JMIR Publications

ABSTRACT

Background:

Despite decreasing prevalence over the last several decades, cigarette smoking remains the leading cause of preventable death and disease, underscoring the need for innovative, effective solutions. Pivot is a novel, inclusive smoking cessation program designed for smokers along the entire spectrum of readiness to quit. Pivot leverages proven methods and technological advancements including a personal portable breath carbon monoxide (CO) sensor, smartphone app, and in-app text-based coaching. We previously reported outcomes from the end of active Pivot program participation in 319 adult smokers. Herein, we report longer-term follow-up in this cohort.

Objective:

Assess and report participant outcomes 3 months after completion of Pivot, including smoking behavior, quit rates, continuous abstinence rates and durability, and predictors of abstinence.

Methods:

This prospective remote cohort study included US cigarette smokers aged 18 to 65 years who smoked ≥5 cigarettes per day (CPD). Three months after completion of active participation in Pivot, final follow-up data were collected via an online questionnaire. Outcomes included smoking behavior (CPD and quit attempts), quit rates (7- and 30-day point prevalence abstinence [PPA]), and continuous abstinence rates (proportion who achieved uninterrupted abstinence) and duration. Exploratory regression analyses were performed to identify baseline characteristics associated with achievement of 7-day PPA, 30-day PPA, and continuous abstinence.

Results:

A total of 319 participants completed onboarding (intention-to-treat [ITT]); 288/319 participants (90.3%) completed follow-up (completers) at a mean of 7.2 (SD 1.2) months after onboarding. At final follow-up, participants reduced CPD by 52.6% (SE 2.1), and 52.8% (152/288, completer) of participants reduced their CPD by at least 50%. Overall, 80.6% (232/288, completer) made at least 1 quit attempt. Quit rates increased after the end of Pivot; using ITT analyses, 35.4% (113/319) achieved 7-day PPA and 31.3% (100/319) achieved 30-day PPA at final follow-up, compared to 32.0% (102/319) and 27.6% (88/319), respectively, at the end of the Pivot program. Continuous abstinence was achieved in 86.4% (76/88) of those who reported 30-day PPA at the end of Pivot, with a mean abstinence duration of 5.8 (SD 0.6) months. In exploratory univariate regression analyses, lower baseline CPD and more positive baseline attitudes reflecting higher self-efficacy (higher confidence to quit and lower perceived difficulty of quitting) were associated with achieving abstinence.

Conclusions:

This study provides the first longer-term outcomes of the Pivot smoking cessation program. At final follow-up, quit rates increased and continuous abstinence was favorable; the majority who achieved abstinence at the end of Pivot sustained abstinence through follow-up. Decreases in CPD persisted and most participants made a quit attempt. Overall, final follow-up outcomes were stable or improved when compared to previous outcomes from the end of the program. These findings validate earlier results and demonstrate that Pivot is an effective and durable solution for smoking cessation. Clinical Trial: ClinicalTrials.gov NCT03295643; https://clinicaltrials.gov/ct2/show/NCT03295643