Brief, Web-Based Interventions to Motivate Smokers With Schizophrenia: Randomized Trial

Abstract

Background In-person motivational interventions increase engagement with evidence-based cessation treatments among smokers with schizophrenia, but access to such interventions can be limited because of workforce shortages and competing demands in mental health clinics. The use of digital technology to deliver interventions can increase access, but cognitive impairments in schizophrenia may impede the use of standard digital interventions. We developed an interactive, multimedia, digital motivational decision support system for smokers with schizophrenia (Let’s Talk About Smoking). We also digitalized a standard educational pamphlet from the National Cancer Institute (NCI Education). Both were tailored to reduce cognitive load during use. Objective We conducted a randomized trial of Let’s Talk About Smoking versus NCI Education to test whether the interactive motivational intervention was more effective and more appealing than the static educational intervention for increasing use of smoking cessation treatment, quit attempts, and abstinence among smokers with schizophrenia, accounting for the level of cognitive functioning. Methods Adult smokers with schizophrenia (n=162) were enrolled in the study from 2014 to 2015, randomly assigned to intervention condition, and assessed in person at 3- and 6-month follow-ups. Interventions were delivered on a laptop computer in a single session. All participants had access to standard, community-delivered cessation treatments during follow-up. Multivariate models were used to evaluate outcomes. Results Treatment initiation outcomes were not different between intervention conditions (27/84 [32%] for Let’s Talk About Smoking vs 36/78 [46%] for NCI Education; odds ratio [OR] 0.71 [95% CI 0.37-1.33]); 38.9% (63/162) of participants initiated treatment. Older age (OR 1.03 [95% CI 1.00-1.07]; P=.05), higher education (OR 1.21 [95% CI 1.04-1.41]; P=.03), and fewer positive symptoms (OR 0.87 [95% CI 0.80-0.96]; P=.01) predicted cessation treatment initiation, whereas level of cognition did not. The mean satisfaction and usability index score was higher for Let’s Talk About Smoking versus NCI Education (8.9 [SD 1.3] vs 8.3 [SD 2.1]; t120.7=2.0; P=.045). Quit attempts (25/84, 30% vs 36/78, 46%; estimate [Est]=−0.093, SE 0.48; P=.85) and abstinence (1/84, 1% vs 6/78, 7%; χ21=3.4; P=.07) were not significantly different between intervention conditions. Cognitive functioning at baseline (Est=1.47, SE 0.47; P=.002) and use of any behavioral or medication cessation treatment (Est=1.43, SE 0.47; P=.003) predicted quit attempts with self-reported abstinence over the 6-month follow-up. Conclusions The interactive, multimedia intervention was not more effective than the static, text-based intervention among smokers with schizophrenia. Both tailored digital interventions resulted in levels of treatment engagement and quit attempts that were similar to findings from previous studies of in-person interventions, confirming the potential role of digital interventions to educate and motivate smokers with schizophrenia to use cessation treatment and to quit smoking. These findings indicate that additional cessation treatment is needed after brief education or motivational interventions, and that cessation treatment should be adjusted for people with cognitive impairment. Trial Registration ClinicalTrials.gov NCT02086162; https://clinicaltrials.gov/show/NCT02086162.

Ideal Cardiovascular Health in Racially and Ethnically Diverse People with Serious Mental Illness

“…To accomplish this, more community mental health centers will need to begin offering smoking cessation services since many of these providers still do not include cessation treatment in their array of services. 43 While lower ICVH scores among females were also driven by a higher prevalence of poor dietary status compared to males, overall only 2.23% of all participants met criteria for ideal dietary status. This is lower than the 10.4% found in another study of ICVH in people with SMI, 26 but consistent with findings from a systematic review showing eight of 15 U.S. general population studies reported ideal diet prevalence of 1% or less and the remaining studies reported prevalence of 10% or less.…”

An Open Trial of Metacognitive Remediation Therapy and Pharmacotherapy to Promote Smoking Cessation among Individuals with Psychotic-Spectrum Disorders

“…Nearly 80% of participants reported a 24-hour quit attempt during their participation in MCR-Q ( Table 5 )—a figure higher tha annual rates of serious quit attempts reported by individuals with psychotic-spectrum disorders in epidemiological studies (27-48%: [ 45 – 47 ]). It also exceeds the rate of serious quit attempts following participation in a web-based, motivational enhancing smoking cessation intervention for individuals with psychotics-spectrum disorders (30%: [ 48 ])—the only previous study to report rates of quit attempts among individuals with psychotic-spectrum disorders participating in a psychosocial smoking cessation intervention.…”

A systematic review of behavioural smoking cessation interventions for people with severe mental ill health—what works?

“…All studies were individually randomized (but not cluster‐randomized) controlled trials, conducted within a single country, in an outpatient or community setting. Seven studies were conducted in the United States [ 25 , 26 , 27 , 28 , 29 , 30 , 31 ], two in the United Kingdom [ 14 , 32 ] and two in Australia [ 33 , 34 ]. One study did not clearly state the country [ 35 ].…”

“…Six of the studies recruited participants with schizophrenia or schizoaffective disorder [ 25 , 27 , 28 , 29 , 33 , 36 ], five included participants with schizophrenia, schizoaffective disorder or bipolar disorder [ 14 , 31 , 32 , 34 , 35 ] and one recruited participants with bipolar disorder only [ 30 ]. Seven studies had a requirement that participants had stable symptoms and/or dose of medication [ 28 , 29 , 30 , 31 , 33 , 34 , 35 ] and five studies did not state whether participants had stable symptoms and/or medication [ 14 , 25 , 27 , 32 , 36 ].…”

“…In seven studies participants had expressed a willingness to quit smoking at the point of trial entry [ 14 , 28 , 30 , 31 , 32 , 33 , 36 ], in one study participants were excluded if planning on quitting in the next 30 days [ 35 ], in one study intention to quit was not required [ 29 ] and in three studies participants’ intentions were not stated [ 25 , 27 , 34 ].…”