Compared to the general population, Veterans with mental health disorders have high rates of smoking (32%-68% vs. 15% in the general population) and low lifetime quit rates (17-33% vs. 43% in the general population). As a result, Veterans with mental health disorders are at high risk of developing severe health problems and poor physical functioning. On average, Veterans with mental health disorders will lose 25 years of their life due to smoking-related causes. In addition, smoking by Veterans with mental health disorders substantially interferes with their mental health and social functioning (e.g., interferes with relationships, work, recreational activities), but current treatments miss the opportunity to help Veterans improve these areas of life functioning. In addition, there is no widely available VA-specific tobacco cessation website, which is a substantial gap in services for Veterans. The goal of this SPiRE project is to adapt and evaluate an existing and effective web-based tobacco cessation program for Veterans with mental health disorders. Web-based Acceptance and Commitment Therapy (ACT) is a new and effective model of smoking cessation treatment. This intervention uses the principles of Acceptance and Commitment Therapy (ACT) for tobacco cessation, an evidence-based tobacco cessation approach which focuses on the use of acceptance, mindfulness, and a commitment to values to help Veterans overcome emotional obstacles to quitting tobacco and achieving life goals. A web-based ACT smoking cessation intervention, WebQuit is: (1) an efficacious web-based smoking cessation intervention for general population smokers (23%-24% at 3 months); and (2) highly acceptable to smokers with clinically significant symptoms of PTSD. However, this web-based program has not adapted to the specific needs of Veterans with mental health disorders. Targeting program content to address a variety of psychiatric symptom- related smoking triggers, the Veteran culture that often encourages smoking, and poor life functioning for Veterans is necessary to address these prevalent motives for smoking in Veterans with mental health disorders. The proposed treatment, Vet WebQuit, is a targeted web-based ACT intervention for Veterans with mental health disorders that specifically targets mental health obstacles to quitting, the Veteran culture of smoking, and poor functioning associated with tobacco use and mental health disorders. The proposed SPiRE will involve several aims: 1) Adapt an existing, effective, and targeted web-based tobacco cessation intervention for Veterans with mental health disorders (Vet WebQuit), using data from Veteran focus groups; 2) Optimize usability of Vet WebQuit via iterative usability testing (n=20), and 3) Prepare a final version of Vet WebQuit for a future grant application of a larger randomized controlled trial of this intervention. This pilot project is significant and innovative in three key respects: (1) it applies a promising new treatment approach (i.e., acceptance, mindfulness, values-based living) to the problem of low quit rates among Veterans with mental health disorders; (2) this web-based intervention is potentially cost-effective and easy to disseminate; and (3) the focus on improving Veterans' functioning and quality of life is substantially different than standard web-based tobacco treatments. Results from this pilot project will inform the development of a randomized clinical trial of Vet WebQuit vs. Smokefree.gov, one of the most widely promoted web-based tobacco cessation programs in VHA and in the United States.
Veterans with mental health disorders demonstrate significant tobacco-related health disparities, including a 25-year decrease in average life expectancy, greater chronic disease burden, more stress and poorer life functioning. This project will develop and evaluate an intervention with great potential to improve quit rates for smokers with mental health disorders and their life functioning by targeting the specific obstacles that Veterans with mental health disorders face during quit attempts. These goals are consistent with the Veterans Health Administration?s strategic plan to provide personalized, proactive, patient-driven health care by reducing tobacco-related health disparities using targeted interventions for Veterans with mental health disorders.