Efficacy of Web-Delivered Acceptance and Commitment Therapy (ACT) for Helping Black Adults Quit Smoking.

BACKGROUND: Digital smoking cessation interventions may reduce racial disparities in cessation because they are low cost, scalable, and can provide support at any place or time. Despite their promise, whether Black adults engage with and benefit from these tools is largely unknown. In a secondary analysis of a randomized trial, we explored the efficacy of an acceptance and commitment therapy (ACT)-based website (WebQuit) for smoking cessation compared to a US clinical practice guidelines-based website (Smokefree.gov) among Black adults. METHODS: A total of 316 Black adult smokers were enrolled in the trial between May 2017 and September 2018 and received access to WebQuit or Smokefree for 12 months. Participants self-reported on 30-day and 7-day abstinence from cigarette smoking at 3, 6, and 12-months. Treatment engagement was objectively measured and compared between arms. Participants also reported on their willingness to accept cues to smoke without smoking. RESULTS: WebQuit versus Smokefree participants engaged more with their website (higher number of logins, Incidence Rate Ratio (IRR) = 2.21; 95% CI: 1.70, 2.89). Complete-case 30-day point prevalence abstinence (PPA) at 12-months was 34% for WebQuit vs. 29% for Smokefree (OR = 1.22 95% CI: 0.73, 2.04). Increases in participants' willingness to accept cues to smoke mediated the intervention effect on abstinence from cigarette smoking at 12 months. CONCLUSIONS: This study addressed the lack of research on the utilization and efficacy of digital interventions for helping Black adults quit smoking. WebQuit participants engaged more with their website and quit smoking at a somewhat higher rate relative to Smokefree participants, albeit nonsignificant. Findings suggest high acceptability of ACT-based digital interventions to enable Black adult smokers to engage and sustain behavior changes. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01812278.

Efficacy of an acceptance and commitment therapy-based smartphone application for helping rural populations quit smoking: Results from the iCanQuit randomized trial.

Limited access to evidence-based smoking cessation interventions among rural populations contributes to high rates of cigarette smoking and poor cessation outcomes. Yet, accessible digital interventions for cessation focusing on rural populations are lacking. In a secondary analysis, we determined the acceptability and efficacy of an Acceptance and Commitment Therapy (ACT)-based smartphone application (iCanQuit) relative to a U.S. Clinical Practice Guidelines (USCPG)-based smartphone application (QuitGuide) for smoking cessation among rural participants enrolled in the two-arm randomized iCanQuit trial. Participants were enrolled between May 2017 and September 2018 and randomized to either receive iCanQuit or QuitGuide for 12-months. Rural residence was determined by sub-county level Rural-Urban Commuting Area codes. A total of 550 rural participants were recruited from 43 U.S. states. Self-reported complete-case 30-day point-prevalence abstinence was 15% (33/226) for iCanQuit vs. 9% (22/253) for QuitGuide at 3-months (OR = 1.83; 95% CI: 1.03, 3.25) and 29% (66/231) for iCanQuit vs. 25% (64/288) for QuitGuide at 12-months (OR = 1.19 95% CI: 0.80, 1.79). Retention rate was 89% at 12-months and did not differ by arm. iCanQuit vs. QuitGuide participants were significantly more engaged and satisfied with the iCanQuit application. Increased acceptance of internal cues to smoke mediated the effect of treatment on cessation. Findings suggest that iCanQuit had significantly higher short-term quit rates, descriptively higher long-term quit rates, and operated through its hypothesized mechanisms of action relative to QuitGuide. Future larger studies are needed to further evaluate the efficacy of and methods for disseminating the iCanQuit application for smoking cessation among U.S. rural adults nationwide. Trial registrationClinicalTrials.gov Identifier: NCT02724462.

Full-scale Randomized Trial Comparing Acceptance and Commitment Therapy Telephone-Delivered Coaching With Standard Telephone-Delivered Coaching Among Medicare/Uninsured Quitline Callers.

INTRODUCTION: The aim of this study was to compare Acceptance and Commitment Therapy (ACT) telephone-delivered coaching with standard quitline (QL) telephone-delivered coaching. METHODS: Medicare/uninsured adults (analyzable sample N = 1170) who smoked at least 10 cigarettes per day were recruited from Optum, a major US provider of QL services, in a two-arm stratified double-blind randomized trial with main outcome of self-reported missing = smoking 30-day point prevalence abstinence (PPA) at the 12-month follow-up. Participants were mean (SD) age 47.4 (12.7), 61% female, and 72% white race. Five sessions of telephone-delivered ACT or QL interventions were offered. Both arms included combined nicotine patch (4 weeks) and gum or lozenge (2 weeks). RESULTS: The 12-month follow-up data retention rate was 67.8%. ACT participants reported their treatment was more useful for quitting smoking (92.0% for ACT vs. 82.3% for QL; odds ratio [OR] = 2.48; 95% confidence interval [CI]: 1.53 to 4.00). Both arms had similar 12-month cessation outcomes (missing = smoking 30-day PPA: 24.6% for ACT vs. 28.8% for QL; OR =.81; 95% CI: 0.62 to 1.05) and the ACT arm trended toward greater reductions in number cigarettes smoked per day (-5.6 for ACT vs. -1.7 QL, among smokers; p = .075). CONCLUSIONS: ACT telephone-delivered coaching was more satisfying, engaging, and was as effective as standard QL telephone-delivered coaching. ACT may help those who fail to quit after standard coaching or who choose not to use nicotine replacement therapy. IMPLICATIONS: In a sample of Medicare and uninsured QL callers, a large randomized trial with long-term follow-up showed that ACT) telephone-delivered coaching was more satisfying, engaging, and was as effective as standard QL telephone-delivered coaching-which has followed the same behavior change approach since the 1990s. This newer model of coaching might be a welcome addition to QL services.

Smartphone Ownership Among US Adult Cigarette Smokers: 2014 Health Information National Trends Survey (HINTS) Data.

BACKGROUND: Despite increasing interest in smartphone apps as a platform for delivery of tobacco cessation interventions, no previous studies have evaluated the prevalence and characteristics of smokers who can access smartphone-delivered interventions. OBJECTIVE: To guide treatment development in this new platform and to evaluate disparities in access to smartphone-delivered interventions, we examined associations of smartphone ownership with demographics, tobacco use and thoughts about quitting, other health behaviors, physical and mental health, health care access, and Internet and technology utilization using a nationally representative sample of US adult smokers. METHODS: Data were from the National Cancer Institute's 2014 Health Information National Trends Survey 4 (HINTS 4), Cycle 4. This mailed survey targeted noninstitutionalized individuals aged 18 years or older using two-stage stratified random sampling. For this analysis, we restricted the sample to current smokers with complete data on smartphone ownership (n=479). RESULTS: Nearly two-thirds (weighted percent=63.8%, 248/479) of smokers reported owning a smartphone. Those who were younger (P<.001), employed (P=.002), never married (P=.002), and had higher education (P=.002) and income (P<.001) had the highest rates of ownership. Smartphone owners did not differ from nonowners on frequency of smoking, recent quit attempts, or future plans to quit smoking, although they reported greater belief in the benefits of quitting (P=.04). Despite being equally likely to be overweight or obese, smartphone owners reported greater fruit and vegetable consumption (P=.03) and were more likely to report past-year efforts to increase exercise (P=.001) and to lose weight (P=.02). No differences in health care access and utilization were found. Smartphone owners reported better physical and mental health in several domains and higher access to and utilization of technology and the Internet, including for health reasons. CONCLUSIONS: Smartphone ownership among smokers mirrors many trends in the general population, including the overall rate of ownership and the association with younger age and higher socioeconomic status. Apps for smoking cessation could potentially capitalize on smartphone owners' efforts at multiple health behavior changes and interest in communicating with health care providers via technology. These data also highlight the importance of accessible treatment options for smokers without smartphones in order to reach smokers with the highest physical and mental health burden and prevent worsening of tobacco-related health disparities as interventions move to digital platforms.