Tobacco Cessation
Conditions
Brief summary
All patients with serious mental illness are abstinent while in the hospital for a psychiatric admission yet almost all return to smoking after discharge. The investigators propose to test a digital intervention adapted to the needs of SMI smokers and to being introduced in the inpatient psychiatric setting. Such an intervention could bridge the inpatient to outpatient gap in cessation services and will help people remain abstinent following hospital discharge.
Detailed description
Persons with serious mental illness (SMI) die on average 10-15 years earlier than those in the general population. Smoking is the strongest risk factor for their elevated mortality. Helping SMI smokers to quit is an urgent and unmet need. The hospital is an optimal setting to provide smoking cessation services. Hospital admissions for SMI are common with more than 1.2 million inpatient stays for schizophrenia and mood disorders per year in the US. Hospitalized patients experience required abstinence, are available for counseling, and can try cessation medications in a supportive setting. The challenge is how to engage SMI patients in cessation services post-discharge. An easy-to-access digital intervention is a scalable and sustainable way to bridge the inpatient-to-outpatient gap and to promote sustained abstinence. Digital interventions can deliver all elements of cessation treatment and yield quit rates comparable to face to face and telephonic interventions. SMI patients use and benefit from technology-based interventions but currently there is no digital smoking cessation program addressing their needs. In this study, the investigators tested a digital intervention adapted to the needs of SMI smokers and to being introduced in the inpatient psychiatric setting. The digital intervention, BecomeAnEX (EX), developed and run by Truth Initiative for over 10 years, includes real-time one on one coaching via live chat, nicotine replacement therapy decision support and delivery, personalized quit plans, a large online social network for peer support, a robust and fully integrated text message program, and tailored email messaging. SMI smokers recruited during psychiatric hospitalization will be randomized to usual care or to an adapted version of EX (EX-SMI) and followed for 3 months after the hospital stay. The investigators will compare the feasibility/acceptability of EX-SMI, measure intervention impact on target mechanisms, and obtain initial estimates of efficacy on 7-day point prevalence abstinence. Such an intervention could bridge the inpatient to outpatient gap in cessation services and will help people remain abstinent following hospital discharge.
Interventions
BEHAVIORALBecomeAnEX
This research study is focused on a smoking cessation program called BecomeAnEx. We are studying how to adapt BecomeAnEx for people with a mental health disorder who want to reduce or quit their tobacco smoking. BecomeAnEx includes a website that provides education about smoking and quitting. It also has a text messaging program that delivers personalized information. Persons in the program have access to real-time digital coaching with a remote coach who has experience helping people quit smoking. In addition, the program has an on-line community of current and former smokers that can provide support and encouragement.
BEHAVIORALUsual Care
Usual care represents what hospitalized psychiatric patients normally receive in terms of smoking cessation: brief individual counseling, NRT during the hospital stay and a prescription for NRT at discharge (consistent with standard hospital procedures), and referral to the MD quitline.
Sponsors
University of Maryland, Baltimore
Sheppard Pratt Health System
Truth Initiative
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Intervention model description
Pilot randomized controlled trial to examine indicators of feasibility, acceptability, target mechanisms, and preliminary efficacy.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 or greater * Diagnosis of serious mental illness (schizophrenia, schizoaffective disorder, bipolar disorder, or major depression) * Current smoker \[prior to admission, smoked at least one cigarette or small cigar per day in the past month (unless restricted, e.g. due to ER/hospital visit) and smoked at least 100 cigarettes lifetime\] * Interested in remaining quit after hospital discharge or quitting within the following 30 days * Expected Internet use at least 3 times/week post-discharge and ownership of mobile device with text messaging plan post-discharge. * Discharge destination within 1-hour of SPH given that Aim 3 involves biochemical verification (carbon monoxide testing). * Reading competence as demonstrated by a score of \>= 37 on the Word Reading subtest of the Wide Range Achievement Test - 4th Edition (WRAT-4)168 to ensure the ability to engage in the intervention.
Exclusion criteria
* Intellectual disability (DSM5 317, 318), traumatic brain injury, or deafness. * Homeless prior to admission or anticipated to be homeless at discharge. * Discharge to a residential setting where smoking is prohibited. * Medical condition for which the use of nicotine replacement therapy (NRT) is contraindicated including pregnant, planning to become pregnant, or breastfeeding; within 4 weeks post myocardial infarction; severe arrhythmia, severe angina pectoris; peptic ulcer; severe renal failure; poorly controlled insulin-dependent diabetes; severely uncontrolled hypertension; peripheral vascular disease.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Smoking Abstinence | 1 month | Self-report 7-day point prevalence abstinence |
| Craving | 1 month | Craving was assessed with 11 items from the Tobacco Cravings Questionnaire (TCQ). Possible scores range from 11-77, with higher scores indicating greater tobacco craving. |
| Self-efficacy | 1 month | The 9-item Abstinence Self-Efficacy Questionnaire (ASEQ) measured confidence to resist smoking across situations and emotional states. Possible scores range from 9-45, with higher scores indicating greater abstinence self-efficacy. |
| Abstinence-Related Motivational | 1 month | The 16-item Abstinence-Related Motivational Engagement (ARME) assessed motivation to maintain smoking abstinence. Possible scores range from 16-112, with higher scores indicating greater abstinence-related motivation. |
Countries
United States
Participant flow
Recruitment details
The trial took place at two inpatient psychiatry units within a Mid-Atlantic hospital system.
Baseline characteristics
| Characteristic | — |
|---|---|
| Abstinence-Related Motivational Engagement (ARME) | 83.5 ARME total score STANDARD_DEVIATION 16.5 |
| Age at onset of regular smoking (years) | 17.2 years STANDARD_DEVIATION 5.1 |
| Age, Continuous | 37.4 years STANDARD_DEVIATION 11.6 |
| Cigarettes per day at admission | 12.6 number of cigarettes per day STANDARD_DEVIATION 8.5 |
| Heaviness of Smoking Index (HSI) | 2.5 HSI total score STANDARD_DEVIATION 1.5 |
| Race/Ethnicity, Customized Ethnicity - Hispanic or Latino | 8 Participants |
| Race/Ethnicity, Customized Ethnicity - Not Hispanic or Latino | 16 Participants |
| Race/Ethnicity, Customized Race - Black | 18 Participants |
| Race/Ethnicity, Customized Race - Multiple Race or Other | 9 Participants |
| Race/Ethnicity, Customized Race - White | 5 Participants |
| Sex: Female, Male Female | 12 Participants |
| Sex: Female, Male Male | 8 Participants |
| Smoking Abstinence Self-Efficacy (ASEQ) | 26.7 ASEQ total score STANDARD_DEVIATION 9.9 |
| Tobacco Craving Questionnaire (TCQ) | 47.6 TCQ total score STANDARD_DEVIATION 22.2 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 38 | 0 / 20 |
| other Total, other adverse events | 4 / 38 | 3 / 20 |
| serious Total, serious adverse events | 7 / 38 | 4 / 20 |
Outcome results
None listed