A Digital Smoking Cessation Program for Heavy Drinkers: Pilot Randomized Controlled Trial

Christopher W Kahler, Amy M Cohn, Catherine Costantino, Benjamin A Toll, Nichea S Spillane, Amanda L Graham, Christopher W Kahler, Amy M Cohn, Catherine Costantino, Benjamin A Toll, Nichea S Spillane, Amanda L Graham

Abstract

Background: Heavy drinking (HD) is far more common among smokers compared with nonsmokers and interferes with successful smoking cessation. Alcohol-focused smoking cessation interventions delivered by counselors have shown promise, but digital versions of these interventions-which could have far greater population reach-have not yet been tested.

Objective: This pilot randomized controlled trial aimed to examine the feasibility, acceptability, and effect sizes of an automated digital smoking cessation program that specifically addresses HD using an interactive web-based intervention with an optional text messaging component.

Methods: Participants (83/119, 69.7% female; 98/119, 82.4% white; mean age 38.0 years) were daily smokers recruited on the web from a free automated digital smoking cessation program (BecomeAnEX.org, EX) who met the criteria for HD: women drinking 8+ drinks/week or 4+ drinks on any day and men drinking 15+ drinks/week or 5+ drinks on any day. Participants were randomized to receive EX with standard content (EX-S) or an EX with additional content specific to HD (EX-HD). Outcomes were assessed by web-based surveys at 1 and 6 months.

Results: Participants reported high satisfaction with the website and the optional text messaging component. Total engagement with both EX-S and EX-HD was modest, with participants visiting the website a median of 2 times, and 52.9% of the participants enrolled to receive text messages. Participants in both the conditions showed substantial, significant reductions in drinking across 6 months of follow-up, with no condition effects observed. Although smoking outcomes tended to favor EX-HD, the condition effects were small and nonsignificant. A significantly smaller proportion of participants in EX-HD reported having a lapse back to smoking when drinking alcohol (7/58, 16%) compared with those in EX-S (18/61, 41%; χ21=6.2; P=.01).

Conclusions: This is the first trial to examine a digital smoking cessation program tailored to HD smokers. The results provide some initial evidence that delivering such a program is feasible and may reduce the risk of alcohol-involved smoking lapses. However, increasing engagement in this and other web-based interventions is a crucial challenge to address in future work.

Trial registration: ClinicalTrials.gov NCT03068611; https://ichgcp.net/clinical-trials-registry/NCT03068611.

Keywords: alcohol drinking; internet; smoking cessation; text messaging; therapy.

Conflict of interest statement

Conflicts of Interest: BT testifies as an expert witness on behalf of plaintiffs who have filed litigation against the tobacco companies. AG is employed by Truth Initiative, which licenses an enterprise version of BecomeAnEX to employers, health plans, and other tobacco control organizations.

©Christopher W Kahler, Amy M Cohn, Catherine Costantino, Benjamin A Toll, Nichea S Spillane, Amanda L Graham. Originally published in JMIR Formative Research (http://formative.jmir.org), 08.06.2020.

Figures

Figure 1
Figure 1
A Consolidated Standards of Reporting Trials diagram showing participant flow. EX-HD: BecomeAnEX with additional content specific to heavy drinking; EX-S: BecomeAnEX with standard content.

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