A Behavioral Application for Improving Smoking Cessation Among Smokers

Actify! An mHealth Mood Management Tool to Improve Population-Level Smoking Cessation

This clinical trial compares two smartphone applications, called Actify! (A & B) for improving smoking cessation outcomes in individuals who smoke. Actify! A is an app grounded in behavioral activation therapy, an evidence-based treatment for depression that can also be used to modify health behaviors such as smoking. The Actify! B app provides evidence-based tobacco cessation strategies based on current clinical guidelines.

OUTLINE: Participants are randomized to 1 of 2 arms.

ARM I: Participants use the Actify! A app, which helps users identify personal values and meaningful activities, prompts users to schedule and complete meaningful activities, visualizes progress towards meeting activity and smoking-related goals, and provides tailored messages, resources, daily tips, personalized feedback, inspirational messages, and user stories, for 8 weeks on study.

ARM II: Participants use the Actify! B app, which contains quit advice, tools for tracking smokefree days, progress and cravings, guidance on preparing to quit, managing cravings and withdrawal, recovering from slips, and a mood management feature, for 8 weeks on study.

After completion of study intervention, participants are followed up at 6 months.

Inclusion Criteria:

• Age 18 or older
• Currently smoke, averaging at least 5 cigarettes/day for the last 30 days
• Interested in quitting smoking in the next 30 days
• Experience downloading and using one or more apps on their smartphone
• Either screens negative for depression (Patient Health Questionnaire - 9 item [PHQ-9] score 0-4; n = 906) or screens positive for mild to moderately severe current depressive symptoms (PHQ-9 score 5-19; n = 906)
• Willing and able to complete all study activities and to receive compensation by mail
• Comfortable reading and writing in English
• Have a mobile data plan and/or access to WiFi to support the use of the assigned app
• Reside in the United States (US)
• Willing to provide information for an emergency contact in case of serious concerns about the participant's physical or mental health

Exclusion Criteria:

• Self-report of currently receiving behavioral treatment for depression (e.g., psychotherapy or counseling, web- or app-based interventions); current use of pharmacotherapy for depression or for other mental health conditions that are not otherwise excluded is allowable (e.g., benzodiazepines, anticonvulsants, opioid agonists, antipsychotics)
• Severe depression (PHQ-9 ≥ 20)
• Current suicidal ideation reported on the PHQ-9
• History of a suicide attempt
• Self-reported lifetime diagnosis of bipolar disorder, schizophrenia, schizoaffective disorder, antisocial personality disorder, or borderline personality disorder; or self-reported lifetime diagnosis of an alcohol or drug use disorder with use of the substance(s) in the past 30 days
• Currently receiving other smoking cessation treatments, including pharmacotherapies (nicotine replacement therapy, bupropion, or varenicline) and behavioral interventions (e.g. quitline counseling, other digital health programs), but excluding electronic (e)-cigarettes/vaping
• Previous use of the QuitGuide program
• Employees/family of investigator or study center
• Member of the same household as another participant
• Woman who is pregnant or breastfeeding, or planning to become pregnant
• Having a Google voice number as their primary phone number (due to association with fraudulent study entry attempts in our previous work)
• Currently incarcerated
• Participated in earlier studies to develop the Actify! app