Commentary on Graham et al.: Biochemical verification of abstinence in remotely conducted smoking cessation trials should not be a universal design requirement for rigor

Heffner, Jaimee L.; McClure, Jennifer B.

doi:10.1111/add.15803

Cited by 7 publications

(4 citation statements)

References 8 publications

(14 reference statements)

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“…Using objective measures, such as remote biochemical verification in conjunction with EMA, may be an important way forward in dynamically assessing smoking relapse [22,37]. However, others have warned against the unnecessary inclusion of remote biochemical verification in smoking studies as standard practice when not sufficiently warranted [57]. Results from this study help to inform that debate and suggest that technological enhancement may improve data accuracy through objective measurement but may also introduce compliance barriers that could result in higher rates of missing data.…”

Section: Discussionmentioning

confidence: 87%

Monitoring Cigarette Smoking and Relapse in Young Adults With and Without Remote Biochemical Verification: Randomized Brief Cessation Study

McClure¹,

Baker²,

Walters³

et al. 2023

JMIR Form Res

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Background Technological advancements to study young adult smoking, relapse, and to deliver interventions remotely offer conceptual appeal, but the incorporation of technological enhancement must demonstrate benefit over traditional methods without adversely affecting outcomes. Further, integrating remote biochemical verification of smoking and abstinence may yield value in the confirmation of self-reported smoking, in addition to ecologically valid, real-time assessments. Objective The goal of this study was to evaluate the impact of remote biochemical verification on 24-hour self-reported smoking and biochemical verification agreement, retention, compliance with remote sessions, and abstinence during a brief, 5-week cessation attempt and relapse monitoring phase. Methods Participants (N=39; aged 18-25 years; mean age 21.6, SD 2.1 years; n=22, 56% male; n=29, 74% White) who smoked cigarettes daily engaged in a 5-week cessation and monitoring study (including a 48-hour quit attempt and provision of tobacco treatment in the form of nicotine replacement therapy, brief cessation counseling, and financial incentives for abstinence during the 2-day quit attempt only). Smoking (cigarettes per day) was self-reported through ecological momentary assessment (EMA) procedures, and participants were randomized to either (1) the inclusion of remote biochemical verification (EMA + remote carbon monoxide [rCO]) 2× per day or (2) in-person, weekly CO (wCO). Groups were compared on the following outcomes: (1) agreement in self-reported smoking and breath carbon monoxide (CO) at common study time points, (2) EMA session compliance, (3) retention in study procedures, and (4) abstinence from smoking during the 2-day quit attempt and at the end of the 5-week study. Results No significant differences were demonstrated between the rCO group and the wCO (weekly in-person study visit) group on agreement between 24-hour self-reported smoking and breath CO (moderate to poor), compliance with remote sessions, or retention, though these outcomes numerically favored the wCO group. Abstinence was numerically higher in the wCO group after the 2-day quit attempt and significantly different at the end of treatment (day 35), favoring the wCO group. Conclusions Though study results should be interpreted with caution given the small sample size, findings suggest that the inclusion of rCO breath added to EMA compared to EMA with weekly, in-person CO collection in young adults did not yield benefit and may have even adversely affected outcomes. Our results suggest that technological advancements may improve data accuracy through objective measurement but may also introduce barriers and burdens and could result in higher rates of missing data. The inclusion of technology to inform smoking cessation research and intervention delivery among young adults should consider (1) the research question and necessity of biochemical verification and then (2) how to seamlessly incorporate monitoring into personalized and dynamic systems to avoid the added burden and detrimental effects to compliance and honesty in self-report.

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Section: Discussionmentioning

confidence: 87%

Monitoring Cigarette Smoking and Relapse in Young Adults With and Without Remote Biochemical Verification: Randomized Brief Cessation Study

McClure¹,

Baker²,

Walters³

et al. 2023

JMIR Form Res

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“…There is debate on whether light-touch interventions (such as M2Q2) with minimal direct contact with participants, as opposed to interventions such as individual counseling, needs biochemical verification of smoking cessation. Some argue that the social desirability in light-touch interventions is low and that needing biochemical verification may reduce the generalizability of the sample (as only the more motivated subset might participate) and the study’s feasibility [ 32 , 33 ]. The high disagreement in our results between the self-report and the carbon-monoxide verified results may indicate that the social desirability in countries like Vietnam is higher and that even light touch interventions in these countries would benefit from biochemical verification.…”

Section: Discussionmentioning

confidence: 99%

Peer Texting to Promote Quitline Use and Smoking Cessation Among Rural Participants in Vietnam: Randomized Clinical Trial

Sadasivam,

Nagawa,

Wijesundara

et al. 2024

Int J Public Health

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Objectives: We tested an adapted version of an effective U.S.-based peer-texting intervention to promote Quitline use and smoking cessation among rural participants in Vietnam.Methods: We conducted a two-arm randomized trial with participants recruited at four rural community centers. The intervention included peer messages sent for six months that promoted Quitline use and smoking cessation. Additionally, biweekly two-way text messages assessed participants’ interest in Quitline referral and current smoking status. Comparison participants received only the bi-weekly text message assessment of their current smoking status. At six months, we assessed Quitline use and smoking cessation. Smoking cessation was assessed using the 7-day point prevalence question and verified with a carbon monoxide breath monitor (<=6 ppm).Results: Among 750 participants, the intervention had higher Quitline verified use (18%, 95% CI 0.14, 0.22) than comparison (1%, 95% CI .2, 2, p < 0.0001). Carbon-monoxide-verified smoking cessation did not differ between the two groups. However, intervention (28.3%, 95% CI) and comparison (28.1%, 95% CI) participants had substantial rates of carbon monoxide cessation at 6 months (both 28%).Conclusion: Our study highlighted the promise of texting interventions to extend tobacco control efforts in Vietnam.

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“…Further, there were no a priori reasons to expect self-reported tobacco product use behaviors to vary across the independent variables of interest in this study (i.e., preference for menthol or non-menthol cigarettes and use of menthol or non-menthol HTP). Although remote biochemical veri cation of smoking status has become logistically possible in recent years (e.g., 49, 50-52), its use in the current actual use study would have further reduced ecological validity and placed unnecessary burden upon participants that may outweigh any bene t of such measurement (53,54).…”

Section: Discussionmentioning

confidence: 99%

Switching Behavior and Changes in Smoking Behavior by Menthol Cigarette Preference and Menthol Heated Tobacco Product Use Among Adults Who Smoke Cigarettes: An Actual Use Study

Karelitz,

He,

Becker

et al. 2024

Preprint

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Background: Heated tobacco products (HTPs) deliver nicotine with significantly lower toxicant exposure relative to combustible cigarettes. HTPs may serve as viable tobacco harm reduction options for adults who smoke (AS) but are not able or willing to stop consuming nicotine-containing products. There is limited information on switching away from or reducing combusted cigarette consumption among AS provided with HTPs, and none assessing differences due to menthol cigarette preference or menthol HTP use. Methods: In a six-week actual use study of HTP, AS ages 21-64 (n=615) who were not planning to quit smoking combusted cigarettes were offered free choice of HTPs (one non-menthol and two menthol varieties) to use ad libitum. Preference for smoking menthol or non-menthol cigarettes was assessed upon study entry (374 menthol; 241 non-menthol). The number of HTP sticks and combusted cigarettes consumed were measured daily. Complete switching was defined as reporting consuming zero combusted cigarettes while continuing to use the HTP research product in Week 6. Results: Overall, 247 participants completely switched to HTP, corresponding to 21.1% of all those enrolled at baseline (n=1173) or 40.2% of the analytic sample (n=615). Among the analytic sample, we observed greater switching among AS who preferred menthol versus non-menthol cigarettes (46.8% vs 29.9%). Probability of switching increased with greater proportional use of menthol versus non-menthol HTPs. Non-menthol cigarette-preferring AS had greater increases in switching when using proportionally more menthol than non-menthol HTPs; switching remained consistently high among menthol-preferring AS. Among participants who did not switch and continued smoking at Week 6, preference for menthol cigarettes and use of proportionally greater menthol versus non-menthol HTPs were each associated with greater reductions in cigarette consumption. Conclusions: HTP use facilitated switching away from or reducing consumption of combusted cigarettes among AS, especially when using menthol HTPs. Most AS used menthol HTPs, regardless of their incoming preference for smoking menthol or non-menthol cigarettes. Availability of HTPs in menthol and non-menthol varieties offers an increased tobacco harm reduction opportunity over non-menthol only by providing AS with smoke-free alternatives that they find appealing, reduce toxicant exposure, and can effectively support their transition away from combusted cigarettes.

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Commentary on Graham et al.: Biochemical verification of abstinence in remotely conducted smoking cessation trials should not be a universal design requirement for rigor

Cited by 7 publications

References 8 publications

Monitoring Cigarette Smoking and Relapse in Young Adults With and Without Remote Biochemical Verification: Randomized Brief Cessation Study

Monitoring Cigarette Smoking and Relapse in Young Adults With and Without Remote Biochemical Verification: Randomized Brief Cessation Study

Peer Texting to Promote Quitline Use and Smoking Cessation Among Rural Participants in Vietnam: Randomized Clinical Trial

Switching Behavior and Changes in Smoking Behavior by Menthol Cigarette Preference and Menthol Heated Tobacco Product Use Among Adults Who Smoke Cigarettes: An Actual Use Study

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