Introduction

Efficacious smoking cessation treatments are needed for heavy-drinking adults who often have difficulty quitting smoking. In a secondary analysis of a parent randomized controlled trial, we explored the efficacy of an Acceptance and Commitment Therapy (ACT)-based smartphone application (iCanQuit) versus a US Clinical Practice Guidelines (USCPG)-based smartphone application (QuitGuide) for smoking cessation among heavy-drinking participants (4+ drinks/day for women; 5+ drinks/day for men).

Methods

Participants were randomized to receive iCanQuit (n=188) or QuitGuide (n=160) for 12-months. Smoking cessation outcomes were measured at 3, 6 and 12-months. The primary outcome was self-reported complete-case 30-day point prevalence abstinence (PPA) at 12-months. Secondary outcomes were 7-day PPA at all timepoints; prolonged abstinence; and cessation of all nicotine-containing products at 12-months. Multiple imputation and missing-as-smoking analyses were also conducted. Exploratory outcomes were cessation of both smoking and heavy drinking and change in alcohol use (drinks/day) at 12-months. Treatment engagement and satisfaction and change in ACT-based processes were compared between arms.

Results

Retention rate was 85% at 12-months and did not differ by arm. At 12-months, iCanQuit participants had nearly double the odds of smoking cessation compared to QuitGuide (complete-case 30-day PPA=24% vs. 15%; OR=1.87 95% CI: 1.03, 3.42). Findings were similar for the multiple imputation and missing-as-smoking outcomes at 12-months. Combined cessation of smoking and heavy drinking, and alcohol use at 12-months did not differ by arm. iCanQuit was significantly more engaging and satisfying than QuitGuide. Increased acceptance of thoughts about smoking mediated the effect of treatment on cessation of heavy drinking at 12-months.

Conclusions

The iCanQuit smartphone application was more efficacious and engaging for smoking cessation among heavy-drinking adults than a USCPG-based smartphone application.

中文翻译：

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智能手机应用对酗酒成人戒烟的功效：iCanQuit 随机试验的二次分析

介绍

经常难以戒烟的酗酒成人需要有效的戒烟治疗。在对父母随机对照试验的二次分析中，我们探讨了基于接受和承诺治疗 (ACT) 的智能手机应用程序 (iCanQuit) 与基于美国临床实践指南 (USCPG) 的智能手机应用程序 (QuitGuide) 戒烟的效果在大量饮酒的参与者中（女性每天 4 杯以上；男性每天 5 杯以上）。

方法

参与者被随机分配接受 iCanQuit (n=188) 或 QuitGuide (n=160) 治疗 12 个月。在 3、6 和 12 个月时测量戒烟结果。主要结果是 12 个月时自我报告的完整病例 30 天点戒断率 (PPA)。次要结果是所有时间点的 7 天 PPA；长期禁欲；12 个月时停止使用所有含尼古丁的产品。还进行了多重插补和吸烟缺失分析。探索性结果是在 12 个月时停止吸烟和大量饮酒以及改变酒精使用量（饮酒/天）。比较了治疗参与度和满意度以及基于 ACT 的过程的变化。

结果

12 个月时的保留率为 85%，并且没有因手臂而异。在 12 个月时，iCanQuit 参与者的戒烟几率几乎是 QuitGuide 的两倍（完整病例 30 天 PPA=24% 对 15%；OR=1.87 95% CI：1.03, 3.42）。在 12 个月时，多重插补和吸烟缺失结果的结果相似。12 个月时戒烟和大量饮酒以及饮酒的组合在手臂上没有差异。iCanQuit 比 QuitGuide 更具吸引力和满意度。对吸烟想法的接受度增加介导了治疗对 12 个月时停止大量饮酒的影响。

结论

与基于 USCPG 的智能手机应用程序相比，iCanQuit 智能手机应用程序对酗酒的成年人戒烟更有效且更有吸引力。