Kahler Christopher W, Cohn Amy M, Costantino Catherine, Toll Benjamin A, Spillane Nichea S, Graham Amanda L
Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI, United States.
University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States.
JMIR Form Res. 2020 Jun 8;4(6):e7570. doi: 10.2196/formative.7570.
Heavy drinking (HD) is far more common among smokers compared with nonsmokers and interferes with successful smoking cessation. Alcohol-focused smoking cessation interventions delivered by counselors have shown promise, but digital versions of these interventions-which could have far greater population reach-have not yet been tested.
This pilot randomized controlled trial aimed to examine the feasibility, acceptability, and effect sizes of an automated digital smoking cessation program that specifically addresses HD using an interactive web-based intervention with an optional text messaging component.
Participants (83/119, 69.7% female; 98/119, 82.4% white; mean age 38.0 years) were daily smokers recruited on the web from a free automated digital smoking cessation program (BecomeAnEX.org, EX) who met the criteria for HD: women drinking 8+ drinks/week or 4+ drinks on any day and men drinking 15+ drinks/week or 5+ drinks on any day. Participants were randomized to receive EX with standard content (EX-S) or an EX with additional content specific to HD (EX-HD). Outcomes were assessed by web-based surveys at 1 and 6 months.
Participants reported high satisfaction with the website and the optional text messaging component. Total engagement with both EX-S and EX-HD was modest, with participants visiting the website a median of 2 times, and 52.9% of the participants enrolled to receive text messages. Participants in both the conditions showed substantial, significant reductions in drinking across 6 months of follow-up, with no condition effects observed. Although smoking outcomes tended to favor EX-HD, the condition effects were small and nonsignificant. A significantly smaller proportion of participants in EX-HD reported having a lapse back to smoking when drinking alcohol (7/58, 16%) compared with those in EX-S (18/61, 41%; χ=6.2; P=.01).
This is the first trial to examine a digital smoking cessation program tailored to HD smokers. The results provide some initial evidence that delivering such a program is feasible and may reduce the risk of alcohol-involved smoking lapses. However, increasing engagement in this and other web-based interventions is a crucial challenge to address in future work.
ClinicalTrials.gov NCT03068611; https://clinicaltrials.gov/ct2/show/NCT03068611.
与不吸烟者相比，重度饮酒在吸烟者中更为常见，并且会干扰戒烟的成功。由咨询师提供的以酒精为重点的戒烟干预措施已显示出前景，但这些干预措施的数字版本——可能具有更大的人群覆盖面——尚未经过测试。
这项试点随机对照试验旨在研究一种自动化数字戒烟计划的可行性、可接受性和效应大小，该计划使用基于网络的交互式干预措施以及可选的短信组件专门解决重度饮酒问题。
参与者（83/119，69.7%为女性；98/119，82.4%为白人；平均年龄38.0岁）是从一个免费的自动化数字戒烟计划（BecomeAnEX.org，EX）在网络上招募的每日吸烟者，他们符合重度饮酒标准：女性每周饮酒8杯以上或任何一天饮酒4杯以上，男性每周饮酒15杯以上或任何一天饮酒5杯以上。参与者被随机分配接受包含标准内容的EX（EX-S）或包含针对重度饮酒的额外内容的EX（EX-HD）。在1个月和6个月时通过基于网络的调查评估结果。
参与者对网站和可选的短信组件表示高度满意。EX-S和EX-HD两者的总体参与度适中，参与者访问网站的中位数为2次，52.9%的参与者注册接收短信。在6个月的随访中，两种情况下的参与者饮酒量均大幅显著减少，但未观察到条件效应。尽管吸烟结果倾向于有利于EX-HD，但条件效应较小且不显著。与EX-S组（18/61，41%；χ=6.2；P=.01）相比，EX-HD组中报告在饮酒时复吸吸烟的参与者比例显著更小（7/58，16%）。
这是第一项研究针对重度饮酒吸烟者量身定制的数字戒烟计划的试验。结果提供了一些初步证据，表明实施这样一个计划是可行的，并且可能降低饮酒导致吸烟复吸的风险。然而，提高对该计划以及其他基于网络的干预措施的参与度是未来工作中需要解决的关键挑战。
ClinicalTrials.gov NCT03068611；https://clinicaltrials.gov/ct2/show/NCT03068611
