Grant: Catalyst Grant: SPOR Innovative Clinical Trials (iCT)

Tobacco smoking contributes to an exceptionally high burden of disease and premature death, and current smoking cessation treatments are often inadequate. In those with co-occurring mental illness, rates of smoking are much higher and existing treatments are less effective. Recently, a new device-based treatment called repetitive transcranial magnetic stimulation (rTMS) has been developed to non-invasively stimulate areas of the brain involved in addiction. New research showing that rTMS is effective in helping people quit smoking and has resulted in regulatory approval from the FDA and Health Canada. However, studies of rTMS for smoking cessation have excluded people who have mental illness. We also do not know how rTMS compares to the other existing evidence-based treatments. Thus, we propose an innovative clinical trial comparing rTMS vs. treatment as usual as a smoking cessation treatment for people with co-occurring mental illness. We will also use methods from implementation science to assess reach, adoption, and feasibility of disseminating rTMS into mainstream clinical care. Patients from historically marginalized populations, such as people who are gender diverse, sexual minorities, Black, Indigenous, or people of colour, have higher rates of smoking and smoking-related harms. Therefore, we have developed a comprehensive plan to increase inclusion of these communities in the study design, recruitment diversity, and engagement with people with lived experience. This project will develop collaborations between clinical trialists, scientists, clinicians, marginalized communities, and patients to conduct future innovative trials in this field. By testing the effectiveness of rTMS in a real-world setting, focused on the patients who need it the most, while also studying ways to reduce implementation barriers, this project takes an ambitious and comprehensive approach to reducing the burden of smoking-related morbidity and mortality in Canada.