Paz Castro Raquel, Haug Severin, Filler Andreas, Kowatsch Tobias, Schaub Michael P
Swiss Research Institute for Public Health and Addiction, Zurich University, Zurich, Switzerland.
Center for Digital Health Interventions, Institute of Technology Management, University of St. Gallen, St. Gallen, Switzerland.
J Med Internet Res. 2017 Nov 1;19(11):e356. doi: 10.2196/jmir.7928.
Although mobile phone-delivered smoking cessation programs are a promising way to promote smoking cessation among adolescents, little is known about how adolescents might actually use them.
The aim of this study was to determine adolescents' trajectories of engagement with a mobile phone-delivered smoking cessation program over time and the associations these trajectories have with baseline characteristics and treatment outcomes.
We performed secondary data analysis on a dataset from a study that compared a mobile phone-delivered integrated smoking cessation and alcohol intervention with a smoking cessation only intervention for adolescents recruited in vocational and upper secondary school classes (N=1418). Throughout the 3-month intervention, participants in both intervention groups received one text message prompt per week that either assessed smoking-related target behaviors or encouraged participation in a quiz or a message contest. Sequence analyses were performed to identify engagement trajectories. Analyses were conducted to identify predictors of engagement trajectory and associations between engagement trajectories and treatment outcomes.
Three engagement trajectories emerged: (1) stable engagement (646/1418, 45.56%), (2) decreasing engagement (501/1418, 35.33%), and (3) stable nonengagement (271/1418, 19.11%). Adolescents who were younger, had no immigrant background, perceived more benefits of quitting smoking, and reported binge drinking preceding the baseline assessment were more likely to exhibit stable engagement. Due to different reach of more engaged and less engaged participants at follow-up, three statistical models (complete-cases, last-observation-carried-forward, and multiple imputation) for the associations of engagement trajectory and smoking outcome were tested. For 7-point smoking abstinence, no association was revealed to be statistically significant over all three models. However, decreasing engagement with the program was associated over all three models, with greater reductions in daily tobacco use than nonengagement.
The majority of tobacco-smoking adolescents engaged extensively with a mobile phone-based smoking cessation program. However, not only stable engagement but also decreasing engagement with a program might be an indicator of behavioral change. Measures to avoid nonengagement among adolescents appear especially necessary for older smokers with an immigrant background who do not drink excessively. In addition, future studies should not only examine the use of specific program components but also users' engagement trajectories to better understand the mechanisms behind behavioral change.
尽管通过手机提供的戒烟项目是促进青少年戒烟的一种很有前景的方式，但对于青少年实际可能如何使用这些项目却知之甚少。
本研究的目的是确定青少年随时间推移参与手机戒烟项目的轨迹，以及这些轨迹与基线特征和治疗结果之间的关联。
我们对一项研究的数据集进行了二次数据分析，该研究将通过手机提供的综合戒烟与酒精干预与仅针对职业学校和高中班级招募的青少年的戒烟干预进行了比较（N = 1418）。在为期3个月的干预期间，两个干预组的参与者每周都会收到一条短信提示，要么评估与吸烟相关的目标行为，要么鼓励参与测验或信息竞赛。进行序列分析以确定参与轨迹。进行分析以确定参与轨迹的预测因素以及参与轨迹与治疗结果之间的关联。
出现了三种参与轨迹：（1）稳定参与（646/1418，45.56%），（2）参与度下降（501/1418，35.33%），以及（3）稳定不参与（271/1418，19.11%）。年龄较小、没有移民背景、认为戒烟益处更多且在基线评估前报告有暴饮行为的青少年更有可能表现出稳定参与。由于随访时参与度较高和较低的参与者的覆盖范围不同，测试了三种用于参与轨迹与吸烟结果关联的统计模型（完全病例、末次观察结转和多重插补）。对于7分制的戒烟情况，在所有三种模型中均未发现有统计学意义的关联。然而，在所有三种模型中，参与项目的程度下降与每日烟草使用量的减少幅度大于不参与项目的情况相关。
大多数吸烟青少年广泛参与了基于手机的戒烟项目。然而，不仅稳定参与，而且参与项目程度的下降也可能是行为改变的一个指标。对于没有过度饮酒的有移民背景的年长吸烟者来说，采取措施避免青少年不参与似乎尤为必要。此外，未来的研究不仅应检查特定项目组成部分的使用情况，还应检查用户的参与轨迹，以更好地理解行为改变背后的机制。
