JMIR Publications

ABSTRACT

Background:

Cigarette smoking remains the leading cause of preventable morbidity and mortality in the U.S. Improving the acceptability and effectiveness of eHealth interventions may help alleviate the public health burden of smoking.

Objective:

The current RCT tested two eHealth smoking cessation interventions well-matched in terms of being fully automated, incorporating best-practices, being internet based, and including very similar content. One intervention (MobileQuit) was delivered via smartphone and the other (QuitOnline) using personal computers and tablets.

Methods:

1271 study participants were recruited through online marketing and randomly assigned to either MobileQuit or QuitOnline. Primary outcomes included self-reported smoking abstinence (7-day point prevalence) at 3- and 6-month follow-up assessments. Engagement using program website visits was measured unobtrusively throughout the project period.

Results:

A higher rate of smoking abstinence was reported by participants in MobileQuit than in QuitOnline. Intent-to-treat analysis revealed results as follows: 3-month assessment (20.7% vs. 11.4%, OR = 2.02 [95% CI: 1.48, 2.76], P < .001), 6-month assessment (24.6% vs. 19.3%, OR = 1.37 [CI: 1.05, 1.79], P = .021), and at both 3 and 6 months (15.8% vs. 8.8%, OR =1.95 [CI: 1.38, 2.76], P < .001). Complete Case analysis showed: 3 months (45.6% vs. 28.4%, OR = 2.12 [CI: 1.48, 3.23], P < .001), at 6 months (43.5% vs. 34.4%, OR = 1.94 [CI: 1.31, 2.89], P < .001), and at both 3 and 6 months (40.5% vs. 25.9%, OR =1.94 [CI: 1.31, 2.89], P < .001). Participants who did not achieve abstinence did not report and between-condition differences at the 3- or 6-month follow-up in terms of their number of cigarettes smoked and number of quit attempts condition. MobileQuit participants were sent a considerable number of text messages (M= 278.51, MD= 295, SD= 71.90), and 11% (70/633) of participants opted out of receiving these messages.

Conclusions:

MobileQuit was delivered on a smartphone using an app and tightly-integrated text messaging, it had the Detective Activity lapse management component, and it adhered to an overall linear tunnel IA. The QuitOnline intervention was delivered on a PC without text messages or a lapse management component, and it used a hybrid matrix-hierarchical IA that enabled participants more flexibility to explore program content and set their own schedule for quitting. Results indicated that smokers assigned to use the MobileQuit smartphone intervention made significantly more visits to their program website, they persisted in visiting their website for a longer period of time, and they were significantly more effective in quitting smoking than the PC web-based comparison intervention. Clinical Trial: ClinicalTrials.gov NCT01952236