Mindfulness-Based Smoking Cessation Enhanced With Mobile Technology (iQuit Mindfully): Pilot Randomized Controlled Trial

Abstract

Background Mindfulness training shows promise for improving smoking cessation and lapse recovery, and between-session mobile health messages could enhance treatment engagement and effectiveness. Personalized, in-the-moment text messaging support could be particularly useful for low-income smokers with fewer smoking cessation resources. Objective This pilot study examined the feasibility of a text messaging program ( iQuit Mindfully ) as an adjunct to in-person Mindfulness-Based Addiction Treatment (MBAT) for smoking cessation. Methods A total of 71 participants were randomly assigned to MBAT (n=33) or iQuit Mindfully (n=38; MBAT + between-session text messages); of these, 70% (50/71) were African American, and 61% (43/71) had an annual household income of US $30,000 or less. All participants received 8 weekly therapist-led group counseling sessions, nicotine patches, and self-help materials. Outcomes were feasibility (attrition, engagement, and participants’ ratings), participants’ feedback regarding the text messaging intervention, and smoking cessation (assessed in person). Results Strong retention was achieved (76% [54/71] at the end of treatment, and 89% [63/71] at 1-month follow-up). In the iQuit Mindfully group, engagement was high (88% [29/33] indicated reading all or most texts, and 89% [34/38] engaged in interactive texting), and participants provided positive ratings (on a 1-10 scale, average rating for recommending the program to others was 8.4 [SD 2.5]). Participants indicated benefiting from the texts (eg, appreciating encouraging reminders, coping strategies, and social support) and suggested improvements (eg, more personalization). Overall, biochemically confirmed smoking cessation rates were 22% (12/55) at the end of treatment and 19% (12/62) at 1-month follow-up, with no differences between conditions. Living below the poverty level predicted worse cessation outcomes at 1-month follow-up among participants receiving in-person only treatment ( P =.03) but not among those receiving iQuit Mindfully. Conclusions Text messaging appears to be a feasible and acceptable modality for supporting mindfulness-based smoking cessation treatment. The availability of 24/7 text messaging might be particularly helpful for low-income smokers who have access to fewer cessation resources and experience significant day-to-day barriers to quitting. Trial Registration ClinicalTrials.gov NCT03029819; https://clinicaltrials.gov/ct2/show/NCT03029819

Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial

“…Participants’ descriptions of their experiences with mindfulness and text messaging dovetail with findings from qualitative studies conducted before the pandemic. In previous iterations of the iQuit Mindfully program, participants similarly noted that mindfulness helped them cope with stress, and that the text messages provided important reminders and social support [ 23 , 24 ]. In other text messaging programs for smoking cessation, participants have also highlighted a sense of emotional support [ 56 , 57 ].…”

“…iQuit Mindfully text messages [ 23 , 24 ] were sent to all participants each day during the 8-week treatment and 1 week of follow-up. The Upland Mobile Messaging platform was used to generate the automated text message system and send and receive text messages.…”

“…In particular, text messaging can provide tailored, just-in-time interventions at relatively low cost. Hence, a mindfulness intervention for smoking cessation “iQuit Mindfully” was implemented with strong feasibility and acceptability among low-income, predominantly African American adults [ 23 ]. Text messages were developed and iteratively refined on the basis of feedback from the target population [ 24 ].…”

Mindfulness-Based Smoking Cessation Delivered Through Telehealth and Text Messaging for Low-Income Smokers: Protocol for a Randomized Controlled Trial

“…On the basis of iterative feedback from low-income smokers, we developed a text messaging program ( iQuit Mindfully ) as an adjunct to in-person, mindfulness-based smoking cessation treatment [ 29 , 30 ]. In a pilot study (N=71), participants were highly engaged and benefited from tailored, in-the-moment strategies and social support from text messages [ 29 ].…”

“…On the basis of iterative feedback from low-income smokers, we developed a text messaging program ( iQuit Mindfully ) as an adjunct to in-person, mindfulness-based smoking cessation treatment [ 29 , 30 ]. In a pilot study (N=71), participants were highly engaged and benefited from tailored, in-the-moment strategies and social support from text messages [ 29 ]. Notably, although poverty status predicted worse cessation outcomes among participants receiving only in-person treatment, poverty status was unrelated to cessation among those receiving iQuit Mindfully.…”