An Avatar-Led Intervention Promotes Smoking Cessation in Young Adults: A Pilot Randomized Clinical Trial

Karekla, Maria; Savvides, Stella Nicoleta; Gloster, Andrew T.

doi:10.1093/abm/kaaa013

Cited by 26 publications

(50 citation statements)

References 38 publications

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“…The importance of social support needs to be made clear to the public and to the degree possible mechanisms that can contribute to social support should be supported. Further, psychological flexibility is a trainable set of skills that has repeatedly been shown to ameliorate suffering [22,39]; and can be widely distributed with modern technological intervention tools such as digital, internet, or virtual means [40]. We do not claim, however, that psychological flexibility is the only factor that can be used for interventions.…”

Section: Plos Onementioning

confidence: 92%

Impact of COVID-19 pandemic on mental health: An international study

et al. 2020

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Background The COVID-19 pandemic triggered vast governmental lockdowns. The impact of these lockdowns on mental health is inadequately understood. On the one hand such drastic changes in daily routines could be detrimental to mental health. On the other hand, it might not be experienced negatively, especially because the entire population was affected. Methods The aim of this study was to determine mental health outcomes during pandemic induced lockdowns and to examine known predictors of mental health outcomes. We therefore surveyed n = 9,565 people from 78 countries and 18 languages. Outcomes assessed were stress, depression, affect, and wellbeing. Predictors included country, sociodemographic factors, lockdown characteristics, social factors, and psychological factors. Results Results indicated that on average about 10% of the sample was languishing from low levels of mental health and about 50% had only moderate mental health. Importantly, three consistent predictors of mental health emerged: social support, education level, and psychologically flexible (vs. rigid) responding. Poorer outcomes were most strongly predicted by a worsening of finances and not having access to basic supplies. Conclusions These results suggest that on whole, respondents were moderately mentally healthy at the time of a population-wide lockdown. The highest level of mental health difficulties were found in approximately 10% of the population. Findings suggest that public health initiatives should target people without social support and those whose finances worsen as a result of the lockdown. Interventions that promote psychological flexibility may mitigate the impact of the pandemic.

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Section: Plos Onementioning

confidence: 92%

Impact of COVID-19 pandemic on mental health: An international study

et al. 2020

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“…It is worth noting that study participants’ readiness to quit smoking at baseline spanned the full range of the Contemplation Ladder, from 0 to 10, suggesting that even sexual and gender minority young adults with very low motivation to quit may be willing to engage with, and may benefit from, an intervention that is designed for smokers at all levels of quit readiness. This was the case in the original Flexiquit trial, where a 29% quit rate was obtained even though 65% of the sample reported low readiness to quit at baseline [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…The Empowered, Queer, Quitting, and Living (EQQUAL) program is a cultural, linguistic, and sexual and gender minority–targeted adaptation of Flexiquit, a web-based acceptance and commitment therapy (ACT) program designed for young adults at all stages of readiness to quit tobacco use [ 7 ]. In addition to focusing on increasing acceptance of smoking triggers and facilitating values-guided action as cessation treatment mechanisms, ACT also teaches generalizable emotion regulation skills that can increase resilience and buffer minority stress [ 8 ] among sexual and gender minority young adults.…”

Section: Methodsmentioning

confidence: 99%

“…EQQUAL also employs another exciting innovation in digital tobacco treatment: an avatar guide designed to make the program more engaging and effective. The original avatar-led Flexiquit program (not sexual and gender minority–targeted) showed great promise in motivating cessation in a pilot randomized controlled trial with young adults in Cyprus, with a 29% posttreatment quit rate for Flexiquit versus 11% for the waitlist [ 7 ]. Importantly, the majority (65%) of participants were in the precontemplation or contemplation stages of change, demonstrating the program’s utility for smokers who are at lower levels of quit readiness [ 7 ].…”

Section: Methodsmentioning

confidence: 99%

“…Eligibility criteria were individuals (1) between 18 and 30 years of age who (2) self-identified as sexual or gender minority (ie, a sexual orientation other than straight, gender that doesn't match sex assigned at birth, or both); (3) resided in the United States; (4) smoked at least 1 cigarette per day over the past 30 days; (5) had at least weekly internet access and were willing and able to stream video online during the 2-month study period; (6) used text messaging; (7) were not engaged in any other smoking cessation treatment at the time of screening, including pharmacotherapies or behavioral counseling, but excluding e-cigarettes or other vaping devices, which are not approved by the US Food and Drug Administration for smoking cessation; and (8) were comfortable reading, writing, and speaking in English.…”

Section: Participantsmentioning

confidence: 99%

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An Avatar-Led Digital Smoking Cessation Program for Sexual and Gender Minority Young Adults: Intervention Development and Results of a Single-Arm Pilot Trial

Heffner¹,

Watson²,

Serfozo³

et al. 2021

JMIR Form Res

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Background Sexual and gender minority young adults have a high prevalence of smoking and unique barriers to accessing tobacco treatment. Objective To address these challenges as well as their preferences for sexual and gender minority–targeted interventions and digital programs, we developed and evaluated the acceptability, preliminary efficacy, and impact on theory-based change processes of an acceptance and commitment therapy–based digital program called Empowered, Queer, Quitting, and Living (EQQUAL). Methods Participants (n=22) of a single-arm trial conducted to evaluate the program were young adults, age 18 to 30 years, who self-identified as sexual and gender minority individuals and smoked at least one cigarette per day. All participants received access to the EQQUAL program. Participants completed web-based surveys at baseline and at a follow-up 2 months after enrollment. We verified self-reported smoking abstinence with biochemical testing; missing data were counted as smoking or using tobacco. Results For young adults who logged in at least once (n=18), the mean number of log-ins was 5.5 (SD 3.6), mean number of sessions completed was 3.1 (SD 2.6), and 39% (7/18) completed all 6 sessions. Overall, 93% of participants (14/15) were satisfied with the EQQUAL program, 100% (15/15) found it easy to use, and 100% (15/15) said it helped them be clearer about how to quit. Abstinence from smoking or using tobacco was confirmed with biochemical testing for 23% of participants (5/22). Both quantitative and qualitative results suggested a positive overall response to the avatar guide, with areas for future improvement largely centered on the avatar’s appearance and movements. Conclusions Treatment acceptability of EQQUAL was very promising. The rate of abstinence, which was biochemically confirmed, was 3 times higher than that of the only other digital program to date that has targeted sexual and gender minority young adults and 6 to 13 times higher than those of nontargeted digital smoking interventions among sexual and gender minority young adults. Planned improvements for the next iteration of the program include making the avatar’s movements more natural; offering multiple avatar guides with different on characteristics such as race, ethnicity, and gender identity from which to choose; and providing a support forum for users to connect anonymously with peers.

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Mindfulness for smoking cessation

Jackson

Brown

Norris

et al. 2022

Cochrane Database of Systematic Reviews

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Background Mindfulness‐based smoking cessation interventions may aid smoking cessation by teaching individuals to pay attention to, and work mindfully with, negative affective states, cravings, and other symptoms of nicotine withdrawal. Types of mindfulness‐based interventions include mindfulness training, which involves training in meditation; acceptance and commitment therapy (ACT); distress tolerance training; and yoga. Objectives To assess the efficacy of mindfulness‐based interventions for smoking cessation among people who smoke, and whether these interventions have an effect on mental health outcomes. Search methods We searched the Cochrane Tobacco Addiction Group's specialised register, CENTRAL, MEDLINE, Embase, PsycINFO, and trial registries to 15 April 2021. We also employed an automated search strategy, developed as part of the Human Behaviour Change Project, using Microsoft Academic. Selection criteria We included randomised controlled trials (RCTs) and cluster‐RCTs that compared a mindfulness‐based intervention for smoking cessation with another smoking cessation programme or no treatment, and assessed smoking cessation at six months or longer. We excluded studies that solely recruited pregnant women. Data collection and analysis We followed standard Cochrane methods. We measured smoking cessation at the longest time point, using the most rigorous definition available, on an intention‐to‐treat basis. We calculated risk ratios (RRs) and 95% confidence intervals (CIs) for smoking cessation for each study, where possible. We grouped eligible studies according to the type of intervention and type of comparator. We carried out meta‐analyses where appropriate, using Mantel‐Haenszel random‐effects models. We summarised mental health outcomes narratively. Main results We included 21 studies, with 8186 participants. Most recruited adults from the community, and the majority (15 studies) were conducted in the USA. We judged four of the studies to be at low risk of bias, nine at unclear risk, and eight at high risk. Mindfulness‐based interventions varied considerably in design and content, as did comparators, therefore, we pooled small groups of relatively comparable studies. We did not detect a clear benefit or harm of mindfulness training interventions on quit rates compared with intensity‐matched smoking cessation treatment (RR 0.99, 95% CI 0.67 to 1.46; I 2 = 0%; 3 studies, 542 participants; low‐certainty evidence), less intensive smoking cessation treatment (RR 1.19, 95% CI 0.65 to 2.19; I 2 = 60%; 5 studies, 813 participants; very low‐certainty evidence), or no treatment (RR 0.81, 95% CI 0.43 to 1.53; 1 study, 325 participants; low‐certainty evidence). In each comparison, the 95% CI encompassed benefit (i.e. higher quit rates), harm (i.e. lower quit rates) and n...

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An Avatar-Led Intervention Promotes Smoking Cessation in Young Adults: A Pilot Randomized Clinical Trial

Cited by 26 publications

References 38 publications

Impact of COVID-19 pandemic on mental health: An international study

Impact of COVID-19 pandemic on mental health: An international study

An Avatar-Led Digital Smoking Cessation Program for Sexual and Gender Minority Young Adults: Intervention Development and Results of a Single-Arm Pilot Trial

Mindfulness for smoking cessation

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