This application is in response to PA-05-019, Health Behavior Change in People with Mental Disorders. Consistent with the focus of Exploratory Research Grants (From Intervention Development to Service: Exploratory Research Grants, March 2006, PAR-06-248), this R34 application is focused on developing, pilot testing, and evaluating the feasibility, tolerability, acceptability, and safety of an innovative intervention for smoking cessation in people with SMI attending psychiatric rehabilitation programs (PRPs). PRP's are attractive sites for smoking cessation programs because the patients who attend them are stable psychiatrically, attendance is more frequent, visits are longer than outpatient clinic visits, and programming is focused on helping to improve patients'long-term health and overall recovery. Consistent with the R34 guidelines, we will: (a) conceptualize an intervention based on theory and empirical research (Stage 1);(b) develop and standardize the intervention (Stage 2);and (c) pilot test the intervention in a small-scale randomized trial (Stage 3). We will first educate and train PRP staff regarding smoking cessation in SMI in order to change the treatment environment to promote smoking cessation as a goal of mental health treatment, support patients'efforts to reduce or quit smoking, and to provide consistent, concrete reinforcement for not smoking at the PRP. We will then develop and pilot test a novel multifaceted behavioral intervention for smoking cessation in SMI patients that will include: (1) A behavioral group intervention emphasizing motivational enhancement, skills training, education, and relapse prevention;(2) Contingency management with financial incentives to reinforce group attendance and reductions in smoking;(3) Supported use of Bupropion or nicotine replacement therapy that is integrated with patients'psychiatric care;and (4) Smoking cessation care coordination aimed at increasing treatment engagement and retention.
Our specific aims are: (1) Develop intervention materials for a multifaceted behavioral intervention for smoking cessation designed for people with SMI, and examine the feasibility, acceptability, and safety of the intervention. (2) Measure the effects at post-treatment and 3-months post-treatment on rates of smoking cessation, number of quit attempts, intention to quit smoking, and rates of smoking reduction. Secondary Aims are: (1) Examine the relationship between changes in attitudes, perceived norms, and self-efficacy with smoking outcomes;and (2) Examine the relationship between smoking outcomes and symptoms. Despite widespread recognition of the devastating health effects of smoking and the extraordinarily high rates of smoking in people SMI, smoking in SMI has not received the full and urgent attention that it deserves. Given the elevated rates of smoking among patients with SMI, our efforts to develop and test an innovative, broad- based smoking cessation program that is tailored to the needs of this multi-handicapped population carry significant cost, health, and quality of care implications. Integration of smoking cessation within the context of psychiatric rehabilitation programs will also provide a new context for addressing nicotine addiction, further enhancing the public health significance of the research.
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