Let’s Talk About Smoking is a smoking cessation website to increase motivation to quit in people with severe mental illness.
Let’s Talk About Smoking was designed to be accessible to people with cognitive deficits and followed national guidelines for usability. The program targets users’ motivation to quit smoking and focuses on perceived risks of smoking and perceived benefits of treatment. A narrator who identifies as a former smoker with mental illness guides users through the program and encourages them to quit. The program assesses smoking behavior by asking users how much they smoke and how much money they spend on smoking. The program provides feedback about users smoking behavior and nicotine dependence and provides users with information about the health risks of smoking. A decisional balance activity supports users in identifying perceived costs and benefits of smoking. The user can view information about evidence-based treatments for smoking in preparation for talking to a clinician. At the end of the program users can print out a report of their responses and referral information to encourage them to meet with a smoking cessation specialist.
Health Behavior Change Theory
Severe Mental Illness
Motivation to Change
Young Adults (18-30)
An electronic decision support system to motivate people with severe mental illness to quit smoking.
Summary: This quasi-experimental study evaluated the efficacy of Let’s Talk About Smoking among smokers with mental illness in residential treatment programs. English speaking adult smokers with severe mental illness receiving supported housing and comprehensive psychiatric services were recruited using fliers and clinician referrals. Of the 48 patients who initially expressed interest, 41 met inclusion criteria and agreed to participate. At baseline and two months later, participants were interviewed about their motivation to quit smoking, psychiatric history, experience with computers, smoking characteristics, and attitudes about smoking. Electronic health records were used to assess psychiatric and demographic information. During baseline, patients received a pamphlet on smoking cessation and referrals to a smoking cessation specialist. Participants were recruited from two treatment programs; 21 participants from one treatment program were invited to use Let’s Talk About Smoking within two weeks and 20 participants from another treatment program were invited to use the website after three months. Participants took 30-90 minutes to complete the program. All participants continued to receive usual care for mental health and smoking cessation. Participants who had used Let’s Talk About Smoking were more likely to have completed at least one cessation motivation behavior than participants in the control group when controlling for baseline group differences. Participants who used the program were also more likely to meet with a clinician regarding cessation treatment.
Take Away: Let’s Talk About Smoking has the potential to increase motivation to quit smoking in smokers with severe mental illness.
Carbon monoxide feedback in a motivational decision support system for nicotine dependence among smokers with severe mental illness.
Summary: This randomized controlled trial compared the smoking cessation behaviors of smokers with severe mental illness who used Let’s Talk About Smoking with feedback from a carbon monoxide monitor and without that feedback. Participants were referred from a mental health treatment organization in Chicago. Participants had to speak English, smoke daily, be in treatment for severe mental illness at the mental health organization, not be dependent on any substances other than nicotine, and not have used smoking cessation treatment in the past month. Of the 279 participants referred, 124 entered the study and 121 completed the two-month follow-up assessment. At baseline, participants were assessed on their history of computer use, psychiatric and substance use history, history and knowledge of smoking, reasons for quitting, nicotine dependence, cognitive functioning, and reading comprehension. Participants were assessed on their initiation of smoking cessation treatment, stage of change, frequency of smoking, and their satisfaction with the decision support website at the two-month follow-up. Participants were randomized into two conditions; one group used Let’s Talk About Smoking with feedback from a carbon monoxide meter and the other used the program without that feedback. Participants then met with a research assistant to use the program for 30 to 90 minutes. Cessation treatment for participants who wanted it after using the program was available at no cost for all participants. Participants completed a follow-up assessment two months after they used the decision support website. More than half of the participants engaged in at least one cessation behavior. Readiness to quit after using the decision support website was related to initiation of cessation treatment. Participants who received carbon monoxide feedback were more likely than participants who did not receive feedback to increase their knowledge of the effects of carbon monoxide, but were no more likely to initiate cessation treatment. Knowledge about the health effects of smoking and reasons given for wanting to quit smoking did not vary by group. Participants reported being satisfied with the website. There was no difference in satisfaction for participants based on reading comprehension.
Take Away: Let’s Talk About Smoking is satisfactory to patients with severe mental illness who smoke and may motivate them to quit smoking. The carbon monoxide meter may not be a critical component of the program, making it more feasible for mental health programs.
Do symptoms and cognitive problems affect the use and efficacy of a web-based decision support system for smokers with serious mental illness?
Summary: Data from the randomized control trial were used to assess how patients used Let’s Talk About Smoking and how diagnosis and symptomology affected use of the decision support website and cessation behavior. Participants spent an average of 92 minutes using the website and 74% of participants used the audio function of the website. Younger participants were more likely than older participants to choose the African American woman to host the program. African American participants were the only group more likely to select a racially matched host compared to white or Latino participants. Stage of change after using the website was the only factor that predicted engaging in cessation behaviors. Patients with lower education, older age, diagnoses of psychotic disorders, and greater symptomology spent more time on the website.
Take Away: Let’s Talk About Smoking successfully encourages smoking cessation behaviors in patients with severe mental illness who smoke, regardless of levels symptomology, diagnosis, or cognitive impairment.
Abstinence and use of community-based cessation treatment after a motivational intervention among smokers with severe mental illness.
Summary: This follow-up study assessed abstinence and engagement in cessation treatment in the six months following use of Let’s Talk About Smoking. Researchers also evaluated mediators of abstinence. At the six-month follow-up, 124 participants completed assessments of engagement in any smoking cessation treatment, abstinence over the since the last assessment, and breath carbon monoxide. Researchers used patient history to verify use of cessation treatment. At 6 months, 40% of participants used at least one type of evidence-based treatment and 25% attended at least one cessation group counselling session. Sixty percent of participants reported at least one day of abstinence from smoking, 29% quit for at least a week, and 7% quit for at least six months. Years of education and use of cessation treatment predicted at least one week of abstinence and use of cessation treatment mediated the relationship between stage of change after using Let’s Talk About Smoking and abstinence.
Take Away: Let’s Talk About Smoking motivates smokers with severe mental illness to engage in cessation treatment, an important factor in achieving smoking abstinence.
A pre-post pilot study of a brief, web-based intervention to engage disadvantaged smokers into cessation treatment.
Summary: This Pilot compared the cessation behaviors of disadvantaged (e.g. low education, low income, unemployed) smokers who used Let’s Talk About Smoking to smokers who had not used the program. Patients of safety net clinics who smoked were referred to researchers by clinic staff. Participants had to be 18-70 years old, smoke at least four cigarettes a day, speak English, not have used cessation treatment in the last two months, and not be dependent on substances other than nicotine. Of 124 interested participants, 41 were eligible to participate and 38 completed the two-month follow-up assessment. The records of 60 adult smokers who had visited their primary care physician during the study period were randomly selected to compare to the study participants. Participants were assessed at baseline for diagnoses, smoking characteristics, recent use of cessation treatment, psychological distress, and reading comprehension. After baseline assessment, participants used Let’s Talk About Smoking. After using the website, participants completed computer assessments of satisfaction with the website and their intention to quit and use cessation treatment and were given referral information for cessation resources. Two months later, participants met with researchers and were assessed about their smoking characteristics and cessation behaviors. Participant’s medical record were used to verify self-reports of using cessation treatment. All participants reported being satisfied with the website. Thirty-nine percent of participants used cessation treatment and non-pregnant participants were more likely to have used treatment than pregnant participants. Participants were more likely to initiate cessation treatment confirmed by their medical records (29%) than the comparison group (3%). Forty-seven percent of participants abstained from smoking for at least a day and participants who continued smoking significantly decreased the mean number of cigarettes smoked daily from 18.1 to 12.8.
Take Away: Let’s Talk About Smoking encourages disadvantaged smokers to engage in cessation behaviors, including initiation of evidence based cessation treatment.
Brief web-based interventions for young adult smokers with severe mental illnesses: A randomized, controlled pilot study.
Summary: Researchers recruited 81 young adults (18-30) with severe mental illness who smoked daily and randomized them to an intervention (Let’s Talk About Smoking), control (digital informational handout), or minimal assessment group. The minimal assessment group received no intervention and completed a reduced baseline assessment battery. Participants in the intervention and control groups completed assessments of mental health symptoms, nicotine dependence, intention to quit, attitudes toward smoking, use of smoking cessation treatment and other support, and quit attempts at baseline and 14 weeks. The primary outcome was use of cessation treatment, which researchers attempted to verify with clinicians or with treatment packaging. Researchers assessed and biochemically verified abstinence in all groups at 14 weeks. Participants in the minimal assessment group completed assessments of nicotine dependence, mental health, and diet and exercise at baseline and the full assessment battery at 14 weeks. Verified cessation treatment was initiated by 5.6% of all participants, all of whom initiated nicotine replacement therapy (NRT). No participants initiated verified cessation medication or counseling. Among self-reported cessation treatment or support, talking to a friend (22.2%) and initiating NRT (13.9%) were the most popular methods. There were no significant differences in use of cessation treatment or support between groups. Intervention participants were significantly more likely to have biologically verified abstinence (14.8%) at 14 weeks than the control (0%) and the minimal assessment (0%) groups. Participants felt Let’s Talk About Smoking was easy to use (100%), they were satisfied with the intervention (83.4%), and would recommend it to a friend (95%).
Take Away: Let’s Talk About Smoking may help young adults with severe mental illness achieve abstinence compared to educational materials or no intervention, but did not affect use of cessation treatment.