者减少或戒烟的努力，并为PRP提供持续的、具体的不吸烟加固。然后，我们将开发和试点一种针对SMI患者戒烟的新型多方面行为干预措施，其中将包括：(1)强调动机增强、技能培训、教育和预防复发的行为小组干预；(2)应急管理和财政激励，以加强小组出勤和减少吸烟；(3)支持使用安非他酮或尼古丁替代疗法，与患者的精神护理相结合；以及(4)旨在提高治疗参与度和保持率的戒烟护理协调。我们的具体目标是：(1)开发针对SMI患者的多方面戒烟行为干预材料，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、戒烟次数、戒烟意向和减烟率的影响。第二个目标是：(1)研究态度、知觉规范和自我效能感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，以及在SMI人群中吸烟率极高，但SMI的吸烟并没有得到应有的充分和紧迫的关注。鉴于SMI患者吸烟率的上升，我们努力开发和测试一种创新的、基础广泛的戒烟计划，以满足这一多残疾人群的需求，这将对成本、健康和护理质量产生重大影响。将戒烟纳入精神康复计划也将为解决尼古丁成瘾问题提供新的背景，进一步加强这项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.