Relative Efficacy of an Acceptance and Commitment Therapy-Based Smartphone App with a Standard US Clinical Practice Guidelines-Based App for Smoking Cessation in Dual Users of Combustible and Electronic Cigarettes: Secondary Findings from a Randomized Trial

Abstract

Background

While smartphone apps for smoking cessation have shown promise for combustible cigarette smoking cessation, their efficacy in helping dual users of combustible and electronic cigarettes (e-cigarettes) to quit cigarettes remains unknown. This study utilized data from a randomized trial to determine if an Acceptance and Commitment Therapy (ACT)-based app (iCanQuit) was more efficacious than a US Clinical Practice Guidelines-based app (QuitGuide) for combustible cigarette smoking cessation among 575 dual users.

Methods

The primary cessation outcome was self-reported, complete-case 30-day abstinence from combustible cigarettes at 12 months. Logistic regression assessed the interaction between dual use and treatment arm on the primary outcome in the full trial sample (N = 2,415). We then compared the primary outcome between arms among dual users (iCanQuit: n = 297; QuitGuide: n = 178). Mediation analyses were conducted to explore mechanisms of action of the intervention: acceptance of cues to smoke and app engagement. Results: There was an interaction between dual use of combustible and e-cigarettes and treatment arm on the primary outcome (p = 0.001). Among dual users, 12-month abstinence from cigarettes did not differ between arms (23% for iCanQuit vs. 27% for QuitGuide, p = 0.40). Mediation analysis revealed a significant positive indirect effect of the iCanQuit app on 12-month abstinence from cigarettes through acceptance of emotions that cue smoking (p = 0.004).

Conclusions

Findings from this study of dual users of combustible and e-cigarettes showed no evidence of a difference in quit rates between arms. Acceptance of emotions that cue smoking is a potential mechanism contributing to cigarette smoking abstinence among dual users.

Keywords:

• Acceptance and commitment therapy
• cigarette smoking cessation
• dual use of combustible and e-cigarettes
• e-cigarettes
• smartphone apps
• vaping
• USCPG

Acknowledgments

We appreciate the tireless contributions of the entire study staff, most notably, Eric Meier, Eric Strand, Carolyn Ehret, Alanna Boynton, the design services of Ayogo, Inc., and the development services of Moby, Inc. We are very appreciative of the study participants.

Declaration of interest

None of the authors have a financial interest in the iCanQuit application.

Data availability statement

The code for the data analysis underlying this article will be shared on reasonable request to Jonathan B. Bricker at [email protected].

Additional information

Funding

This study was supported by the National Cancer Institute under grant R01 CA192849 awarded to Dr. Bricker. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.