The purpose of this pilot study is to evaluate the acceptability and feasibility of the proposed smoking cessation intervention (called MyMAP or My Mobile Advice Program).

Investigators will develop and pilot test a prototype of the MyMAP intervention.The intervention is designed to help smokers better manage issues known to reduce treatment adherence (withdrawal symptoms, medication side-effects, low motivation, and inadequate behavioral skills for medication adherence) and to facilitate greater communication between patients and providers so clinicians can provide appropriate oversight of medication use, intervene when medically necessary, and address patient concerns that may otherwise lead to non-adherence or early treatment termination.

Inclusion Criteria:

• An invited member of Group Health, a health care system in the Pacific Northwest
• Plan to remain enrolled in Group Health for the next 6 months
• aged 18 - 65
• Eligible for smoking cessation treatment through Group Health insurance coverage
• smoke >= 10 cigs a day
• speak and read in English
• willing to use varenicline and no contraindications for this medication
• ready to quit smoking
• have a smart phone with internet access
• willing to receive study texts and emails
• receive care at a Group Health clinic and have electronic medical records in this system
• fill prescriptions through the Group Health pharmacy
• agree to use birth control while taking study medication, if there is a risk of pregnancy

Exclusion Criteria:

• lifetime history of dementia
• psychosis or bipolar disorder based on self-report or medical record review
• hearing, comprehension or visual limitations that preclude full study participation
• current use of other forms of tobacco
• any medical contraindication for varenicline use
• documented history of suicidal ideation/intent

Adverse events were monitored throughout the study period (~ 6 months).

Medication side-effects/nicotine withdrawal symptoms (adverse events) were assessed at each follow-up using a standard checklist of events, resulting in a high number of reports in both arms. Experimental participants were also asked to report ongoing side-effects and symptoms to receive tailored treatment advice, increasing reports in this arm.

The primary limitation of this pilot study is the small sample size, which prevents definitive conclusions about the efficacy of the MyMAP intervention.