Outcomes of a Comprehensive Mobile Smoking Cessation Program with Nicotine Replacement Therapy in Ad
Thursday, November 17, 2022
Posted by: Natalia Gromov
Marler
JD, Fujii CA, Utley MT, Balbierz DJ, Galanko JA, Utley DS.
Outcomes of a
Comprehensive Mobile Smoking Cessation Program with Nicotine Replacement
Therapy in Adult Smokers: Pilot Randomized Controlled Trial.
[published online ahead of print, 2022 Oct 18]. JMIR Mhealth Uhealth.
2022;10.2196/41658. doi:10.2196/41658
Background. Cigarette
smoking remains the leading cause of preventable illness and death,
underscoring ongoing need for evidence-based solutions. Pivot, a US Clinical
Practice Guideline (USCPG)-based mobile smoking cessation program, comprises a
personal carbon monoxide (CO) breath sensor, smartphone app, in-app, text-based
human-provided coaching, nicotine replacement therapy (NRT), and moderated
online community. Promising Pivot cohort studies have established the
foundation for comparative assessment.
Objective. Compare
engagement, retention, attitudes towards quitting smoking, smoking behavior and
participant feedback in Pivot vs. QuitGuide, a USCPG-based smoking cessation
smartphone app from the National Cancer Institute (NCI).
Methods. In
this remote pilot randomized controlled trial (RCT), cigarette smokers in the
US were recruited online and randomized to Pivot or QuitGuide. Participants
were offered 12 weeks of free NRT. Data were self-reported via weekly online
questionnaires for 12 weeks and at 26 weeks. Outcomes included engagement and
retention, attitudes towards quitting smoking, smoking behavior, and
participant feedback. The primary outcome was self-reported app openings at 12
weeks. Cessation outcomes included self-reported 7- and 30-day point prevalence
abstinence (PPA), abstinence from all tobacco products and continuous
abstinence at 12 and 26 weeks. PPA and continuous abstinence were biovalidated
via breath CO samples.
Results. Participants
comprised 188 smokers (94 Pivot, 94 QuitGuide): mean (SD) age 46.4 (9.2) years,
104 women (55.3%), 128 White individuals (68.1%), mean (SD) cigarettes per day
(CPD) 17.6 (9.0). Engagement via mean (SD) total app openings through 12 weeks
(primary outcome) was Pivot 157.9 (SD 210.6) vs. QuitGuide 86.5 (SD 66.3)
(incidence rate ratio [IRR],1.8; 95% CI, 1.4, 2.3; P<.001). Self-reported
7-day PPA at 12 and 26 weeks was Pivot 35.1% (33/94) vs. QuitGuide 27.7%
(26/94), (intention to treat [ITT]), (odds ratio [OR], 1.4; 95% CI, 0.8, 2.7;
P=.28), and Pivot 36.2% (34/94) vs. QuitGuide 26.6% (25/94), (ITT), (OR, 1.7;
95% CI, 0.9, 3.2; P=.12), respectively. Self-reported 30-day PPA at 12 and 26
weeks was Pivot 28.7% (27/94) vs. QuitGuide 22.3% (21/94), (ITT), (OR, 1.4; 95%
CI, 0.7, 2.8; P=.32), and Pivot 31.9% (30/94) vs. QuitGuide 22.3% (21/94),
(ITT), (OR, 1.7; 95% CI, 0.9, 3.4; P=.12), respectively. The biovalidated
abstinence rate at 12 weeks was Pivot 28.7% (27/94) vs. QuitGuide 12.8%
(12/94), (ITT), (OR, 2.8; 95% CI, 1.3, 6.1; P=.008). Biovalidated continuous
abstinence at 26 weeks was Pivot 21.3% (20/94) vs. QuitGuide 9.6% (9/94),
(ITT), (OR, 2.7; 95% CI, 1.1, 6.4; P=.03). Participant feedback, including ease
of set-up, impact on smoking, and likelihood of program recommendation were
favorable for Pivot.
Conclusions. In
this RCT comparing the app-based smoking cessation programs Pivot and
QuitGuide, Pivot participants had higher engagement and biovalidated cessation
rates, and more favorable user feedback at 12 and 26 weeks. These findings
support Pivot as an effective, durable mobile smoking cessation program.
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