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Efficacy of Web-Delivered Acceptance and Commitment Therapy (ACT) for Helping Black Adults Quit Smoking

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Abstract

Background

Digital smoking cessation interventions may reduce racial disparities in cessation because they are low cost, scalable, and can provide support at any place or time. Despite their promise, whether Black adults engage with and benefit from these tools is largely unknown. In a secondary analysis of a randomized trial, we explored the efficacy of an acceptance and commitment therapy (ACT)-based website (WebQuit) for smoking cessation compared to a US clinical practice guidelines-based website (Smokefree.gov) among Black adults.

Methods

A total of 316 Black adult smokers were enrolled in the trial between May 2017 and September 2018 and received access to WebQuit or Smokefree for 12 months. Participants self-reported on 30-day and 7-day abstinence from cigarette smoking at 3, 6, and 12-months. Treatment engagement was objectively measured and compared between arms. Participants also reported on their willingness to accept cues to smoke without smoking.

Results

WebQuit versus Smokefree participants engaged more with their website (higher number of logins, Incidence Rate Ratio (IRR) = 2.21; 95% CI: 1.70, 2.89). Complete-case 30-day point prevalence abstinence (PPA) at 12-months was 34% for WebQuit vs. 29% for Smokefree (OR = 1.22 95% CI: 0.73, 2.04). Increases in participants’ willingness to accept cues to smoke mediated the intervention effect on abstinence from cigarette smoking at 12 months.

Conclusions

This study addressed the lack of research on the utilization and efficacy of digital interventions for helping Black adults quit smoking. WebQuit participants engaged more with their website and quit smoking at a somewhat higher rate relative to Smokefree participants, albeit nonsignificant. Findings suggest high acceptability of ACT-based digital interventions to enable Black adult smokers to engage and sustain behavior changes.

Trial Registration

ClinicalTrials.gov Identifier: NCT01812278.

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Code Availability

The code for the data analysis underlying this article will be shared on reasonable request to Jonathan B. Bricker at jbricker@fredhutch.org.

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Acknowledgements

We appreciate the tireless contributions of the entire study staff, most notably Eric Meier, Carolyn Ehret, Brianna Sullivan, the design services of Blink UX, and the development services of Moby, Inc. We are very appreciative of the study participants.

Funding

The study was funded by the NIH (NIH: 5R01CA166646 and 5R01CA192849), awarded to Dr. Bricker, from the National Cancer Institute. Manuscript preparation was additionally supported by the National Institute on Minority Health and Health Disparities (grant number 1K01MD015295-01A1). Ahluwalia funded in part by P20GM130414, a NIH-funded Center of Biomedical Research Excellence (COBRE). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Division of Public Health Sciences, Cancer Prevention Program, Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, Seattle, WA, 98109, USA

    Margarita Santiago-Torres, Diana M. Kwon, Kristin E. Mull, Brianna M. Sullivan & Jonathan B. Bricker

  2. Department of Psychology, University of Washington, Seattle, WA, USA

    Diana M. Kwon & Jonathan B. Bricker

  3. Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, 02912, USA

    Jasjit S. Ahluwalia

  4. TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA

    Adam C. Alexander

  5. Department of Population Health, University of Kansas School of Medicine, 3901 Rainbow Boulevard Mail Stop 1008, Kansas City, KS, 66160, USA

    Nicole L. Nollen

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Contributions

Jonathan J. Bricker, Margarita Santiago-Torres, Diana M. Kwon, and Kristin E. Mull conceptualized the study. Margarita Santiago-Torres led the manuscript writing. Kristin Mull led and conducted the data analysis. All authors assisted in manuscript writing and provided critical review. All authors have read and agreed to the published versions of the manuscript.

Corresponding author

Correspondence to Margarita Santiago-Torres.

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Study procedures were approved by the Fred Hutchinson Cancer Center Institutional Review Board (IRB approval number: 7859).

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Informed consent was obtained from all individual participants included in the study.

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The authors declare no or competing interests.

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Santiago-Torres, M., Kwon, D.M., Mull, K.E. et al. Efficacy of Web-Delivered Acceptance and Commitment Therapy (ACT) for Helping Black Adults Quit Smoking. J. Racial and Ethnic Health Disparities 10, 2816–2825 (2023). https://doi.org/10.1007/s40615-022-01458-5

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