Tobacco use is the leading preventable cause of death in the United States. Unfortunately efforts to successfully decrease smoking among individuals with schizophrenia have been limited. This application in response to PA-13-078 will be a Stage I pilot or feasibility study that will include the creative use of technology to boost effects and increase intervention implementability. Building upon our experience with mobile technologies and treating smokers with psychiatric disorders, the purpose of the current study will be to evaluate a combined treatment capitalizing on mobile technologies for smoking cessation among smokers with schizophrenia. Behavioral approaches shown to be helpful in achieving and maintaining abstinence will be combined with other evidence based treatment components (bupropion, nicotine replacement therapy, smoking cessation counseling) and smart phone technology to promote short and long term abstinence. Two mobile smart phone applications (the development of which the PI was involved) will be evaluated in the combined treatment in terms of acceptability, feasibility and compliance in this difficult to treatment smokr population. Mechanisms of self-efficacy and psychiatric symptom intensity will be investigated as putative mediators. We will use a successive cohort design that allows for a structured approach to therapy modification. We will recruit two successive cohorts of 5 smokers each to participate in a 4 week treatment (mobile contingency management, four smoking cessation counseling sessions, bupropion and nicotine replacement) and Stay Quit Coach (a mobile application populated during the counseling sessions to promote abstinence in the post-treatment period). After treating smokers 1-5, we will analyze additional indicated changes to the protocol and counseling sessions. After treatment smokers 6-10, we will analyze data and feasibility, and will modify the protocol accordingly beginning a Stage 1b pilot RCT. In the RCT, we will randomize smokers (N = 36) to the combined treatment or to mobile contingency management alone. Outcomes will be assessed at 1, 3, and 6 months after the target quit date. We will test the feasibility and preliminary efficacy of the intervention (through bioverified prolonged abstinence and cigarettes per day) and evaluate the relationships between changes in self-efficacy, psychiatric symptoms and smoking cessation abstinence. Analyses will include evaluating moderator and mediator variables. Our team is particularly well qualified to conduct this study given our work in smoking cessation among psychiatric smokers. This project has strong potential significance in that the combined approach may improve both short and long term smoking cessation abstinence.

Public Health Relevance

Tobacco use is the leading preventable cause of death in the United States. Unfortunately efforts to successfully decrease smoking among individuals with schizophrenia have been limited. The purpose of the current study will be to evaluate a combined treatment capitalizing on mobile technologies for smoking cessation among smokers with schizophrenia. This project has strong potential significance in that the combined approach may improve both short and long term smoking cessation abstinence among smokers with schizophrenia.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Planning Grant (R34)
Project #
5R34DA038272-03
Application #
9233982
Study Section
Adult Psychopathology and Disorders of Aging Study Section (APDA)
Program Officer
Aklin, Will
Project Start
2015-04-01
Project End
2018-02-28
Budget Start
2017-03-01
Budget End
2018-02-28
Support Year
3
Fiscal Year
2017
Total Cost
Indirect Cost
Name
Duke University
Department
Psychiatry
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
Green, Kimberly T; Dennis, Paul A; Neal, Lydia C et al. (2016) Exploring the relationship between posttraumatic stress disorder symptoms and momentary heart rate variability. J Psychosom Res 82:31-4
Dennis, Paul A; Kimbrel, Nathan A; Dedert, Eric A et al. (2016) Supplemental nicotine preloading for smoking cessation in posttraumatic stress disorder: Results from a randomized controlled trial. Addict Behav 59:24-9