An Integrated Approach to Smoking Cessation in SMI

描述（由申请人提供）：本申请是对PA-05-019《精神障碍患者的健康行为改变》的回应。与探索性研究赠款（从干预开发到服务：探索性研究赠款，2006年3月，PAR-06-248）的重点一致，该R34申请的重点是开发、试点测试和评估一种创新干预措施的可行性、耐受性、可接受性和安全性，用于参加精神病康复项目（PRP）的SMI患者戒烟。PRP是戒烟计划的有吸引力的网站，因为参加这些计划的患者精神状况稳定，出勤率更高，访问时间比门诊诊所访问时间长，并且编程专注于帮助改善患者的长期健康和整体恢复。根据R34指南，我们将：（a）基于理论和实证研究（第1阶段）对干预措施进行概念化;（B）开发和标准化干预措施（第2阶段）;（c）在小规模随机试验中对干预措施进行试点测试（第3阶段）。我们将首先对PRP工作人员进行有关SMI戒烟的教育和培训，以改变治疗环境，促进戒烟作为精神健康治疗的目标，支持患者减少或戒烟的努力，并在PRP中提供不吸烟的一致，具体的强化。然后，我们将开发和试点测试一种新的多方面的行为干预戒烟的SMI患者，将包括：（1）行为小组干预，强调动机增强，技能培训，教育和复发预防;（2）应急管理与财政激励，以加强小组出勤率和减少吸烟;（3）支持使用安非他酮或尼古丁替代疗法，与患者的精神病护理相结合;（4）戒烟护理协调，旨在增加治疗参与和保留。我们的具体目标是：（1）针对重度精神障碍患者，开发多方面戒烟行为干预的干预材料，并对干预的可行性、可接受性和安全性进行研究。(2)测量治疗后和治疗后3个月对戒烟率、戒烟尝试次数、戒烟意图和吸烟减少率的影响。次要目标是：（1）检查态度变化，感知规范和自我效能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重度精神病患者的吸烟率非常高，但重度精神病患者的吸烟问题尚未得到应有的充分和紧迫的关注。鉴于重度精神障碍患者的吸烟率升高，我们努力开发和测试一种创新的、基础广泛的戒烟计划，该计划针对这一多重残疾人群的需求，具有重大的成本、健康和护理质量影响。将戒烟纳入精神康复计划也将为解决尼古丁成瘾提供新的背景，进一步增强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.