Use of Technological Advances to Prevent Smoking Relapse Among Smokers With PTSD
Condition: PTSD; Smoking
MeSH terms: Recurrence; Stress Disorders, Post-Traumatic
Study type: Interventional

Summary: 
      The primary goal of the study is to evaluate the use of a new smart phone application in
      preventing relapse to smoking among people with PTSD. The technology intervention will
      combine a mobile system to reward non-smoking, smoking cessation counseling, smoking
      cessation medications, and use of the smart phone app. The primary aim is to evaluate how
      effective this intervention is in preventing smoking relapse compared to another intervention
      that does not include the app.
    

Detailed description: 
      The primary goal of the current study will be to evaluate the use of a new smart phone
      application (app; Stay Quit Coach) in preventing relapse to smoking among individuals with
      PTSD. The enhanced technology intervention will combine mobile contingency management (mCM),
      guideline-based smoking cessation counseling, bupropion and nicotine replacement therapy
      (NRT), and use of the Stay Quit Coach. For this study, we will propose a clinical trial with
      a two-group design in which 20 smokers with PTSD will be randomized to either:

      QUIT4EVER, an intervention that combines guideline-based smoking cessation counseling,
      bupropion and NRT, mCM and Stay Quit Coach.

      COMBINED CONTACT CONTROL (CCC) an intervention that is identical to QUIT4EVER except Stay
      Quit Coach will not be included. The CCC controls for compensation, monitoring, time and
      attention effects.

      Specific aims are to:

      AIM 1: evaluate the efficacy of QUIT4EVER on rates of abstinence from cigarettes (assessed
      with multiple measures including bioverified abstinence) during short and long term
      abstinence (measured at 3 and 6 months).

      Hypothesis 1: QUIT4EVER will be associated with increased long term abstinence (self-reported
      and bio-verified prolonged abstinence at the 3 and 6 month follow-up).

      AIM 2: assess the impact of QUIT4EVER on counseling treatment completion and medication
      adherence.

      Hypothesis 2. Increased abstinence associated with QUIT4EVER will be partially mediated by
      increased telephone counseling treatment completion and greater medication adherence.

      AIM 3: calculate the relative cost-effectiveness of the QUIT4EVER intervention in quality
      adjusted life years (QALY).

      Hypothesis 3: QUIT4EVER based treatment will result in greater cost-effectiveness compared to
      the control condition as measured by the incremental cost-effectiveness ratio.

      Overall, results of this study could lead to a highly efficient, effective, and easily
      disseminated treatment method for reducing smoking among smokers with PTSD and other
      psychiatric disorders.
    

Intervention name(s): Bupropion; nicotine replacement therapy; Smoking cessation counseling; mobile contingency management; Stay Quit Coach
Intervention type(s): Drug; Drug; Other; Behavioral; Other
Intervention description(s): All participants who are medically eligible will be prescribed bupropion, which they will start two weeks prior to their quit day. Dosage will be 150 mg/daily for days 1-7 and 300 mg/daily (administered in two daily doses) until the 3-month follow-up.; Participants will be prescribed NRT patch and one nicotine rescue method (e.g., nicotine gum, lozenge, inhaler) for use during the post-quit phase of the study. Participants will be given the choice between nicotine gum, nicotine inhaler, or nicotine nasal spray, and will be instructed to use the rescue method as needed to reduce cigarette cravings; Participants will receive four 20-minute smoking cessation counseling sessions and a participant manual. The four sessions are based on standard cognitive-behavioral therapy techniques shown to be efficacious for smoking cessation.; Participants will be asked to provide video recordings of themselves taking carbon monoxide readings in order to confirm smoking abstinence. Participants are asked to upload these videos to the study's secured server, and are provided monetary reward for videos that suggest smoking abstinence.; Stay Quit Coach is a smart phone application that serves as a source of readily available support and information for adults who are already in treatment to quit smoking and to help them stay quit after treatment. The app guides user in creating tailored plans that include their personal reasons for quitting, interactive tools to help users cope with urges to smoke, motivational messages, support contacts to help users stay smoke free and how to address lapses. Participants assigned to this condition will be asked to use Stay Quit Coach from Session 2 through the 6-month follow-up.
Other intervention name(s): Zyban, Wellbutrin; nicotine gum, patch, inhaler, or lozenge; mCM; smart phone app
Intervention MeSH terms: Bupropion; Nicotine
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: PTSD; smoking