mActive-Smoke: A Prospective Observational Study Using Mobile Health Tools to Assess the Association of Physical Activity With Smoking Urges

Abstract

BackgroundEvidence that physical activity can curb smoking urges is limited in scope to acute effects and largely reliant on retrospective self-reported measures. Mobile health technologies offer novel mechanisms for capturing real-time data of behaviors in the natural environment.ObjectiveThis study aimed to explore this in a real-world longitudinal setting by leveraging mobile health tools to assess the association between objectively measured physical activity and concurrent smoking urges in a 12-week prospective observational study.MethodsWe enrolled 60 active smokers (≥3 cigarettes per day) and recorded baseline demographics, physical activity, and smoking behaviors using a Web-based questionnaire. Step counts were measured continuously using the Fitbit Charge HR. Participants reported instantaneous smoking urges via text message using a Likert scale ranging from 1 to 9. On study completion, participants reported follow-up smoking behaviors in an online exit survey.ResultsA total of 53 participants (aged 40 [SD 12] years, 57% [30/53] women, 49% [26/53] nonwhite) recorded at least 6 weeks of data and were thus included in the analysis. We recorded 15,365 urge messages throughout the study, with a mean of 290 (SD 62) messages per participant. Mean urge over the course of the study was positively associated with daily cigarette consumption at follow-up (Pearson r=.33; P=.02). No association existed between daily steps and mean daily urge (beta=−6.95×10−3 per 1000 steps; P=.30). Regression models of acute effects, however, did reveal modest inverse associations between steps within 30-, 60-, and 120-min time windows of a reported urge (beta=−.0191 per 100 steps, P<.001). Moreover, 6 individuals (approximately 10% of the study population) exhibited a stronger and consistent inverse association between steps and urge at both the day level (mean individualized beta=−.153 per 1000 steps) and 30-min level (mean individualized beta=−1.66 per 1000 steps).ConclusionsAlthough there was no association between objectively measured daily physical activity and concurrently self-reported smoking urges, there was a modest inverse relationship between recent step counts (30-120 min) and urge. Approximately 10% of the individuals appeared to have a stronger and consistent inverse association between physical activity and urge, a provocative finding warranting further study.

Using Mobile Health Tools to Assess Physical Activity Guideline Adherence and Smoking Urges: Secondary Analysis of mActive-Smoke

“…The goal of mActive-Smoke, a 12-week prospective observational study, was to assess the day-level association between objectively measured physical activity and concurrent smoking urges. Previously reported primary results [14] demonstrate that acute bouts of physical activity (ie, number of steps accumulated in a 30-min period before urge reporting), but not total daily steps, were associated with a modest decrease in smoking urges. Although we previously found a temporal association between acute bouts of activity and decreased urge, it is unclear whether the intensity of daily activity is associated with daily urge.…”

“…The aims of this secondary analysis were to report adherence to physical activity guidelines among smokers in the mActive-Smoke study population and to investigate the relationship between the intensity of physical activity and the urge to smoke. The methods for this 12-week prospective observational study have been previously reported [14], and a summary is provided below (Recruitment and Measurement of Baseline Variables and Data Collection). This study was approved by the Johns Hopkins School of Medicine Institutional Review Board.…”

“…Participants were asked to complete a Web-based end-of-study survey regarding the study experience and their perceptions on physical activity and smoking urges. Survey questions and results were previously reported [14].…”

“…The study flow diagram, baseline characteristics, and survey results have been previously reported [14]. In brief, 60 participants were enrolled, and 53 participants recorded at least 6 weeks of data and were thus included in this analysis.…”

“…Given that our prior work validating the urge to smoke revealed a positive association between mean urge over the course of the study and the number of cigarettes per day reported at the end of the study [14], we explored associations by baseline cigarette consumption. When stratifying by baseline cigarettes per day, those who smoked more than 10 cigarettes per day (n=19; 1333 person-days) had 0.293 lower daily urge per 30 min per day of MVPA (P=.03; 95% CI −0.563 to −0.023; Figure 1), but this was not significant on stratifying by greater than equal to 15 (n=16; 1100 person-days; P=.80) or greater than equal to 20 cigarettes per day (n=11; 809 person-days; P=.88).…”