An Ecological Momentary Intervention for Smoking Cessation: Evaluation of Feasibility and Effectiveness

Abstract

BackgroundDespite substantial public health progress in reducing the prevalence of smoking in the United States overall, smoking among socioeconomically disadvantaged adults remains high.ObjectiveTo determine the feasibility and preliminary effectiveness of a novel smartphone-based smoking cessation app designed for socioeconomically disadvantaged smokers.MethodsParticipants were recruited from a safety-net hospital smoking cessation clinic in Dallas, Texas, and were followed for 13 weeks. All participants received standard smoking cessation clinic care (ie, group counseling and cessation pharmacotherapy) and a smartphone with a novel smoking cessation app (ie, Smart-T). The Smart-T app prompted 5 daily ecological momentary assessments (EMAs) for 3 weeks (ie, 1 week before cessation and 2 weeks after cessation). During the precessation period, EMAs were followed by messages that focused on planning and preparing for the quit attempt. During the postcessation period, participant responses to EMAs drove an algorithm that tailored messages to the current level of smoking lapse risk and currently present lapse triggers (eg, urge to smoke, stress). Smart-T offered additional intervention features on demand (eg, one-click access to the tobacco cessation quitline; “Quit Tips” on coping with urges to smoke, mood, and stress).ResultsParticipants (N=59) were 52.0 (SD 7.0) years old, 54% (32/59) female, and 53% (31/59) African American, and 70% (40/57) had annual household income less than US $16,000. Participants smoked 20.3 (SD 11.6) cigarettes per day and had been smoking for 31.6 (SD 10.9) years. Twelve weeks after the scheduled quit date, 20% (12/59) of all participants were biochemically confirmed abstinent. Participants responded to 87% of all prompted EMAs and received approximately 102 treatment messages over the 3-week EMA period. Most participants (83%, 49/59) used the on-demand app features. Individuals with greater nicotine dependence and minority race used the Quit Tips feature more than their counterparts. Greater use of the Quit Tips feature was linked to nonabstinence at the 2 (P=.02), 4 (P<.01), and 12 (P=.03) week follow-up visits. Most participants reported that they actually used or implemented the tailored app-generated messages and suggestions (83%, 49/59); the app-generated messages were helpful (97%, 57/59); they would like to use the app in the future if they were to lapse (97%, 57/59); and they would like to refer friends who smoke to use the Smart-T app (85%, 50/59). A minority of participants (15%, 9/59) reported that the number of daily assessments (ie, 5) was “too high.”ConclusionsThis novel just-in-time adaptive intervention delivered an intensive intervention (ie, 102 messages over a 3-week period), was well-liked, and was perceived as helpful and useful by socioeconomically disadvantaged adults who were seeking smoking cessation treatment. Smartphone apps may be used to increase treatment exposure and may ultimately reduce tobacco-related health disparities among socioeconomically disadvant...

Using mHealth to Increase Treatment Utilization Among Recently Incarcerated Homeless Adults (Link2Care): Protocol for a Randomized Controlled Trial (Preprint)

“…The EMA methodology that will be used in this study is similar to that developed by Shiffman and colleagues [51,67,68] and was used in previous studies conducted by the investigative team. [69][70][71][72][73] EMA items will assess numerous constructs that are hypothesized to be related to the study outcomes (see Table 3). The phone will audibly and visually cue EMAs for five minutes, 30 minutes after each participant's pre-set waking time.…”

Effective Behavioral Changes through a Digital mHealth App: Exploring the Impact of Hedonic Well-Being, Psychological Empowerment and Inspiration (Preprint)

“…To date, the majority of prior work has focused on the usability and feasibility of mobile apps as mHealth interventions for self-guided care in smoking cessation [31][32][33][34]. Our focus differs from this approach, as we investigate a more psychological side of effectiveness in addition to behavioral therapy.…”

Context-Aware Systems for Chronic Disease Patients: Scoping Review (Preprint)

“…Even though contextaware systems have been piloted in some health care settings, their impact on health care outcomes remains unclear. Specifically, context-aware systems have mainly been piloted in the hospital setting [4] and for primary prevention [6][7][8] rarely addressing the context of chronic disease patients' health-related activities in everyday life.…”