Tobacco use among women now approaches that of men, with approximately 27 million women smokers in the United States alone. Lung cancer is the leading cause of cancer death among women, and more than 180,000 women die of other illnesses linked to smoking annually. Women report greater difficulties quitting smoking and are more likely to relapse than men. In addition, tobacco use co-varies with poor dietary practices and lack of physical activity, with 92% of smokers reporting at least one other health risk factor. The presence of multiple behavioral risk factors greatly increases the risk of developing many acute and chronic conditions (e.g., MI, COPD, etc.). Concerns surrounding weight gain, negative body image, and low self-efficacy, may be key factors affecting smoking cessation among weight-concerned women smokers. These smokers are less satisfied with their bodies, have lower self-esteem, and are more concerned about becoming overweight than non-smokers. These findings suggest that targeting weight concern, body image and self-efficacy to quit with weight-concerned women who smoke may be an effective intervention strategy. One cognitive approach, guided imagery, has been successfully employed in separate lines of inquiry to address physical activity, diet and smoking cessation. However, guided imagery has not been employed to target weight concerned women who smoke or to simultaneously target smoking, diet, and exercise behavior in a single intervention. The proposed study would be the first of its kind to create a theory-based, guided imagery intervention to assist weight-concerned women smokers to quit. While imagery is an effective therapeutic tool for behavior change, the mode of delivery has generally been in-person, limiting the dissemination of guided imagery-based interventions to large populations. Mobile health applications (mobile apps) delivered via smart phones offer a unique channel through which to distribute imagery-based interventions. The use of a mobile app offers an innovative approach to addressing the multiple behaviors involved in smoking cessation efforts of weight-concerned women, and has the potential to reach large numbers of women smokers. If successful, a mobile application for guided imagery could be used to address other health behaviors as well. The present project aims to develop and test the feasibility of a mobile health application using guided imagery in order to increase smoking cessation among a population of weight-concerned women smokers. We will also collect data on the eating and physical activity behaviors of our participants before and after receiving the imagery intervention. Results of this study will prepare us for a future randomized controlled trial to test the efficacy and cost-effectiveness of a multi-behavioral, guided imagery mobile health application versus a single smoking cessation imagery mobile health application.

Public Health Relevance

The smoking rate among adult females in the U.S. has increased in recent decades and now approaches that of males, presenting a critical public health issue. However, about half of women smokers are reluctant to quit because of concerns about weight gain, and few resources are available for them. The proposed study will develop and test the feasibility and acceptability of a mobile phone application that delivers a guided imagery intervention and resources for quitting smoking, eating a healthy diet, and engaging in physical activity.

National Institute of Health (NIH)
National Cancer Institute (NCI)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZCA1-SRLB-B (O1))
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Hesse, Bradford
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University of Arizona
Family Medicine
Schools of Medicine
United States
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Armin, Julie; Johnson, Thienne; Hingle, Melanie et al. (2017) Development of a Multi-Behavioral mHealth App for Women Smokers. J Health Commun 22:153-162
Abbate, Kristopher J; Hingle, Melanie D; Armin, Julie et al. (2017) Recruiting Women to a Mobile Health Smoking Cessation Trial: Low- and No-Cost Strategies. JMIR Res Protoc 6:e219
Gordon, Judith S; Armin, Julie; D Hingle, Melanie et al. (2017) Development and evaluation of the See Me Smoke-Free multi-behavioral mHealth app for women smokers. Transl Behav Med 7:172-184
Schmidt, Chris A; Romine, James K; Bell, Melanie L et al. (2017) User Participation and Engagement With the See Me Smoke-Free mHealth App: Prospective Feasibility Trial. JMIR Mhealth Uhealth 5:e142
Giacobbi Jr, Peter; Hingle, Melanie; Johnson, Thienne et al. (2016) See Me Smoke-Free: Protocol for a Research Study to Develop and Test the Feasibility of an mHealth App for Women to Address Smoking, Diet, and Physical Activity. JMIR Res Protoc 5:e12