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McClure JB, Heffner JL, Krakauer C, Mun S, Catz SL. A Novel mHealth App for Smokers Living With HIV Who Are Ambivalent About Quitting Smoking: Formative Research and Randomized Feasibility Study. JMIR Form Res 2024; 8:e58063. [PMID: 38976321 PMCID: PMC11263889 DOI: 10.2196/58063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 05/14/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND More people who smoke and are living with HIV now die from tobacco-related diseases than HIV itself. Most people are ambivalent about quitting smoking and want to quit someday but not yet. Scalable, effective interventions are needed to motivate and support smoking cessation among people ambivalent about quitting smoking (PAQS) who are living with HIV. OBJECTIVE This study aims to develop an app-based intervention for PAQS who are living with HIV and assess its feasibility, acceptability, and potential impact. Results of this study will inform plans for future research and development. METHODS In phase 1, PAQS living with HIV (n=8) participated in user-centered design interviews to inform the final intervention app design and recruitment plan for a subsequent randomized pilot study. In phase 2, PAQS living with HIV were randomized to either a standard care control app or a similar experimental app with additional content tailored for PAQS and those with HIV. Participants were followed for 3 months. Feasibility focused on recruitment, retention, and participants' willingness to install the app. The study was not powered for statistical significance. Indices of acceptability (satisfaction and use) and impact (smoking behavior change and treatment uptake) were assessed via automated data and self-report among those who installed and used the app (n=19). RESULTS Recruitment for both study phases was a challenge, particularly via web-based and social media platforms. Enrollment success was greater among people living with HIV recruited from a health care provider and research registry. Once enrolled, retention for the phase 2 randomized study was good; 74% (14/19) of the participants completed the 3-month follow-up. Phase 1 findings suggested that PAQS living with HIV were receptive to using an app-based intervention to help them decide whether, when, and how to stop smoking, despite not being ready to quit smoking. Phase 2 findings further supported this conclusion based on feedback from people who agreed to use an app, but group differences were observed. Indices of acceptability favored the experimental arm, including a descriptively higher mean number of sessions and utilization badges. Similarly, indices of potential impact were descriptively higher in the experimental arm (proportion reducing smoking, making a quit attempt, or calling free tobacco quitline). No participants in either arm quit smoking at the 3-month follow-up. CONCLUSIONS On the basis of this formative work, PAQS living with HIV may be receptive to using a mobile health-based app intervention to help them decide whether, when, or how to stop using tobacco. Indices of acceptability and impact indicate that additional research and development are warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT05339659; https://clinicaltrials.gov/study/NCT05339659.
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Affiliation(s)
- Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
- Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, United States
| | | | - Chloe Krakauer
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Sophia Mun
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Sheryl L Catz
- Betty Irene Moore School of Nursing, University of California, Davis, Sacramento, CA, United States
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Carroll DM, Jennings D, Stately A, Kamath A, Tessier KM, Cotoc C, Egbert A, Begnaud A, Businelle M, Hatsukami D, Pickner W. Pilot randomised controlled trial of a culturally aligned smoking cessation app for American Indian persons. Tob Control 2024:tc-2024-058665. [PMID: 38964856 DOI: 10.1136/tc-2024-058665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024]
Abstract
OBJECTIVE To pilot test QuitGuide for Natives, a culturally aligned version of the National Cancer Institute's QuitGuide smartphone app for smoking cessation. METHODS This randomised controlled trial was conducted remotely during 2022-2023. American Indian adults who smoked and resided in the Midwest (n=115) were randomised to QuitGuide for Natives or the general audience QuitGuide smartphone-based intervention. Group differences in feasibility (times the app was initiated), usability, acceptability ('How likely would you be to recommend the app to a friend?'), fit of app with culture and preliminary efficacy (24-hour quit attempts, cotinine-confirmed self-reported 7-day abstinence) outcomes were examined. RESULTS QuitGuide for Natives versus the general audience QuitGuide did not differ in the number of times the app was opened (adjusted incidence rate ratio 0.94 (95% CI 0.63 to 1.40); p=0.743) nor in usability score (adjusted mean difference (aMD) 0.73 (95% CI: -5.00 to 6.46); p=0.801) or likeliness of recommending the app to a friend (aMD 0.62 (95% CI -0.02 to 1.27); p=0.058). Differences were observed for all cultural fit outcomes such as 'The app fits my American Indian culture (aMD 0.75 (95% CI 0.35 to 1.16); p<0.001). QuitGuide for Natives versus the general audience QuitGuide resulted in an average of 6.6 vs 5.1 24-hour quit attempts (p=0.349) and cotinine-confirmed 7-day abstinence was achieved by 6.9% vs 3.5% (p=0.679). CONCLUSIONS Acceptability, cultural fit and preliminary efficacy findings are encouraging and will inform future, larger-scale evaluation of culturally aligned digital smoking cessation resources for American Indian adults.
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Affiliation(s)
- Dana Mowls Carroll
- Division of Environmental Health Sciences, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Dylan Jennings
- Sigurd Olson Environmental Institute, Northland College, Ashland, Wisconsin, USA
| | - Antony Stately
- Native American Community Clinic, Minneapolis, Minnesota, USA
| | - Amika Kamath
- American Indian Cancer Foundation, Minneapolis, Minnesota, USA
| | - Katelyn M Tessier
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Crina Cotoc
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew Egbert
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Abbie Begnaud
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Michael Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Dorothy Hatsukami
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Wyatt Pickner
- American Indian Cancer Foundation, Minneapolis, Minnesota, USA
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Siegel LN, Wiseman KP, Budenz A, Prutzman Y. Identifying Patterns of Smoking Cessation App Feature Use That Predict Successful Quitting: Secondary Analysis of Experimental Data Leveraging Machine Learning. JMIR AI 2024; 3:e51756. [PMID: 38875564 PMCID: PMC11153975 DOI: 10.2196/51756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 02/29/2024] [Accepted: 03/04/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Leveraging free smartphone apps can help expand the availability and use of evidence-based smoking cessation interventions. However, there is a need for additional research investigating how the use of different features within such apps impacts their effectiveness. OBJECTIVE We used observational data collected from an experiment of a publicly available smoking cessation app to develop supervised machine learning (SML) algorithms intended to distinguish the app features that promote successful smoking cessation. We then assessed the extent to which patterns of app feature use accounted for variance in cessation that could not be explained by other known predictors of cessation (eg, tobacco use behaviors). METHODS Data came from an experiment (ClinicalTrials.gov NCT04623736) testing the impacts of incentivizing ecological momentary assessments within the National Cancer Institute's quitSTART app. Participants' (N=133) app activity, including every action they took within the app and its corresponding time stamp, was recorded. Demographic and baseline tobacco use characteristics were measured at the start of the experiment, and short-term smoking cessation (7-day point prevalence abstinence) was measured at 4 weeks after baseline. Logistic regression SML modeling was used to estimate participants' probability of cessation from 28 variables reflecting participants' use of different app features, assigned experimental conditions, and phone type (iPhone [Apple Inc] or Android [Google]). The SML model was first fit in a training set (n=100) and then its accuracy was assessed in a held-aside test set (n=33). Within the test set, a likelihood ratio test (n=30) assessed whether adding individuals' SML-predicted probabilities of cessation to a logistic regression model that included demographic and tobacco use (eg, polyuse) variables explained additional variance in 4-week cessation. RESULTS The SML model's sensitivity (0.67) and specificity (0.67) in the held-aside test set indicated that individuals' patterns of using different app features predicted cessation with reasonable accuracy. The likelihood ratio test showed that the logistic regression, which included the SML model-predicted probabilities, was statistically equivalent to the model that only included the demographic and tobacco use variables (P=.16). CONCLUSIONS Harnessing user data through SML could help determine the features of smoking cessation apps that are most useful. This methodological approach could be applied in future research focusing on smoking cessation app features to inform the development and improvement of smoking cessation apps. TRIAL REGISTRATION ClinicalTrials.gov NCT04623736; https://clinicaltrials.gov/study/NCT04623736.
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Affiliation(s)
- Leeann Nicole Siegel
- National Cancer Instiute, National Institutes of Health, Rockville, MD, United States
| | - Kara P Wiseman
- University of Virginia School of Medicine, Charlottesville, VA, United States
| | - Alex Budenz
- National Cancer Instiute, National Institutes of Health, Rockville, MD, United States
| | - Yvonne Prutzman
- National Cancer Instiute, National Institutes of Health, Rockville, MD, United States
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Chen Z, Siegel LN, Prutzman YM, Wiseman KP. Characterizing perceived usability and its correlation with smoking cessation: An analysis of user assessments of the smoking cessation app quitSTART. Internet Interv 2024; 35:100714. [PMID: 38313141 PMCID: PMC10835281 DOI: 10.1016/j.invent.2024.100714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/09/2023] [Accepted: 01/15/2024] [Indexed: 02/06/2024] Open
Abstract
Background As smartphone ownership has become common in all demographic groups in the United States, smartphone applications (apps) for smoking cessation have grown in popularity due to their potential for supporting the diverse populations in the United States who are attempting to quit smoking. Usability is commonly assessed in mobile health (mHealth) technology as an important aspect of the user experience that could influence users' adherence to a health app and health outcomes. However, the variation of perceived usability across demographic groups, and the implications of that variation for app success, have not been well studied. Objective The aims of this study were to characterize variation in the perceived usability of the National Cancer Institute Smokefree.gov Initiative smoking cessation app quitSTART across demographic groups, and to assess the correlation between perceived usability and short-term smoking cessation. Methods We conducted a secondary analysis of data from a randomized controlled trial conducted from 2020 to 2021, which used a 16-item modified version of the mHealth App Usability Questionnaire (MAUQ) to quantify perceived usability four weeks after app download among 131 smokers attempting to quit. Responses were coded on a 5-point Likert-type scale ranging from strongly disagree (1) to strongly agree (5) and total perceived usability was calculated as the sum of all 16 items (range: 16-80). Associations between participant demographic characteristics (gender, race, education level, age, etc.) and total usability were determined using an ANCOVA model. A multivariable logistic regression model was used to assess the association between usability and smoking cessation, also assessed 4 weeks after app download. Results The ANCOVA model demonstrated that race was associated with perceived usability, with participants from a racial minority group reporting higher total usability than White participants (p < 0.001). White participants had an adjusted mean total usability of 55.8 (95 % CI: 52.8, 58.8) while racial minority group participants had an adjusted mean total usability of 66.5 (95 % CI: 61.2, 71.6). Other participant demographic characteristics, such as gender and sexual minority status, were not associated with mean total usability. Total usability was positively associated with smoking cessation (OR: 1.04, 95 % CI: 1.00, 1.08, p = 0.031). Conclusions Total perceived usability of quitSTART was higher among adults from a racial minority group compared to White adults, and perceived usability was positively associated with cessation success. These findings emphasize the importance of ensuring high usability of mHealth smoking cessation apps for diverse populations.
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Affiliation(s)
- Ziyan Chen
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Leeann N Siegel
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Yvonne M Prutzman
- National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Kara P Wiseman
- University of Virginia School of Medicine, Charlottesville, VA, USA
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Sweileh WM. Technology-based interventions for tobacco smoking prevention and treatment: a 20-year bibliometric analysis (2003-2022). Subst Abuse Treat Prev Policy 2024; 19:13. [PMID: 38321493 PMCID: PMC10848402 DOI: 10.1186/s13011-024-00595-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/20/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Substance abuse, particularly tobacco smoking, is a significant global public health concern. Efforts have been made to reduce smoking prevalence and promote cessation, but challenges, such as nicotine addiction, marketing tactics by tobacco industry, and cultural acceptability hinder progress. Technology has emerged as a potential tool to address these challenges by providing innovative scalable interventions. The objective of the study was to analyze and map scientific literature on technology-based intervention for tobacco prevention and treatment. METHODS A bibliometric methodology was conducted. Scopus database was used to retrieve relevant research articles published between 2003 and 2022. The analysis included publication trends, key contributors, research hotspots, research themes, the most impactful articles, and emerging research topics. RESULTS A total of 639 articles were found, with a slow and fluctuating growth pattern observed after 2011. The Journal of Medical Internet Research was the most prominent journal in the field. The United States was the leading country in the field, followed up by the United Kingdom, and the Netherlands. Research hotspots included smoking cessation, randomized controlled trials, and technology-based methods such as internet, mHealth, smartphone apps, text messages, and social media. Four primary research themes were identified: development of smartphone applications, efficacy of text messaging interventions, acceptance and effectiveness of smartphone applications, and interventions targeting young adults and students using mobile phone and social media platforms. The top 10 cited articles demonstrated effectiveness of digital interventions in promoting smoking cessation rates and reducing relapse rates. Emerging research topics included the use of virtual reality interventions, interventions for specific populations through personalized tools, and technology-based interventions in non-Western countries. CONCLUSIONS The findings of the current study highlight the potential of technology to address the challenges associated with tobacco smoking. Further future research in this area is warranted to continue advancing the field and developing effective and evidence-based interventions to combat tobacco smoking.
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Affiliation(s)
- Waleed M Sweileh
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
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6
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Long SE, Lama Y, D'Angelo H. Digital Communication Inequalities Among U.S. Adults Reporting Current Cigarette Use. Am J Prev Med 2024; 66:307-314. [PMID: 37793558 PMCID: PMC10842098 DOI: 10.1016/j.amepre.2023.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION To reduce tobacco-related health problems, it is critical to reach people who smoke with smoking cessation information and treatment. However, digital communication inequalities may limit access to online information sources. METHODS Digital device ownership, high-speed internet access, and online health information-seeking were examined among adults reporting current smoking in the Health Information National Trends Survey (n=847). Data were collected in 2019 and 2020 and analyzed in 2022. Multivariable logistic regression models examined associations between demographics, digital technology access, and online health information-seeking. RESULTS Only 47.6% (95% CI 39.0%, 56.3%) of adults aged 65+, 54.2% of Black/African American adults (95% CI 37.8%, 69.8%), and 59.6% with high school or less education (95% CI 51.5%, 67.1%) reported high-speed internet access (vs. 74.0% overall, 95% CI 68.9%, 78.6%). Inequalities in device ownership, high-speed internet access, and online health information-seeking were found by education and income. Adults with high school or less education (vs. college or more) had 78% lower odds of digital device ownership (aOR 0.22, 95% CI 0.08, 0.59) and 75% lower odds of high-speed internet access (aOR 0.25, 95% CI 0.09, 0.71). High-speed internet access (vs. no digital device or high-speed internet) was associated with 4.9 times greater odds of online health information-seeking (95% CI 1.81, 13.4). CONCLUSIONS Digital communication inequalities among adults who smoke exist. Understanding digital technology access among lower income populations could inform the development and delivery of interventions and health communication strategies to improve health outcomes among this population.
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Affiliation(s)
| | - Yuki Lama
- National Cancer Institute, Rockville, Maryland
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7
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Struik L, Christianson K, Khan S, Sharma RH. Strengths and Limitations of Web-Based Cessation Support for Individuals Who Smoke, Dual Use, or Vape: Qualitative Interview Study. JMIR Form Res 2023; 7:e43096. [PMID: 38064266 PMCID: PMC10746965 DOI: 10.2196/43096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/17/2023] [Accepted: 10/05/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Tobacco use has shifted in recent years, especially with the introduction of e-cigarettes. Despite the current variable and intersecting tobacco product use among tobacco users, most want to quit, which necessitates cessation programs to adapt to these variable trends (vs focusing on combustible cigarettes alone). The use of web-based modalities for cessation support has become quite popular in recent years and has been compounded by the COVID-19 pandemic. Therefore, understanding the current strengths and limitations of existing programs to meet the needs of current various tobacco users is critical for ensuring the saliency of such programs moving forward. OBJECTIVE The purpose of this study was to understand the strengths and limitations of web-based cessation support offered through QuitNow to better understand the needs of a variety of end users who smoke, dual use, or vape. METHODS Semistructured interviews were conducted with 36 nicotine product users in British Columbia. Using conventional content analysis methods, we inductively derived descriptive categories and themes related to the strengths and limitations of QuitNow for those who smoke, dual use, or vape. We analyzed the data with the support of NVivo (version 12; QSR International) and Excel (Microsoft Corporation). RESULTS Participants described several strengths and limitations of QuitNow and provided suggestions for improvement, which fell under 2 broad categories: look and feel and content and features. Shared strengths included the breadth of information and the credible nature of the website. Individuals who smoke were particularly keen about the site having a nonjudgmental feeling. Moreover, compared with individuals who smoke, individuals who dual use and individuals who vape were particularly keen about access to professional quit support (eg, quit coach). Shared limitations included the presence of too much text and the need to create an account. Individuals who dual use and individuals who vape thought that the content was geared toward older adults and indicated that there was a lack of information about vaping and personalized content. Regarding suggestions for improvement, participants stated that the site needed more interaction, intuitive organization, improved interface esthetics, a complementary smartphone app, forum discussion tags, more information for different tobacco user profiles, and user testimonials. Individuals who vape were particularly interested in website user reviews. In addition, individuals who vape were more interested in an intrinsic approach to quitting (eg, mindfulness) compared with extrinsic approaches (eg, material incentives), the latter of which was endorsed by more individuals who dual use and individuals who smoke. CONCLUSIONS The findings of this study provide directions for enhancing the saliency of web-based cessation programs for a variety of tobacco use behaviors that hallmark current tobacco use.
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Affiliation(s)
- Laura Struik
- School of Nursing, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Kyla Christianson
- School of Nursing, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Shaheer Khan
- School of Health and Exercise Science, University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Ramona H Sharma
- School of Social Work, University of British Columbia Okanagan, Kelowna, BC, Canada
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Carabot F, Donat-Vargas C, Santoma-Vilaclara J, Ortega MA, García-Montero C, Fraile-Martínez O, Zaragoza C, Monserrat J, Alvarez-Mon M, Alvarez-Mon MA. Exploring Perceptions About Paracetamol, Tramadol, and Codeine on Twitter Using Machine Learning: Quantitative and Qualitative Observational Study. J Med Internet Res 2023; 25:e45660. [PMID: 37962927 PMCID: PMC10685273 DOI: 10.2196/45660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Paracetamol, codeine, and tramadol are commonly used to manage mild pain, and their availability without prescription or medical consultation raises concerns about potential opioid addiction. OBJECTIVE This study aims to explore the perceptions and experiences of Twitter users concerning these drugs. METHODS We analyzed the tweets in English or Spanish mentioning paracetamol, tramadol, or codeine posted between January 2019 and December 2020. Out of 152,056 tweets collected, 49,462 were excluded. The content was categorized using a codebook, distinguishing user types (patients, health care professionals, and institutions), and classifying medical content based on efficacy and adverse effects. Scientific accuracy and nonmedical content themes (commercial, economic, solidarity, and trivialization) were also assessed. A total of 1000 tweets for each drug were manually classified to train, test, and validate machine learning classifiers. RESULTS Of classifiable tweets, 42,840 mentioned paracetamol and 42,131 mentioned weak opioids (tramadol or codeine). Patients accounted for 73.10% (60,771/83,129) of the tweets, while health care professionals and institutions received the highest like-tweet and tweet-retweet ratios. Medical content distribution significantly differed for each drug (P<.001). Nonmedical content dominated opioid tweets (23,871/32,307, 73.9%), while paracetamol tweets had a higher prevalence of medical content (33,943/50,822, 66.8%). Among medical content tweets, 80.8% (41,080/50,822) mentioned drug efficacy, with only 6.9% (3501/50,822) describing good or sufficient efficacy. Nonmedical content distribution also varied significantly among the different drugs (P<.001). CONCLUSIONS Patients seeking relief from pain are highly interested in the effectiveness of drugs rather than potential side effects. Alarming trends include a significant number of tweets trivializing drug use and recreational purposes, along with a lack of awareness regarding side effects. Monitoring conversations related to analgesics on social media is essential due to common illegal web-based sales and purchases without prescriptions.
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Affiliation(s)
- Federico Carabot
- Department of Medicine and Medical Specialities, University of Alcalá, Alcalá de Henares, Spain
- Ramon y Cajal Institute of Sanitary Research, Madrid, Spain
| | - Carolina Donat-Vargas
- Institute of Environmental Medicine, Karolinska Institutet, Unit of Cardiovascular and Nutritional Epidemiology, Stockholm, Sweden
- ISGlobal, Institut de Salut Global de Barcelona, Campus MAR, Barcelona, Spain
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública, Madrid, Spain
| | - Javier Santoma-Vilaclara
- Department of Medicine and Medical Specialities, University of Alcalá, Alcalá de Henares, Spain
- Data & AI, Filament Consultancy Group., London, United Kingdom
| | - Miguel A Ortega
- Department of Medicine and Medical Specialities, University of Alcalá, Alcalá de Henares, Spain
- Ramon y Cajal Institute of Sanitary Research, Madrid, Spain
- Cancer Registry and Pathology Department, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
| | - Cielo García-Montero
- Department of Medicine and Medical Specialities, University of Alcalá, Alcalá de Henares, Spain
- Ramon y Cajal Institute of Sanitary Research, Madrid, Spain
| | - Oscar Fraile-Martínez
- Department of Medicine and Medical Specialities, University of Alcalá, Alcalá de Henares, Spain
- Ramon y Cajal Institute of Sanitary Research, Madrid, Spain
| | - Cristina Zaragoza
- Biomedical Sciences Department, University of Alcalá, Pharmacology Unit, Alcala de Henares, Spain
| | - Jorge Monserrat
- Department of Medicine and Medical Specialities, University of Alcalá, Alcalá de Henares, Spain
- Ramon y Cajal Institute of Sanitary Research, Madrid, Spain
| | - Melchor Alvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcalá, Alcalá de Henares, Spain
- Ramon y Cajal Institute of Sanitary Research, Madrid, Spain
- Immune System Diseases-Rheumatology and Internal Medicine Service, Centro de Investigación Biomédica en Red Enfermedades Hepáticas y Digestivas, University Hospital Príncipe de Asturias, Alcala de Henares, Spain
| | - Miguel Angel Alvarez-Mon
- Department of Medicine and Medical Specialities, University of Alcalá, Alcalá de Henares, Spain
- Ramon y Cajal Institute of Sanitary Research, Madrid, Spain
- Department of Psychiatry and Mental Health, Hospital Universitario Infanta Leonor, Madrid, Spain
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Jenssen BP, Kelly MK, Faerber JA, Asch DA, Shults J, Schnoll RA, Fiks AG. Pediatrician-Delivered Smoking-Cessation Messages for Parents: An Update. Acad Pediatr 2023; 23:1140-1141. [PMID: 37244523 PMCID: PMC10524647 DOI: 10.1016/j.acap.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/13/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Affiliation(s)
- Brian P Jenssen
- Department of Pediatrics (BP Jenssen, J Shults and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Clinical Futures and PolicyLab (BP Jenssen, MK Kelly and AG Fiks), Children...s Hospital of Philadelphia, Pa.
| | - Mary Kate Kelly
- Clinical Futures and PolicyLab (BP Jenssen, MK Kelly and AG Fiks), Children...s Hospital of Philadelphia, Pa
| | - Jennifer A Faerber
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics (JA Faerber), Children...s Hospital of Philadelphia, Pa
| | - David A Asch
- Department of Medicine (DA Asch), Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Justine Shults
- Department of Pediatrics (BP Jenssen, J Shults and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Department of Biostatistics (J Shults), Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Robert A Schnoll
- Department of Psychiatry and Abramson Cancer Center (RA Schnoll), Perelman School of Medicine University of Pennsylvania, Philadelphia
| | - Alexander G Fiks
- Department of Pediatrics (BP Jenssen, J Shults and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Clinical Futures and PolicyLab (BP Jenssen, MK Kelly and AG Fiks), Children...s Hospital of Philadelphia, Pa
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Thrul J, Howe CL, Devkota J, Alexander A, Allen AM, Businelle MS, Hébert ET, Heffner JL, Kendzor DE, Ra CK, Gordon JS. A Scoping Review and Meta-analysis of the Use of Remote Biochemical Verification Methods of Smoking Status in Tobacco Research. Nicotine Tob Res 2023; 25:1413-1423. [PMID: 36449414 PMCID: PMC10347976 DOI: 10.1093/ntr/ntac271] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 09/30/2022] [Accepted: 11/28/2022] [Indexed: 07/20/2023]
Abstract
INTRODUCTION Increasing digital delivery of smoking cessation interventions has resulted in the need to employ novel strategies for remote biochemical verification. AIMS AND METHODS This scoping review and meta-analysis aimed to investigate best practices for remote biochemical verification of smoking status. The scientific literature was searched for studies that reported remotely obtained (not in-person) biochemical confirmation of smoking status (ie, combustible tobacco). A meta-analysis of proportions was conducted to investigate key outcomes, which included rates of returned biological samples and the ratio of biochemically verified to self-reported abstinence rates. RESULTS A total of 82 studies were included. The most common samples were expired air (46%) and saliva (40% of studies), the most common biomarkers were carbon monoxide (48%) and cotinine (44%), and the most common verification methods were video confirmation (37%) and mail-in samples for lab analysis (26%). Mean sample return rates determined by random-effects meta-analysis were 70% for smoking cessation intervention studies without contingency management (CM), 77% for CM studies, and 65% for other studies (eg, feasibility and secondary analyses). Among smoking cessation intervention studies without CM, self-reported abstinence rates were 21%, biochemically verified abstinence rates were 10%, and 47% of individuals who self-reported abstinence were also biochemically confirmed as abstinent. CONCLUSIONS This scoping review suggests that improvements in sample return rates in remote biochemical verification studies of smoking status are needed. Recommendations for reporting standards are provided that may enhance confidence in the validity of reported abstinence rates in remote studies. IMPLICATIONS This scoping review and meta-analysis included studies using remote biochemical verification to determine smoking status. Challenges exist regarding implementation and ensuring high sample return rates. Higher self-reported compared to biochemically verified abstinence rates suggest the possibility that participants in remote studies may be misreporting abstinence or not returning samples for other reasons (eg, participant burden, inconvenience). Remote biochemical confirmation of self-reported smoking abstinence should be included in smoking cessation studies whenever feasible. However, findings should be considered in the context of challenges to sample return rates. Better reporting guidelines for future studies in this area are needed.
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Affiliation(s)
- Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
| | - Carol L Howe
- University of Arizona Health Sciences Library, Tucson, AZ, USA
| | - Janardan Devkota
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Adam Alexander
- Department of Family and Preventive Medicine and TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Alicia M Allen
- Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, AZ, USA
| | - Michael S Businelle
- Department of Family and Preventive Medicine and TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Emily T Hébert
- Department of Health Promotion and Behavioral Science, The University of Texas Health Science Center at Houston School of Public Health, Austin, TX, USA
| | - Jaimee L Heffner
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Darla E Kendzor
- Department of Family and Preventive Medicine and TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Chaelin K Ra
- Section of Behavioral Sciences, Rutgers Cancer Institute of New Jersey, NJ, USA
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Villanti AC, Peasley-Miklus C, Cha S, Schulz J, Klemperer EM, LePine SE, West JC, Mays D, Mermelstein R, Higgins ST, Graham AL. Tailored text message and web intervention for smoking cessation in U.S. socioeconomically-disadvantaged young adults: A randomized controlled trial. Prev Med 2022; 165:107209. [PMID: 35995105 PMCID: PMC10186588 DOI: 10.1016/j.ypmed.2022.107209] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/29/2022] [Accepted: 08/14/2022] [Indexed: 02/03/2023]
Abstract
The prevalence of cigarette smoking in young adults is higher among those with socioeconomic disadvantage than those without. Low treatment-seeking among young adult smokers is compounded by few efficacious smoking cessation interventions for this group, particularly socioeconomically-disadvantaged young adults (SDYA) who smoke cigarettes. The goal of this study was to test a tailored smoking-cessation intervention for SDYA. 343 SDYA aged 18-30 living in the U.S. (85% female) who smoke cigarettes with access to a smartphone and interest in quitting smoking in the next six months were recruited online in Spring 2020 and randomized to referral to online quit resources (usual care control; n = 171) or a 12-week tailored text message smoking-cessation program with a companion web-based intervention (n = 172). Intent to treat analyses examined associations between study condition, self-reported 30-day point prevalence abstinence (PPA), and confidence to quit smoking at 12 weeks, controlling for potential confounders. Intervention group participants had greater self-reported 30-day PPA at 12-weeks than controls (adjusted relative risk 3.93, 95% CI 2.14-7.24). Among those who continued smoking, the intervention increased confidence to quit (0.81 points, 95% confidence interval 0.08-1.53). Weekly engagement in the intervention predicted greater cessation. A tailored text message intervention for SDYA increased smoking abstinence and confidence to quit at the end-of-treatment. Findings may have been influenced by recruitment at the start of the COVID pandemic but suggest that text messaging is an acceptable and efficacious cessation strategy for SDYA smokers. Future studies should examine the impact on longer-term smoking-cessation and importance of intervention tailoring for SDYA.
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Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States.
| | - Catherine Peasley-Miklus
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States
| | - Sarah Cha
- Innovations Center, Truth Initiative, United States
| | - Jonathan Schulz
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States
| | - Elias M Klemperer
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States
| | - S Elisha LePine
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States
| | - Julia C West
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States
| | - Darren Mays
- Center for Tobacco Research, The Ohio State University James Comprehensive Cancer Center, Department of Internal Medicine, The Ohio State University, United States
| | - Robin Mermelstein
- Department of Psychology and Institute for Health Research and Policy, University of Illinois at Chicago, United States
| | - Stephen T Higgins
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States; Department of Psychological Science, University of Vermont, United States
| | - Amanda L Graham
- Innovations Center, Truth Initiative, United States; Department of Medicine, Mayo Clinic College of Medicine and Science, United States; Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, United States
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12
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Kathuria H, Shankar D, Cobb V, Newman J, Bulekova K, Werntz S, Borrelli B. Integrating Social Determinants of Health With Tobacco Treatment for Individuals With Opioid Use Disorder: Feasibility and Acceptability Study of Delivery Through Text Messaging. JMIR Form Res 2022; 6:e36919. [PMID: 36048509 PMCID: PMC9478816 DOI: 10.2196/36919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/17/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Individuals with opioid use disorder (OUD) have a high prevalence of smoking and frequently experience unmet social determinants of health (SDOH), which may be barriers to smoking cessation. Hospitalization is an opportunity to encourage smoking cessation. Unfortunately, many clinicians do not provide tobacco treatment to support the maintenance of cessation achieved during hospitalization. Interventions are required to support these high-risk individuals after hospital discharge. Objective This study aimed to test the feasibility and acceptability of a 28-day SMS text messaging program tailored to individuals with OUD, which provides smoking cessation support and addresses unmet SDOH needs. Methods From July to December 2019, we enrolled 25 individuals who were hospitalized with tobacco dependence and OUD at our large safety net hospital. The SMS text messaging program was initiated during hospitalization and continued for 28 days. Participants were enrolled in either the ready to quit within 30 days or the not ready to quit within 30 days program based on their readiness to quit. Automated SMS text messages were sent twice daily for 4 weeks. The topics included health and cost benefits of quitting, both general and opioid specific (16 messages); managing mood and stress (8 messages); motivation, coping strategies, and encouragement (18 messages); addressing medication misconceptions (5 messages); links to resources to address substance use (2 messages providing links to the Massachusetts Substance Use Helpline and Boston Medical Center resources), tobacco dependence (1 message providing a link to the Massachusetts Quitline), and unmet SDOH needs (6 messages assessing SDOH needs with links to resources if unmet SDOH needs were identified). Questionnaires and interviews were conducted at baseline and at 2 and 4 weeks after enrollment. Results The participants were 56% (14/25) female, 36% (9/25) African American, 92% (23/25) unemployed, and 96% (24/25) Medicaid insured. Approximately 84% (21/25) activated the program, and none of the participants unsubscribed. Approximately 57% (12/21) completed either the 2- or 4-week questionnaires. Program satisfaction was high (overall mean 6.7, SD 0.8, range 1-7). Many perceived that the SMS text messaging program provided social support, companionship, and motivation to stop smoking. Messages about the health benefits of quitting were well received, whereas messages on how quitting cigarettes may prevent relapse from other substances had mixed views, highlighting the importance of tailoring interventions to patient preferences. Conclusions SMS text messaging to promote smoking cessation and address SDOH needs may be an effective tool for improving quit rates and health outcomes in individuals with tobacco dependence and OUD. Our study adds to the growing body of evidence that SMS text messaging approaches are feasible and acceptable for providing tobacco treatment to all individuals who smoke, even among low-income populations who have OUD and are not ready to quit.
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Affiliation(s)
- Hasmeena Kathuria
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States
| | - Divya Shankar
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States
| | - Vinson Cobb
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States
| | - Julia Newman
- The Pulmonary Center, Boston University School of Medicine, Boston, MA, United States
| | | | | | - Belinda Borrelli
- Henry M Goldman School of Dental Medicine, Boston University, Boston, MA, United States
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13
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Budenz A, Wiseman KP, Keefe B, Prutzman Y. User Engagement With Mood-Related Content on the National Cancer Institute Smokefree.Gov Initiative Cessation Resources. HEALTH EDUCATION & BEHAVIOR 2022; 49:613-617. [PMID: 35112581 PMCID: PMC9807027 DOI: 10.1177/10901981211073736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AIMS This study aimed to examine engagement with mood-related content on the Smokefree.gov Initiative's smoking cessation resources. METHODS Smokefree.gov website analytics (July 2018-July 2019) were analyzed for user interactions with mood content on informational webpages and interactive self-assessment tools (mood quizzes, smoking quit plans). We also examined mood feature engagement (texting or pressing a command button for mood support) among text program and app users (July 2018-July 2019). RESULTS Mood webpage views comprised 1.5% of all Smokefree.gov webpage views. Depression quizzes represented 82.9% of quiz completions, and stress quizzes represented 0.4% of quiz completions. Stress, anxiety, and low mood were the most reported smoking triggers on quit plans. Approximately 7,000 text program users and 3,000 app users sought real-time mood support. CONCLUSIONS Given the importance of mood management in the smoking cessation process these findings demonstrate promising opportunities to increase the reach of mood support resources.
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Affiliation(s)
| | - Kara P. Wiseman
- University of Virginia School of Medicine, Charlottesville,
VA, USA
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Can Digital Health Solutions Fill in the Gap for Effective Guideline Implementation in Cardiovascular Disease Prevention: Hope or Hype? Curr Atheroscler Rep 2022; 24:747-754. [PMID: 35761153 DOI: 10.1007/s11883-022-01050-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW To evaluate the use of digital health solutions in improving the implementation of cardiovascular disease (CVD) prevention guidelines and review current evidence supporting it. RECENT FINDINGS Healthy diet guideline recommendations can be improved by text-messaging programs and apps for reinforcing healthy food intake and reducing unhealthy nutrients purchase and consumption. Wearable activity trackers are also effective in increasing physical activity levels. Text-messaging programs for smoking cessation have demonstrated benefits in increasing quitting rates; however, evidence on smartphone apps for smoking cessation is still lacking. Smartphone apps have the potential to improve medication adherence; however, better quality evidence is needed. Digital pills are another promising digital solution to improve medication adherence. The use of digital health solutions in CVD prevention is an evolving field and, to date, there is an increasing body of evidence that supports that such technologies are effective in improving CVD prevention guideline implementation.
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Interventions for Increasing Digital Equity and Access (IDEA) among rural patients who smoke: Study protocol for a pragmatic randomized pilot trial. Contemp Clin Trials 2022; 119:106838. [PMID: 35760340 DOI: 10.1016/j.cct.2022.106838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 06/17/2022] [Accepted: 06/21/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cigarette smoking prevalence is higher among rural compared with urban adults, yet access to cessation programming is reduced. The Increasing Digital Equity and Access (IDEA) study aims to evaluate three digital access and literacy interventions for promoting engagement with an online evidence-based smoking cessation treatment (EBCT) program among rural adults. METHODS The pilot trial will use a pragmatic, three-arm, randomized, parallel-group design with participants recruited from a Midwest community-based health system in Minnesota, Wisconsin, and Iowa. All participants will receive an online, 12-week, EBCT program, and written materials on digital access resources. Participants will be stratified based on state of residence and randomly assigned with 1:1:1 allocation to one of three study groups: (1) Control Condition-no additional study intervention (n = 30); (2) Loaner Digital Device-Bluetooth enabled iPad with data plan coverage loaned for the study duration (n = 30); (3) Loaner Digital Device + Coaching Support-loaner device plus up to six, 15-20 min motivational interviewing-based coaching calls to enhance participants' digital access and literacy (n = 30). All participants will complete study assessments at baseline and 4- and 12-weeks post-randomization. Outcomes are cessation program and trial engagement, biochemically confirmed smoking abstinence, and patient experience. RESULTS A rural community advisory committee was formed that fostered co-design of the study protocol for relevance to rural populations, including the trial design and interventions. CONCLUSION Study findings, processes, and resources may have relevance to other health systems aiming to foster digital inclusion in smoking cessation and chronic disease management programs and clinical trials in rural communities.
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16
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Borrelli B, Endrighi R, Jurasic MM, Hernandez H, Jones E, Ospina J, Cabral HJ, Quintiliani LM, Werntz S. A smoking cessation induction intervention via virtual reality headset during a dental cleaning: protocol for a randomized controlled trial. BMC Public Health 2022; 22:1074. [PMID: 35641925 PMCID: PMC9158367 DOI: 10.1186/s12889-022-13427-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Effective smoking cessation programs exist but are underutilized by smokers, especially by disadvantaged smokers. Cessation interventions in dental settings have been shown to be effective, but are not consistently delivered due to provider burden and lack of training, especially on how to counsel smokers who are not motivated to quit. METHODS This study is a 2-arm, phase III longitudinal randomized controlled efficacy trial to motivate utilization of evidenced based treatments (EBTs) for smoking cessation (e.g., state quitline, clinic-based counseling, the National Cancer Institute's text message program, and pharmacotherapy). Patients attending an urban dental clinic (n = 376) will be randomized to an intervention group (INT; smoking cessation induction video delivered via VR headset during their teeth cleaning, brochure about EBTs, and a 4-week text message program) or control group (CTRL; relaxation video delivered via VR headset during teeth cleaning, the same brochure as INT, and assessment-only text messages). Assessments will occur at baseline, immediately after the clinic appointment, one-month post-appointment and 3-and 6 months later. We hypothesize INT will be more likely to contact EBTs vs CTRL and have greater utilization rates of EBTs. Secondary objectives are to test the efficacy of INT on point-prevalence smoking abstinence, quit smoking attempts, and motivation to quit vs. CTRL. DISCUSSION Incorporating smoking cessation into a dental clinic visit and targeting all smokers, regardless of motivation to quit, provides proactive reach to cigarette smokers who otherwise may not seek treatment for smoking. TRIAL REGISTRATION NCT04524533 Registered August 24, 2020.
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Affiliation(s)
- B Borrelli
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA.
| | - R Endrighi
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - M M Jurasic
- Department of General Dentistry and Health Policy and Health Services Research, Henry M. Goldman School of Dental Medicine, Boston University, Boston, MA, USA
| | - H Hernandez
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - E Jones
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - J Ospina
- Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, 560 Harrison Avenue, 3rd Floor, Boston, MA, 02118, USA
| | - H J Cabral
- Department of Biostatistics, School of Public Health, Boston University, Boston, MA, 02118, USA
| | - L M Quintiliani
- Section of General Internal Medicine, School of Medicine, Boston University, Boston Medical Center, Boston, MA, 02118, USA
| | - S Werntz
- President, Agile Health, Inc, Lincolnshire, IL, 60069, USA
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Hoepper BB, Siegel KR, Carlon HA, Kahler CW, Park ER, Taylor ST, Simpson HV, Hoeppner SS. Feature-level analysis of a smoking cessation smartphone app that uses a positive psychology approach (Preprint). JMIR Form Res 2022; 6:e38234. [PMID: 35900835 PMCID: PMC9377446 DOI: 10.2196/38234] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 04/27/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background Smoking cessation smartphone apps have emerged as highly accessible tools to support smoking cessation efforts. It is unknown how specific app features contribute to user engagement over time and relate to smoking outcomes. Objective To provide a feature-level analysis of the Smiling Instead of Smoking app (version 2) and to link feature use to subsequent smoking cessation. Methods Nondaily smokers (N=100) used the app for a period of 49 days (1 week before quitting and 6 weeks after quitting). Participants self-reported 30-day point-prevalence abstinence at the end of this period and at a 6-month follow up (the survey response rate was 94% and 89% at these points, respectively). Self-reported 30-day point prevalence abstinence rates were 40% at the end of treatment and 56% at the 6-month follow up. The app engaged users in both positive psychology content and traditional behavioral smoking cessation content. The app sent push notifications to prompt participants to complete prescribed content (ie, a “happiness exercise” every day and a “behavioral challenge” to use the app’s smoking cessation tools on 15 out of 49 days). Actions that participants took within the app were timestamped and recorded. Results Participants used the app on 24.7 (SD 13.8) days out of the 49 prescribed days, interacting with the happiness content on more days than the smoking content (23.8, SD 13.8 days vs 17.8, SD 10.3 days; t99=9.28 [2-tailed]; P<.001). The prescribed content was frequently completed (45% of happiness exercises; 57% of behavioral challenges) and ad libitum tools were used on ≤7 days. Most participants used each ad libitum smoking cessation tool at least once, with higher use of personalized content (≥92% used “strategies,” “cigarette log,” “smoke alarms,” and “personal reasons”) than purely didactic content (79% viewed “benefits of quitting smoking”). The number of days participants used the app significantly predicted 30-day point-prevalence abstinence at the end of treatment (odds ratio [OR] 1.05, 95% CI 1.02-1.09; P=.002) and at the 6-month follow up (OR 1.04, 95% CI 1.008-1.07; P=.01). The number of days participants engaged with the happiness content significantly predicted smoking abstinence at the end of treatment (OR 1.05, 95% CI 1.02-1.08; P=.002) and at the 6-month follow up (OR 1.04, 95% CI 1.007-1.07; P=.02). This effect was not significant for the number of days participants engaged with the smoking cessation content of the app, either at the end of treatment (OR 1.04, 95% CI 0.996-1.08, P=.08) or at the 6-month follow up (OR 1.02, 95% CI 0.98-1.06; P=.29). Conclusions Greater app usage predicted greater odds of self-reported 30-day point-prevalence abstinence at both the end of treatment and over the long term, suggesting that the app had a therapeutic benefit. Positive psychology content and prescriptive clarity may promote sustained app engagement over time. Trial Registration ClinicalTrials.gov NCT03951766; https://clinicaltrials.gov/ct2/show/NCT03951766
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Affiliation(s)
- Bettina B Hoepper
- Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Kaitlyn R Siegel
- Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Hannah A Carlon
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
| | - Elyse R Park
- Mongan Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Steven Trevor Taylor
- Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Hazel V Simpson
- Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Susanne S Hoeppner
- Obsessive-Compulsive Disorder and Related Disorders Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
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Fradkin N, Zbikowski SM, Christensen T. Analysis of Demographic Characteristics of Users of a Free Tobacco Cessation Smartphone App: Observational Study. JMIR Public Health Surveill 2022; 8:e32499. [PMID: 35262491 PMCID: PMC8943539 DOI: 10.2196/32499] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/25/2021] [Accepted: 12/27/2021] [Indexed: 01/23/2023] Open
Abstract
Background Tobacco use continues to be the leading preventable cause of death, disease, and disability in the United States. Since 2000, Washington state has offered free tobacco “quitline” services to help its residents stop using tobacco. In 2015, the state began offering free access to a tobacco cessation smartphone app to absorb excess quitline demand. Since most publicly funded tobacco cessation programs are designed to provide access to populations disproportionately impacted by tobacco use, it is important to consider who these public health interventions reach. Objective The aim of this study is to understand who used a free cessation app and the extent to which users represented populations disproportionately impacted by tobacco use. Methods This is an observational study of 1280 adult Washington state residents who registered for and activated the cessation app. Demographic data were collected as part of the sign-up process, examined using standard descriptive measures, and assessed against state-level surveillance data for representativeness. Results Participants were primarily non-Hispanic White (978/1218, 80.3%), identified as female (780/1236, 63.1%), were between ages 25-54 years (903/1186, 76.1%), had at least some college education (836/1222, 68.4%), and reported a household income under US $50,000 (742/1055, 70.3%). Fewer respondents were from rural counties (359/1220, 29.4%); identified as lesbian, gay, bisexual, pansexual, queer, questioning, or asexual (LGBQA; 153/1222, 12.5%); were uninsured (147/1206, 12.2%); or were currently pregnant, planning pregnancy, or breastfeeding (42/624, 6.7%). However, relative to available state data for tobacco users, there was high representation of women, 35- to 54-year-olds, college graduates, and LGBQA individuals, as well as individuals with low household income, poor mental health, Medicaid insurance, and those residing in rural counties. Conclusions A diverse population of tobacco users will use a free cessation app, including some demographic groups disproportionately impacted by tobacco use. With high reach and high efficacy, it is possible to address health disparities associated with tobacco use and dependence treatment among certain underserved and at-risk groups.
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Affiliation(s)
- Nick Fradkin
- Office of Healthy and Safe Communities, Division of Prevention and Community Health, Washington State Department of Health, Olympia, WA, United States
| | | | - Trevor Christensen
- Office of Healthy and Safe Communities, Division of Prevention and Community Health, Washington State Department of Health, Olympia, WA, United States
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Arauz RF, Mayer M, Reyes-Guzman C, Ryan BM. Racial Disparities in Cigarette Smoking Behaviors and Differences Stratified by Metropolitan Area of Residence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052910. [PMID: 35270603 PMCID: PMC8910057 DOI: 10.3390/ijerph19052910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/08/2022] [Accepted: 02/21/2022] [Indexed: 02/04/2023]
Abstract
Background: Black cigarette smokers experience a disproportionate burden of non-small cell lung cancer (NSCLC) compared to other racial and ethnic groups, despite starting to smoke later in life, smoking less frequently, and smoking fewer cigarettes per day compared with White smokers. Research has shown that these disparities in NSCLC are wider in rural areas. Objective: To examine differences in smoking behaviors between Black and White individuals living in non-metropolitan areas and metropolitan areas. Methods: Using harmonized data from the Tobacco Use Supplement to the Current Population Survey (TUS-CPS) years 2010–2011, 2014–2015, and 2018–2019, we compared smoking behaviors between Black and White current and former smokers by metropolitan status (i.e., whether an individual lives in a densely populated area or not) and by both metropolitan status and sex. Results: Smoking prevalence was higher among White participants living in non-metropolitan versus Black participants. Further, in non-metropolitan areas, Black individuals reported smoking fewer cigarettes per day, fewer years of smoking, and a later age of initiation compared to White individuals. Additionally, Black individuals, especially men, were more likely than White individuals to be current non-daily smokers. Conclusions: Our findings show that Black individuals living in non-metropolitan areas do not, in aggregate, have more cigarette smoking exposure relative to White individuals. Additional research is needed to further understand smoking-related exposures and other factors that may contribute to lung cancer disparities, especially in non-metropolitan areas.
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Affiliation(s)
- Rony F. Arauz
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA;
| | - Margaret Mayer
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA; (M.M.); (C.R.-G.)
| | - Carolyn Reyes-Guzman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA; (M.M.); (C.R.-G.)
| | - Bríd M. Ryan
- Laboratory of Human Carcinogenesis, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20892, USA;
- Correspondence: ; Tel.: +1-301-496-5886
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Coughlin LN, Bonar EE, Walton MA, Fernandez AC, Duguid I, Nahum-Shani I. New Directions for Motivational Incentive Interventions for Smoking Cessation. Front Digit Health 2022; 4:803301. [PMID: 35310552 PMCID: PMC8931767 DOI: 10.3389/fdgth.2022.803301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background Motivational incentive interventions are highly effective for smoking cessation. Yet, these interventions are not widely available to people who want to quit smoking, in part, due to barriers such as administrative burden, concern about the use of extrinsic reinforcement (i.e., incentives) to improve cessation outcomes, suboptimal intervention engagement, individual burden, and up-front costs. Purpose Technological advancements can mitigate some of these barriers. For example, mobile abstinence monitoring and digital, automated incentive delivery have the potential to lower the clinic burden associated with monitoring abstinence and administering incentives while also reducing the frequency of clinic visits. However, to fully realize the potential of digital technologies to deliver motivational incentives it is critical to develop strategies to mitigate longstanding concerns that reliance on extrinsic monetary reinforcement may hamper internal motivation for cessation, improve individual engagement with the intervention, and address scalability limitations due to the up-front cost of monetary incentives. Herein, we describe the state of digitally-delivered motivational incentives. We then build on existing principles for creating just-in-time adaptive interventions to highlight new directions in leveraging digital technology to improve the effectiveness and scalability of motivational incentive interventions. Conclusions Technological advancement in abstinence monitoring coupled with digital delivery of reinforcers has made the use of motivational incentives for smoking cessation increasingly feasible. We propose future directions for a new era of motivational incentive interventions that leverage technology to integrate monetary and non-monetary incentives in a way that addresses the changing needs of individuals as they unfold in real-time.
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Affiliation(s)
- Lara N. Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
- *Correspondence: Lara N. Coughlin
| | - Erin E. Bonar
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Maureen A. Walton
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, United States
| | - Anne C. Fernandez
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Isabelle Duguid
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
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21
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Brunet J, Price J, Harris C. Women's Preferences for Body Image Programming: A Qualitative Study to Inform Future Programs Targeting Women Diagnosed With Breast Cancer. Front Psychol 2021; 12:720178. [PMID: 34721173 PMCID: PMC8548366 DOI: 10.3389/fpsyg.2021.720178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/16/2021] [Indexed: 12/25/2022] Open
Abstract
Purpose: This paper describes women's opinions of the attributes of the ideal body image program to inform the design, development, and implementation of future programs for those diagnosed with breast cancer. Methods: Deductive-inductive content analysis of semi-structured interviews with 26 women diagnosed with breast cancer (mean age = 55.96 years; mean time since diagnosis = 2.79 years) was performed. Findings: Participants' opinions regarding the ideal body image program are summarized into five themes, mapping the where (community-based, hospital-based, or online), when (across the cancer continuum or at specific points), how (peer-led programs, professional help, events, presentations/workshops, resources, support groups), what (self-care, counseling and education for one self, education for others, support for addressing sexuality/sexual health concerns, and concealing treatment-related changes), and who (team approach or delivered by women, health professionals, make-up artists). Conclusion: This study provides useful data on what women believe are the attributes of the ideal body image program, which can contribute to efforts aimed at developing and delivering body image programs for women diagnosed with breast cancer that prioritize their needs and preferences.
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Affiliation(s)
- Jennifer Brunet
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Institut du Savoir Montfort, Hôpital Montfort, Ottawa, ON, Canada
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Jenson Price
- School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Cheryl Harris
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
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22
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Chopra K. Maslow’s theory for preventive healthcare in India – a content analysis approach. INTERNATIONAL JOURNAL OF PHARMACEUTICAL AND HEALTHCARE MARKETING 2021. [DOI: 10.1108/ijphm-10-2020-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of the study was to apply Maslow’s hierarchy of needs to understand consumer motivation for preventive health care in India using content analysis.
Design/methodology/approach
Content analysis approach which is a qualitative-based approach was adopted. The responses were collected through semi-structured interviews using purposeful sampling method, and the responses were analyzed using content analysis approach. Sub themes and main themes were derived from the data which related to concepts in Maslow’s theory.
Findings
The results indicate the following: healthy food, healthy diet and health supplements are the basic need; sustainability of health and fitness and health security relate to safety and security need; feeling of pride in being fit, being a role model of fitness for others and influence of electronic media relate to social and self-esteem need; freedom from disease and peace of mind fulfill the need for self-actualization.
Research limitations/implications
To strengthen the external validity, a mix of alternate research methodologies adopting qualitative and quantitative approach need to be adopted.
Practical implications
This study will help to better understand motivation for preventive health care. It will enable health-care companies to design health-care marketing programs based on Maslow’s theory to motivate individuals to purchase health products. The public health-care departments can issue guidelines based on Maslow’s theory to motivate citizens toward preventive health care.
Originality/value
Maslow’s theory was applied in the context of preventive health care.
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Budenz A, Coa K, Grenen E, Keefe B, Sanders A, Wiseman KP, Roditis M. User experiences with a text messaging program for smoking cessation: A qualitative study (Preprint). JMIR Form Res 2021; 6:e32342. [PMID: 35302505 PMCID: PMC8976256 DOI: 10.2196/32342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/17/2021] [Accepted: 01/20/2022] [Indexed: 12/04/2022] Open
Abstract
Background Mobile health strategies for smoking cessation (eg, SMS text messaging–based interventions) have been shown to be effective in helping smokers quit. However, further research is needed to better understand user experiences with these platforms. Objective This qualitative study aims to explore the experiences of real-world users of a publicly available smoking cessation program (SmokefreeTXT). Methods Semistructured phone interviews were conducted with 36 SmokefreeTXT users between March and July 2014. Of these 36 participants, 50% (18/36) of participants completed the SmokefreeTXT program (ie, did not opt out of the program before the 6- to 8-week completion period), and 50% (18/36) did not complete the program (ie, requested to opt out of the program before the completion period). Interview questions focused on smoking behaviors, quitting history, opinions on the program’s content and structure, answering assessment questions, using keywords, reasons for opting out, and perceived usefulness of the program for quitting smoking. A thematic content analysis was conducted, with a focus on themes to increase program engagement and optimization. Results The findings highlighted features of the program that participants found beneficial, as well as some elements that showed opportunities for improvement to boost program retention and successful cessation. Specifically, most participants found the SmokefreeTXT program to be convenient and supportive of cessation; however, some found the messages to be repetitive and reported a desire for more flexibility based on their readiness to quit and cessation progress. We also found that program completion did not necessarily indicate successful smoking cessation and that program opt out, which might be interpreted as a less positive outcome, may occur because of successful cessation. Finally, several participants reported using SmokefreeTXT together with other evidence-based cessation methods or non–evidence-based strategies. Conclusions Qualitative interviews with real-world SmokefreeTXT users showed high program acceptability, engagement with program features, and perceived utility for smoking cessation. Our findings directly informed several program updates, such as adding an adaptive quit date feature and offering supplemental information on live support services for users who prefer human interaction during the cessation process. The study has implications for other digital tobacco cessation interventions and highlights important topics that warrant future research, such as the relationship between program engagement (eg, opt out and retention) and successful cessation.
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Affiliation(s)
- Alexandra Budenz
- Tobacco Control Research Branch, National Cancer Institute, Rockville, MD, United States
| | - Kisha Coa
- Centers for Medicare and Medicaid Services, Woodlawn, MD, United States
| | | | | | | | - Kara P Wiseman
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, United States
| | - Maria Roditis
- Tobacco Control Research Branch, National Cancer Institute, Rockville, MD, United States
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24
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El-Toukhy S. Insights From the SmokeFree.gov Initiative Regarding the Use of Smoking Cessation Digital Platforms During the COVID-19 Pandemic: Cross-sectional Trends Analysis Study. J Med Internet Res 2021; 23:e24593. [PMID: 33646963 PMCID: PMC7986806 DOI: 10.2196/24593] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 12/31/2020] [Accepted: 02/19/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Smoking is a plausible risk factor for COVID-19 progression and complications. Smoking cessation digital platforms transcend pandemic-driven social distancing and lockdown measures in terms of assisting smokers in their quit attempts. OBJECTIVE This study aims to examine trends in the number of visitors, followers, and subscribers on smoking cessation digital platforms from January to April 2020 and to compare these traffic data to those observed during the same 4-month period in 2019. The examination of prepandemic and postpandemic trends in smoking cessation digital platform traffic can reveal whether interest in smoking cessation among smokers is attributable to the COVID-19 pandemic. METHODS We obtained cross-sectional data from daily visitors on the SmokeFree website; the followers of six SmokeFree social media accounts; and subscribers to the SmokeFree SMS text messaging and mobile app interventions of the National Cancer Institute's SmokeFree.gov initiative platforms, which are publicly available to US smokers. Average daily percentage changes (ADPCs) were used to measure trends for the entire 2020 and 2019 study periods, whereas daily percentage changes (DPCs) were used to measure trends for each time segment of change within each 4-month period. Data analysis was conducted in May and June 2020. RESULTS The number of new daily visitors on the SmokeFree website (between days 39 and 44: DPC=18.79%; 95% CI 5.16% to 34.19%) and subscribers to the adult-focused interventions QuitGuide (between days 11 and 62: DPC=1.11%; 95% CI 0.80% to 1.43%) and SmokeFreeTXT (between days 11 and 89: DPC=0.23%; 95% CI 0.004% to 0.47%) increased, but this was followed by declines in traffic. No comparable peaks were observed in 2019. The number of new daily subscribers to quitSTART (ie, the teen-focused intervention) trended downward in 2020 (ADPC=-1.02%; 95% CI -1.88% to -0.15%), whereas the overall trend in the number of subscribers in 2019 was insignificant (P=.07). The number of SmokeFree social media account followers steadily increased by <0.1% over the 4-month study periods in 2019 and 2020. CONCLUSIONS Peaks in traffic on the SmokeFree website and adult-focused intervention platforms in 2020 could be attributed to an increased interest in smoking cessation among smokers during the COVID-19 pandemic. Coordinated campaigns, especially those for adolescents, should emphasize the importance of smoking cessation as a preventive measure against SARS-CoV-2 infection and raise awareness of digital smoking cessation platforms to capitalize on smokers' heightened interest during the pandemic.
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Affiliation(s)
- Sherine El-Toukhy
- Division of Intramural Research, National Institute on Minority Health & Health Disparities, National Institutes of Health, Bethesda, MD, United States
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25
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Hacker KA, Kang JY. Tobacco Cessation Quitlines: An Evolving Mainstay for an Enduring Cessation Support Infrastructure. Am J Prev Med 2021; 60:S185-S187. [PMID: 33663706 DOI: 10.1016/j.amepre.2020.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/01/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Karen A Hacker
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joann Yoon Kang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
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26
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Glover-Kudon RM, Gates EF. The Role of Quitlines in Tobacco Cessation: An Introduction. Am J Prev Med 2021; 60:S99-S102. [PMID: 33663707 DOI: 10.1016/j.amepre.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 12/14/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Rebecca M Glover-Kudon
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Emily F Gates
- Measurement, Evaluation, Statistics, & Assessment (MESA), Lynch School of Education and Human Development, Boston College, Chestnut Hill, Massachusetts
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