TY  - JOUR
AU  - Dahne, Jennifer
AU  - Wahlquist, Amy E
AU  - Kustanowitz, Jacob
AU  - Natale, Noelle
AU  - Fahey, Margaret
AU  - Graboyes, Evan M
AU  - Diaz, Vanessa A
AU  - Carpenter, Matthew J
PY  - 2023
DA  - 2023/11/1
TI  - Behavioral Activation–Based Digital Smoking Cessation Intervention for Individuals With Depressive Symptoms: Randomized Clinical Trial
JO  - J Med Internet Res
SP  - e49809
VL  - 25
KW  - smoking cessation
KW  - depression
KW  - digital health
KW  - decentralized trial
KW  - mental health
KW  - depressive
KW  - RCT
KW  - randomized
KW  - controlled trial
KW  - smoking
KW  - smoke
KW  - smoker
KW  - quit
KW  - quitting
KW  - cessation
KW  - eHealth
KW  - e-health
KW  - NRT
KW  - nicotine
KW  - mobile health
KW  - mHealth
KW  - app
KW  - apps
KW  - application
KW  - applications
AB  - Background: Depression is common among adults who smoke cigarettes. Existing depression-specific cessation interventions have limited reach and are unlikely to improve smoking prevalence rates among this large subgroup of smokers. Objective: This study aimed to determine whether a mobile app–based intervention tailored for depression paired with a mailed sample of nicotine replacement therapy (NRT) is efficacious for treating depression and promoting smoking cessation. Methods: A 2-arm nationwide remote randomized clinical trial was conducted in the United States. Adults (N=150) with elevated depressive symptoms (Patient Health Questionnaire-8≥10) who smoked were enrolled. The mobile app (“Goal2Quit”) provided behavioral strategies for treating depression and quitting smoking based on Behavioral Activation Treatment for Depression. Goal2Quit participants also received a 2-week sample of combination NRT. Treatment as usual participants received a self-help booklet for quitting smoking that was not tailored for depression. Primary end points included Goal2Quit usability, change in depression (Beck Depression Inventory-II) across 12 weeks, and smoking cessation including reduction in cigarettes per day, incidence of 24-hour quit attempts, floating abstinence, and 7-day point prevalence abstinence (PPA). Results: In total, 150 participants were enrolled between June 25, 2020, and February 23, 2022, of which 80 were female (53.3%) and the mean age was 38.4 (SD 10.3) years. At baseline, participants on average reported moderate depressive symptoms and smoked a mean of 14.7 (SD 7.5) cigarettes per day. Goal2Quit usability was strong with a mean usability rating on the System Usability Scale of 78.5 (SD 16.9), with 70% scoring above the ≥68 cutoff for above-average usability. Retention data for app use were generally strong immediately following trial enrollment and declined in subsequent weeks. Those who received Goal2Quit and the NRT sample reported lower mean depressive symptoms over the trial duration as compared to treatment as usual (difference of mean 3.72, SE 1.37 points less; P=.01). Across time points, all cessation outcomes favored Goal2Quit. Regarding abstinence, Goal2Quit participants reported significantly higher rates of 7-day PPA at weeks 4 (11% vs 0%; P=.02), 8 (7-day PPA: 12% vs 0%; P=.02), and 12 (16% vs 2%; P=.02). Conclusions: A mobile app intervention tailored for depression paired with a sample of NRT was effective for depression treatment and smoking cessation. Findings support the utility of this intervention approach for addressing the currently unmet public health treatment need for tailored, scalable depression-specific cessation treatments. Trial Registration: ClinicalTrials.gov NCT03837379; https://clinicaltrials.gov/ct2/show/NCT03837379 
SN  - 1438-8871
UR  - https://www.jmir.org/2023/1/e49809
UR  - https://doi.org/10.2196/49809
UR  - http://www.ncbi.nlm.nih.gov/pubmed/37910157
DO  - 10.2196/49809
ID  - info:doi/10.2196/49809
ER  -