An Integrated Approach to Smoking Cessation in Severe Mental Illness (SMI)
Condition: Smoking Cessation
MeSH terms: Mental Disorders
Study type: Interventional

Summary: 
      This 3-year study will involve the design and small-scale clinical trial of a behavioral
      treatment program for smoking cessation in people with severe mental illness (called
      Behavioral Treatment for Smoking Cessation in Serious and Persistent Mental Illness or BTSCS)
      in two psychosocial rehabilitation programs (PRPs) in Baltimore. Our aims are: (1) Develop
      intervention materials and examine feasibility, acceptability, and safety; (2) Measure the
      effects of the intervention at post-treatment and 3-month follow-up on rates of smoking
      cessation, number of quit attempts, rates of smoking reduction and intention/motivation to
      quit smoking.
    

Detailed description: 
      Smoking is the leading cause of preventable death in the United States, contributing to
      increased rates of lung cancer and heart disease, and adding complications to other health
      problems. Over 70% of people with serious mental illnesses (SMI) smoke, a rate that is double
      that of the general population and remains high despite decreases in overall smoking rates.
      Smoking contributes to elevated morbidity and mortality in SMI, has other life-threatening
      consequences, and increases health care costs in SMI. While treating smoking is a critical
      step in improving the health of people with SMI, there are features of SMI that make
      treatment difficult (low motivation to quit, symptoms, barriers to attendance, cognitive
      deficits, poor social functioning). Stop-smoking groups have had limited success in achieving
      smoking cessation (SC), likely because they have not been tailored for people with SMI. SC
      for SMI must address the deficits and barriers to change found in this population, and must
      be integrated with mental health services.

      This study will involve the design and small-scale clinical trial of a behavioral treatment
      program for SC in people with SMI called Behavioral Treatment for Smoking Cessation in
      Serious and Persistent Mental Illness (BTSCS) in two psychosocial rehabilitation programs
      (PRPs) in Baltimore.

      We will first provide basic education for PRP staff regarding smoking cessation in SMI to
      promote smoking cessation as a goal of mental health treatment. We will then pilot test BTSCS
      with components that include: (1) A behavioral group emphasizing motivational enhancement,
      skills training, education, and relapse prevention; (2) Contingency management with financial
      incentives to reinforce reductions in smoking; (3) Supported use of Bupropion or nicotine
      replacement therapy that is integrated with clients' psychiatric care in participants who are
      interested; and (4) Smoking cessation care coordination to increase treatment engagement and
      retention. Our primary aims are: (1) Develop intervention materials and examine feasibility,
      acceptability, and safety; (2) Measure the effects of the intervention at post-treatment and
      3-month follow-up on rates of smoking cessation, number of quit attempts, rates of smoking
      reduction and intention/motivation to quit smoking.
    

Intervention name(s): BTSCS
Intervention type(s): Behavioral
Intervention description(s): BTSCS includes: (1) A behavioral group emphasizing motivational enhancement, skills training, education, and relapse prevention; (2) Contingency management with financial incentives to reinforce reductions in smoking; (3) Supported use of Bupropion or nicotine replacement therapy that is integrated with clients' psychiatric care in participants who are interested; and (4) Smoking cessation care coordination to increase treatment engagement and retention.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Smoking cessation, severe mental illness, behavioral treatment