Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: May 10, 2023
Open Peer Review Period: May 10, 2023 - May 25, 2023
Date Accepted: Oct 6, 2023
(closed for review but you can still tweet)
Adults who used e-cigarettes had lower success in quitting cigarette smoking: Secondary results from an app-delivered behavioral intervention randomized trial for smoking cessation
ABSTRACT
Background:
Many adults use e-cigarettes to help them quit cigarette smoking. However, the potential impact on smoking cessation of e-cigarettes used concurrently with app-delivered behavioral interventions has not been explored.
Objective:
This study used data from a randomized trial that compared the efficacy of the iCanQuit app to the QuitGuide app for cigarette smoking cessation. The aim was to examine the impact of adopting e-cigarettes on combustible cigarette smoking cessation while concurrently receiving the assigned app-delivered intervention, by comparing e-cigarette adopters (n=465) with non-adopters (n=1097).
Methods:
Smoking cessation outcomes were measured at the 3, 6 and 12-month follow-ups. Consistent with the main trial, the primary outcome was self-reported complete-case 30-day point prevalence abstinence (PPA) at 12-months. Secondary outcomes were missing-as-smoking and multiple imputation analyses of the primary outcome; prolonged abstinence from cigarette smoking, and cessation of all nicotine and tobacco products at 12-months. We used logistic regression models to test whether there was an interaction between adopting e-cigarettes and app treatment assignment (iCanQuit vs. QuitGuide) on the primary cessation outcome, and to evaluate the efficacy of using each intervention app plus e-cigarettes relative to the app alone to compare the primary cigarette smoking cessation outcome and secondary outcomes at 12-months between adopters and non-adopters.
Results:
There was suggestive evidence for an interaction between adopting e-cigarettes and treatment arm on combustible smoking cessation (p=0.058). In the iCanQuit arm, adopters had significantly lower 12-month smoking cessation rates compared with non-adopters (21% vs. 35%, OR=0.55; 95% CI: 0.37 to 0.81, p=0.003). In contrast, in the QuitGuide arm, adopting e-cigarettes had no significant impact on 12-month smoking cessation rates compared with non-adopters (19% vs. 20%, OR=0.91; 95% CI: 0.62 to 1.35, p=0.640). Prolonged abstinence in both arms was reduced by 3-fold among adopters compared with non-adopters (5% vs. 17% in iCanQuit; 3% vs. 8% in QuitGuide, p<0.05). Exploratory analyses to understand these associations were inconclusive.
Conclusions:
Adults who adopted e-cigarettes while concurrently receiving an app-delivered smoking cessation intervention had either a lower or an unimproved likelihood of quitting cigarette smoking. Future research on behavioral treatments for smoking cessation should consider including education on the potential consequences of e-cigarette use. Clinical Trial: Clinical Trials.gov Registration Number: NCT02724462
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.