SBIR-STTR Award

Despite overall declines in the rate of tobacco use in the United States over the past 30 years, nearly 38 million Americans still smoke, posing extremely high risk for long-term health problems and death. There has been extensive research evaluating a wide range of smoking cessation approaches over the past 40 years. Recent reviews note that there has been significant progress in the application of both clinical and public health interventions to help smokers quit; however, they have also concluded that the overall success rate of smokers quitting has not significantly improved. Individual, group and public health interventions - both with and without adjunctive aids such as nicotine replacement therapy - have generally used some combination of cognitive-behavioral interventions, but there remains a need for novel, theory-driven approaches to enhance quit rates and innovative interventions that increase reach and engagement, such as those offered via computer or mobile app. We propose to adapt and test the feasibility of a previously piloted cognitive dissonance intervention (CDI) for smoking cessation that will be delivered via a mobile app. Cognitive dissonance interventions have been shown to be successful in treating health-related problems, as well as substance use, and preliminary findings support its use in smoking cessation. The program will be evaluated with 60 adult daily smokers and will be the only cognitive dissonance mobile app for smoking cessation. Our research and development team has extensive experience developing and testing mobile apps and developing and testing cognitive dissonance and smoking cessation interventions. In the first phase, we will use an iterative development plan to design and develop functionality of the first 3 modules of the CDI prototype app. The research team will partner with Twenty Ideas who have extensive experience in the development of mobile apps for smartphones, many of which have been commercialized. We will assess navigation and usability with adult daily smokers. Additional pilot testing will be used to create a prototype version for evaluation. The evaluation study will involve having 60 adults use the app and complete baseline, 1- and 3-month follow-up. Usability data, system log data on program use, and participant satisfaction data will also be analyzed. Input from participants will be gathered to incorporate additional features to be developed during Phase II. Significant changes in quit attempts, number of days without smoking (smokefree days) and changes in smoking attitudes and behavior will be used to determine the efficacy of the Phase I program and evidence for proceeding to Phase II development and evaluation.

Public Health Relevance Statement:
Project Narrative Despite overall declines in the rate of tobacco use in the United States over the past 30 years, improving quit rates among current smokers continues to be a significant public health focus given the high risk for long- term negative health outcomes. New, innovative, theory-driven approaches are needed to both improve the long-term quit rates, as well as to increase the reach of effective interventions. Recent research has demonstrated the efficacy and potential of using cognitive dissonance interventions for a wide range of health and behavioral problems including smoking cessation. Cognitive dissonance refers to the conflict between beliefs and behaviors and interventions are designed to promote this conflict to motivate the person to change their behavior, which is this case is quitting smoking. The proposed study aims to adapt and test the feasibility of a cognitive dissonance-based mobile app for smoking cessation (CDI). Following development, the CDI mobile app will be evaluated in a pilot study with 60 adult smokers.

Project Terms:

Despite overall declines in the rate of tobacco use in the United States over the past 30 years, nearly 38 million Americans still smoke, posing extremely high risk for long-term health problems and death. Recent reviews note that there has been significant progress in the application of both clinical and public health interventions to help smokers quit; however, they have also concluded that the overall success rate of smokers quitting has not significantly improved. Individual, group and public health interventions – both with and without adjunctive aids such as nicotine replacement therapy – have generally used some combination of cognitive- behavioral interventions, but there remains a need for novel, theory-driven approaches to enhance quit rates. Innovative interventions such as those offered via computer or mobile app can increase reach and engagement. We propose to adapt and test the feasibility of a previously piloted cognitive dissonance intervention (CDI) for smoking cessation delivered via a mobile app. Cognitive dissonance interventions have been shown to be successful in treating health-related problems, as well as substance use, and preliminary findings support its use in smoking cessation. The program, entitled CoQuit, is based on cognitive dissonance and smoking cessation components tested in our Phase I prototype mobile app. This prototype app demonstrated efficacy and the results of our evaluation study met criteria for moving to Phase II. We will expand and revise the six module CoQuit program, which includes 12 video components (6 instructional components and 6 cognitive dissonance activities) to improve ease of use, increase interactivity with other smokers who are quitting, and improve social support elements in partnership with Emberex, who has extensive experience in the development and commercialization of mobile apps. This development will assess navigation and usability with adult daily smokers and conduct pilot testing to guide development of the CoQuit app for evaluation. Our research and development team has extensive experience developing and testing mobile apps and developing and testing cognitive dissonance and smoking cessation interventions. The evaluation study will include 500 adults recruited through social media and randomly assigned to either the Cognitive Dissonance mobile app or a comparable app without cognitive dissonance tasks; participants will be assessed at baseline, 1- and 3-month follow-up. Significant changes in quit attempts, number of days without smoking (smokefree days), point prevalence cessation, and changes in smoking attitudes will be used to determine the efficacy of the CoQuit app. Usability data, system log data on program use, and participant satisfaction data will also be analyzed.

Public Health Relevance:
New, innovative, theory-driven approaches are needed to both improve the long-term quit rates, as well as to increase the reach of effective interventions. The proposed study aims to adapt and test the efficacy of a cognitive dissonance-based mobile app for smoking cessation (CoQuit). Following development, the CoQuit mobile app will be evaluated in a randomized evaluation trial with 500 adult smokers recruited through social media and evaluated for cessation outcomes and consumer satisfaction measures at 1 and 3 months after enrollment.