Smoking Cessation
Conditions
Brief summary
This study investigated the feasibility of a cognitive dissonance-based mobile app for smoking cessation (CDI). Cognitive dissonance refers to the conflict between beliefs and behaviors; interventions are designed to promote this conflict to motivate people to change their behavior. 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. This study developed an initial version of the CDI mobile app and evaluated the app in an evaluation study with 60 adult smokers.
Detailed description
An initial version of the CoQuit app was developed and tested with 60 adult smokers. All participants were recruited through social media and were screened and consented online. After enrolling, participants received a link to the baseline survey which asked about past and current tobacco use, nicotine dependence, motivation to quit, cognitive dissonance and demographic information. All participants were assigned to an online support group of 5 or 6 people. The group received simultaneous invites to the app so they were able to move through the 25 day program together. The app contained short videos of a CoQuit facilitator who presented instructions for specific tasks, such as writing a brief letter to a friend or family member explaining their commitment to stop smoking. Participants recorded videos of themselves related to these activities and posted the videos within the app where they were viewed by other members of the group. All participants completed a six weeks post baseline online assessment asking about past and current tobacco use, quit attempts, as well as feedback on usability and possible improvements to the app.
Interventions
BEHAVIORALCoQuit App
The CoQuit App is a cognitive dissonance based app for smoking cessation.
Sponsors
Oregon Research Behavioral Intervention Strategies, Inc.
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age 18 or older * Self-reported daily smoking * Having a valid home mailing address * English speaking * Access to a smart phone with video capability and internet * Expressed desire to quit smoking
Exclusion criteria
* Currently participating in any tobacco cessation programs
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cognitive Dissonance | Baseline, 5 times during app use (days 3, 6, 10, 14 and 19 of the 25 day program), Six weeks post baseline | Participants were asked to give a gut-level response to 14 words used to describe various attributes of cognitive dissonance (e.g., uncomfortable, shame). Response options for each attribute were on a 7-point scale (1 = does not apply at all, 7 = applies very much). A mean score was computed across all 14 words. A higher score was associated with greater levels of cognitive dissonance. In addition to the baseline and six-week follow-up assessment of cognitive dissonance, participants were asked five times during the 25 days of using the app. The five times were after completing the Costs activity on day 3, the Quit Letter activity on day 6, the Planning for Pitfalls activity on day 10, the Staying Smoke Free activity on day 14, and the Letter to Youth activity on day 19. |
| Number of Participants With Number Cigarettes Smoked Per Day | Baseline and Six Weeks Post Baseline | A one-item question that asked about the number of cigarettes smoked per day. Response options were on a 6-point scale, where 1 = 5 or less, 2 = 6-10, 3 = 11-15, 4 = 16-20, 5 = 21-30, and 6 = 31 or more. A higher score indicates a greater number of cigarettes smoked per day. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Readiness to Quit | Baseline, 5 times during app use (days 3, 6, 10, 14 and 19 of the 25 day program), Six weeks post baseline | Participants were asked to rate what best describes how they currently think about quitting smoking. The one item had a 1-point scale (0 = I have no thought about quitting smoking, 2 = I think I need to consider quitting smoking someday, 5 = I think I should quit smoking, but I am not quite ready, 8 = I am starting to think about how to reduce the number of cigarettes I smoke a day, 10 = I am taking action to quit smoking, 11 = I have stopped smoking). A higher score was associated with greater readiness to quit smoking. In addition to the baseline and six-week follow-up assessment of readiness to quit, participants were asked five times during the 25 days of using the app. The five times were after completing the Costs activity on day 3, the Quit Letter activity on day 6, the Planning for Pitfalls activity on day 10, the Staying Smoke Free activity on day 14, and the Letter to Youth activity on day 19. |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Intervention All participants will use the CoQuit App for Smoking Cessation
CoQuit App: The CoQuit App is a cognitive dissonance based app for smoking cessation. | 72 |
| Total | 72 |
Withdrawals & dropouts
| Period | Reason | FG000 |
|---|---|---|
| Overall Study | Lost to Follow-up | 18 |
Baseline characteristics
| Characteristic | Intervention |
|---|---|
| Age, Continuous | 48.4 years STANDARD_DEVIATION 11 |
| Education Level Bachelor degree | 11 Participants |
| Education Level Did not graduate high school | 2 Participants |
| Education Level Doctorate degree | 1 Participants |
| Education Level High school graduate | 10 Participants |
| Education Level Master degree | 6 Participants |
| Education Level Some college, no degree | 26 Participants |
| Education Level Technical school or Associate degree | 16 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 3 Participants |
| Race (NIH/OMB) Asian | 1 Participants |
| Race (NIH/OMB) Black or African American | 1 Participants |
| Race (NIH/OMB) More than one race | 1 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 7 Participants |
| Race (NIH/OMB) White | 59 Participants |
| Sex: Female, Male Female | 55 Participants |
| Sex: Female, Male Male | 17 Participants |
Adverse events
| Event type | EG000 affected / at risk |
|---|---|
| deaths Total, all-cause mortality | 0 / 72 |
| other Total, other adverse events | 0 / 72 |
| serious Total, serious adverse events | 0 / 72 |
Outcome results
Primary
Cognitive Dissonance
Participants were asked to give a gut-level response to 14 words used to describe various attributes of cognitive dissonance (e.g., uncomfortable, shame). Response options for each attribute were on a 7-point scale (1 = does not apply at all, 7 = applies very much). A mean score was computed across all 14 words. A higher score was associated with greater levels of cognitive dissonance. In addition to the baseline and six-week follow-up assessment of cognitive dissonance, participants were asked five times during the 25 days of using the app. The five times were after completing the Costs activity on day 3, the Quit Letter activity on day 6, the Planning for Pitfalls activity on day 10, the Staying Smoke Free activity on day 14, and the Letter to Youth activity on day 19.
Time frame: Baseline, 5 times during app use (days 3, 6, 10, 14 and 19 of the 25 day program), Six weeks post baseline
Population: Due to conceptual concerns about imputing smoking status, decreases in smoking from pretest to posttest were evaluated with participants who completed both the pretest and posttest assessment
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Intervention | Cognitive Dissonance | Baseline | 2.23 units on a scale | Standard Deviation 1.23 |
| Intervention | Cognitive Dissonance | In app 1 - After Costs Activity | 3.32 units on a scale | Standard Deviation 1.43 |
| Intervention | Cognitive Dissonance | In app 2 - After Quit Letter Activity | 4.33 units on a scale | Standard Deviation 1.48 |
| Intervention | Cognitive Dissonance | In app 3 - After Pitfalls Activity | 3.67 units on a scale | Standard Deviation 1.76 |
| Intervention | Cognitive Dissonance | In app 4 - After Smoke Free Activity | 3.14 units on a scale | Standard Deviation 1.83 |
| Intervention | Cognitive Dissonance | In app 5 - After Letter to Youth Activity | 3.69 units on a scale | Standard Deviation 1.89 |
| Intervention | Cognitive Dissonance | 6 Weeks Post Baseline | 2.48 units on a scale | Standard Deviation 1.34 |
p-value: 0.003t-test, 2 sided
Comparison: This model is a paired t-test that tests for change in cognitive dissonance from baseline to after the Quit Letter activityp-value: <0.001t-test, 2 sided
Comparison: This model is a paired t-test that tests for change in cognitive dissonance from baseline to after the Pitfalls activityp-value: 0.004t-test, 2 sided
Comparison: This model is a paired t-test that tests for change in cognitive dissonance from baseline to after the Smoke Free activityp-value: 0.098t-test, 2 sided
Comparison: This model is a paired t-test that tests for change in cognitive dissonance from baseline to after the Letter to Youth activityp-value: 0.042t-test, 2 sided
Comparison: This model is a paired t-test that tests for change in cognitive dissonance from baseline to 6 weeks post baseline.p-value: 0.364t-test, 2 sided
Primary
Number of Participants With Number Cigarettes Smoked Per Day
A one-item question that asked about the number of cigarettes smoked per day. Response options were on a 6-point scale, where 1 = 5 or less, 2 = 6-10, 3 = 11-15, 4 = 16-20, 5 = 21-30, and 6 = 31 or more. A higher score indicates a greater number of cigarettes smoked per day.
Time frame: Baseline and Six Weeks Post Baseline
Population: Due to conceptual concerns about imputing smoking status, decreases in smoking from pretest to posttest was evaluated with participants who completed both the pretest and posttest number of cigarettes smoked item.
| Arm | Measure | Group | Category | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|---|
| Intervention | Number of Participants With Number Cigarettes Smoked Per Day | 6 Weeks Post Baseline | 31 or more | 0 Participants |
| Intervention | Number of Participants With Number Cigarettes Smoked Per Day | Baseline | 5 or less | 0 Participants |
| Intervention | Number of Participants With Number Cigarettes Smoked Per Day | Baseline | 6-10 | 12 Participants |
| Intervention | Number of Participants With Number Cigarettes Smoked Per Day | Baseline | 11-15 | 13 Participants |
| Intervention | Number of Participants With Number Cigarettes Smoked Per Day | Baseline | 16-20 | 10 Participants |
| Intervention | Number of Participants With Number Cigarettes Smoked Per Day | Baseline | 21-30 | 11 Participants |
| Intervention | Number of Participants With Number Cigarettes Smoked Per Day | Baseline | 31 or more | 0 Participants |
| Intervention | Number of Participants With Number Cigarettes Smoked Per Day | 6 Weeks Post Baseline | 5 or less | 13 Participants |
| Intervention | Number of Participants With Number Cigarettes Smoked Per Day | 6 Weeks Post Baseline | 6-10 | 16 Participants |
| Intervention | Number of Participants With Number Cigarettes Smoked Per Day | 6 Weeks Post Baseline | 11-15 | 5 Participants |
| Intervention | Number of Participants With Number Cigarettes Smoked Per Day | 6 Weeks Post Baseline | 16-20 | 9 Participants |
| Intervention | Number of Participants With Number Cigarettes Smoked Per Day | 6 Weeks Post Baseline | 21-30 | 3 Participants |
Comparison: The non-parametric Wilcoxon signed-rank test was used to evaluate whether participants were smoking fewer cigarettes per day.p-value: <0.001Wilcoxson Signed Rank Test
Secondary
Readiness to Quit
Participants were asked to rate what best describes how they currently think about quitting smoking. The one item had a 1-point scale (0 = I have no thought about quitting smoking, 2 = I think I need to consider quitting smoking someday, 5 = I think I should quit smoking, but I am not quite ready, 8 = I am starting to think about how to reduce the number of cigarettes I smoke a day, 10 = I am taking action to quit smoking, 11 = I have stopped smoking). A higher score was associated with greater readiness to quit smoking. In addition to the baseline and six-week follow-up assessment of readiness to quit, participants were asked five times during the 25 days of using the app. The five times were after completing the Costs activity on day 3, the Quit Letter activity on day 6, the Planning for Pitfalls activity on day 10, the Staying Smoke Free activity on day 14, and the Letter to Youth activity on day 19.
Time frame: Baseline, 5 times during app use (days 3, 6, 10, 14 and 19 of the 25 day program), Six weeks post baseline
Population: Due to conceptual concerns about imputing smoking data, readiness to quit from was evaluated with participants who completed both the pretest and posttest readiness items.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Intervention | Readiness to Quit | Baseline | 7.52 units on a scale | Standard Deviation 1.63 |
| Intervention | Readiness to Quit | In app 1 - After Costs Activity | 7.64 units on a scale | Standard Deviation 2.2 |
| Intervention | Readiness to Quit | In app 2 - After Quit Latter Activity | 8.24 units on a scale | Standard Deviation 1.81 |
| Intervention | Readiness to Quit | In app 3 - After Pitfalls Activity | 8.81 units on a scale | Standard Deviation 1.54 |
| Intervention | Readiness to Quit | In app 4 - After Smoke Free Activity | 8.50 units on a scale | Standard Deviation 1.86 |
| Intervention | Readiness to Quit | In app 5 - After Letter to Youth Activity | 8.93 units on a scale | Standard Deviation 1.75 |
| Intervention | Readiness to Quit | 6 week Post Baseline | 7.50 units on a scale | Standard Deviation 2.08 |
p-value: 0.776t-test, 2 sided
p-value: 0.219t-test, 2 sided
p-value: 0.043t-test, 2 sided
p-value: 0.219t-test, 2 sided
p-value: 0.11t-test, 2 sided
p-value: 0.868t-test, 2 sided