JMIR Publications

ABSTRACT

Background:

Smoking is the leading cause of premature death, and low-income adults suffer disproportionate burden from tobacco. Mindfulness interventions show promise for improving smoking cessation. A text messaging program, iQuit Mindfully, was created to deliver just-in-time support for quitting smoking among low-income adults. A pilot study of iQuit Mindfully was conducted in spring 2020, right in the midst of the COVID-19 pandemic among low-income and predominantly African American smokers.

Objective:

This pilot study examined the acceptability and feasibility of delivering Mindfulness-Based Addiction Treatment via mHealth during the COVID-19 pandemic.

Methods:

Participants were adult cigarette smokers (N=23, 35% female, 83% African American, 78% annual income <$24,000). They were randomly assigned to either 8 weeks of iQuit Mindfully as a standalone intervention or iQuit Mindfully in combination with in-person group treatment. For participant safety, in-person mindfulness groups were transitioned online and assessments took place online or by telephone. Survey questions asked participants about changes in their stress, smoking habits and quit attempts, as well as their perceptions of the mindfulness and text messaging intervention in the context of the pandemic.

Results:

Most participants (71%) indicated a change in stress due to the pandemic, with 93% of those indicating higher stress. Participants shared concerns about finances, homelessness, health and social isolation. Most (81%) believed that smoking increases risk for contracting COVID-19, and although that was motivating for some, others expressed lower motivation to quit because of higher stress. Most (86%) said that practicing mindfulness was helpful during the pandemic. Mean ratings of the helpfulness of text messages and the extent they would recommend the program to others were 7.1 (median 8 on 10-point scale, SD=2.9) and 8.2 (median 9, SD=2.5), respectively. Through open-ended program evaluations, participants shared details about how mindfulness practice and the text messages helped them to manage stress and feel a sense of social support during the pandemic. Moreover, 53% of participants achieved 7-day abstinence from smoking, with no differences between conditions.

Conclusions:

This study supports the promise of text messaging and use of teleconferencing to provide mindfulness and smoking cessation services to underserved populations during a global pandemic.