Businelle Michael S, Ma Ping, Kendzor Darla E, Frank Summer G, Vidrine Damon J, Wetter David W
Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
Oklahoma Tobacco Research Center, Stephenson Cancer Center, Okahoma City, OK, United States.
J Med Internet Res. 2016 Dec 12;18(12):e321. doi: 10.2196/jmir.6058.
Despite substantial public health progress in reducing the prevalence of smoking in the United States overall, smoking among socioeconomically disadvantaged adults remains high.
To determine the feasibility and preliminary effectiveness of a novel smartphone-based smoking cessation app designed for socioeconomically disadvantaged smokers.
Participants were recruited from a safety-net hospital smoking cessation clinic in Dallas, Texas, and were followed for 13 weeks. All participants received standard smoking cessation clinic care (ie, group counseling and cessation pharmacotherapy) and a smartphone with a novel smoking cessation app (ie, Smart-T). The Smart-T app prompted 5 daily ecological momentary assessments (EMAs) for 3 weeks (ie, 1 week before cessation and 2 weeks after cessation). During the precessation period, EMAs were followed by messages that focused on planning and preparing for the quit attempt. During the postcessation period, participant responses to EMAs drove an algorithm that tailored messages to the current level of smoking lapse risk and currently present lapse triggers (eg, urge to smoke, stress). Smart-T offered additional intervention features on demand (eg, one-click access to the tobacco cessation quitline; "Quit Tips" on coping with urges to smoke, mood, and stress).
Participants (N=59) were 52.0 (SD 7.0) years old, 54% (32/59) female, and 53% (31/59) African American, and 70% (40/57) had annual household income less than US $16,000. Participants smoked 20.3 (SD 11.6) cigarettes per day and had been smoking for 31.6 (SD 10.9) years. Twelve weeks after the scheduled quit date, 20% (12/59) of all participants were biochemically confirmed abstinent. Participants responded to 87% of all prompted EMAs and received approximately 102 treatment messages over the 3-week EMA period. Most participants (83%, 49/59) used the on-demand app features. Individuals with greater nicotine dependence and minority race used the Quit Tips feature more than their counterparts. Greater use of the Quit Tips feature was linked to nonabstinence at the 2 (P=.02), 4 (P<.01), and 12 (P=.03) week follow-up visits. Most participants reported that they actually used or implemented the tailored app-generated messages and suggestions (83%, 49/59); the app-generated messages were helpful (97%, 57/59); they would like to use the app in the future if they were to lapse (97%, 57/59); and they would like to refer friends who smoke to use the Smart-T app (85%, 50/59). A minority of participants (15%, 9/59) reported that the number of daily assessments (ie, 5) was "too high."
This novel just-in-time adaptive intervention delivered an intensive intervention (ie, 102 messages over a 3-week period), was well-liked, and was perceived as helpful and useful by socioeconomically disadvantaged adults who were seeking smoking cessation treatment. Smartphone apps may be used to increase treatment exposure and may ultimately reduce tobacco-related health disparities among socioeconomically disadvantaged adults.
尽管美国在降低总体吸烟率方面取得了显著的公共卫生进展，但社会经济地位不利的成年人吸烟率仍然很高。
确定一款专为社会经济地位不利的吸烟者设计的新型基于智能手机的戒烟应用程序的可行性和初步效果。
参与者从得克萨斯州达拉斯的一家安全网医院戒烟诊所招募，并随访13周。所有参与者均接受标准的戒烟诊所护理（即团体咨询和戒烟药物治疗），并获得一部装有新型戒烟应用程序（即Smart-T）的智能手机。Smart-T应用程序在3周内（即戒烟前1周和戒烟后2周）每天提示5次生态瞬时评估（EMA）。在戒烟前阶段，EMA之后会收到侧重于为戒烟尝试进行规划和准备的信息。在戒烟后阶段，参与者对EMA的回答驱动一种算法，该算法根据当前吸烟复吸风险水平和当前出现的复吸触发因素（如吸烟冲动、压力）定制信息。Smart-T按需提供额外的干预功能（如一键接入戒烟热线；关于应对吸烟冲动、情绪和压力的“戒烟小贴士”）。
参与者（N=59）年龄为52.0（标准差7.0）岁，54%（32/59）为女性，53%（31/59）为非裔美国人，70%（40/57）家庭年收入低于16,000美元。参与者每天吸烟20.3（标准差11.6）支，吸烟31.6（标准差10.9）年。在预定戒烟日期后的12周，所有参与者中有20%（12/59）经生化确认戒烟。参与者对所有提示的EMA的回复率为87%，在3周的EMA期间收到了约102条治疗信息。大多数参与者（83%，49/59）使用了按需应用程序功能。尼古丁依赖性较强的个体和少数族裔比其他个体更多地使用“戒烟小贴士”功能。在第2周（P=0.02）、第4周（P<0.01）和第12周（P=0.03）的随访中，更多地使用“戒烟小贴士”功能与未戒烟有关。大多数参与者报告说他们实际使用或实施了应用程序生成的定制信息和建议（83%，49/59）；应用程序生成的信息很有帮助（97%，57/59）；如果他们复吸，未来愿意使用该应用程序（97%，57/59）；并且他们愿意推荐吸烟的朋友使用Smart-T应用程序（85%，5%）。少数参与者（15%，9/59）报告说每天的评估次数（即5次）“太多”。
这种新型的即时适应性干预提供了强化干预（即在3周内发送102条信息），很受欢迎，并且被寻求戒烟治疗的社会经济地位不利的成年人认为是有帮助和有用的。智能手机应用程序可用于增加治疗接触，并最终可能减少社会经济地位不利的成年人中与烟草相关的健康差距。
