||5R21CA234003-02 Interpret this number
||Kaiser Foundation Research Institute
||Development of a Mhealth Intervention for Ambivalent Smokers: a Pilot Feasibility Study
Tobacco use remains the leading preventable cause of death and illness in our society. Despite this, 36.5 million
US adults continue to smoke. Most of these people (70%) want to quit smoking someday, but are not yet ready to quit
or actively seeking treatment. That is, they are “ambivalent” about quitting. NCI has called for innovative, scalable,
and effective mobile health (mHealth) smoking cessation interventions, but to truly reduce smoking prevalence in
this country, future mHealth interventions need to effectively engage “ambivalent smokers”, encourage them to stop
smoking, and support them through this process. The current proposal is responsive to this important goal.
Building on our programmatic research developing mHealth smoking cessation apps, population-level
motivational interventions, and more than a year of user-centered design and development work with
ambivalent smokers, we have designed a mHealth app which blends sound scientific theory, evidence-based
treatment, and best practice treatment guidelines for nicotine dependence with intervention content that is also
responsive to the needs and preferences of ambivalent smokers. The experimental intervention uses a series
of discreet behavioral experiments (called `personal experiments') to help ambivalent smokers clarify their
goals for smoking reduction/quitting; build and strengthen their motivation, confidence, and outcome
expectations for quitting; and teach them the basic skills necessary to cut back and quit smoking. The
experiments are paired with action-oriented guidance how to quit and a referral to evidence-based quitline
counseling. Our preliminary testing found the intervention concept was well received by ambivalent smokers.
They particularly liked the personal experiments, which allow them to try new behaviors and have discreet
mastery experiences without having to commit to quitting smoking. This element is particularly critical.
[The goals of this formative study are to complete the intervention development and evaluate the
program's: a) feasibility and acceptability; b) impact on potential cognitive mediators (e.g., self-efficacy,
motivation); and c) impact on indices of change in motivation or behavior (e.g., quit attempts, smoking
reduction, biochemically-confirmed abstinence).] We will then plan for a future large-scale RCT to test program
efficacy. The final intervention design will be informed by ambivalent smokers and experts in designing and
disseminating population-level behavioral interventions for health plans, tobacco quitlines, and public health
agencies. Stakeholders will also review the final results to evaluate the program's dissemination potential.
The study uses a combination of qualitative and quantitative methods. Pilot participants (n=60) will be
randomized to the experimental intervention or a control condition which includes the same best-practice self-
help guidance and treatment referral, without the personal experiments. Participants will be followed for 3
months. If effective, this novel intervention could be disseminated through health plans, tobacco quitlines, or
other public health agencies, expanding their reach to ambivalent smokers and reducing smoking prevalence.
Commentary on Graham et al.: Biochemical verification of abstinence in remotely conducted smoking cessation trials should not be a universal design requirement for rigor.
, McClure J.B.
Addiction (Abingdon, England), 2022 Apr; 117(4), p. 1047-1048.
Recognizing and Preventing Participant Deception in Online Nicotine and Tobacco Research Studies: Suggested Tactics and a Call to Action.
, Watson N.L.
, Dahne J.
, Croghan I.
, Kelly M.M.
, McClure J.B.
, Bars M.
, Thrul J.
, Meier E.
Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 2021-08-29; 23(10), p. 1810-1812.
Development of a Mobile Health Intervention with Personal Experiments for Smokers Who Are Ambivalent About Quitting: Formative Design and Testing.
, Catz S.L.
, Klasnja P.
, Tiffany B.
, McClure J.B.
JMIR formative research, 2020-08-27; 4(8), p. e21784.