A Mobile Just-in-Time Adaptive Intervention for Smoking Cessation: Pilot Randomized Controlled Trial

Emily T Hébert, Chaelin K Ra, Adam C Alexander, Angela Helt, Rachel Moisiuc, Darla E Kendzor, Damon J Vidrine, Rachel K Funk-Lawler, Michael S Businelle, Emily T Hébert, Chaelin K Ra, Adam C Alexander, Angela Helt, Rachel Moisiuc, Darla E Kendzor, Damon J Vidrine, Rachel K Funk-Lawler, Michael S Businelle

Abstract

Background: Smartphone apps for smoking cessation could offer easily accessible, highly tailored, intensive interventions at a fraction of the cost of traditional counseling. Although there are hundreds of publicly available smoking cessation apps, few have been empirically evaluated using a randomized controlled trial (RCT) design. The Smart-Treatment (Smart-T2) app is a just-in-time adaptive intervention that uses ecological momentary assessments (EMAs) to assess the risk for imminent smoking lapse and tailors treatment messages based on the risk of lapse and reported symptoms.

Objective: This 3-armed pilot RCT aimed to determine the feasibility and preliminary efficacy of an automated smartphone-based smoking cessation intervention (Smart-T2) relative to standard in-person smoking cessation clinic care and the National Cancer Institute's free smoking cessation app, QuitGuide.

Methods: Adult smokers who attended a clinic-based tobacco cessation program were randomized into groups and followed for 13 weeks (1 week prequitting through 12 weeks postquitting). All study participants received nicotine patches and gum and were asked to complete EMAs five times a day on study-provided smartphones for 5 weeks. Participants in the Smart-T2 group received tailored treatment messages after the completion of each EMA. Both Smart-T2 and QuitGuide apps offer on-demand smoking cessation treatment.

Results: Of 81 participants, 41 (50%) were women and 55 (68%) were white. On average, participants were aged 49.6 years and smoked 22.4 cigarettes per day at baseline. A total of 17% (14/81) of participants were biochemically confirmed 7-day point prevalence abstinent at 12 weeks postquitting (Smart-T2: 6/27, 22%, QuitGuide: 4/27, 15%, and usual care: 4/27, 15%), with no significant differences across groups (P>.05). Participants in the Smart-T2 group rated the app positively, with most participants agreeing that they can rely on the app to help them quit smoking, and endorsed the belief that the app would help them stay quit, and these responses were not significantly different from the ratings given by participants in the usual care group.

Conclusions: Dynamic smartphone apps that tailor intervention content in real time may increase user engagement and exposure to treatment-related materials. The results of this pilot RCT suggest that smartphone-based smoking cessation treatments may be capable of providing similar outcomes to traditional, in-person counseling.

Trial registration: ClinicalTrials.gov NCT02930200; https://ichgcp.net/clinical-trials-registry/NCT02930200.

Keywords: just-in-time adaptive intervention; mHealth; mobile phones; smartphones; smoking cessation.

Conflict of interest statement

Conflicts of Interest: MB, DK, and DV are inventors of the Insight mHealth Platform, which was used to develop the Smart-T2 app. They receive royalties related to its use.

©Emily T Hébert, Chaelin K Ra, Adam C Alexander, Angela Helt, Rachel Moisiuc, Darla E Kendzor, Damon J Vidrine, Rachel K Funk-Lawler, Michael S Businelle. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 09.03.2020.

Figures

Figure 1
Figure 1
The Smart-Treatment app home screen.
Figure 2
Figure 2
Consolidated Standards of Reporting Trials diagram. CO: carbon monoxide.
Figure 3
Figure 3
The distribution of on-demand tips accessed over time.
Figure 4
Figure 4
The distribution of high-risk messages over time.

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