Outcomes of a Comprehensive Mobile Smoking Cessation Program with Nicotine Replacement Therapy in Ad
Thursday, January 5, 2023
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.
JMIR Mhealth Uhealth. 2022;10(11):e41658. Published 2022 Nov 24.
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-based mobile smoking cessation program, comprises a personal
carbon monoxide breath sensor; a smartphone app; in-app, text-based
human-provided coaching; nicotine replacement therapy; and a moderated
web-based community. Promising Pivot cohort studies have established the
foundation for comparative assessment.
Objective. This
study aimed to compare engagement, retention, attitudes toward quitting
smoking, smoking behavior, and participant feedback between Pivot and
QuitGuide, a US Clinical Practice Guideline-based smoking cessation smartphone
app from the National Cancer Institute.
Methods. In
this remote pilot randomized controlled trial, cigarette smokers in the United
States were recruited on the web and randomized to Pivot or QuitGuide.
Participants were offered 12 weeks of free nicotine replacement therapy. Data
were self-reported via weekly web-based questionnaires for 12 weeks and at 26
weeks. Outcomes included engagement and retention, attitudes toward 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 carbon monoxide samples.
Results. Participants
comprised 188 smokers (94 Pivot and 94 QuitGuide): mean age 46.4 (SD 9.2)
years, 104 (55.3%) women, 128 (68.1%) White individuals, and mean cigarettes
per day 17.6 (SD 9.0). Engagement via mean "total app openings through 12
weeks" (primary outcome) was Pivot, 157.9 (SD 210.6) versus QuitGuide,
86.5 (SD 66.3; P<.001). Self-reported 7-day PPA at 12 and 26 weeks was
Pivot, 35% (33/94) versus QuitGuide, 28% (26/94; intention to treat [ITT]:
P=.28) and Pivot, 36% (34/94) versus QuitGuide, 27% (25/94; ITT: P=.12),
respectively. Self-reported 30-day PPA at 12 and 26 weeks was Pivot, 29%
(27/94) versus QuitGuide, 22% (21/94; ITT: P=.32) and Pivot, 32% (30/94) versus
QuitGuide, 22% (21/94; ITT: P=.12), respectively. The biovalidated abstinence rate
at 12 weeks was Pivot, 29% (27/94) versus QuitGuide, 13% (12/94; ITT: P=.008).
Biovalidated continuous abstinence at 26 weeks was Pivot, 21% (20/94) versus
QuitGuide, 10% (9/94; ITT: P=.03). Participant feedback, including ease of
setup, impact on smoking, and likelihood of program recommendation were
favorable for Pivot.
Conclusions. In
this randomized controlled trial 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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