Peer Mentoring and Automated Text Messages for Smoking Cessation: A Randomized Pilot Trial

E-cigarette cessation interest and quit attempts among young adults reporting exclusive e-cigarette use or dual use with other tobacco products: How can we reach them?

INTRODUCTION

There is limited evidence to inform e-cigarette quitting interventions. This mixed-methods study examined: 1) e-cigarette and other tobacco product perceptions and cessation-related factors; and 2) potential behavioral intervention strategies among young adults reporting exclusive e-cigarette use or dual use with other tobacco products.

METHODS

We analyzed Fall 2020 survey data from 726 participants reporting past 6-month e-cigarette use (mean age=24.15 years, 51.1% female, 38.5% racial/ethnic minority) from 6 US metropolitan areas and Spring 2021 qualitative interview data from a subset (n=40), comparing tobacco-related perceptions and cessation-related factors among those reporting exclusive use versus dual use.

RESULTS

Among survey participants (35.5% exclusive e-cigarette use, 64.5% dual use), those reporting dual use indicated greater importance of quitting all tobacco or nicotine products (mean=5.28, SD=3.44 vs mean=4.65, SD=3.75, p=0.033), whereas those reporting exclusive use expressed greater confidence in quitting e-cigarettes (mean=7.59, SD=3.06 vs mean=7.08, SD=3.01, p=0.029) and all tobacco and nicotine products (mean=7.00, SD=3.16 vs mean=6.31, SD=3.13, p=0.008), as well as less favorable perceptions (i.e. more harmful to health and addictive, less socially acceptable) of cigarettes, cigars, and smokeless tobacco (p<0.05). Interview participants (50.0% exclusive e-cigarette use; 50.0% dual use) attributed previous failed e-cigarette quit attempts to their inability to cope with social influences, stress, and withdrawal symptoms. Although most expressed disinterest in quitting due to belief of eventually outgrowing e-cigarettes (among those reporting exclusive use) or unreadiness to abstain from nicotine (among those reporting dual use), many acknowledged the need for quitting interventions.

CONCLUSIONS

Young adult e-cigarette cessation interventions should target risk perceptions, cessation barriers, and social influences/support.

Effectiveness of eHealth Smoking Cessation Interventions: Systematic Review and Meta-Analysis

BACKGROUND

Rapid advancements in eHealth and mobile health (mHealth) technologies have driven researchers to design and evaluate numerous technology-based interventions to promote smoking cessation. The evolving nature of cessation interventions emphasizes a strong need for knowledge synthesis.

OBJECTIVE

This systematic review and meta-analysis aimed to summarize recent evidence from randomized controlled trials regarding the effectiveness of eHealth-based smoking cessation interventions in promoting abstinence and assess nonabstinence outcome indicators, such as cigarette consumption and user satisfaction, via narrative synthesis.

METHODS

We searched for studies published in English between 2017 and June 30, 2022, in 4 databases: PubMed (including MEDLINE), PsycINFO, Embase, and Cochrane Library. Two independent reviewers performed study screening, data extraction, and quality assessment based on the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework. We pooled comparable studies based on the population, follow-up time, intervention, and control characteristics. Two researchers performed an independent meta-analysis on smoking abstinence using the Sidik-Jonkman random-effects model and log risk ratio (RR) as the effect measurement. For studies not included in the meta-analysis, the outcomes were narratively synthesized.

RESULTS

A total of 464 studies were identified through an initial database search after removing duplicates. Following screening and full-text assessments, we deemed 39 studies (n=37,341 participants) eligible for this review. Of these, 28 studies were shortlisted for meta-analysis. According to the meta-analysis, SMS or app text messaging can significantly increase both short-term (3 months) abstinence (log RR=0.50, 95% CI 0.25-0.75; I2=0.72%) and long-term (6 months) abstinence (log RR=0.77, 95% CI 0.49-1.04; I2=8.65%), relative to minimal cessation support. The frequency of texting did not significantly influence treatment outcomes. mHealth apps may significantly increase abstinence in the short term (log RR=0.76, 95% CI 0.09-1.42; I2=88.02%) but not in the long term (log RR=0.15, 95% CI -0.18 to 0.48; I2=80.06%), in contrast to less intensive cessation support. In addition, personalized or interactive interventions showed a moderate increase in cessation for both the short term (log RR=0.62, 95% CI 0.30-0.94; I2=66.50%) and long term (log RR=0.28, 95% CI 0.04-0.53; I2=73.42%). In contrast, studies without any personalized or interactive features had no significant impact. Finally, the treatment effect was similar between trials that used biochemically verified or self-reported abstinence. Among studies reporting outcomes besides abstinence (n=20), a total of 11 studies reported significantly improved nonabstinence outcomes in cigarette consumption (3/14, 21%) or user satisfaction (8/19, 42%).

CONCLUSIONS

Our review of 39 randomized controlled trials found that recent eHealth interventions might promote smoking cessation, with mHealth being the dominant approach. Despite their success, the effectiveness of such interventions may diminish with time. The design of more personalized interventions could potentially benefit future studies.

TRIAL REGISTRATION

PROSPERO CRD42022347104; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=347104.

Gender Differences in the Interrelations Among Social Support, Stressful Life Events, and Smoking Cessation in People With Severe Mental Illnesses

BACKGROUND

Social support and stressful life events (SLEs) have been found to be influential factors for smoking cessation in the general population, but little is known about these factors among smokers with severe mental illnesses (SMIs) and whether their associations with smoking cessation differ by gender.

AIMS

To examine the association between social support and smoking cessation as mediated by SLEs in people with SMI and to examine whether the interrelations among social support, SLEs, and smoking cessation differ by gender.

METHODS

A population sample of 4,610 American lifetime adult smokers with schizophrenia, bipolar disorder, or major depressive disorder were identified in a limited public use data set of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. Four mediation and moderated mediation models were used to examine gender differences in the interrelations among social support (total and three subscales of the Interpersonal Support Evaluation List-12), SLEs (summative score of positive responses to 16 types experienced in past year and related to health, job, death, or legal situations), and smoking status in prior year.

RESULTS

Total, appraisal, and tangible support among females exerted indirect effects on smoking cessation via decreasing SLE scores. Among males, only belonging support exerted an indirect effect on smoking cessation via an increased SLE score.

CONCLUSIONS

Findings suggest that interventions focusing on improving social support should be a priority for those working with smokers with SMI.

A pilot randomized controlled trial of automated and counselor-delivered text messages for e-cigarette cessation

INTRODUCTION

Automated text messaging programs show promise for e-cigarette cessation. Adding live text counseling could make them more engaging. We developed Quit the Vape (QTV), an automated e-cigarette cessation text messaging program, designed to be delivered as stand-alone or with counselor-delivered messages (QTV-C), and evaluated the acceptability and preliminary efficacy of QTV and QTV-C.

METHODS

Between May and August 2021, we recruited 58 e-cigarette users, aged 20-43 years, 53.5% male, 63.8% non-Hispanic White, from an ongoing cohort study in the United States. Inclusion criteria were: using nicotine-containing e-cigarettes on ≥4 days per month; smartphone ownership; and not receiving tobacco cessation treatment. Motivation to quit did not impact eligibility. Participants were randomized to QTV (n=20), QTV-C (n=19), or control (link to e-cigarette cessation website, n=19). At end-of-treatment, we assessed program engagement and satisfaction, and self-reported quitting behaviors (e.g. point prevalence abstinence, PPA).

RESULTS

At baseline, average past-month e-cigarette use was 26.8 days (SD=6.2). At follow-up at 4 weeks, among QTV and QTV-C participants, ≥85% replied to ≥1 message, ≥35% set a quit date, and ≤15% opted out. More QTV and QTV-C participants (55.6%) versus control (17.7%) reported program satisfaction (p=0.034). QTV-C participants (vs QTV and control) trended more favorably on 7-day e-cigarette PPA [27.8% (95% CI: 11.5-53.3) vs 11.1% (95% CI: 2.6-37.0) and 5.9% (95% CI: 0.7-34.5)] and quit attempts [66.7% (95% CI: 41.6-84.9) vs 50.0% (95% CI: 27.4-72.6) and 52.9% (95% CI: 29.2-75.5)].

CONCLUSIONS

Adding live text counseling to an automated text messaging program is acceptable and shows promise for e-cigarette cessation. A larger trial is warranted to assess its efficacy.

Analysis of Patient Cues in Asynchronous Health Interactions: Pilot Study Combining Empathy Appraisal and Systemic Functional Linguistics

BACKGROUND

Lifestyle-related diseases are among the leading causes of death and disability. Their rapid increase worldwide has called for low-cost, scalable solutions to promote health behavior changes. Digital health coaching has proved to be effective in delivering affordable, scalable programs to support lifestyle change. This approach increasingly relies on asynchronous text-based interventions to motivate and support behavior change. Although we know that empathy is a core element for a successful coach-user relationship and positive patient outcomes, we lack research on how this is realized in text-based interactions. Systemic functional linguistics (SFL) is a linguistic theory that may support the identification of empathy opportunities (EOs) in text-based interactions, as well as the reasoning behind patients' linguistic choices in their formulation.

OBJECTIVE

This study aims to determine whether empathy and SFL approaches correspond and complement each other satisfactorily to study text-based communication in a health coaching context. We sought to explore whether combining empathic assessment with SFL categories can provide a means to understand client-coach interactions in asynchronous text-based coaching interactions.

METHODS

We retrieved 148 text messages sent by 29 women who participated in a randomized trial of telecoaching for the prevention of gestational diabetes mellitus (GDM) and postnatal weight loss. We conducted a pilot study to identify users' explicit and implicit EOs and further investigated these statements using the SFL approach, focusing on the analysis of transitivity and thematic analysis.

RESULTS

We identified 164 EOs present in 42.37% (3478/8209) of the word count in the corpus. These were mainly negative (n=90, 54.88%) and implicit (n=55, 60.00%). We distinguished opening, content and closing messages structures. Most of the wording was found in the content (n=7077, 86.21%) with a declarative structure (n=7084, 86.30%). Processes represented 22.4% (n=1839) of the corpus, with half being material (n=876, 10.67%) and mostly related to food and diet (n=196, 54.92%), physical activity (n=96, 26.89%), and lifestyle goals (n=40, 11.20%).

CONCLUSIONS

Our findings show that empathy and SFL approaches are compatible. The results from our transitivity analysis reveal novel insights into the meanings of the users' EOs, such as their seek for help or praise, often missed by health care professionals (HCPs), and on the coach-user relationship. The absence of explicit EOs and direct questions could be attributed to low trust on or information about the coach's abilities. In the future, we will conduct further research to explore additional linguistic features and code coach messages.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620001240932; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380020.

Perceptions and Aspirations Toward Peer Mentoring in Social Media-Based Electronic Cigarette Cessation Interventions for Adolescents and Young Adults: Focus Group Study

BACKGROUND

Social media offer a promising channel to deliver e-cigarette cessation interventions to adolescents and young adults (AYAs); however, interventions delivered on social media face challenges of low participant retention and decreased engagement over time. Peer mentoring has the potential to ameliorate these challenges.

OBJECTIVE

The aim of this study was to understand, from both the mentee and potential mentor perspective, the needs, expectations, and concerns of AYAs regarding peer mentoring to inform the development of social media-based peer mentoring interventions for e-cigarette cessation among AYAs.

METHODS

Seven focus groups, including four mentee groups and three potential mentor groups, were conducted with 26 AYAs who had prior experience with e-cigarette use and attempts to quit in the context of a social media-based e-cigarette cessation intervention. Discussion focused on preferred characteristics of peer mentors, expectations about peer mentoring, mentoring mode, mentor training, incentives for peer mentors, preferred social media platforms for intervention delivery, supervision, and concerns. Focus group transcripts were coded and analyzed using a thematic analysis approach.

RESULTS

Overall, participants were receptive to peer mentoring in social media-based cessation interventions and believed they could be helpful in assisting e-cigarette cessation. Participants identified the most important characteristics of peer mentors to be of similar age and to be abstinent from e-cigarette use. Participants expected peer mentors would share personal experiences, provide emotional support, and send check-ins and reminders. Peer mentors supporting a group of mentees in combination with one-on-one mentoring as needed was the preferred mentoring mode. A group of 10 mentees with a mentor:mentee ratio of 1:3-5 was deemed acceptable for most participants. Participants expressed that mentor training should include emotional intelligence, communication skills, and the scientific evidence about e-cigarettes. Although monetary incentives were not the main motivating factor for being a peer mentor, they were viewed as a good way to compensate mentors' time. Instagram was considered an appropriate social media platform to deliver a peer-mentored intervention due to its functionality. Participants did not express many privacy concerns about social media-based peer mentoring, but mentioned that boundaries and community agreements should be set to keep relationships professional.

CONCLUSIONS

This study reflects the needs and preferences of young people for a peer mentoring intervention to complement a social media program to support e-cigarette cessation. The next step will be to establish the feasibility, acceptability, and preliminary efficacy of such a peer mentoring program.

Adaptation and Assessment of a Text Messaging Smoking Cessation Intervention in Vietnam: Pilot Randomized Controlled Trial

Background

Text message (ie, short message service, SMS) smoking cessation interventions have demonstrated efficacy in high-income countries but are less well studied in low- and middle-income countries, including Vietnam.

Objective

The goal of the research is to assess the feasibility, acceptability, and preliminary efficacy of a fully automated bidirectional SMS cessation intervention adapted for Vietnamese smokers.

Methods

The study was conducted in 3 phases. In phase 1, we adapted the SMS library from US-based SMS cessation programs (ie, SmokefreeTXT and Text2Quit). The adaptation process consisted of 7 focus groups with 58 smokers to provide data on culturally relevant patterns of tobacco use and assess message preferences. In phase 2, we conducted a single-arm pilot test of the SMS intervention with 40 smokers followed by in-depth interviews with 10 participants to inform additional changes to the SMS library. In phase 3, we conducted a 2-arm pilot randomized controlled trial (RCT) with 100 smokers. Participants received either the SMS program (intervention; n=50) or weekly text assessment on smoking status (control; n=50). The 6-week SMS program consisted of a 2-week prequit period and a 4-week postquit period. Participants received 2 to 4 automated messages per day. The main outcomes were engagement and acceptability which were assessed at 6 weeks (end of intervention). We assessed biochemically confirmed smoking abstinence at 6 weeks and 12 weeks. Postintervention in-depth interviews explored user experiences among a random sample of 16 participants in the intervention arm.

Results

Participants in both arms reported high levels of engagement and acceptability. Participants reported using the program for an average of 36.4 (SD 3.4) days for the intervention arm and 36.0 (SD 3.9) days for the control arm. Four of the 50 participants in the intervention arm (8%) reset the quit date and 19 (38%) texted the keyword TIPS. The majority of participants in both arms reported that they always or usually read the text messages. Compared to the control arm, a higher proportion of participants in the intervention arm reported being satisfied with the program (98% [49/50] vs 82% [41/50]). Biochemically verified abstinence was higher in the intervention arm at 6 weeks (20% [10/50] vs 2% [1/50]; P=.01), but the effect was not significant at 12 weeks (12% [6/50] vs 6% [3/50]; P=.49). In-depth interviews conducted after the RCT suggested additional modifications to enhance the program including tailoring the timing of messages, adding more opportunities to interact with the program, and placing a greater emphasis on messages that described the harms of smoking.

Conclusions

The study supported the feasibility and acceptability of an SMS program adapted for Vietnamese smokers. Future studies need to assess whether, with additional modifications, the program is associated with prolonged abstinence.

Trial Registration

ClinicalTrials.gov NCT03219541; https://clinicaltrials.gov/ct2/show/NCT03219541

A synthesis of the literature to inform vaping cessation interventions for young adults

There is an urgent need to address young adult (YA) vaping. However, there is limited vaping cessation intervention research, particularly studies tested via experimental designs. This manuscript focuses on YA vaping and critical needs for research to advance vaping cessation interventions for YAs. The smoking cessation literature, especially regarding YA smoking, provides evidence and theory from which to draw. However, the extent to which this literature has utility for vaping cessation warrants investigation. Research to inform the development and optimization of effective vaping cessation interventions for YAs requires attention to both potential targets for behavioral intervention (e.g., conceptual framework) and how to best reach YAs (i.e., delivery modality). Regarding the former, such interventions must consider the complexity of YA vaping (e.g., complex social influences, limited negative outcome expectancies, quit intentions). One particularly challenging aspect of YA cessation is co-use of other tobacco products and marijuana and ensuring that those who quit vaping do not continue or increase other product use. With regard to intervention modality, technology-based interventions (e.g., text messaging, apps) may prove promising, and individualized intervention (e.g., one-on-one counseling) may be needed to carefully intervene on the complexity of substance use, particularly cigarette and marijuana use, within this population.

The Effect of Peer Education on Decision-Making, Smoking-Promoting Factors, Self-Efficacy, Addiction, and Behavior Change in the Process of Quitting Smoking of Young People

Purpose

The study aims to examine the effect of peer education on the decision to quit smoking, factors that encourage smoking, self-efficacy, addiction, and behavior change in students who apply to the Youth Friendly Center to quit smoking.

Participants and Methods

This research is a Randomized Controlled Trials study. The experimental group consisted of students who were enrolled in the peer education course (n=759). The control group has consisted of students (n=1095) who did not enroll in this course.

Results

Participants in the experimental group to quit smoking, more than the control group (p>0,01). The addiction level of the participants in the experimental group, less than the participants in the control group (p>0,01). According to the scores of the participants in the control group of the participants in the experimental group, the factors that trigger smoking, and the benefit sub-dimension scores in the Decision Balance Scale were low. Loss sub-dimension scores, which show the losses from the harms of smoking, increased significantly in the Self-Efficacy Scale, Behavior Change Process Scale, and Decision Balance Scale (p>0,01).

Conclusion

Peer educators trained by the researcher and her team in the Youth Friendly Center Smoking Quit Program have an important effect in supporting/improving the cognitive and behavioral change processes of university students in smoking quit compared to those who do not receive an education. 94% success of the smoking quit program; Students’ voluntary application to receive professional support, students’ voluntary attendance of the treatment program for 6 months, strong communication and feedback, effective and functional professional counseling, and social support depend on strengthening the program with peer education. Especially with peer education, the development of leadership and role model characteristics made the smoking quit program preferred by students.

Mobile phone-based messaging for tobacco cessation in low and middle-income countries: A systematic review

INTRODUCTION

Mobile phone-based tobacco cessation (mCessation) interventions are effective in high-income countries but their effectiveness in low and middle-income countries (LMICs) is unclear. We aimed to assess the evidence-base for mCessation interventions in LMICs by synthesizing study characteristics and to describe intervention characteristics and content.

METHODS

Studies were included in this review if they evaluated an intervention that targeted tobacco users, were conducted in an LMIC, measured tobacco cessation as a primary or secondary outcome, and were primarily delivered using mobile phone (text or app-based) messaging. Data were extracted on fields pertaining to study and intervention characteristics and study quality was assessed using the Effective Public Health Practice Project tool. Screening, extraction and quality assessment were conducted by two independent reviewers.

RESULTS

Of 606 unique records, 12 articles were included. The majority of studies were methodologically weak. Methodological limitations included small sample sizes, short follow-up durations and use of self-reported outcomes. Most evaluations were conducted in upper middle-income countries with urban, adult smokers intending to quit smoking. Approximately half the interventions were bidirectional (enabled two-way messaging) and fully automated. Almost all interventions were delivered via SMS. Treatment offerings of the intervention and control groups varied widely.

CONCLUSIONS

More rigorous large-scale randomized controlled trials are needed to conclusively establish the efficacy of mCessation interventions in LMICs. Interventions also need to be tested across more diverse populations and settings. Future studies should test the relative effectiveness of different intervention characteristics.

Effectiveness of community health workers involvement in smoking cessation programme: A systematic review

BACKGROUND

Sustainable Development Goals (SDG) has set the target to reduce premature mortalities from non-communicable diseases (NCDs) by one-third. One of the ways to achieve this is through strengthening the countries' implementation of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). Community health workers (CHWs) involvement has shown promising results in the prevention of NCDs. This systematic review is aimed at critically evaluating the available evidence on the effectiveness of involving CHWs in smoking cessation.

MATERIALS AND METHODS

We systemically searched PubMed and CENTRAL up to September 2019. We searched for published interventional studies on smoking cessation interventions using the usual care that complemented with CHWs as compared to the usual or standard care alone. Our primary outcome was abstinence of smoking. Two reviewers independently extracted data and assessed study risks of bias.

RESULT

We identified 2794 articles, of which only five studies were included. A total of 3513 smokers with 41 CHWs were included in the studies. The intervention duration range from 6 weeks to 30 months. The studies used behavioral intervention or a combination of behavioral intervention and pharmacological treatment. Overall, the smoking cessation intervention that incorporated involvement of CHWs had higher smoking cessation rates [OR 1.95, 95% CI (1.35, 2.83)]. Significant smoking cessation rates were seen in two studies.

CONCLUSION

Higher smoking cessation rates were seen in the interventions that combined the usual care with interventions by CHWs as compared to the usual care alone. However, there were insufficient studies to prove the effectiveness. In addition, there was high heterogeneity in terms of interventions and participants in the current studies.

Text2Quit: An analysis of user experiences with a mobile smoking cessation program

INTRODUCTION

Studies have shown that Text2Quit and other mobile cessation programs increase quit rates in adult smokers, but the mechanism of effects and user experiences are not well understood.

AIMS

This study reports on participants' experiences with the program and explores aspects of the program that they liked and disliked.

METHODS

Self-reported experiences of the program were collected through a follow-up survey conducted one month after enrollment (n=185). Participant responses to open-ended items were dual coded by independent coders.

RESULTS

Overall participants agreed that they liked the program (4.2/5), that the program was helpful (4.1/5) and that they would recommend the program to a friend (4.3/5). Top reasons for liking the program included that it served as a constant reminder of quitting (17.8%), the content (16.7%), the encouragement provided (13.3%), and the on-demand tools (12.2%). Top reasons for disliking the program were message frequency (20.5%), content (7.0%), and the lack of personal interaction (7.0%).

CONCLUSIONS

The constancy of messaging was both liked as a reminder and disliked as an annoyance. Future programs might be improved by pre-testing and customizing the content based on user preferences, and by adding in human interactions, while keeping a supportive tone and offering on-demand tools.

Live counselor contact in a Facebook intervention predicts smoking cessation outcomes

Digital smoking cessation interventions frequently use automated delivery of content. Integrating a counselor may improve participant engagement and facilitate health behavior change. We investigated engagement with live counseling compared to automated content in a Facebook intervention and the impact of engagement on smoking cessation outcomes. The Tobacco Status Project is a 90-day smoking cessation intervention for young adults utilizing automated posts and weekly sessions with a live counselor in Facebook groups tailored to readiness to quit (precontemplation, contemplation, preparation). Data came from the treatment group of a randomized trial. Post-level analyses investigated participant engagement (number of comments) by post type (e.g., counselor posts or automated posts based on transtheoretical model of behavior change, clinical practice guidelines, motivational interviewing), stratified by readiness to quit. Participant-level analyses examined whether extent of participant engagement with counselor posts predicted abstinence at 3 months. We analyzed data of N = 251 participants and N = 2,941 posts, 11% of which were live counselor initiated, and together generated 8,403 comments. Post-level analyses found that compared to the most engaging automated content (motivational content for precontemplation and contemplation, informational content for preparation), live counseling generated more engagement among participants in preparation, similar engagement in precontemplation, and less engagement in contemplation. Extent of live counseling participation predicted 3-month verified abstinence (adjusted OR = 1.10, 95% CI [1.02, 1.20]). In digital interventions, counselor contact may be beneficial in addition to automated posts at yielding engagement and abstinence; however, participants engage differently with counseling according to readiness to quit. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Smoking cessation with smartphone applications (SWAPP): study protocol for a randomized controlled trial

Background

Tobacco smoking remains one of the biggest public health threats. Smartphone apps offer new promising opportunities for supporting smoking cessation in real-time. The social context of smokers has, however, been neglected in smartphone apps promoting smoking cessation. This randomized controlled trial investigates the effectiveness of a smartphone app in which smokers quit smoking with the help of a social network member.

Methods

This protocol describes the design of a single-blind, two-arm, parallel-group, intensive longitudinal randomized controlled trial. Participants of this study are adult smokers who smoke at least one cigarette per day and intend to quit smoking at a self-set quit date. Blocking as means of group-balanced randomization is used to allocate participants to intervention or control conditions. Both intervention and control group use a smartphone-compatible device for measuring their daily smoking behavior objectively via exhaled carbon monoxide. In addition, the intervention group is instructed to use the SmokeFree Buddy app, a multicomponent app that also facilitates smoking-cessation specific social support from a buddy over a smartphone application. All participants fill out a baseline diary for three consecutive days and are invited to the lab for a background assessment. They subsequently participate in an end-of-day diary phase from 7 days before and until 20 days after a self-set quit date. Six months after the self-set quit date a follow-up diary for three consecutive days takes place. The primary outcome measures are daily self-reported and objectively-assessed smoking abstinence and secondary outcome measures are daily self-reported number of cigarettes smoked.

Discussion

This is the first study examining the effectiveness of a smoking cessation mobile intervention using the SmokeFree Buddy app compared to a control group in a real-life setting around a self-set quit date using a portable objective measure to assess smoking abstinence. Opportunities and challenges with running studies with smoking participants and certain design-related decisions are discussed.

Trial registration

This trial was prospectively registered on 04/04/2018 at ISRCTNregistry: ISRCTN11154315.