Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial

Abstract

Background Smoking is the leading cause of premature death, and low-income adults experience disproportionate burden from tobacco. Mindfulness interventions show promise for improving smoking cessation. A text messaging program “iQuit Mindfully” was developed to deliver just-in-time support for quitting smoking among low-income adults. A pilot study of iQuit Mindfully was conducted in spring 2020, during the COVID-19 pandemic, among low-income and predominantly African American smokers. Objective This pilot study examined the acceptability and feasibility of delivering Mindfulness-Based Addiction Treatment via mHealth during the COVID-19 pandemic. Methods Participants were adult cigarette smokers (n=23), of whom 8 (34.8%) were female, 19 (82.6%) were African American, and 18 (78.3%) had an annual income of <US $24,000. They were randomly assigned to either 8 weeks of iQuit Mindfully as a fully automated standalone intervention or iQuit Mindfully in combination with therapist-led in-person group treatment. For participant safety, in-person mindfulness groups were transitioned to the internet and assessments also took place over the internet. Survey questions asked participants about changes in their stress, smoking habits and quit attempts, and their perceptions of the mindfulness and text messaging intervention in the context of the pandemic. Results Most participants (n=15 of 21, 71.4%) indicated a change in stress due to the pandemic, of whom 14 (93.3%) indicated higher stress. Participants shared concerns about finances, homelessness, health, and social isolation. Most (n=17 of 21, 80.9%) believed that smoking increases the risk of contracting COVID-19, and although that was motivating for some, others expressed lower motivation to quit smoking because of higher stress. Most (n=18 of 21, 85.7%) stated that practicing mindfulness was helpful during the pandemic. Mean ratings of the helpfulness of text messages and the extent to which they would recommend the program to others were 7.1 (median 8 on a 10-point scale, SD 2.9) and 8.2 (median 9, SD 2.5), respectively. Through open-ended program evaluations, participants shared details about how mindfulness practices and the text messages helped them manage stress and feel a sense of social support during the pandemic. Moreover, 10 of 19 (52.6%) of participants achieved 7-day abstinence from smoking, with no differences between conditions. Conclusions This study supports the promise of text messaging and the use of teleconferencing to provide mindfulness and smoking cessation services to underserved populations during a pandemic.

Dismantling the Component-Specific Effects of Yogic Breathing: Feasibility of a Fully Remote Three-Arm RCT with Virtual Laboratory Visits and Wearable Physiology

“…Studies with remotely delivered mindfulness-based interventions have been increasing [ 23 ], especially during the COVID-19 pandemic. An increasing number of studies have aimed to investigate the feasibility of remotely delivered mindfulness-based interventions involving various populations, for example, perinatal women [ 26 , 62 ], elementary school students [ 63 ], adolescents [ 24 ], advanced cancer patients and their informal caregivers [ 64 ], adult cigarette smokers [ 65 ], and medical students/professionals [ 25 , 62 ]. Collectively, these studies have reported improvements in resilience, stress management, depression, anxiety, emotional wellbeing, sleep, and mindfulness.…”

Mindfulness and Mobile Health for Quitting Smoking: A Qualitative Study Among Predominantly African American Adults with Low Socioeconomic Status

“…Participants indicated positive experiences with the text messages and reported that the encouragement, social support, and specific strategies offered were useful in their attempts to quit smoking. Participants' suggestions are being incorporated into the next version of iQuit Mindfully (e.g., Mhende et al, 2021). The COVID-19 pandemic has further heightened awareness of the need for mHealth interventions when in-person treatment is not feasible.…”

Mindfulness-Based Smoking Cessation Delivered Through Telehealth and Text Messaging for Low-Income Smokers: Protocol for a Randomized Controlled Trial

“…To our knowledge, mindfulness-based smoking cessation treatment has not been delivered through group videoconferencing, although MBIs for smoking cessation have been provided through web-based prerecorded video instructions with telephone counseling support [ 22 ] and smartphone apps [ 23 , 24 ]. Given the safety concerns with in-person groups during the COVID-19 pandemic and our goal of developing more scalable interventions, we recently transitioned mindfulness-based addiction treatment (MBAT), an 8-week group-based smoking cessation intervention, from in-person to web-based delivery [ 25 ]. The first 5 weekly sessions were conducted in person, with the last 3 successfully delivered through group videoconferencing.…”

“…Building on this initial work, we incorporated participant feedback to further increase interactivity and personalization so that iQuit Mindfully can more flexibly adapt to the changing needs of the participants. We also developed a version of iQuit Mindfully that can be implemented as a stand-alone program (ie, without weekly mindfulness-based group sessions) [ 25 ].…”