Efficacy of Smartphone Applications for Smoking Cessation A Randomized Clinical Trial
Efficacy of Smartphone Applications for Smoking Cessation A Randomized Clinical Trial
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DOI：
10.1001/jamainternmed.2020.4055
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发表时间：
2020-09-21
影响因子：
39
通讯作者：
Heffner, Jaimee L.
中科院分区：
文献类型：
--
作者：
Bricker, Jonathan B.;Watson, Noreen L.;Heffner, Jaimee L.
吸烟是全球过早死亡的主要原因。智能手机戒烟应用程序无处不在，解决了获得传统疗法的障碍，但其有效性的证据有限。目的比较基于接受与承诺疗法(ACT)的智能手机戒烟应用程序与基于美国临床实践指南(USCPG)的国家癌症研究所戒烟应用程序的有效性。设计、设置和参与者2017年5月27日至2018年9月28日，2415名成年吸烟者(基于ACT的戒烟应用组为1214人，基于USCPG的戒烟应用组为1201人)进行了2组分层、双盲、个人随机临床试验，并在随机后3、6和12个月进行了随访。这项研究是在试验方案中预先指定的。跟踪数据收集从2017年8月26日开始，于2019年12月23日结束最后一次随机参与者为期12个月的跟踪调查。对2020年2月25日至4月3日的数据进行了分析。初步分析是在完全病例的基础上进行的，遗漏意向治疗为吸烟和多重归因敏感性分析。INTERVENTIONSiCanQuit，一个基于ACT的戒烟应用程序，教人接受吸烟触发因素，以及国家癌症研究所QuitGuide，一个基于USCPG的戒烟应用程序，教人避免吸烟触发因素。主要结果和测量：主要结果是随机分组后12个月自我报告的30天点戒烟患病率(PPA)。次要结果是随机化后12个月的7天PPA，长期戒烟，随机3个月和6个月后30天和7天的PPA，缺失被归因于多次归因于或编码为吸烟的数据，以及在随机化后12个月停止所有烟草制品(包括电子烟)。结果参与研究的2415名成年吸烟者(1700名女性[70.4%]；1666名白人[69.0%]和868名种族/少数民族[35.9%]；登记时的平均[SD]年龄，38.2[10.9]岁)。随访3个月数据保留率为86.7%(2093例)，6个月保留率为88.4%(2136例)，12个月保留率为87.2%(2107例)。在12个月的随访中，对于30天PPA的主要结果，iCanQuit参与者戒烟的几率是QuitGuide参与者的1.49倍(28.2%[1040人中的293人]对21.1%[1067人中的225人]；优势比[OR]，1.49；95%CI，1.22-1.83；P<；.001)。在12个月的随访中，7天的PPA(OR，1.35；95%CI，1.12-1.63；P=.002)、12个月的长期戒烟(OR，2.00；95%CI，1.45-2.76；P<；.001)、12个月的随访时戒除所有烟草制品(包括电子烟)(OR，1.60；95%CI，1.28-1.99；P<；)的效果大小非常相似，且具有统计学意义。3个月随访30天PPA(OR，2.20；95%CI，1.68-2.89；P<；.001)，6个月随访30天PPA(OR，2.03；95%CI，1.63-2.54；P<；.001)，3个月随访7天PPA(OR，2.04；95%CI，1.64-2.54；P<；在6个月的随访中(OR，1.73；95%CI，1.42-2.10；P<；.001)。结论和结论本试验提供的证据表明，与基于USCPG的智能手机应用程序相比，基于ACT的智能手机应用程序在戒烟方面更有效，因此可以成为一种有效的治疗方案。
IMPORTANCESmoking is a leading cause of premature death globally. Smartphone applications for smoking cessation are ubiquitous and address barriers to accessing traditional treatments, yet there is limited evidence for their efficacy.OBJECTIVETo determine the efficacy of a smartphone application for smoking cessation based on acceptance and commitment therapy (ACT) vs a National Cancer Institute smoking cessation application based on US clinical practice guidelines (USCPG). Design, Setting, and Participants A 2-group, stratified, double-blind, individually randomized clinical trial was conducted from May 27, 2017, to September 28, 2018, among 2415 adult cigarette smokers (n = 1214 for the ACT-based smoking cessation application group and n = 1201 for the USCPG-based smoking cessation application group) with 3-, 6-, and 12-month postrandomization follow-up. The study was prespecified in the trial protocol. Follow-up data collection started on August 26, 2017, and ended at the last randomized participant's 12-month follow-up survey on December 23, 2019. Data were analyzed from February 25 to April 3, 2020. The primary analysis was performed on a complete-case basis, with intent-to-treat missing as smoking and multiple imputation sensitivity analyses.INTERVENTIONSiCanQuit, an ACT-based smoking cessation application, which taught acceptance of smoking triggers, and the National Cancer Institute QuitGuide, a USCPG-based smoking cessation application, which taught avoidance of smoking triggers.MAIN OUTCOMES AND MEASURESThe primary outcome was self-reported 30-day point prevalence abstinence (PPA) at 12 months after randomization. Secondary outcomes were 7-day PPA at 12 months after randomization, prolonged abstinence, 30-day and 7-day PPA at 3 and 6 months after randomization, missing data imputed with multiple imputation or coded as smoking, and cessation of all tobacco products (including e-cigarettes) at 12 months after randomization.RESULTSParticipants were 2415 adult cigarette smokers (1700 women [70.4%]; 1666 White individuals [69.0%] and 868 racial/ethnic minorities [35.9%]; mean [SD] age at enrollment, 38.2 [10.9] years) from all 50 US states. The 3-month follow-up data retention rate was 86.7% (2093), the 6-month retention rate was 88.4% (2136), and the 12-month retention rate was 87.2% (2107). For the primary outcome of 30-day PPA at the 12-month follow-up, iCanQuit participants had 1.49 times higher odds of quitting smoking compared with QuitGuide participants (28.2% [293 of 1040] vs 21.1% [225 of 1067]; odds ratio [OR], 1.49; 95% CI, 1.22-1.83;P < .001). Effect sizes were very similar and statistically significant for 7-day PPA at the 12-month follow-up (OR, 1.35; 95% CI, 1.12-1.63;P = .002), prolonged abstinence at the 12-month follow-up (OR, 2.00; 95% CI, 1.45-2.76;P < .001), abstinence from all tobacco products (including e-cigarettes) at the 12-month follow-up (OR, 1.60; 95% CI, 1.28-1.99;P < .001), 30-day PPA at 3-month follow-up (OR, 2.20; 95% CI, 1.68-2.89;P < .001), 30-day PPA at 6-month follow-up (OR, 2.03; 95% CI, 1.63-2.54;P < .001), 7-day PPA at 3-month follow-up (OR, 2.04; 95% CI, 1.64-2.54;P < .001), and 7-day PPA at 6-month follow-up (OR, 1.73; 95% CI, 1.42-2.10;P < .001).CONCLUSIONS AND RELEVANCEThis trial provides evidence that, compared with a USCPG-based smartphone application, an ACT-based smartphone application was more efficacious for quitting cigarette smoking and thus can be an impactful treatment option.