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Sammenligning af to adfærdsmæssige tilgange til rygestop i mentale sundhedsindstillinger (MTQT)

4. november 2026 opdateret af: Wake Forest University Health Sciences

The study team will conduct a Multisite Randomized Controlled Trial to evaluate the advantages and disadvantages of two approaches for quitting smoking among people with serious mental illness (SMI). The study will compare a novel app tailored to people with SMI, Quit on the Go, to a standard of care smoking cessation intervention. We will test the effectiveness of the Quit on the Go app, an intervention that has demonstrated feasibility and acceptability in the target population, as a tool for smoking cessation in people with SMI. Participants with SMI will be recruited across 3 sites (Duke University, Univ. at Buffalo, and Wake Forest University).

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

Smoking tobacco shortens the lifespan of adults with serious mental illness by 25 years and contributes to 317 billion dollar 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. However, our research has shown that apps developed for the general public have inadequate levels usability and engagement in people with serious mental illness.

In a previous pilot trial of a tailored smoking cessation app for people with serious mental illness, Learn to Quit (NCT03069482), we identified successful recruitment and retention methods for smokers with SMI, demonstrated a 4-fold increase in objectively measured interactions of the novel app, obtained promising cessation rates for the experimental app (12% for Quit on the Go formerly "Learn to Quit" versus 3% for NCI QuitGuide), and identified a reliable methodological approach to conduct a fully-powered randomized controlled trial.

Based on this pilot work, we plan to conduct a clinical trial to test this new model in a diverse and representative sample of the SMI population. Specifically, the proposed trial will test whether a tailored smoking cessation app for people with serious mental illness, Quit on the Go, results in higher levels of smoking abstinence compared to a standard of care intervention for this psychiatric population, Brief Advice. Both interventions will receive combined nicotine replacement therapy. The second aim of this trial is to test a mechanistic model of app efficacy by examining mediators of app engagement and treatment outcomes. Finally, the trial will evaluate the cost-effectiveness of these interventions to inform public health policy regard the use of mHealth in this population.

In a multi-site, two-arm randomized controlled trial, 450 individuals with serious mental illness will be randomly assigned to one of two conditions. In the experimental condition, participants will use the Quit on the Go app. In the comparator condition, participants will receive Brief Advice for smoking cessation. Participants in both conditions will receive combined Nicotine Replacement Therapy (standard dosing of nicotine patch plus 5 week course of nicotine gums). Study duration will be 6 months, with 3 follow-up appointments at 1-month, 3-month, and 6-months. Our proposed methods are appropriate given our established procedures during our pilot trial regard to participant assignment, delivery of interventions, data collection and analysis (NCT03069482).

The proposed study meets NIDA's major programmatic priorities of using innovative technologies (e.g., smartphones) and integrating behavioral and pharmacological interventions to improve substance use treatment and outcomes (NOT-DA-10-019). The proposal addresses a serious problem -- high smoking rates in people with SMI -- in a high priority, high cost population, by delivering a novel behavioral intervention for smoking cessation in "real-world" settings. If shown to be effective, the proposed intervention will provide a new model for delivering inexpensive, widely accessible smoking cessation interventions in adults with SMI.

Undersøgelsestype

Interventionel

Tilmelding (Faktiske)

343

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

    • New York
      • Buffalo, New York, Forenede Stater, 14260-1660
        • University at Buffalo
    • North Carolina
      • Durham, North Carolina, Forenede Stater, 27705
        • Duke University
      • Winston-Salem, North Carolina, Forenede Stater, 27157
        • Wake Forest Health Sciences

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

18 år og ældre (Voksen, Ældre voksen)

Tager imod sunde frivillige

Ingen

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  1. DSM-5 diagnosis of schizophrenia, schizoaffective, bipolar, recurring major depressive disorder or Persistent Depressive Disorder
  2. Functional impairment as indicated by a score of 2 or greater on the WHODAS 8 item version
  3. Smoker as indicated by smoking greater than or equal to 5 cigarettes per day over the past 6 months;
  4. Desire to quit smoking as indicated by self-reported serious intention to quitting tobacco within the next 6 months;
  5. Age 18 and older;
  6. Willing and medically eligible to use NRT;
  7. Currently receiving psychiatric treatment and intent to receive treatment for the duration of the study (therapy, medications, etc.).

Exclusion Criteria

  1. Problematic substance use, as defined by the Addiction Severity Index, within the last 30 days, twice within the past 6 months, or hospitalization for substance abuse within the past year.
  2. Current acute psychotic episode or unsafe to participate in the study as defined by the Mini International Neuropsychiatric Interview for Psychotic Disorders (Sheehan et al., 1998);
  3. Being pregnant or the intention to become pregnant in the next 6 months;
  4. Currently receiving any pharmacological and/or behavioral intervention or counseling for smoking cessation;
  5. Currently using e-cigarettes or other tobacco products besides cigarettes > 10 days in the past 30 days.
  6. Unsafe to participate in the study due to moderate or high risk of suicide determined by the Columbia-Suicide Severity Rating Scale (C-SSRS) - Screen Version, defined as answering 'yes' to both question 3 for the last month and 'yes' to question 6 for lifetime (moderate risk), or 'yes' to questions 4 and 5 for the recent month, or 'yes' to question 6 for the last 3 months (high risk).

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Behandling
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: "Quit on the Go" (formerly "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. This app intervention is combined with an 8-week course of nicotine replacement therapy (NRT) patches and a 5-10 week course of NRT gum (or Nicotine Lozenges if unable to use gum). Participants also receive technical smartphone coaching for the first 4 weeks of the study.

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.

All participants will receive an 8-week course of transdermal nicotine patches. The first 4 weeks of use will be 21mg/24 hours, followed by 2 weeks of 14mg/24 hours patches, and finally 2 weeks of 7mg/24 hours patches.

Andre navne:
  • NRT

Participants randomized to the smartphone app intervention will receive 4 weeks of smartphone coaching given by research staff. The coaching is meant to be a time to address any issues that may rise with the participants' study smartphone or app.

Each participant enrolled will be given NRT gum (5-10week course) to be taken orally as nicotine cravings arise. Depending on participants' nicotine dependence, they will receive either the 2mg or 4mg (if they smoke within the first 30 minutes of waking) gum pieces per package instructions. We will direct subjects to use them for the first weeks following their quit date, using no more than one every 1-2 hours.

Andre navne:
  • NRT

In cases where participants are unable to chew nicotine gum, lozenges will be sent as a replacement of Nicotine gum. Depending on participants' nicotine dependence, they will receive either the 2mg or 4mg (if they smoke within the first 30 minutes of waking) lozenge pieces per package instructions. We will direct subjects to use them for the first weeks following their quit date, using no more than one every 1-2 hours.

Andre navne:
  • NRT
Andet: Brief Advice (Standard of Care)

Brief Advice and Combined Nicotine Replacement Therapy (patches and gum or lozenges) has been recommended by the US Clinical Practice Guidelines for patients with psychiatric illness. Brief Advice will consist of 20 minutes of guidance about the use of nicotine replacement therapy, and strategies to initiate and maintain a quit attempt. The intervention is combined with an 8-week course of nicotine replacement therapy (NRT) patches and a 5-10 week course of NRT gum (or Nicotine Lozenges if unable to use gum).

All participants will receive an 8-week course of transdermal nicotine patches. The first 4 weeks of use will be 21mg/24 hours, followed by 2 weeks of 14mg/24 hours patches, and finally 2 weeks of 7mg/24 hours patches.

Andre navne:
  • NRT

Each participant enrolled will be given NRT gum (5-10week course) to be taken orally as nicotine cravings arise. Depending on participants' nicotine dependence, they will receive either the 2mg or 4mg (if they smoke within the first 30 minutes of waking) gum pieces per package instructions. We will direct subjects to use them for the first weeks following their quit date, using no more than one every 1-2 hours.

Andre navne:
  • NRT

In cases where participants are unable to chew nicotine gum, lozenges will be sent as a replacement of Nicotine gum. Depending on participants' nicotine dependence, they will receive either the 2mg or 4mg (if they smoke within the first 30 minutes of waking) lozenge pieces per package instructions. We will direct subjects to use them for the first weeks following their quit date, using no more than one every 1-2 hours.

Andre navne:
  • NRT

Brief Advice will consist of 20 minutes of guidance about the use of nicotine replacement therapy, and strategies to initiate and maintain a quit attempt.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Bio-verified 7-day point-prevalence abstinence at 24 weeks
Tidsramme: At 24 weeks from Baseline

Abstinence is binary, and requires both (a) self-report of no smoking at all for at least 7 days prior to week 24; and (b) biochemical verification [either expired CO breath test reading of < 5 ppm using the Belfont Micro+® Smokerlyzer test, or of < 6 ppm if using the iCOquit® Smokerlyzer test, or a cotinine level of less than or equal to 30 ng/ml if using an Alere iScreen saliva test]. If the participant does not meet both criteria, they are not considered abstinent.

As per convention, participants are assumed to be smoking if they report smoking at the time-point, cannot be reached to provide data at the time-point, or fail to provide a breath and saliva sample at the time-point.

At 24 weeks from Baseline

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Change in average number of cigarettes smoked per day
Tidsramme: At 24 weeks from Baseline

Change in self-reported number of cigarettes smoked per day, averaged within groups.

At 24 weeks from Baseline
Average number of 24-hr quit attempts per group
Tidsramme: At 24 weeks from Baseline

Average number of quit attempts self-reported per group between baseline and week 24. Quit attempts are defined by no smoking at all for 24 hours or more.

At 24 weeks from Baseline
7-day point prevalence abstinence rates
Tidsramme: At 12 weeks from Baseline

Percent of subjects in each group self-reporting no smoking at all for greater or equal to 7 days prior to the timepoint.

At 12 weeks from Baseline
7-day point prevalence abstinence rates
Tidsramme: At 24 weeks from Baseline

Percent of subjects in each group self-reporting no smoking at all for greater or equal to 7 days prior to the timepoint.

At 24 weeks from Baseline
30-day point prevalence abstinence rates
Tidsramme: At 12 weeks from Baseline

Percent of subjects in each group self-reporting no smoking at all for greater or equal to 30 days prior to the timepoint.

At 12 weeks from Baseline
30-day point prevalence abstinence rates
Tidsramme: At 24 weeks from Baseline

Percent of subjects in each group self-reporting no smoking at all for greater or equal to 30 days prior to the timepoint.

At 24 weeks from Baseline
Biochemically confirmed 7-day point prevalence abstinence rates
Tidsramme: At 12 weeks from Baseline

Percent of subjects in each group self-reporting no smoking at all for greater or equal to 7 days prior to the time point. Abstinence requires both (a) self-report of no smoking at all for at least 7 days prior to week 24; and (b) biochemical verification [either expired CO breath test reading of < 5 ppm using the Belfont Micro+® Smokerlyzer test, or of < 6 ppm if using the iCOquit® Smokerlyzer test, or a cotinine level of less than or equal to 30 ng/ml if using an Alere iScreen saliva test]. If the participant does not meet both criteria, they are not considered abstinent.

At 12 weeks from Baseline

Andre resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Average frequency of app use
Tidsramme: Weeks 0-24

Average frequency of app use over the 24-week study period. Measured by average number of app openings.

Weeks 0-24
Average duration of app use
Tidsramme: Weeks 0-24

Average duration of app use over the 24-week study period.

Weeks 0-24
Average number of app modules completed
Tidsramme: Weeks 0-24

Average number of app modules completed over the 24-week study period.

Weeks 0-24
Average app usability scores
Tidsramme: At 4 weeks from baseline

Average self-reported scores of usability on the 10-item System Usability Scale. Scores range from 0-100 with higher scores indicating higher usability of the app.

At 4 weeks from baseline
Average user experience scores
Tidsramme: At 4 weeks from baseline

Average self-reported scores of user experience using the User Experience Questionnaire - Short Version.

At 4 weeks from baseline
Average user experience scores
Tidsramme: At 12 weeks from baseline

Average self-reported scores of user experience using the User Experience Questionnaire - Short Version.

At 12 weeks from baseline
Average user experience scores
Tidsramme: At 24 weeks from baseline

Average self-reported scores of user experience using the User Experience Questionnaire - Short Version.

At 24 weeks from baseline
Average acceptance of physical smoking cravings
Tidsramme: At 4 weeks from baseline

Average self-reported scores of acceptance of cravings on the physical sensations subscale of the Avoidance and Inflexibility Scale. Scores range from 4-20 with lower scores indicating more acceptance of smoking cravings.

At 4 weeks from baseline
Average acceptance of physical smoking cravings
Tidsramme: At 12 weeks from baseline

Average self-reported scores of acceptance of cravings on the physical sensations subscale of the Avoidance and Inflexibility Scale. Scores range from 4-20 with lower scores indicating more acceptance of smoking cravings.

At 12 weeks from baseline
Average acceptance of physical smoking cravings
Tidsramme: At 24 weeks from baseline

Average self-reported scores of acceptance of cravings on the physical sensations subscale of the Avoidance and Inflexibility Scale. Scores range from 4-20 with lower scores indicating more acceptance of smoking cravings.

At 24 weeks from baseline
Nicotine patch use
Tidsramme: At 12 weeks from baseline

Average number of days (out of 56 possible) per arm that participants used the nicotine patch.

At 12 weeks from baseline
Nicotine gum use
Tidsramme: At 12 weeks from baseline

Average number of nicotine gum used per arm.

At 12 weeks from baseline
Smoking Costs at 4 Weeks
Tidsramme: At 4 weeks from baseline

Average costs of smoking per group as measured by the Smoking Costs Questionnaire

At 4 weeks from baseline
Smoking Costs at 12 Weeks
Tidsramme: At 12 weeks from baseline

Average costs of smoking per group as measured by the Smoking Costs Questionnaire

At 12 weeks from baseline
Smoking Costs at 24 Weeks
Tidsramme: At 24 weeks from baseline

Average costs of smoking per group as measured by the Smoking Costs Questionnaire

At 24 weeks from baseline
Costs of technical coaching
Tidsramme: At 24 weeks from baseline

Cost of technical coaching calls estimated by number of technical coaching calls to assist with the use of the QoG DTx

At 24 weeks from baseline
Experiences of racism at week 4
Tidsramme: At 4 weeks from baseline

Self-reported experiences of racism per group as measured by the Everyday Discrimination Scale

At 4 weeks from baseline
Experiences of racism at week 12
Tidsramme: At 12 weeks from baseline

Self-reported experiences of racism per group as measured by the Everyday Discrimination Scale

At 12 weeks from baseline
Experiences of racism at week 24
Tidsramme: At 24 weeks from baseline

Self-reported experiences of racism per group as measured by the Everyday Discrimination Scale

At 24 weeks from baseline
Quality of Life at week 4
Tidsramme: At 4 weeks from baseline

Self-reported quality of life per group as measured by the World Health Organization Quality of Life Scale - BREF

At 4 weeks from baseline
Quality of Life at week 12
Tidsramme: At 12 weeks from baseline

Self-reported quality of life per group as measured by the World Health Organization Quality of Life Scale - BREF

At 12 weeks from baseline
Quality of Life at week 24
Tidsramme: At 24 weeks from baseline

Self-reported quality of life per group as measured by the World Health Organization Quality of Life Scale - BREF

At 24 weeks from baseline
Frequency of e-cigarette use at Week 4
Tidsramme: At 4 weeks from baseline

Average number of days of e-cigarette use per group as measured by a Timeline Follow Back Interview

At 4 weeks from baseline
Frequency of e-cigarette use at Week 12
Tidsramme: At 12 weeks from baseline

Average number of days of e-cigarette use per group as measured by a Timeline Follow Back Interview

At 12 weeks from baseline
Frequency of e-cigarette use at Week 24
Tidsramme: At 24 weeks from baseline

Average number of days of e-cigarette use per group as measured by a Timeline Follow Back Interview

At 24 weeks from baseline
Frequency of use of other tobacco products at week 4
Tidsramme: At 4 weeks from baseline

Average number of days of use of other tobacco products per group as measured by a Timeline Follow Back Interview.

At 4 weeks from baseline
Frequency of use of other tobacco products at week 12
Tidsramme: At 12 weeks from baseline

Average number of days of use of other tobacco products per group as measured by a Timeline Follow Back Interview.

At 12 weeks from baseline
Frequency of use of other tobacco products at week 24
Tidsramme: At 24 weeks from baseline

Average number of days of use of other tobacco products per group as measured by a Timeline Follow Back Interview.

At 24 weeks from baseline
Frequency of use of cannabis at week 4
Tidsramme: At 4 weeks from baseline

Average number of days of cannabis per group as measured by a Timeline Follow Back Interview.

At 4 weeks from baseline
Frequency of use of cannabis at week 12
Tidsramme: At 12 weeks from baseline

Average number of days of cannabis per group as measured by a Timeline Follow Back Interview.

At 12 weeks from baseline
Frequency of use of cannabis at week 24
Tidsramme: At 24 weeks from baseline

Average number of days of cannabis per group as measured by a Timeline Follow Back Interview.

At 24 weeks from baseline
Frequency of use of alcohol at week 4
Tidsramme: At 4 weeks from baseline

Average number of days of alcohol use per group as measured by a Timeline Follow Back Interview.

At 4 weeks from baseline
Frequency of use of alcohol at week 12
Tidsramme: At 12 weeks from baseline

Average number of days of alcohol use per group as measured by a Timeline Follow Back Interview.

At 12 weeks from baseline
Frequency of use of alcohol at week 24
Tidsramme: At 24 weeks from baseline

Average number of days of alcohol use per group as measured by a Timeline Follow Back Interview.

At 24 weeks from baseline

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

Samarbejdspartnere

Efterforskere

  • Ledende efterforsker: Roger Vilardaga, PhD, Wake Forest University

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart (Faktiske)

21. september 2021

Primær færdiggørelse (Faktiske)

30. december 2025

Studieafslutning (Faktiske)

30. december 2025

Datoer for studieregistrering

Først indsendt

26. august 2021

Først indsendt, der opfyldte QC-kriterier

26. august 2021

Først opslået (Faktiske)

1. september 2021

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

9. november 2026

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

4. november 2026

Sidst verificeret

1. juli 2025

Mere information

Begreber relateret til denne undersøgelse

Andre undersøgelses-id-numre

  • IRB00110770
  • R01DA047301 (U.S. NIH-bevilling/kontrakt)

Plan for individuelle deltagerdata (IPD)

Planlægger du at dele individuelle deltagerdata (IPD)?

INGEN

Lægemiddel- og udstyrsoplysninger, undersøgelsesdokumenter

Studerer et amerikansk FDA-reguleret lægemiddelprodukt

Ingen

Studerer et amerikansk FDA-reguleret enhedsprodukt

Ja

produkt fremstillet i og eksporteret fra U.S.A.

Ingen

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