Tobacco use remains the most important cause of morbidity and premature mortality in the United States. Young adults have high smoking rates and low use of evidence-based smoking cessation services. Smartphones are widely used among young adults and offer a promising strategy to deliver smoking cessation treatment to a large, diverse audience of young adult smokers. Available smoking cessation apps for smartphones are rarely evidence-based and able to deliver intervention content that is tailored to the specific needs of the individual smoker. Little is known how smartphone-based interventions need to be designed and what kind of tailored intervention content they should deliver. While there is evidence for the efficacy of both Cognitive Behavioral Therapy (CBT) and Mindfulness/ Acceptance and Commitment Therapy (ACT) smoking cessation interventions, it is unclear if these approaches are efficacious when implemented in real-time and with young adults. The overall goal of this proposal is to evaluate the efficacy of CBT and ACT-based messages for young adults targeted at specific high-risk situations for smoking. Our team has experience in using smartphones and Ecological Momentary Assessment (EMA) to understand situational predictors of smoking in everyday life, and smoking cessation trials with young adults using Facebook. We have demonstrated feasibility of determining high-risk situations for smoking and delivering tailored messages based on geofence triggers.
The specific aims are to: 1) To test CBT and Mindfulness/ACT intervention message efficacy for reducing momentary smoking urges. We will conduct a micro-randomized trial (within-subject randomization) to test the efficacy of CBT and Mindfulness/ACT compared to control messages for reducing smoking urge 15 minutes after message delivery. 2) To test if exposure to urge reduction messages results in changes in smoking behavior over time compared to an EMA only control group. A control group of participants that will complete EMA only without intervention messages will allow us to test, if messages reduce cigarettes per day at end of treatment, 3-, and 6-months follow-up. 3) Explore moderation effects of substance co-use (cannabis, alcohol, other drugs) and exposure to specific location (home, work, bars) on urge reduction message efficacy. Among intervention group participants, we will explore how message efficacy may be moderated by substance co-use and exposure to specific settings. Smoking onset is now more common among young adults than adolescents and early cessation substantially reduces morbidity and mortality from smoking, making age-appropriate, tailored, and scalable interventions for this high priority population ever more important.
Effective smoking cessation treatments that reach the target population of young adults are direly needed and smartphone interventions are a promising strategy. Few of the available smoking cessation apps are based on evidence or deliver intervention content tailored to participant-specific high-risk situations for smoking. The aim of this proposal is to test smartphone-delivered messages for smoking cessation and urge reduction among young adults that target specific high-risk situations for smoking and have the potential to curb smoking in this underserved age group.