A Mobile App Based Cognitive Dissonance Intervention for Smoking Cessation

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Abstract Despite overall declines in the rate of tobacco use in the United States over the past 30 years, nearly 38 million Americans still smoke, posing extremely high risk for long-term health problems and death. Recent reviews note that there has been significant progress in the application of both clinical and public health interventions to help smokers quit; however, they have also concluded that the overall success rate of smokers quitting has not significantly improved. Individual, group and public health interventions – both with and without adjunctive aids such as nicotine replacement therapy – have generally used some combination of cognitive- behavioral interventions, but there remains a need for novel, theory-driven approaches to enhance quit rates. Innovative interventions such as those offered via computer or mobile app can increase reach and engagement. We propose to adapt and test the feasibility of a previously piloted cognitive dissonance intervention (CDI) for smoking cessation delivered via a mobile app. Cognitive dissonance interventions have been shown to be successful in treating health-related problems, as well as substance use, and preliminary findings support its use in smoking cessation. The program, entitled CoQuit, is based on cognitive dissonance and smoking cessation components tested in our Phase I prototype mobile app. This prototype app demonstrated efficacy and the results of our evaluation study met criteria for moving to Phase II. We will expand and revise the six module CoQuit program, which includes 12 video components (6 instructional components and 6 cognitive dissonance activities) to improve ease of use, increase interactivity with other smokers who are quitting, and improve social support elements in partnership with Emberex, who has extensive experience in the development and commercialization of mobile apps. This development will assess navigation and usability with adult daily smokers and conduct pilot testing to guide development of the CoQuit app for evaluation. Our research and development team has extensive experience developing and testing mobile apps and developing and testing cognitive dissonance and smoking cessation interventions. The evaluation study will include 500 adults recruited through social media and randomly assigned to either the Cognitive Dissonance mobile app or a comparable app without cognitive dissonance tasks; participants will be assessed at baseline, 1- and 3-month follow-up. Significant changes in quit attempts, number of days without smoking (smokefree days), point prevalence cessation, and changes in smoking attitudes will be used to determine the efficacy of the CoQuit app. Usability data, system log data on program use, and participant satisfaction data will also be analyzed.