Initial Assessment of a Comprehensive Digital Smoking Cessation Program That Incorporates a Mobile App, Breath Sensor, and Coaching: Cohort Study (Preprint)

BACKGROUND Cigarette smoking is the leading cause of preventable morbidity and mortality, excess health care expenditure, and lost work productivity. Otherwise effective evidence-based treatments have had limited success owing to challenges with access, engagement, and scale. Pivot is a comprehensive digital smoking cessation program that incorporates a Food and Drug Administration–cleared carbon monoxide breath sensor, smartphone app, and text-based human coaching. OBJECTIVE This initial evaluation of Pivot aimed to assess participant engagement, changes in attitudes toward quitting, and changes in smoking behavior. METHODS US cigarette smokers aged 18 to 65 years who smoked ≥5 cigarettes per day (CPD) were recruited online. Participants completed a screening call, electronic informed consent, registration, and onboarding before beginning Pivot. Pivot includes 5 sequential stages (Explore, Build, Mobilize, Quit, and Secure), taking 14.5 to 18.5 weeks to complete. Data were collected via app and online questionnaires. Outcomes included engagement and retention (ie, weeks of active engagement and Pivot stage progression); attitudes toward quitting (ie, quit readiness, quit confidence, and expected difficulty maintaining quit); and smoking behavior (ie, quit attempts, cigarette reduction, and abstinence (7- and 30-day point prevalence abstinence [PPA]). RESULTS A total of 319 participants completed onboarding (intention-to-treat [ITT] sample); 272/319 participants (85.3%) completed the end-of-Pivot questionnaire (study completer sample). Most (212/319, 66.5%) were not ready to quit in the next 30 days at baseline. On average, participants actively engaged in the program for a mean 12.4 (SD 7.1) weeks. Pivot stage completion rates were Explore: 88.7% (283/319), Build: 57.4% (183/319), Mobilize: 43.6% (139/319), Quit: 41.1% (131/319), and Secure: 39.5% (126/319). Repeated measures linear mixed model analyses demonstrated positive changes in attitudes from baseline to Mobilize (pre-Quit): increased confidence to quit (4.2 to 7.4, P<.001) and decreased expected difficulty maintaining quit (3.1 to 6.8, P<.001). The quit attempt rate (ie, those making ≥1 quit attempt lasting ≥1 day) was 79.4% (216/272, completer). At the end of Pivot, 7-day PPA rates were 32.0% (102/319, ITT) and 37.5% (102/272, completer); 30-day PPA rates were 27.6% (88/319, ITT) and 32.4% (88/272, completer). Moreover, 30-day PPA rates were comparable among those ready and not ready to quit in the next 30 days at baseline. Of those not achieving abstinence, 25.9% (44/170, completer) achieved ≥50% reduction in CPD by study end. CONCLUSIONS This study evaluated Pivot’s initial performance with comparable quit rates among those ready and not ready to quit in the next 30 days at entry. The present data, considered with the program’s accessibility, innovation, evidence-based foundation, and design for all smokers, suggest Pivot has the potential to address limitations of reach and scale and thereby advance smoking cessation efforts. CLINICALTRIAL ClinicalTrials.gov NCT03295643; https://clinicaltrials.gov/ct2/show/NCT03295643 (Archived by WebCite at http://www.webcitation.org/75TiNe6BE).

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Durability of Abstinence After Completing a Comprehensive Digital Smoking Cessation Program Incorporating a Mobile App, Breath Sensor, and Coaching: Cohort Study (Preprint)

10.2196/preprints.25578 ◽

2020 ◽

Author(s):

Jennifer D Marler ◽

Craig A Fujii ◽

Joseph A Galanko ◽

Daniel J Balbierz ◽

David S Utley

Keyword(s):

Smoking Cessation ◽

Cohort Study ◽

Smoking Behavior ◽

Mobile App ◽

Smoking Cessation Program ◽

Regression Analyses ◽

Online Questionnaire ◽

Quit Attempt ◽

Continuous Abstinence

BACKGROUND Despite decreasing prevalence over the last several decades, cigarette smoking remains the leading cause of preventable death and disease, underscoring the need for innovative, effective solutions. Pivot is a novel, inclusive smoking cessation program designed for smokers along the entire spectrum of readiness to quit. Pivot leverages proven methods and technological advancements, including a personal portable breath carbon monoxide sensor, smartphone app, and in-app text-based coaching. We previously reported outcomes from the end of active Pivot program participation in 319 adult smokers. Herein, we report longer-term follow up in this cohort. OBJECTIVE The aim of this study was to assess and report participant outcomes 3 months after completion of Pivot, including smoking behavior, quit rates, continuous abstinence rates and durability, and predictors of abstinence. METHODS This prospective remote cohort study included US-based cigarette smokers aged 18 to 65 years who smoked ≥5 cigarettes per day (CPD). Three months after completion of active participation in Pivot, final follow-up data were collected via an online questionnaire. Outcomes included smoking behavior (CPD and quit attempts), self-reported quit rates (7- and 30-day point prevalence abstinence [PPA]), and continuous abstinence rates (proportion who achieved uninterrupted abstinence) and duration. Exploratory regression analyses were performed to identify baseline characteristics associated with achievement of 7-day PPA, 30-day PPA, and continuous abstinence. RESULTS A total of 319 participants completed onboarding (intention-to-treat [ITT]); 288/319 participants (90.3%) completed follow up (completers) at a mean of 7.2 (SD 1.2) months after onboarding. At final follow up, CPD were reduced by 52.6% (SE 2.1; <i>P</i><.001) among all 319 participants, and most completers (152/288, 52.8%) reduced their CPD by at least 50%. Overall, most completers (232/288, 80.6%) made at least one quit attempt. Quit rates increased after the end of Pivot; using ITT analyses, 35.4% (113/319) achieved 7-day PPA and 31.3% (100/319) achieved 30-day PPA at final follow up compared with 32.0% (102/319) and 27.6% (88/319), respectively, at the end of the Pivot program. Continuous abstinence was achieved in about a quarter of those who onboarded (76/319, 23.8%) and in most who reported 30-day PPA at the end of Pivot (76/88, 86.4%), with a mean abstinence duration of 5.8 (SD 0.6) months. In exploratory regression analyses, lower baseline CPD, more positive baseline attitudes reflecting higher self-efficacy (higher confidence to quit and lower perceived difficulty of quitting), and higher education were associated with achieving abstinence. CONCLUSIONS This study provides the first longer-term outcomes of the Pivot smoking cessation program. At final follow up, quit rates increased and continuous abstinence was favorable; the majority who achieved abstinence at the end of Pivot sustained abstinence throughout follow up. Decreases in CPD persisted and most participants made a quit attempt. Overall, final follow-up outcomes were stable or improved when compared to previous outcomes from the end of the program. These findings validate earlier results, and suggest that Pivot is an effective and durable solution for smoking cessation. CLINICALTRIAL ClinicalTrials.gov NCT03295643; https://clinicaltrials.gov/ct2/show/NCT03295643

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Durability of Abstinence After Completing a Comprehensive Digital Smoking Cessation Program Incorporating a Mobile App, Breath Sensor, and Coaching: Cohort Study

Journal of Medical Internet Research ◽

10.2196/25578 ◽

2021 ◽

Vol 23 (2) ◽

pp. e25578

Author(s):

Jennifer D Marler ◽

Craig A Fujii ◽

Joseph A Galanko ◽

Daniel J Balbierz ◽

David S Utley

Keyword(s):

Smoking Cessation ◽

Cohort Study ◽

Smoking Behavior ◽

Mobile App ◽

Smoking Cessation Program ◽

Regression Analyses ◽

Online Questionnaire ◽

Quit Attempt ◽

Continuous Abstinence

Background Despite decreasing prevalence over the last several decades, cigarette smoking remains the leading cause of preventable death and disease, underscoring the need for innovative, effective solutions. Pivot is a novel, inclusive smoking cessation program designed for smokers along the entire spectrum of readiness to quit. Pivot leverages proven methods and technological advancements, including a personal portable breath carbon monoxide sensor, smartphone app, and in-app text-based coaching. We previously reported outcomes from the end of active Pivot program participation in 319 adult smokers. Herein, we report longer-term follow up in this cohort. Objective The aim of this study was to assess and report participant outcomes 3 months after completion of Pivot, including smoking behavior, quit rates, continuous abstinence rates and durability, and predictors of abstinence. Methods This prospective remote cohort study included US-based cigarette smokers aged 18 to 65 years who smoked ≥5 cigarettes per day (CPD). Three months after completion of active participation in Pivot, final follow-up data were collected via an online questionnaire. Outcomes included smoking behavior (CPD and quit attempts), self-reported quit rates (7- and 30-day point prevalence abstinence [PPA]), and continuous abstinence rates (proportion who achieved uninterrupted abstinence) and duration. Exploratory regression analyses were performed to identify baseline characteristics associated with achievement of 7-day PPA, 30-day PPA, and continuous abstinence. Results A total of 319 participants completed onboarding (intention-to-treat [ITT]); 288/319 participants (90.3%) completed follow up (completers) at a mean of 7.2 (SD 1.2) months after onboarding. At final follow up, CPD were reduced by 52.6% (SE 2.1; P<.001) among all 319 participants, and most completers (152/288, 52.8%) reduced their CPD by at least 50%. Overall, most completers (232/288, 80.6%) made at least one quit attempt. Quit rates increased after the end of Pivot; using ITT analyses, 35.4% (113/319) achieved 7-day PPA and 31.3% (100/319) achieved 30-day PPA at final follow up compared with 32.0% (102/319) and 27.6% (88/319), respectively, at the end of the Pivot program. Continuous abstinence was achieved in about a quarter of those who onboarded (76/319, 23.8%) and in most who reported 30-day PPA at the end of Pivot (76/88, 86.4%), with a mean abstinence duration of 5.8 (SD 0.6) months. In exploratory regression analyses, lower baseline CPD, more positive baseline attitudes reflecting higher self-efficacy (higher confidence to quit and lower perceived difficulty of quitting), and higher education were associated with achieving abstinence. Conclusions This study provides the first longer-term outcomes of the Pivot smoking cessation program. At final follow up, quit rates increased and continuous abstinence was favorable; the majority who achieved abstinence at the end of Pivot sustained abstinence throughout follow up. Decreases in CPD persisted and most participants made a quit attempt. Overall, final follow-up outcomes were stable or improved when compared to previous outcomes from the end of the program. These findings validate earlier results, and suggest that Pivot is an effective and durable solution for smoking cessation. Trial Registration ClinicalTrials.gov NCT03295643; https://clinicaltrials.gov/ct2/show/NCT03295643

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Initial Assessment of a Comprehensive Digital Smoking Cessation Program That Incorporates a Mobile App, Breath Sensor, and Coaching: Cohort Study

JMIR mhealth and uhealth ◽

10.2196/12609 ◽

2019 ◽

Vol 7 (2) ◽

pp. e12609 ◽

Cited By ~ 8

Author(s):

Jennifer D Marler ◽

Craig A Fujii ◽

David S Utley ◽

Lydia J Tesfamariam ◽

Joseph A Galanko ◽

...

Keyword(s):

Smoking Cessation ◽

Cohort Study ◽

Mobile App ◽

Smoking Cessation Program ◽

Initial Assessment

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Analyzing the Adherence of a Mobile App in a Smoke-Quitting Program (Preprint)

10.2196/preprints.19420 ◽

2020 ◽

Author(s):

Marc Pifarre ◽

Jordi Vilaplana ◽

Francesc Solsona ◽

Francesc Abella ◽

Rui Alves ◽

...

Keyword(s):

Smoking Cessation ◽

Conventional Treatment ◽

Mobile Apps ◽

Mobile App ◽

Smoking Cessation Program ◽

Quit Smoking ◽

The Difference

BACKGROUND Many mobile apps have been made to quit smoking. Many do not have the support of specialists, and often are apps for self-guidance. There is no record of any study looking at the apps' adherence to patient treatments from hospitals, and therefore it is not known for sure if they serve to increase the adherence of treatments. OBJECTIVE Analyzing and evaluating the adherence of using a mobile app (TControl) on a smoking cessation program. METHODS TControl, an app to follow up and assist smoke-free patients. 197 patients to measure the effectiveness of the app for decreasing the number of relapses were analysed. RESULTS Actually, the difference between those using TControl is the number of relapses (7.7%), which is much lower than among those not using it (33.9%), and which could retain considerably more patients on the program than the conventional treatment. CONCLUSIONS TControl increased adherence in a smoke-quitting program. However, no correlation between adherence and success was found.

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Prevalence and Smoking Behavior Characteristics of Nonselected Smokers With Childhood and/or Adult Self-Reported ADHD Symptoms in a Smoking-Cessation Program

Journal of Attention Disorders ◽

10.1177/1087054713497396 ◽

2013 ◽

Vol 19 (4) ◽

pp. 293-300 ◽

Cited By ~ 15

Author(s):

Guillaume Fond ◽

Sebastien Guillaume ◽

Isabelle Jaussent ◽

Severine Beziat ◽

Alexandra Macgregor ◽

...

Keyword(s):

Smoking Cessation ◽

Smoking Behavior ◽

Smoking Cessation Program ◽

Adhd Symptoms ◽

Behavior Characteristics

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A Comprehensive Digital Program for Smoking Cessation: Assessing Feasibility in a Single-Group Cohort Study (Preprint)

10.2196/preprints.11708 ◽

2018 ◽

Author(s):

Heather Patrick ◽

Craig A Fujii ◽

Debra B Glaser ◽

David S Utley ◽

Jennifer D Marler

Keyword(s):

Smoking Cessation ◽

Text Messaging ◽

Smoking Behavior ◽

Smoking Cessation Program ◽

Matched Pair ◽

Great Promise ◽

Perceived Difficulty ◽

Readiness To Quit ◽

Attitudes Toward Smoking ◽

Program Acceptability

BACKGROUND Cigarette smoking remains the leading cause of preventable death and disease worldwide. Evidence-based approaches are available, but few people access them. Although digital solutions offer great promise for population reach, few multicomponent programs exist. Pivot is a comprehensive digital solution combining a Food and Drug Administration–cleared carbon monoxide (CO) breath sensor; cigarette logging; a 6-phase, app-delivered smoking cessation program based on the US Clinical Practice Guidelines; and dedicated human coaching via text-based chat. OBJECTIVE The purpose of this study was to assess program engagement, changes in attitudes toward smoking, self-reported changes in smoking behavior, and program acceptability for the initial phase of Pivot: Explore. METHODS A total of 48 participants enrolled, and 41 completed the study. About half the participants (54%, 22/41) were men, and the mean age was 43 years. Most (85%, 35/41) were daily smokers and smoked an average of 12 cigarettes per day. Explore includes CO breath sensing, logging cigarettes in-app, learning via in-app activities, and dedicated human coaching through a text messaging interface. Participants completed surveys at baseline and exit assessing attitudes toward quitting including readiness, perceived difficulty, and confidence in quit success. At exit, participants also completed a survey of changes in smoking behavior and ratings of program acceptability. RESULTS More than 80% of participants (34-39 of 41) took ≥1 CO breath sample each day, and more than 55% (23-27 of 41) took ≥5 samples each day. More than 65% of participants (27-34 of 41) logged ≥1 cigarette using the in-app logging feature each day. All 9 in-app activities had completion rates ≥80% (33-40 of 41). Response to coach-initiated outreach was also high, with all contacts receiving ≥73% (30-39 of 41) response. In matched pair analyses, significant positive changes in mean attitudes toward quitting (scale 1-10) were evident from baseline (T1) to study exit (T2), including increased readiness to quit (T1 mean=6.1, T2 mean=7.4, P=.005), lower perceived difficulty (T1 mean=3.7, T2 mean=5.6, P=.001), and greater expectations of success (T1 mean=4.5, T2 mean=6.5, P<.001). At exit, 78% (32/41) of participants reported decreasing the number of cigarettes smoked per day during the study. Participants rated program quality and satisfaction very high (mean ≥8 for all items). CONCLUSIONS These results support the feasibility and acceptability of the initial 9-day phase of Pivot: Explore. Participants had high levels of engagement with sensing, logging, learning, and coaching. Attitudes toward quitting improved significantly, and the majority of users indicated decreasing smoking behavior. Explore was designed to raise smoker awareness and motivation. Additional research is underway to assess how users progress through the full Pivot smoking cessation program and determine the program’s effectiveness for achieving sustained cessation.

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Takore i te Kai Ava’ava (Quit smoking), a mCessation Program Adapted for the Cook Islands: Indicators of Potential for Tobacco Control

Asia Pacific Journal of Public Health ◽

10.1177/10105395211036267 ◽

2021 ◽

Vol 33 (6-7) ◽

pp. 714-720

Author(s):

Teinatangi Ringi ◽

Josephine Aumea Herman ◽

Maina Tairi ◽

Rosie Dobson ◽

Vili Nosa ◽

...

Keyword(s):

Smoking Cessation ◽

Smoking Behavior ◽

Text Message ◽

Value Added ◽

Cost Effective ◽

Cook Islands ◽

Quit Attempt ◽

Quit Attempts ◽

Evidence Of Impact

Mobile phone–based smoking cessation interventions (mCessation) are an established evidence-based intervention designed to support smokers to quit. Evidence of impact to date is modestly positive but skewed in favor of high-resourced countries, with less evidence of value added to low-resourced settings. Takore i te Kai Ava’ava, a text message–based smoking cessation program, was delivered to smokers living on the island of Rarotonga in 2019. Eighty-eight smokers consented to take part. Participants completed a baseline questionnaire about current smoking behavior and previous quit attempts; follow-up measures at 2 months assess quit attempts feedback on the program. Thirty-two people completed the follow-up interviews; 10 (31%) had not smoked in the past 7 days, 23 (72%) reported a serious quit attempt, and 29 (91%) felt the program was effective for the Cook Islands. Takore i te Kai Ava’ava was deemed to be highly acceptable and potentially cost-effective.

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Gender and smoking behavior in a worksite smoking cessation program

Addictive Behaviors ◽

10.1016/s0306-4603(99)00074-x ◽

2000 ◽

Vol 25 (3) ◽

pp. 347-360 ◽

Cited By ~ 25

Author(s):

Mary C Stockton ◽

Susan D Mcmahon ◽

Leonard A Jason

Keyword(s):

Smoking Cessation ◽

Smoking Behavior ◽

Smoking Cessation Program

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Smoking-Related Stigma: A Public Health Tool or a Damaging Force?

Nicotine & Tobacco Research ◽

10.1093/ntr/nty151 ◽

2018 ◽

Vol 22 (1) ◽

pp. 96-103 ◽

Cited By ~ 3

Author(s):

Paula Lozano ◽

James F Thrasher ◽

Melinda Forthofer ◽

James Hardin ◽

Luz Myriam Reynales Shigematsu ◽

...

Keyword(s):

Smoking Cessation ◽

Tobacco Control ◽

Smoking Behavior ◽

Control Policy ◽

Quit Attempt ◽

Quit Smoking ◽

Tobacco Control Policies ◽

Quit Attempts ◽

Lower Likelihood ◽

Related Stigma

Abstract Background Tobacco control policies and other denormalization strategies may reduce tobacco use by stigmatizing smoking. This raises an important question: Does perceived smoking-related stigma contribute to a smoker’s decision to quit? The aim of this study was to evaluate if perceived smoking-related stigma was associated with smoking cessation outcomes among smokers in Mexico and Uruguay. Methods We analyzed prospective data from a panel of adult smokers who participated in the 2008–2012 administrations of the International Tobacco Control Policy Evaluation Surveys in Mexico and Uruguay. We defined two analytic samples of participants: the quit behavior sample (n = 3896 Mexico; n = 1525 Uruguay) and the relapse sample (n = 596 Mexico). Generalized estimating equations were used to evaluate if different aspects of perceived stigma (ie, discomfort, marginalization, and negative stereotype) at baseline were associated with smoking cessation outcomes at follow-up. Results We found that perceived smoking-related stigma was associated with a higher likelihood of making a quit attempt in Uruguay but with a lower likelihood of successful quitting in Mexico. Conclusions This study suggests that perceived smoking-related stigma may be associated with more quit attempts, but less successful quitting among smokers. It is possible that once stigma is internalized by smokers, it may function as a damaging force. Future studies should evaluate the influence of internalized stigma on smoking behavior. Implications Although perceived smoking-related stigma may prompt smokers to quit smoking, smoking stigma may also serve as a damaging force for some individuals, making quitting more difficult. This study found that perceived smoking-related stigma was associated with a higher likelihood of making a quit attempt in Uruguay but with a lower likelihood of successful quitting in Mexico.

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1442Implementation and outcomes of systematic approaches to tobacco treatment: the Ottawa Model for Smoking Cessation

European Heart Journal ◽

10.1093/eurheartj/ehz748.0077 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Coja ◽

K A Mullen ◽

A L Pipe ◽

R D Reid

Keyword(s):

Primary Care ◽

Smoking Cessation ◽

Smoking Status ◽

Evidence Based ◽

Quit Attempt ◽

Healthcare Settings ◽

Tobacco Treatment ◽

Quit Rate ◽

Quitting Smoking

Abstract Background/Introduction Tobacco use is a major risk factor for the leading chronic diseases, is a leading cause of preventable death worldwide, and is a large cost driver of healthcare spending. Quitting smoking is the single most effective thing a patient can do to improve their health. The Ottawa Model for Smoking Cessation (OMSC) is a systematic, comprehensive approach to clinical tobacco dependence treatment. It provides support to healthcare settings in establishing a high quality tobacco treatment protocol and addressing common barriers to ensure optimal delivery of evidence-based smoking cessation interventions. Purpose The OMSC assists healthcare professionals to transform clinical practices through knowledge translation, implementation support, and quality evaluation. It promotes the delivery of evidence-based interventions to a greater number of smokers using a systematic approach, ultimately increasing cessation rates. The OMSC assists providers to identify smoking status, provide strategic advice to quit, support patients in making a quit attempt, and provide follow-up support. Methods OMSC Outreach Facilitators work with healthcare setting to assist with implementing evidence-based smoking cessation interventions. This is guided by an OMSC workplan which covers planning, implementing, evaluating and sustainability. Pre and post implementation along with program-level data is collected and used to determine rates of smoking status documentation, brief advice to stop smoking, delivery of cessation support and patient quit rates. Results The OMSC program has worked with approximately 450 healthcare settings, trained over 20,000 healthcare professionals, and supported approximately 500,000 patients with quitting smoking. Of those not ready to quit, 45% of patients seen in primary care were supported in reducing the amount they smoke. For OMSC hospital and specialty care patients receiving follow-up support, the six month responder-quit rate was 48%. For OMSC primary care patients, the two month responder-quit rate was 57%. Patients who had previously been supported by their OMSC primary care practice but had not presented to their provider in at least 6 months were contacted to assess their smoking status. Of those reached, 44% were smoke-free. Of those who relapsed, 53% indicated they would be willing to make another quit attempt, 37% of which went back to their healthcare provider to try again. Conclusion The OMSC has shown to be a simple, systematic step-by-step approach to addressing tobacco use in healthcare settings. It provides a way to create clinical efficiencies while increasing the rates at which evidence-based smoking cessation interventions are being delivered to patients, which leads to more patients making further quit attempts. The OMSC continues to expand across Canada and internationally in hopes of creating a wider smoking cessation network to support more patients with quitting smoking. Acknowledgement/Funding Ontario Ministry of Health and Long-Term Care

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