Up to 80% of people with schizophrenia and schizoaffective disorders smoke - a rate that is four times the rate in the general population. This high rate of smoking leads to early mortality due in large part to smoking-related cancers, lung diseases and cardiovascular diseases. Cessation treatments are effective, but these smokers don't use them. In order to provide an easy-to-use, cost-effective strategy to engage this group of smokers into effective treatments, we developed a single-session;web-based, motivational decision support system, Let's Talk About Smoking. The system incorporates features that insure high usability among those who can't use current websites due to cognitive impairments and low computer skills. It provides compelling content that engages users into evidence-based cessation treatments. In our pilot work, almost half (47%) of smokers with severe mental illnesses who used this system initiated evidence-based cessation treatments, compared to only 10% of those who received a public health pamphlet. The proposed three-year study will definitively test this highly promising web-based intervention in a randomized, controlled trial among 162 smokers with schizophrenia and schizoaffective disorders who are stable in community mental health treatment. After baseline assessment, participants will be randomly assigned to use the decision support system or a computerized educational pamphlet (control condition). Participants will be assessed three and six months after receiving the intervention for initiation of and engagement in evidence-based cessation treatment, biologically confirmed abstinence, and other quit behaviors, smoking behaviors and outcome expectancies, level of dependence, and intention to quit and to use cessation treatment. Analyses will assess whether this system, designed for a cognitively impaired population, is effective among smokers schizophrenia and schizoaffective disorders with a range of cognitive abilities. If we are able to show that this system is effective, it will become part of a comprehensive, web-based treatment approach to reduce smoking in people with schizophrenia that can dramatically expand the reach of smoking cessation treatment for this population. Further, this system may become a model strategy to reach other populations of disadvantaged smokers with low education and computer experience.

Public Health Relevance

Up to 80% of people with schizophrenia and schizoaffective disorders smoke tobacco. Motivational interventions to engage this disparity group into effective cessation treatment are needed. We propose to conduct a randomized, controlled trial to assess whether an easy-to-use, motivational web-based decision support system leads to higher rates of initiation of and engagement in smoking cessation treatment than use of a computerized educational pamphlet. We will also assess abstinence outcomes and whether cognitive ability moderates initiation of smoking cessation treatment and cessation. If effective, this web-based system will serve as an important component of a comprehensive treatment strategy to treat nicotine dependence in people with schizophrenia and schizoaffective disorders, as well as become a model for engaging other difficult-to-reach populations of smokers. The overall goal of this work is to prevent cancer and other smoking-related diseases in this group.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Research Project (R01)
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Risk, Prevention and Intervention for Addictions Study Section (RPIA)
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Morgan, Glen D
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Dartmouth College
Schools of Medicine
United States
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Akerman, Sarah C; Brunette, Mary F; Green, Alan I et al. (2015) Treating tobacco use disorder in pregnant women in medication-assisted treatment for an opioid use disorder: a systematic review. J Subst Abuse Treat 52:40-7
Akerman, Sarah C; Brunette, Mary F; Noordsy, Douglas L et al. (2014) Pharmacotherapy of Co-Occurring Schizophrenia and Substance Use Disorders. Curr Addict Rep 1:251-260