Community-Centered eHealth Smoking Cessation Intervention(CCeSCI)

Community-Centered eHealth Smoking Cessation Intervention Based on the "Smoking Rationalization Beliefs" Framework for Chinese Male Smokers

Recent findings regarding why Chinese male smokers are reluctant to quit have offered insight for a possible new solution. Consistent with the Cognitive Dissonance Theory, "smoking rationalization beliefs" are a set of beliefs by smokers to rationalize their smoking behavior and avoid quitting. These beliefs have been well studied by global researchers, and a "smoking rationalization beliefs" scale was recently developed and validated for Chinese male smokers. The six dimensions of these beliefs are: smoking functional beliefs, risk generalization beliefs, social acceptability beliefs, safe smoking beliefs, self-exempting beliefs, and quitting is harmful beliefs. Studies on smoking rationalization in China have primarily been observational. Investigators propose to develop a Community-Centered eHealth Smoking Cessation Intervention (CCeSCI). The trinity of CCeSCI are the triangular unity of "smoking rationalization beliefs" framework, the non-physician community workers, and the eHealth technologies. The latter two were previously proven effective in interventional studies (including three conducted by the PI) but not yet widely used in smoking cessation. With the adoption of smoking rationalization beliefs framework aiming to address the cognitive causes of phycological addition to smoking and supported by the community-based behavioral interventions and the use of eHealth, CCeSCI is designed to overcome previous challenges with the principles of people-centeredness, convenience, and personalization.

Study Overview

• Status: Completed
• Conditions: Smoking Cessation; Lifestyle, Healthy
• Intervention / Treatment: Other: Community-Centered eHealth Smoking Cessation Intervention (CCeSCI); Other: Traditional "smoking is harmful" education

Detailed Description

Investigators will firstly evaluate the feasibility of CCeSCI. Once CCeSCI is ready to deploy, investigators will recruit 60 smokers (male, 25-64 years old) in two communities in Qingpu to conduct a pilot non-blinded randomized controlled trial. They will be randomized in a 1:1 ratio into either the intervention group to receive CCeSCI or the control group to receive the traditional "smoking is harmful" education video. Investigators will also use qualitative research methods (one on one interviews) to conduct process evaluations at 4th, 8th, and 12th weeks according to the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. At the end of the 12th week after the participants joined the RCT, saliva samples will be collected by community workers and quitting outcomes will be biochemically verified by a third party lab.

• Study Type: Interventional
• Enrollment (Actual): 60
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Shanghai
    • Shanghai, Shanghai, China, 201700
      • Shanghai Qingpu Patriotic Hygiene and Health Promotion Guidance Center

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 25 years to 64 years (Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. Male, current cigarette smokers who are willing to quit
2. Citizens who currently reside in Qingpu District, Shanghai, China
3. Age 25-64
4. Smoking index greater than or equal to 100 (smoking index = average number of cigarettes smoked per day × years of smoking)
5. Able to understand mandarin Chinese
6. Willing to provide informed consent to participate in the study

Exclusion Criteria:

1. Ever or currently on pharmacologic treatments, including various forms of NRT formulations such as gum, transdermal patch, nasal spray, oral inhaler, lozenge, Bupropion, Varenicline and newly emerged precision medicine
2. Currently participating in other individual-based cessation program(s), such as psychological counseling, behavioral therapy etc.
3. Currently under treatment of life-threatening medical conditions or critically ill
4. Unable to make commitment of a consecutive 4-hour video viewing
5. Plan to move out of the community in the next 3 month

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Community-Centered eHealth Smoking Cessation Intervention (CCeSCI) group; The intervention group will receive Community-Centered eHealth Smoking Cessation Intervention(CCeSCI).	Other: Community-Centered eHealth Smoking Cessation Intervention (CCeSCI); We will equip CCeSCI with both core eHealth features and provider-side intervention. Patients assigned to the intervention group will receive a series of online interactive and personalization technologies, including an algorithm-based video curriculum with auto-texting, backstage monitoring system etc. Besides, the patients will also have the face-to-face meetings with community health workers. Provider-side intervention includes training for community workers, WeChat group discussion, and performance-based incentives. The training aims to provide essential skills for community workers so that they can provide face-to-face meetings with smokers during the first 3 months of quitting to prevent or revert relapse in a timely and proactive manner.
Active Comparator: Traditional "smoking is harmful" education group; The control group to receive the traditional "smoking is harmful" education.	Other: Traditional "smoking is harmful" education; In the control group, the participants will receive traditional "smoking is harmful" education video, which is recorded by the clinical physicians.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Biochemically verified continuous smoking abstinence at 3 month	Investigators will use cotinine to measure the smoking abstinence. Cotinine is a good biomarker for nicotine with a longer half-life (16-18h), and lab test for saliva is highly sensitive, convenient, and cost-effective. measured by cotinine saliva tests (<10ng•mL-1)	3 month

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fagerstrom Test For Nicotine Dependence (FTND) Score	Investigators will use the Fagerström Test for Nicotine Dependence as a standard instrument for assessing the intensity of physical addiction to nicotine. In scoring the Fagerstrom Test for Nicotine Dependence, the three yes/no items are scored 0 (no) and 1 (yes). The three multiple-choice items are scored from 0 to 3. The items are summed to yield a total score of 0-10. A higher score means more dependence on nicotine.	Change from baseline to 3-month follow up
Patient Health Questionnaire-9	Investigators will use PHQ-9 as a 9-question instrument to screen for depression. The scale ranges from 0 to 27. Total scores of 5, 10, 15, and 20 represent cutpoints for mild, moderate, moderately severe, and severe depression, respectively. Higher score indicates severe depression	Change from baseline to 3-month follow up
Self-reported 7-day point smoking status	self-reported 7-day point prevalence of abstinence (not even a puff of smoke, for the last 7 days) at 3 months	3-month follow up
Self-reported continuous abstinence at 3 month	not even a puff of smoke, for the last 3 months	3-month follow up
Self-reported average number of cigarettes	Investigators will count the number of cigarettes at 3 month	Change from baseline to 3-month follow up
Smoking Rationalization Scale	Investigators will use Smoking Rationalization Scale to measure smokers' thoughts about smoking. The scale comprised 26 items (e.g., "Smoking is good for inspiration and active thinking.") and was divided into 6 dimensions including smoking functional beliefs, risk generalization beliefs, social acceptability beliefs, safe smoking beliefs, self-exempting beliefs and quitting is harmful beliefs. Participants responded on a 5-point Likert scale (1 = completely disagree, 5 = completely agree). Higher scores indicated a higher level of smoking rationalization beliefs.	Change from baseline to 3-month follow up
Questionnaire about community health workers' Knowledge, Attitude and Practices (KAP)	The knowledge, attitude, and practices (KAPs) survey provides a design to evaluate existing programs and to identify effective strategies for behavior change in society. The first section was related to knowledge, and this section had some questions where 1 point was assigned to the correct answer and 0 points were assigned to the wrong answer. A higher score demonstrated good knowledge. The second section was on attitude and had some questions on a 5-point Likert scale as strongly disagree = 1, disagree = 2, uncertain = 3, agree = 4, and strongly agree = 5. A higher score demonstrated a good attitude. The last part of the questionnaire was composed of questions related to the practice, and each question was scored as "yes" (1-point), "no" (0-point), and "sometimes" (0-point). A higher score indicated good practice.	3-month follow up
Weight in kilograms	Investigators will measure the participants' heights	Change from baseline to 3-month follow up
Blood Pressure	Investigators will measure the participants' both systolic and diastolic blood pressure	Change from baseline to 3-month follow up
Waist Circumference	Investigators will measure the waist circumference of the participants	Change from baseline to 3-month follow up

Collaborators and Investigators

• Sponsor: Duke Kunshan University

Publications and helpful links

General Publications

• Ni Z, Liu C, Wu B, Yang Q, Douglas C, Shaw RJ. An mHealth intervention to improve medication adherence among patients with coronary heart disease in China: Development of an intervention. Int J Nurs Sci. 2018 Sep 8;5(4):322-330. doi: 10.1016/j.ijnss.2018.09.003. eCollection 2018 Oct 10.
• GBD 2015 Risk Factors Collaborators. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1659-1724. doi: 10.1016/S0140-6736(16)31679-8. Erratum In: Lancet. 2017 Jan 7;389(10064):e1.
• Wang L, Shen Y, Jiang Y, Yang Y. [Investigation and analysis on current status of smoking cessation clinics in China]. Zhonghua Liu Xing Bing Xue Za Zhi. 2015 Sep;36(9):917-20. Chinese.
• Wang J, Xie L, Jiang Y, Li Q. Conclusions and impacts of U.S. Surgeon General' s Reports on smoking and tobacco use. Chinese Journal of Health Education 2012;28(7):591-593+601. DOI: 10.16168/j.cnki.issn.1002-9982.2012.07.019.
• Huang X, Fu W, Zhang H, Li H, Li X, Yang Y, Wang F, Gao J, Zheng P, Fu H, Chapman S, Ding D. Why are male Chinese smokers unwilling to quit? A multicentre cross-sectional study on smoking rationalisation and intention to quit. BMJ Open. 2019 Feb 19;9(2):e025285. doi: 10.1136/bmjopen-2018-025285.
• Fotuhi O, Fong GT, Zanna MP, Borland R, Yong HH, Cummings KM. Patterns of cognitive dissonance-reducing beliefs among smokers: a longitudinal analysis from the International Tobacco Control (ITC) Four Country Survey. Tob Control. 2013 Jan;22(1):52-8. doi: 10.1136/tobaccocontrol-2011-050139. Epub 2012 Jan 3.
• Huang X, Fu W, Zhang H, Li H, Li X, Yang Y, Wang F, Gao J, Zheng P, Fu H, Ding D, Chapman S. Development and validation of a smoking rationalization scale for male smokers in China. J Health Psychol. 2020 Mar;25(4):472-489. doi: 10.1177/1359105317720276. Epub 2017 Jul 20.
• Chen S, Gong E, Kazi DS, Gates AB, Bai R, Fu H, Peng W, De La Cruz G, Chen L, Liu X, Su Q, Girerd N, Karaye KM, Alhabib KF, Yan LL, Schwalm JD. Using Mobile Health Intervention to Improve Secondary Prevention of Coronary Heart Diseases in China: Mixed-Methods Feasibility Study. JMIR Mhealth Uhealth. 2018 Jan 25;6(1):e9. doi: 10.2196/mhealth.7849.
• Gong E, Gu W, Luo E, Tan L, Donovan J, Sun C, Yang Y, Zang L, Bao P, Yan LL. Development and Local Contextualization of Mobile Health Messages for Enhancing Disease Management Among Community-Dwelling Stroke Patients in Rural China: Multimethod Study. JMIR Mhealth Uhealth. 2019 Dec 17;7(12):e15758. doi: 10.2196/15758.
• Gong E, Sun L, Long Q, Xu H, Gu W, Bettger JP, Tan J, Ma J, Jafar TH, Oldenburg B, Yan LL. The Implementation of a Primary Care-Based Integrated Mobile Health Intervention for Stroke Management in Rural China: Mixed-Methods Process Evaluation. Front Public Health. 2021 Nov 17;9:774907. doi: 10.3389/fpubh.2021.774907. eCollection 2021.
• Yan LL, Gong E, Gu W, Turner EL, Gallis JA, Zhou Y, Li Z, McCormack KE, Xu LQ, Bettger JP, Tang S, Wang Y, Oldenburg B. Effectiveness of a primary care-based integrated mobile health intervention for stroke management in rural China (SINEMA): A cluster-randomized controlled trial. PLoS Med. 2021 Apr 28;18(4):e1003582. doi: 10.1371/journal.pmed.1003582. eCollection 2021 Apr.
• Tian M, Ajay VS, Dunzhu D, Hameed SS, Li X, Liu Z, Li C, Chen H, Cho K, Li R, Zhao X, Jindal D, Rawal I, Ali MK, Peterson ED, Ji J, Amarchand R, Krishnan A, Tandon N, Xu LQ, Wu Y, Prabhakaran D, Yan LL. A Cluster-Randomized, Controlled Trial of a Simplified Multifaceted Management Program for Individuals at High Cardiovascular Risk (SimCard Trial) in Rural Tibet, China, and Haryana, India. Circulation. 2015 Sep 1;132(9):815-24. doi: 10.1161/CIRCULATIONAHA.115.015373. Epub 2015 Jul 17.

Study record dates

Study Major Dates

• Study Start (Actual): March 13, 2023
• Primary Completion (Actual): May 31, 2023
• Study Completion (Actual): June 30, 2023

Study Registration Dates

• First Submitted: August 15, 2022
• First Submitted That Met QC Criteria: August 18, 2022
• First Posted (Actual): August 19, 2022

Study Record Updates

• Last Update Posted (Estimated): February 28, 2024
• Last Update Submitted That Met QC Criteria: February 25, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Keywords: Smoking Cessation; Disease control and prevention; Health management; Effectiveness evaluation
• Other Study ID Numbers: 22KDKUF016

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: The investigators will not share the individual participant data. But de-identified data is available upon request.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No