Mindfulness-Based Smoking Cessation Enhanced With Mobile Technology (iQuit Mindfully): Pilot Randomized Controlled Trial

Claire Adams Spears, Lorien C Abroms, Carol R Glass, Donald Hedeker, Michael P Eriksen, Cherell Cottrell-Daniels, Binh Q Tran, David W Wetter, Claire Adams Spears, Lorien C Abroms, Carol R Glass, Donald Hedeker, Michael P Eriksen, Cherell Cottrell-Daniels, Binh Q Tran, David W Wetter

Abstract

Background: Mindfulness training shows promise for improving smoking cessation and lapse recovery, and between-session mobile health messages could enhance treatment engagement and effectiveness. Personalized, in-the-moment text messaging support could be particularly useful for low-income smokers with fewer smoking cessation resources.

Objective: This pilot study examined the feasibility of a text messaging program (iQuit Mindfully) as an adjunct to in-person Mindfulness-Based Addiction Treatment (MBAT) for smoking cessation.

Methods: A total of 71 participants were randomly assigned to MBAT (n=33) or iQuit Mindfully (n=38; MBAT + between-session text messages); of these, 70% (50/71) were African American, and 61% (43/71) had an annual household income of US $30,000 or less. All participants received 8 weekly therapist-led group counseling sessions, nicotine patches, and self-help materials. Outcomes were feasibility (attrition, engagement, and participants' ratings), participants' feedback regarding the text messaging intervention, and smoking cessation (assessed in person).

Results: Strong retention was achieved (76% [54/71] at the end of treatment, and 89% [63/71] at 1-month follow-up). In the iQuit Mindfully group, engagement was high (88% [29/33] indicated reading all or most texts, and 89% [34/38] engaged in interactive texting), and participants provided positive ratings (on a 1-10 scale, average rating for recommending the program to others was 8.4 [SD 2.5]). Participants indicated benefiting from the texts (eg, appreciating encouraging reminders, coping strategies, and social support) and suggested improvements (eg, more personalization). Overall, biochemically confirmed smoking cessation rates were 22% (12/55) at the end of treatment and 19% (12/62) at 1-month follow-up, with no differences between conditions. Living below the poverty level predicted worse cessation outcomes at 1-month follow-up among participants receiving in-person only treatment (P=.03) but not among those receiving iQuit Mindfully.

Conclusions: Text messaging appears to be a feasible and acceptable modality for supporting mindfulness-based smoking cessation treatment. The availability of 24/7 text messaging might be particularly helpful for low-income smokers who have access to fewer cessation resources and experience significant day-to-day barriers to quitting.

Trial registration: ClinicalTrials.gov NCT03029819; https://ichgcp.net/clinical-trials-registry/NCT03029819.

Keywords: low-income populations; smoking cessation; text messaging.

Conflict of interest statement

Conflicts of Interest: LCA has stock in Welltok Inc and receives royalties from the licensing of Text2Quit to Welltok, Inc. MPE receives research funding support from Pfizer, Inc (“Diffusion of Tobacco Control Fundamentals to Other Large Chinese Cities,” MPE, Principal Investigator). The other authors have no conflicts of interest to declare.

©Claire Adams Spears, Lorien C Abroms, Carol R Glass, Donald Hedeker, Michael P Eriksen, Cherell Cottrell-Daniels, Binh Q Tran, David W Wetter. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 24.06.2019.

Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials flow diagram. CPD: cigarettes per day; MBAT: Mindfulness-Based Addiction Treatment; NRT: nicotine replacement therapy; REALM: Rapid Estimate of Adult Literacy in Medicine.

References

    1. The Health Consequences of Smoking-50 Years of Progress: A Report of the Surgeon General. Washington, DC: US Department of Health and Human Services; 2014.
    1. Babb S, Malarcher A, Schauer G, Asman K, Jamal A. Quitting smoking among adults - United States, 2000-2015. MMWR Morb Mortal Wkly Rep. 2017 Jan 6;65(52):1457–64. doi: 10.15585/mmwr.mm6552a1. doi: 10.15585/mmwr.mm6552a1.
    1. US National Cancer Institute Division of Cancer Control and Population Sciences. 2017. Monograph 22. A sociological approach to addressing tobacco-related health disparities
    1. Drope J, Liber AC, Cahn Z, Stoklosa M, Kennedy R, Douglas CE, Henson R, Drope J. Who's still smoking? Disparities in adult cigarette smoking prevalence in the United States. CA Cancer J Clin. 2018;68(2):106–15. doi: 10.3322/caac.21444. doi: 10.3322/caac.21444.
    1. Jamal A, Phillips E, Gentzke AS, Homa DM, Babb SD, King BA, Neff LJ. Current cigarette smoking among adults - United States, 2016. MMWR Morb Mortal Wkly Rep. 2018 Jan 19;67(2):53–9. doi: 10.15585/mmwr.mm6702a1. doi: 10.15585/mmwr.mm6702a1.
    1. Hiscock R, Bauld L, Amos A, Fidler JA, Munafò M. Socioeconomic status and smoking: a review. Ann N Y Acad Sci. 2012;1248:107–23. doi: 10.1111/j.1749-6632.2011.06202.x.
    1. Centers for Disease Control and Prevention. 2013. CDC Health Disparities and Inequalities Report - United States, 2013 .
    1. Businelle MS, Kendzor DE, Reitzel LR, Costello TJ, Cofta-Woerpel L, Li Y, Mazas CA, Vidrine JI, Cinciripini PM, Greisinger AJ, Wetter DW. Mechanisms linking socioeconomic status to smoking cessation: a structural equation modeling approach. Health Psychol. 2010;29(3):262–73. doi: 10.1037/a0019285.
    1. Baer RA, Smith GT, Hopkins J, Krietemeyer J, Toney L. Using self-report assessment methods to explore facets of mindfulness. Assessment. 2006;13(1):27–45. doi: 10.1177/1073191105283504.
    1. Kabat-Zinn J. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York: Delacorte Press; 1990.
    1. Brewer JA, Mallik S, Babuscio TA, Nich C, Johnson HE, Deleone CM, Minnix-Cotton CA, Byrne SA, Kober H, Weinstein AJ, Carroll KM, Rounsaville BJ. Mindfulness training for smoking cessation: results from a randomized controlled trial. Drug Alcohol Depend. 2011;119(1-2):72–80. doi: 10.1016/j.drugalcdep.2011.05.027.
    1. Vidrine JI, Spears CA, Heppner WL, Reitzel LR, Marcus MT, Cinciripini PM, Waters AJ, Li Y, Nguyen NT, Cao Y, Tindle HA, Fine M, Safranek LV, Wetter DW. Efficacy of mindfulness-based addiction treatment (MBAT) for smoking cessation and lapse recovery: a randomized clinical trial. J Consult Clin Psychol. 2016;84(9):824–38. doi: 10.1037/ccp0000117.
    1. Oikonomou MT, Arvanitis M, Sokolove RL. Mindfulness training for smoking cessation: a meta-analysis of randomized-controlled trials. J Health Psychol. 2017;22(14):1841–50. doi: 10.1177/1359105316637667.
    1. Davis JM, Goldberg SB, Anderson MC, Manley AR, Smith SS, Baker TB. Randomized trial on mindfulness training for smokers targeted to a disadvantaged population. Subst Use Misuse. 2014 Apr;49(5):571–85. doi: 10.3109/10826084.2013.770025.
    1. Davis JM, Manley AR, Goldberg SB, Smith SS, Jorenby DE. Randomized trial comparing mindfulness training for smokers to a matched control. J Subst Abuse Treat. 2014;47(3):213–21. doi: 10.1016/j.jsat.2014.04.005.
    1. Witkiewitz K, Greenfield BL, Bowen S. Mindfulness-based relapse prevention with racial and ethnic minority women. Addict Behav. 2013 Dec;38(12):2821–4. doi: 10.1016/j.addbeh.2013.08.018.
    1. Spears CA, Houchins SC, Bamatter WP, Barrueco S, Hoover DS, Perskaudas R. Perceptions of mindfulness in a low-income, primarily African American treatment-seeking sample. Mindfulness (N Y) 2017 Dec;8(6):1532–43.
    1. Heron KE, Smyth JM. Ecological momentary interventions: incorporating mobile technology into psychosocial and health behaviour treatments. Br J Health Psychol. 2010 Feb;15(Pt 1):1–39. doi: 10.1348/135910709X466063.
    1. Sliwinski J, Katsikitis M, Jones CM. A review of interactive technologies as support tools for the cultivation of mindfulness. Mindfulness. 2017;8(5):1150–59. doi: 10.1007/s12671-017-0698-x.
    1. Fish J, Brimson J, Lynch S. Mindfulness interventions delivered by technology without facilitator involvement: what research exists and what are the clinical outcomes? Mindfulness (N Y) 2016;7(5):1011–23. doi: 10.1007/s12671-016-0548-2.
    1. Davis JM, Manley AR, Goldberg SB, Stankevitz KA, Smith SS. Mindfulness training for smokers via web-based video instruction with phone support: a prospective observational study. BMC Complement Altern Med. 2015 Mar 29;15:95. doi: 10.1186/s12906-015-0618-3.
    1. Bricker JB, Mull KE, Kientz JA, Vilardaga R, Mercer LD, Akioka KJ, Heffner JL. Randomized, controlled pilot trial of a smartphone app for smoking cessation using acceptance and commitment therapy. Drug Alcohol Depend. 2014 Oct 01;143:87–94. doi: 10.1016/j.drugalcdep.2014.07.006.
    1. Garrison KA, Pal P, O'Malley SS, Pittman BP, Gueorguieva R, Rojiani R, Scheinost D, Dallery J, Brewer JA. Craving to quit: a randomized controlled trial of smartphone app-based mindfulness training for smoking cessation. Nicotine Tob Res. 2018 Jun 18; doi: 10.1093/ntr/nty126. (forthcoming)
    1. Mani M, Kavanagh DJ, Hides L, Stoyanov SR. Review and evaluation of mindfulness-based iPhone apps. JMIR Mhealth Uhealth. 2015 Aug 19;3(3):e82. doi: 10.2196/mhealth.4328.
    1. Free C, Knight R, Robertson S, Whittaker R, Edwards P, Zhou W, Rodgers A, Cairns J, Kenward MG, Roberts I. Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial. Lancet. 2011 Jul 2;378(9785):49–55. doi: 10.1016/S0140-6736(11)60701-0.
    1. Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev. 2016 Apr 10;4:CD006611. doi: 10.1002/14651858.CD006611.pub4.
    1. Armanasco AA, Miller YD, Fjeldsoe BS, Marshall AL. Preventive health behavior change text message interventions: a meta-analysis. Am J Prev Med. 2017 Mar;52(3):391–402. doi: 10.1016/j.amepre.2016.10.042.
    1. Abroms LC, Boal AL, Simmens SJ, Mendel JA, Windsor RA. A randomized trial of Text2Quit: a text messaging program for smoking cessation. Am J Prev Med. 2014 Sep;47(3):242–50. doi: 10.1016/j.amepre.2014.04.010.
    1. Scott-Sheldon LA, Lantini R, Jennings EG, Thind H, Rosen RK, Salmoirago-Blotcher E, Bock BC. Text messaging-based interventions for smoking cessation: a systematic review and meta-analysis. JMIR Mhealth Uhealth. 2016 May 20;4(2):e49. doi: 10.2196/mhealth.5436.
    1. Spohr SA, Nandy R, Gandhiraj D, Vemulapalli A, Anne S, Walters ST. Efficacy of SMS text message interventions for smoking cessation: a meta-analysis. J Subst Abuse Treat. 2015 Sep;56:1–10. doi: 10.1016/j.jsat.2015.01.011.
    1. Pew Research Center. 2018. Mobile Fact Sheet
    1. Smith A. Pew Research Center. 2011. Americans and Text Messaging .
    1. McCurdie T, Taneva S, Casselman M, Yeung M, McDaniel C, Ho W, Cafazzo J. mHealth consumer apps: the case for user-centered design. Biomed Instrum Technol. 2012;Suppl:49–56. doi: 10.2345/0899-8205-46.s2.49.
    1. Abroms LC, Whittaker R, Free C, Mendel van Alstyne J, Schindler-Ruwisch JM. Developing and pretesting a text messaging program for health behavior change: recommended steps. JMIR Mhealth Uhealth. 2015 Dec 21;3(4):e107. doi: 10.2196/mhealth.4917.
    1. Bock BC, Rosen RK, Barnett NP, Thind H, Walaska K, Foster R, Deutsch C, Traficante R. Translating behavioral interventions onto mHealth platforms: developing text message interventions for smoking and alcohol. JMIR Mhealth Uhealth. 2015 Feb 24;3(1):e22. doi: 10.2196/mhealth.3779.
    1. Spears CA, Bell SA, Scarlett CA, Anderson NK, Cottrell-Daniels C, Lotfalian S, Bandlamudi M, Grant A, Sigurdardottir A, Carter BP, Abroms LC, Wetter DW. Text messaging to enhance mindfulness-based smoking cessation treatment: program development through qualitative research. JMIR Mhealth Uhealth. 2019 Jan 7;7(1):e11246. doi: 10.2196/11246.
    1. Davis TC, Crouch MA, Long SW, Jackson RH, Bates P, George RB, Bairnsfather LE. Rapid assessment of literacy levels of adult primary care patients. Fam Med. 1991 Aug;23(6):433–5.
    1. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient Health Questionnaire. J Am Med Assoc. 1999 Nov 10;282(18):1737–44.
    1. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003 Nov;41(11):1284–92. doi: 10.1097/01.MLR.0000093487.78664.3C.
    1. Clinical Practice Guideline Treating Tobacco Use and Dependence 2008 Update Panel‚ Liaisons‚ and Staff A clinical practice guideline for treating tobacco use and dependence: 2008 update. A US public health service report. Am J Prev Med. 2008 Aug;35(2):158–76. doi: 10.1016/j.amepre.2008.04.009.
    1. Segal ZV, Williams JM, Teasdale JD. Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. New York: The Guilford Press; 2001.
    1. United States Census Bureau. 2018. Poverty Thresholds .
    1. Kozlowski LT, Porter CQ, Orleans CT, Pope MA, Heatherton T. Predicting smoking cessation with self-reported measures of nicotine dependence: FTQ, FTND, and HSI. Drug Alcohol Depend. 1994 Feb;34(3):211–6.
    1. Hedeker D, Mermelstein RJ, Demirtas H. Analysis of binary outcomes with missing data: missing = smoking, last observation carried forward, and a little multiple imputation. Addiction. 2007 Oct;102(10):1564–73. doi: 10.1111/j.1360-0443.2007.01946.x.
    1. Blankers M, Smit ES, van der Pol P, de Vries H, Hoving C, van Laar M. The missing=smoking assumption: a fallacy in internet-based smoking cessation trials? Nicotine Tob Res. 2016 Jan;18(1):25–33. doi: 10.1093/ntr/ntv055.
    1. Senn S. Testing for baseline balance in clinical trials. Stat Med. 1994 Sep 15;13(17):1715–26.
    1. Pocock SJ, Assmann SE, Enos LE, Kasten LE. Subgroup analysis, covariate adjustment and baseline comparisons in clinical trial reporting: current practice and problems. Stat Med. 2002 Oct 15;21(19):2917–30. doi: 10.1002/sim.1296.
    1. Abroms LC, Ahuja M, Kodl Y, Thaweethai L, Sims J, Winickoff JP, Windsor RA. Text2Quit: results from a pilot test of a personalized, interactive mobile health smoking cessation program. J Health Commun. 2012;17(Suppl 1):44–53. doi: 10.1080/10810730.2011.649159.
    1. Heminger CL, Schindler-Ruwisch JM, Abroms LC. Smoking cessation support for pregnant women: role of mobile technology. Subst Abuse Rehabil. 2016;7:15–26. doi: 10.2147/SAR.S84239. doi: 10.2147/SAR.S84239.
    1. Daly AT, Deshmukh AA, Vidrine DJ, Prokhorov AV, Frank SG, Tahay PD, Houchen ME, Cantor SB. Cost-effectiveness analysis of smoking cessation interventions using cell phones in a low-income population. Tob Control. 2019;28(1):88–94. doi: 10.1136/tobaccocontrol-2017-054229.
    1. Heminger CL, Boal AL, Zumer M, Abroms LC. Text2Quit: an analysis of participant engagement in the mobile smoking cessation program. Am J Drug Alcohol Abuse. 2016;42(4):450–8. doi: 10.3109/00952990.2016.1149591.
    1. Zeng EY, Heffner JL, Copeland WK, Mull KE, Bricker JB. Get with the program: adherence to a smartphone app for smoking cessation. Addict Behav. 2016 Dec;63:120–4. doi: 10.1016/j.addbeh.2016.07.007.
    1. Bricker JB, Copeland W, Mull KE, Zeng EY, Watson NL, Akioka KJ, Heffner JL. Single-arm trial of the second version of an acceptance & commitment therapy smartphone application for smoking cessation. Drug Alcohol Depend. 2017 Jan 1;170:37–42. doi: 10.1016/j.drugalcdep.2016.10.029.
    1. Krebs P, Duncan DT. Health app use among US mobile phone owners: a national survey. JMIR Mhealth Uhealth. 2015 Nov 4;3(4):e101. doi: 10.2196/mhealth.4924.
    1. Thrul J, Klein AB, Ramo DE. Smoking cessation intervention on Facebook: which content generates the best engagement? J Med Internet Res. 2015 Nov 11;17(11):e244. doi: 10.2196/jmir.4575.
    1. Strecher VJ, McClure J, Alexander G, Chakraborty B, Nair V, Konkel J, Greene S, Couper M, Carlier C, Wiese C, Little R, Pomerleau C, Pomerleau O. The role of engagement in a tailored web-based smoking cessation program: randomized controlled trial. J Med Internet Res. 2008 Nov 4;10(5):e36. doi: 10.2196/jmir.1002.
    1. Krebs P, Prochaska JO, Rossi JS. A meta-analysis of computer-tailored interventions for health behavior change. Prev Med. 2010;51(3-4):214–21. doi: 10.1016/j.ypmed.2010.06.004.
    1. Lloyd A, White R, Eames C, Crane R. The utility of home-practice in mindfulness-based group interventions: a systematic review. Mindfulness (N Y) 2018;9(3):673–92. doi: 10.1007/s12671-017-0813-z.
    1. Vettese LC, Toneatto T, Stea JN, Nguyen L, Wang JJ. Do mindfulness meditation participants do their homework? And does it make a difference? A review of the empirical evidence. J Cogn Psychother. 2009;23(3):198–225. doi: 10.1891/0889-8391.23.3.198.
    1. Parsons CE, Crane C, Parsons LJ, Fjorback LO, Kuyken W. Home practice in mindfulness-based cognitive therapy and mindfulness-based stress reduction: a systematic review and meta-analysis of participants' mindfulness practice and its association with outcomes. Behav Res Ther. 2017 Aug;95:29–41. doi: 10.1016/j.brat.2017.05.004.
    1. Grau LE, Pham T, O'Leary T, Weiss J, Toll B, Bernstein SL. Smokers' perspectives on texting for tobacco dependence treatment: a qualitative analysis. Nicotine Tob Res. 2017 Mar 1;19(3):307–13. doi: 10.1093/ntr/ntw184.
    1. Douglas N, Free C. 'Someone batting in my corner': experiences of smoking-cessation support via text message. Br J Gen Pract. 2013 Nov;63(616):e768–76. doi: 10.3399/bjgp13X674459.
    1. Smith A. Pew Research Center. 2017. Record Shares of Americans Now Own Smartphones, Have Home Broadband
    1. Businelle MS, Ma P, Kendzor DE, Frank SG, Vidrine DJ, Wetter DW. An ecological momentary intervention for smoking cessation: evaluation of feasibility and effectiveness. J Med Internet Res. 2016 Dec 12;18(12):e321. doi: 10.2196/jmir.6058.
    1. Little RJ, Yau LH. Statistical techniques for analyzing data from prevention trials: treatment of no-shows using Rubin's causal model. Psychol Methods. 1998;3(2):147–59.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever