Center on Psychiatric Disability and Co-Occurring Medical Conditions

Research Projects /
Randomized Controlled Trial of an Electronic Decision Support System for Individuals with Serious Mental Illness

The purpose of this research project led by Dr. Mary Brunette of Dartmouth College is to conduct a randomized controlled trial study of the efficacy of a motivational intervention for smoking cessation for people in mental health recovery. While up to 80% of Americans with psychiatric disabilities smoke cigarettes, they seldom initiate evidence-based smoking cessation treatment, despite having an interest in quitting.

Researchers at Dartmouth Psychiatric Research Center have collaborated with Thresholds Psychiatric Rehabilitation Centers in Chicago to create an easy-to-use, web-based, motivational electronic decision support system (EDSS) tailored for smokers in recovery. The EDSS includes individualized feedback about lung damage due to smoking from a breath carbon monoxide monitor, which measures the amount of toxic particles in a person’s breath. This feedback is thought to motivate the user by personalizing the health risks of smoking.  But the carbon monoxide monitor is an expensive machine that is not commonly available in community mental health settings, which acts as a barrier to broad implementation. For this reason, the project will assess whether the EDSS is effective without carbon monoxide monitor feedback.

The study involves 120 smokers who are clients at Thresholds. They are being randomly assigned with their consent to use the EDSS with the carbon monoxide monitor or to use the version without the monitor. Participants are assessed at study baseline and again two months later. The main study outcome is initiation of evidence-based smoking cessation treatments which consist of group interventions and/or smoking cessation medications.

All study participants receive a research stipend for using the EDSS and completing the data collection interviews. Analyses will assess whether users of the system with the carbon monoxide monitor are more likely to initiate smoking cessation treatments than users of the EDSS without the carbon monoxide monitor. Evidence-based treatment is being made available to all research participants free of charge through the project.



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