• Total number of videogame sessions attended [ Time Frame: 12-weeks ]
  Feasibility will be measured with a total count of sessions attended. The graduate student researcher (GSR) will document participant attendance.
• Total minutes of videogame sessions attended [ Time Frame: 12-weeks ]
  Feasibility will be measured with a sum of minutes attended. The GSR will monitor and document the times when participants enter and leave the sessions.
• Week-6 Self-report acceptability rankings of the videogames [ Time Frame: administered at week 6 ]
  This internally developed acceptability questionnaire has 7 questions. Three questions use a 1 to 5 scale with 1 indicating least acceptable and 5 indicating most acceptable, for a possible total range of 3-15. The remaining open-ended questions are scored using qualitative thematic analysis.
• Week-12 Self-report acceptability rankings of the videogames -week 12 [ Time Frame: administered at week 12. ]
  This internally developed acceptability questionnaire has 7 questions. Three questions use a 1 to 5 scale with 1 indicating least acceptable and 5 indicating most acceptable, for a possible total range of 3-15. The remaining open-ended questions are scored using qualitative thematic analysis. Used to measure change from week-6 to week-12.
• Tobacco reduction and abstinence [ Time Frame: administered at week 6. ]
  The investigators will ask about the number of cigarettes, even a puff, smoked in the past week (7-day abstinence) or use of any form of tobacco or alternative tobacco product e.g., e-cigarette or heat not burn. Salivary cotinine levels will be measured to determine abstinence from smoking.
• Tobacco reduction and abstinence [ Time Frame: administered at week 12. ]
  The investigators will ask about the number of cigarettes, even a puff, smoked in the past week (7-day abstinence) or use of any form of tobacco or alternative tobacco product e.g., e-cigarette or heat not burn. Salivary cotinine levels will be measured to determine abstinence from smoking.
• Baseline Brief Psychiatric Rating Scale (BPRS) [ Time Frame: Baseline interview with the participant and observations of the participant's behavior over the previous 2-3 days. ]
  The Semi-Structured Interview for Brief Psychiatric Rating Scale is completed by the PI or trained research staff and assesses the number and severity of psychiatric symptoms. It consists of 24 items that are rated from 1 (not present) to 7 (extremely severe), and the items are summed for a total psychopathology score, with a possible range from 24-168 and a higher score indicating a higher severity of illness. The score will be used to measure change between the baseline, 6-week, and 12-week time points.
• Week-6 Brief Psychiatric Rating Scale (BPRS) [ Time Frame: interview at week-6 with the participant and observations of the participant's behavior over the previous 2-3 days. ]
  The Semi-Structured Interview for Brief Psychiatric Rating Scale is completed by the PI or trained research staff and assesses the number and severity of psychiatric symptoms. It consists of 24 items that are rated from 1 (not present) to 7 (extremely severe), and the items are summed for a total psychopathology score, with a possible range from 24-168 and a higher score indicating a higher severity of illness. The score will be used to measure change between the baseline, 6-week, and 12-week time points.
• Week-12 Brief Psychiatric Rating Scale (BPRS) [ Time Frame: interview at week-12 with the participant and observations of the participant's behavior over the previous 2-3 days. ]
  The Semi-Structured Interview for Brief Psychiatric Rating Scale is completed by the PI or trained research staff and assesses the number and severity of psychiatric symptoms. It consists of 24 items that are rated from 1 (not present) to 7 (extremely severe), and the items are summed for a total psychopathology score, with a possible range from 24-168 and a higher score indicating a higher severity of illness. The score will be used to measure change between the baseline, 6-week, and 12-week time points.

• Total number of videogame sessions attended [ Time Frame: 12-weeks ]
  Feasibility will be measured with a total count of sessions attended. The GSR will document participant attendance.
• Total minutes of videogame sessions attended [ Time Frame: 12-weeks ]
  Feasibility will be measured with a sum of minutes attended. The GSR will monitor and document the times when participants enter and leave the sessions.
• Week-6 Self-report acceptability rankings of the videogames [ Time Frame: administered at week 6 ]
  This internally developed acceptability questionnaire has 7 questions. Three questions use a 1 to 5 scale with 1 indicating least acceptable and 5 indicating most acceptable, for a possible total range of 3-15. The remaining open-ended questions are scored using qualitative thematic analysis.
• Week-12 Self-report acceptability rankings of the videogames -week 12 [ Time Frame: administered at week 12. ]
  This internally developed acceptability questionnaire has 7 questions. Three questions use a 1 to 5 scale with 1 indicating least acceptable and 5 indicating most acceptable, for a possible total range of 3-15. The remaining open-ended questions are scored using qualitative thematic analysis. Used to measure change from week-6 to week-12.
• Tobacco reduction and abstinence [ Time Frame: administered at week 6. ]
  The investigators will ask about the number of cigarettes, even a puff, smoked in the past week (7-day abstinence) or use of any form of tobacco or alternative tobacco product e.g., e-cigarette or heat not burn. Salivary cotinine levels will be measured to determine abstinence from smoking.
• Tobacco reduction and abstinence [ Time Frame: administered at week 12. ]
  The investigators will ask about the number of cigarettes, even a puff, smoked in the past week (7-day abstinence) or use of any form of tobacco or alternative tobacco product e.g., e-cigarette or heat not burn. Salivary cotinine levels will be measured to determine abstinence from smoking.
• Baseline Brief Psychiatric Rating Scale (BPRS) [ Time Frame: Baseline interview with the participant and observations of the participant's behavior over the previous 2-3 days. ]
  The Semi-Structured Interview for Brief Psychiatric Rating Scale is completed by the PI or trained research staff and assesses the number and severity of psychiatric symptoms. It consists of 24 items that are rated from 1 (not present) to 7 (extremely severe), and the items are summed for a total psychopathology score, with a possible range from 24-168 and a higher score indicating a higher severity of illness. The score will be used to measure change between the baseline, 6-week, and 12-week time points.
• Week-6 Brief Psychiatric Rating Scale (BPRS) [ Time Frame: interview at week-6 with the participant and observations of the participant's behavior over the previous 2-3 days. ]
  The Semi-Structured Interview for Brief Psychiatric Rating Scale is completed by the PI or trained research staff and assesses the number and severity of psychiatric symptoms. It consists of 24 items that are rated from 1 (not present) to 7 (extremely severe), and the items are summed for a total psychopathology score, with a possible range from 24-168 and a higher score indicating a higher severity of illness. The score will be used to measure change between the baseline, 6-week, and 12-week time points.
• Week-12 Brief Psychiatric Rating Scale (BPRS) [ Time Frame: interview at week-12 with the participant and observations of the participant's behavior over the previous 2-3 days. ]
  TThe Semi-Structured Interview for Brief Psychiatric Rating Scale is completed by the PI or trained research staff and assesses the number and severity of psychiatric symptoms. It consists of 24 items that are rated from 1 (not present) to 7 (extremely severe), and the items are summed for a total psychopathology score, with a possible range from 24-168 and a higher score indicating a higher severity of illness. The score will be used to measure change between the baseline, 6-week, and 12-week time points.

The purpose of this study is to learn more about how adults with serious mental illness respond to a smoking cessation program combining a Videogame-based Physical activity, counseling for smoking cessation, and a medication (bupropion) for smoking cessation.

Study participants will receive counseling to quit smoking and a medication to help decrease cravings and withdrawal. Additionally, participants will be randomly selected to participate in either a videogame-based physical activity group or a videogame group where the participants sit to play the games.

Participants will be in this study for 12 weeks total. There are 3 assessment visits (2 hours each) at the beginning of the study, 6 weeks after starting, and at the end of the 12 weeks. There will be 8 30- minute counseling sessions during the 12 weeks. The hour-long videogame groups will be held 3 times a week for 12 weeks (36 sessions). Upon completion of the 12-week program, there will be a 1-2 hour group interview. The total time commitment is 48 hours over the course of the 12-week study.

• Smoking Cessation
• Smoking, Tobacco
• Mental Illness
• Tobacco Use Disorder

• Behavioral: Videogame-based physical activity
  videogame-based physical activity
• Behavioral: sedentary videogame
  sedentary videogame
• Drug: Bupropion
  Bupropion
  Other Names:

  • Wellbutrin
  • Zyban
• Behavioral: Counseling
  Counseling for smoking cessation

• Active Comparator: Videogame-based Physical Activity Group

  The videogame-based physical activity group, will play active videogames using the Kinect for Xbox 360 game system. Each videogame group will be facilitated by the study coordinator, the principal investigator or other study staff.

  Participants in this group will also receive bupropion and counseling for smoking cessation.

  Interventions:

  • Behavioral: Videogame-based physical activity
  • Drug: Bupropion
  • Behavioral: Counseling
• Placebo Comparator: Sedentary Videogame Group

  The sedentary videogame group will play videogames while seated using the Xbox 360 game system (without the Kinect sensor). Each sedentary videogame group will be facilitated by study staff.

  Participants in this group will also receive bupropion and counseling for smoking cessation.

  Interventions:

  • Behavioral: sedentary videogame
  • Drug: Bupropion
  • Behavioral: Counseling

Inclusion Criteria:

• A diagnosis of a SMI*
• 18 years and older
• Smoking at least five cigarettes per day for the past 6 months
• Willingness to set a quit date
• Not currently taking bupropion or using nicotine replacement therapy (NRT)
• Current participant in the residential or day treatment program at a Progress Foundation program with the intention to continue in the residential or day treatment program for at least the 12 week intervention period

• Capacity to consent.

  • SMI is characterized by the American Psychological Association as distinct conditions that require routine management, produce functional impairment, and interfere with quality of life. Individuals that typically meet the criteria of SMI have illnesses that include schizophrenia, schizoaffective disorder, psychotic disorders, major depressive disorders, bipolar disorders, and borderline personality disorder.

Exclusion Criteria:

• Currently pregnant or breastfeeding
• Diagnosis of seizure disorder, history of anorexia/bulimia, undergoing abrupt discontinuation of ethanol or sedatives, other conditions that increase seizure risk (e.g., arteriovenous malformation (AVM), severe head injury, central nervous system (CNS) tumor)
• use of Monoamine oxidase (MAO) inhibitors (concurrently or within 14 days of discontinuing either bupropion or the MAO inhibitor)
• Planning to become pregnant during the study period
• Previous participation in the videogame-based physical activity intervention.
• Known medical conditions or other physical problems that need special attention in an exercise program (e.g. prior myocardial infarction, uncontrolled hypertension, history of angioplasty, history of angina, use of nitroglycerin to treat angina)