Actify! An mHealth mood management tool to improve population-level smoking cessation

Fred Hutchinson Cancer Center, Seattle WA

Investigators

Abstract

PROJECT SUMMARY Cigarette smoking is responsible for over 480,000 deaths annually in the US—nearly double the number of drug overdose and alcohol-related deaths combined—making cigarettes the most deadly drug of abuse. Although smoking rates have declined over the past 50 years, tobacco use remains a critical public health problem, and more effective cessation interventions are needed. Depressive symptoms are a key barrier to cessation for many and reduce the odds of cessation by as much as 50-60%. Despite this, standard cessation treatments do not focus on reducing depressive symptoms as a means of supporting cessation. Doing so, however, could increase treatment effectiveness. Behavioral activation (BA) is a proven intervention for depression. Research suggests combining BA and standard cessation treatment may increase quit rates. Delivering this intervention through a mobile health application (mHealth app) would also make the treatment more accessible (smoking cessation apps are downloaded over 1 million times per year in the US alone), thereby increasing its impact. To test this hypothesis, we developed Actify!, the first app-based cessation intervention to combine BA with standard cessation support. In a rigorous, pilot randomized trial (n = 242), Actify! had descriptively higher user satisfaction and quit rates than the National Cancer Institute’s (NCI) QuitGuide app (e.g., 18.5% vs. 12.2% abstinence at 6 months). We now propose to conduct a fully-powered, randomized controlled trial to evaluate the efficacy of Actify! relative to QuitGuide at 6 months post- randomization (Aim 1), examine the moderating effects of pre-quit depression on 6-month cessation outcomes (Aim 2), and evaluate the extent to which changes in behavioral activation and depressive symptoms mediate these outcomes (Aim 3). This work is highly significant and innovative: (1) Actify! is the first standalone mHealth intervention of any kind to actively target reducing depression and promoting smoking cessation simultaneously; (2) strong preliminary evidence supports Actify!’s acceptability and efficacy relative to an active standard care comparator, the NCI QuitGuide app; and, (3) mHealth apps offer a promising and cost-effective modality for disseminating the intervention, if it is found to be effective. This project will also provide a definitive test of whether Actify! is superior to QuitGuide and, therefore, warrants future dissemination. It will also provide critical insights into our premise that addressing depressive symptoms with app-based BA can enhance cessation for people with and without a history of depressive symptoms at treatment initiation.