A Website Designed to Motivate and Educate Adults with Severe Mental Illness to Quit Smoking

Background and Purpose: People with serious mental illnesses (SMI) such as schizophrenia and mood disorders smoke at higher rates than those without mental illness. Most individuals with SMI attempt to quit multiple times in their lifetime, however they are often unsuccessful because they underutilize evidence-based smoking cessation treatment. Two studies suggest that motivational interviewing and education increases motivation to seek treatment for smoking cessation in this population. Interactive websites provide a way to educate and motivate a large number of individuals with minimal professional assistance. We tested the ability of a tailored website for smoking cessation to increase engagement in smoking cessation treatments among people with SMI. Methods: Participants were recruited through two separate treatment sites at a major mental health center in Chicago, IL. Both groups were provided smoking cessation pamphlets at baseline and one group used the website between the baseline and two-month interviews. A total of 41 participants with SMI were interviewed at baseline and two month follow-up for smoking characteristics and clinician-verified engagement behaviors. A participant's engagement into treatment was measured by an index, which included all of the following: 1) meeting with a smoking cessation counselor, 2) meeting with a doctor to discuss smoking cessation, 3) initiating a smoking cessation medication, 4) attending group treatment for smoking cessation, and 5) patient-initiated quit attempt. The main outcome was the sum of these motivation behaviors. Negative binomial regressions, controlling for baseline differences in diagnosis and attitude subscale scores, was used to evaluate the impact of the website. Results: Of the study participants, 29 (69.0%) were diagnosed with schizophrenia and 31 (73.8%) were diagnosed with a lifetime substance use disorder. On average, the group smoked 15.9 (SD = 10.1) cigarettes per day. At the two-month follow-up, and after controlling for baseline differences in mental illness diagnosis and substance abuse, significantly more individuals who used the website (14/22 or 70.0%) demonstrated smoking cessation motivation behaviors than those who did not use the website (7/22 or 35.0%; Chi-square=4.21, p=0.04). Similarly, those who used the website were more likely to have contact with a professional (Chi-square =3.78, p=0.05). Implications: This study suggests that computer programs can provide education and motivational exercises that increase motivation for evidence-based smoking cessation treatment. Interventions, like this website, provide an alternative engagement tool to valuable clinician time and may be a cost effective way to engage this high risk population into treatment.