Avatar-led Digital Health Intervention for Sexual and Gender Minority Young Adult Smoking Cessation:

Heffner JL, Baker K, Fan X, Kelly MM, Orzechowski M, Ruiz RA, Nfn S, Serfozo E, Stimatze T, Karekla M.
Avatar-led Digital Health Intervention for Sexual and Gender Minority Young Adult Smoking Cessation: Randomized Controlled Pilot Trial
Nicotine Tob Res. 2026 May 21:ntag113. doi: 10.1093/ntr/ntag113. Epub ahead of print. PMID: 42166213.

Introduction: Accessible, culturally tailored interventions are needed to address the high prevalence of cigarette smoking and the challenges to cessation experienced by sexual and gender minority (SGM) young adults. This study evaluated, in a randomized, controlled pilot trial, the acceptability, preliminary cessation-related outcomes, and impact on theory-based change processes of the SGM-tailored, Acceptance and Commitment Therapy (ACT)-based Empowered, Queer, Quitting, and Living (EQQUAL) digital program relative to the National Cancer Institute's Smokefree.gov program.

Methods: Participants were SGM young adults, aged 18-30, who smoked at least weekly. Participants were randomized 1:1 to either EQQUAL or Smokefree.gov, both of which included a web app and text messaging. Outcomes were assessed at 3 months post-randomization, and smoking abstinence was biochemically verified.

Results: The sample included 124 participants (n=63 in EQQUAL, n=61 in Smokefree.gov). On the primary acceptability outcomes, overall satisfaction was descriptively higher in the EQQUAL arm (68.8% vs. 60.0%; OR=1.17, 95% CI=0.50-2.78), and EQQUAL usability ratings exceeded the acceptable benchmark score of 68. The average number of EQQUAL digital sessions completed was 1.4 (of 6). On the primary cessation outcomes, biochemically verified 7-day point prevalence abstinence was higher in EQQUAL than Smokefree.gov (11.1% vs. 4.9%; OR=1.89, 95% CI=0.45-9.66). Change in readiness to quit and cigarettes per day were similar between arms, as were outcomes of theory-based change processes.

Conclusions: EQQUAL demonstrated potential benefits over Smokefree.gov on acceptability and cessation, albeit with a lack of robust effect on theory-based change processes. Increased engagement with the web-based portion of the program may be needed to improve outcomes.