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White JS, Toussaert S, Raiff BR, Salem MK, Chiang AY, Crane D, Warrender E, Lyles CR, Abroms LC, Westmaas JL, Thrul J. Evaluating the Impact of a Game (Inner Dragon) on User Engagement Within a Leading Smartphone App for Smoking Cessation: Randomized Controlled Trial. J Med Internet Res 2024; 26:e57839. [PMID: 39475840 DOI: 10.2196/57839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/30/2024] [Accepted: 08/23/2024] [Indexed: 11/02/2024] Open
Abstract
BACKGROUND Smartphone apps are a convenient, low-cost approach to delivering smoking cessation support to large numbers of individuals. Yet, the apps are susceptible to low rates of user engagement and retention. OBJECTIVE This study aims to test the effects of a new game module (called Inner Dragon) integrated into Smoke Free (23 Limited), a leading smoking cessation app with established efficacy. The primary outcomes measured user engagement with the app. METHODS A 2-arm, parallel-group, randomized controlled trial was conducted in the United States with an 8-week follow-up. Adult individuals who smoked ≥1 cigarettes daily and planned to quit smoking within 7 days were recruited and randomized (N=500), with equal allocation. Both groups received free access to the original Smoke Free app with "core" features of its smoking cessation program (eg, a diary and craving log). The treated group received additional access to the integrated Inner Dragon game that incorporated several game mechanics designed to increase user engagement. User engagement outcomes were the number of unique app sessions, average minutes per session, days with a session, and program adherence. Self-reported and verified smoking abstinence and app satisfaction were also assessed. The main analysis estimated the intention-to-treat effect of access to Inner Dragon on each outcome. Further analyses assessed effect modification by participant characteristics and the association of intensity of game use with program adherence and abstinence. RESULTS Overall, user engagement was greater for treated versus control participants: they had 5.3 more sessions of Smoke Free (mean 29.6, SD 36.5 sessions vs mean 24.3, SD 37.9 sessions; P=.06), 0.8 more minutes per session (mean 6.9, SD 5.4 min vs mean 6.1, SD 5.2 min; P=.047), and 3.4 more days with a session (mean 14.3, SD 15.3 days vs mean 11.9, SD 14.3 days; P=.03). Program adherence, based on the number of times core features of the original Smoke Free app were used, was higher for treated versus control participants (mean 29.4, SD 41.3 times vs mean 22.6, SD 35.6 times; P=.03). Self-reported 7-day and 30-day point-prevalence abstinence and verified 7-day point-prevalence abstinence at 8 weeks did not significantly differ by study group. The mean repeated 1-day prevalence of quitting was higher among the treated group versus the control group (mean 17.3%, SD 25.6 vs mean 12.4%, SD 21.3; P=.01). App satisfaction and the motivation to (stay) quit did not differ by study group. Higher intensity of game use was associated with increased program adherence and self-reported abstinence. CONCLUSIONS Findings suggest that the Inner Dragon game increased user engagement and program adherence. Additional refinements to the game design may clarify whether the game increases abstinence rates. Overall, it is feasible to deploy games and gamification to enhance user engagement in existing smoking cessation interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT05227027; https://clinicaltrials.gov/study/NCT05227027.
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Affiliation(s)
- Justin S White
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, United States
- Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States
| | | | - Bethany R Raiff
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | - Marie K Salem
- Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States
- Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Amy Yunyu Chiang
- Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States
| | | | | | - Courtney R Lyles
- Department of Public Health Sciences, University of California, Davis, Davis, CA, United States
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - J Lee Westmaas
- Population Science, American Cancer Society, Atlanta, GA, United States
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, United States
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Mendoza-Vasconez AS, King AC, Chandler G, Mackey S, Follis S, Stefanick ML. Engagement With Remote Delivery Channels in a Physical Activity Intervention for Senior Women in the US. Am J Health Promot 2024; 38:692-703. [PMID: 38344760 DOI: 10.1177/08901171241229537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
PURPOSE Identify the effects of engagement with different intervention delivery channels on physical activity (PA), and the participant subgroups engaging with the different channels, among Women's Health Initiative Strong and Healthy (WHISH) PA trial participants. DESIGN Secondary analysis of data from WHISH, a pragmatic trial that used passive randomized consent. SETTING United States (remote intervention in all 50 states). SAMPLE 18,080 U.S. women, aged 68-99 years, assigned to the WHISH PA intervention arm. MEASURES 6 dichotomous variables operationalized engagement: Engagement with Targeted Inserts, Email (opened), Email (clicked links), Website (logging in), Website (tracking), Interactive Voice Response (IVR). PA was measured using the CHAMPS PA questionnaire. ANALYSIS Linear regressions evaluated effects of engagement on PA. Conditional Inference Trees identified subgroups of participants engaging with different channels based on demographic and psychosocial variables. RESULTS Engagement with each channel, except IVR, was associated with significantly more hours/week of PA (square root coefficients .29 - .13, P values <.001). Consistently across channels, features that identified subgroups of participants with higher engagement included younger age, and higher levels of PA and physical function. Subgroups with the highest engagement differed from those with the lowest in most participant characteristics. CONCLUSIONS For equitable population-level impact via large-scale remotely-delivered PA programs, it may be necessary to identify strategies to engage and target harder to reach subgroups more precisely. CLINICAL TRIAL REGISTRATION The WHISH trial is registered at ClinicalTrials.gov (No. NCT02425345).
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Affiliation(s)
- Andrea S Mendoza-Vasconez
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Abby C King
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
| | | | - Sally Mackey
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Shawna Follis
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Marcia L Stefanick
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
- Department of Epidemiology and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA
- Department of Obstetrics and Gynecology, Stanford University
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Wang X, Zhao K, Amato MS, Stanton CA, Shuter J, Graham AL. The Role of Seed Users in Nurturing an Online Health Community for Smoking Cessation Among People With HIV/AIDS. Ann Behav Med 2024; 58:122-130. [PMID: 37931160 PMCID: PMC10831217 DOI: 10.1093/abm/kaad063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND To nurture a new online community for health behavior change, a fruitful strategy is to recruit "seed users" to create content and encourage participation. PURPOSE This study evaluated the impact of support from seed users in an online community for smoking cessation among people living with HIV/AIDS and explored the linguistic characteristics of their interactions. METHODS These secondary analyses examined data from a randomized trial of a smoking cessation intervention for HIV+ smokers delivered via an online health community (OHC). The analytic sample comprised n = 188 participants randomized to the intervention arm who participated in the community. Independent variables were OHC interactions categorized by participant interlocutor type (study participant, seed user) and interaction type (active, passive). The primary outcome was biochemically verified 7-day abstinence from cigarettes measured 3 months post-randomization; 30-day abstinence was examined for robustness. RESULTS Logistic regression models showed that participants' interactions with seed users were a positive predictor of abstinence but interactions with other study participants were not. Specifically, the odds of abstinence increased as the number of posts received from seed users increased. Exploratory linguistic analyses revealed that seed users wrote longer comments which included more frequent use of "we" and "you" pronouns and that study participants users used more first-person singular pronouns ("I"). CONCLUSIONS Seeding a community at its inception and nurturing its growth through seed users may be a scalable way to foster behavior change among OHC members. These findings have implications for the design and management of an OHC capable of promoting smoking cessation.
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Affiliation(s)
- Xiangyu Wang
- Department of Business Analytics, The University of Iowa, Iowa City, IA, USA
| | - Kang Zhao
- Department of Business Analytics, The University of Iowa, Iowa City, IA, USA
| | - Michael S Amato
- Innovations Center, Truth Initiative, Washington, DC, USA
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Cassandra A Stanton
- Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Jonathan Shuter
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
- Division of Infectious Diseases, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC, USA
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
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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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White JS, Salem MK, Toussaert S, Westmaas JL, Raiff BR, Crane D, Warrender E, Lyles C, Abroms L, Thrul J. Developing a Game (Inner Dragon) Within a Leading Smartphone App for Smoking Cessation: Design and Feasibility Evaluation Study. JMIR Serious Games 2023; 11:e46602. [PMID: 37566442 PMCID: PMC10457699 DOI: 10.2196/46602] [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: 02/17/2023] [Revised: 04/08/2023] [Accepted: 07/08/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Several stand-alone smartphone apps have used serious games to provide an engaging approach to quitting smoking. So far, the uptake of these games has been modest, and the evidence base for their efficacy in promoting smoking cessation is still evolving. The feasibility of integrating a game into a popular smoking cessation app is unclear. OBJECTIVE The aim of this paper was to describe the design and iterative development of the Inner Dragon game within Smoke Free, a smartphone app with proven efficacy, and the results of a single-arm feasibility trial as part of a broad program that seeks to assess the effectiveness of the gamified app for smoking cessation. METHODS In phase 1, the study team undertook a multistep process to design and develop the game, including web-based focus group discussions with end users (n=15). In phase 2, a single-arm study of Smoke Free users who were trying to quit (n=30) was conducted to assess the feasibility and acceptability of the integrated game and to establish the feasibility of the planned procedures for a randomized pilot trial. RESULTS Phase 1 led to the final design of Inner Dragon, informed by principles from psychology and behavioral economics and incorporating several game mechanics designed to increase user engagement and retention. Inner Dragon users maintain an evolving pet dragon that serves as a virtual avatar for the users' progress in quitting. The phase-2 study established the feasibility of the study methods. The mean number of app sessions completed per user was 13.8 (SD 13.1; median 8; range 1-46), with a mean duration per session of 5.8 (median 1.1; range 0-81.1) minutes. Overall, three-fourths (18/24, 75%) of the participants entered the Inner Dragon game at least once and had a mean of 2.4 (SD 2.4) sessions of game use. The use of Inner Dragon was positively associated with the total number of app sessions (correlation 0.57). The mean satisfaction score of participants who provided ratings (11/24, 46%) was 4.2 (SD 0.6) on a 5-point scale; however, satisfaction ratings for Inner Dragon were only completed by 13% (3/24) of the participants. CONCLUSIONS Findings supported further development and evaluation of Inner Dragon as a beneficial feature of Smoke Free. The next step of this study is to conduct a randomized pilot trial to determine whether the gamified version of the app increases user engagement over a standard version of the app.
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Affiliation(s)
- Justin S White
- Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA, United States
| | - Marie K Salem
- Philip R Lee Institute for Health Policy Studies, University of California, San Francisco, CA, United States
| | | | - J Lee Westmaas
- Population Science, American Cancer Society, Atlanta, GA, United States
| | - Bethany R Raiff
- Department of Psychology, Rowan University, Glassboro, NJ, United States
| | | | | | - Courtney Lyles
- Department of Medicine, University of California, San Francisco, CA, United States
| | - Lorien Abroms
- Department of Prevention and Community Health, George Washington University, Washington, DC, United States
| | - Johannes Thrul
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, Baltimore, MD, United States
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, Australia
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Bijkerk LE, Oenema A, Geschwind N, Spigt M. Measuring Engagement with Mental Health and Behavior Change Interventions: an Integrative Review of Methods and Instruments. Int J Behav Med 2023; 30:155-166. [PMID: 35578099 PMCID: PMC10036274 DOI: 10.1007/s12529-022-10086-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Engagement is a complex construct consisting of behavioral, cognitive, and affective dimensions, making engagement a difficult construct to measure. This integrative review aims to (1) present a multidisciplinary overview of measurement methods that are currently used to measure engagement with adult mental health and behavior change interventions, delivered in-person, blended, or digitally, and (2) provide a set of recommendations and considerations for researchers wishing to study engagement. METHODS We used an integrative approach and identified original studies and reviews on engagement with mental health or behavior change interventions that were delivered in-person, digitally, or blended. RESULTS Forty articles were analyzed in this review. Common methods to assess engagement were through objective usage data, questionnaire-based data, and qualitative data, with objective usage data being used most frequently. Based on the synthesis of engagement measures, we advise researchers to (1) predefine the operationalization of engagement for their specific research context, (2) measure behavioral, cognitive, and affective dimensions of engagement in all cases, and (3) measure engagement over time. CONCLUSIONS Current literature shows a bias towards behavioral measures of engagement in research, as most studies measured engagement exclusively through objective usage data, without including cognitive and affective measures of engagement. We hope that our recommendations will help to reduce this bias and to steer engagement research towards an integrated approach.
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Affiliation(s)
- Laura Esther Bijkerk
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.
| | - Anke Oenema
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Nicole Geschwind
- Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | - Mark Spigt
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
- General Practice Research Unit, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
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Mavragani A, Wielgosz J, Hallenbeck HW, Chang A, Rosen C, Owen J, Kuhn E. The PTSD Family Coach App in Veteran Family Members: Pilot Randomized Controlled Trial. JMIR Form Res 2023; 7:e42053. [PMID: 36602852 PMCID: PMC9893731 DOI: 10.2196/42053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/10/2022] [Accepted: 11/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) among US military veterans can adversely impact their concerned significant others (CSOs; eg, family members and romantic partners). Mobile apps can be tailored to support CSO mental health through psychoeducation, coping skills, and stress monitoring. OBJECTIVE This study assessed the feasibility, acceptability, and potential efficacy of PTSD Family Coach 1.0, a free, publicly available app that includes psychoeducation, stress management tools, self-assessments, and features for connecting to alternative supports, compared with a psychoeducation-only version of the app for cohabitating CSOs of veterans with PTSD. METHODS A total of 200 participants with an average age of 39 (SD 8.44) years, primarily female (193/200, 97%), and White (160/200, 80%) were randomized to self-guided use of either PTSD Family Coach 1.0 (n=104) or a psychoeducation-only app (n=96) for 4 weeks. Caregiver burden, stress, depression, anxiety, beliefs about treatment, CSO self-efficacy, and relationship functioning assessed using measures of dyadic adjustment, social constraints, and communication danger signs were administered via a web survey at baseline and after treatment. User satisfaction and app helpfulness were assessed after treatment. Data were analyzed using linear mixed methods. RESULTS Overall, 50.5% (101/200) of randomized participants used their allocated app. Participants found PTSD Family Coach 1.0 somewhat satisfying (mean 4.88, SD 1.11) and moderately helpful (mean 2.99, SD 0.97) to use. Linear mixed effects models revealed no significant differences in outcomes by condition for caregiver burden (P=.45; Cohen d=0.1, 95% CI -0.2 to 0.4), stress (P=.64; Cohen d=0.1, 95% CI -0.4 to 0.6), depression (P=.93; Cohen d= 0.0, 95% CI -0.3 to 0.3), anxiety (P=.55; Cohen d=-0.1, 95% CI -0.4 to 0.2), beliefs about treatment (P=.71; Cohen d=0.1, 95% CI -0.2 to 0.3), partner self-efficacy (P=.59; Cohen d=-0.1, 95% CI -0.4 to 0.2), dyadic adjustment (P=.08; Cohen d=-0.2, 95% CI -0.5 to 0.0), social constraints (P=.05; Cohen d=0.3, 95% CI 0.0-0.6), or communication danger signs (P=.90; Cohen d=-0.0, 95% CI -0.3 to 0.3). Post hoc analyses collapsing across conditions revealed a significant between-group effect on stress for app users versus nonusers (β=-3.62; t281=-2.27; P=.02). CONCLUSIONS Approximately half of the randomized participants never used their allocated app, and participants in the PTSD Family Coach 1.0 condition only opened the app approximately 4 times over 4 weeks, suggesting limitations to this app version's feasibility. PTSD Family Coach 1.0 users reported moderately favorable impressions of the app, suggesting preliminary acceptability. Regarding efficacy, no significant difference was found between PTSD Family Coach 1.0 users and psychoeducation app users across any outcome of interest. Post hoc analyses suggested that app use regardless of treatment condition was associated with reduced stress. Further research that improves app feasibility and establishes efficacy in targeting the domains most relevant to CSOs is warranted. TRIAL REGISTRATION ClinicalTrials.gov NCT02486705; https://clinicaltrials.gov/ct2/show/NCT02486705.
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Affiliation(s)
| | - Joseph Wielgosz
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States.,National Center for PTSD, Veteran Affairs Palo Alto Healthcare System, Palo Alto, CA, United States
| | - Haijing Wu Hallenbeck
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States.,National Center for PTSD, Veteran Affairs Palo Alto Healthcare System, Palo Alto, CA, United States
| | - Andrew Chang
- National Center for PTSD, Veteran Affairs Palo Alto Healthcare System, Palo Alto, CA, United States
| | - Craig Rosen
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States.,National Center for PTSD, Veteran Affairs Palo Alto Healthcare System, Palo Alto, CA, United States
| | - Jason Owen
- National Center for PTSD, Veteran Affairs Palo Alto Healthcare System, Palo Alto, CA, United States
| | - Eric Kuhn
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, United States.,National Center for PTSD, Veteran Affairs Palo Alto Healthcare System, Palo Alto, CA, United States
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Asfar T, Alcaide ML, Jones DL, McClure LA, Brewer J, Lee DJ, Carrico A. HIV patients’ perceptions of a potential multi-component mindfulness-based smoking cessation smartphone application intervention. PLoS One 2022; 17:e0271946. [PMID: 36006893 PMCID: PMC9409537 DOI: 10.1371/journal.pone.0271946] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 06/14/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives Cigarette smoking rates among people living with HIV (PLWH) in the US is triple that of the general population. PLWH smokers are a high-risk group for smoking-related health disparities and should be a prime focus for smoking cessation efforts. Our team has developed a novel evidence-based Mindfulness Training (MT) smoking cessation smartphone application (app), “Craving-to-Quit.” Using qualitative focus groups among PLWH smokers, this study aims to tailor and optimize the app’s content and design to PLWH’s unique psychosocial profile and needs. Methods We conducted 8 focus groups among PLWH smokers (n = 59; 47.5% females; ≥18 years) to gain insight into participants’ perceptions about the app, MT, and the feasibility and acceptability of adding two additional strategies (CM: Contingency Management; self-monitoring of anti-retroviral therapies intake [ART]) to further optimize the app. Participants were asked to practice MTs and watch videos from the app presented on a screen in the conference room to discuss their experience. Sessions were audio-taped, transcribed verbatim, and analyzed thematically using NVivo. Results Most participants were non-Hispanic black (67.8%), on a federal health insurance program (61.0%). Participants considered it easy to learn the app and thought that MT is helpful in reducing stress and motivating quit attempts and were supportive of adding CM and recommended providing $20-$50 weekly cash incentives to help in quitting. Participants felt that adding self-monitoring of ART is helpful but were concerned about confidentiality in case they lost their phone. Participants recommended making the app cost-free and adding information about smoking cessation medications and the negative effects of smoking among PLWH. Conclusions Findings will guide the development of a novel multi-component smoking cessation intervention app integrating MT, CM, and ART self-monitoring strategies. This intervention has the potential to address several barriers to quitting in PLWH. Further clinical research is needed to test this intervention.
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Affiliation(s)
- Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
- * E-mail:
| | - Maria Luisa Alcaide
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Internal Medicine, Jackson Memorial Hospital, Miami, FL, United States of America
| | - Deborah L. Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Laura A. McClure
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Judson Brewer
- Department of Behavioral and Social Sciences, Brown Mindfulness Center, Brown University School of Public Health, Providence, RI, United States of America
| | - David J. Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, United States of America
| | - Adam Carrico
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, United States of America
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Graham AL, Papandonatos GD, Cha S, Amato MS, Jacobs MA, Cohn AM, Abroms LC, Whittaker R. Effectiveness of an optimized text message and Internet intervention for smoking cessation: A randomized controlled trial. Addiction 2022; 117:1035-1046. [PMID: 34472676 PMCID: PMC9293135 DOI: 10.1111/add.15677] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/11/2021] [Indexed: 01/08/2023]
Abstract
AIMS To evaluate the effectiveness of a combined internet and text message intervention for smoking cessation compared with an internet intervention alone. The text message intervention was optimized for engagement in an earlier multiphase optimization (MOST) screening phase. DESIGN A parallel, two-group, individually randomized clinical trial (RCT) was conducted in a MOST confirming phase. Recruitment spanned December 2018 to March 2019. Follow-up was conducted at 3 and 9 months, beginning March 2019 and ending January 2020. SETTING United States: a digital study conducted among new registrants on a free tobacco cessation website. PARTICIPANTS Eligible individuals were 618 adult current smokers in the United States, age 18 years or older who signed up for text messages during website registration (67.2% female, 70.4% white). INTERVENTIONS The treatment arm (WEB+TXT; n = 311) received access to the website and text messaging. The control arm (WEB; n = 307) received access to the website alone. MEASUREMENTS The primary outcome was self-reported 30-day point prevalence abstinence (ppa) at 9 months post-randomization analyzed under intent to treat (ITT), counting non-responders as smoking. Secondary outcomes included 3-month measures of 30-day ppa, intervention engagement and intervention satisfaction. FINDINGS Abstinence rates at 9 months were 23.1% among WEB+TXT and 23.2% among WEB (OR = 1.00, 95% CI = 0.69-1.45; P = 0.99). WEB+TXT increased engagement with 5 of 6 interactive features (standardized mean difference (SMD) = 0.26-0.47, all P < 0.001) and repeat website visits (48.7% vs 38.9%, SMD = 0.14, P = 0.02). Satisfaction metrics favored WEB+TXT (satisfied: 96.3% vs 90.5%, SMD = 0.17, P = 0.008; recommend to friend: 95.9% vs 90.1%, SMD = 0.16, P = 0.028). CONCLUSIONS A randomized controlled trial found no evidence that a combined internet and text message intervention for smoking cessation compared with an internet intervention alone increased 9-month abstinence rates among adult current smokers in the United States, despite evidence of higher levels of intervention engagement and satisfaction at 3 months.
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Affiliation(s)
- Amanda L. Graham
- Innovations Center, Truth InitiativeWashingtonDCUSA,Department of MedicineMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | | | - Sarah Cha
- Innovations Center, Truth InitiativeWashingtonDCUSA
| | - Michael S. Amato
- Innovations Center, Truth InitiativeWashingtonDCUSA,Department of MedicineMayo Clinic College of Medicine and ScienceRochesterMNUSA
| | | | - Amy M. Cohn
- Health Promotion Research CenterUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA,Department of Pediatrics, Children's HospitalUniversity of Oklahoma Health Sciences CenterOklahoma CityOKUSA
| | - Lorien C. Abroms
- Department of Prevention and Community Health, Milken Institute School of Public HealthThe George Washington UniversityWashingtonDCUSA
| | - Robyn Whittaker
- National Institute for Health InnovationUniversity of AucklandAucklandNew Zealand
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10
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Nelson LA, Spieker AJ, Mayberry LS, McNaughton C, Greevy RA. Estimating the impact of engagement with digital health interventions on patient outcomes in randomized trials. J Am Med Inform Assoc 2021; 29:128-136. [PMID: 34963143 PMCID: PMC8714267 DOI: 10.1093/jamia/ocab254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/18/2021] [Accepted: 11/01/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Guidance is needed on studying engagement and treatment effects in digital health interventions, including levels required for benefit. We evaluated multiple analytic approaches for understanding the association between engagement and clinical outcomes. MATERIALS AND METHODS We defined engagement as intervention participants' response rate to interactive text messages, and considered moderation, standard regression, mediation, and a modified instrumental variable (IV) analysis to investigate the relationship between engagement and clinical outcomes. We applied each approach to two randomized controlled trials featuring text message content in the intervention: REACH (Rapid Encouragement/Education and Communications for Health), which targeted diabetes, and VERB (Vanderbilt Emergency Room Bundle), which targeted hypertension. RESULTS In REACH, the treatment effect on hemoglobin A1c was estimated to be -0.73% (95% CI: [-1.29, -0.21]; P = 0.008), and in VERB, the treatment effect on systolic blood pressure was estimated to be -10.1 mmHg (95% CI: [-17.7, -2.8]; P = 0.007). Only the IV analyses suggested an effect of engagement on outcomes; the difference in treatment effects between engagers and non-engagers was -0.29% to -0.51% in the REACH study and -1.08 to -3.25 mmHg in the VERB study. DISCUSSION Standard regression and mediation have less power than a modified IV analysis, but the IV approach requires specification of assumptions. This is the first review of the strengths and limitations of various approaches to evaluating the impact of engagement on outcomes. CONCLUSIONS Understanding the role of engagement in digital health interventions can help reveal when and how these interventions achieve desired outcomes.
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Affiliation(s)
- Lyndsay A Nelson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrew J Spieker
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Lindsay S Mayberry
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Health Behavior and Health Education, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Center for Diabetes Translation Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Candace McNaughton
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Geriatric Research Education Clinical Center, Tennessee Valley Healthcare System VA Medical Center, Nashville, Tennessee, USA
| | - Robert A Greevy
- Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
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11
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Bricker JB, Levin M, Lappalainen R, Mull K, Sullivan B, Santiago-Torres M. Mechanisms of Smartphone Apps for Cigarette Smoking Cessation: Results of a Serial Mediation Model From the iCanQuit Randomized Trial. JMIR Mhealth Uhealth 2021; 9:e32847. [PMID: 34751662 PMCID: PMC8663588 DOI: 10.2196/32847] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/28/2021] [Accepted: 10/12/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Engagement with digital interventions is a well-known predictor of treatment outcomes, but this knowledge has had limited actionable value. Instead, learning why engagement with digital interventions impact treatment outcomes can lead to targeted improvements in their efficacy. OBJECTIVE This study aimed to test a serial mediation model of an Acceptance and Commitment Therapy (ACT) smartphone intervention for smoking cessation. METHODS In this randomized controlled trial, participants (N=2415) from 50 US states were assigned to the ACT-based smartphone intervention (iCanQuit) or comparison smartphone intervention (QuitGuide). Their engagement with the apps (primary measure: number of logins) was measured during the first 3 months, ACT processes were measured at baseline and 3 months (acceptance of internal cues to smoke, valued living), and smoking cessation was measured at 12 months with 87% follow-up retention. RESULTS There was a significant serial mediation effect of iCanQuit on smoking cessation through multiple indicators of intervention engagement (ie, total number of logins, total number of minutes used, and total number of unique days of use) and in turn through increases in mean acceptance of internal cues to smoke from baseline to 3 months. Analyses of the acceptance subscales showed that the mediation was through acceptance of physical sensations and emotions, but not acceptance of thoughts. There was no evidence that the effect of the iCanQuit intervention was mediated through changes in valued living. CONCLUSIONS In this first study of serial mediators underlying the efficacy of smartphone apps for smoking cessation, our results suggest the effect of the iCanQuit ACT-based smartphone app on smoking cessation was mediated through multiple indicators of engagement and in turn through increases in the acceptance of physical sensations and emotions that cue smoking. TRIAL REGISTRATION Clinical Trials.gov NCT02724462; https://clinicaltrials.gov/ct2/show/NCT02724462.
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Affiliation(s)
- Jonathan B Bricker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.,Department of Psychology, University of Washington, Seattle, WA, United States
| | - Michael Levin
- Department of Psychology, Utah State University, Logan, UT, United States
| | - Raimo Lappalainen
- Department of Psychology, University of Jyvaskyla, Jyvaskyla, Finland
| | - Kristin Mull
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Brianna Sullivan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Margarita Santiago-Torres
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, United States
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12
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Theory-Based Social and Non-Social Engagement Features in Smoking Cessation Mobile Apps: A Content Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179106. [PMID: 34501696 PMCID: PMC8431714 DOI: 10.3390/ijerph18179106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/12/2021] [Accepted: 08/18/2021] [Indexed: 11/17/2022]
Abstract
Despite the ubiquity of smartphone ownership and the increasing integration of social engagement features in smoking cessation apps to engage users, the social and non-social engagement features that are present in current smoking cessation apps and the effectiveness of these features in engaging users remain understudied. To fill the gap in the literature, a content analysis of free and paid smoking cessation mobile apps was conducted to examine (a) the presence of social features (i.e., social support, social announcement, and social referencing) and non-social engagement features (e.g., personal environmental changes, goal setting, progress tracking, reinforcement tracking, self-monitoring, and personalized recommendations) and (b) their relationships with user engagement scores measured by the Mobile App Rating Scale. In this study, 28.2% of the smoking cessation apps enable social announcement and 8.1% offered the social support feature. Only two apps provided a social referencing feature (1.3%). No app included reinforcement tracking, with the percentage of other non-social engagement features ranging from 9.4% to 49.0%. Social support (β = 0.30, p < 0.001), social announcement (β = 0.21, p < 0.05), and social referencing (β = 0.18, p < 0.05) were significant predictors of user engagement. Regarding the non-social engagement features, personal environment changes (β = 0.38, p < 0.001), progress tracking (β = 0.18, p < 0.05), and personalized recommendations (β = 0.37, p < 0.001) significantly predicted user engagement. The findings not only contribute to the mobile communication literature by applying and extending the theory-based mobile health apps engagement typology, but also inform the future architecture design of smoking cessation mobile apps.
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13
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Heffner JL, Watson NL, Serfozo E, Kelly MM, Reilly ED, Kim D, Baker K, Scout NFN, Karekla M. An Avatar-Led Digital Smoking Cessation Program for Sexual and Gender Minority Young Adults: Intervention Development and Results of a Single-Arm Pilot Trial. JMIR Form Res 2021; 5:e30241. [PMID: 34328430 PMCID: PMC8367141 DOI: 10.2196/30241] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/09/2021] [Accepted: 07/06/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Sexual and gender minority young adults have a high prevalence of smoking and unique barriers to accessing tobacco treatment. OBJECTIVE To address these challenges as well as their preferences for sexual and gender minority-targeted interventions and digital programs, we developed and evaluated the acceptability, preliminary efficacy, and impact on theory-based change processes of an acceptance and commitment therapy-based digital program called Empowered, Queer, Quitting, and Living (EQQUAL). METHODS Participants (n=22) of a single-arm trial conducted to evaluate the program were young adults, age 18 to 30 years, who self-identified as sexual and gender minority individuals and smoked at least one cigarette per day. All participants received access to the EQQUAL program. Participants completed web-based surveys at baseline and at a follow-up 2 months after enrollment. We verified self-reported smoking abstinence with biochemical testing; missing data were counted as smoking or using tobacco. RESULTS For young adults who logged in at least once (n=18), the mean number of log-ins was 5.5 (SD 3.6), mean number of sessions completed was 3.1 (SD 2.6), and 39% (7/18) completed all 6 sessions. Overall, 93% of participants (14/15) were satisfied with the EQQUAL program, 100% (15/15) found it easy to use, and 100% (15/15) said it helped them be clearer about how to quit. Abstinence from smoking or using tobacco was confirmed with biochemical testing for 23% of participants (5/22). Both quantitative and qualitative results suggested a positive overall response to the avatar guide, with areas for future improvement largely centered on the avatar's appearance and movements. CONCLUSIONS Treatment acceptability of EQQUAL was very promising. The rate of abstinence, which was biochemically confirmed, was 3 times higher than that of the only other digital program to date that has targeted sexual and gender minority young adults and 6 to 13 times higher than those of nontargeted digital smoking interventions among sexual and gender minority young adults. Planned improvements for the next iteration of the program include making the avatar's movements more natural; offering multiple avatar guides with different on characteristics such as race, ethnicity, and gender identity from which to choose; and providing a support forum for users to connect anonymously with peers.
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Affiliation(s)
- Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Noreen L Watson
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Edit Serfozo
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Megan M Kelly
- Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Erin D Reilly
- Veterans Affairs Bedford Healthcare System, Bedford, MA, United States
- University of Massachusetts Medical School, Worcester, MA, United States
| | - Daniella Kim
- University of Washington, Seattle, WA, United States
| | - Kelsey Baker
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - N F N Scout
- National LGBT Cancer Network, Providence, RI, United States
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14
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Gowarty MA, Longacre MR, Vilardaga R, Kung NJ, Gaughan-Maher AE, Brunette MF. Usability and Acceptability of Two Smartphone Apps for Smoking Cessation Among Young Adults With Serious Mental Illness: Mixed Methods Study. JMIR Ment Health 2021; 8:e26873. [PMID: 34255699 PMCID: PMC8295834 DOI: 10.2196/26873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/25/2021] [Accepted: 03/29/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Young adults with serious mental illness (SMI) have higher smoking rates and lower cessation rates than young adults without SMI. Scalable interventions such as smartphone apps with evidence-based content (eg, the National Cancer Institute's [NCI's] QuitGuide and quitSTART) could increase access to potentially appealing and effective treatment for this group but have yet to be tested in this population. OBJECTIVE The goal of this user-centered design study is to determine the user experience (including usability and acceptability) of 2 widely available apps developed by the NCI-QuitGuide and quitSTART-among young adult tobacco users with SMI. METHODS We conducted usability and acceptability testing of QuitGuide and quitSTART among participants with SMI aged between 18 and 35 years who were stable in community mental health treatment between 2019 and 2020. Participants were randomly assigned to use QuitGuide or quitSTART on their smartphones. App usability was evaluated at baseline and following a 2-week field test of independent use via a video-recorded task completion protocol. Using a mixed method approach, we triangulated 4 data sources: nonparticipant observation, open-ended interviews, structured interviews (including the System Usability Scale [SUS]), and backend app use data obtained from the NCI. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed using thematic analysis. RESULTS Participants were 17 smokers who were not interested in quitting, with a mean age of 29 (SD 4) years; 41% (n=7) presented with psychotic disorders. Participants smoked an average of 15 (SD 7) cigarettes per day. The mean SUS scores for QuitGuide were similar at visits one and two (mean 64, SD 18 and mean 66, SD 18, respectively). The mean SUS scores for quitSTART numerically increased from visit one (mean 55, SD 20) to visit two (mean 64, SD 16). Acceptability scores followed the same pattern. Observed task completion rates were at least 75% (7/9 for QuitGuide, 6/8 for quitSTART) for both apps at both visits for all but 2 tasks. During the 13-day trial period, QuitGuide and quitSTART users interacted with their assigned app on an average of 4.6 (SD 2.8) days versus 10.8 (SD 3.5) days, for a mean total of 5.6 (SD 3.8) interactions versus 41 (SD 26) interactions, and responded to a median of 1 notification (range 0-8) versus 18.5 notifications (range 0-37), respectively. Qualitative comments indicated moderate to high satisfaction overall but also included concerns about the accuracy of the apps' feedback. CONCLUSIONS Both QuitGuide and quitSTART had acceptable levels of usability and mixed levels of acceptability among young adults with SMI. The higher level of engagement with quitSTART suggests that quitSTART may be a favorable tool for young adult smokers with SMI. However, clinical support or coaching may be needed to overcome initial usability issues.
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Affiliation(s)
- Minda A Gowarty
- Departments of Internal Medicine and Community and Family Medicine, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States.,Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Meghan R Longacre
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Roger Vilardaga
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Nathan J Kung
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States
| | - Ashley E Gaughan-Maher
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Mary F Brunette
- Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States.,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, NH, United States.,Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
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15
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Asfar T, Koru-Sengul T, Annane D, McClure LA, Perez A, Antoni MA, Brewer J, Lee DJ. Reach versus effectiveness: The design and protocol of randomized clinical trial testing a smartphone application versus in-person mindfulness-based smoking cessation intervention among young cancer survivors. Contemp Clin Trials Commun 2021; 22:100784. [PMID: 34222709 PMCID: PMC8243289 DOI: 10.1016/j.conctc.2021.100784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 02/10/2021] [Accepted: 05/05/2021] [Indexed: 11/23/2022] Open
Abstract
Approximately 45% of young cancer survivors (18-40 years) are cigarette smokers. Continued smoking after cancer diagnosis leads to lower survival rates. A major logistical problem with smoking cessation efforts in this group is their geographic dispersion which makes them hard to reach. In addition, depression is a major predictor of smoking relapse and its rates are roughly twice as high in cancer survivors as the general population. Smartphone applications (apps) show promise in terms of efficacy, dissemination, and improving access to treatment. Mindfulness training (defined as maintaining attention on one's immediate experience and cultivating an attitude of acceptance toward this experience) is effective in improving smoking cessation outcomes by reducing psychological stress and controlling craving. Given that smartphone apps can address the issues of mobility and remote access, and mindfulness can address the high depression rate among cancer survivors, validating the feasibility and efficacy of a mindfulness-based smoking cessation intervention app in young cancer survivors is a high priority. Thus, the aims of the current study are: (1) test the feasibility, acceptability, and potential efficacy of the mindfulness-based smoking cessation app versus in-person mindfulness or usual care in a 3-arm pilot randomized clinical trial among young cancer survivors (n = 60; 18-40 years); and 2) conduct semi-structured exit interviews with participants in the two mindfulness groups to fine-tune the two active interventions based on feedback from participants. Findings will have implications for the development and dissemination of innovative and highly scalable tobacco cessation interventions designed for young cancer survivors.
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Affiliation(s)
- Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, 9th Floor, Miami, FL, 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th St, 9th Floor, Miami, FL, 33136, USA
| | - Tulay Koru-Sengul
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, 9th Floor, Miami, FL, 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th St, 9th Floor, Miami, FL, 33136, USA
| | - Debra Annane
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, 9th Floor, Miami, FL, 33136, USA
| | - Laura A McClure
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, 9th Floor, Miami, FL, 33136, USA
| | - Amanda Perez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, 9th Floor, Miami, FL, 33136, USA
| | - Michael A Antoni
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th St, 9th Floor, Miami, FL, 33136, USA
| | - Judson Brewer
- Department of Behavioral and Social Sciences, Brown Mindfulness Center, Brown University School of Public Health, 1 Davol Square, 2nd Floor, Providence, RI, 02903, USA
| | - David J Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St, 9th Floor, Miami, FL, 33136, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1120 NW 14th St, 9th Floor, Miami, FL, 33136, USA
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Sherman LD, Patterson MS, Tomar A, Wigfall LT. Use of Digital Health Information for Health Information Seeking Among Men Living With Chronic Disease: Data From the Health Information National Trends Survey. Am J Mens Health 2021; 14:1557988320901377. [PMID: 31973642 PMCID: PMC6984431 DOI: 10.1177/1557988320901377] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Although diabetes education plays an important role in self-management for people living with diabetes, male health “help-seeking” lags far behind women. These gender-related “help-seeking” disparities often result in males being less engaged in their health care, which subsequently leads to poorer health outcomes among males. In this cross-sectional study, we used data from the 2017 Health Information National Trends Survey (HINTS) to identify factors that may contribute to communication inequalities between males and females. A hierarchical {linear/logistic} regression model was used to examine factors associated with online health information seeking among males living with diabetes. The results suggest that education, income, age, identifying as Hispanic, being a smoker, using a device to track progress toward a health-related goal, and using device to seek health information were all related to eHealth sum scores. Future research should consider testing applications among various at-risk groups to determine if the technology itself is becoming a barrier to eHealth.
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Affiliation(s)
- Ledric D Sherman
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Megan S Patterson
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Aditi Tomar
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
| | - Lisa T Wigfall
- Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
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17
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Graham AL. Engaging People in Tobacco Prevention and Cessation: Reflecting Back Over 20 Years Since the Master Settlement Agreement. Ann Behav Med 2021; 54:932-941. [DOI: 10.1093/abm/kaaa089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Over the past 20 years, tobacco prevention and cessation efforts have evolved to keep pace with the changing tobacco product landscape and the widespread adoption of digital technologies. In 2019, Truth Initiative was awarded the Society of Behavioral Medicine’s Jessie Gruman Award for Health Engagement in recognition of the major role it has played on both fronts since its inception in 1999. This manuscript reviews the challenges and opportunities that have emerged over the past two decades, the evolving tactics deployed by Truth Initiative to engage people in tobacco prevention and cessation efforts, the approaches used to evaluate those efforts, and key achievements. It concludes with a summary of lessons learned and considerations for tobacco control researchers and practitioners to accelerate their impact on public health.
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Affiliation(s)
- Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC, USA
- Department of Medicine, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
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18
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Yang Q, Millette D, Zhou C, Beatty M, Carcioppolo N, Wilson G. The Effectiveness of Interactivity in Improving Mediating Variables, Behaviors and Outcomes of Web-Based Health Interventions: A Meta-Analytic Review. HEALTH COMMUNICATION 2020; 35:1334-1348. [PMID: 31240958 DOI: 10.1080/10410236.2019.1631992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Despite the increasing amount of research investigating health interventions that applies to interactive computer technology, the effect sizes in Cohen's d obtained across these studies range from -0.32 to 1.74. The lack of systematic review of interactive health interventions leaves their overall effectiveness unknown. To address this, a meta-analysis of 67 studies examining the effects of web-based interactive health interventions was conducted. Results indicated that web-based interactive health interventions were effective in general, but the effects were moderated by health topic, theoretical framework, and design of treatment and control groups. The unique advantage of interactivity was small but significant when comparing to health interventions with comparable information in non-interactive version. Theoretical and practical implications of findings were discussed.
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Affiliation(s)
- Qinghua Yang
- Department of Communication Studies, Texas Christian University
| | - Diane Millette
- Department of Communication Studies, University of Miami
| | - Chun Zhou
- Department of Communication, Florida International University
| | - Michael Beatty
- Department of Communication Studies, University of Miami
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19
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Pot M, Paulussen TG, Ruiter RA, Mollema L, Hofstra M, Van Keulen HM. Dose-Response Relationship of a Web-Based Tailored Intervention Promoting Human Papillomavirus Vaccination: Process Evaluation of a Randomized Controlled Trial. J Med Internet Res 2020; 22:e14822. [PMID: 32520718 PMCID: PMC7395256 DOI: 10.2196/14822] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 11/04/2019] [Accepted: 05/14/2020] [Indexed: 01/17/2023] Open
Abstract
Background In the Netherlands, human papillomavirus (HPV) vaccination uptake remains low. To improve informed decision making (IDM) and HPV vaccination acceptability, we systematically developed an interactive, web-based tailored intervention to which mothers of Dutch girls were invited to participate. Objective The aim of this study was to provide insight into the intervention’s working mechanisms by evaluating (1) program use, (2) program acceptability, and (3) the relationship of program use with program acceptability and intervention effects (ie, dose-response relationship). Methods Only mothers from the intervention arm of a randomized controlled trial that assessed the effectiveness of the web-based, tailored intervention were included in this study. They were invited to visit the website of the web-based intervention between baseline (January 2015, just before access to the intervention) and follow up (March 2015, prior to the first HPV vaccination). Indicators for program use were time of website use (ie, duration of intervention exposure) and completeness (ie, proportion of all available web pages visited). HPV vaccination uptake registered by Praeventis was used as the primary outcome. Secondary outcomes were IDM, decisional conflict, and social-psychological determinants of HPV vaccination uptake. Results Among the 3995 invited mothers, 2509 (62.80%) logged on to the website, 2239 of whom (89.24%) visited at least one page of the intervention components. On average, mothers spent 21.39 minutes (SD 12.41) on the website and completed 50.04% (SD 26.18%) of the website components. Participants rated the website 7.64 (SD 1.39) on a 10-point scale. Program acceptability was significantly associated with completeness (β=4.36, P<.001), but not with time of website use (β=–.07, P=.77). Intention-to-treat analysis (N=3995) showed a significant positive effect of completeness on all outcome measures (all P<.003; Bonferroni-corrected α=.05/15 factors), including on HPV vaccination uptake. Time of website use had a significant positive effect on all outcomes (all P<.003), except for uptake (P=.20), risk perception when not vaccinated (P=.14), subjective norms (P=.03), and habit (P=.01). Conclusions Program use and acceptability of the intervention were adequate. Completeness was positively associated with acceptability. Furthermore, positive effects (ie, dose-response effects) were found for completeness and time of website use on the mothers’ IDM, decisional conflict, and almost all of the social-psychological determinants of HPV vaccination acceptability. In addition, the extent to which mothers completed the intervention had a positive impact on their daughters’ vaccination uptake. This indicates that the web-based, tailored intervention fits well with the mothers’ needs, and that completeness of use is essential for improving HPV vaccination uptake, acceptability, and IDM. Program use should therefore be promoted. Trial Registration Netherlands Trial Register NTR4795; https://www.trialregister.nl/trial/4795
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Affiliation(s)
- Mirjam Pot
- Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, Netherlands
| | - Theo Gwm Paulussen
- Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, Netherlands
| | - Robert Ac Ruiter
- Department of Work and Social Psychology, Maastricht University, Maastricht, Netherlands
| | - Liesbeth Mollema
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Disease Control, Bilthoven, Netherlands
| | - Miranda Hofstra
- Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, Netherlands
| | - Hilde M Van Keulen
- Child Health, Netherlands Organization for Applied Scientific Research (TNO), Leiden, Netherlands
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Kahler CW, Cohn AM, Costantino C, Toll BA, Spillane NS, Graham AL. A Digital Smoking Cessation Program for Heavy Drinkers: Pilot Randomized Controlled Trial. JMIR Form Res 2020; 4:e7570. [PMID: 32348286 PMCID: PMC7308890 DOI: 10.2196/formative.7570] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/29/2020] [Accepted: 03/29/2020] [Indexed: 11/29/2022] Open
Abstract
Background Heavy drinking (HD) is far more common among smokers compared with nonsmokers and interferes with successful smoking cessation. Alcohol-focused smoking cessation interventions delivered by counselors have shown promise, but digital versions of these interventions—which could have far greater population reach—have not yet been tested. Objective This pilot randomized controlled trial aimed to examine the feasibility, acceptability, and effect sizes of an automated digital smoking cessation program that specifically addresses HD using an interactive web-based intervention with an optional text messaging component. Methods Participants (83/119, 69.7% female; 98/119, 82.4% white; mean age 38.0 years) were daily smokers recruited on the web from a free automated digital smoking cessation program (BecomeAnEX.org, EX) who met the criteria for HD: women drinking 8+ drinks/week or 4+ drinks on any day and men drinking 15+ drinks/week or 5+ drinks on any day. Participants were randomized to receive EX with standard content (EX-S) or an EX with additional content specific to HD (EX-HD). Outcomes were assessed by web-based surveys at 1 and 6 months. Results Participants reported high satisfaction with the website and the optional text messaging component. Total engagement with both EX-S and EX-HD was modest, with participants visiting the website a median of 2 times, and 52.9% of the participants enrolled to receive text messages. Participants in both the conditions showed substantial, significant reductions in drinking across 6 months of follow-up, with no condition effects observed. Although smoking outcomes tended to favor EX-HD, the condition effects were small and nonsignificant. A significantly smaller proportion of participants in EX-HD reported having a lapse back to smoking when drinking alcohol (7/58, 16%) compared with those in EX-S (18/61, 41%; χ21=6.2; P=.01). Conclusions This is the first trial to examine a digital smoking cessation program tailored to HD smokers. The results provide some initial evidence that delivering such a program is feasible and may reduce the risk of alcohol-involved smoking lapses. However, increasing engagement in this and other web-based interventions is a crucial challenge to address in future work. Trial Registration ClinicalTrials.gov NCT03068611; https://clinicaltrials.gov/ct2/show/NCT03068611
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Affiliation(s)
- Christopher W Kahler
- Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States
| | - Amy M Cohn
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | | | - Benjamin A Toll
- Medical University of South Carolina, Charleston, SC, United States
| | - Nichea S Spillane
- Department of Psychology, University of Rhode Island, South Kingston, RI, United States
| | - Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC, United States.,Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, United States
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21
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Graham AL, Papandonatos GD, Jacobs MA, Amato MS, Cha S, Cohn AM, Abroms LC, Whittaker R. Optimizing Text Messages to Promote Engagement With Internet Smoking Cessation Treatment: Results From a Factorial Screening Experiment. J Med Internet Res 2020; 22:e17734. [PMID: 32238338 PMCID: PMC7386536 DOI: 10.2196/17734] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 02/09/2020] [Accepted: 02/22/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Smoking remains a leading cause of preventable death and illness. Internet interventions for smoking cessation have the potential to significantly impact public health, given their broad reach and proven effectiveness. Given the dose-response association between engagement and behavior change, identifying strategies to promote engagement is a priority across digital health interventions. Text messaging is a proven smoking cessation treatment modality and a powerful strategy to increase intervention engagement in other areas of health, but it has not been tested as an engagement strategy for a digital cessation intervention. OBJECTIVE This study examined the impact of 4 experimental text message design factors on adult smokers' engagement with an internet smoking cessation program. METHODS We conducted a 2×2×2×2 full factorial screening experiment wherein 864 participants were randomized to 1 of 16 experimental conditions after registering with a free internet smoking cessation program and enrolling in its automated text message program. Experimental factors were personalization (on/off), integration between the web and text message platforms (on/off), dynamic tailoring of intervention content based on user engagement (on/off), and message intensity (tapered vs abrupt drop-off). Primary outcomes were 3-month measures of engagement (ie, page views, time on site, and return visits to the website) as well as use of 6 interactive features of the internet program. All metrics were automatically tracked; there were no missing data. RESULTS Main effects were detected for integration and dynamic tailoring. Integration significantly increased interactive feature use by participants, whereas dynamic tailoring increased the number of features used and page views. No main effects were found for message intensity or personalization alone, although several synergistic interactions with other experimental features were observed. Synergistic effects, when all experimental factors were active, resulted in the highest rates of interactive feature use and the greatest proportion of participants at high levels of engagement. Measured in terms of standardized mean differences (SMDs), effects on interactive feature use were highest for Build Support System (SMD 0.56; 95% CI 0.27 to 0.81), Choose Quit Smoking Aid (SMD 0.38; 95% CI 0.10 to 0.66), and Track Smoking Triggers (SMD 0.33; 95% CI 0.05 to 0.61). Among the engagement metrics, the largest effects were on overall feature utilization (SMD 0.33; 95% CI 0.06 to 0.59) and time on site (SMD 0.29; 95% CI 0.01 to 0.57). As no SMD >0.30 was observed for main effects on any outcome, results suggest that for some outcomes, the combined intervention was stronger than individual factors alone. CONCLUSIONS This factorial experiment demonstrates the effectiveness of text messaging as a strategy to increase engagement with an internet smoking cessation intervention, resulting in greater overall intervention dose and greater exposure to the core components of tobacco dependence treatment that can promote abstinence. TRIAL REGISTRATION ClinicalTrials.gov NCT02585206; https://clinicaltrials.gov/ct2/show/NCT02585206. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2015-010687.
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Affiliation(s)
- Amanda L Graham
- Innovations Center, Truth Initiative, Washington, DC, United States.,Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | | | - Megan A Jacobs
- Innovations Center, Truth Initiative, Washington, DC, United States
| | - Michael S Amato
- Innovations Center, Truth Initiative, Washington, DC, United States.,Mayo Clinic College of Medicine and Science, Rochester, MN, United States
| | - Sarah Cha
- Innovations Center, Truth Initiative, Washington, DC, United States
| | - Amy M Cohn
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Lorien C Abroms
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
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22
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Abstract
Background: Partner Assisted Smoking Cessation Treatment (PACT) was designed to improve smoking abstinence rates by integrating evidence-based relationship education strategies to build effective couple support into standard cognitive behavioral smoking cessation treatment (CBT). Methods: This small randomized clinical trial examined the feasibility, acceptability, and efficacy of PACT versus CBT in improving couple support processes and smoking outcomes, focusing on effect sizes. Thirty-eight smokers and their nonsmoking partners were randomized to and completed either PACT or CBT. Both treatments included 8 weekly group sessions and nicotine replacement therapy. Results: Treatment credibility and satisfaction were high and comparable between conditions, though perceived helpfulness and treatment engagement were higher in PACT (ds = .48-.68). Compared to CBT, PACT showed no difference in effects on perceived partner support, small effects on observed social support behaviors (ds = .23 to .46), a medium effect on dyadic efficacy (d = .63), and a large effect on active listening (d = .85). Biochemically-verified smoking abstinence rates did not differ between conditions at 12-week follow-up (CBT: 27.3%, PACT: 37.5%). Conclusions: PACT may have stronger effects than standard CBT on treatment engagement and some couple support processes, but not abstinence. Program refinement and testing in larger samples are needed.
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Watson NL, Heffner JL, Mull KE, McClure JB, Bricker JB. Comparing Treatment Acceptability and 12-Month Cessation Rates in Response to Web-Based Smoking Interventions Among Smokers Who Do and Do Not Screen Positive for Affective Disorders: Secondary Analysis. J Med Internet Res 2019; 21:e13500. [PMID: 31219052 PMCID: PMC6607777 DOI: 10.2196/13500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 04/02/2019] [Accepted: 04/20/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Web-based cessation programs are now common for intervening with smokers. However, it remains unclear how acceptable or effective these interventions are among people with affective disorders and symptoms (ADS; eg, depression and anxiety). Research examining this is extremely limited, with mixed results on cessation rates. Additional large studies are needed to more fully understand whether Web-based interventions are similarly used and equally effective among people with and without affective disorder symptomology. If not, more targeted Web-based interventions may be required. OBJECTIVE The goal of the research was to compare Web-based treatment acceptability (defined by satisfaction and use) and 12-month cessation outcomes between smokers with and without ADS. METHODS Participants (N=2512) were adult smokers enrolled in a randomized, comparative effectiveness trial of two Web-based smoking interventions designed for the general population of smokers. At baseline, participants reported demographic and smoking characteristics and completed measures assessing ADS. Participants were then classified into subgroups based on their self-reported ADS-either into a no ADS group or into six nonmutually exclusive subgroups: depression, posttraumatic stress disorder (PTSD), panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and more than one ADS. Surveys at 12 months postrandomization included subjective ratings of treatment acceptability and self-reported smoking cessation. Treatment use (ie, number of log-ins and total duration of exposure) was assessed via automated records. RESULTS Relative to the no ADS group, all six ADS subgroups reported significantly greater satisfaction with their assigned Web treatment program, but they spent less time logged in than those with no ADS. For number of log-ins, a treatment arm by ADS group interaction was observed across all ADS subgroups except GAD, suggesting that relative to the no ADS group, they logged in less to one website but not the other. At the 12-month follow-up, abstinence rates in the no ADS group (153/520, 29.42%) were significantly higher than for participants who screened positive for depression (306/1267, 24.15%; P=.03), PTSD (294/1215, 24.19%; P=.03), PD (229/1003, 23.83%; P=.009), and two or more ADS (323/1332, 24.25%; P=.03). Post hoc analyses suggest the lower quit rates may be associated with differences in baseline nicotine dependence and levels of commitment to resist smoking in difficult situations. Website use did not explain the differential abstinence rates. CONCLUSIONS Despite reporting higher levels of treatment satisfaction, most smokers with ADS used their assigned intervention less often and had lower quit rates than smokers with no ADS at treatment onset. The results support the need for developing more targeted interventions for smokers with ADS. TRIAL REGISTRATION Clinical Trials.gov NCT01812278; https://clinicaltrials.gov/ct2/show/NCT01812278 (Archived by WebCite at http://www.webcitation.org/78L9cNdG4).
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Affiliation(s)
- Noreen L Watson
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Kristin E Mull
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - Jennifer B McClure
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States
| | - Jonathan B Bricker
- Fred Hutchinson Cancer Research Center, Seattle, WA, United States
- University of Washington, Seattle, WA, United States
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Mailey EL, Irwin BC, Joyce JM, Hsu W. InDependent but not Alone: A Web‐Based Intervention to Promote Physical and Mental Health among Military Spouses. Appl Psychol Health Well Being 2019; 11:562-583. [DOI: 10.1111/aphw.12168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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25
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Deutsch C, Bock BC, Lantini R, Walaska K, Rosen RK, Fava JL, Jennings EG, Foster R, Flanagan W. A text message delivered smoking cessation intervention: Design and rationale of the Text My Quit Study. Contemp Clin Trials 2019; 81:19-27. [PMID: 30999058 PMCID: PMC6550345 DOI: 10.1016/j.cct.2019.04.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/05/2019] [Accepted: 04/13/2019] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Smoking cessation interventions delivered through mobile technologies offer promise as an effective intervention tool. However, most existing programs have not been empirically tested, were not developed with end-user participation, and/or do not address evidence-based cognitive and behavioral variables shown to enhance smoking cessation in clinical trials. In addition, many programs tested in research trials have required users to access the internet and/or a smartphone app to access all program features, limiting the potential reach of those programs. METHODS/DESIGN This study is a randomized controlled trial testing the efficacy of the TMQ intervention for smoking cessation. All participants are randomly assigned to receive 12 weeks of either; (1) a tailored smoking-cessation intervention delivered 100% through text messaging (TMQ), or (2) non-smoking-related text messages serving as a control for contact and subject burden (Mojo). Assessments are conducted at baseline, 3- and 6-month follow-up. The primary outcome is prolonged abstinence using an intent-to-treat approach. To understand why TMQ may be more effective than Mojo, we will test several posited mechanisms of action (i.e., mediators) that may underlie intervention efficacy and will examine use of the TMQ integrated social support (ISS) network. At the end of treatment, semi-structured interviews will be conducted with TMQ participants. CONCLUSIONS This study will provide a rigorous test of an innovative smoking cessation program delivered 100% through text messages. Use of mixed methodologies will provide the opportunity to enhance our understanding of the user's experience with TMQ and identify areas for future enhancement and/or expansion.
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Affiliation(s)
| | - Beth C Bock
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
| | - Ryan Lantini
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States.
| | - Kristen Walaska
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Rochelle K Rosen
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States; Department of Behavioral and Social Sciences, School of Public Health of Brown University, Providence, RI, United States
| | - Joseph L Fava
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States
| | - Ernestine G Jennings
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, United States
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Beintner I, Görlich D, Berger T, Ebert DD, Zeiler M, Herrero Camarano R, Waldherr K, Jacobi C. Interrelations between participant and intervention characteristics, process variables and outcomes in online interventions: A protocol for overarching analyses within and across seven clinical trials in ICare. Internet Interv 2019; 16:86-97. [PMID: 30775268 PMCID: PMC6364443 DOI: 10.1016/j.invent.2018.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 05/23/2018] [Accepted: 05/23/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND It is well known that web-based interventions can be effective treatments for various conditions. Less is known about predictors, moderators, and mediators of outcome and especially interrelations between participant and interventions characteristics, process variables and outcomes in online interventions. Clinical trials often lack statistical power to detect variables that affect intervention effects and their interrelations. Within ICare, we can investigate the interrelation of potential predictor and process variables in a large sample. METHOD The ICare consortium postulated a model of interrelations between participant and intervention characteristics, process variables and outcomes in online interventions. We will assess general and disorder-specific interrelations between characteristics of the intervention, characteristics of the participants, adherence, working alliance, early response, and intervention outcomes in a sample of over 7500 participants from seven clinical trials evaluating 15 online interventions addressing a range of mental health conditions and disorders, using an individual participant data meta-analyses approach. DISCUSSION/CONCLUSION Existing research tends to support the efficacy of online mental health interventions, but the knowledge base regarding factors that affect intervention effects needs to be expanded. The overarching analyses using data from the ICare intervention trials will add considerably to the evidence.
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Affiliation(s)
- Ina Beintner
- Technische Universität Dresden, School of Science, Department of Psychology, Chair of Clinical Psychology and E-Mental-Health, Dresden, Germany
| | - Dennis Görlich
- Westfälische Wilhelms-Universität Münster, Institut für Biometrie und Klinische Forschung, Schmedingstraße 56, Münster, Germany
| | - Thomas Berger
- Universität Bern, Department of Clinical Psychology and Psychotherapy, Bern, Switzerland
| | - David Daniel Ebert
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Department of Clinical Psychology and Psychotherapy, Nägelsbachstr 25a, Erlangen, Germany
| | - Michael Zeiler
- Medizinische Universität Wien, Department for Child and Adolescent Psychiatry, Waehringer Guertel 18-20, Vienna, Austria
| | | | - Karin Waldherr
- Ferdinand PorscheFernFH Distance-Learning University of Applied Sciences, Wien, Austria
| | - Corinna Jacobi
- Technische Universität Dresden, School of Science, Department of Psychology, Chair of Clinical Psychology and E-Mental-Health, Dresden, Germany
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Treatment engagement mediates the links between symptoms of anxiety, depression, and alcohol use disorder with abstinence among smokers registered on an Internet cessation program. J Subst Abuse Treat 2019; 98:59-65. [DOI: 10.1016/j.jsat.2018.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 11/07/2018] [Accepted: 11/08/2018] [Indexed: 12/13/2022]
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Goecke M, Duhme K. [Tobacco prevention using the example of the "smoke-free" campaign : Nationwide measures by the Federal Center for Health Education (BZgA)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:1439-1445. [PMID: 30284622 DOI: 10.1007/s00103-018-2824-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Currently, 28.7% of 18- to 64-year-olds in Germany smoke (26.1% of women/31.2% of men). Among the 12- to 17-year-olds, the smoking rate at 7.4%, is at a historic low. The smoking rate among the 18- to 25-year-olds has also fallen in recent years.The most important goal of the nationwide measures of the Federal Center for Health Education (BZgA) on tobacco prevention is to reduce the smoking rate. For this purpose, the BZgA carries out the "smoke-free" campaign, which is targeted at both adolescents and adults. With a closely interlinked and continuously reviewed and further developed mix of measures, the target groups are reached on the internet, in settings and via media and mass communication. In addition to the information on the risks of smoking and passive smoking, the motivation to quit smoking and the quality-assured support in smoking cessation play an important role here.The measures of the BZgA are reviewed and further developed on the basis of representative surveys on the smoking behavior of the 12- to 25-year-olds, which the BZgA regularly carries out. On this basis, new products, such as e‑cigarettes, e‑shishas or tobacco heaters, and new consumer trends, such as the trend for waterpipe smoking, are integrated. Access routes to the target groups are continuously reviewed against the background of the digitization of society and the health-promoting design of settings is supported. All in all, the smoke-free campaign offers a quality-assured range of measures that is continuously being developed.
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Affiliation(s)
- Michaela Goecke
- Referat 1-13, Prävention des Substanzmissbrauchs, Suchtprävention, Bundeszentrale für gesundheitliche Aufklärung (BZgA), Maarweg 149-161, 50825, Köln, Deutschland.
| | - Kathrin Duhme
- Referat 1-13, Prävention des Substanzmissbrauchs, Suchtprävention, Bundeszentrale für gesundheitliche Aufklärung (BZgA), Maarweg 149-161, 50825, Köln, Deutschland
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Daly AT, Deshmukh AA, Vidrine DJ, Prokhorov AV, Frank SG, Tahay PD, Houchen ME, Cantor SB. Cost-effectiveness analysis of smoking cessation interventions using cell phones in a low-income population. Tob Control 2018; 28:88-94. [PMID: 29886411 DOI: 10.1136/tobaccocontrol-2017-054229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/27/2018] [Accepted: 04/19/2018] [Indexed: 11/04/2022]
Abstract
BACKGROUND The prevalence of cigarette smoking is significantly higher among those living at or below the federal poverty level. Cell phone-based interventions among such populations have the potential to reduce smoking rates and be cost-effective. METHODS We performed a cost-effectiveness analysis of three smoking cessation interventions: Standard Care (SC) (brief advice to quit, nicotine replacement therapy and self-help written materials), Enhanced Care (EC) (SC plus cell phone-delivered messaging) and Intensive Care (IC) (EC plus cell phone-delivered counselling). Quit rates were obtained from Project ACTION (Adult smoking Cessation Treatment through Innovative Outreach to Neighborhoods). We evaluated shorter-term outcomes of cost per quit and long-term outcomes using cost per quality-adjusted life year (QALY). RESULTS For men, EC cost an additional $541 per quit vs SC; however, IC cost an additional $5232 per quit vs EC. For women, EC was weakly dominated by IC-IC cost an additional $1092 per quit vs SC. Similarly, for men, EC had incremental cost-effectiveness ratio (ICER) of $426 per QALY gained vs SC; however, IC resulted in ICER of $4127 per QALY gained vs EC. For women, EC was weakly dominated; the ICER of IC vs SC was $1251 per QALY gained. The ICER was below maximum acceptable willingness-to-pay threshold of $50 000 per QALY under all alternative modelling assumptions. DISCUSSION Cell phone interventions for low socioeconomic groups are a cost-effective use of healthcare resources. Intensive Care was the most cost-effective strategy both for men and women. TRIAL REGISTRATION NUMBER NCT00948129; Results.
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Affiliation(s)
- Allan T Daly
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ashish A Deshmukh
- Department of Health Services Research, The University of Florida Health Science Center, Gainesville, Florida, USA
| | - Damon J Vidrine
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Alexander V Prokhorov
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Summer G Frank
- Oklahoma Tobacco Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Patricia D Tahay
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Maggie E Houchen
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Scott B Cantor
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Morrison LG, Geraghty AW, Lloyd S, Goodman N, Michaelides DT, Hargood C, Weal M, Yardley L. Comparing usage of a web and app stress management intervention: An observational study. Internet Interv 2018; 12:74-82. [PMID: 30135771 PMCID: PMC6096327 DOI: 10.1016/j.invent.2018.03.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 03/19/2018] [Indexed: 12/31/2022] Open
Abstract
Choices in the design and delivery of digital health behaviour interventions may have a direct influence on subsequent usage and engagement. Few studies have been able to make direct, detailed comparisons of differences in usage between interventions that are delivered via web or app. This study compared the usage of two versions of a digital stress management intervention, one delivered via a website (Healthy Paths) and the other delivered via an app (Healthy Mind). Design modifications were introduced within Healthy Mind to take account of reported differences in how individuals engage with websites compared to apps and mobile phones. Data were collected as part of an observational study nested within a broader exploratory trial of Healthy Mind. Objective usage of Healthy Paths and Healthy Mind were automatically recorded, including frequency and duration of logins, access to specific components within the intervention and order of page/screen visits. Usage was compared for a two week period following initial registration. In total, 381 participants completed the registration process for Healthy Paths (web) and 162 participants completed the registration process for Healthy Mind (app). App users logged in twice as often (Mdn = 2.00) as web users (Mdn = 1.00), U = 13,059.50, p ≤ 0.001, but spent half as much time (Mdn = 5.23 min) on the intervention compared to web users (Mdn = 10.52 min), U = 19,740.00, p ≤ 0.001. Visual exploration of usage patterns over time revealed that a significantly higher proportion of app users (n = 126, 82.35%) accessed both types of support available within the intervention (i.e. awareness and change-focused tools) compared to web users (n = 92, 40.17%), χ2(1, n = 382) = 66.60, p < 0.001. This study suggests that the digital platform used to deliver an intervention (i.e. web versus app) and specific design choices (e.g. navigation, length and volume of content) may be associated with differences in how the intervention content is used. Broad summative usage data (e.g. total time spent on the intervention) may mask important differences in how an intervention is used by different user groups if it is not complemented by more fine-grained analyses of usage patterns over time. TRIAL REGISTRATION NUMBER ISRCTN67177737.
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Affiliation(s)
- Leanne G. Morrison
- Department of Psychology, Faculty of Social, Human, and Mathematical Sciences, University of Southampton, Southampton, Hampshire, UK
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - Adam W.A. Geraghty
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK
| | - Scott Lloyd
- Redcar & Cleveland Borough Council, Redcar, Yorkshire, UK
- Health and Social Care Institute, School of Health and Social Care, Teesside University, Middlesbrough, Tees Valley, UK
- Fuse, Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Centre for Public Policy and Health, School of Medicine, Pharmacy and Health, Durham University, Stockton on Tees, UK
| | | | - Danius T. Michaelides
- Electronics and Computer Science, University of Southampton, Southampton, Hampshire, UK
| | - Charlie Hargood
- Electronics and Computer Science, University of Southampton, Southampton, Hampshire, UK
| | - Mark Weal
- Electronics and Computer Science, University of Southampton, Southampton, Hampshire, UK
| | - Lucy Yardley
- Department of Psychology, Faculty of Social, Human, and Mathematical Sciences, University of Southampton, Southampton, Hampshire, UK
- Nuffield Department of Primary Care Health Sciences, Medical Sciences Division, University of Oxford, Oxford, UK
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31
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Bruno M, Wright M, Baker CL, Emir B, Carda E, Clausen M, Sigler C, Patel A. Mobile App Usage Patterns of Patients Prescribed a Smoking Cessation Medicine: Prospective Observational Study. JMIR Mhealth Uhealth 2018; 6:e97. [PMID: 29666043 PMCID: PMC5930175 DOI: 10.2196/mhealth.9115] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 12/25/2022] Open
Abstract
Background Cigarette smoking is the leading preventable cause of death and is responsible for more than 480,000 deaths per year in the United States. Smoking cessation is challenging for many patients. Regardless of available treatment options, most quit attempts are unaided, and it takes multiple attempts before a patient is successful. With the ever-increasing use of smartphones, mobile apps hold promise in supporting cessation efforts. This study evaluates the ease of use and user satisfaction with the Pfizer Meds app to support smoking cessation among patients prescribed varenicline (Chantix). Objective Study participants included varenicline users who downloaded and used the app on their personal smartphone. The main objectives were to report mobile app download frequency and usage details and to describe the participant-reported satisfaction with and usefulness of the app over the 14-week follow-up study period. Methods Adults aged 18 years or older who had been prescribed varenicline were identified from the Express Scripts Incorporated pharmacy claims database. After meeting privacy restrictions, subjects were sent an invitation letter and second reminder letter with instructions on how to download the Pfizer Meds mobile app. Participants received a push notification to complete a smartphone-enabled survey regarding the utility of the app 12 weeks after downloading the app. Descriptive statistics summarized sociodemographics, use of varenicline, and details of use and satisfaction with the mobile app. Results Of the 38,129 varenicline users who were sent invitation letters, 1281 participants (3.35%) downloaded the Pfizer Meds app. Of the 1032 users with demographic and other data, 585 (56.68%) were females, and 446 (43.22%) were males; mean age was 46.4 years (SD 10.8). The mean number of app sessions per participant was 4.0 (SD 6.8). The end-of-study survey was completed by 131 survey respondents (10.23%, 131/1281); a large number of participants (117/131, 89.3%) reported being extremely, very, or moderately satisfied with the app. A total of 97 survey respondents (97/131, 74.0%) reported setting up a quit date in the app. Of those, 74 (74/97, 76%) reported quitting on their quit date. Conclusions Positive patient engagement was observed in this study based on app download and usage. This study quantified how the Pfizer Meds app performed in an observational real-world data setting. The findings demonstrate the willingness of participants to set a quit date and use the app for support in medication adherence, refill reminders, and information regarding how to take the medication. This study provides real-world evidence of the contribution apps can make to the continued encouragement of smokers to improve their health by smoking cessation.
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Affiliation(s)
| | | | | | | | | | | | | | - Aanal Patel
- Express Scripts Inc, St Louis, MO, United States
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Pugatch J, Grenen E, Surla S, Schwarz M, Cole-Lewis H. Information Architecture of Web-Based Interventions to Improve Health Outcomes: Systematic Review. J Med Internet Res 2018; 20:e97. [PMID: 29563076 PMCID: PMC5978245 DOI: 10.2196/jmir.7867] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 12/06/2017] [Accepted: 01/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background The rise in usage of and access to new technologies in recent years has led to a growth
in digital health behavior change interventions. As the shift to digital platforms
continues to grow, it is increasingly important to consider how the field of information
architecture (IA) can inform the development of digital health interventions. IA is the
way in which digital content is organized and displayed, which strongly impacts users’
ability to find and use content. While many information architecture best practices
exist, there is a lack of empirical evidence on the role it plays in influencing
behavior change and health outcomes. Objective Our aim was to conduct a systematic review synthesizing the existing literature on
website information architecture and its effect on health outcomes, behavioral outcomes,
and website engagement. Methods To identify all existing information architecture and health behavior literature, we
searched articles published in English in the following databases (no date restrictions
imposed): ACM Digital Library, CINAHL, Cochrane Library, Google Scholar, Ebsco, and
PubMed. The search terms used included information terms (eg, information architecture,
interaction design, persuasive design), behavior terms (eg, health behavior, behavioral
intervention, ehealth), and health terms (eg, smoking, physical activity, diabetes). The
search results were reviewed to determine if they met the inclusion and exclusion
criteria created to identify empirical research that studied the effect of IA on health
outcomes, behavioral outcomes, or website engagement. Articles that met inclusion
criteria were assessed for study quality. Then, data from the articles were extracted
using a priori categories established by 3 reviewers. However, the limited health
outcome data gathered from the studies precluded a meta-analysis. Results The initial literature search yielded 685 results, which was narrowed down to three
publications that examined the effect of information architecture on health outcomes,
behavioral outcomes, or website engagement. One publication studied the isolated impact
of information architecture on outcomes of interest (ie, website use and engagement;
health-related knowledge, attitudes, and beliefs; and health behaviors), while the other
two publications studied the impact of information architecture, website features (eg,
interactivity, email prompts, and forums), and tailored content on these outcomes. The
paper that investigated IA exclusively found that a tunnel IA improved site engagement
and behavior knowledge, but it decreased users’ perceived efficiency. The first study
that did not isolate IA found that the enhanced site condition improved site usage but
not the amount of content viewed. The second study that did not isolate IA found that a
tailored site condition improved site usage, behavior knowledge, and some behavior
outcomes. Conclusions No clear conclusion can be made about the relationship between IA and health outcomes,
given limited evidence in the peer-reviewed literature connecting IA to behavioral
outcomes and website engagement. Only one study reviewed solely manipulated IA, and we
therefore recommend improving the scientific evidence base such that additional
empirical studies investigate the impact of IA in isolation. Moreover, information from
the gray literature and expert opinion might be identified and added to the evidence
base, in order to lay the groundwork for hypothesis generation to improve empirical
evidence on information architecture and health and behavior outcomes.
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Affiliation(s)
| | | | | | | | - Heather Cole-Lewis
- Johnson & Johnson Health and Wellness Solutions, Inc, New Brunswick, NJ, United States
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Baskerville NB, Struik LL, Dash D. Crush the Crave: Development and Formative Evaluation of a Smartphone App for Smoking Cessation. JMIR Mhealth Uhealth 2018; 6:e52. [PMID: 29500157 PMCID: PMC5856923 DOI: 10.2196/mhealth.9011] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/21/2017] [Accepted: 12/06/2017] [Indexed: 12/01/2022] Open
Abstract
Background Emerging evidence supports the use of smartphone apps for smoking cessation, especially in young adults given their high smoking rates and high smartphone ownership rates. Although evaluative evidence is encouraging for supporting smoking cessation, there remains a paucity of research describing the design and development processes of mobile health (mHealth) interventions. Objective The aim of this paper was to describe the process of developing Crush the Crave (CTC), an evidence-informed app to support smoking cessation in young adults, and the results of a formative evaluation of app usage behavior, as part of a broader program of research that seeks to establish the effectiveness of the CTC app. Methods The Spiral Technology Action Research (STAR) 5-cycle model (listen, plan, do, act, and study) was employed to guide the development, implementation, and dissemination of CTC. The approach to development and formative evaluation included focus groups with young adult smokers (n=78) across 2 phases, analysis of the content of existing apps, 2 sessions with content experts, and Google Analytics to assess user behavior during a 12-month pilot. Results LISTEN—focus groups revealed young adult smoker preferences of (1) positive reinforcement, (2) personalization, (3) social support, (4) quit support, (5) tracking the behavior, and (6) tracking quit benefits. PLAN—informed by evidence for smoking cessation, young adult preferences and an assessment of popular cessation apps, content experts produced a mind map and a storyboard describing app content and structure. DO—focus groups with young adult smokers provided feedback on the first version of the app with opinions on content and suggestions for improvement such as providing alerts and distractions from craving. ACT—refinements were made, and app content was organized using the 4 key design components informed by principles of persuasive technology for behavior change: credibility, task support, dialogue support, and social support. CTC was launched in April 2013 and piloted from the period July 2013 to June 2014 where 1987 Android users had 18,567 sessions, resulting in 59,384 page views and 89.58% (1780/1987) of users returning within the same day to use CTC. STUDY—a pragmatic randomized controlled trial of CTC was launched in August 2014 to demonstrate that including mHealth technology as a population-based intervention can help young adult smokers to quit. The results of this phase will be presented in a subsequent publication. Conclusions CTC is one of the first smoking cessation apps designed to meet the needs of young adult smokers. The development was informed by the inclusion of young adults in the design and the systematic application of multiple stakeholder input, scientific evidence, and theory. The STAR model approach was followed from the beginning of intervention development, which should facilitate optimization of mHealth interventions in the future. Trial Registration ClinicalTrials.gov NCT01983150; http://clinicaltrials.gov/ct2/show/NCT01983150 (Archived by WebCite at http://www.webcitation.org/6VGyc0W0i)
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Affiliation(s)
- Neill B Baskerville
- Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Laura L Struik
- Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Darly Dash
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, ON, Canada
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34
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Graham AL, Burke MV, Jacobs MA, Cha S, Croghan IT, Schroeder DR, Moriarty JP, Borah BJ, Rasmussen DF, Brookover MJ, Suesse DB, Midthun DE, Hays JT. An integrated digital/clinical approach to smoking cessation in lung cancer screening: study protocol for a randomized controlled trial. Trials 2017; 18:568. [PMID: 29179734 PMCID: PMC5704639 DOI: 10.1186/s13063-017-2312-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/01/2017] [Indexed: 01/06/2023] Open
Abstract
Background Delivering effective tobacco dependence treatment that is feasible within lung cancer screening (LCS) programs is crucial for realizing the health benefits and cost savings of screening. Large-scale trials and systematic reviews have demonstrated that digital cessation interventions (i.e. web-based and text message) are effective, sustainable over the long-term, scalable, and cost-efficient. Use of digital technologies is commonplace among older adults, making this a feasible approach within LCS programs. Use of cessation treatment has been improved with models that proactively connect smokers to treatment rather than passive referrals. Proactive referral to cessation treatment has been advanced through healthcare systems changes such as modifying the electronic health record to automatically link smokers to treatment. Methods This study evaluates the impact of a proactive enrollment strategy that links LCS-eligible smokers with an evidence-based intervention comprised of a web-based (WEB) program and integrated text messaging (TXT) in a three-arm randomized trial with repeated measures at one, three, six, and 12 months post randomization. The primary outcome is biochemically confirmed abstinence at 12 months post randomization. We will randomize 1650 smokers who present for a clinical LCS to: (1) a usual care control condition (UC) which consists of Ask–Advise–Refer; (2) a digital (WEB + TXT) cessation intervention; or (3) a digital cessation intervention combined with tobacco treatment specialist (TTS) counseling (WEB + TXT + TTS). Discussion The scalability and sustainability of a digital intervention may represent the most cost-effective and feasible approach for LCS programs to proactively engage large numbers of smokers in effective cessation treatment. We will also evaluate the impact and cost-effectiveness of adding proven clinical intervention provided by a TTS. We expect that a combined digital/clinical intervention will yield higher quit rates than digital alone, but that it may not be as cost-effective or feasible for LCS programs to implement. This study is innovative in its use of interoperable, digital technologies to deliver a sustainable, scalable, high-impact cessation intervention and to facilitate its integration within clinical practice. It will add to the growing knowledge base about the overall effectiveness of digital interventions and their role in the healthcare delivery system. Trial registration ClinicalTrials.gov, NCT03084835. Registered on 9 March 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2312-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA. .,Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA.
| | - Michael V Burke
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | - Megan A Jacobs
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Ivana T Croghan
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA.,Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Darrell R Schroeder
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - James P Moriarty
- Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Bijan J Borah
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Donna F Rasmussen
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA
| | - M Jody Brookover
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G Street NW, 4th Floor, Washington, DC, 20001, USA
| | - Dale B Suesse
- Division of Research and Education Systems Support, Mayo Clinic, Rochester, MN, USA
| | - David E Midthun
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - J Taylor Hays
- Mayo Clinic Nicotine Dependence Center, Mayo Clinic, Rochester, MN, USA.,Division of General Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, MN, USA
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35
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Paz Castro R, Haug S, Filler A, Kowatsch T, Schaub MP. Engagement Within a Mobile Phone-Based Smoking Cessation Intervention for Adolescents and its Association With Participant Characteristics and Outcomes. J Med Internet Res 2017; 19:e356. [PMID: 29092811 PMCID: PMC5688246 DOI: 10.2196/jmir.7928] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/07/2017] [Accepted: 09/07/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Although mobile phone-delivered smoking cessation programs are a promising way to promote smoking cessation among adolescents, little is known about how adolescents might actually use them. OBJECTIVE The aim of this study was to determine adolescents' trajectories of engagement with a mobile phone-delivered smoking cessation program over time and the associations these trajectories have with baseline characteristics and treatment outcomes. METHODS We performed secondary data analysis on a dataset from a study that compared a mobile phone-delivered integrated smoking cessation and alcohol intervention with a smoking cessation only intervention for adolescents recruited in vocational and upper secondary school classes (N=1418). Throughout the 3-month intervention, participants in both intervention groups received one text message prompt per week that either assessed smoking-related target behaviors or encouraged participation in a quiz or a message contest. Sequence analyses were performed to identify engagement trajectories. Analyses were conducted to identify predictors of engagement trajectory and associations between engagement trajectories and treatment outcomes. RESULTS Three engagement trajectories emerged: (1) stable engagement (646/1418, 45.56%), (2) decreasing engagement (501/1418, 35.33%), and (3) stable nonengagement (271/1418, 19.11%). Adolescents who were younger, had no immigrant background, perceived more benefits of quitting smoking, and reported binge drinking preceding the baseline assessment were more likely to exhibit stable engagement. Due to different reach of more engaged and less engaged participants at follow-up, three statistical models (complete-cases, last-observation-carried-forward, and multiple imputation) for the associations of engagement trajectory and smoking outcome were tested. For 7-point smoking abstinence, no association was revealed to be statistically significant over all three models. However, decreasing engagement with the program was associated over all three models, with greater reductions in daily tobacco use than nonengagement. CONCLUSIONS The majority of tobacco-smoking adolescents engaged extensively with a mobile phone-based smoking cessation program. However, not only stable engagement but also decreasing engagement with a program might be an indicator of behavioral change. Measures to avoid nonengagement among adolescents appear especially necessary for older smokers with an immigrant background who do not drink excessively. In addition, future studies should not only examine the use of specific program components but also users' engagement trajectories to better understand the mechanisms behind behavioral change.
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Affiliation(s)
- Raquel Paz Castro
- Swiss Research Institute for Public Health and Addiction, Zurich University, Zurich, Switzerland
| | - Severin Haug
- Swiss Research Institute for Public Health and Addiction, Zurich University, Zurich, Switzerland
| | - Andreas Filler
- Center for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland.,Energy Efficient Systems Group, University of Bamberg, Bamberg, Germany
| | - Tobias Kowatsch
- Center for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland
| | - Michael P Schaub
- Swiss Research Institute for Public Health and Addiction, Zurich University, Zurich, Switzerland
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Grau LE, Pham T, O'Leary T, Weiss J, Toll B, Bernstein SL. Smokers' Perspectives on Texting for Tobacco Dependence Treatment: A Qualitative Analysis. Nicotine Tob Res 2017; 19:307-313. [PMID: 27613935 DOI: 10.1093/ntr/ntw184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 07/12/2016] [Indexed: 12/30/2022]
Abstract
Background Numerous evidence-based pharmacologic and behavioral approaches exist for the treatment of tobacco dependence. Short-message service texting is a newer modality which shows promise, but smokers' perspectives on texting have not been widely explored. Objective To use a qualitative research approach to elicit from a sub-sample of participants in a pilot clinical trial their perspectives concerning the feasibility, acceptability, and personal relevance of a publicly available texting program for smoking cessation. Methods Adult smokers enrolled in the intervention arm in a randomized trial of tobacco treatment were interviewed by telephone. Consenting subjects engaged in a 15-30min semi-structured interview with a trained research assistant, discussing their experience with and attitudes about the texting program and how it affected their tobacco use. Interviews were audio-recorded, transcribed verbatim, and analyzed thematically. Descriptive statistics were calculated for the 16 Likert-formatted items. Results Of 30 subjects in the intervention arm, 25 (83%) agreed to participate in the qualitative interviews. In general subjects found the program helpful. Common themes were that the texts served as a form of social support, provided useful strategies to reduce tobacco use, validated subjects' attempts to quit, and offered welcome distractions from cravings. Subjects were satisfied with the frequency, timing, and number of texts, although some improvements were suggested. Conclusions Texting was perceived as feasible, acceptable, and helpful in smokers' attempts to abstain from tobacco. Implications The major themes identified included the program being a valued source of external support that provided useful strategies to reduce tobacco use. Subjects were satisfied with the frequency, timing, and number of texts. Texting was perceived as feasible, acceptable, and helpful in smokers' attempts to abstain from tobacco. Suggestions to improve the program primarily concerned increasing customizable options and using simple, declarative sentences.
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Affiliation(s)
- Lauretta E Grau
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
| | - Timothy Pham
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Teresa O'Leary
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - June Weiss
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT
| | - Benjamin Toll
- Department of Psychiatry, Yale School of Medicine, New Haven, CT.,Yale Cancer Center, New Haven, CT.,Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC
| | - Steven L Bernstein
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT.,Yale Cancer Center, New Haven, CT.,Department of Health Policy, Yale School of Public Health, New Haven, CT
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Cha S, Ganz O, Cohn AM, Ehlke SJ, Graham AL. Feasibility of biochemical verification in a web-based smoking cessation study. Addict Behav 2017; 73:204-208. [PMID: 28551588 DOI: 10.1016/j.addbeh.2017.05.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/03/2017] [Accepted: 05/19/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Cogent arguments have been made against the need for biochemical verification in population-based studies with low-demand characteristics. Despite this fact, studies involving digital interventions (low-demand) are often required in peer review to report biochemically verified abstinence. To address this discrepancy, we examined the feasibility and costs of biochemical verification in a web-based study conducted with a national sample. METHODS Participants were 600U.S. adult current smokers who registered on a web-based smoking cessation program and completed surveys at baseline and 3months. Saliva sampling kits were sent to participants who reported 7-day abstinence at 3months, and analyzed for cotinine. RESULTS The response rate at 3-months was 41.2% (n=247): 93 participants reported 7-day abstinence (38%) and were mailed a saliva kit (71% returned). The discordance rate was 36.4%. Participants with discordant responses were more likely to report 3-month use of nicotine replacement therapy or e-cigarettes than those with concordant responses (79.2% vs. 45.2%, p=0.007). The total cost of saliva sampling was $8280 ($125/sample). CONCLUSIONS Biochemical verification was both time- and cost-intensive, and yielded a relatively small number of samples due to low response rates and use of other nicotine products during the follow-up period. There was a high rate of discordance of self-reported abstinence and saliva testing. Costs for data collection may be prohibitive for studies with large sample sizes or limited budgets. Our findings echo previous statements that biochemical verification is not necessary in population-based studies, and add evidence specific to technology-based studies.
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A prospective examination of online social network dynamics and smoking cessation. PLoS One 2017; 12:e0183655. [PMID: 28832621 PMCID: PMC5568327 DOI: 10.1371/journal.pone.0183655] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 06/29/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction Use of online social networks for smoking cessation has been associated with abstinence. Little is known about the mechanisms through which the formation of social ties in an online network may influence smoking behavior. Using dynamic social network analysis, we investigated how temporal changes of an individual’s number of social network ties are prospectively related to abstinence in an online social network for cessation. In a network where quitting is normative and is the focus of communications among members, we predicted that an increasing number of ties would be positively associated with abstinence. Method Participants were N = 2,657 adult smokers recruited to a randomized cessation treatment trial following enrollment on BecomeAnEX.org, a longstanding Internet cessation program with a large and mature online social network. At 3-months post-randomization, 30-day point prevalence abstinence was assessed and website engagement metrics were extracted. The social network was constructed with clickstream data to capture the flow of information among members. Two network centrality metrics were calculated at weekly intervals over 3 months: 1) in-degree, defined as the number of members whose posts a participant read; and 2) out-degree-aware, defined as the number of members who read a participant’s post and commented, which was subsequently viewed by the participant. Three groups of users were identified based on social network engagement patterns: non-users (N = 1,362), passive users (N = 812), and active users (N = 483). Logistic regression modeled 3-month abstinence by group as a function of baseline variables, website utilization, and network centrality metrics. Results Abstinence rates varied by group (non-users = 7.7%, passive users = 10.7%, active users = 20.7%). Significant baseline predictors of abstinence were age, nicotine dependence, confidence to quit, and smoking temptations in social situations among passive users (ps < .05); age and confidence to quit among active users. Among centrality metrics, positive associations with abstinence were observed for in-degree increases from Week 2 to Week 12 among passive and active users, and for out-degree-aware increases from Week 2 to Week 12 among active users (ps < .05). Conclusions This study is the first to demonstrate that increased tie formation among members of an online social network for smoking cessation is prospectively associated with abstinence. It also highlights the value of using individuals’ activities in online social networks to predict their offline health behaviors.
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Welding K, De Leon E, Cha S, Johnson M, Cohen JE, Graham AL. Weekly enrollment and usage patterns in an Internet smoking cessation intervention. Internet Interv 2017; 9:100-105. [PMID: 30135843 PMCID: PMC6096301 DOI: 10.1016/j.invent.2017.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 07/15/2017] [Accepted: 07/21/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Previous analyses of Google search queries identified circaseptan (weekly) rhythms in smoking cessation information seeking, with Google searches for "quit" and "smoking" peaking early in the week. Similar patterns were observed for smoking cessation treatment seeking, such as calls to quitlines. These findings suggest that smoking cessation behaviors may have a weekly rhythm that could be leveraged to improve smoking cessation efforts. AIMS To assess whether weekly enrollment and usage patterns exist for an Internet smoking cessation intervention. METHODS We used process data from a large, longstanding Internet smoking cessation intervention (www.becomeanex.org). Pearson's chi-squared tests were performed to identify day-of-the week differences in enrollment, first visit to site community pages, and quit date. Differences were considered statistically significant at the 1% level if p < 0.00167 due to multiple comparisons. Regression analysis was used to examine differences in engagement activity based on the day of the week a user enrolled. RESULTS Website users (n = 69,237) were more likely to enroll on the site at the beginning of the week (Mondays and Tuesdays) (p < 0.0001). Current smokers who selected quit dates (n = 5574) preferred quit dates that came early in the week (Sundays and Mondays) compared to other weekdays (p < 0.0001). Generally, there were no significant differences in overall website utilization metrics by day of enrollment, but there were some exceptions. Use of interactive features to select quit dates, track cigarette use, and record coping strategies was generally lower for Friday/Saturday enrollees. CONCLUSIONS Consistent with prior research, the beginning of the week appears to be a time when individuals are more likely to enroll in an Internet smoking cessation intervention and engage with its core features. Emphasizing marketing and promotional efforts during the beginning of the week could result in greater reach of Internet smoking cessation interventions.
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Affiliation(s)
- Kevin Welding
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Corresponding author at: Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St, 4th Floor, Baltimore, MD 21205, USA
| | - Elaine De Leon
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA
| | | | - Joanna E. Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amanda L. Graham
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA,Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC USA
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Perski O, Blandford A, West R, Michie S. Conceptualising engagement with digital behaviour change interventions: a systematic review using principles from critical interpretive synthesis. Transl Behav Med 2017; 7:254-267. [PMID: 27966189 PMCID: PMC5526809 DOI: 10.1007/s13142-016-0453-1] [Citation(s) in RCA: 564] [Impact Index Per Article: 80.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
"Engagement" with digital behaviour change interventions (DBCIs) is considered important for their effectiveness. Evaluating engagement is therefore a priority; however, a shared understanding of how to usefully conceptualise engagement is lacking. This review aimed to synthesise literature on engagement to identify key conceptualisations and to develop an integrative conceptual framework involving potential direct and indirect influences on engagement and relationships between engagement and intervention effectiveness. Four electronic databases (Ovid MEDLINE, PsycINFO, ISI Web of Knowledge, ScienceDirect) were searched in November 2015. We identified 117 articles that met the inclusion criteria: studies employing experimental or non-experimental designs with adult participants explicitly or implicitly referring to engagement with DBCIs, digital games or technology. Data were synthesised using principles from critical interpretive synthesis. Engagement with DBCIs is conceptualised in terms of both experiential and behavioural aspects. A conceptual framework is proposed in which engagement with a DBCI is influenced by the DBCI itself (content and delivery), the context (the setting in which the DBCI is used and the population using it) and the behaviour that the DBCI is targeting. The context and "mechanisms of action" may moderate the influence of the DBCI on engagement. Engagement, in turn, moderates the influence of the DBCI on those mechanisms of action. In the research literature, engagement with DBCIs has been conceptualised in terms of both experience and behaviour and sits within a complex system involving the DBCI, the context of use, the mechanisms of action of the DBCI and the target behaviour.
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Affiliation(s)
- Olga Perski
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Ann Blandford
- UCL Interaction Centre, University College London, 66-72 Gower Street, London, WC1E 6EA, UK
| | - Robert West
- Cancer Research UK, Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
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Yang Q. Are Social Networking Sites Making Health Behavior Change Interventions More Effective? A Meta-Analytic Review. JOURNAL OF HEALTH COMMUNICATION 2017; 22:223-233. [PMID: 28248623 DOI: 10.1080/10810730.2016.1271065] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The increasing popularity of social networking sites (SNSs) has drawn scholarly attention in recent years, and a large amount of efforts have been made in applying SNSs to health behavior change interventions. However, these interventions showed mixed results, with a large variance of effect sizes in Cohen's d ranging from -1.17 to 1.28. To provide a better understanding of SNS-based interventions' effectiveness, a meta-analysis of 21 studies examining the effects of health interventions using SNS was conducted. Results indicated that health behavior change interventions using SNS are effective in general, but the effects were moderated by health topic, methodological features, and participant features. Theoretical and practical implications of findings are discussed.
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Affiliation(s)
- Qinghua Yang
- a Annenberg School for Communication , University of Pennsylvania , Philadelphia , Pennsylvania , USA
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Bricker JB, Copeland W, Mull KE, Zeng EY, Watson NL, Akioka KJ, Heffner JL. Single-arm trial of the second version of an acceptance & commitment therapy smartphone application for smoking cessation. Drug Alcohol Depend 2017; 170:37-42. [PMID: 27870987 PMCID: PMC5183543 DOI: 10.1016/j.drugalcdep.2016.10.029] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/21/2016] [Accepted: 10/23/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The first randomized trial of a smartphone application (app) for adult smoking cessation (SmartQuit 1.0) revealed key features that predict cessation. These findings guided the revision of this Acceptance & Commitment Therapy (ACT)-based application (SmartQuit 2.0), which was primarily tested to examine participant receptivity, short-term cessation and reduction, and the relationship between program completion, smoking cessation and reduction. Secondarily, outcomes were descriptively compared with the SmartQuit1.0 trial. METHOD Adult participants (78% female, 25% with high school or less education, 30% unemployed) were recruited into the single-arm pilot trial (N=99) of SmartQuit 2.0 with a two-month follow-up (85% retention). RESULTS Regarding receptivity, 84% of participants were satisfied with SmartQuit 2.0 (vs. 59% for SmartQuit1.0), 73% would recommend it to a friend (vs. 48% for SmartQuit1.0), 81% found the ACT exercises useful for quitting (vs. 44% for SmartQuit1.0). At the 2-month follow-up, the quit rates were 21% for 7-day point prevalence (vs. 23% for SmartQuit1.0), 11% for 30-day point prevalence (vs. 13% for SmartQuit1.0), and 75% of participants reduced their smoking frequency (vs. 57% for SmartQuit1.0). Among program completers (24% of total sample), the quit rates were 33% for 7-day point prevalence, 28% for 30-day point prevalence, and 88% of participants reduced their smoking frequency. CONCLUSIONS The revised app had high user receptivity, modest quit rates, and high smoking reduction rates. Program completion may be key to boosting the app's effectiveness.
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Affiliation(s)
- Jonathan B Bricker
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA; University of Washington, Department of Psychology, Box 351525, Seattle, WA 98195, USA.
| | - Wade Copeland
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Kristin E Mull
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Emily Y Zeng
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Noreen L Watson
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Katrina J Akioka
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
| | - Jaimee L Heffner
- Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N., Seattle, WA 98109, USA
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Zeng EY, Heffner JL, Copeland WK, Mull KE, Bricker JB. Get with the program: Adherence to a smartphone app for smoking cessation. Addict Behav 2016; 63:120-4. [PMID: 27454354 DOI: 10.1016/j.addbeh.2016.07.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/28/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Although engagement is generally predictive of positive outcomes in technology-based behavioral change interventions, engagement measures remain largely atheoretical and lack treatment-specificity. This study examines the extent to which adherence measures based on the underlying behavioral change theory of an Acceptance and Commitment Therapy (ACT) app for smoking cessation predict smoking outcomes, and user characteristics associated with adherence. METHODS Study sample was adult daily smokers in a single arm pilot study (n=84). Using the app's log file data, we examined measures of adherence to four key components of the ACT behavior change model as predictors of smoking cessation and reduction. We also examined baseline user characteristics associated with adherence measures that predict smoking cessation. RESULTS Fully adherent users (24%) were over four times more likely to quit smoking (OR=4.45; 95% CI=1.13, 17.45; p=0.032). Both an increase in tracking the number of urges passed (OR=1.02; 95% CI=1.00, 1.03; p=0.043) and ACT modules completed (OR=1.27; 95% CI=1.01, 1.60; p=0.042) predicted cessation. Lower baseline acceptance of cravings was associated with over four times higher odds of full adherence (OR=4.59; 95% CI=1.35, 15.54; p=0.014). CONCLUSIONS Full adherence and use of specific ACT theory-based components of the app predicted quitting. Consistent with ACT theory, users with low acceptance were most likely to adhere to the app. Further research is needed on ways to promote app engagement.
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Sadasivam RS, Borglund EM, Adams R, Marlin BM, Houston TK. Impact of a Collective Intelligence Tailored Messaging System on Smoking Cessation: The Perspect Randomized Experiment. J Med Internet Res 2016; 18:e285. [PMID: 27826134 PMCID: PMC5120237 DOI: 10.2196/jmir.6465] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 09/15/2016] [Accepted: 10/07/2016] [Indexed: 11/30/2022] Open
Abstract
Background Outside health care, content tailoring is driven algorithmically using machine learning compared to the rule-based approach used in current implementations of computer-tailored health communication (CTHC) systems. A special class of machine learning systems (“recommender systems”) are used to select messages by combining the collective intelligence of their users (ie, the observed and inferred preferences of users as they interact with the system) and their user profiles. However, this approach has not been adequately tested for CTHC. Objective Our aim was to compare, in a randomized experiment, a standard, evidence-based, rule-based CTHC (standard CTHC) to a novel machine learning CTHC: Patient Experience Recommender System for Persuasive Communication Tailoring (PERSPeCT). We hypothesized that PERSPeCT will select messages of higher influence than our standard CTHC system. This standard CTHC was proven effective in motivating smoking cessation in a prior randomized trial of 900 smokers (OR 1.70, 95% CI 1.03-2.81). Methods PERSPeCT is an innovative hybrid machine learning recommender system that selects and sends motivational messages using algorithms that learn from message ratings from 846 previous participants (explicit feedback), and the prior explicit ratings of each individual participant. Current smokers (N=120) aged 18 years or older, English speaking, with Internet access were eligible to participate. These smokers were randomized to receive either PERSPeCT (intervention, n=74) or standard CTHC tailored messages (n=46). The study was conducted between October 2014 and January 2015. By randomization, we compared daily message ratings (mean of smoker ratings each day). At 30 days, we assessed the intervention’s perceived influence, 30-day cessation, and changes in readiness to quit from baseline. Results The proportion of days when smokers agreed/strongly agreed (daily rating ≥4) that the messages influenced them to quit was significantly higher for PERSPeCT (73%, 23/30) than standard CTHC (44%, 14/30, P=.02). Among less educated smokers (n=49), this difference was even more pronounced for days strongly agree (intervention: 77%, 23/30; comparison: 23%, 7/30, P<.001). There was no significant difference in the frequency which PERSPeCT randomized smokers agreed or strongly agreed that the intervention influenced them to quit smoking (P=.07) and use nicotine replacement therapy (P=.09). Among those who completed follow-up, 36% (20/55) of PERSPeCT smokers and 32% (11/34) of the standard CTHC group stopped smoking for one day or longer (P=.70). Conclusions Compared to standard CTHC with proven effectiveness, PERSPeCT outperformed in terms of influence ratings and resulted in similar cessation rates. ClinicalTrial Clinicaltrials.gov NCT02200432; https://clinicaltrials.gov/ct2/show/NCT02200432 (Archived by WebCite at http://www.webcitation.org/6lEJY1KEd)
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Affiliation(s)
- Rajani Shankar Sadasivam
- Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical Scool, Worcester, MA, United States
| | - Erin M Borglund
- Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical Scool, Worcester, MA, United States
| | - Roy Adams
- College of Information and Computer Sciences, University of Massaachusttes Amherst, Amherst, MA, United States
| | - Benjamin M Marlin
- College of Information and Computer Sciences, University of Massaachusttes Amherst, Amherst, MA, United States
| | - Thomas K Houston
- Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical Scool, Worcester, MA, United States.,Center for Healthcare Organization and Implementation Research, US Department Veterans Affairs, Bedford VA Medical Center, Bedford, MA, United States
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Christofferson DE, Hertzberg JS, Beckham JC, Dennis PA, Hamlett-Berry K. Engagement and abstinence among users of a smoking cessation text message program for veterans. Addict Behav 2016; 62:47-53. [PMID: 27318948 DOI: 10.1016/j.addbeh.2016.06.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND SmokefreeVET is a text messaging smoking cessation program available to veterans enrolled in the Veterans Health Administration. SmokefreeVET was developed in collaboration with the National Cancer Institute as part of the SmokefreeTXT initiative. PURPOSE To evaluate the real world use of and effectiveness of the SmokefreeVET program for SmokefreeVET users who enrolled between 2013 and 2014. METHODS Demographics and smoking behavior of 1470 SmokefreeVET users who enrolled between 2013 and 2014 were analyzed. Latent growth mixture modeling was used to identify discrete classes of SmokefreeVET users based on engagement patterns. Multi-level modeling determined class differences in abstinence. RESULTS The average age of the SmokefreeVET user was 48, 75% of users were male, and 84% were daily smokers. After five weeks, 13% of all users reported abstinence from smoking. Five statistically distinct engagement classes of SmokefreeVET users were identified. Highly engaged classes were significantly less likely to opt-out and more likely to report abstinence. Over 60% of users who were classified as high engagers throughout the program reported abstinence 5weeks after their quit date. Users were more likely to report abstinence after two weeks if they used smoking cessation medication than those that did not use medication (OR=9.01, p<0.001). CONCLUSIONS SmokefreeVET may be effective at supporting abstinence among a real world group of highly engaged users. Smoking cessation medication use was also associated with abstinence in SmokefreeVET users. Engagement appears to be a critical component when assessing the efficacy of a text messaging smoking cessation intervention.
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Campbell W, Hester RK, Lenberg KL, Delaney HD. Overcoming Addictions, a Web-Based Application, and SMART Recovery, an Online and In-Person Mutual Help Group for Problem Drinkers, Part 2: Six-Month Outcomes of a Randomized Controlled Trial and Qualitative Feedback From Participants. J Med Internet Res 2016; 18:e262. [PMID: 27701064 PMCID: PMC5069403 DOI: 10.2196/jmir.5508] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 07/13/2016] [Accepted: 08/03/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite empirical evidence supporting the use of Web-based interventions for problem drinking, much remains unknown about factors that influence their effectiveness. OBJECTIVE We evaluated the performance of 2 resources for people who want to achieve and maintain abstinence: SMART Recovery (SR) and Overcoming Addictions (OA). OA is a Web application based on SR. We also examined participant and intervention-related factors hypothesized to impact clinical outcomes of Web-based interventions. METHODS We recruited 189 heavy drinkers through SR's website and in-person meetings throughout the United States. We began by randomly assigning participants to (1) SR meetings alone, (2) OA alone, and (3) OA and SR (OA+SR). Recruitment challenges compelled us to assign participants only to SR (n=86) or OA+SR (n=102). The experimental hypotheses were as follows: (1) Both groups will reduce their drinking and alcohol-related consequences at follow-up compared with their baseline levels, and (2) The OA+SR condition will reduce their drinking and alcohol or drug-related consequences more than the SR only condition. Additionally, we derived 3 groups empirically (SR, OA, and OA+SR) based on the participants' actual use of each intervention and conducted analyses by comparing them. Primary outcome measures included percent days abstinent (PDA), mean drinks per drinking day (DDD), and alcohol or drug-related consequences. Postbaseline assessments were conducted by phone at 3 and 6 months. Secondary analyses explored whether clinical issues (eg, severity of alcohol problems, level of distress, readiness to change) or intervention-related factors (eg, Internet fluency, satisfaction with site) affected outcomes. RESULTS Both intent-to-treat analyses and the actual-use analyses showed highly significant improvement from baseline to follow-ups for all 3 groups. Mean within-subject effect sizes were large (d>0.8) overall. There was no significant difference between groups in the amount of improvement from baseline to the average of the follow-ups. We found that participants who stopped drinking before joining the clinical trial had significantly better outcomes than participants who were still drinking when they joined the study. Neither Internet fluency nor participants' reported ease of navigating the site had an impact on outcomes. CONCLUSIONS These results support our first experimental hypothesis but not the second. On average, participants improved on all dependent measures. Both SR and OA helped participants recover from their problem drinking. Web-based interventions can help even those individuals with lengthy histories of heavy drinking to make clinically significant reductions in their consumption and related problems. These interventions work well for individuals in the action stage of change. TRIAL REGISTRATION Clinicaltrials.gov NCT01389297; https://clinicaltrials.gov/ct2/show/NCT01389297 (Archived by WebCite at http://www.webcitation.org/6kLNUNDcc).
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Affiliation(s)
- William Campbell
- Behavior Therapy Associates, LLC, Research Division, Albuquerque, NM, United States.
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Web-Based Intervention for Transitioning Smokers From Inpatient to Outpatient Care: An RCT. Am J Prev Med 2016; 51:620-9. [PMID: 27647062 DOI: 10.1016/j.amepre.2016.04.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 04/01/2016] [Accepted: 04/08/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Smoking-cessation follow-up care after hospitalization is known to be effective. Cost-effective and disseminable interventions adoptable by hospitals are needed. DESIGN RCT. SETTING/PARTICIPANTS Fourteen hundred eighty-eight current smokers recruited during a tertiary care hospital stay were randomly assigned to Usual Care (UC) or Usual Care plus Web-Based Intervention (WI). Data were collected in 2011-2013 and analyzed in 2014-2015. INTERVENTION UC provided brief bedside advice to quit, a quit plan template, and quitline contact information. WI included access to a website with asynchronous e-message communication with a tobacco counselor, use of interactive self-assessments, helpful cessation information, and access to additional web resources, as well as automated e-mail messages tailored for health concern and readiness to quit. MAIN OUTCOME MEASURES Self-reported 30-day abstinence at 6 months was the primary outcome; a subset was verified by saliva cotinine. RESULTS Six-month follow-up was completed by 83% of participants. No difference was found between study arms for self-reported abstinence rates in intent-to-treat (25.4% WI vs 26.8% UC) and complete case (31.3% WI vs 31.4% UC) analyses. Reduced smoking was reported by 45.5% (WI, n=276) and 47% (UC, n=296) of non-abstinent responders (p=0.59). Using a 10-ng/mL cotinine cut off, abstinence was verified in 52.1% of WI and 62.5% of UC (p=0.11). Significant covariates associated with abstinence at 6 months were being male, not smoking during hospitalization, being very confident in quitting, planning to quit/stay quit, smoking fewer days in the past 30 days, fewer years of smoking, and having cerebrovascular or connective tissue rheumatic disease as primary hospital diagnosis. CONCLUSIONS Lack of difference between treatment arms suggests a strong effect for UC, WI was not effective, or both. Low intervention engagement may be partially responsible. Self-reported abstinence rates were relatively high in both arms, although the biochemically verified rates indicate over-reporting of abstinence. These findings suggest brief bedside counseling for all hospitalized smokers is beneficial. TRIAL REGISTRATION This study is registered at www.clinicaltrials.gov NCT01277250.
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Graham AL, Papandonatos GD, Erar B, Stanton CA. Use of an online smoking cessation community promotes abstinence: Results of propensity score weighting. Health Psychol 2016; 34S:1286-95. [PMID: 26651470 DOI: 10.1037/hea0000278] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We estimated the causal effects of use of an online smoking cessation community on 30-day point prevalence abstinence at 3 months. METHODS Participants (N = 492) were adult current smokers in the enhanced Internet arm of The iQUITT Study, a randomized trial of Internet and telephone treatment for smoking cessation. All participants accessed a Web-based smoking-cessation program that included a large, established online community. Automated tracking metrics of passive (e.g., reading forum posts, viewing member profiles) and active (e.g., writing forum posts, sending private messages) community use were extracted from the site at 3 months. Self-selected community use defines the groups of interest: "None," "Passive," and "Both" (passive + active). Inverse probability of treatment weighting corrected for baseline imbalances on demographic, smoking, psychosocial, and medical history variables. Propensity weights estimated via generalized boosted models were used to calculate Average Treatment Effects (ATE) and Average Treatment effects on the Treated (ATT). RESULTS Patterns of community use were: None = 198 (40.2%), Passive = 110 (22.4%), and Both = 184 (37.4%). ATE-weighted abstinence rates were: None = 4.2% (95% CI = 1.5-6.9); Passive = 15.1% (95% CI = 8.4-21.9); Both = 20.4% (95% CI = 13.9-26.8). ATT-weighted abstinence rates indicated even greater benefits of community use. CONCLUSIONS Community users were more likely to quit smoking at 3 months than nonusers. The estimated benefit from use of online community resources was even larger among subjects with high propensity to use them. No differences in abstinence emerged between passive and passive/active users. Results suggest that lurking in online communities confers specific abstinence benefits. Implications of these findings for online cessation communities are discussed.
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Affiliation(s)
- Amanda L Graham
- Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation
| | | | - Bahar Erar
- Center for Statistical Sciences, Brown University
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Cantrell J, Ilakkuvan V, Graham AL, Richardson A, Xiao H, Mermelstein RJ, Curry SJ, Sporer AK, Vallone DM. Young Adult Utilization of a Smoking Cessation Website: An Observational Study Comparing Young and Older Adult Patterns of Use. JMIR Res Protoc 2016; 5:e142. [PMID: 27401019 PMCID: PMC4960403 DOI: 10.2196/resprot.4881] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 12/28/2015] [Accepted: 02/09/2016] [Indexed: 11/13/2022] Open
Abstract
Background There is little research on how young adults or young adult subgroups utilize and engage with Web-based cessation interventions when trying to quit smoking. Addressing this knowledge gap is important to identify opportunities to optimize the effectiveness of online cessation programs across diverse young adult users. Objective This study examines utilization of the BecomeAnEX.org smoking cessation website among young adults and young adult subgroups compared with older adults to identify patterns of use by age, gender, and race/ethnicity. Methods Study participants were 5983 new registered users on a free smoking cessation website who were aged 18 to 70 years. Website utilization was tracked for 6 months; metrics of use included website visits, pages per visit, length of visit, and interaction with specific website features. Differences in website use by age were examined via bivariate analyses and multivariate logistic regression adjusted for age, gender, and race/ethnicity. Interactions were examined to determine differences by gender and race/ethnicity within young (18- to 24-year-olds and 25- to 34-year-olds) and older (35 years and older) adult segments. Results A greater percentage of young adults aged 18 to 34 years visited the site only once compared with older adults aged 35 years and older (72.05% vs 56.59%, respectively; P<.001). Young adults also spent less time on the site and viewed fewer pages than older adults. In adjusted analyses, young adults were significantly less likely than older adults to visit the site more than once (18-24 years: adjusted odds ratio [AOR] 0.58, 95% CI 0.49-0.68, P<.001; 25-34 years: AOR 0.56, 95% CI 0.50-0.64, P<.001), spend more than 3 minutes on the site (18-24 years: AOR 0.67, 95% CI 0.57-0.79, P<.001; 25-34 years: AOR 0.56, 95% CI 0.49-0.64, P<.001), view 12 or more pages (18-24 years: AOR 0.72, 95% CI 0.61-0.83; P<.001; 25-34 years: AOR 0.67, 95% CI 0.59-0.76, P<.001), utilize the BecomeAnEX.org community (18-24 years: AOR 0.61, 95% CI 0.48-0.79, P<.001; 25-34 years: AOR 0.73, 95% CI 0.60-0.88, P<.001), or utilize Separation Exercises (18-24 years: AOR 0.68, 95% CI 0.51-0.89, P<.01; 25-34 years: AOR 0.77, 95% CI 0.63-0.94, P<.01). Gender differences in utilization were more pronounced among young adults compared with older adults, with lower levels of utilization among young men than young women. For all age groups, utilization was higher among whites and African Americans than among Hispanics and other racial minorities, with one exception—BecomeAnEX.org community utilization was significantly higher among Hispanic young adults compared with white and African American young adults. Conclusions Results point to important areas of inquiry for future research and development efforts. Research should focus on enhancing demand and increasing engagement among younger adults and men, examining strategies for capitalizing on young adult developmental needs, and increasing utilization of effective site features among diverse young adult users.
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Affiliation(s)
- Jennifer Cantrell
- Evaluation Science and Research, Truth Initiative, Washington, DC, United States.
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Saul JE, Amato MS, Cha S, Graham AL. Engagement and attrition in Internet smoking cessation interventions: Insights from a cross-sectional survey of "one-hit-wonders". Internet Interv 2016; 5:23-29. [PMID: 30135803 PMCID: PMC6096296 DOI: 10.1016/j.invent.2016.07.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/01/2016] [Accepted: 07/03/2016] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Internet interventions can reach large numbers of individuals. However, low levels of engagement and high rates of follow-up attrition are common, presenting major challenges to evaluation. This study investigated why registrants of an Internet smoking cessation intervention did not return after joining ("one hit wonders"), and explored the impact of graduated incentives on survey response rates and responder characteristics. METHODS A sample of "one hit wonders" that registered on a free smoking cessation website between 2014 and 2015 were surveyed. The initial invitation contained no incentive. Subsequent invitations were sent to random subsamples of non-responders from each previous wave offering $25 and $50 respectively. Descriptive statistics characterized respondents on demographic characteristics, reasons for not returning, and length of time since last visit. Differences were investigated with Fisher's Exact tests, Kruskal-Wallis, and logistic regression. RESULTS Of 8779 users who received the initial invitation, 132 completed the survey (1.5%). Among those subsequently offered a $25 incentive, 127 (3.7%) responded. Among those offered a $50 incentive, 97 responded (5.7%). The most common reasons endorsed for not returning were being unable to quit (51%), not having enough time (33%), having forgotten about the website (28%), and not being ready to quit (21%). Notably, however, 23% reported not returning because they had successfully quit smoking. Paid incentives yielded a higher proportion of individuals who were still smoking than the $0 incentive (72% vs. 61%). Among $0 and $25 responders, likelihood of survey response decreased with time since registration; the $50 incentive removed the negative effect of time-since-registration on probability of response. CONCLUSIONS One third of participants that had disengaged from an Internet intervention reported abstinence at follow-up, suggesting that low levels of engagement are not synonymous with treatment failure in all cases. Paid incentives above $25 may be needed to elicit survey responses, especially among those with longer intervals of disengagement from an intervention.
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Affiliation(s)
- Jessie E. Saul
- North American Research & Analysis, Inc., Faribault, MN, United States
| | - Michael S. Amato
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, United States
| | - Sarah Cha
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, United States
| | - Amanda L. Graham
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC, United States,Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, United States,Corresponding author at: Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, 900 G Street, NW, Fourth Floor, Washington, DC 20001, United States.
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