Acceptance and Commitment Therapy-Based Smartphone Applications for Cessation of Tobacco Use among Adults with High Nicotine Dependence: Results from the iCanQuit Randomized Trial

Abstract

Background: With 1 in 2 adult tobacco users being highly dependent on nicotine, population-based interventions specifically designed for this group are urgently needed. This study used data from a randomized trial to evaluate whether (1) Acceptance and Commitment Therapy (ACT) delivered via a smartphone application (iCanQuit) would be more efficacious for cessation of nicotine-containing tobacco products than the US Clinical Practice Guidelines (USCPG)-based application (QuitGuide) among highly nicotine-dependent adults, (2) the effect of treatment on cessation was mediated by increases in acceptance of cravings to smoke, and (3) treatment utilization and satisfaction differed by arm. Methods: A total of 1452 highly nicotine-dependent adults received the iCanQuit or QuitGuide application for 12-months. Cessation outcomes were self-reported complete-case 30-day abstinence of nicotine-containing tobacco products (e.g., combustible cigarettes, e-cigarettes, chewing tobacco, snus, hookahs, cigars, cigarillos, tobacco pipes, and kreteks) at 3, 6, and 12-month post-randomization timepoints, missing-as-smoking, and multiple imputation analyses. Acceptance of cues to smoke and satisfaction with the applications was also reported. Results: Participants who received iCanQuit were significantly more likely to report 30-day abstinence of nicotine-containing tobacco products than those who received QuitGuide at 12-months (24% vs. 17%; OR = 1.47 95% CI: 1.11, 1.95). iCanQuit participants utilized their application more frequently and reported greater satisfaction than those who received QuitGuide. Increases in participants’ acceptance of cues to smoke mediated the intervention effect on cessation of nicotine-containing tobacco products. Conclusions: Among nicotine-dependent adults, an application-delivered ACT-based intervention was more engaging and efficacious than a USCPG-based intervention for cessation of nicotine-containing tobacco products.

Keywords:

• Acceptance & Commitment Therapy
• iCanQuit
• QuitGuide
• nicotine dependence
• smartphone applications
• smoking cessation

Acknowledgements

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.

Disclosure statement

None of the authors have a financial interest in the iCanQuit application. Nancy A Rigotti has been a consultant for Achieve Life Sciences and received funds from the company to conduct a clinical trial of an investigational smoking cessation medication (cytisine).

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.