Decision Support for Smoking Cessation in Young Adults With Severe Mental Illness
Condition: Mental Illness; Tobacco Smoking; Psychotic Disorders
MeSH terms: Mental Disorders; Psychotic Disorders
Study type: Interventional

Summary: 
      Up to 77% of young people with severe mental illnesses smoke, a rate that is up to five times
      higher than the rate of daily smoking in other young adults. Contrary to popular belief,
      smoking tobacco does not provide any benefit for mental illness symptom control. People with
      severe mental illnesses (SMI: schizophrenia and severe mood disorders) are dying, on average,
      25 years earlier than those without SMI. Much of this early mortality is due to higher rates
      of heart and lung diseases, cancers, strokes, and diabetes.

      Cessation of smoking in these transition-age young adults can prevent cancer and increase
      life expectancy to that of non-smokers. Combination treatments are effective in this group
      and therefore key to improving outcomes, but few SMI smokers use them despite their interest
      in quitting. Motivational interventions for cessation increase interest in quitting, but
      public mental health clinicians do not deliver them, in part due to economic reasons. Thus
      cost effective methods to deliver motivational interventions to engage young smokers with SMI
      into treatment are needed.

      To address this gap, we have developed an electronic decision support system (EDSS) for
      smoking cessation that is specifically tailored for smokers with SMI, who tend to have
      cognitive deficits and limited computer experience. Similar to EDSSs developed for other
      health problems, this EDSS provides information and motivational exercises within an
      easy-to-use, web-based computer program that can be used with minimal or no staff assistance.
      Initial piloting of the EDSS in middle-aged SMI smokers showed excellent usability and
      promising efficacy. Pilot-testing among young patients suggested that the EDSS increased
      motivation to quit smoking and provided direction to adapt the format and content of the EDSS
      for young SMI smokers.

      The purpose of this proposal is to further develop the motivational decision support system
      and to test its ability to motivate young smokers with SMI to quit smoking with cessation
      treatment.
    

Detailed description: 
      The research will take place over 2 years at the Long Island Zucker Hillside Hospital system.
      In Year 1, we will adapt our electronic decision support system, a web-based motivational
      tool, for young smokers with severe mental illness. We will first identify beliefs of young
      smokers with severe mental illness that impede use of smoking cessation treatments. Then, the
      decision support system will be revised to change these beliefs, field-tested for usability,
      and improved as needed. In Year 2, we will conduct a randomized control trial of the newly
      revised version of the system among 60 young smokers with severe psychotic disorders.

      In the controlled trial, participants will be assessed at baseline for mental health symptoms
      and smoking behavior and history, and then randomized to use the system or a computerized
      public health pamphlet (control condition) within two weeks. Participants will be assessed
      again at 14-week follow-up for clinician-confirmed initiation of smoking cessation treatment
      (main outcome), beliefs, and smoking characteristics. Analyses will assess whether use of the
      decision support system results in greater initiation of cessation treatment (main outcome),
      and changes in beliefs about treatment, than use of the control intervention.
    

Intervention name(s): Electronic Decision Support System
Intervention type(s): Behavioral
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: Mental Illness; Tobacco Smoking; Young Adults; Treatment Engagement; Motivational Intervention