Persistence Targeted Smoking Cessation in Serious Mental Illness (SMI)

Study Overview
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Brief Summary
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Due to the pandemic, this study was modified from a randomized clinical trial to test the feasibility, initial efficacy, and mechanisms of action of our PTSC-S intervention to a feasibility and acceptability test of our intervention when delivered via telehealth in a single group, within-subjects design.

Detailed Description
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The investigators will test the feasibility and acceptability of a telehealth-delivered treatment designed to help smokers with serious mental illness to quit using a therapy approach focused on increasing task persistence. We will provide free, weekly individual telehealth video counseling sessions for 8 weeks and 10-weeks' worth of the nicotine transdermal patch (an FDA-approved smoking cessation product available over the counter). All sessions will be video recorded for treatment integrity and supervision. The investigators hypothesize that 1) the PTSC-S intervention will be acceptable to participants, and the study will be feasible to conduct. We will report prolonged and point prevalence abstinence rates at end-of-counseling and at 3-month follow-up (CO verified <8ppm).

Official Title
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Persistence Targeted Smoking Cessation in Schizophrenia (PTSC-S)

Conditions
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Tobacco Use, Tobacco Smoking, Tobacco Use Cessation, Tobacco Use Disorder, Schizophrenia, Schizoaffective Disorder

Intervention / Treatment
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* Behavioral: Persistence Targeted Smoking Cessation in SMI (PTSC-S)
* Drug: Nicotine patch


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Must be between 18 - 70 years old Must indicate willingness to make a quit attempt in the next 30 days Must report being a daily cigarette smoker (including those labeled little cigars) for past month Must have a diagnosis of Schizophrenia, Schizoaffective Disorder, or Bipolar Disorder on the Structured Clinical Interview for Diagnostic and Statistical Manual (DSM), 5th edition, Research Version (SCID-5-RV) Psychiatric illness must be stable, as indicated by no hospitalizations in previous 8 weeks, and a stable psychotropic medication regimen for 8 weeks Must have a smartphone, tablet, or computer with ability to download apps Must currently receive mental health treatment Must sign release of information for current mental health treatment providers Exclusion Criteria: Must not currently (in past 10 days) be taking varenicline (Chantix), Must not currently (in past 10 days) be taking bupropion (Zyban/Wellbutrin) to quit smoking. Must not be taking any nicotine preparations (gum, lozenge, patch, spray, inhaler) daily over the last 10 days Must not report myocardial infarction, unstable angina pectoris, or significant cardiac arrhythmia (including atrial fibrillation) in the past 30 days. Women must not be pregnant, test positive on a pregnancy test, nursing, or planning on becoming pregnant in the next three months. Women who can become pregnant may be included if using effective birth control. Must not have pending legal matters with potential to result in jail time Must not be planning on moving outside local area in next 3-months Problematic substance use in the past 3 months (Alcohol Use Disorders Identification Test-Concise (AUDIT-C) ≥5 for men and ≥4 for women, Drug Abuse Screening Test (DAST-10) score of ≥4) Must not have suicidal ideation in the past week with intent, plan, or access to method; must not have attempted suicide in the past year (as assessed on the SCID-RV)

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Interventional Model Description: Due to the pandemic, this study was modified from a randomized clinical trial to test the feasibility, initial efficacy, and mechanisms of action of our PTSC-S intervention to a feasibility and acceptability test of our intervention when delivered via telehealth in a single group, within-subjects design.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: NRT + Persistence Targeted Smoking Cessation in SMI<br>Participants will receive 10 weeks of nicotine patch (NRT) plus 8 weeks of task persistence focused cessation counseling delivered via telehealth. | Behavioral: Persistence Targeted Smoking Cessation in SMI (PTSC-S)<br>* All participants will receive 8 weeks of persistence focused smoking cessation counseling delivered via telehealth<br>Drug: Nicotine patch<br>* All participants will receive 10 weeks of nicotine patch<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Acceptability 1: Participant Rating of Usefulness of Intervention | After each session, participants (N=33) provided a 1-7 rating of how easy to understand and how helpful the intervention was. Higher numbers represent greater ease and greater helpfulness, respectfully. There is no official scale title because the scale was developed for this study. | 3-months post quit date (approximately 4-months after baseline assessment) | 
| Acceptability 2: Participant Rating of Counseling Session Length | After each session, participants (N=33) provided a 1-7 rating of agreement with the statement, There was too much information in today's session. (as a proxy for appropriateness of session length). Higher numbers represent greater agreement. There is no official scale title because the scale was developed for this study. | 3-months post quit date (approximately 4 months after baseline assessment) | 
| Acceptability 3: Participant Rating of Treatment Length / Timing of Target Quit-Date | We asked participants how acceptable the placement of the target quit date was to participants (i.e., it was scheduled for session 4). We report the percentage of participants who responded that the quit date was too soon, too late, or just about right. | 3-months post quit date (approximately 4 months after baseline assessment) | 
| Feasibility 1: Number of Participants Contacted at 3 Months Post-Quite Date | We will calculate follow-up rates to determine if they meet our goal of 80% follow-up rates at the 3-month follow-up. | 3-months post quit date (approximately 4 months after baseline assessment) | 
| Feasibility 2: Missing/Unusable Data | We will determine the rate of missing or unusable carbon monoxide (CO) data to determine if the rate meets our goal of less than 10% missing/unusable data. There were a possible 340 CO assessment data points. | 3-months post quit date (approximately 4 months after baseline assessment) | 
| Feasibility 3: Participant Attendance | Participants in the PTSC-S intervention will attend at least 60% of their sessions | 8 weeks of counseling with a 2-week grace period to make up missed sessions (10 weeks) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Participants With Seven-day Point Prevalence Abstinence at End-of-counseling | No smoking on the 7 days before the final counseling session, biochemically verified with CO<8ppm | End-of-counseling (8 weeks) | 
| Number of Participants With Prolonged Abstinence at End-of-counseling | Prolonged abstinence with a 2-week grace period following the target quit date until end-of-counseling, biochemically verified with CO<8ppm | End-of-counseling (8 weeks) | 
| Number of Participants With Seven-day Point Prevalence Abstinence at 3-month Follow-up | No smoking on the 7 days before the 3-month follow-up, biochemically verified with CO<8ppm | 3-months post target quit date (approximately 4 months after baseline assessment) | 
| Number of Participants With Prolonged Abstinence at at 3-month Followup | Prolonged abstinence with a 2-week grace period following the target quit date until 3-months post quit-date, biochemically verified with CO<8ppm | 3-months post target quit date (approximately 4 months after baseline assessment) | 
| Task Persistence Scores | 14-item Thoughts About Smoking Questionnaire (TASQ). Lower scores represent greater task persistence. The total score can range from a minimum of 14 to a maximum of 98. | 2 months after baseline assessment and 4 months after baseline assessment | 
| Cigarettes Per Day | Hypothesis 3: As compared to baseline, participants will report smoking fewer cigarettes per day at 2- and 4-months post-baseline. Analysis 3: One-tailed, paired sample t-tests will be used to examine decreases in cigarettes smoked per day on the TASQ at each timepoint. | 2 months after baseline assessment and 4 months after baseline assessment | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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tobacco, cigarette, schizophrenia, schizoaffective disorders, smoking cessation