Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jun 9, 2023
Date Accepted: Sep 28, 2023
Behavioral Activation-Based Digital Smoking Cessation Intervention for Individuals with Depressive Symptoms: A Randomized Clinical Trial
ABSTRACT
Background:
Depression is common among adults who smoke cigarettes. Existing depression-specific cessation interventions have limited reach and are unlikely to improve smoking prevalence rates among this large subgroup of smokers.
Objective:
The aim of this study was to determine whether a mobile app-based intervention tailored for depression paired with a mailed sample of nicotine replacement therapy (NRT) is efficacious for treating depression and promoting smoking cessation.
Methods:
Two-arm nationwide remote randomized clinical trial in the United States. Adults (N=150) with elevated depressive symptoms (Patient Health Questionnaire-8 ≥ 10) who smoke were enrolled. The mobile app (“Goal2Quit”) provided behavioral strategies for treating depression and quitting smoking based on Behavioral Activation Treatment for Depression. Goal2Quit participants also received a 2-week sample of combination NRT. Treatment As Usual (TAU) participants received a self-help booklet for quitting smoking that was not tailored for depression. Primary endpoints included Goal2Quit usability, change in depression (Beck Depression Inventory-II) across 12 weeks, and smoking cessation including reduction in cigarettes per day (CPD), incidence of 24-hour quit attempts, floating abstinence, and 7-day point prevalence abstinence.
Results:
One hundred fifty participants were enrolled (80 of 150 were female [53.3%]; mean [SD] age, 38.4[10.3] years) between June 25, 2020 and February 23, 2022. At baseline, participants on average reported moderate depressive symptoms and smoked a mean of 14.7 (SD=7.5) CPD. Goal2Quit usability was strong with a mean (SD) usability rating on the System Usability Scale of 78.5(16.9), with 70% scoring above the ≥ 68 cutoff for above average usability. Those who received Goal2Quit and the NRT sample reported lower mean depressive symptoms over the trial duration as compared to TAU (mean(SE) difference of 3.72(1.37) points less, P=.01). Across timepoints, all cessation outcomes favored Goal2Quit. Goal2Quit participants reported greater reductions in CPD compared to the TAU group (mean(SE) difference of 1.97(0.93) CPD less, P=.03).
Conclusions:
A mobile app intervention tailored for depression paired with a sample of NRT was effective for depression treatment and smoking cessation. Findings support the utility of this intervention approach for addressing the currently unmet public health treatment need for tailored, scalable depression-specific cessation treatments. Clinical Trial: NCT03837379
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.