Feasibility Trial of a Tailored Smoking Cessation App for People With Serious Mental Illness
Quitting smoking has important health benefits for people with serious mental illness, more than half of whom are smokers. Smoking reductions in this population, in turn, could contribute to saving billions of dollars in healthcare expenditures.
Finding ways to deliver more effective and wider reaching smoking cessation interventions to individuals with serious mental illness is a pressing priority. Smartphone apps are a wide reaching technology that could provide a viable platform to deliver smoking cessation interventions for individuals with serious mental illness.
However, do smoking cessation apps need to be tailored for people with serious mental illness to ensure their success? Or can providers simply use standard and freely available smoking cessation mobile health treatments designed for the general population? Furthermore, is it feasible to conduct mHealth trials in this population?
Therefore, this trial will test whether (1) a tailored smoking cessation app for people with serious mental illness results in higher levels of engagement with smoking cessation content as compared to an app designed for the general population and (2) smoking cessation mHealth trials can be feasibly conducted in this population.
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Smoking tobacco shortens the lifespan of adults with serious mental illness by 25 years and contributes to $317 billion expenditures in healthcare, indirect loss of earnings and disability benefits. Determining whether it is possible to deliver more effective and wider reaching smoking cessation interventions to individuals with serious mental illness is a high priority. Smartphone apps are a wide reaching technology that could provide individuals with serious mental illness the necessary skills for quitting.
This feasibility trial will test whether a tailored smoking cessation app for people with serious mental illness, Learn to Quit, results in higher levels of engagement with smoking cessation content as compared to an app designed for the general population, NCI QuitGuide. The trial will also demonstrate whether it is possible to (a) feasibly recruit and retain individuals with serious mental illness in an mHealth clinical trial, and (b) successfully gather smoking cessation outcomes. Ninety individuals with serious mental illness will be randomly assigned to one of two conditions. In the experimental condition, participants will use the Learn to Quit app. In the comparator condition, participants will use the NCI QuitGuide app. Participants in both conditions will receive Nicotine Replacement Therapy (standard dosing of nicotine patch + 1-week course of 4mg nicotine lozenges) and technical coaching. Study duration will be 4 months, with four follow-up appointments at 1-month, 2-month, 3-month, and 4-months.
Study Type
Study Type
Enrollment (Actual)
Enrollment
Phase
Phase
- Phase 1
Contacts and Locations
Study Locations
-
-
North Carolina
-
Durham, North Carolina, United States, 27705
- Duke University
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
- ICD-10 diagnosis of schizophrenia, schizoaffective, bipolar or recurring depressive disorder
- Smoking ≥ 5 cigarettes per day over the past 30 days
- Desire to quit smoking in the next 30 days
- Willing and medically eligible to use Nicotine Replacement Therapy
- Fluent in spoken and written English
- Working email, mailing address, or alternative contact person
- Taking psychiatric medications as prescribed by their provider
- Stable housing
Exclusion Criteria:
- Problematic alcohol or illicit drug use in the last 30 days
- Acute psychotic episode, unsafe to participate in the study, or psychiatrically unstable
- Pregnant, breastfeeding, or having the intention to become pregnant in the next 4 months
- Hearing, comprehension, or visual limitations that preclude study participation
- Currently receiving any pharmacological and/or behavioral intervention or counseling for smoking cessation
- Using non-cigarette forms of tobacco as the primary source of nicotine (e.g. e-cigarettes, chew)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Learn to Quit
A smartphone app developed by the research team designed for people with serious mental illness, that provides Acceptance and Commitment Therapy skills to address (a) smoking cessation and (b) mental health symptoms.
|
A smartphone app designed for individuals with serious mental illness.
The main intervention components of the app are skills based on an intervention called Acceptance and Commitment Therapy that will (a) teach smoking cessation skills and (b) help cope with mental health symptoms.
The app incorporates gaming features to keep users engaged, and a tracking component to record smoking habits and moods.
Participants enrolled in the study will be given an 8-week course of Nicotine patches.
The 8-week course of trans-dermal nicotine patches starting at 21mg/24h for 4 weeks, then transitioning to 14mg/24h for 2 weeks, and finally to 7mg/24h for the last 2 weeks.
This dosing will follow recommendations contained in the US DHHS Clinical Practice Guidelines.
Each participant will be given a 1-week course of 4mg Nicotine lozenges to be taken orally as nicotine cravings arise (about 10 lozenges per day).
They will be directed to use them for the week following their quit date, using no more than once every 1-2 hours.
This dosing will follow recommendations contained in the US DHHS Clinical Practice Guidelines.
Coaching to assist the user on the use of each assigned smartphone app.
This coaching will be delivered by research staff following a coaching procedure.
These in-person coaching meetings will be brief (~15 minutes), done on a weekly basis for 4 weeks, and will have a focus on providing technical assistance.
|
|
Active Comparator: NCI QuitGuide
A smartphone app developed by the National Cancer Institute which uses smoking cessation recommendations contained in the US DHHS Clinical Practice Guidelines.
|
Participants enrolled in the study will be given an 8-week course of Nicotine patches.
The 8-week course of trans-dermal nicotine patches starting at 21mg/24h for 4 weeks, then transitioning to 14mg/24h for 2 weeks, and finally to 7mg/24h for the last 2 weeks.
This dosing will follow recommendations contained in the US DHHS Clinical Practice Guidelines.
Each participant will be given a 1-week course of 4mg Nicotine lozenges to be taken orally as nicotine cravings arise (about 10 lozenges per day).
They will be directed to use them for the week following their quit date, using no more than once every 1-2 hours.
This dosing will follow recommendations contained in the US DHHS Clinical Practice Guidelines.
Coaching to assist the user on the use of each assigned smartphone app.
This coaching will be delivered by research staff following a coaching procedure.
These in-person coaching meetings will be brief (~15 minutes), done on a weekly basis for 4 weeks, and will have a focus on providing technical assistance.
A smartphone app developed by the National Cancer Institute which uses recommendations contained in the US DHHS Clinical Practice Guidelines and smokefree.gov.
NCI QuitGuide has the following intervention components: (a) psycho-education about the impact of smoking in health, (b) tracking of smoking habits, and (c) Tips for quitting (e.g., distraction strategies).
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Days of App Use
Time Frame: Daily throughout study duration, 4 months
|
Frequency of app openings in each group
|
Daily throughout study duration, 4 months
|
|
Duration of App Use
Time Frame: Daily throughout study duration, 4 months
|
Mean duration of app use in each group over the course of study participation (4 months)
|
Daily throughout study duration, 4 months
|
|
Feasibility as Measured by Study Accrual Relative to Recruitment Goal
Time Frame: Approximately 15 months
|
Percent of subjects consented into study relative to study recruitment goal (N=90).92
subjects signed consent prior to eligibility determination and randomization.
|
Approximately 15 months
|
|
Feasibility as Measured by Study Attrition
Time Frame: 4-months
|
Number and percentage of subjects who complete 4-month follow up assessment
|
4-months
|
|
Recruitment Yield Effort
Time Frame: Approximately 15 months
|
Percent of subjects responding to ads and clinician referrals
|
Approximately 15 months
|
|
Feasibility of Measurement Strategy
Time Frame: Approximately 19 months
|
Percent completion of assessment measures.
Assessment measures include surveys, questionnaires, and cognitive tasks.
|
Approximately 19 months
|
|
Usability of App Design as Measured by the System Usability Scale (SUS)
Time Frame: 1-month follow-up
|
10-item scale giving a global assessment of systems usability using a 5-point Likert Scale with a composite score ranging from 0-100.
Higher scores indicate higher usability rating.
|
1-month follow-up
|
|
Usability of App Design as Measured by the System Usability Scale (SUS)
Time Frame: 2-month follow-up
|
10-item scale giving a global assessment of systems usability using a 5-point Likert Scale with a composite score ranging from 0-100.
Higher scores indicate higher usability rating.
|
2-month follow-up
|
|
Usability of App Design as Measured by the System Usability Scale (SUS)
Time Frame: 3-month follow-up
|
10-item scale giving a global assessment of systems usability using a 5-point Likert Scale with a composite score ranging from 0-100.
Higher scores indicate higher usability rating.
|
3-month follow-up
|
|
Usability of App Design as Measured by the System Usability Scale (SUS)
Time Frame: 4-month follow-up
|
10-item scale giving a global assessment of systems usability using a 5-point Likert Scale with a composite score ranging from 0-100.
Higher scores indicate higher usability rating.
|
4-month follow-up
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Biochemically Confirmed 7-day Point Prevalence Abstinence
Time Frame: 1 month follow-up
|
Percent of subjects in each group reporting biochemically confirmed 7-day point prevalence abstinence.
Abstinence is determined by a self-report of not smoking for 7 days prior to the specified timepoint AND by a result of ≤ 5 ppm in carbon monoxide breath testing.
If the participant does not meet both criteria, they are not considered abstinent.
|
1 month follow-up
|
|
Biochemically Confirmed 7-day Point Prevalence Abstinence
Time Frame: 2 month follow-up
|
Percent of subjects in each group reporting biochemically confirmed 7-day point prevalence abstinence.
Abstinence is determined by a self-report of not smoking for 7 days prior to the specified timepoint AND by a result of ≤ 5 ppm in carbon monoxide breath testing.
If the participant does not meet both criteria, they are not considered abstinent.
|
2 month follow-up
|
|
Biochemically Confirmed 7-day Point Prevalence Abstinence
Time Frame: 3 month follow-up
|
Percent of subjects in each group reporting biochemically confirmed 7-day point prevalence abstinence.
Abstinence is determined by a self-report of not smoking for 7 days prior to the specified timepoint AND by a result of ≤ 5 ppm in carbon monoxide breath testing.
If the participant does not meet both criteria, they are not considered abstinent.
|
3 month follow-up
|
|
Biochemically Confirmed 7-day Point Prevalence Abstinence
Time Frame: 4 month follow-up
|
Percent of subjects in each group reporting biochemically confirmed 7-day point prevalence abstinence.
Abstinence is determined by a self-report of not smoking for 7 days prior to the specified timepoint AND by a result of ≤ 5 ppm in carbon monoxide breath testing.
If the participant does not meet both criteria, they are not considered abstinent.
|
4 month follow-up
|
|
Biochemically Confirmed Prolonged Abstinence Rates
Time Frame: 1 month follow up
|
Total number of participants in each group reporting prolonged abstinence at the specified time point.
Abstinence is determined by a self-report of not relapsing after their quit date (i.e., not smoking for 7 consecutive days, or not smoking at least once each week for 2 consecutive weeks) following a 2-week grace period, AND by a result of ≤ 6 ppm in carbon monoxide breath testing.
If the participant does not meet both criteria, they are not considered abstinent
|
1 month follow up
|
|
Biochemically Confirmed Prolonged Abstinence Rates
Time Frame: 2 month follow up
|
Total number of participants in each group reporting prolonged abstinence at the specified time point.
Abstinence is determined by a self-report of not relapsing after their quit date (i.e., not smoking for 7 consecutive days, or not smoking at least once each week for 2 consecutive weeks) following a 2-week grace period, AND by a result of ≤ 6 ppm in carbon monoxide breath testing.
If the participant does not meet both criteria, they are not considered abstinent
|
2 month follow up
|
|
Biochemically Confirmed Prolonged Abstinence Rates
Time Frame: 3 month follow up
|
Total number of participants in each group reporting prolonged abstinence at the specified time point.
Abstinence is determined by a self-report of not relapsing after their quit date (i.e., not smoking for 7 consecutive days, or not smoking at least once each week for 2 consecutive weeks) following a 2-week grace period, AND by a result of ≤ 6 ppm in carbon monoxide breath testing.
If the participant does not meet both criteria, they are not considered abstinent.
|
3 month follow up
|
|
Biochemically Confirmed Prolonged Abstinence Rates
Time Frame: 4 month follow up
|
Total number of participants in each group reporting prolonged abstinence at the specified time point.
Abstinence is determined by a self-report of not relapsing after their quit date (i.e., not smoking for 7 consecutive days, or not smoking at least once each week for 2 consecutive weeks) following a 2-week grace period, AND by a result of ≤ 6 ppm in carbon monoxide breath testing.
If the participant does not meet both criteria, they are not considered abstinent.
|
4 month follow up
|
|
30-day Point Prevalence Abstinence Rates
Time Frame: 1 month follow up
|
Participants who self-reported not smoking for 30 days prior to the specified timepoint.
|
1 month follow up
|
|
30-day Point Prevalence Abstinence Rates
Time Frame: 2 month follow up
|
Participants who self-reported not smoking for 30 days prior to the specified timepoint.
|
2 month follow up
|
|
30-day Prevalence Abstinence Rates
Time Frame: 3 month follow up
|
Participants who self-reported not smoking for 30 days prior to the specified timepoint.
|
3 month follow up
|
|
30-day Point Prevalence Abstinence Rates
Time Frame: 4 month follow up
|
Participants who self-reported not smoking for 30 days prior to the specified timepoint.
|
4 month follow up
|
|
7-day Point Prevalence Abstinence
Time Frame: 1 month follow up
|
Participants who self-reported not smoking for 7 days prior to the specified timepoint.
|
1 month follow up
|
|
7-day Point Prevalence Abstinence
Time Frame: 2 month follow up
|
Participants who self-reported not smoking for 7 days prior to the specified timepoint.
|
2 month follow up
|
|
7-day Point Prevalence Abstinence
Time Frame: 3 month follow up
|
Participants who self-reported not smoking for 7 days prior to the specified timepoint.
|
3 month follow up
|
|
7-day Point Prevalence Abstinence
Time Frame: 4 month follow up
|
Participants who self-reported not smoking for 7 days prior to the specified timepoint.
|
4 month follow up
|
|
24-hour Point Prevalence Abstinence
Time Frame: 1 month follow up
|
Participants who self-reported not smoking for 24 hours prior to the specified timepoint.
|
1 month follow up
|
|
24-hour Point Prevalence Abstinence
Time Frame: 2 month follow up
|
Participants who self-reported not smoking for 24 hours prior to the specified timepoint.
|
2 month follow up
|
|
24-hour Point Prevalence Abstinence
Time Frame: 3 month follow up
|
Participants who self-reported not smoking for 24 hours prior to the specified timepoint.
|
3 month follow up
|
|
24-hour Point Prevalence Abstinence
Time Frame: 4 month follow up
|
Participants who self-reported not smoking for 24 hours prior to the specified timepoint.
|
4 month follow up
|
|
Average Number of Quit Attempts Per Arm
Time Frame: 1 month follow up
|
Average number of quit attempts per group defined as self-reported no smoking at all for 24 hours at the specified time point.
|
1 month follow up
|
|
Average Number of Quit Attempts Per Arm
Time Frame: 2 month follow up
|
Average number of quit attempts per group defined as self-reported no smoking at all for 24 hours at the specified time point.
|
2 month follow up
|
|
Average Number of Quit Attempts Per Arm
Time Frame: 3 month follow up
|
Average number of quit attempts per group defined as self-reported no smoking at all for 24 hours at the specified time point.
|
3 month follow up
|
|
Average Number of Quit Attempts Per Arm
Time Frame: 4 month follow up
|
Average number of quit attempts per group defined as self-reported no smoking at all for 24 hours at the specified time point.
|
4 month follow up
|
|
Change in Nicotine Dependence as Measured by the Fagerstrom Test of Nicotine Dependence
Time Frame: Baseline to 1, 2, 3 and 4 month follow up
|
The Fagerstrom Test of Nicotine Dependence ranges from 0 to 10 with the lower score indicating "no dependence" and the highest score indicating "very dependent"
|
Baseline to 1, 2, 3 and 4 month follow up
|
|
Change in Average Number of Cigarettes Smoked Per Day
Time Frame: Baseline to 1, 2, 3 and 4 month follow up
|
Change in average number of self-reported cigarettes smoked per day per arm from baseline to the specified time point.
|
Baseline to 1, 2, 3 and 4 month follow up
|
|
Nicotine Replacement Patch Utilization
Time Frame: 1 month follow up
|
Days of patch use over the last 30 days.
|
1 month follow up
|
|
Nicotine Replacement Patch Utilization
Time Frame: 2 month follow up
|
Days of patch use over the last 30 days.
|
2 month follow up
|
|
Nicotine Replacement Patch Utilization
Time Frame: 3 month follow up
|
Days of patch use over the last 30 days.
|
3 month follow up
|
|
Nicotine Replacement Patch Utilization
Time Frame: 4 month follow up
|
Days of patch use over the last 30 days.
|
4 month follow up
|
|
Nicotine Replacement Lozenge Utilization
Time Frame: 1 month follow up
|
Days of lozenge use over the last 30 days.
|
1 month follow up
|
|
Nicotine Replacement Lozenge Utilization
Time Frame: 2 month follow up
|
Days of lozenge use over the last 30 days.
|
2 month follow up
|
|
Nicotine Replacement Lozenge Utilization
Time Frame: 3 month follow up
|
Days of lozenge use over the last 30 days.
|
3 month follow up
|
|
Nicotine Replacement Lozenge Utilization
Time Frame: 4 month follow up
|
Days of lozenge use over the last 30 days.
|
4 month follow up
|
|
Affect Ratings - Learn to Quit
Time Frame: Daily throughout study duration, 4 months
|
Average mood rating as self-reported through the Learn to Quit app.
Ratings range from 1-10 with lower scores indicating poorer mood ratings.
|
Daily throughout study duration, 4 months
|
|
Affect Ratings - QuitGuide
Time Frame: Daily throughout study, 4 months
|
Percent of reported positive, negative, and mixed affect.
Negative affect was coded as '1' when the following types of mood were reported using the mood tracking feature within the app: frustrated, stressed, nervous, anxious, angry, sad.
Positive affect was coded as '1' when the following types of mood were reported using the mood tracking feature within the app: happy, relaxed, excited.
Mixed affect was coded as '1' when there were instances where participants reported both positive and negative affect at different times of the day.
|
Daily throughout study, 4 months
|
|
Smoking Cravings
Time Frame: Daily throughout study duration, 4 months
|
Average daily smoking cravings as self-reported through each smartphone app.
Cravings range from a score of 1 to 10 with higher scores indicating higher cravings to smoke.
|
Daily throughout study duration, 4 months
|
|
Psychotic Symptoms
Time Frame: 1 month follow up
|
Psychotic symptoms (positive and negative symptoms) at the specified time point as measured by the Positive and Negative Symptoms Scale.
Scores range from 7 to 49 with higher scores indicating more psychopathology.
|
1 month follow up
|
|
Psychotic Symptoms
Time Frame: 2 month follow up
|
Psychotic symptoms (positive and negative symptoms) at the specified time point as measured by the Positive and Negative Symptoms Scale.
Scores range from 7 to 49 with higher scores indicating more psychopathology.
|
2 month follow up
|
|
Psychotic Symptoms
Time Frame: 3 month follow up
|
Psychotic symptoms (positive and negative symptoms) at the specified time point as measured by the Positive and Negative Symptoms Scale.
Scores range from 7 to 49 with higher scores indicating more psychopathology.
|
3 month follow up
|
|
Psychotic Symptoms
Time Frame: 4 month follow up
|
Psychotic symptoms (positive and negative symptoms) at the specified time point as measured by the Positive and Negative Symptoms Scale.
Scores range from 7 to 49 with higher scores indicating more psychopathology.
|
4 month follow up
|
|
General Psychiatric Symptoms
Time Frame: 1 month follow up
|
General psychiatric symptoms at the specified time point as measured by the Global Severity Index of the Brief Symptom Inventory.
Scores range from 0 to 4 with higher scores indicating more psychiatric symptoms.
|
1 month follow up
|
|
General Psychiatric Symptoms
Time Frame: 2 month follow up
|
General psychiatric symptoms at the specified time point as measured by the Global Severity Index of the Brief Symptom Inventory.
Scores range from 0 to 4 with higher scores indicating more psychiatric symptoms.
|
2 month follow up
|
|
General Psychiatric Symptoms
Time Frame: 3 month follow up
|
General psychiatric symptoms at the specified time point as measured by the Global Severity Index of the Brief Symptom Inventory.
Scores range from 0 to 4 with higher scores indicating more psychiatric symptoms.
|
3 month follow up
|
|
General Psychiatric Symptoms
Time Frame: 4 month follow up
|
General psychiatric symptoms at the specified time point as measured by the Global Severity Index of the Brief Symptom Inventory.
Scores range from 0 to 4 with higher scores indicating more psychiatric symptoms.
|
4 month follow up
|
Collaborators and Investigators
Sponsor
Sponsor
Collaborators
Collaborators
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Actual)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
- Chemically-Induced Disorders
- Substance-Related Disorders
- Mental Disorders
- Tobacco Use Disorder
- Physiological Effects of Drugs
- Neurotransmitter Agents
- Molecular Mechanisms of Pharmacological Action
- Autonomic Agents
- Peripheral Nervous System Agents
- Cholinergic Agents
- Ganglionic Stimulants
- Nicotinic Agonists
- Cholinergic Agonists
- Nicotine
Other Study ID Numbers
Other Study ID Numbers
- Pro00075165
- 4R00DA037276-03 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
Clinical Trials on Serious Mental Illness
-
NCT00520728CompletedSerious Mental Illness
-
NCT01566513CompletedSerious Mental Illness
-
NCT01820468WithdrawnConditions: Serious Mental Illness
-
NCT06940843RecruitingOlder Adults | Serious Mental Illness
-
NCT02420340CompletedSerious Mental Illness | Psychosocial Rehabilitation
-
NCT07025499Not yet recruiting
-
NCT06370767RecruitingSerious Mental Illness
Clinical Trials on Learn to Quit App
-
NCT03978455CompletedSmoking | Smoking Cessation
-
NCT04765813Completed
-
NCT06883097RecruitingSmoking Cessation | Human Immunodeficiency Virus (HIV) | Tobacco | Tobacco Abstinence | Cancer Prevention | Smoking Cessation; Tobacco Dependence | Tobacco Dependence Caused by Cigarettes
-
NCT02701686Completed
-
NCT02188433CompletedSmoking Cessation Intervention
-
NCT07181551Active, not recruiting
-
NCT00989755Completed