Individuals with schizophrenia are more likely to smoke, less likely to quit, and die approximately 25 years earlier than the general population. A significant barrier to addressing this disparity is the fact that smoking cessation treatments designed for the general population appear to be less effective for smokers with schizophrenia. Additionally, research on smokers with schizophrenia has focused almost exclusively on medications at the expense of exploring innovative psychosocial solutions. One potential contributor to the lower cessation rates among smokers with schizophrenia as compared to those without serious mental illness is reduced task persistence (Steinberg et al., 2010, 2012). Task persistence predicts smoking cessation in smokers with schizophrenia (Steinberg et al., 2012), and is lower in smokers with schizophrenia as compared to those without schizophrenia (Steinberg et al., 2010). This study will be the first to test whether psychosocial interventions can improve task persistence in smokers with schizophrenia, and if so, whether this will improve smoking cessation rates. The R21 portion of this study will include modifying an existing psychosocial treatment for smokers with schizophrenia and conducting an open pilot (N=26) testing the ability of this new intervention (Persistence Targeted Smoking Cessation in Schizophrenia (PTSC-S)) to increase task persistence in smokers with schizophrenia. The R33 portion of this study will include a randomized clinical trial (N=90) of PTSC-S compared to a modified, time-matched version of the NCI's Clearing the Air intervention to test the feasibility and initial efficacy of the PTSC-S intervention and to evaluate the mechanisms underlying the relationship between PTSC-S and tobacco use outcomes. The contribution of the proposed research is expected to be that we will create a more efficacious smoking cessation counseling approach targeted towards addressing the reduced task persistence in smokers with schizophrenia. This contribution will be significant because if we can increase smoking cessation rates in this population, we can increase quality of life and reduce the gap in death and disability between those with schizophrenia and those in the general population. The proposed research is innovative, in our opinion, because we are using a novel psychosocial approach to target a newly identified vulnerability (i.e., low task persistence) that may be contributing to low cessation rates in this population.
The proposed research is relevant to public health because in addition to the devastating consequences of tobacco use in the general population, tobacco use comes with further, unique consequences for those with schizophrenia. When smokers with schizophrenia quit smoking, they are likely to increase their life expectancy and quality of life: They are likely to benefit socially from stopping a stigmatized behavior, their psychiatric medications may be more effective, and they may be able to afford healthier foods or better living arrangements with the money they save. We hope that this innovative psychosocial treatment will help smokers with schizophrenia to quit and will reduce the disparity in death and disability between those with schizophrenia and those in the general population.
