Mobile Health Technology for Personalized Tobacco Cessation Support in Laos

PROJECT SUMMARY: Tobacco use remains the leading cause of preventable morbidity and mortality worldwide. Although tobacco use has declined in developed nations in recent decades, smoking prevalence remains strikingly high in many low- and middle-income countries (LMICs). In Lao People's Democratic Republic (Lao PDR), 51% of adult men and 7% of adult women smoke tobacco. The development and evaluation of sustainable tobacco cessation interventions suitable for widespread adoption in nations such as Lao PDR are pressing public health needs. To address this need, we propose a project that adapts our theoretically and empirically based mobile health (mHealth) technology to help people quit smoking cigarettes in Lao PDR. This mHealth approach includes a fully automated, interactive, personalized, smartphone- delivered intervention for behavioral treatment, delivered through our Insight™ platform. mHealth interventions are proliferating in developed countries, but efforts to utilize similar approaches in Lao PDR are extremely limited. The World Health Organization acknowledges that using mHealth for health promotion is cost-effective, scalable, and sustainable, including for the least-developed countries. Additionally, text-messaging interventions for smoking cessation have been shown to be effective, cost-effective, and affordable for tobacco control globally. We have already developed the mHealth platform and intervention approach proposed for this study and pilot tested this technology with a group of Cambodian smokers. Preliminary results demonstrated that our mHealth technology is efficacious, highly feasible, appropriate, and potentially scalable for LMIC settings. This proposed project for Lao PDR includes 2 main phases. In the R21 Phase, we will use formative research methods to adapt our intervention content to the sociocultural context, language, and communication styles of Laotians. In the subsequent R33 Phase, we will conduct a randomized controlled trial (RCT) to evaluate the efficacy of our mHealth intervention and technology. Adult smokers of both sexes will be recruited through 2 large hospitals: Setthathirath Hospital in Vientiane and Champasak Hospital in Champasak Province. Participants (n=500) will be randomized to 1 of 2 treatment groups: Standard Care (SC; n=250) or Automated Treatment (AT; n=250). SC consists of brief advice to quit smoking delivered by research staff, self- help written materials, and a 2-week supply of NRT (transdermal patches). AT consists of all SC components plus a fully automated smartphone-based treatment program that involves interactive and personalized proactive messages, images, or videos. The primary health outcome of the trial is biochemically confirmed self- reported 7-day point prevalence abstinence 12 months post study enrollment. The project also aims to advance mHealth research capacity in Lao PDR and sustain the US-Lao PDR research network. The project has the potential to transform healthcare services for tobacco cessation treatment throughout the country and, ultimately, to significantly reduce tobacco-induced morbidity and mortality.