6.2 DIGITAL THERAPEUTICS FOR TOBACCO USE DISORDER IN PEOPLE WITH SERIOUS MENTAL HEALTH CONDITIONS

Abstract

Background: People with serious mental illness (SMI; schizophrenia, severe mood and anxiety disorders) are more likely to smoke and less likely to quit than the general population. Combinations of intensive behavioral intervention and pharmacotherapy improve cessation outcomes, but most smokers with SMI try to quit without treatment, in part due to misinformation about treatments, but also due to lack of access to treatments. We have developed a line of appealing and usable web‐based tools to provide scalable motivational and behavioral treatment to smokers with SMI. Here we will describe a recent RCT testing a web‐based, interactive, motivational intervention compared to a computerized, static National Cancer Institute (NCI) patient pamphlet. Methods: We conducted a randomized trial among 162 adult smokers with schizophrenia comparing two brief interventions adapted for people with cognitive impairments; an interactive motivational website, Let's Talk About Smoking, vs. computerized, static, standard education from the NCI provided in a tailored format with audio. Participants were assessed at baseline for cognition and smoking characteristics, used their assigned intervention within two weeks, and were assessed again for smoking and breath carbon monoxide over the 6‐month follow‐up. All had access to standard cessation treatments. Results: Participants (mean age 45.91±11.32 years) smoked 14.56±10.49 cigarettes per day. Over the 6‐month follow‐up, 38.9% of participants had used cessation treatment (not different between groups). 37.7% reported quit attempts, 4% had verified abstinence at the 6‐month follow‐up, and mean days of self‐reported abstinence were 11.0 vs. 12.1, t=‐.22, p=.82). In multivariate models, older age, higher education, and fewer positive symptoms predicted cessation treatment initiation. In turn, engaging in cessation treatment and level of cognition predicted days of total abstinence. Satisfaction and usability scores were higher for Let's Talk About Smoking than NCI education (8.9±1.3 vs. 8.3±2.1, df= 120.7, t= 2.0, p=.045). Conclusions: Brief, web‐based, motivational interventions tailored for people with cognitive impairment can motivate smokers with schizophrenia to use cessation treatments, with outcomes that are similar or superior to in‐person motivational intervention. Interactive, multimedia interventions are more appealing to smokers with schizophrenia than non‐interactive interventions. More intensive interventions are needed to enable protracted cessation.