What is the research about?

Tobacco smoking is the leading cause of preventable disease, disability, and death in the United States. Smoking harms nearly every organ in the body and costs the United States billions of dollars each year. Recent improvements in digital technology and in behavioral science have led to two breakthroughs in mobile health (mHealth) treatments for smoking cessation.

One treatment, iCanQuit, is the only mHealth smoking cessation approach shown effective in a large (phase 3) clinical trial. iCanQuit is a modern, cognitive-behavioral treatment that promotes cessation through greater acceptance of triggers for smoking and commitment to personal values. The second, Motiv8, promotes smoking cessation with automatic financial rewards based on actual evidence of smoking abstinence. Motiv8 is part of the new generation of technology-enabled health incentive treatments that can reach an increasingly diverse range of people.

 This project is directly responsive to the 2020 Surgeon General’s report on smoking cessation. The report identifies a gap in the evidence related to the effectiveness of mHealth smoking cessation treatments compared to other forms of treatment, such as state quitlines that provide telephone counseling. To fill this gap, the “PROMOTE-UP Florida Study” will compare the combination of iCanQuit and Motiv8, iCanQuit alone, and the Florida Quitline.

Who can this research help?

Patients, clinicians, and insurance companies face important unanswered questions about mHealth treatments. Which treatments should be used to promote smoking cessation? Is a combination of treatments more effective? Are new mHealth approaches more effective than existing quitlines? Who responds best to which treatment? These questions are particularly relevant to patients and clinicians in rural areas, where access to evidence-based smoking treatment is limited.

What is the research team doing?

The research team will recruit 1,332 adult patients who smoke from primary care clinics in North Central Florida, focusing on:

• The relative effectiveness of the three treatments in adult patients who smoke cigarettes, in underserved urban and rural primary care settings. The team will assign patients by chance to one of the three treatments. Smoking cessation will be confirmed with a breath test (measured at 2, 6, and 12 months). The team will measure the effects of these treatments in vulnerable subgroups based on gender, race, ethnicity, rurality, and social vulnerability.
• Their effects on patients’ quality of life, self-confidence in quitting, and satisfaction with the treatments
• Their impact on patients’ reported levels of motivation, commitment to values, and acceptance of triggers for smoking

The team is working with a diverse stakeholder advisory committee to assist the team in study design, and in ongoing evaluation of the study to improve the dissemination and implementation potential of the treatments. The committee includes citizen scientists, former smokers, community partners, clinicians, and insurance companies. The study team will conduct interviews with clinicians and patients who smoke, to better understand barriers and facilitators to promote the treatments’ implementation and sustained use.

This study will inform (a) patients who smoke about the effectiveness of mHealth treatments for smoking; (b) healthcare providers about outcomes; and (c) insurance companies about the value of new mHealth technologies.