Smartphone-Based Smoking Cessation and Mental Health Intervention

SPECIFIC AIMS

Cigarette smoking is the leading preventable cause of morbidity and mortality in the United States. Smokers with serious mental illness (SMI; e.g., schizophrenia, bipolar disorder, major depressive disorder, anxiety disorders) have an increased risk of dying from cancer, lung disease, and cardiovascular disease and account for more than 200,000 of the 520,000 tobacco-related deaths each year. Many studies have shown that smoking rates are 2-5 times higher in adults with SMI compared with adults with no mental illness. People with SMI smoke more frequently and heavily than the general population, and they often lack access to cessation services. Furthermore, smokers with SMI are more dependent on nicotine and are less likely to quit than those without SMI. Thus, smoking and smoking cessation in this population are critical public health concerns that warrant further study.

Although there is substantial evidence for the effectiveness of multiple smoking cessation treatments for the general population of smokers, these interventions tend to be less effective or not effective at all when provided to smokers with SMI. Thus, while smoking rates among those without a history of SMI has radically declined over the past 5 decades, smoking prevalence among those with SMI has remained alarmingly high over this same time period. While several studies have identified some reasons for disparities in smoking cessation treatment effectiveness in adults with SMI, understanding of the complex causes of this known and growing disparity remains limited. A more granular examination of the cessation, lapse, and relapse process among adult smokers with SMI is needed: 1) to improve understanding of smoking cessation in this vulnerable and understudied population, and 2) to inform the development of more effective interventions for this underserved population. Smartphone-based Ecological Momentary Assessments (EMA) have been used to identify antecedents to smoking lapse in various populations. Just-in-Time Adaptive Interventions (JITAI) that provide tailored treatment content for adults with SMI in moments when it is needed most may offer cost-effective, easily accessible, highly tailored interventions in free-living settings. To date, four smartphone-based smoking cessation JITAIs have been created, and pilot tested in SMI samples. Yet, few JITAI for SMI populations have been investigated regarding their acceptability, feasibility, and usefulness.

The long-term goal of this research is to increase smoking cessation rates of smokers with SMI using a smartphone-based mobile health application. The primary objective of this study, which is the next step towards achieving this long-term objective, is to conduct a pilot randomized controlled trial (RCT) to evaluate the feasibility of an innovative smoking cessation app that has been tailored for smokers with SMI. Seventy-five treatment-seeking smokers with SMI, referred from the Oklahoma Department of Mental Health and Substance Abuse Services (ODMH),49 will be randomly assigned to receive either (1) QuitGuide,50 a free smoking cessation app developed by the National Cancer Institute (NCI), (2) a smoking cessation app that tracks and automatically intervenes upon psychological distress in real-time during a quit attempt and delivers real-time intervention messages tailored to the current level of lapse risk and current lapse triggers (i.e., Smart-T Mental Health; STMH), or (3) STMH with additional nicotine replacement therapy adherence messaging (STMH+). Participants in both study conditions will be followed for 5 weeks (1-week pre-cessation and 4 weeks post-cessation), receive nicotine replacement therapy (NRT), and complete smartphone-based ecological momentary assessments (EMA). The primary objective of this study will be attained by pursuing the following specific aims.

Determine the feasibility, ease of use, and perceived utility of a smoking cessation app designed for adults with SMI.