Durability of Abstinence After Completing a Comprehensive Digital Smoking Cessation Program Incorporating a Mobile App, Breath Sensor, and Coaching: Cohort Study

Abstract

Background Despite decreasing prevalence over the last several decades, cigarette smoking remains the leading cause of preventable death and disease, underscoring the need for innovative, effective solutions. Pivot is a novel, inclusive smoking cessation program designed for smokers along the entire spectrum of readiness to quit. Pivot leverages proven methods and technological advancements, including a personal portable breath carbon monoxide sensor, smartphone app, and in-app text-based coaching. We previously reported outcomes from the end of active Pivot program participation in 319 adult smokers. Herein, we report longer-term follow up in this cohort. Objective The aim of this study was to assess and report participant outcomes 3 months after completion of Pivot, including smoking behavior, quit rates, continuous abstinence rates and durability, and predictors of abstinence. Methods This prospective remote cohort study included US-based cigarette smokers aged 18 to 65 years who smoked ≥5 cigarettes per day (CPD). Three months after completion of active participation in Pivot, final follow-up data were collected via an online questionnaire. Outcomes included smoking behavior (CPD and quit attempts), self-reported quit rates (7- and 30-day point prevalence abstinence [PPA]), and continuous abstinence rates (proportion who achieved uninterrupted abstinence) and duration. Exploratory regression analyses were performed to identify baseline characteristics associated with achievement of 7-day PPA, 30-day PPA, and continuous abstinence. Results A total of 319 participants completed onboarding (intention-to-treat [ITT]); 288/319 participants (90.3%) completed follow up (completers) at a mean of 7.2 (SD 1.2) months after onboarding. At final follow up, CPD were reduced by 52.6% (SE 2.1; P<.001) among all 319 participants, and most completers (152/288, 52.8%) reduced their CPD by at least 50%. Overall, most completers (232/288, 80.6%) made at least one quit attempt. Quit rates increased after the end of Pivot; using ITT analyses, 35.4% (113/319) achieved 7-day PPA and 31.3% (100/319) achieved 30-day PPA at final follow up compared with 32.0% (102/319) and 27.6% (88/319), respectively, at the end of the Pivot program. Continuous abstinence was achieved in about a quarter of those who onboarded (76/319, 23.8%) and in most who reported 30-day PPA at the end of Pivot (76/88, 86.4%), with a mean abstinence duration of 5.8 (SD 0.6) months. In exploratory regression analyses, lower baseline CPD, more positive baseline attitudes reflecting higher self-efficacy (higher confidence to quit and lower perceived difficulty of quitting), and higher education were associated with achieving abstinence. Conclusions This study provides the first longer-term outcomes of the Pivot smoking cessation program. At final follow up, quit rates increased and continuous abstinence was favorable; the majority who achieved abstinence at the end of Pivot sustained abstinence throughout follow up. Decreases in CPD persisted and most participants made a quit attempt. Overall, final follow-up outcomes were stable or improved when compared to previous outcomes from the end of the program. These findings validate earlier results, and suggest that Pivot is an effective and durable solution for smoking cessation. Trial Registration ClinicalTrials.gov NCT03295643; https://clinicaltrials.gov/ct2/show/NCT03295643

Long-Term Effectiveness of a Digital Therapeutic Intervention for Smoking Cessation: A Randomized Controlled Trial

“…Moreover, longer term quit rates reported in the literature typically refer to the proportion of individuals abstinent at a given point in time, rather than capturing continuous abstinence across multiple follow-ups, a more stringent measurement of favorable treatment outcomes. Thus, the 26-week point prevalence abstinence rate of 35.9% observed among QG participants not only exceeds long term quit rates reported for other digital smoking cessation interventions, such as iCanQuit, an ACT-based smoking cessation application (29.6% quit rate at 6 months post-treatment) 20 , and Craving to Quit, a mobile app based mindfulness training program (11% abstinence rate at 6 months post-baseline) 21 , but our primary outcome of continuous abstinence at 6 and 12 months (27.2% and 22.6%, respectively) far exceeds those reported for various digital programs, including iCanQuit (prolonged abstinence rate of 13.8% at 12 months post-treatment) 20 , Happy Quit, a text messaging based intervention (6.5% at 6 months post-treatment) 22 , and is comparable to Pivot's 23.8% (ITT) continuous abstinence at 7 months post-enrollment 23 .…”

“…perpetuity. preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in The copyright holder for this this version posted August 24, 2021. ; https://doi.org/10.1101/2021.08.19.21262270 doi: medRxiv preprint including iCanQuit (prolonged abstinence rate of 13.8% at 12 months post-treatment) (20), Happy Quit, a text messaging based intervention (6.5% at 6 months post-treatment) (22), and is comparable to Pivot's 23.8% (ITT) continuous abstinence at 7 months post-enrollment (23).…”

Analysis of Demographic Characteristics of Users of a Free Tobacco Cessation Smartphone App: Observational Study

“…Furthermore, younger adults and certain ethnic and racial groups are less likely to seek help or use treatment [20]. Although there is a growing body of evidence evaluating [21,22] and testing the effectiveness of cessation apps [13][14][15]23,24], there is little known about who these apps can reach and benefit when offered, for free, to an entire population. Since most publicly funded tobacco cessation programs are designed to provide access to underserved communities and groups disproportionately impacted by tobacco use, both effectiveness Lack of access to smartphone technology can serve as an obstacle to digital or app-based treatments.…”

Identifying Desired Features That Would Be Acceptable and Helpful in a Wrist-Worn Biosensor–Based Alcohol Intervention: Interview Study Among Adults Who Drink Heavily

“…Furthermore, a smoking cessation intervention that leveraged portable carbon monoxide sensors reported promising results, with significant shifts in attitudes toward quitting (eg, readiness to quit and confidence in quitting) [21]. Longer-term (ie, 3 months after the intervention) results revealed increased quit rates and continuous abstinence [22]. This intervention built off several studies that suggested that receiving real-time biometric data from carbon monoxide sensors could be educational and motivational, thus leading to positive changes related to smoking attitudes and behaviors [23][24][25][26].…”