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Agràs-Guàrdia M, Martínez-Torres S, Satué E, Granado-Font E, Pallejà-Millán M, Patricio D, Leiva M, Rey-Reñones C, Martín-Luján F. Experiences of smoking and tobacco use during pregnancy: A qualitative study protocol. PLoS One 2024; 19:e0308781. [PMID: 39121101 PMCID: PMC11315274 DOI: 10.1371/journal.pone.0308781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 07/30/2024] [Indexed: 08/11/2024] Open
Abstract
Tobacco use during pregnancy is the main avoidable cause of morbidity and mortality both for pregnant women and their offspring. Between 12 and 22% of pregnant women in industrialized countries smoke during pregnancy, and 13% are unable to stop smoking. Pregnancy is considered an ideal opportunity to intervene and control tobacco use among smokers and their families. However, pregnant women experience barriers to quitting smoking, including social stigma and fear of being judged. Thus, it is necessary to develop interventions for smoking cessation adapted for pregnant women. This paper presents a qualitative study protocol to assess the barriers and facilitators of smoking cessation during pregnancy that female smokers encounter or perceive. It consists of a series of focus groups and individual interviews with female smokers who have been pregnant within the last five years. Participants will be recruited from the Sexual and Reproductive Health Care Services of the Camp de Tarragona. A group of 5-10 women who have been pregnant and tried to quit smoking over the last 5 years will be selected. The data will be collected by means of semistructured interviews. All interviews will be transcribed verbatim, coded and synthesized into categories and main themes. Thematic analysis will be conducted employing an iterative and reflexive approach. The results of this study will offer new perspectives on smoking interventions for pregnant women and enhance our comprehension of the main barriers to and facilitators of smoking cessation during pregnancy. This will contribute to the adaptation of the Tobbstop app, originally designed for the general public, to suit the needs of pregnant women. Consequently, the creation of targeted interventions will positively influence the health outcomes of both pregnant women and newborns. Trial registration: Clinicaltrials.gov ID: NCT05222958. The trial was registered 3 February 2022, at https://clinicaltrials.gov/ct2/show/NCT05222958.
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Affiliation(s)
- Maria Agràs-Guàrdia
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Department of Primary Care Camp de Tarragona, Institut Català de la Salut, Primary Care Center Llibertat (Reus– 3), Reus, Spain
- ISAC Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
| | - Sara Martínez-Torres
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- ISAC Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Primary Healthcare Research Support Unit Camp de Tarragona, Reus, Spain
- Universitat Oberta de Catalunya (UOC), Barcelona, Spain
| | - Eva Satué
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- ISAC Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Primary Healthcare Research Support Unit Camp de Tarragona, Reus, Spain
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
| | - Ester Granado-Font
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- ISAC Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
- Department of Primary Care Camp de Tarragona, Institut Català de la Salut, Primary Care Center Horts de Miró (Reus– 4), Reus, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), TICS-AP Research Group, Barcelona, Spain
| | - Meritxell Pallejà-Millán
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- ISAC Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Primary Healthcare Research Support Unit Camp de Tarragona, Reus, Spain
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
| | - Demetria Patricio
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- ISAC Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), TICS-AP Research Group, Barcelona, Spain
- Department of Primary Care Camp de Tarragona, Institut Català de la Salut, Sexual and Reproductive Health Care Unit (ASSIR), Reus, Spain
| | - Miriam Leiva
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), TICS-AP Research Group, Barcelona, Spain
- Department of Primary Care Camp de Tarragona, Institut Català de la Salut, Sexual and Reproductive Health Care Unit (ASSIR), Reus, Spain
| | - Cristina Rey-Reñones
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- ISAC Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Primary Healthcare Research Support Unit Camp de Tarragona, Reus, Spain
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), TICS-AP Research Group, Barcelona, Spain
| | - Francisco Martín-Luján
- Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
- ISAC Research Group, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP JGol), Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Primary Healthcare Research Support Unit Camp de Tarragona, Reus, Spain
- School of Medicine and Health Sciences, Universitat Rovira i Virgili, Reus, Spain
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Zhang X, Liu Y, Li X, Sun J. Health IT in our daily life: impact of mobile phone use on the emotions and compliance of diabetes patients. INFORMATION TECHNOLOGY & PEOPLE 2022. [DOI: 10.1108/itp-06-2020-0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
PurposeLeveraging information technology (IT) to improve the treatment and support of patients is a widely studied topic in healthcare. For chronic diseases, such as diabetes, the use of information technology is even more important since its effect extends from a clinic environment to patients’ daily life. The purpose of this paper is to investigate the impacts of one widely adopted information technology, the mobile phone, on diabetes treatment, specifically on the complicated process of patients’ health, emotions and compliance.Design/methodology/approachWe leverage a unique longitudinal dataset on diabetes patients’ health status in rural areas of China to study the problem. We also cross-link the dataset with mobile carrier data to further differentiate mobile phone use to phone calls and network use. To address the endogeneity concerns, we apply PSM and a series of instrument variables.FindingsWe identify clear evidence that mobile phone use can significantly improve patients’ emotions and compliance, where the effect is generally larger on patients in worse health conditions. While mobile phone calls clearly benefit diabetes patients, we do notice that mobile phone network use has a negative moderating effect with patients’ health condition on improving compliance.Originality/valueThis study not only enriches our theoretical understanding of the role of mobile phones in diabetes management, it also shows the economic benefit of promoting patients’ use of mobile phones, which should be considered by medical care providers and medical policymakers.
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Cottrell-Daniels C, Jones DM, Bell SA, Bandlamudi M, Spears CA. Mindfulness and Mobile Health for Quitting Smoking: A Qualitative Study Among Predominantly African American Adults with Low Socioeconomic Status. AMERICAN JOURNAL OF QUALITATIVE RESEARCH 2022; 6:19-41. [PMID: 35392178 PMCID: PMC8985517 DOI: 10.29333/ajqr/11427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Low-income and African American adults experience severe tobacco-related health disparities. Mindfulness-based interventions show promise for promoting smoking cessation, but most mindfulness research has focused on higher income, Caucasian samples. "iQuit Mindfully" is a personalized, interactive text messaging program that teaches mindfulness for smoking cessation. This qualitative study sought feedback from predominantly low-income African American smokers, to improve the intervention for this priority population. After receiving 8 weekly group sessions of Mindfulness-Based Addiction Treatment for smoking cessation and between-session iQuit Mindfully text messages, participants (N=32) completed semi-structured interviews. Participants were adult cigarette smokers (90.6% African American, 62.6% annual income <$30,000, mean age 45.1 [±12.9]). Interviews inquired about participants' experiences with and suggestions for improving iQuit Mindfully, including message content, number, and timing. Interviews were audio-recorded, transcribed verbatim, and coded by a team of 5 coders in NVivo. The coding manual was developed based on response categories from the interview guide and themes emerging from the data. Themes were organized into a conceptual model of factors related to engagement with the mHealth program. Response categories included helpful aspects (e.g., themes of social support, mindfulness, personalization); unhelpful/disliked aspects (e.g., too many/repetitive messages); links between in-person sessions and texts; and suggestions (e.g., changes to number/timing and more personalization). Findings provide insight into participants' day-to-day experiences with iQuit Mindfully and suggest ways to improve mHealth programs among low-income and African American adults.
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Affiliation(s)
- Cherell Cottrell-Daniels
- Corresponding Author: Cherell Cottrell-Daniels, PhD, MPH, Moffitt Cancer Center. 4115 E. Fowler Ave., Tampa, FL 33617; Phone: 813.745.2149.
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García-Pazo P, Sesé A, Llabrés J, Fornés-Vives J. NoFumo+: A Clinical Trial of an mHealth for Smoking Cessation with Hospitalized Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10476. [PMID: 34639776 PMCID: PMC8507632 DOI: 10.3390/ijerph181910476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/30/2021] [Accepted: 10/01/2021] [Indexed: 01/08/2023]
Abstract
Smartphone applications (apps) improve accessibility to smoking cessation treatments. The NoFumo+ app administers a cognitive behavioral therapy program for smoking cessation. This study evaluates the efficacy of NoFumo+ for quitting smoking or reducing cigarette consumption versus the usual information-based treatment. A clinical trial was conducted with 99 hospitalized smokers, 54 pseudo-randomly assigned to the app treatment and 45 to the usual treatment. The two groups had homogeneous baseline characteristics to ensure comparability. Abstinence was evaluated at post-treatment (two months) and at a six-month follow-up. The results obtained indicate that participants who receive the usual treatment are 5.40 times more likely to continue smoking than those who undergo the app treatment (95% CI = [1.35; 20.15]). Participants who do not succeed in quitting smoking with the app manage to decrease their habitual consumption. Users who successfully complete treatment with NoFumo+ access all its contents and use the chat, but without requesting professional support. There is not enough empirical evidence to attribute this success to any specific element of the app. NoFumo+ achieves better abstinence rates than the usual information-based treatments, and the goal of generalizing its use to the non-hospitalized smoking population may be achievable in the future.
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Affiliation(s)
- Patricia García-Pazo
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Balearic Island, 07122 Palma, Spain;
- Balearic Islands Health Research Institute (IdISBa), Hospital Universitario Son Espases, Balearic Island, 07120 Palma, Spain; (A.S.); (J.L.)
| | - Albert Sesé
- Balearic Islands Health Research Institute (IdISBa), Hospital Universitario Son Espases, Balearic Island, 07120 Palma, Spain; (A.S.); (J.L.)
- Department of Psychology, University of the Balearic Islands, Balearic Island, 07122 Palma, Spain
| | - Jordi Llabrés
- Balearic Islands Health Research Institute (IdISBa), Hospital Universitario Son Espases, Balearic Island, 07120 Palma, Spain; (A.S.); (J.L.)
- Department of Psychology, University of the Balearic Islands, Balearic Island, 07122 Palma, Spain
| | - Joana Fornés-Vives
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Balearic Island, 07122 Palma, Spain;
- Balearic Islands Health Research Institute (IdISBa), Hospital Universitario Son Espases, Balearic Island, 07120 Palma, Spain; (A.S.); (J.L.)
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Lee H, Lee H, Kim Y, Kim S, Lee YM. Network Support Using Social Networking Services to Increase Exercise Adherence Among Korean-Chinese Middle-Aged Migrant Women: Mixed Methods Study. JMIR Mhealth Uhealth 2020; 8:e19159. [PMID: 33151155 PMCID: PMC7677014 DOI: 10.2196/19159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/23/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022] Open
Abstract
Background Social networking services (SNSs) are recognized to be a promising approach to easily deliver health interventions and to enhance social support for exercise adherence. However, the patterns and aspects of social support through SNSs have not been reported and their influence on other social-cognitive factors remains inconclusive. Objective Our objective is to explore how social support delivered through SNSs impacts interactions among Korean-Chinese (KC) middle-aged women and to identify how this approach influences social-cognitive factors for exercise (eg, sense of community, self-efficacy for exercise, and social support for exercise). Methods A mixed methods design was used. Text analysis of SNS messages and text mining using the Korean Natural Language Application (KoALA) were conducted. Social-cognitive factors (eg, sense of community, self-efficacy for exercise, and social support for exercise) were assessed at baseline and after 12 weeks using a structured questionnaire. A comparison of social-cognitive factors at baseline and at 12 weeks was conducted to identify any potential significant changes, using the Wilcoxon signed-rank test. Results A total of 259 SNS messages were collected from 24 KC women, distributed among four chat groups, who participated in a 12-week walking intervention program between August and October 2018. The individual average frequency of chatting via the SNS was 10.79 (range 0-34) and the most frequent type of social support through the SNS was network support (172/259, 66.4%). The most common words extracted from the SNS were Health, Exercise, Participation, and We. Overall, the perceived levels of sense of community (P<.001) and social support for exercise (P=.002) were significantly increased at 12 weeks compared with baseline. Group 1 (P=.03) and Group 4 (P=.03), whose members demonstrated the highest frequency of network support, experienced a significant increase only in the level of sense of community. Conclusions By integrating these data and conducting a mixed methods analysis, we observed that among the types of social support, network support was a key point for the promotion of social-cognitive factors in increasing exercise adherence. Therefore, network support through SNS-based interventions should be considered as a useful strategy to help vulnerable migrant populations make changes to exercise behaviors.
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Affiliation(s)
- Hyeyeon Lee
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Hyeonkyeong Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Youlim Kim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Sookyung Kim
- College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Young-Me Lee
- School of Nursing, College of Science and Health, Depaul University, Chicago, IL, United States
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Hoeppner BB, Hoeppner SS, Carlon HA, Perez GK, Helmuth E, Kahler CW, Kelly JF. Leveraging Positive Psychology to Support Smoking Cessation in Nondaily Smokers Using a Smartphone App: Feasibility and Acceptability Study. JMIR Mhealth Uhealth 2019; 7:e13436. [PMID: 31271147 PMCID: PMC6636238 DOI: 10.2196/13436] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/01/2019] [Accepted: 05/18/2019] [Indexed: 01/07/2023] Open
Abstract
Background Nondaily smoking is an increasingly prevalent smoking pattern that poses substantial health risks. Objective We tested the feasibility of using a smartphone app with positive psychology exercises to support smoking cessation in nondaily smokers. Methods In this prospective, single-group pilot study, nondaily smokers (n=30) used version 1 of the Smiling Instead of Smoking (SiS) app for 3 weeks while undergoing a quit attempt. The app assigned daily happiness exercises, provided smoking cessation tools, and made smoking cessation information available. Participants answered surveys at baseline and 2, 6, 12, and 24 weeks after their chosen quit day and participated in structured user feedback sessions 2 weeks after their chosen quit day. Results App usage during the prescribed 3 weeks of use was high, with an average 84% (25.2/30) of participants using the app on any given day. App use was largely driven by completing happiness exercises (73%, 22/30) of participants per day), which participants continued to complete even after the end of the prescribed period. At the end of prescribed use, 90% (27/30) of participants reported that the app had helped them during their quit attempt, primarily by reminding them to stay on track (83%, 25/30) and boosting their confidence to quit (80%, 24/30) and belief that quitting was worthwhile (80%, 24/30). Happiness exercises were rated more favorably than user-initiated smoking cessation tools, and 80% (24/30) of participants proactively expressed in interviews that they liked them. App functionality to engage social support was not well received. Functionality to deal with risky times was rated useful but was rarely used. Within-person changes from baseline to the end of prescribed use were observed for several theorized mechanisms of behavior change, all in the expected direction: confidence increased (on a 0-100 scale, internal cues: b=16.7, 95% CI 7.2 to 26.3, P=.001; external cues: b=15.8, 95% CI 5.4 to 26.1, P=.004), urge to smoke decreased (on a 1-7 scale, b=−0.8, 95% CI −1.3 to −0.3, P=.002), and perceptions of smoking became less positive (on a 1-5 scale, psychoactive benefits: b=−0.5, 95% CI −0.9 to −0.2, P=.006; pleasure: b=−0.4, 95% CI −0.7 to −0.01, P=.03; on a 0-100 scale, importance of pros of smoking: b=−11.3, 95% CI −18.9 to −3.8, P=.004). Self-reported abstinence rates were 40% (12/30) and 53% (16/30) of participants 2 and 24 weeks post quit, respectively, with 30% (9/30) biochemically validated as abstinent 2 weeks post quit. Conclusions A smartphone app using happiness exercises to aid smoking cessation was well received by nondaily smokers. Given the high nonadherence and dropout rates for technology-delivered interventions reported in the literature, the high engagement with positive psychology exercises is noteworthy. Observed within-person changes and abstinence rates are promising and warrant further development of this app.
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Affiliation(s)
- Bettina B Hoeppner
- Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Susanne S Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States.,Center for Anxiety and Traumatic Stress Disorders, Massachusetts General Hospital, Boston, MA, United States
| | - Hannah A Carlon
- Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Giselle K Perez
- Behavioral Medicine Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Eric Helmuth
- School of Public Health, Boston University, Boston, MA, 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
| | - John F Kelly
- Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
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Marin-Gomez FX, Garcia-Moreno Marchán R, Mayos-Fernandez A, Flores-Mateo G, Granado-Font E, Barrera Uriarte ML, Duch J, Rey-Reñones C. Exploring Efficacy of a Serious Game (Tobbstop) for Smoking Cessation During Pregnancy: Randomized Controlled Trial. JMIR Serious Games 2019; 7:e12835. [PMID: 30916655 PMCID: PMC6456830 DOI: 10.2196/12835] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/07/2019] [Accepted: 01/20/2019] [Indexed: 02/06/2023] Open
Abstract
Background Tobacco use during pregnancy entails a serious risk to the mother and harmful effects on the development of the child. Europe has the highest tobacco smoking prevalence (19.3%) compared with the 6.8% global mean. Between 20% to 30% of pregnant women used tobacco during pregnancy worldwide. These data emphasize the urgent need for community education and implementation of prevention strategies focused on the risks associated with tobacco use during pregnancy. Objective The aim of this study was to investigate the efficacy of an intervention that incorporates a serious game (Tobbstop) to help pregnant smokers quit smoking. Methods A two-arm randomized controlled trial enrolled 42 women who visited 2 primary care centers in Catalonia, Spain, between March 2015 and November 2016. All participants were pregnant smokers, above 18 years old, attending consultation with a midwife during the first trimester of pregnancy, and had expressed their desire to stop smoking. Participants were randomized to the intervention (n=21) or control group (n=21). The intervention group was instructed to install the game on their mobile phone or tablet and use it for 3 months. Until delivery, all the participants were assessed on their stage of smoking cessation during their follow-up midwife consultations. The primary outcome was continuous tobacco abstinence until delivery confirmed by the amount of carbon monoxide at each visit, measured with a carboxymeter. Results Continuous abstinence until delivery outcome was 57% (12/21) in the intervention group versus 14% (3/21) in the control group (hazard ratio=4.31; 95% CI 1.87-9.97; P=.001). The mean of total days without smoking until delivery was higher in the intervention group (mean 139.75, SD 21.76) compared with the control group (mean 33.28, SD 13.27; P<.001). In addition, a Kapplan-Meier survival analysis showed that intervention group has a higher abstinence rate compared with the control group (log-rank test, χ21=13.91; P<.001). Conclusions Serious game use is associated with an increased likelihood to maintain abstinence during the intervention period if compared with those not using the game. Pregnancy is an ideal opportunity to intervene and control tobacco use among future mothers. On the other hand, serious games are an emerging technology, growing in importance, which are shown to be a good tool to help quitting smoking during pregnancy and also to maintain this abstinent behavior. However, because of the study design limitations, these outcomes should be interpreted with caution. More research, using larger samples and longer follow-up periods, is needed to replicate the findings of this study. Trial Registration ClinicalTrials.gov NCT01734421; https://clinicaltrials.gov/ct2/show/NCT01734421 (Archived by WebCite at http://www.webcitation.org/75ISc59pB)
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Affiliation(s)
- Francesc X Marin-Gomez
- Servei d'Atenció Primària d'Osona, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Vic, Spain.,Unitat de Suport a la Recerca Catalunya Central, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Sant Fruitós de Bages, Spain.,Health Promotion in Rural Areas Research Group, Institut Català de la Salut, Sant Fruitós de Bages, Spain.,Digital Care Research Group, Universitat de Vic-Universitat Central de Catalunya, Centre for Health and Social Care Research, Vic, Spain
| | - Rocio Garcia-Moreno Marchán
- Sexual and Reproductive Health Unit, Servei d'Atenció Primària d'Osona, Institut Català de la Salut, Vic, Spain
| | - Anabel Mayos-Fernandez
- Sexual and Reproductive Health Unit, Servei d'Atenció Primària d'Osona, Institut Català de la Salut, Vic, Spain
| | - Gemma Flores-Mateo
- Grup de Recerca en Tecnologies de la Informació en Atenció Primaria, Unitat de Suport a la Recerca Tarragona-Reus, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Reus, Spain.,Unitat d'Anàlisi i Qualitat, Xarxa Sanitària i Social Santa Tecla, Tarragona, Spain
| | - Esther Granado-Font
- Grup de Recerca en Tecnologies de la Informació en Atenció Primaria, Unitat de Suport a la Recerca Tarragona-Reus, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Reus, Spain.,Departament d'Infermeria, Facultat d'Infermeria, Universitat Rovira i Virgili, Tarragona, Spain.,Centre d'Atenció Primària Horts de Miró (Reus-4), Gerència d'Àmbit d'Atenció Primària Camp de Tarragona, Institut Català de la Salut, Tarragona, Spain
| | - Maria Luisa Barrera Uriarte
- Grup de Recerca en Tecnologies de la Informació en Atenció Primaria, Unitat de Suport a la Recerca Tarragona-Reus, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Reus, Spain.,Centre d'Atenció Primària La Granja (Tarragona-2), Gerència d'Àmbit d'Atenció Primària Camp de Tarragona, Institut Català de la Salut, Torreforta, Tarragona, Spain
| | - Jordi Duch
- Grup de Recerca en Tecnologies de la Informació en Atenció Primaria, Unitat de Suport a la Recerca Tarragona-Reus, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Reus, Spain.,Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona, Spain
| | - Cristina Rey-Reñones
- Grup de Recerca en Tecnologies de la Informació en Atenció Primaria, Unitat de Suport a la Recerca Tarragona-Reus, Institut Universitari d'Investigació en Atenció Primària Jordi Gol, Reus, Spain.,Departament d'Infermeria, Facultat d'Infermeria, Universitat Rovira i Virgili, Tarragona, Spain
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