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Bennett ME, Medoff D, Cowan T, Fang L, Kacmarek C, Oikonomou MT, Calkins ME, Baker KK, Bencivengo D, Boumaiz Y, Buchanan RW, Campbell P, Chengappa KNR, Conroy CG, Cooke A, Dong F, Fauble M, Goldberg RW, Harvin A, Jumper MBE, Kauffman B, Kelly C, Kohler CG, Kreyenbuhl J, Li L, Lucksted A, Margolis RL, Marsteller JA, Moxam A, Namowicz D, Oko J, Riggs J, Saravana A, Sarpal DK, Scheinberg R, Smith WR, States R, Taylor J, Vatza C, Wolcott M, Dickerson F. Tobacco smoking and nicotine vaping in persons with first episode psychosis. Schizophr Res 2024; 267:141-149. [PMID: 38547716 PMCID: PMC11102839 DOI: 10.1016/j.schres.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 05/21/2024]
Abstract
Tobacco smoking is highly prevalent in persons with psychosis and is the leading cause of preventable mortality in this population. Less is known about tobacco smoking in persons with first episode psychosis (FEP) and there have been no estimates about the prevalence of nicotine vaping in FEP. This study reports rates of tobacco smoking and nicotine vaping in young people with FEP enrolled in Coordinated Specialty Care programs in Pennsylvania and Maryland. Using data collected from 2021 to 2023, we examined lifetime and recent smoking and vaping and compared smokers and vapers to nonusers on symptoms, functioning, and substance use. The sample included 445 participants aged 13-35 with recent psychosis onset. Assessments were collected by program staff. Overall, 28 % of participants engaged in either smoking or vaping within 30 days of the admission assessment. Smokers and vapers were disproportionately male, cannabis users, and had lower negative symptom severity than non-smokers. Vapers had higher role and social functioning. Both smoking and vaping were related to a longer time from psychosis onset to program enrollment. We compare these findings to previous studies and suggest steps for addressing smoking and vaping in this vulnerable population.
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Affiliation(s)
- Melanie E Bennett
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Deborah Medoff
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Tovah Cowan
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Lijuan Fang
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Corinne Kacmarek
- VA VISN5 Mental Illness Research, Education, and Clinical Center, Baltimore, MD, USA
| | - Maria Theodora Oikonomou
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Monica E Calkins
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Krista K Baker
- Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Donna Bencivengo
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Yasmine Boumaiz
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Robert W Buchanan
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Phillip Campbell
- Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - K N Roy Chengappa
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Catherine G Conroy
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Akinyi Cooke
- Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Fanghong Dong
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Mandy Fauble
- University of Pittsburgh Medical Center, Western Behavioral Health at Safe Harbor, Erie, PA, USA
| | - Richard W Goldberg
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Megan B E Jumper
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Belinda Kauffman
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - Christian G Kohler
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Julie Kreyenbuhl
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Lan Li
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Alicia Lucksted
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Russell L Margolis
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jill A Marsteller
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alex Moxam
- Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Jamie Oko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jessie Riggs
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Arunadevi Saravana
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Deepak K Sarpal
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; UPMC, Western Psychiatric Hospital, Pittsburgh, PA, USA
| | - Rachel Scheinberg
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - William R Smith
- Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Richard States
- University of Pittsburgh Medical Center, Western Behavioral Health at Safe Harbor, Erie, PA, USA
| | - Jerome Taylor
- Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Crystal Vatza
- Pennsylvania Early Intervention Center (PEIC)/HeadsUp, Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Max Wolcott
- Johns Hopkins Bayview Medical Center, Baltimore, MD, USA
| | - Faith Dickerson
- Department of Psychology, Sheppard Pratt, Baltimore, MD, USA
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Li S, Qu Z, Li Y, Ma X. Efficacy of e-health interventions for smoking cessation management in smokers: a systematic review and meta-analysis. EClinicalMedicine 2024; 68:102412. [PMID: 38273889 PMCID: PMC10809126 DOI: 10.1016/j.eclinm.2023.102412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Background Smoking is one of the major risk factors for shortened lifespan and disability, while smoking cessation is currently the only guaranteed method to reduce the harm caused by smoking. E-health is a field that utilizes information and communication technology to support the health status of its users. The emergence of this digital health approach has provided a new way of smoking cessation support for smokers seeking help, and an increasing number of researchers are attempting to use e-health for a wide range of effective smoking cessation interventions. We conducted a systematic review and meta-analysis of studies that used e-health as a smoking cessation support tool. Methods This systematic review and meta-analysis searched the PubMed, Embase, and Cochrane Library databases until December 2022. The included studies were randomized controlled trials (RCTs) comparing the use of e-health interventions and traditional offline smoking cessation care interventions. The primary outcome of the studies was the point smoking cessation rate (7-day and 30-day), and the secondary outcome was sustained smoking cessation rates. Studies were excluded if there was no clear e-health intervention described or if standard-compliant cessation outcomes were not clearly reported. Fixed-effects meta-analysis and meta-regression analyses were performed on the included study data to evaluate the effectiveness of the interventions. The meta-analysis outcome was the risk ratio (RR) and a 95% confidence interval. The study was registered with PROSPERO, CRD42023388667. Findings We collectively screened 2408 articles, and ultimately included 39 articles with a total of 17,351 eligible participants, of which 44 studies were included in the meta-analysis. The meta-analysis revealed that compared to traditional smoking cessation interventions, e-health interventions can increase point quit rates (RR 1.86, 95% CI 1.69-2.04) as well as sustained quit rates in the long-term (RR 1.79, 95% CI 1.60-2.00) among smokers. Subgroup analysis showed that text and telephone interventions in e-health significantly improved short-term quit rates for up to 7 days (RR 2.10, 95% CI 1.77-2.48). Website and app interventions also had a positive impact on improving short-term quit rates for up to 7 days (RR 1.74, 95% CI 1.56-1.94). The heterogeneity of the study results was low, demonstrating the significant smoking cessation advantages of e-health interventions. Interpretation We have found that personalized e-health interventions can effectively help smokers quit smoking. The diverse remote intervention methods of e-health can provide more convenient options for further customization. Additionally, further follow-up research is needed to evaluate the sustained effectiveness of interventions on smokers' continuous abstinence over a longer period (greater than one year). In the future, e-health can further optimize smoking cessation strategies. Funding No funding.
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Affiliation(s)
- Shen Li
- Department of Biotherapy, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
| | - Zhan Qu
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yiyang Li
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Xuelei Ma
- Department of Biotherapy, West China Hospital and State Key Laboratory of Biotherapy, Sichuan University, Chengdu, China
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Sawyer C, McKeon G, Hassan L, Onyweaka H, Martinez Agulleiro L, Guinart D, Torous J, Firth J. Digital health behaviour change interventions in severe mental illness: a systematic review. Psychol Med 2023; 53:6965-7005. [PMID: 37759417 PMCID: PMC10719689 DOI: 10.1017/s0033291723002064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/13/2023] [Accepted: 07/03/2023] [Indexed: 09/29/2023]
Abstract
The use of digital technologies as a method of delivering health behaviour change (HBC) interventions is rapidly increasing across the general population. However, the role in severe mental illness (SMI) remains overlooked. In this study, we aimed to systematically identify and evaluate all of the existing evidence around digital HBC interventions in people with an SMI. A systematic search of online electronic databases was conducted. Data on adherence, feasibility, and outcomes of studies on digital HBC interventions in SMI were extracted. Our combined search identified 2196 titles and abstracts, of which 1934 remained after removing duplicates. Full-text screening was performed for 107 articles, leaving 36 studies to be included. From these, 14 focused on physical activity and/or cardio-metabolic health, 19 focused on smoking cessation, and three concerned other health behaviours. The outcomes measured varied considerably across studies. Although over 90% of studies measuring behavioural changes reported positive changes in behaviour/attitudes, there were too few studies collecting data on mental health to determine effects on psychiatric outcomes. Digital HBC interventions are acceptable to people with an SMI, and could present a promising option for addressing behavioural health in these populations. Feedback indicated that additional human support may be useful for promoting adherence/engagement, and the content of such interventions may benefit from more tailoring to specific needs. While the literature does not yet allow for conclusions regarding efficacy for mental health, the available evidence to date does support their potential to change behaviour across various domains.
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Affiliation(s)
- Chelsea Sawyer
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - Grace McKeon
- School of Population Health, University of New South Wales, Randwick, NSW 2052, Australia
- Discipline of Psychiatry and Mental Health, University of New South Wales, Randwick, NSW 2052, Australia
| | - Lamiece Hassan
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
| | - Henry Onyweaka
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Psychiatry, Massachusetts General/Mclean Hospital, Boston, MA, USA
| | - Luis Martinez Agulleiro
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
| | - Daniel Guinart
- Hospital del Mar Research Institute, Institut de Salut Mental, Hospital del Mar, Barcelona, Spain
- Centro de Investigacion Biomedica en Red de Salud Mental (CIBERSAM), Spain
- Department of Psychiatry, the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, USA
| | - John Torous
- Department of Psychiatry, Institute for Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- Zucker School of Medicine at Northwell/Hofstra, New York, NY, USA
- Department of Psychiatry, Beth Israel Deaconess Hospital, Boston, MA, USA
| | - Joseph Firth
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9PL, UK
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Martinez Agulleiro L, Patil B, Firth J, Sawyer C, Amann BL, Fonseca F, Torrens M, Perez V, Castellanos FX, Kane JM, Guinart D. A systematic review of digital interventions for smoking cessation in patients with serious mental illness. Psychol Med 2023; 53:4856-4868. [PMID: 37161690 PMCID: PMC10476065 DOI: 10.1017/s003329172300123x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/06/2023] [Accepted: 04/12/2023] [Indexed: 05/11/2023]
Abstract
Tobacco smoking is highly prevalent among patients with serious mental illness (SMI), with known deleterious consequences. Smoking cessation is therefore a prioritary public health challenge in SMI. In recent years, several smoking cessation digital interventions have been developed for non-clinical populations. However, their impact in patients with SMI remains uncertain. We conducted a systematic review to describe and evaluate effectiveness, acceptability, adherence, usability and safety of digital interventions for smoking cessation in patients with SMI. PubMed/MEDLINE, EMBASE, CINAHL, Web of Science, PsychINFO and the Cochrane Tobacco Addiction Group Specialized Register were searched. Studies matching inclusion criteria were included and their information systematically extracted by independent investigators. Thirteen articles were included, which reported data on nine different digital interventions. Intervention theoretical approaches ranged from mobile contingency management to mindfulness. Outcome measures varied widely between studies. The highest abstinence rates were found for mSMART MIND (7-day point-prevalent abstinence: 16-40%). Let's Talk About Quitting Smoking reported greater acceptability ratings, although this was not evaluated with standardized measures. Regarding usability, Learn to Quit showed the highest System Usability Scale scores [mean (s.d.) 85.2 (15.5)]. Adverse events were rare and not systematically reported. Overall, the quality of the studies was fair to good. Digitally delivered health interventions for smoking cessation show promise for improving outcomes for patients with SMI, but lack of availability remains a concern. Larger trials with harmonized assessment measures are needed to generate more definitive evidence and specific recommendations.
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Affiliation(s)
- Luis Martinez Agulleiro
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
| | - Bhagyashree Patil
- Department of Psychiatry, Maimonides Medical Center, Brooklyn, NY, USA
| | - Joseph Firth
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, M13 9 PL
| | - Chelsea Sawyer
- Division of Psychology and Mental Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK, M13 9 PL
| | - Benedikt L. Amann
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Francina Fonseca
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Marta Torrens
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Universitat de Vic i Central de Catalunya, Vic, Spain
| | - Victor Perez
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Francisco Xavier Castellanos
- Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, NY, USA
- Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - John M. Kane
- Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
| | - Daniel Guinart
- Institute of Neuropsychiatry and Addictions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Madrid, Spain
- Department of Psychiatry Research, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Institute of Behavioral Science, Feinstein Institutes for Medical Research, Manhasset, NY, USA
- The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY, USA
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Monarque M, Sabetti J, Ferrari M. Digital interventions for substance use disorders in young people: rapid review. Subst Abuse Treat Prev Policy 2023; 18:13. [PMID: 36805783 PMCID: PMC9937742 DOI: 10.1186/s13011-023-00518-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 01/26/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Young people are disproportionately more likely than other age groups to use substances. The rise in substance use and related harms, including overdose, during the Covid-19 pandemic has created a critical need for more innovative and accessible substance use interventions. Digital interventions have shown effectiveness and can provide more engaging, less stigmatizing, and accessible interventions that meet the needs of young people. This review provides an overview of recent literature on the nature of recently published digital interventions for young people in terms of technologies used, substances targeted, intended outcomes and theoretical or therapeutic models employed. METHODS Rapid review methodology was used to identify and assess the literature on digital interventions for young people. An initial keyword search was conducted using MEDLINE the Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), Health Technology Assessment Database (HTA) and PROSPERO for the years 2015-2020, and later updated to December 2021. Following a title/abstract and full-text screening of articles, and consensus decision on study inclusion, the data extraction process proceeded using an extraction grid developed for the study. Data synthesis relied on an adapted conceptual framework by Stockings, et al. that involved a three-level treatment spectrum for youth substance use (prevention, early intervention, and treatment) for any type of substance. RESULTS In total, the review identified 43 articles describing 39 different digital interventions. Most were early interventions (n = 28), followed by prevention interventions (n = 6) and treatment interventions (n = 5). The identified digital technologies included web-based (n = 14), game-based (n = 10), mobile-based (n = 7), and computer-based (n = 5) technologies, and virtual reality (n = 3). Most interventions targeted alcohol use (n = 20) followed by tobacco/nicotine (n = 5), cannabis (n = 2), opioids (n = 2), ketamine (1) and multiple, or any substances (n = 9). Most interventions used a personalized or normative feedback approach and aimed to effect behaviour change as the intended outcome. Interestingly, a harm reduction approach guided only one of the 39 interventions. CONCLUSIONS While web-based interventions represented the most common type of technology, more recently developed immersive and interactive technologies such as virtual reality and game-based interventions call for further exploration. Digital interventions focused mainly on alcohol use, reflecting less concern for tobacco, cannabis, co-occurring substance use, and illicit drug use. Specifically, the recent exacerbation in the opioid crisis throughout North American underlines the urgent need for more prevention-oriented digital interventions for opioid use. The uptake of digital interventions among youth also depends on the incorporation of harm reduction approaches.
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Affiliation(s)
- Marika Monarque
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Judith Sabetti
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Manuela Ferrari
- Douglas Mental Health University Institute, Montreal, QC, Canada.
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
- Douglas Hospital Research Centre, 6875 Boulevard LaSalle, Perry C3 E-3102, QC H4H 1R3, Montreal, Canada.
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Lamontagne-Godwin FR, Henderson C, Lafarge C, Stock R, Barley EA. The effectiveness and design of informed choice tools for people with severe mental illness: a systematic review. J Ment Health 2023; 32:260-275. [PMID: 32772607 DOI: 10.1080/09638237.2020.1803232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND People with severe mental illness (SMI) report difficulty in making health-related decisions. Informed choice tools are designed to guide individuals through a decision-making process. AIMS To determine the effectiveness of these tools for people with SMI and to identify what methods and processes may contribute to effectiveness. METHOD A systematic electronic search was conducted for studies published between 1996 and January 2018. The search was updated in March 2020. Studies of any design reporting the development or evaluation of any informed choice tool for people with SMI were considered. A structured, narrative synthesis was conducted. RESULTS Ten articles describing four tools were identified. Tools were designed to assist with decision-making around bipolar treatment, smoking cessation and disclosure of mental illness in employment situations. Positive changes in decisional conflict, stage of change, knowledge and self-efficacy were reported for two tools, though insufficient data exists for definitive conclusions of effectiveness. Feedback from service users and attention to readability appeared key. CONCLUSIONS The evidence base for informed choice tools for people with SMI is limited. Such tools should be developed in stages and include the views of people with SMI at each phase; readability should be considered, and a theoretical framework should be used to facilitate process evaluation.
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Affiliation(s)
| | - Claire Henderson
- Health Service and Population Research Department, King's College London, London, UK
| | - Caroline Lafarge
- School of Human and Social Sciences, University of West London, London, UK
| | - Rosemary Stock
- School of Human and Social Sciences, University of West London, London, UK
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7
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Huddlestone L, Shoesmith E, Pervin J, Lorencatto F, Watson J, Ratschen E. A systematic review of mental health professionals, patients and carers' perceived barriers and enablers to supporting smoking cessation in mental health settings. Nicotine Tob Res 2022; 24:945-954. [PMID: 35018458 PMCID: PMC9199941 DOI: 10.1093/ntr/ntac004] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 10/20/2021] [Accepted: 01/05/2022] [Indexed: 11/13/2022]
Abstract
Introduction Evidence-based smoking cessation and temporary abstinence interventions to address smoking in mental health settings are available, but the impact of these interventions is limited. Aims and Methods We aimed to identify and synthesize the perceived barriers and enablers to supporting smoking cessation in mental health settings. Six databases were searched for articles reporting the investigation of perceived barriers and enablers to supporting smoking cessation in mental health settings. Data were extracted and coded using a mixed inductive/deductive method to the theoretical domains framework, key barriers and enablers were identified through the combining of coding frequency, elaboration, and expressed importance. Results Of 31 included articles, 56 barriers/enablers were reported from the perspectives of mental healthcare professionals (MHPs), 48 from patient perspectives, 21 from mixed perspectives, and 0 from relatives/carers. Barriers to supporting smoking cessation or temporary abstinence in mental health settings mainly fell within the domains: environmental context and resources (eg, MHPs lack of time); knowledge (eg, interactions around smoking that did occur were ill informed); social influences (eg, smoking norms within social network); and intentions (eg, MHPs lack positive intentions to deliver support). Enablers mainly fell within the domains: environmental context and resources (eg, use of appropriate support materials) and social influences (eg, pro-quitting social norms). Conclusions The importance of overcoming competing demands on staff time and resources, the inclusion of tailored, personalized support, the exploitation of patients wider social support networks, and enhancing knowledge and awareness around the benefits smoking cessation is highlighted. Implications Identified barriers and enablers represent targets for future interventions to improve the support of smoking cessation in mental health settings. Future research needs to examine the perceptions of the carers and family/friends of patients in relation to the smoking behavior change support delivered to patients.
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Affiliation(s)
| | | | - Jodi Pervin
- Department of Health Sciences, University of York, York
| | | | - Jude Watson
- Department of Health Sciences, University of York, York
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Onyeaka H, Firth J, Kessler RC, Lovell K, Torous J. Use of smartphones, mobile apps and wearables for health promotion by people with anxiety or depression: An analysis of a nationally representative survey data. Psychiatry Res 2021; 304:114120. [PMID: 34303946 DOI: 10.1016/j.psychres.2021.114120] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 07/06/2021] [Accepted: 07/13/2021] [Indexed: 12/14/2022]
Abstract
People with mental illness have increased cardiovascular risk factors, which contributes significantly to mortality in this population. Digital interventions have emerged as promising models to promote physical health, although their potential for use in mental health populations is relatively unexplored. We examined the potential for using digital tools for health promotion by people with common mental disorders like anxiety or depression. Using data from the 2019 edition of the Health Information National Trends Survey (HINTS 5), we evaluated differences between individuals with self-reported history of diagnosed depression/anxiety and the general population with respect to ownership, usage, and perceived usefulness of digital tools for managing their health. Overall, individuals with anxiety or depression were as likely as the general population to use digital devices for their care. Those with anxiety or depression who had health apps were more likely to report intentions to lose weight than those without health apps. Significant sociodemographic predictors of digital tools usage included gender, age, income, and education level. People with anxiety or depression own and use digital health tools at similarly high rates to the general population, suggesting that these tools present a novel opportunity for health promotion among people with these disorders.
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Affiliation(s)
- Henry Onyeaka
- Department of Psychiatry, Massachusetts General Hospital/McLean Hospital, Harvard Medical School, Boston, MA, United States
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom; NICM Health Research Institute, Western Sydney University, Westmead, Australia; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Ronald C Kessler
- Department of HealthCare Policy, Harvard Medical School, Boston, United States
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - John Torous
- Department of Psychiatry, Beth Israeli Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.
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9
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Gowarty MA, Longacre MR, Vilardaga R, Kung NJ, Gaughan-Maher AE, Brunette MF. Usability and Acceptability of Two Smartphone Apps for Smoking Cessation Among Young Adults With Serious Mental Illness: Mixed Methods Study. JMIR Ment Health 2021; 8:e26873. [PMID: 34255699 PMCID: PMC8295834 DOI: 10.2196/26873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/25/2021] [Accepted: 03/29/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Young adults with serious mental illness (SMI) have higher smoking rates and lower cessation rates than young adults without SMI. Scalable interventions such as smartphone apps with evidence-based content (eg, the National Cancer Institute's [NCI's] QuitGuide and quitSTART) could increase access to potentially appealing and effective treatment for this group but have yet to be tested in this population. OBJECTIVE The goal of this user-centered design study is to determine the user experience (including usability and acceptability) of 2 widely available apps developed by the NCI-QuitGuide and quitSTART-among young adult tobacco users with SMI. METHODS We conducted usability and acceptability testing of QuitGuide and quitSTART among participants with SMI aged between 18 and 35 years who were stable in community mental health treatment between 2019 and 2020. Participants were randomly assigned to use QuitGuide or quitSTART on their smartphones. App usability was evaluated at baseline and following a 2-week field test of independent use via a video-recorded task completion protocol. Using a mixed method approach, we triangulated 4 data sources: nonparticipant observation, open-ended interviews, structured interviews (including the System Usability Scale [SUS]), and backend app use data obtained from the NCI. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using thematic analysis. RESULTS Participants were 17 smokers who were not interested in quitting, with a mean age of 29 (SD 4) years; 41% (n=7) presented with psychotic disorders. Participants smoked an average of 15 (SD 7) cigarettes per day. The mean SUS scores for QuitGuide were similar at visits one and two (mean 64, SD 18 and mean 66, SD 18, respectively). The mean SUS scores for quitSTART numerically increased from visit one (mean 55, SD 20) to visit two (mean 64, SD 16). Acceptability scores followed the same pattern. Observed task completion rates were at least 75% (7/9 for QuitGuide, 6/8 for quitSTART) for both apps at both visits for all but 2 tasks. During the 13-day trial period, QuitGuide and quitSTART users interacted with their assigned app on an average of 4.6 (SD 2.8) days versus 10.8 (SD 3.5) days, for a mean total of 5.6 (SD 3.8) interactions versus 41 (SD 26) interactions, and responded to a median of 1 notification (range 0-8) versus 18.5 notifications (range 0-37), respectively. Qualitative comments indicated moderate to high satisfaction overall but also included concerns about the accuracy of the apps' feedback. CONCLUSIONS Both QuitGuide and quitSTART had acceptable levels of usability and mixed levels of acceptability among young adults with SMI. The higher level of engagement with quitSTART suggests that quitSTART may be a favorable tool for young adult smokers with SMI. However, clinical support or coaching may be needed to overcome initial usability issues.
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Affiliation(s)
- Minda A Gowarty
- Departments of Internal Medicine and Community and Family Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States.,Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Meghan R Longacre
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Nathan J Kung
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Ashley E Gaughan-Maher
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Mary F Brunette
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
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10
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Gowarty MA, Kung NJ, Maher AE, Longacre MR, Brunette MF. Perceptions of Mobile Apps for Smoking Cessation Among Young People in Community Mental Health Care: Qualitative Study. JMIR Form Res 2020; 4:e19860. [PMID: 33006560 PMCID: PMC7568217 DOI: 10.2196/19860] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/14/2020] [Accepted: 08/17/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Young adults with serious mental illness are over twice as likely to have tobacco use disorder than those in the general population and are less likely to utilize proven treatment methods during quit attempts. However, little research has evaluated the efficacy of interventions for this group. Smartphone apps may be an underutilized tool for tobacco use disorder among young adults with serious mental illness. OBJECTIVE The aim of this study was to explore attitudes toward smoking cessation apps and preferences regarding app design in young adult smokers with serious mental illness. METHODS Five focus groups involving 25- to 35-year-old adults with serious mental illness receiving treatment at a community mental health center were conducted between May 2019 and August 2019. Three researchers independently coded transcripts and identified themes using thematic analysis. RESULTS Participants (n=22) were individuals who smoke daily: 10 (46%) self-identified as female, 18 (82%) self-identified as White, and 9 (41%) had psychotic disorders. Key themes that emerged included a general interest in using health apps; a desire for apps to provide ongoing motivation during a quit attempt via social support, progress tracking, and rewards; a desire for apps to provide distraction from smoking; concerns about app effectiveness due to a lack of external accountability; and concerns that apps could trigger cravings or smoking behavior by mentioning cigarettes or the act of smoking. CONCLUSIONS Apps have the potential to support smoking cessation or reduction efforts among young adults with serious mental illness. However, they may require tailoring, optimization, and clinical support to effectively promote cessation in this population.
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Affiliation(s)
- Minda A Gowarty
- Departments of Internal Medicine and Community and Family Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States.,Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Nathan J Kung
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Ashley E Maher
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Meghan R Longacre
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Mary F Brunette
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
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11
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Vilardaga R, Rizo J, Ries RK, Kientz JA, Ziedonis DM, Hernandez K, McClernon FJ. Formative, multimethod case studies of learn to quit, an acceptance and commitment therapy smoking cessation app designed for people with serious mental illness. Transl Behav Med 2020; 9:1076-1086. [PMID: 30445507 DOI: 10.1093/tbm/iby097] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Despite public health efforts, individuals with serious mental illness (SMI) still have very high rates of tobacco smoking. Innovative approaches to reach this population are needed. These series of case studies aimed to descriptively evaluate the usability, user experience (UX), and user engagement (UE) of Learn to Quit (LTQ), an acceptance and commitment therapy smoking cessation app designed for people with SMI, and to compare it with an app designed for the general population, NCI (National Cancer Institute) QuitGuide (QG). Both apps were combined with nicotine replacement therapy and technical coaching. Inspired by the ORBIT model, we implemented two case studies with crossover AB interventions, two B-phase training designs, and three bi-phasic AB single-case designs with Start-Point and Order randomization (A = QG, B = LTQ). Study outcomes were measured using the System Usability Scale, UX interviews, and background analytics. LTQ's usability levels were above the standard cutoff and on average higher than QG. UX outcomes suggested the relative benefits of LTQ's visual design, gamification and simple design structure. LTQ's overall UE was high; the app was opened for an average of 14 min per day (vs. QG: 7 min). However, users showed low levels of UE with each of the app's tracking feature. Measures of psychiatric functioning suggested the safety of LTQ in people with SMI. LTQ appears to be a usable and engaging smoking cessation app in people with SMI. An optimized version of LTQ should be tested in a Phase II study.
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Affiliation(s)
- Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Javier Rizo
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Richard K Ries
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Julie A Kientz
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Douglas M Ziedonis
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
| | - Kayla Hernandez
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
| | - Francis J McClernon
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA
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12
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Supportive and palliative care for people with respiratory problems and preexisting serious mental illness. Curr Opin Support Palliat Care 2020; 14:190-196. [PMID: 32701857 DOI: 10.1097/spc.0000000000000510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW People living with serious mental illness are at a higher risk of developing respiratory problems that can lead to increased morbidity and early mortality. This review aimed to identify recent advances in care provision for people with respiratory problems and preexisting serious mental illness to ease symptom burden and reduce the risk of premature mortality. RECENT FINDINGS Intervention-based studies in this area are scarce. The evidence reviewed originated from observational studies. Concluding comments from the synthesis suggest there are specific needs for proactive screening of respiratory function as part of routine physical health checks across care settings for people living with serious mental illness, more stringent monitoring of comorbid chronic lung conditions and increased attention in reducing the frequency respiratory infections. Integrated services across care settings are needed to support people with serious mental illness to limit the impact of modifiable lifestyle factors known to be detrimental to respiratory health, such as smoking. SUMMARY Key priorities are identified to improve accessibility and inclusivity of respiratory care pathways for people living with serious mental illness to support early detection and proactive monitoring of respiratory problems to help reduce the risk of early mortality.
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13
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Villanti AC, West JC, Klemperer EM, Graham AL, Mays D, Mermelstein RJ, Higgins ST. Smoking-Cessation Interventions for U.S. Young Adults: Updated Systematic Review. Am J Prev Med 2020; 59:123-136. [PMID: 32418800 PMCID: PMC7453837 DOI: 10.1016/j.amepre.2020.01.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 01/15/2023]
Abstract
CONTEXT Recent data suggest that the onset of cigarette smoking is now more likely during young adulthood than adolescence. Additionally, the landscape of delivering smoking-cessation interventions has changed in the past decade, with the emergence of mobile phone and web-based approaches. The objective of this study is to update a 2010 systematic review of smoking-cessation interventions for U.S. young adults (aged 18-24 years). EVIDENCE ACQUISITION Electronic searches were conducted in CINAHL, the Cochrane Library, Embase, PsycINFO, PubMed, Scopus, and Sociological Abstracts to identify eligible interventions from August 31, 2009 through July 17, 2019. Two independent coders critically evaluated the methodology and findings of all retrieved articles. Data analysis was conducted in 2019. EVIDENCE SYNTHESIS A total of 17 RCTs and 1 nonrandomized study were added to the original 14 studies meeting the inclusion criteria for this review; these studies varied with respect to sample size, intervention, assessed outcomes, and smoking measures. Of the new studies, 3 increased cessation in the short term, 2 at 6 months, and 1 had short-term effects on cigarette reduction. Pooled analyses supported the use of interventions employing social cognitive theory, quitline counseling, and text message programs for short-term cessation in young adults. CONCLUSIONS Of 32 included studies, 9 demonstrated efficacy of smoking cessation or reduction in U.S. young adults. There were no eligible pharmacologic interventions included in this review. Findings support the promise of 3 approaches for young adult cessation not included in the prior review: text message interventions, sustained quit-and-win contests, and multiple behavior interventions.
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Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, Vermont.
| | - Julia C West
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, Vermont
| | - Elias M Klemperer
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, Vermont
| | - Amanda L Graham
- Innovations, Truth Initiative, Washington, District of Columbia; Department of Oncology, Georgetown University Medical Center, Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Darren Mays
- Department of Oncology, Georgetown University Medical Center, Cancer Prevention & Control Program, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Robin J Mermelstein
- Department of Psychology and Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, Vermont
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14
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Lo B, Shi J, Hollenberg E, Abi-Jaoudé A, Johnson A, Wiljer D. Surveying the Role of Analytics in Evaluating Digital Mental Health Interventions for Transition-Aged Youth: Scoping Review. JMIR Ment Health 2020; 7:e15942. [PMID: 32348261 PMCID: PMC7381002 DOI: 10.2196/15942] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 11/20/2019] [Accepted: 02/10/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Consumer-facing digital health interventions provide a promising avenue to bridge gaps in mental health care delivery. To evaluate these interventions, understanding how the target population uses a solution is critical to the overall validity and reliability of the evaluation. As a result, usage data (analytics) can provide a proxy for evaluating the engagement of a solution. However, there is paucity of guidance on how usage data or analytics should be used to assess and evaluate digital mental health interventions. OBJECTIVE This review aimed to examine how usage data are collected and analyzed in evaluations of mental health mobile apps for transition-aged youth (15-29 years). METHODS A scoping review was conducted using the Arksey and O'Malley framework. A systematic search was conducted on 5 journal databases using keywords related to usage and engagement, mental health apps, and evaluation. A total of 1784 papers from 2008 to 2019 were identified and screened to ensure that they included analytics and evaluated a mental health app for transition-aged youth. After full-text screening, 49 papers were included in the analysis. RESULTS Of the 49 papers included in the analysis, 40 unique digital mental health innovations were evaluated, and about 80% (39/49) of the papers were published over the past 6 years. About 80% involved a randomized controlled trial and evaluated apps with information delivery features. There were heterogeneous findings in the concept that analytics was ascribed to, with the top 3 being engagement, adherence, and acceptability. There was also a significant spread in the number of metrics collected by each study, with 35% (17/49) of the papers collecting only 1 metric and 29% (14/49) collecting 4 or more analytic metrics. The number of modules completed, the session duration, and the number of log ins were the most common usage metrics collected. CONCLUSIONS This review of current literature identified significant variability and heterogeneity in using analytics to evaluate digital mental health interventions for transition-aged youth. The large proportion of publications from the last 6 years suggests that user analytics is increasingly being integrated into the evaluation of these apps. Numerous gaps related to selecting appropriate and relevant metrics and defining successful or high levels of engagement have been identified for future exploration. Although long-term use or adoption is an important precursor to realizing the expected benefits of an app, few studies have examined this issue. Researchers would benefit from clarification and guidance on how to measure and analyze app usage in terms of evaluating digital mental health interventions for transition-aged youth. Given the established role of adoption in the success of health information technologies, understanding how to abstract and analyze user adoption for consumer digital mental health apps is also an emerging priority.
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Affiliation(s)
- Brian Lo
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Information Management Group, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jenny Shi
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Elisa Hollenberg
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Alexxa Abi-Jaoudé
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Andrew Johnson
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - David Wiljer
- Office of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Education, Technology and Innovation, University Health Network, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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15
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Budney AJ, Marsch LA, Aklin WM, Borodovsky JT, Brunette MF, Campbell AT, Dallery J, Kotz D, Knapp AA, Lord SE, Nunes EV, Scherer EA, Stanger C, Torrey WC. Workshop on the Development and Evaluation of Digital Therapeutics for Health Behavior Change: Science, Methods, and Projects. JMIR Ment Health 2020; 7:e16751. [PMID: 32130155 PMCID: PMC7066510 DOI: 10.2196/16751] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/11/2019] [Accepted: 12/15/2019] [Indexed: 12/22/2022] Open
Abstract
The health care field has integrated advances into digital technology at an accelerating pace to improve health behavior, health care delivery, and cost-effectiveness of care. The realm of behavioral science has embraced this evolution of digital health, allowing for an exciting roadmap for advancing care by addressing the many challenges to the field via technological innovations. Digital therapeutics offer the potential to extend the reach of effective interventions at reduced cost and patient burden and to increase the potency of existing interventions. Intervention models have included the use of digital tools as supplements to standard care models, as tools that can replace a portion of treatment as usual, or as stand-alone tools accessed outside of care settings or direct to the consumer. To advance the potential public health impact of this promising line of research, multiple areas warrant further development and investigation. The Center for Technology and Behavioral Health (CTBH), a P30 Center of Excellence supported by the National Institute on Drug Abuse at the National Institutes of Health, is an interdisciplinary research center at Dartmouth College focused on the goal of harnessing existing and emerging technologies to effectively develop and deliver evidence-based interventions for substance use and co-occurring disorders. The CTBH launched a series of workshops to encourage and expand multidisciplinary collaborations among Dartmouth scientists and international CTBH affiliates engaged in research related to digital technology and behavioral health (eg, addiction science, behavioral health intervention, technology development, computer science and engineering, digital security, health economics, and implementation science). This paper summarizes a workshop conducted on the Development and Evaluation of Digital Therapeutics for Behavior Change, which addressed (1) principles of behavior change, (2) methods of identifying and testing the underlying mechanisms of behavior change, (3) conceptual frameworks for optimizing applications for mental health and addictive behavior, and (4) the diversity of experimental methods and designs that are essential to the successful development and testing of digital therapeutics. Examples were presented of ongoing CTBH projects focused on identifying and improving the measurement of health behavior change mechanisms and the development and evaluation of digital therapeutics. In summary, the workshop showcased the myriad research targets that will be instrumental in promoting and accelerating progress in the field of digital health and health behavior change and illustrated how the CTBH provides a model of multidisciplinary leadership and collaboration that can facilitate innovative, science-based efforts to address the health behavior challenges afflicting our communities.
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Affiliation(s)
- Alan J Budney
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Will M Aklin
- Clinical Research Grants Branch, National Institute on Drug Abuse, National Institutes of Health, Rockville, MD, United States
| | - Jacob T Borodovsky
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, United States
| | - Mary F Brunette
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Andrew T Campbell
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Jesse Dallery
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychology, University of Florida, Gainesville, FL, United States
| | - David Kotz
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Ashley A Knapp
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Sarah E Lord
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Edward V Nunes
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University, New York, NY, United States
| | - Emily A Scherer
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Biomedical Data Science, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - William C Torrey
- Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
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16
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Brunette MF, Ferron JC, McGurk SR, Williams JM, Harrington A, Devitt T, Xie H. Brief, Web-Based Interventions to Motivate Smokers With Schizophrenia: Randomized Trial. JMIR Ment Health 2020; 7:e16524. [PMID: 32039811 PMCID: PMC7055792 DOI: 10.2196/16524] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/02/2019] [Accepted: 12/05/2019] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND In-person motivational interventions increase engagement with evidence-based cessation treatments among smokers with schizophrenia, but access to such interventions can be limited because of workforce shortages and competing demands in mental health clinics. The use of digital technology to deliver interventions can increase access, but cognitive impairments in schizophrenia may impede the use of standard digital interventions. We developed an interactive, multimedia, digital motivational decision support system for smokers with schizophrenia (Let's Talk About Smoking). We also digitalized a standard educational pamphlet from the National Cancer Institute (NCI Education). Both were tailored to reduce cognitive load during use. OBJECTIVE We conducted a randomized trial of Let's Talk About Smoking versus NCI Education to test whether the interactive motivational intervention was more effective and more appealing than the static educational intervention for increasing use of smoking cessation treatment, quit attempts, and abstinence among smokers with schizophrenia, accounting for the level of cognitive functioning. METHODS Adult smokers with schizophrenia (n=162) were enrolled in the study from 2014 to 2015, randomly assigned to intervention condition, and assessed in person at 3- and 6-month follow-ups. Interventions were delivered on a laptop computer in a single session. All participants had access to standard, community-delivered cessation treatments during follow-up. Multivariate models were used to evaluate outcomes. RESULTS Treatment initiation outcomes were not different between intervention conditions (27/84 [32%] for Let's Talk About Smoking vs 36/78 [46%] for NCI Education; odds ratio [OR] 0.71 [95% CI 0.37-1.33]); 38.9% (63/162) of participants initiated treatment. Older age (OR 1.03 [95% CI 1.00-1.07]; P=.05), higher education (OR 1.21 [95% CI 1.04-1.41]; P=.03), and fewer positive symptoms (OR 0.87 [95% CI 0.80-0.96]; P=.01) predicted cessation treatment initiation, whereas level of cognition did not. The mean satisfaction and usability index score was higher for Let's Talk About Smoking versus NCI Education (8.9 [SD 1.3] vs 8.3 [SD 2.1]; t120.7=2.0; P=.045). Quit attempts (25/84, 30% vs 36/78, 46%; estimate [Est]=-0.093, SE 0.48; P=.85) and abstinence (1/84, 1% vs 6/78, 7%; χ21=3.4; P=.07) were not significantly different between intervention conditions. Cognitive functioning at baseline (Est=1.47, SE 0.47; P=.002) and use of any behavioral or medication cessation treatment (Est=1.43, SE 0.47; P=.003) predicted quit attempts with self-reported abstinence over the 6-month follow-up. CONCLUSIONS The interactive, multimedia intervention was not more effective than the static, text-based intervention among smokers with schizophrenia. Both tailored digital interventions resulted in levels of treatment engagement and quit attempts that were similar to findings from previous studies of in-person interventions, confirming the potential role of digital interventions to educate and motivate smokers with schizophrenia to use cessation treatment and to quit smoking. These findings indicate that additional cessation treatment is needed after brief education or motivational interventions, and that cessation treatment should be adjusted for people with cognitive impairment. TRIAL REGISTRATION ClinicalTrials.gov NCT02086162; https://clinicaltrials.gov/show/NCT02086162.
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Affiliation(s)
- Mary F Brunette
- Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock, Concord, NH, United States
- Dartmouth-Hitchcock, Concord, NH, United States
| | | | | | | | - Amy Harrington
- University of Massachusetts, Worcester, MA, United States
| | | | - Haiyi Xie
- Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock, Concord, NH, United States
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17
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Brunette MF, Ferron JC, Geiger P, Villanti AC. Menthol cigarette use in young adult smokers with severe mental illnesses. Nicotine Tob Res 2019; 21:691-694. [PMID: 29660059 DOI: 10.1093/ntr/nty064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 04/10/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Smokers with severe mental illness (SMI) are more likely to start smoking and less likely to quit. Menthol may facilitate smoking progression, dependence, and maintenance by reducing harshness and irritation from smoking and providing a unique sensory experience during use. High rates of menthol use have been reported in smokers with SMI, but information on young adults with SMI has not been reported. METHODS This study provides a secondary analysis to assess the impact of menthol use in a pilot trial of brief tobacco interventions. Participants were assessed at baseline and again at a 3-month follow-up with structured interviews and breath carbon monoxide to confirm self-reported 7-day abstinence at follow-up. RESULTS Participants included 81 young adult smokers with SMI, mean age of 24.2 years (SD = 3.6; range 18-30). Overall, 58% of the group reported that they recently used a menthol-flavored product. Menthol use was correlated with race (African American [18/21, 85.7%] vs. White [24/53, 45.3%] or other race [5/7, 71.4%]; χ2 = 10.7, p = .005) and more lifetime psychiatric hospitalizations (t = 2.39, p = .02), but not with cigarettes per day, nicotine dependence, quit attempts over the follow-up period, nor with achieving biologically confirmed abstinence at the follow-up assessment. CONCLUSIONS The high prevalence of menthol-flavored cigarette use in this study group is consistent with previous reports of high rates of menthol use among young adults, Blacks, and middle-aged SMI smokers. This study supports existing evidence that policies to restrict menthol flavoring in combustible tobacco products could reduce smoking in young adults with SMI. IMPLICATIONS High rates of menthol use have been reported in middle-aged smokers with SMI, but information on young adults with SMI has not been reported. In this study, more than half (58%) of 81 young adult smokers with SMI used a menthol-flavored product. Menthol use was associated with race and with history of psychiatric hospitalizations. The research supports existing evidence that policies to restrict menthol flavoring in combustible tobacco products could reduce smoking in young adults with SMI.
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Affiliation(s)
- Mary F Brunette
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Joelle C Ferron
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Pamela Geiger
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, VT
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Naslund JA, Aschbrenner KA. Digital technology for health promotion: opportunities to address excess mortality in persons living with severe mental disorders. EVIDENCE-BASED MENTAL HEALTH 2019; 22:17-22. [PMID: 30559332 PMCID: PMC6359972 DOI: 10.1136/ebmental-2018-300034] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/31/2018] [Accepted: 11/21/2018] [Indexed: 12/24/2022]
Abstract
Persons with severe mental disorders (SMDs) experience dramatically reduced life expectancy compared with the general population. We consider the role of digital technologies for addressing this serious public health concern. In this clinical review, we apply the multilevel risk model recently introduced by the WHO to conceptualise how digital technology can support efforts to reduce excess mortality risk at the individual, health system and social determinants of health levels. In particular, digital technologies show promise for targeting preventable physical health conditions in persons with SMDs. However, evidence on the use of these technologies for addressing early mortality risk factors is lacking. At the individual level, digital interventions show promise for managing mental health symptoms, promoting healthy lifestyle behaviours and targeting substance use concerns. At the health system level, digital interventions can support care coordination, clinician training, screening and monitoring health indices and shared decision-making. At the social determinants of health level, digital interventions can facilitate opportunities to engage peers for illness self-management and health promotion and for delivering and/or augmenting supported employment programmes. The time is ripe to capitalise on early evidence to support future development, testing and delivery of effective digital efforts targeting risk factors that contribute to shorter life expectancy in persons with SMDs. Key challenges and opportunities for future research include increasing user engagement, involving users during development and testing of digital interventions, carefully considering risks/harms and rigorously evaluating effectiveness and costs to support the scalability and sustainability of promising digital approaches.
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Affiliation(s)
- John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Kelly A Aschbrenner
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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19
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Hughes JR. The Diversity of Nicotine and Tobacco Research. Nicotine Tob Res 2018; 20:1161-1162. [PMID: 29878240 DOI: 10.1093/ntr/nty100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/14/2018] [Indexed: 11/12/2022]
Affiliation(s)
- John R Hughes
- Department of Psychiatry, Vermont Center on Behavior and Health, Burlington, VT
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