Translating Social Network Science Discoveries to Enhance Smoking Cessation Interventions for Adults with Serious Mental Illness

Dartmouth SYNERGY Translational Pilot Grant

5/1/15-1/31/17

Kelly A. Aschbrenner, PhD (PI, Psychiatry and The Dartmouth Institute for Health Policy and Clinical Practice); A. James O’Malley, PhD (Co-PI, Biomedical Data Science and The Dartmouth Institute for Health Policy and Clinical Practice); Mary F. Brunette, MD (Co-PI, Psychiatry)

John Naslund, MPH (Project Co-I); Denise Anthony, PhD (Project Co-I); Stephen Bartels, MD, MS (Project Co-I)

Despite significant decreases in rates of smoking in the US over the past 50 years, an estimated 50-85% of adults with serious mental illness (SMI), such as schizophrenia and major mood disorders, smoke cigarettes compared to only 18% of adults in the general population.  A significant body of work spanning the translational research spectrum has demonstrated evidence of the efficacy of FDA-approved cessation medications in improving outcomes for smokers with SMI and evidence that smokers with mental illness—just like smokers in the general population—want to quit and can quit, yet the prevalence of quitting is low.  While modestly effective cessation treatments exist for smokers with SMI, new interventions are needed to engage and effectively motivate persons with SMI to participate in smoking cessation.

Targeting social networks may be an effective intervention strategy for individuals with SMI as social factors play a key role as both facilitators and barriers to cessation.  Research in the general population (including work by co-investigator James O’Malley on “social contagion” and smoking) suggests that social ties strongly influence a person’s decision to quit smoking.  Although smokers often perceive their battle with nicotine as an individual struggle, many tend to quit smoking in relation to others in their social network.  Whether and how social networks encourage or limit smoking cessation among individuals with SMI has received little attention to date.

In this translational pilot project we will address this major gap in research and practice. Our first aim is to explore the social networks of individuals with SMI who experienced cessation success or failure following treatment.  We will use a social network interview to quantify and characterize social networks and explore relationships between network properties and smoking behaviors among 40 individuals with SMI who participated in cessation treatment: quitters (n = 20) and non-quitters (n = 20).  We will also collect data on participants’ preferences for cessation support from social ties (e.g., family, friends, and peers) through open-ended questions.  As a second aim, we will use data from the open-ended survey questions on participants’ preferences for cessation support to adapt an evidence-based intervention (originally developed for the general population by colleagues at the Mayo Clinic) to train social network members of smokers with SMI to promote smoker’s use of cessation treatment in a feasibility study among 20 support partner-smoker dyads.

Social network analysis is a basic social science discipline that may inform new clinical interventions.  This study will provide a preliminary understanding of how social networks impact smoking cessation among individuals with SMI.  These data will help inform efforts to reduce smoking in this high-risk group and launch a research agenda using systems science to inform future cessation interventions.