App-Delivered Mindfulness Training to Reduce Anxiety in People with HIV Who Smoke: A One-Armed Feasibility Trial

Abstract

Introduction: People with HIV (PWH) who smoke have reported that managing anxiety is a barrier to making a quit attempt and maintaining abstinence post-quit. This study examined the feasibility and acceptability of an app-based mindfulness intervention, Unwinding Anxiety, to reduce anxiety prior to a quit attempt in PWH who were not planning to quit in the next 30 days. Methods: Sixteen PWH (mean age 51.5 [SD = 13.2]; mean cigarettes per day 11.4 [SD = 5.4]) were enrolled and followed for eight weeks. A smartphone-based app with 30 modules designed to reduce anxiety was introduced at baseline; participants were encouraged to complete one module daily for four weeks. Symptoms of anxiety and readiness to quit smoking were measured at baseline and weeks 4 and 8. The mean number of modules completed, session attendance, and number of study completers were examined. Generalized estimating equations (GEE) were used to examine changes in self-reported anxiety and readiness to quit at baseline, week 4, and week 8. A brief qualitative interview was conducted at week 4 to explore the acceptability of the app. Results: Feasibility was high, with 93% of participants completing the study. The mean number of study sessions completed was 2.7 (SD = 0.59), and the mean number of modules completed was 16.0 (SD 16.8). Anxiety was high at baseline (M = 14.4, SD = 3.9), but lower at week 4 (b = −5.5; CI: [−9.4, −1.7]; p = 0.004) and week 8 (b = −5.1; CI: [−8.8, −1.3]; p = 0.008), and stable between weeks 4 and 8 (b = 0.48; CI: [−2.0, 3.0]; p = 0.706). Readiness to quit significantly increased from baseline M = 5.5 (SD = 1.6) to week 4 (b = 0.56; CI: [0.20, 0.91]; p = 0.002) but was not significantly different from baseline at week 8 (b = 0.34; CI: [−0.30, 1.0]; p = 0.30). Ad-hoc moderation analyses found that anxiety had a small significantly positive association with readiness to quit at baseline (main effect: b = 0.10; SE = 0.03; p < 0.001) and significantly attenuated the increase in readiness to quit observed at week 4 (anxiety by week 4 interaction: b = −0.08; SE = 0.03; p = 0.009). Conclusions: App-based mindfulness training appears to be feasible and acceptable for PWH who smoke and report baseline anxiety. At week 4, anxiety was reduced and readiness to quit was increased, perhaps a key time point for a smoking cessation attempt.

Pilot Testing of an mHealth App for Tobacco Cessation in People Living With HIV: Protocol for a Pilot Randomized Controlled Trial

“…Smartwatch technology has been developed and tested in interventional smoking cessation studies within the past decade, yet study samples have been small, and more testing is required to improve the accuracy of smoking detection [40][41][42][43]. Similarly, mHealth has been used for smoking cessation and has been found to be effective in the short term [44][45][46][47][48][49][50][51], with little evidence of efficacy in the long term [52]. A systematic review of quit-smoking apps in Android's Play Store and Apple's App Store found high rates of existing irrelevant or nonfunctioning apps and few apps with evidence-based support [53].…”

A Novel mHealth App for Smokers Living With HIV Who Are Ambivalent About Quitting Smoking: Formative Research and Randomized Feasibility Study

“…Relative to a control app that included access to standard care advice and access to treatment for people ready to quit, the experimental app (called GEMS) had higher engagement (mean sessions 19.9, SD 16.2 vs 7.3, SD 6.6), was associated with greater requests for either NRT or quitline counseling accessed through the app (36% vs 10%), and had a higher 7-day point prevalence abstinence at the 3-month follow-up (14.7% vs 6.9%) in a randomized pilot study [ 31 ]. Recent studies have also found app-based smoking interventions to be feasible and acceptable to people living with HIV who were ready to quit [ 32 , 33 ]. Taken together, these recent studies suggest that it is reasonable to explore the use of an app-based intervention to change smoking behavior among PAQS living with HIV.…”