Accepted for/Published in: JMIR Research Protocols
Date Submitted: Mar 23, 2025
Date Accepted: Aug 14, 2025
App-based smoking urge reduction intervention for young adults: Study protocol combining a micro-randomized trial and conventional between-subject randomized trial
ABSTRACT
Background:
Tobacco smoking is the leading preventable cause of morbidity and mortality in the United States, and young adults have high smoking rates. Although most young adult smokers are interested in quitting, they underutilize professional cessation support. Smartphones have wide reach and integration into young adults’ lives and these devices offer great opportunities to deliver cessation interventions by delivering messages suggesting coping strategies “in the moment” when smokers need cessation support.
Objective:
The overall goal of this trial is to evaluate the efficacy of Cognitive Behavioral Therapy (CBT) and Mindfulness/Acceptance and Commitment Therapy (ACT) messages for young adults targeted at specific high-risk situations for smoking.
Methods:
We will conduct a micro-randomized trial (within-subject randomization) to test the efficacy of CBT and Mindfulness/ACT compared to control messages for reducing smoking urge up to 15 minutes after message delivery, nested in a conventional between subject randomized controlled trial (RCT). A conventional between-subject control group of participants that will complete EMA only without intervention messages will allow us to test, if messages reduce cigarettes per day at end of treatment, 3-, and 6-months follow-up. Among MRT intervention group participants, we will explore how message efficacy may be moderated by substance co-use (cannabis, alcohol, other drugs) and exposure to specific settings (home, work, bars).
Results:
Smoking onset is now more common among young adults than adolescents and early cessation substantially reduces morbidity and mortality from smoking, making age-appropriate, tailored, and scalable interventions for this high priority population ever more important. Results of this trial will provide evidence on the efficacy of tailored intervention messages to help young adult smokers cope with smoking urges as an integral part of smartphone interventions.
Conclusions:
Findings will inform the field about key principles, strategies, and efficacy of situational tailoring of app-based tobacco use urge reduction messages. Clinical Trial: NCT05836103
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