Adaptation and Evaluation of a Tobacco Cessation Program: An Integrated mHealth Approach

University Of Alabama At Birmingham, Birmingham AL

Investigators

Abstract

It has been shown that although women tend to smoke less than men, they are less likely to quit tobacco use. We developed and established the efficacy of a theory-based Community Health Worker (CHW) intervention for low-income women that augments the tobacco cessation program offered through the public health system. Through previous NIH funding (R01), we developed and established the efficacy of a theory-based Community Health Worker (CHW)-led intervention for low-income women that augments the tobacco cessation program offered through the public health system. Participants in the intervention had 1.88 times the odds of tobacco cessation than participants in the control condition, which consisted of a scheduled appointment to attend the tobacco cessation program through the public health system (20% vs. 11% cessation, respectively). Although our tobacco cessation intervention was successful, CHWs’ feedback indicated that the program was very time consuming. Thus, we propose an adaptation of this CHW-delivered tobacco cessation program to be integrated with mHealth support through mobile devices (App) for participants and a tracking system for CHWs. The relevance of this approach is that it is theory-based (Social Cognitive Theory) and will be adapted based on an efficacious intervention as well as salient features of other mHealth applications that have been shown to be successful in engaging users. During the R21 phase, we will make the adaptations and determine feasibility of a CHW-delivered intervention that is integrated with a mHealth tobacco cessation application (interactive App for participants and tracking system for CHWs) through formative assessments among all involved, pretesting, and pilot testing of the intervention. In the R33 phase, we will assess the effectiveness of the integrated CHW-mHealth tobacco cessation intervention through a group randomized trial with towns as the unit of randomization (8 towns, N=344). The comparison group will be the same as the previous intervention (consisting of a home visit by a CHW during which the participant is scheduled to attend the tobacco cessation program at the neighborhood public health clinic) to allow for comparisons. We hypothesize that at 6-months, women smokers who receive the integrated CHW-mHealth intervention will have significantly higher 7-day point prevalence abstinence (defined as no cigarettes in the past 7 days) than women smokers in the control condition. Self-report will be verified through measurement of exhaled carbon monoxide levels among 30% of participants. If shown to be effective, this approach could be utilized as a model for a population-based intervention in low-resource settings, including rural and disadvantaged women in the U.S.