Project 5: Development and pilot evaluation of a novel mobile health intervention for young adult tobacco cessation

Approximately one in five young adults (YAs) ages 18-30 use nicotine and tobacco products. Helping YA nicotine and tobacco users to quit is a critical piece of tobacco control interventions, yet there have been few efforts to develop tailored treatments specifically designed to meet the needs of YAs with differing levels of readiness to quit. This is a critical gap given that this is a population whose access to and use of traditional cessation treatments involving counseling and pharmacotherapy is poor. We previously developed an avatar-led, digital Acceptance and Commitment Therapy (ACT) program for smoking cessation called Flexiquit. In this study, we propose to develop an adapted version of the program that is tailored for YAs who use any type of commercial nicotine and tobacco products, at all levels of quit readiness. We will then conduct a pilot randomized controlled trial (n=120) to preliminarily evaluate acceptability and efficacy of the new program, Living Free from Tobacco (LiFT), relative to a reduced control version of LiFT that only contains educational content. We hypothesize that, compared with the control, LiFT will show a trend toward greater satisfaction, number of logins, biochemically confirmed 7-day point prevalence abstinence from all commercial nicotine and tobacco products, and psychological flexibility (i.e., ACT’s theory-based change mechanism). We will also explore baseline readiness to quit nicotine and tobacco use as a moderators of treatment effects. This project is significant: (1) young nicotine/tobacco users are at risk for developing nicotine dependence and exposure to toxicants that negatively impact health, and almost all risks of tobacco use can be mitigated by stopping prior to the age of 30; (2) standard care tobacco interventions don’t address the unique treatment needs of YAs, including low readiness to quit, lack of acceptability of standard treatment, and need to consider use of multiple types of tobacco products as opposed to use of single product like cigarettes, and (3) ACT has demonstrated better efficacy than standard care approaches for tobacco treatment. It is also innovative: (1) it is the first self-guided digital cessation treatment for young adult users of all types of nicotine/tobacco products, (2) its novel treatment approach advances the science of ACT for tobacco cessation by testing effectiveness for YAs at all stages of readiness to quit; and, (3) use of avatars and interactive games as engagement strategies is substantially different than existing treatments.