Digital smoking cessation intervention for nationally-recruited American Indians and Alaska Natives: A full-scale randomized controlled trial

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PROJECT SUMMARY/ABSTRACT (DESCRIPTION) Since the early 1980s, American Indians and Alaska Natives (AIANs) have maintained the highest rates of commercial cigarette smoking of any racial/ethnic group in the US. Currently, 27% of AIANs smoke cigarettes. Compared to other racial/ethnic groups, they have 6 times higher rates of developing smoking-related cancers. AIANs are only half as likely to quit smoking compared to other races/ethnicities. The result is that commercial cigarette smoking accounts for half of all deaths among AIANs nationwide. A major cause of these longstanding inequities is the lack of access to efficacious smoking cessation interventions among AIANs. Compounding the barrier of lack of access to smoking cessation interventions is the barrier of lack of research on the efficacy of smoking cessation interventions for AIANs. Despite having the highest smoking prevalence of any racial/ethnic group in the US for over 40 years, a mere 0.3% of all full-scale smoking cessation randomized controlled trials (RCTs) have focused on AIANs. Regarding accessibility, a smartphone application (“app”) has the potential to deliver a low-cost smoking cessation intervention with wide geographic reach to AIANs and in regions of the US with smoking rates as high as 57% in this group (i.e., Northern Plains). Regarding efficacy, our preliminary data provides promising evidence for our Acceptance and Commitment Therapy (ACT)-based smartphone app, called iCanQuit, to help AIANs quit smoking. We compared the iCanQuit app with the NCI’s QuitGuide app among the AIAN subsample (N = 165 recruited from 32 US states) enrolled in our full-scale RCT. This secondary analysis of AIANs showed descriptively higher rates of smoking cessation at the 12-month follow-up (30% for iCanQuit vs. 18% for QuitGuide; OR = 1.96; 95% CI = 0.90, 4.26, p = .089). While encouraging, analyses were exploratory, non-significant, and not a substitute for a full-scale efficacy test. To address weaknesses of prior research, a fully-powered comparative efficacy RCT of iCanQuit vs. QuitGuide focusing nationwide on AIANs who smoke is now needed. Thus, the goal of this project is to conduct a nationally recruited and fully-powered two-arm RCT comparing iCanQuit (n = 388) to QuitGuide (n = 388), in order to determine: (1) the efficacy of iCanQuit relative to the QuitGuide app for biochemically verified 30-day point prevalence abstinence (PPA) at 12 months post-randomization and (2) whether iCanQuit’s (but not QuitGuide’s) 12-month smoking cessation outcomes are significantly mediated by improvements in core ACT-based processes. This study will be the first full-scale RCT of a digital intervention for helping AIANs nationwide stop smoking. Qualitative interviews with (1) a subsample of iCanQuit participants to thematize testimonials of their experience with iCanQuit and (2) AIAN members from our study Community Advisory Board (CAB) will guide our plan for broadly disseminating iCanQuit to AIAN adults nationwide. Positive results would improve health equity by providing a highly accessible and efficacious intervention with potential for sustainability and broad dissemination for AIANs nationwide.