Efficiently connecting underserved smokers with limited resources to efficacious tobacco cessation treatments that are easily accessible is crucial for disease prevention and the elimination of health disparities. This study seeks to address this need through partnering with a large social service network to evaluate the efficacy and economic impact of a theoretically-based, fully automated, interactive smartphone-based smoking cessation intervention. The Regional Food Bank of Oklahoma (RFBO) is the largest hunger-relief charity in the state, and through a network of 14 Food and Resource Centers (FRC), provides food to more than 136,000 food insecure clients each week across 53 counties. Our preliminary data indicate that the prevalence of current smoking among adult clients is 46% (more than 3 times the prevalence in the general US population). Participants (n=500) will be randomized to one of two treatment conditions: 1) Standard Treatment (ST; n=250) or Automated Treatment (AT; n=250). ST participants will be electronically connected to the Oklahoma Tobacco Helpline using a tablet-based web portal that is specific to this study. This approach is designed to mirror the Ask Advise Connect (AAC) approach to linking smokers in healthcare systems with quitline treatment that our team has previously developed and evaluated. ST will be evaluated against AT, a fully automated treatment enrollment and delivery approach. In the AT condition, participants will receive an interactive smartphone- based intervention that comprises content delivered via audio/video clips and interactive text content. Much of the programming and developmental work for AT has already been completed by the Stephenson Cancer Center's mHealth Shared Resource, and results from a series of pilot studies (including work conducted in partnership with the RFBO sites) with beta versions of the mobile application are extremely encouraging. Nicotine replacement therapy (NRT) in the form of transdermal patches will be provided to all participants (ST and AT). Our overall goal of this project is to determine if AT performs better than the more resource intensive ST approach. If efficacy is established, the AT approach will be readily scalable, easily implemented by community-based organizations, and offer an efficient way to allocate limited public health resources to tobacco control interventions. The primary aim is to evaluate the efficacy of AT and ST in facilitating abstinence from smoking. It is hypothesized that at the 12-month follow-up assessment, 7-day point prevalence smoking abstinence rates will be higher in AT compared to ST. Secondary aims are to: 1) Compare the magnitude of the mediated effects via common mechanisms (i.e., motivation, agency, and stress/negative affect) on smoking abstinence between the AT and ST treatment groups; and 2) Conduct economic evaluations to assess the cost and/or cost-effectiveness of AT vs. ST. There is a critical need for theoretically-based, cost-effective, and sustainable cessation treatments that have broad dissemination potential, and the AT intervention has been designed to help fill this need.
Smoking remains the leading cause of preventable morbidity and mortality in the United States, with tobacco use accounting for more deaths each year than the combined deaths attributable to alcohol, other drugs, homicide, suicide, motor vehicle accidents, and sexual behavior. Efficiently connecting underserved smokers with limited resources to efficacious tobacco cessation programs is crucial for disease prevention and the elimination of health disparities. This study seeks to address this need through partnering with a large social service network, the Regional Food Bank of Oklahoma, to evaluate the efficacy and economic impact of a theoretically-based, fully automated, interactive smartphone-based smoking cessation intervention.