Electronic Decision Support Systems for Smokers With Severe Mental Illness
Condition: Severe Mental Illness; Nicotine Dependence; Schizophrenia; Tobacco Use Disorder
MeSH terms: Tobacco Use Disorder; Schizophrenia; Mental Disorders
Study type: Interventional

Summary: 
      This randomized clinical trial among SMI smokers assessed whether the EDSS with carbon
      monoxide monitor and health-checklist feedback lead to higher rates of initiation of smoking
      cessation treatment, days of smoking abstinence and Fagerstrom Dependence scores, compared to
      use of the EDSS with checklist feedback alone.
    

Detailed description: 
      Up to 80% of Americans with serious mental illnesses (SMI; schizophrenia and severe mood
      disorders) smoke cigarettes, and most suffer related health consequences. Although combined
      treatment with medication and psychosocial therapy can help people with SMI to quit smoking,
      it is rarely used. Motivational interventions can enhance the use of combined treatment, but
      motivational interventions are expensive and unavailable. To fill this gap, Dartmouth and
      Thresholds investigators have developed an easy-to-use, web-based electronic decision support
      system (EDSS) that aims to educate and motivate smokers with SMI. Preliminary testing has
      demonstrated excellent usability and increased engagement in smoking cessation treatments.

      One critical issue is the use of personalized health feedback. Motivational interventions for
      smoking cessation for smokers with SMI, including our EDSS, have included personal feedback
      from a breath monitor that measures carbon monoxide, a toxic component of cigarette smoke.
      Feedback regarding carbon monoxide is thought to motivate the user by personalizing the
      health risks of smoking. The carbon monoxide monitor is, however, expensive, difficult to
      implement, and largely unavailable in public mental health and primary care clinics. Further,
      research on use of carbon monoxide monitoring in the general population is equivocal. Another
      motivational strategy to personalize the negative health effects of smoking is a health
      checklist with feedback. Health checklists have been shown to be effective, are easy to use,
      have no expense, but have not been assessed separately from carbon monoxide monitor feedback
      among SMI smokers. Testing the effect of feedback from the health checklist compared to
      feedback from the carbon monoxide monitor is an essential next step in the development of
      this tool.

      Aim 1. The investigators propose a randomized clinical trial among SMI smokers to assess
      whether the EDSS with carbon monoxide monitor and health-checklist feedback will lead to
      higher rates of initiation of smoking cessation treatment than the EDSS with health-checklist
      feedback alone.

      Aim 1.a. To explore whether use of the EDSS with carbon monoxide monitor and health-checklist
      feedback leads to higher rates of the distal outcomes, days of smoking abstinence and
      Fagerstrom Dependence scores, than use of the EDSS with checklist feedback alone.
    

Intervention name(s): EDSS with CO feedback and health checklist; EDSS with health checklist feedback alon
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Web-based electronic decision support system with CO feedback and health-checklist; Web-based electronic decision support system (EDSS) with health-checklist feedback alone (without CO feedback)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: schizophrenia; severe mental illness; nicotine; smoking; motivation; electronic decision support system; motivational interviewing