%0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63693 %T Testing a Machine Learning–Based Adaptive Motivational System for Socioeconomically Disadvantaged Smokers (Adapt2Quit): Protocol for a Randomized Controlled Trial %A Kamberi,Ariana %A Weitz,Benjamin %A Flahive,Julie %A Eve,Julianna %A Najjar,Reem %A Liaghat,Tara %A Ford,Daniel %A Lindenauer,Peter %A Person,Sharina %A Houston,Thomas K %A Gauvey-Kern,Megan E %A Lobien,Jackie %A Sadasivam,Rajani S %+ Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Ave North, Worcester, MA, 01655, United States, 1 774 317 1539, Ariana.Kamberi@umassmed.edu %K smoking cessation %K mHealth %K socioeconomically disadvantaged, biochemical verification %K machine learning %D 2025 %7 16.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Individuals who are socioeconomically disadvantaged have high smoking rates and face barriers to participating in smoking cessation interventions. Computer-tailored health communication, which is focused on finding the most relevant messages for an individual, has been shown to promote behavior change. We developed a machine learning approach (the Adapt2Quit recommender system), and our pilot work demonstrated the potential to increase message relevance and smoking cessation effectiveness among individuals who are socioeconomically disadvantaged. Objective: This study protocol describes our randomized controlled trial to test whether the Adapt2Quit recommender system will increase smoking cessation among individuals from socioeconomically disadvantaged backgrounds who smoke. Methods: Individuals from socioeconomically disadvantaged backgrounds who smoke were identified based on insurance tied to low income or from clinical settings (eg, community health centers) that provide care for low-income patients. They received text messages from the Adapt2Quit recommender system for 6 months. Participants received daily text messages for the first 30 days and every 14 days until the end of the study. Intervention participants also received biweekly texting facilitation messages, that is, text messages asking participants to respond (yes or no) if they were interested in being referred to the quitline. Interested participants were then actively referred to the quitline by study staff. Intervention participants also received biweekly text messages assessing their current smoking status. Control participants did not receive the recommender messages but received the biweekly texting facilitation and smoking status assessment messages. Our primary outcome is the 7-day point-prevalence smoking cessation at 6 months, verified by carbon monoxide testing. We will use an inverse probability weighting approach to test our primary outcome. This involves using a logistic regression model to predict nonmissingness, calculating the inverse probability of nonmissingness, and using it as a weight in a logistic regression model to compare cessation rates between the two groups. Results: The Adapt2Quit study was funded in April 2020 and is still ongoing. We have completed the recruitment of individuals (N=757 participants). The 6-month follow-up of all participants was completed in November 2024. The sample consists of 64% (486/757) female participants, 35% (265/757) Black or African American individuals, 51.1% (387/757) White individuals, and 16% (121/757) Hispanic or Latino individuals. In total, 52.6% (398/757) of participants reported having a high school education or being a high school graduate; 70% (529/757) smoked their first cigarette within 30 minutes of waking, and half (379/757, 50%) had stopped smoking for at least one day in the past year. Moreover, 16.6% (126/757) had called the quitline before study participation. Conclusions: We have recruited a diverse sample of individuals who are socioeconomically disadvantaged and designed a rigorous protocol to evaluate the Adapt2Quit recommender system. Future papers will present our main analysis of the trial. Trial Registration: ClinicalTrials.gov NCT04720625; https://clinicaltrials.gov/study/NCT04720625 International Registered Report Identifier (IRRID): DERR1-10.2196/63693 %M 40239194 %R 10.2196/63693 %U https://www.researchprotocols.org/2025/1/e63693 %U https://doi.org/10.2196/63693 %U http://www.ncbi.nlm.nih.gov/pubmed/40239194 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59997 %T User Perceptions of E-Cigarette Cessation Apps: Content Analysis of App Reviews %A Rodberg,Danielle %A Nawara,Roula %A Taylor,Mischa %A Struik,Laura %+ School of Nursing, University of British Columbia, 1147 Research Road, Kelowna, BC, Canada, 1 4039928122, danielle.rodberg@ubc.ca %K qualitative research %K vaping %K e-cigarette %K mobile phone %K mHealth %K smartphone app %K cessation %K nicotine %K consumer %K perception %K user %K content analysis %K Canada %K experiences %D 2025 %7 15.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaping rates in Canada are continuing to increase. In 2019, 4.7% of Canadians used an electronic cigarette (e-cigarette) in the past 30 days, which rose to 5.8% in 2022. In the same year, young adults aged 20-24 years demonstrated the highest use among Canadians, at 19.7%. Given this, existing interventions are not resulting in the desired outcomes, and smartphone apps have the potential to address this gap. Although limited, current evidence highlights that apps can be an effective cessation support; however, a gap persists in understanding the user experience of vaping cessation apps. Objective: The purpose of this study was to explore the user experience of vaping cessation apps through an analysis of app reviews. More specifically, this study aimed to identify positive and negative experiences of app users, as well as highlight recommendations from app users to improve the quality of these apps. Methods: Vaping cessation apps were identified through searches on the Canadian and US versions of Apple App Store and Android Google Play Store in August 2022. Searches revealed a total of 11 vaping cessation apps with app reviews, which resulted in a total of 310 reviews for analysis. Review material was analyzed using a deductive content analysis approach and divided into the following primary categories: content, functionality, aesthetic, cost, and other. These were further divided into 3 secondary categories (praise, criticism, and recommendations) and various tertiary categories. Results: The most discussed primary categories were content, functionality and cost. Comments regarding content tended to be positive (n=103, 33.2%), praising features, such as hypnosis audio sessions (n=29, 28.2%) and tracking features. In contrast, comments tended to criticize functionality (n=58, 18.7%), indicating issues with the functioning of an app that either made the whole app unusable (n=29, 50%) or a specific feature unusable (n=28, 48.3%). Reviews regarding cost were mixed, with 27 (8.7%) positive comments, the majority of these encompassing reviewers satisfied with their purchase (n=17, 63%), and 38 (12.3%) negative comments, including individuals both unsatisfied with their purchase (n=15, 39.5%) and unsatisfied with the free version (n=12, 31.6%). Conclusions: This study is the first of its kind to evaluate the user experience with vaping cessation apps via an analysis of app reviews. App developers may benefit from reading our findings to identify areas to focus on when developing and updating apps. Our study forms a basis for the development of future vaping interventions, as well as future studies. Future research should be conducted on vaping cessation interventions with an emphasis on the user experience because there is limited research available for comparison with the promising results from this study. %M 40233344 %R 10.2196/59997 %U https://www.jmir.org/2025/1/e59997 %U https://doi.org/10.2196/59997 %U http://www.ncbi.nlm.nih.gov/pubmed/40233344 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e72002 %T Design and Baseline Evaluation of Social Media Vaping Prevention Trial: Randomized Controlled Trial Study %A Evans,William Douglas %A Ichimiya,Megumi %A Bingenheimer,Jeffrey B %A Cantrell,Jennifer %A D'Esterre,Alexander P %A Pincus,Olivia %A Yu,Linda Q %A Hair,Elizabeth C %+ Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue NW, Washington, DC, 20052, United States, 1 2023519546, wdevans@gwu.edu %K social media %K e-cigarettes %K randomized controlled trial %K nicotine %K oral nicotine products %K nicotine poly-use %D 2025 %7 31.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic cigarette (e-cigarette) use is a major public health problem and young adults aged 18-24 years are at high risk. Furthermore, oral nicotine products (ONPs) are growing in popularity in this population. Poly-use is widespread. New methodologies for rigorous online studies using social media have been conducted and shown to reduce nicotine use. Objective: We report on the design and baseline evaluation of a large-scale social media–based randomized controlled trial to evaluate the effects of antivaping social media on young adult vaping and determinants of use. Methods: Using the Virtual Lab social media platform, participants were recruited using an artificial intelligence chatbot and social media advertising, completed a baseline survey, and were randomized to 1 of 4 study arms. The design was to achieve specific numbers of impressions per arm over 3 survey time points. We recruited 8437 participants, stratified by vaper (n=5026) and nonvaper (n=3321) status. Questionnaire data were collected using the Qualtrics survey platform. Future analyses will examine the effects of social media content on vaping at the endline. Our data analysis describes the 2 cohort samples, examines balance across the 4 study arms on baseline variables in each of the cohorts, and evaluates the internal consistency of several multi-indicator measures of psychosocial constructs. Results: Among vapers, almost three-fourths were current vapers, >40% were current smokers (using in the past 30 days), and >48% were current poly-users (using e-cigarettes and ≥1 other tobacco products). Substantial numbers of current vapers also currently use some other product, including cigars (n=1520, 30.2%), hookah (n=794, 15.8%), smokeless devices (n=462, 9.2%), and ONPs (n=578, 11.5%). The average age of participants was 21.2 (SD 2) years. Just less than 45% of participants were non-Hispanic White (n=3728, 44.7%), just less than 47% (n=3913, 46.9%) of the sample was male, more than 44% (n=3704, 44.4%) reported completing high school, and 79.3% reported meeting basic needs or better. There were no significant differences between arms and strata by any of these demographics. We calculated scale scores for depression and covariates related to nicotine use and found high alphas. Finally, participants who reported having seen antitobacco brand advertising were more likely to have higher levels of these variables and scales than participants who reported not having seen the advertisements. These results will be examined in future studies. Conclusions: Social media can be used as a platform at scale for longitudinal randomized controlled trials over extended periods, which extends previous research on short-term trials. Interventions delivered by social media can be used with large samples to evaluate social media health behavior change interventions. Future studies based on this research will evaluate the intervention and dose-response effects of social media exposure on vaping behavior and determinants. Trial Registration: ClinicalTrials.gov NCT04867668; https://clinicaltrials.gov/study/NCT04867668 %M 40164170 %R 10.2196/72002 %U https://www.jmir.org/2025/1/e72002 %U https://doi.org/10.2196/72002 %U http://www.ncbi.nlm.nih.gov/pubmed/40164170 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e60620 %T Evaluating the Effect of the JUUL2 System With 5 Flavors on Cigarette Smoking and Tobacco Product Use Behaviors Among Adults Who Smoke Cigarettes: 6-Week Actual Use Study %A Goldenson,Nicholas I %A Shiffman,Saul %A Sembower,Mark A %A Selya,Arielle %A Pype,Steve %A Black,Ryan A %+ , Juul Labs, Inc, 1000 F Street NW, Suite 800, Washington, DC, 20004, United States, 1 510 501 5964, nicholas.goldenson@juul.com %K cigarette %K smoking %K electronic nicotine delivery system %K switching %K actual use study %K real world %D 2025 %7 26.3.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Adults who switch completely from smoking cigarettes to using electronic nicotine delivery systems (ENDS) substantially reduce their exposure to toxicants and carcinogens that are associated with smoking-related diseases. Objective: This 6-week actual use study—a prospective uncontrolled real-world study designed to evaluate quasi-naturalistic product use—aimed to assess switching behavior among US adults who smoked cigarettes and were provided with JUUL2 ENDS products. Methods: US adults who smoked cigarettes every day but were predominantly not ready to quit (N=1160; mean age 39.42, SD 11.03 years; 641/1160, 55.26% female participants; 667/1160, 57.5% non-Hispanic White; mean cigarettes per day 14.11, SD 8.96; only 1% [11/1160] planning to stop smoking within 30 days; and 481/1160, 41.47% dual users) were recruited to use JUUL2 ENDS products (18 mg/mL nicotine) in 1 of 5 flavors in real-world environments for 6 weeks. Participants who expressed sufficient interest in using JUUL2 products were enrolled at 24 different consumer research sites across the United States into one of the two following study arms: (1) traditional flavors (Virginia Tobacco and Polar Menthol, 10 sites); or (2) complex flavors (Autumn Tobacco, Summer Menthol, and Ruby Menthol, 14 sites). No instructions regarding JUUL2 product use or cigarette smoking were provided. After a 1-week trial period, participants were provided with their preferred flavor for 6 weeks of ad libitum use (10 pods per week). In total, 6 weekly web-based surveys were used to assess switching (smoking abstinence) and smoking reduction; dependence and respiratory symptoms were assessed at baseline and week 6. Results: Across the 5 flavor groups at week 6, the rates of complete past-7-day switching away from cigarettes ranged from 38.2% (79/207) to 47.3% (95/201), and 24.3% (55/226) to 33.9% (74/218) of participants reported complete past-30-day switching. Participants who used the 3 menthol-flavored (vs 2 tobacco-flavored) JUUL2 products had significantly higher rates of past-30-day switching at week 6 (odds ratio 1.36, 95% CI 1.04-1.78). Compared to their baseline values when they were smoking, the past-30-day switchers at week 6 had significantly reduced their dependence (mean differences in dependence, cigarettes – JUUL2: 0.57-0.99; P<.001) and self-reported frequency of respiratory symptoms (P<.05). Among participants who continued to smoke at week 6, 50.9% (59/116) to 62.9% (73/116) reduced their daily cigarette consumption by at least 50% from baseline. Conclusions: Adoption of JUUL2 ENDS products can likely help substantial proportions of US adults who smoke to switch completely away from cigarettes or meaningfully reduce their cigarette consumption, thereby reducing their dependence on tobacco products and improving their respiratory symptoms. %M 40138686 %R 10.2196/60620 %U https://www.i-jmr.org/2025/1/e60620 %U https://doi.org/10.2196/60620 %U http://www.ncbi.nlm.nih.gov/pubmed/40138686 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e56296 %T Application of Behavior Change Techniques and Rated Quality of Smoking Cessation Apps in China: Content Analysis %A Hong,Qiumian %A Wei,Shuochi %A Duoliken,Hazizi %A Jin,Lefan %A Zhang,Ning %K smoking cessation %K behavior change techniques %K mobile application %K content analysis %K China %D 2025 %7 24.3.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Smoking cessation apps are increasingly being used to help smokers quit smoking. In China, whether behavioral science–based techniques are being incorporated into smoking cessation apps remains unknown. Objectives: This study aims to describe the usage of behavior change techniques (BCTs) among smoking cessation apps available in China and to evaluate the relationship between BCT utilization and the quality of available smoking cessation apps. Methods: We searched eligible smoking cessation apps twice on September 12 and October 4, 2022. We coded them with BCTs and assessed their quality by the Mobile App Rating Scale (MARS) and rating score in the App Store. We described the quality of each app (ie, engagement, function, esthetic, and information) and the BCTs used within it, as well as the amount and proportion of all BCTs used. Correlation analysis and linear regression analysis were used to assess the association between the number of BCTs used and the quality of apps. Results: Nine apps were included in the final analyses. The average number of BCTs being used was 11.44 (SD 2.57), ranging from 5 to 29. Only 1 app used more than 20 BCTs. The most frequently used BCTs were providing feedback on current smoking behavior (9/9, 100%), prompting review of goals (8/9, 88.89%), prompting self-monitoring of one’s smoking behavior (7/9, 77.78%), and assessing current and past smoking behavior (7/9, 77.78%). The most commonly used BCTS specifically focus on behavior, including BM (B refers to behavior change, M focuses on addressing motivation; 4.44/11, 40.36%) and BS (B refers to behavior change, S refers to maximizing self-regulatory capacity or skills; 3.78/11, 34.36%). The average score of MARS for the apps was 3.88 (SD 0.38), ranging from 3.29 to 4.46, which was positively correlated with the number of BCTs used (r=0.79; P=.01). Specifically, more usage of BCTs was associated with higher engagement score (β=.74; P=.02; R2=0.52) and higher information score (β=.76; P=.02; R2=0.52). Conclusions: The quality of smoking cessation apps assessed by MARS was correlated with the number of BCTs used. However, overall, the usage of BCTs was insufficient and imbalanced, and the apps demonstrated low quality of engagement and information dimensions. Coordinated efforts from policy makers, technology companies, health behavior professionals, and health care providers should be made to reduce tobacco consumption and to develop high-quality, widely accessible, and effective smoking cessation apps to help smokers quit smoking. %R 10.2196/56296 %U https://mhealth.jmir.org/2025/1/e56296 %U https://doi.org/10.2196/56296 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63584 %T Vaping, Acculturation, and Social Media Use Among Mexican American College Students: Protocol for a Mixed Methods Web-Based Cohort Study %A Bataineh,Bara S %A Marti,C Nathan %A Murthy,Dhiraj %A Badillo,David %A Chow,Sherman %A Loukas,Alexandra %A Wilkinson,Anna V %+ University of Texas Health Science Center at Houston, 1836 San Jacinto, Austin, TX, 78701, United States, 1 9723527755, Bara.bataineh@uth.tmc.edu %K vaping %K social media %K Mexican American %K college students %K marketing %K acculturation %K protocol %K artificial intelligence %D 2025 %7 24.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The tobacco industry has a history of targeting minority communities, including Hispanic individuals, by promoting vaping through social media. This marketing increases the risk of vaping among Hispanic young adults, including college students. In Texas, college enrollment among Mexican Americans has significantly increased over recent years. However, little research exists on the link between social media and vaping and the underlying mechanisms (ie, outcome expectations, attitudes, and beliefs) explaining how vaping-related social media impacts vaping among Mexican American college students. Moreover, there is limited knowledge about how acculturation moderates the association between social media and vaping. Hispanic individuals, particularly Mexican Americans, are the largest ethnic group in Texas colleges; thus, it is crucial to understand the impact of social media and acculturation on their vaping behaviors. Objective: We outline the mixed methods used in Project Vaping, Acculturation, and Media Study (VAMoS). We present descriptive analyses of the participants enrolled in the study, highlight methodological strengths, and discuss lessons learned during the implementation of the study protocol related to recruitment and data collection and management. Methods: Project VAMoS is being conducted with Mexican American students attending 1 of 6 Texas-based colleges: University of Texas (UT) Arlington, UT Dallas, UT El Paso, UT Rio Grande Valley, UT San Antonio, and the University of Houston System. This project has 2 phases. Phase 1 included an ecological momentary assessment (EMA) study and qualitative one-on-one interviews (years 1-2), and phase 2 includes cognitive interviews and a 4-wave web-based survey study (years 2-4) with objective assessments of vaping-related social media content to which participants are exposed. Descriptive statistics summarized participants’ characteristics in the EMA and web-based survey. Results: The EMA analytic sample comprised 51 participants who were primarily female (n=37, 73%), born in the United States (n=48, 94%), of middle socioeconomic status (n=38, 75%), and aged 21 years on average (SD 1.7 years). The web-based survey cohort comprised 1492 participants self-identifying as Mexican American; Tejano, Tejana, or Tejanx; or Chicano, Chicana, or Chicanx heritage who were primarily female (n=1042, 69.8%), born in the United States (n=1366, 91.6%), of middle socioeconomic status (n=1174, 78.7%), and aged 20.1 years on average at baseline (SD 2.2 years). Of the baseline cohort, the retention rate in wave 2 was 74.7% (1114/1492). Conclusions: Project VAMoS is one of the first longitudinal mixed methods studies exploring the impact of social media and acculturation on vaping behaviors specifically targeting Mexican American college students. Its innovative approach to objectively measuring social media exposure and engagement related to vaping enhances the validity of self-reported data beyond what national surveys can achieve. The results can be used to develop evidence-based, culturally relevant interventions to prevent vaping among this rapidly growing minority population. International Registered Report Identifier (IRRID): DERR1-10.2196/63584 %M 40127433 %R 10.2196/63584 %U https://www.researchprotocols.org/2025/1/e63584 %U https://doi.org/10.2196/63584 %U http://www.ncbi.nlm.nih.gov/pubmed/40127433 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e56973 %T The Impact of ChatGPT Exposure on User Interactions With a Motivational Interviewing Chatbot: Quasi-Experimental Study %A Zhu,Jiading %A Dong,Alec %A Wang,Cindy %A Veldhuizen,Scott %A Abdelwahab,Mohamed %A Brown,Andrew %A Selby,Peter %A Rose,Jonathan %K chatbot %K digital health %K motivational interviewing %K natural language processing %K ChatGPT %K large language models %K artificial intelligence %K experimental %K smoking cessation %K conversational agent %D 2025 %7 21.3.2025 %9 %J JMIR Form Res %G English %X Background: The worldwide introduction of ChatGPT in November 2022 may have changed how its users perceive and interact with other chatbots. This possibility may confound the comparison of responses to pre-ChatGPT and post-ChatGPT iterations of pre-existing chatbots, in turn affecting the direction of their evolution. Before the release of ChatGPT, we created a therapeutic chatbot, MIBot, whose goal is to use motivational interviewing to guide smokers toward making the decision to quit smoking. We were concerned that measurements going forward would not be comparable to those in the past, impacting the evaluation of future changes to the chatbot. Objective: The aim of the study is to explore changes in how users interact with MIBot after the release of ChatGPT and examine the relationship between these changes and users’ familiarity with ChatGPT. Methods: We compared user interactions with MIBot prior to ChatGPT’s release and 6 months after the release. Participants (N=143) were recruited through a web-based platform in November of 2022, prior to the release of ChatGPT, to converse with MIBot, in an experiment we refer to as MIBot (version 5.2). In May 2023, a set of (n=129) different participants were recruited to interact with the same version of MIBot and asked additional questions about their familiarity with ChatGPT, in the experiment called MIBot (version 5.2A). We used the Mann-Whitney U test to compare metrics between cohorts and Spearman rank correlation to assess relationships between familiarity with ChatGPT and other metrics within the MIBot (version 5.2A) cohort. Results: In total, 83(64.3%) participants in the MIBot (version 5.2A) cohort had used ChatGPT, with 66 (51.2%) using it on a regular basis. Satisfaction with MIBot was significantly lower in the post-ChatGPT cohort (U=11,331.0; P=.001), driven by a decrease in perceived empathy as measured by the Average Consultation and Relational Empathy Measure (U=10,838.0; P=.01). Familiarity with ChatGPT was positively correlated with average response length (ρ=0.181; P=.04) and change in perceived importance of quitting smoking (ρ=0.296; P<.001). Conclusions: The widespread reach of ChatGPT has changed how users interact with MIBot. Post-ChatGPT users are less satisfied with MIBot overall, particularly in terms of perceived empathy. However, users with greater familiarity with ChatGPT provide longer responses and demonstrated a greater increase in their perceived importance of quitting smoking after a session with MIBot. These findings suggest the need for chatbot developers to adapt to evolving user expectations in the era of advanced generative artificial intelligence. %R 10.2196/56973 %U https://formative.jmir.org/2025/1/e56973 %U https://doi.org/10.2196/56973 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66709 %T Using Text Messaging Ecological Momentary Assessment to Record Changes in e-Cigarette and Combustible Cigarette Use: Pilot Randomized Clinical Trial %A Morgan,Tucker %A He,Michelle %A Nicholson,Andrew %A El Shahawy,Omar %A Sherman,Scott E %A Stevens,Elizabeth R %K smoking %K electronic cigarette %K smoking cessation %K ecological momentary assessment %K EMA %K adherence %K real-time data %K mobile phone %K cigarette %K smoker %K e-cigarettes %K pilot randomized clinical trial %K clinical trial %K pilot study %K adult smoker %K chronic condition %D 2025 %7 21.3.2025 %9 %J JMIR Form Res %G English %X Background: Ecological momentary assessment (EMA) provides insight into the effectiveness and feasibility of smoking-related interventions. Objective: The objective of this paper was to assess adherence to an EMA protocol and compare EMA-derived responses with measures collected through multiple surveys. Methods: A subanalysis was conducted using data from a 12-week, open-label, and 2-arm pilot randomized clinical trial among adult smokers with chronic obstructive pulmonary disease, coronary artery disease, peripheral vascular disease, or asthma in the last 12 months (n=109). Participants were randomized to either electronic cigarette (EC) or nicotine replacement therapy (NRT) treatment arms. We compared EMA data collected through automated SMS text message prompts sent to participants 4 times daily for 12 weeks, including cigarettes smoked per day (CPD), craving, and satisfaction, to survey data collected at 12 weeks. Convergent validity between survey- and EMA-reported measures was evaluated using Pearson correlation and paired t tests. CPD was modeled using negative binomial regression. Relative rates (RRs) of reaching at least 50%, 75%, and 100% CPD reduction between two arms were calculated using both EMA and survey data. Results: The majority of participants were non-Hispanic White (63/109, 58%) and female (60/109, 55%), and had a median age of 60 (IQR 54‐65) years. Among the 109 participants, 59.6% (n=65) were consistently adherent to the EMA protocol over the 12-week period. Median weekly EMA response rate remained high over the 12-week study period even though a modest decline was observed (week 1, 97.8% and week 12, 89.4%). The mean CPD declined significantly (week 1, mean 14.2, SD 9.9 and week 12, mean 4.6, SD 6.7; P<.001). EMA-derived and survey-based CPD measurements were positively correlated (r=0.73, 95% CI 0.6-0.82) as were measures of craving (r=0.38, 95% CI 0.17-0.56). No significant paired difference in CPD was observed between EMA measurements and surveys. A significant effect of time on CPD EMA data (incidence rate ratio [IRR] 1-week change 0.93; P<.01) and survey data was found (IRR 12-week change 0.36; P<.01). However, the treatment effect was not significant, which aligned with the RR results. An increase in the EC consumption was observed over time in the EC arm, with 12.1% (7/58) fully switched to EC (defined as CPD=0 and EC use>0) and 20.7% (12/58) mostly switched (defined as a reduction in CPD>75% and EC use>0) in week 12. Conclusions: EMA is a suitable method to collect recall-based smoking-related data. Though results from mixed effect modeling and RR comparisons were similar using EMA or survey data, EMA provides unique advantages, namely greater granularity in the time and the capability to detect switching patterns in near real time. These findings provide the feasibility of using EMA in developing smoking cessation interventions in future tobacco harm reduction research. Trial Registration: ClinicalTrials.gov NCT04465318; https://clinicaltrials.gov/study/NCT04465318 International Registered Report Identifier (IRRID): RR2-10.1186/s13722-021-00284-0 %R 10.2196/66709 %U https://formative.jmir.org/2025/1/e66709 %U https://doi.org/10.2196/66709 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66010 %T Contextualizing Changes in e-Cigarette Use During the Early COVID-19 Pandemic and Accompanying Infodemic (“So Much Contradictory Evidence”): Qualitative Document Analysis of Reddit Forums %A Watkins,Shannon Lea %A Snodgrass,Katherine %A Fahrion,Lexi %A Shaw,Emily %+ Department of Community and Behavioral Health, College of Public Health, University of Iowa, 145 N Riverside Dr, Iowa City, IA, 52242, United States, 1 3194671489, shannon-watkins@uiowa.edu %K vaping %K nicotine %K tobacco %K health communication %K social media %K new media %D 2025 %7 20.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Understanding how social media platforms facilitate information exchange and influence behavior during health crises can enhance public health responses during times of uncertainty. While some risk factors for COVID-19 susceptibility and severity (eg, old age) were clear, whether e-cigarette use increased risk was not clear. People who used e-cigarettes had to navigate both the COVID-19 infodemic and a conflicting, politicized, and changing information environment about the interaction between COVID-19 and e-cigarette use. Objective: This study aims to characterize and contextualize e-cigarette–related behavior changes during the early COVID-19 pandemic and illuminate the role that social media played in decision-making. Methods: We conducted a qualitative analysis of COVID-19–related e-cigarette discussions on 3 Reddit forums about e-cigarettes. We collected 189 relevant discussion threads made in the first 6 months of the pandemic (collected from June 27, 2020, to July 3, 2020). Threads included 3155 total comments (mean 17 comments) from approximately 1200 unique Redditors. We developed and applied emergent codes related to e-cigarette perceptions and behaviors (eg, the role of nicotine in COVID-19 and do-it-yourself narratives) and web-based community interactions (eg, advice), identified thematic patterns across codes, and developed a model to synthesize the socioecological context of e-cigarette behaviors. Results: e-Cigarette subreddits provided a platform for Redditors to discuss perceptions and experiences with e-cigarettes, make sense of information, and provide emotional support. Discussions reflected an array of e-cigarette–related behavioral responses, including increases and decreases in use intensity, changes in purchasing practices (eg, stockpiling), and changes in vaping practices (eg, reusing disposable pods). This study presented a theoretically and empirically informed model of how circumstances created by the pandemic (eg, changes in activity space and product shortages) compelled behavior changes. Redditors drew from their existing perceptions, intentions, and experiences with nicotine and tobacco products; their personal pandemic experiences; and their participation on Reddit to decide whether and how to change their e-cigarette behaviors during the early pandemic. Forums reflected uncertainty, stress, and debate about the rapidly evolving and complicated public health information. Consumption and discussion of media (eg, news articles and peer-reviewed publications) on Reddit informed e-cigarette perceptions and behaviors. Decisions were complicated by distrust of the media. Conclusions: Variations in individual traits and environmental circumstances during the early COVID-19 pandemic provide context for why there was no unified direction of e-cigarette behavior change during this period. Information and discussion on Reddit also informed risk perceptions and decisions during the pandemic. Social media is an effective and important place to communicate public health information, particularly during crisis or disaster situations. Moving forward, transparent, accurate, and specific message development should consider the stress, struggles, and stigma of people who use e-cigarettes and address the roles mistrust and misinformation play in decisions. %M 40112286 %R 10.2196/66010 %U https://www.jmir.org/2025/1/e66010 %U https://doi.org/10.2196/66010 %U http://www.ncbi.nlm.nih.gov/pubmed/40112286 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e55379 %T Proximal Effects of a Just-in-Time Adaptive Intervention for Smoking Cessation With Wearable Sensors: Microrandomized Trial %A Vinci,Christine %A Sutton,Steve K %A Yang,Min-Jeong %A Jones,Sarah R %A Kumar,Santosh %A Wetter,David W %+ , Moffitt Cancer Center, 12902 Magnolia Dr., Tampa, FL, 33612, United States, 1 813 745 5421, Christine.vinci@moffitt.org %K smoking cessation %K mindfulness %K ecological momentary assessment %K micro-randomized trial %K Just-in-Time Adaptive Intervention %K JITAI %K EMA %K ecological momentary %K smoking %K smokers %K quitting %K cessation %K meditation %K mind body %K sensors %K motivational %K tobacco %K nicotine %K NRT %K counseling %K wearables %K abstinence %K stress %K craving %K adaptive intervention %K mobile phone %D 2025 %7 19.3.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Tobacco use remains the leading preventable cause of morbidity and mortality in the United States. Novel interventions are needed to improve smoking cessation rates. Mindfulness-based interventions (MBIs) for cessation address tobacco use by increasing awareness of the automatic nature of smoking and related behaviors (eg, reactivity to triggers for smoking) from a nonjudgmental stance. Delivering MBIs for smoking cessation via innovative technologies allows for flexibility in the timing of intervention delivery, which has the potential to improve the efficacy of cessation interventions. Research shows MBIs target key mechanisms in the smoking cessation process and can be used to minimize drivers of smoking lapse. Objective: This single-arm study investigated the impact of mindfulness-based strategies and motivational messages on proximal outcomes, collected via ecological momentary assessment (EMA), relevant to tobacco abstinence via a microrandomized trial. This approach allows for the evaluation of intervention content on proximal outcomes (eg, reduced negative affect) that are thought to impact positive distal outcomes (eg, smoking abstinence). Methods: All participants were motivated to quit smoking, and the intervention they received included nicotine replacement therapy, brief individual counseling, and a 2-week Just-in-Time Adaptive Intervention (JITAI) with wearable sensors. Throughout the JITAI period, a single strategy was randomly pushed (vs not) multiple times per day through the smartphone application. An EMA next assessed negative affect, positive affect, mindfulness, abstinence self-efficacy, motivation to quit, craving, and smoking motives. The primary analyses evaluated differences in EMA outcomes (proximal) for when a strategy was pushed versus not pushed. Additional analyses evaluated changes in similar outcomes collected from surveys at the baseline and end-of-treatment visits. Results: Participants (N=38) were 63% (24/38) female, 18% (7/38) Hispanic or Latino, and 29% (11/38) African American. They had an average age of 49 years and smoked an average of 15 (SD 7.9) cigarettes per day. Results indicated that receiving the JITAI significantly reduced proximal negative affect in the second (and final) week of the intervention. Self-reports provided at baseline and end of treatment showed significant decreases in perceived stress, automaticity of smoking and craving, and a significant increase in abstinence self-efficacy. Increases in abstinence self-efficacy significantly predicted abstinence. Conclusions: To our knowledge, this is the first study to test the proximal impact of a mindfulness-based JITAI on key variables associated with smoking cessation. Our primary finding was that negative affect was lower following the completion of a strategy (vs when no strategy was delivered) in the final week of the JITAI. Among a larger sample size, future research should extend the length of the intervention to further evaluate the impact of the JITAI, as well as include a comparison condition to further evaluate how each component of the intervention uniquely impacts outcomes. Trial Registration: ClinicalTrials.gov NCT03404596; https://clinicaltrials.gov/study/NCT03404596 %M 40106803 %R 10.2196/55379 %U https://mhealth.jmir.org/2025/1/e55379 %U https://doi.org/10.2196/55379 %U http://www.ncbi.nlm.nih.gov/pubmed/40106803 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60791 %T Prehabilitation Program for Lung and Esophageal Cancers (Boosting Recovery and Activity Through Early Wellness): Protocol for a Nonrandomized Trial %A Langley,Jodi E %A Sibley,Daniel %A Chiekwe,Joy %A Keats,Melanie R %A Snow,Stephanie %A Purcell,Judith %A Sollows,Stephen %A Hill,Leslie %A Watton,David %A Gaudry,Abbigael E %A Hashish,Ibrahim %A Wallace,Alison %+ Dalhousie University, 6299 South Street, Halifax, NS, B3H 4J1, Canada, 1 9023186113, jodi.langley@dal.ca %K cancer %K prehabilitation %K physical activity %K lung %K esophageal %K wellness %K surgical %K candidacy %K feasibility %K implementation %K community-based %K coaching program %K Canada %K lung cancer %K esophageal cancer %K surgery %K nonrandomized trial %K mixed method %D 2025 %7 10.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer is the leading cause of death in Canada, responsible for 28.2% of all deaths. Based on surgical candidacy and disease status, both lung and esophageal cancer are treated through surgical resection by a thoracic surgeon. Although surgery contributes to improved outcomes, the 30-day postoperative mortality risks are as high as 10% and 2.8%, respectively. Evidence has shown that prehabilitation is a way in which patients can have improved postoperative outcomes. Prehabilitation is multimodal, often including some form of movement, nutrition, stress management, and smoking cessation. Given the complexity of the health care system, pragmatic trials are important methodological tools to assess internal validity and improve current practice under real-world conditions. Concurrently, using community resources is imperative to keep people active in their community and create sustainable programming. Objective: The Boosting Recovery and Activity Through Early Wellness (BREATHE WELL) study aims to explore the feasibility, implementation, and preliminary effectiveness of a clinically integrated, community-based, prehabilitation health coaching program. This includes nutrition, smoking cessation, sleep hygiene, and movement for individuals scheduled to undergo surgery for lung or esophageal cancer. Methods: This is a pilot, nonrandomized, pragmatic, repeated measures, mixed methods trial. We will recruit 32 participants diagnosed with lung or esophageal cancer and are scheduled to undergo surgical resection into the prehabilitation program, with 32 additional participants who decline participation to act as a control group. Participants who agree will then go through an 8-week tailored prehabilitation program (in person or virtual), covering movement, nutrition, stress management, nutrition, goal setting, and smoking cessation. They will complete 6 sessions prior to surgery and then have 4 sessions, 1×/week following surgery. Following the completion of the program, they will have 3 booster sessions via phone or Zoom (Zoom Video Communications). The primary outcome is feasibility: (1) recruitment feasibility—recruitment rate (the number of participants referred per month), enrollment rate (the number of enrolled participants divided by the number of referred participants), reasons for declining, and prehabilitation window (time between consent and surgery); and (2) intervention feasibility—adherence to the movement intervention, attrition, safety, study completion rate, and adverse events. Secondary outcomes include measures of preliminary effectiveness including patient-reported outcomes, such as well-being, fatigue, and functional measures. All measures will be assessed before, during, and after the prehabilitation program. Results: Enrollment has begun in January 2025, with 2 participants enrolled in the health coaching program. The full study is expected to be completed in approximately 3 years and be published in winter 2027. Conclusions: This study will inform the feasibility, implementation, and preliminary effectiveness of a clinically integrated, community-based, prehabilitation program in Nova Scotia, Canada, for people scheduled to undergo curative intent surgery for lung and esophageal cancer. Trial Registration: ClinicalTrials.gov NCT06354959; https://clinicaltrials.gov/study/NCT06354959 International Registered Report Identifier (IRRID): PRR1-10.2196/60791 %M 40063931 %R 10.2196/60791 %U https://www.researchprotocols.org/2025/1/e60791 %U https://doi.org/10.2196/60791 %U http://www.ncbi.nlm.nih.gov/pubmed/40063931 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63631 %T Large Language Models’ Accuracy in Emulating Human Experts’ Evaluation of Public Sentiments about Heated Tobacco Products on Social Media: Evaluation Study %A Kim,Kwanho %A Kim,Soojong %+ Department of Communication, University of California Davis, 1 Shields Ave, Kerr Hall #361, Davis, CA, 95616, United States, 1 530 752 0966, sjokim@ucdavis.edu %K heated tobacco products %K artificial intelligence %K large language models %K social media %K sentiment analysis %K ChatGPT %K generative pre-trained transformer %K GPT %K LLM %K NLP %K natural language processing %K machine learning %K language model %K sentiment %K evaluation %K social media %K tobacco %K alternative %K prevention %K nicotine %K OpenAI %D 2025 %7 4.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Sentiment analysis of alternative tobacco products discussed on social media is crucial in tobacco control research. Large language models (LLMs) are artificial intelligence models that were trained on extensive text data to emulate the linguistic patterns of humans. LLMs may hold the potential to streamline the time-consuming and labor-intensive process of human sentiment analysis. Objective: This study aimed to examine the accuracy of LLMs in replicating human sentiment evaluation of social media messages relevant to heated tobacco products (HTPs). Methods: GPT-3.5 and GPT-4 Turbo (OpenAI) were used to classify 500 Facebook (Meta Platforms) and 500 Twitter (subsequently rebranded X) messages. Each set consisted of 200 human-labeled anti-HTPs, 200 pro-HTPs, and 100 neutral messages. The models evaluated each message up to 20 times to generate multiple response instances reporting its classification decisions. The majority of the labels from these responses were assigned as a model’s decision for the message. The models’ classification decisions were then compared with those of human evaluators. Results: GPT-3.5 accurately replicated human sentiment evaluation in 61.2% of Facebook messages and 57% of Twitter messages. GPT-4 Turbo demonstrated higher accuracies overall, with 81.7% for Facebook messages and 77% for Twitter messages. GPT-4 Turbo’s accuracy with 3 response instances reached 99% of the accuracy achieved with 20 response instances. GPT-4 Turbo’s accuracy was higher for human-labeled anti- and pro-HTP messages compared with neutral messages. Most of the GPT-3.5 misclassifications occurred when anti- or pro-HTP messages were incorrectly classified as neutral or irrelevant by the model, whereas GPT-4 Turbo showed improvements across all sentiment categories and reduced misclassifications, especially in incorrectly categorized messages as irrelevant. Conclusions: LLMs can be used to analyze sentiment in social media messages about HTPs. Results from GPT-4 Turbo suggest that accuracy can reach approximately 80% compared with the results of human experts, even with a small number of labeling decisions generated by the model. A potential risk of using LLMs is the misrepresentation of the overall sentiment due to the differences in accuracy across sentiment categories. Although this issue could be reduced with the newer language model, future efforts should explore the mechanisms underlying the discrepancies and how to address them systematically. %M 40053746 %R 10.2196/63631 %U https://www.jmir.org/2025/1/e63631 %U https://doi.org/10.2196/63631 %U http://www.ncbi.nlm.nih.gov/pubmed/40053746 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55592 %T Utilization and Experiences of Using Quit Now, a Nicotine and Tobacco Smoking Cessation Website: Thematic Analysis %A Salaheddin,Tala %A Sharma,Ramona H %A Fajardo,Marcela %A Panter,Cameron %A De Souza,Lauren %A Matano,Sheila Kanyevu %A Struik,Laura %+ Doctor of Medicine Program, Faculty of Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada, 1 6048222211, talasala@student.ubc.ca %K smoking cessation %K user experiences %K nicotine %K vaping %K web-based %K Google Analytics %K thematic analysis %K digital health %K nicotine replacement therapy %K quit attempts %K tobacco %K British Columbia %K behavioral support %K pharmacotherapy %K qualitative interview %K cessation support %K QuitNow %K mobile health %K mHealth %K intervention %D 2025 %7 4.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: British Columbia residents have access to a program called QuitNow that provides behavioral support and information about pharmacotherapy to nicotine and tobacco users. Web- or computer-based smoking cessation programs have been shown to yield an abstinence rate about 1.5 times higher when compared to a control. Although quantitative evidence reveals significant promise for web-based services like QuitNow, there is very little qualitative evidence available. Understanding website utilization and the experiences of end users is key to contextualizing the effectiveness of web-based cessation services and providing directions for enhancing these services. Objective: This qualitative interview study aims to delve into users’ utilization and experiences of QuitNow, which is supplemented by Google Analytics data. Methods: We interviewed 10 QuitNow users using semistructured interviews to understand what they liked the most and the least about QuitNow. We transcribed these interviews and conducted an inductive thematic analysis using NVivo (QSR International) software to extract common themes about user experiences. We also gathered utilization metrics via Google Analytics (n=13,856 users) to understand which aspects of QuitNow were used the most and which were used the least during the study period. Results: Thematic analysis yielded four major themes: (1) barriers to information access reduce opportunities to take action, (2) lack of clarity around pharmacological options is discouraging, (3) hearing from others is an important part of the journey, and (4) recognizing own agency throughout the quit process. These themes provided context and support for the Google Analytics data, which showed that end user activity, measured by indicators such as page views and average time spent on each page, was highest on pages about how to quit (10,393 page views), pharmacology information (1999 page views), and the community forum (11,560 page views). Conclusions: Results of this study point to several important implications for improving the website, as well as directions for enhancing cessation support services in general. %M 40053769 %R 10.2196/55592 %U https://www.jmir.org/2025/1/e55592 %U https://doi.org/10.2196/55592 %U http://www.ncbi.nlm.nih.gov/pubmed/40053769 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60527 %T Enhancing Text Message Support With Media Literacy and Financial Incentives for Vaping Cessation in Young Adults: Protocol for a Pilot Randomized Controlled Trial %A Michaud,Tzeyu %A Puga,Troy %A Archer,Rex %A Theye,Elijah %A Zagurski,Cleo %A Estabrooks,Paul %A Dai,Hongying Daisy %+ Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE, 68198, United States, 1 4028369195, tzeyu.michaud@unmc.edu %K contingency management %K e-cigarettes %K social support %K youth %K electronic health record %K opt-in %K recruitment %K tobacco marketing %K cessation %K peer support %K young adult %K feasibility %K public health %D 2025 %7 21.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The persistent high prevalence of e-cigarette use among young adults remains a significant public health concern, with limited evidence and guidance on effective vaping cessation programs targeting this population. Objective: This study aims to outline the study design and protocol of a pilot randomized controlled trial aimed at investigating feasibility and assessing whether media literacy education or financial incentives enhance the effectiveness of evidence-based text message support in promoting vaping abstinence among young adult e-cigarette users. Methods: The pilot study uses a 4-arm (1:1:1:1) randomized controlled trial design to assess the potential impact of different combinations of media literacy education, financial incentives, and text message support on vaping abstinence over a 3-month period. The first month serves as a preparatory phase for quitting, followed by 2 months focused on abstinence. A total of 80 individuals, aged 19-29 years, who have used e-cigarettes within the past 30 days, have internet access, and express interest in quitting vaping within the next 30 days, will be enrolled. Eligible individuals will be randomized into one of the four study groups: (1) Text Message, (2) Media Literacy, (3) Financial Incentive, and (4) Combined. All participants, regardless of group assignment, will receive text message support. Participants will be followed for 12 weeks, with abstinence status assessed at week 12, as well as during remote check-ins at weeks 6, 8, and 10. Feasibility measures include recruitment rate, reach, engagement, and retention. Other outcomes of interest include self-reported 7-day abstinence and changes in nicotine dependence and media literacy scores. Exit interviews will be conducted with those who complete the study to explore facilitators of and barriers to participation and engagement in vaping cessation, which will inform future program refinement and uptake. Results: Recruitment for the study commenced in December 2023 and concluded in August 2024. A total of 40 participants were randomized into these groups: 9 for Text Message, 11 for Media Literacy, 10 for Financial Incentive, and 10 for the Combined group. The final assessment was completed in November 2024, and analyses are currently ongoing. Conclusions: The findings from this trial could provide valuable insights into the design and uptake of vaping cessation strategies among the young adult population. Trial Registration: ClinicalTrials.gov NCT05586308; https://clinicaltrials.gov/study/NCT05586308 International Registered Report Identifier (IRRID): DERR1-10.2196/60527 %M 39983103 %R 10.2196/60527 %U https://www.researchprotocols.org/2025/1/e60527 %U https://doi.org/10.2196/60527 %U http://www.ncbi.nlm.nih.gov/pubmed/39983103 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66446 %T Spatiotemporal Characteristics and Influential Factors of Electronic Cigarette Web-Based Attention in Mainland China: Time Series Observational Study %A Zhang,Zhongmin %A Xu,Hengyi %A Pan,Jing %A Song,Fujian %A Chen,Ting %+ Healthy Hubei Development and Social Progress Research Center of the Key Research Base of Humanities and Social Sciences in Hubei Province, School of Public Health, Wuhan University of Science and Technology, 2 Huangjiahuxi Road, Hongshan District, Wuhan, 430065, China, 86 18120237582, chent41@wust.edu.cn %K electronic cigarettes %K Baidu index %K web-based attention %K spatiotemporal characteristics %K China %D 2025 %7 10.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The popularity of electronic cigarettes (e-cigarettes) has steadily increased, prompting a considerable number of individuals to search for relevant information on them. Previous e-cigarette infodemiology studies have focused on assessing the quality and reliability of website content and quantifying the impact of policies. In reality, most low-income countries and low- and middle-income countries have not yet conducted e-cigarette use surveillance. Data sourced from web-based search engines related to e-cigarettes have the potential to serve as cost-effective supplementary means to traditional monitoring approaches. Objective: This study aimed to analyze the spatiotemporal distribution characteristics and associated sociodemographic factors of e-cigarette searches using trends from the Baidu search engine. Methods: The query data related to e-cigarettes for 31 provinces in mainland China were retrieved from the Baidu index database from January 1, 2015, to December 31, 2022. Concentration ratio methods and spatial autocorrelation analysis were applied to analyze the temporal aggregation and spatial aggregation of the e-cigarette Baidu index, respectively. A variance inflation factor test was performed to avoid multicollinearity. A spatial panel econometric model was developed to assess the determinants of e-cigarette web-based attention. Results: The daily average Baidu index for e-cigarettes increased from 53,234.873 in 2015 to 85,416.995 in 2021 and then declined to 52,174.906 in 2022. This index was concentrated in the southeastern coastal region, whereas the hot spot shifted to the northwestern region after adjusting for population size. Positive spatial autocorrelation existed in the per capita Baidu index of e-cigarettes from 2015 to 2022. The results of the local Moran’s I showed that there were mainly low-low cluster areas of the per capita Baidu index, especially in the central region. Furthermore, the male-female ratio, the proportion of high school and above education, and the per capita gross regional domestic product were positively correlated with the per capita Baidu index for e-cigarettes. A higher urbanization rate was associated with a reduced per capita Baidu index. Conclusions: With the increasing popularity of web-based searches for e-cigarettes, a targeted e-cigarette health education program for individuals in the northwest, males, rural populations, high school and above educated individuals, and high-income groups is warranted. %M 39928402 %R 10.2196/66446 %U https://www.jmir.org/2025/1/e66446 %U https://doi.org/10.2196/66446 %U http://www.ncbi.nlm.nih.gov/pubmed/39928402 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57398 %T Tobacco Use, Risk Perceptions, and Characteristics of Adults Who Used a Heated Tobacco Product (IQOS) in the United States: Cross-Sectional Survey Study %A Cheng,Hui G %A Noggle,Brendan %A Vansickel,Andrea R %A Largo,Edward G %A Magnani,Pierpaolo %+ Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, United States, 1 8595765695, Andrea.R.Vansickel@altria.com %K United States Food and Drug Administration %K FDA %K IQOS %K Tobacco Heating System %K THS %K heated tobacco products %K modified risk tobacco products %K MRTP %K tobacco %K nicotine %K smokers %K tobacco harm reduction %K cross-sectional surveys %K cigarettes %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The Tobacco Heating System (THS; commercialized as IQOS) is a smoke-free heated tobacco product introduced in the United States in 2019 and authorized by the US Food and Drug Administration as a modified risk tobacco product (MRTP) in 2020. THS consists of a holder and specially designed tobacco sticks that are heated instead of burned to produce a nicotine-containing aerosol. THS was available in Atlanta, Georgia; Richmond, Virginia; Charlotte, North Carolina; the Northern Virginia region; and South Carolina before its market removal in November 2021. Objective: This study aims to describe selected sociodemographic characteristics and self-reported health history of adults who used IQOS (AUIs), their tobacco use patterns (eg, tobacco use history, exclusive and dual-use, and switching from cigarette smoking), their risk perceptions of the product, and their understanding of MRTP messages. Methods: The IQOS Cross-Sectional Postmarket Adult Consumer Study was a study of AUIs aged 21 years or older who were recruited from a consumer database via direct postal mail and emails. Participants completed the online survey between September and November 2021. Results: The survey was completed by 645 current and 43 former AUIs who had used at least 100 tobacco sticks (considered established THS use) before the assessment. Of the 688 participants, 424 (61.6%) were male, 502 (73.0%) were non–Hispanic White, and the mean age was 45 years. The vast majority (680/688, 98.8%) of AUIs had ever smoked combusted cigarettes before first trying THS and 628 (91.3%) had smoked cigarettes in the 30 days before first using THS. At the time of assessment, 161 (23.4%) reported using e-cigarettes (vs 229, 33.3%, before THS use), 92 (13.4%) reported smoking cigars (vs 114, 16.6%, before THS use), and 338 (49.1%) were still smoking after an average of 1 year of THS use. Among those currently using THS who were still smoking (n=298), 249 (83.6%) smoked fewer cigarettes compared with before first trying THS; 362 of 688 (52.6%) AUIs reported having no physical health conditions evaluated in this study and almost three-quarters reported having no mental health conditions. Among all AUIs, over 563 (81.8%) had never used a cessation treatment or had not used it in the past 12 months, and 555 (80.7%) AUIs demonstrated a correct understanding of the MRTP message and AUIs perceived THS as having a lower risk than cigarettes (43.8 vs 64.4 on a 100-point composite score scale). Conclusions: This study provides evidence that THS can help adult smokers in the United States completely switch away from cigarettes or reduce smoking. %M 39919732 %R 10.2196/57398 %U https://formative.jmir.org/2025/1/e57398 %U https://doi.org/10.2196/57398 %U http://www.ncbi.nlm.nih.gov/pubmed/39919732 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e53566 %T Adapting a Mobile Health App for Smoking Cessation in Black Adults With Anxiety Through an Analysis of the Mobile Anxiety Sensitivity Program Proof-of-Concept Trial: Qualitative Study %A Cheney,Marshall K %A Alexander,Adam C %A Garey,Lorra %A Gallagher,Matthew W %A Hébert,Emily T %A Vujanovic,Anka A %A Kezbers,Krista M %A Matoska,Cameron T %A Zvolensky,Michael J %A Businelle,Michael S %+ Department of Health and Exercise Science, University of Oklahoma, 1401 Asp Ave, Norman, OK, 73019, United States, 1 4053255211, marshall@ou.edu %K cultural tailoring %K tailoring %K African American %K black %K smoking cessation %K mHealth %K smartphone application %K just in time adaptive intervention %K qualitative %K formative evaluation %K app %K application %K anxiety %K adult %K qualitative analysis %K smoking %K mobile phone %K tobacco %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: At least half of smokers make a serious quit attempt each year, but Black adults who smoke are less likely than White adults who smoke to quit smoking successfully. Black adults who smoke and have high anxiety sensitivity (an individual difference factor implicated in smoking relapse and culturally relevant to Black adults) are even less successful. The Mobile Anxiety Sensitivity Program for Smoking (MASP) is a smoking cessation smartphone app culturally tailored to Black adults who smoke to increase smoking cessation rates by targeting anxiety sensitivity. Objective: This study examined the acceptability and feasibility of the MASP smartphone app following a 6-week pilot test through postintervention qualitative interviews. Methods: The MASP smoking cessation app was adapted from an evidence-based app by adding culturally tailored narration and images specific to the Black community, educational content on tobacco use in the Black community and the role of menthol, culturally tailored messages, and addressing tobacco use and racial discrimination. The MASP app was piloted with 24 adults with high anxiety sensitivity who identified as Black, smoked daily, and were not currently using medications or psychotherapy for smoking cessation. At the end of the 6-week pilot test, 21/24 participants (67% female; 95.2% non-Hispanic; mean age=47.3 years; 43% college educated; 86% single or separated) completed an audio-recorded semistructured interview assessing the acceptability and utility of the app, individual experiences, barriers to use, the cultural fit for Black adults who wanted to quit smoking, and identified areas for improvement. Transcribed interviews were coded using NVivo (Lumivero), and then analyzed for themes using an inductive, use-focused process. Results: Most participants (17/21, 81%) had smoked for more than 20 years and 29% (6/21) of them smoked more than 20 cigarettes daily. Participants felt the MASP app was helpful in quitting smoking (20/21, 95%) and made them more aware of smoking thoughts, feelings, and behaviors (16/19, 84%). Half of the participants (11/21, 52%) thought the combination of medication and smartphone app gave them the best chance of quitting smoking. Themes related to participant experiences using the app included establishing trust and credibility through the recruitment experience, providing personally tailored content linked to evidence-based stress reduction techniques, and self-reflection through daily surveys. The culturally tailored material increased app relevance, engagement, and acceptability. Suggested improvements included opportunities to engage with other participants, more control over app functions, and additional self-monitoring functions. Conclusions: Adding culturally tailored material to an evidence-based mobile health (mHealth) intervention could increase the use of smoking cessation interventions among Black adults who want to quit smoking. Qualitative interviews provide mHealth app developers important insights into how apps can be improved before full study implementation and emphasize the importance of getting feedback from the target population throughout the development process of mHealth interventions. Trial Registration: ClinicalTrials.gov NCT04838236; https://clinicaltrials.gov/ct2/show/NCT04838236 %M 39918847 %R 10.2196/53566 %U https://formative.jmir.org/2025/1/e53566 %U https://doi.org/10.2196/53566 %U http://www.ncbi.nlm.nih.gov/pubmed/39918847 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e69311 %T Evaluating the Impact of Pharmacotherapy in Augmenting Quit Rates Among Hispanic Adults in an App-Delivered Smoking Cessation Intervention: Secondary Analysis of a Randomized Controlled Trial %A Santiago-Torres,Margarita %A Mull,Kristin E %A Sullivan,Brianna M %A Cupertino,Ana Paula %A Salloum,Ramzi G %A Triplette,Matthew %A Zvolensky,Michael J %A Bricker,Jonathan B %+ Division of Public Health Sciences, Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, Seattle, WA, 98109, United States, 1 206 667 4780, msantiag@fredhutch.org %K acceptance and commitment therapy %K Hispanic or Latino %K iCanQuit %K QuitGuide %K smartphone apps %K smoking cessation %K mobile phone %D 2025 %7 31.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Hispanic adults receive less advice to quit smoking and use fewer evidence-based smoking cessation treatments compared to their non-Hispanic counterparts. Digital smoking cessation interventions, such as those delivered via smartphone apps, provide a feasible and within-reach treatment option for Hispanic adults who smoke and want to quit smoking. While the combination of pharmacotherapy and behavioral interventions are considered best practices for smoking cessation, its efficacy among Hispanic adults, especially alongside smartphone app–based interventions, is uncertain. Objective: This secondary analysis used data from a randomized controlled trial that compared the efficacy of 2 smoking cessation apps, iCanQuit (based on acceptance and commitment therapy) and QuitGuide (following US clinical practice guidelines), to explore the association between pharmacotherapy use and smoking cessation outcomes among the subsample of 173 Hispanic participants who reported on pharmacotherapy use. Given the randomized design, we first tested the potential interaction of pharmacotherapy use and intervention arm on 12-month cigarette smoking abstinence. We then examined whether the use of any pharmacotherapy (ie, nicotine replacement therapy [NRT], varenicline, or bupropion) and NRT alone augmented each app-based intervention efficacy. Methods: Participants reported using pharmacotherapy on their own during the 3-month follow-up and cigarette smoking abstinence at the 12-month follow-up via web-based surveys. These data were used (1) to test the interaction effect of using pharmacotherapy to aid smoking cessation and intervention arm (iCanQuit vs QuitGuide) on smoking cessation at 12 months and (2) to test whether the use of pharmacotherapy to aid smoking cessation augmented the efficacy of each intervention arm to help participants successfully quit smoking. Results: The subsample of Hispanic participants was recruited from 30 US states. They were on average 34.5 (SD 9.3) years of age, 50.9% (88/173) were female, and 56.1% (97/173) reported smoking at least 10 cigarettes daily. Approximately 22% (38/173) of participants reported using pharmacotherapy to aid smoking cessation at the 3-month follow-up, including NRT, varenicline, or bupropion, with no difference between intervention arms. There was an interaction between pharmacotherapy use and intervention arm that marginally influenced 12-month quit rates at 12 months (P for interaction=.053). In the iCanQuit arm, 12-month missing-as-smoking quit rates were 43.8% (7/16) for pharmacotherapy users versus 28.8% (19/16) for nonusers (odds ratio 2.21, 95% CI 0.66-7.48; P=.20). In the QuitGuide arm, quit rates were 9.1% (2/22) for pharmacotherapy users versus 21.7% (15/69) for nonusers (odds ratio 0.36, 95% CI 0.07-1.72; P=.20). Results were similar for the use of NRT only. Conclusions: Combining pharmacotherapy to aid smoking cessation with a smartphone app–based behavioral intervention that teaches acceptance of cravings to smoke (iCanQuit) shows promise in improving quit rates among Hispanic adults. However, this combined approach was not effective with the US clinical guideline–based app (QuitGuide). Trial Registration: ClinicalTrials.gov NCT02724462; https://clinicaltrials.gov/study/NCT02724462 International Registered Report Identifier (IRRID): RR2-10.1001/jamainternmed.2020.4055 %R 10.2196/69311 %U https://formative.jmir.org/2025/1/e69311 %U https://doi.org/10.2196/69311 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e69771 %T An mHealth Intervention With Financial Incentives to Promote Smoking Cessation and Physical Activity Among Black Adults: Protocol for a Feasibility Randomized Controlled Trial %A Alexander,Adam %A Businelle,Michael %A Cheney,Marshall %A Cohn,Amy %A McNeill,Lorna %A Short,Kevin %A Frank-Pearce,Summer %A Bradley,David %A Estrada,Kimberly %A Flores,Iván %A Fronheiser,Jack %A Kendzor,Darla %+ University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 (405) 965 05, Adam-Alexander@ouhsc.edu %K African American %K Black %K mobile health %K mHealth %K smartphone app %K smoking cessation %K physical activity, mobile phone %D 2025 %7 31.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black adults in the United States experience disproportionately high rates of tobacco- and obesity-related diseases, driven in part by disparities in smoking cessation and physical activity. Smartphone-based interventions with financial incentives offer a scalable solution to address these health disparities. Objective: This study aims to assess the feasibility and preliminary efficacy of a mobile health intervention that provides financial incentives for smoking cessation and physical activity among Black adults. Methods: A total of 60 Black adults who smoke (≥5 cigarettes/d) and are insufficiently physically active (engaging in <150 min of weekly moderate-intensity physical activity) will be randomly assigned to either HealthyCells intervention (incentives for smoking abstinence only) or HealthyCells+ intervention (incentives for both smoking abstinence and daily step counts). Participants will use study-provided smartphones, smartwatches, and carbon monoxide monitors for 9 weeks (1 wk prequit date through 8 wk postquit date). Feasibility will be evaluated based on recruitment rates, retention, and engagement. The primary outcomes include carbon monoxide–verified, 7-day smoking abstinence at 8 weeks postquit date and changes in average daily step count. Feasibility benchmarks include a recruitment rate of ≥5 participants per month, a retention rate of ≥75%, and a smoking abstinence rate of ≥20% at 8 weeks postquit date. Expected increases in physical activity include a net gain of 500 to 1500 steps per day compared to baseline. Results: Recruitment is expected to begin in February 2025 and conclude by September 2025, with data analysis completed by October 2025. Conclusions: This study will evaluate the feasibility of a culturally tailored mobile health intervention combining financial incentives for smoking cessation and physical activity promotion. Findings will inform the design of larger-scale trials to address health disparities through scalable, technology-based approaches. Trial Registration: ClinicalTrials.gov NCT05188287; https://clinicaltrials.gov/ct2/show/NCT05188287 International Registered Report Identifier (IRRID): PRR1-10.2196/69771 %M 39888657 %R 10.2196/69771 %U https://www.researchprotocols.org/2025/1/e69771 %U https://doi.org/10.2196/69771 %U http://www.ncbi.nlm.nih.gov/pubmed/39888657 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66896 %T Assessing the Adherence of ChatGPT Chatbots to Public Health Guidelines for Smoking Cessation: Content Analysis %A Abroms,Lorien C %A Yousefi,Artin %A Wysota,Christina N %A Wu,Tien-Chin %A Broniatowski,David A %+ Department of Prevention & Community Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Avenue NW, Washington, DC, 20052, United States, 1 202 9943518, lorien@gwu.edu %K ChatGPT %K large language models %K chatbots %K tobacco %K smoking cessation %K cigarettes %K artificial intelligence %D 2025 %7 30.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Large language model (LLM) artificial intelligence chatbots using generative language can offer smoking cessation information and advice. However, little is known about the reliability of the information provided to users. Objective: This study aims to examine whether 3 ChatGPT chatbots—the World Health Organization’s Sarah, BeFreeGPT, and BasicGPT—provide reliable information on how to quit smoking. Methods: A list of quit smoking queries was generated from frequent quit smoking searches on Google related to “how to quit smoking” (n=12). Each query was given to each chatbot, and responses were analyzed for their adherence to an index developed from the US Preventive Services Task Force public health guidelines for quitting smoking and counseling principles. Responses were independently coded by 2 reviewers, and differences were resolved by a third coder. Results: Across chatbots and queries, on average, chatbot responses were rated as being adherent to 57.1% of the items on the adherence index. Sarah’s adherence (72.2%) was significantly higher than BeFreeGPT (50%) and BasicGPT (47.8%; P<.001). The majority of chatbot responses had clear language (97.3%) and included a recommendation to seek out professional counseling (80.3%). About half of the responses included the recommendation to consider using nicotine replacement therapy (52.7%), the recommendation to seek out social support from friends and family (55.6%), and information on how to deal with cravings when quitting smoking (44.4%). The least common was information about considering the use of non–nicotine replacement therapy prescription drugs (14.1%). Finally, some types of misinformation were present in 22% of responses. Specific queries that were most challenging for the chatbots included queries on “how to quit smoking cold turkey,” “...with vapes,” “...with gummies,” “...with a necklace,” and “...with hypnosis.” All chatbots showed resilience to adversarial attacks that were intended to derail the conversation. Conclusions: LLM chatbots varied in their adherence to quit-smoking guidelines and counseling principles. While chatbots reliably provided some types of information, they omitted other types, as well as occasionally provided misinformation, especially for queries about less evidence-based methods of quitting. LLM chatbot instructions can be revised to compensate for these weaknesses. %M 39883917 %R 10.2196/66896 %U https://www.jmir.org/2025/1/e66896 %U https://doi.org/10.2196/66896 %U http://www.ncbi.nlm.nih.gov/pubmed/39883917 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e53971 %T Smoking Cessation Smartphone App for Nondaily Smoking With Telephone Onboarding: Proof-of-Concept Randomized Controlled Trial %A Hoeppner,Bettina B %A Siegel,Kaitlyn R %A Futter,Allison E %A Finley-Abboud,Diadora %A Williamson,Alivia C %A Kahler,Christopher W %A Park,Elyse R %A Hoeppner,Susanne S %+ Health through Flourishing (HtF) program, Department of Psychiatry, Massachusetts General Hospital, 125 Nashua St, 4th Fl., Boston, MA, 02114, United States, 1 617 643 198, bhoeppner@mgh.harvard.edu %K mobile health %K mHealth %K smoking cessation %K nondaily smoking %K smartphone %K smoking %K positive psychology %K mobile phone %D 2025 %7 15.1.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nondaily smoking is a widespread and increasingly prevalent pattern of use. To date, no effective treatment approach for nondaily smoking has been identified. Objective: This study aimed to conduct an unblinded randomized controlled trial to evaluate proof-of-concept markers of the Smiling instead of Smoking (SiS) app, a smartphone app for smoking cessation, designed specifically for people who smoke less than daily, within the framework of positive psychology. Methods: Overall, 226 adults who smoke less than daily were recruited on the web and asked to undertake a quit attempt while using assigned smoking cessation support materials. Participants were randomly assigned to 1 of 3 materials: the SiS smartphone app, the National Cancer Institute’s smartphone app QuitGuide (QG), or the National Cancer Institute’s smoking cessation brochure, “Clearing the Air” (CtA). All participants engaged in a 15-minute scripted onboarding phone call and were introduced to their support materials to use for the next 7 weeks. Follow-up self-assessment web surveys were sent 2, 6, 12, and 24 weeks after participants’ initially chosen quit date (ie, 1 week after onboarding). The primary outcome for this study was self-efficacy to remain abstinent from smoking at treatment end. Secondary outcomes assessed treatment acceptability, treatment feasibility (eg, number of days of app use, time spent using app, and use of smoking cessation strategies), and secondary proof-of-concept efficacy outcomes (eg, positive affect, craving, and attitudes toward smoking). Smoking outcomes (ie, 30-day point prevalence abstinence and smoking reduction) were also assessed. Results: Results indicated a significant effect of treatment on the primary outcome, where SiS participants (n=80) reported higher self-efficacy to abstain from smoking at the end of treatment than the 2 control groups (QG: n=75; P=.02; Cohen d=0.40 and CtA: n=71; P=.007; Cohen d=0.50). This effect was also significant on both self-efficacy subscales (ie, internal cues and external cues) with effect sizes ranging from Cohen d=0.34 to 0.50 across the pairwise comparisons. The SiS app group also reported lower craving (QG: P=.005; Cohen d=–0.57 and CtA: P=.005; Cohen d=–0.57) and higher positive affect than QG (QG: P=.01; Cohen d=0.44 and CtA: P=.05; Cohen d=0.38); attitudes toward smoking were largely similar across groups. Treatment acceptability was comparable across groups (P values for all groups >.05; Cohen d range 0.06-0.23). Treatment feasibility measures indicated that participants used the SiS app on 33 out of 49 days, for 35 to 40 minutes per week, resulting in greater use of smoking cessation strategies than QG (QG: P=.04; Cohen d=0.38 and CtA: P=.16; Cohen d=0.24). Conclusions: These findings provide strong evidence for the conceptual underpinnings of the SiS app, and thereby provide compelling justification for conducting a large-scale randomized controlled trial that can test the effectiveness of the SiS app on smoking cessation. Trial Registration: ClinicalTrials.gov NCT04672239; https://clinicaltrials.gov/study/NCT04672239 International Registered Report Identifier (IRRID): RR2-10.2196/40867 %M 39814363 %R 10.2196/53971 %U https://mhealth.jmir.org/2025/1/e53971 %U https://doi.org/10.2196/53971 %U http://www.ncbi.nlm.nih.gov/pubmed/39814363 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e37083 %T Eliciting Preferences for the Uptake of Smoking Cessation Apps: Discrete Choice Experiment %A Szinay,Dorothy %A Cameron,Rory A %A Jones,Andy %A Whitty,Jennifer A %A Chadborn,Tim %A Brown,Jamie %A Naughton,Felix %+ Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Research Park, Norwich, NR4 7TJ, United Kingdom, 44 01603456161, dorothy.szinay@uea.ac.uk %K discrete choice experiment %K uptake, engagement %K mHealth %K smartphone app %K smoking cessation %K health app %K behavior change %K TDF %K theoretical domains framework %K mobile phone %D 2025 %7 14.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: If the most evidence-based and effective smoking cessation apps are not selected by smokers wanting to quit, their potential to support cessation is limited. Objective: This study sought to determine the attributes that influence smoking cessation app uptake and understand their relative importance to support future efforts to present evidence-based apps more effectively to maximize uptake. Methods: Adult smokers from the United Kingdom were invited to participate in a discrete choice experiment. Participants made 12 choices between two hypothetical smoking cessation app alternatives, with five predefined attributes reflecting domains from the theoretical domains framework: (1) monthly price of the app (environmental resources), (2) credible source as app developer (social influence), (3) social proof as star rating (social influence), (4) app description type (beliefs about consequences), and (5) images shown (beliefs about consequences); or opting out (choosing neither app). Preferences and the relative importance of attributes were estimated using mixed logit modeling. Willingness to pay and predicted uptake of the most and least preferred app were also calculated. Results: A total of 337 adult smokers completed the survey (n=168, 49.8% female; mean age 35, SD 11 years). Participants selected a smoking cessation app rather than opting out for 90% of the choices. Relative to other attributes, a 4.8-star user rating, representing social proof, was the strongest driver of app selection (mean preference parameter 2.27, SD 1.55; 95% CI 1.95-2.59). Participants preferred an app developed by health care–orientated trusted organization (credible source) over a hypothetical company (mean preference parameter 0.93, SD 1.23; 95% CI 0.72-1.15), with a logo and screenshots over logo only (mean preference parameter 0.39, SD 0.96; 95% CI 0.19-0.59), and with a lower monthly cost (mean preference parameter –0.38, SD 0.33; 95% CI –0.44 to –0.32). App description did not influence preferences. The uptake estimate for the best hypothetical app was 93% and for the worst, 3%. Participants were willing to pay a single payment of up to an additional US $6.96 (UK £5.49) for 4.8-star ratings, US $3.58 (UK £2.82) for 4-star ratings, and US $2.61(UK £2.06) for an app developed by a trusted organization. Conclusions: On average, social proof appeared to be the most influential factor in app uptake, followed by credible source, one perceived as most likely to provide evidence-based apps. These attributes may support the selection of evidence-based apps. %M 39808479 %R 10.2196/37083 %U https://www.jmir.org/2025/1/e37083 %U https://doi.org/10.2196/37083 %U http://www.ncbi.nlm.nih.gov/pubmed/39808479 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58614 %T International Expert Consensus on Relevant Health and Functioning Concepts to Assess in Users of Tobacco and Nicotine Products: Delphi Study %A Law,Vivienne %A Afolalu,Esther F %A Abetz-Webb,Linda %A Wemyss,Lee Andrew %A Turner,Andrew %A Chrea,Christelle %+ PMI R&D, Philip Morris Product S.A., Quai Jeanrenaud 5, Neuchâtel, 2000, Switzerland, 41 58 242 2218, esther.afolalu@pmi.com %K Delphi study %K expert consensus %K outcome measures %K health and functioning %K tobacco and/or nicotine products %D 2025 %7 2.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: A Delphi study was conducted to reach a consensus among international clinical and health care experts on the most important health and functioning self-reported concepts when evaluating a switch from smoking cigarettes to using smoke-free tobacco and/or nicotine products (sf-TNPs). Objective: The aim of this research was to identify concepts considered important to measure when assessing the health and functioning status of users of tobacco and/or nicotine products. Methods: Experts (n=105), including health care professionals, researchers, and policy makers, from 26 countries with professional experience and knowledge of sf-TNPs completed a 3-round, adapted Delphi panel. Online surveys combining quantitative (MaxDiff best-worst scaling and latent class analysis) and qualitative assessments were used to rank and achieve alignment on the importance of 69 health and functioning concepts. All experts participating in round I completed round II, and 101 (95%) completed round III. Results: The round I analysis identified 36 (52%) out of 69 concepts that were refined for the round II assessment. The highest-ranked concepts reflected health-related impacts, while the lowest-ranked ranked concepts were related to aesthetics and social impacts. Round II ranking reinforced the importance of concepts relating to health impacts, and the analysis resulted in 20 concepts retained for round III assessment. In round III, the 4 highest-ranked concepts were cardiovascular symptoms, shortness of breath, chest pain, and worry about smoking-related diseases and impact on general health, and they made up 50% of the total score in the MaxDiff analysis. Experts reported likelihood of seeing measurable levels of change in the final 20 concepts with a switch to an sf-TNP. The majority of experts felt it was “likely” or “extremely likely” to observe changes in concepts such as gum problems (74/101, 73%), phlegm or mucus while coughing or not coughing (72/101, 71%), general perception of well-being (72/101, 71%), and throat irritation or sore throat (72/101, 71%). Latent class analysis revealed subgroups of experts with different perceptions of the relative importance of the concepts, which varied depending on professional specialty and geographic region. For example, 74% (14/19) of oncologists aligned with the subgroup prioritizing physical health symptoms, while 71% (12/17) of experts from Asia aligned with the subgroup considering both physical health and psychosocial aspects. Conclusions: This study identified key concepts to be considered in the development of a new measurement instrument to assess the self-reported health and functioning status of individuals using sf-TNPs. The findings contribute to the scientific evidence base for understanding and evaluating both the individual and public health impacts of sf-TNPs. %M 39746194 %R 10.2196/58614 %U https://formative.jmir.org/2025/1/e58614 %U https://doi.org/10.2196/58614 %U http://www.ncbi.nlm.nih.gov/pubmed/39746194 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54661 %T Concerns Over Vuse e-Cigarette Digital Marketing and Implications for Public Health Regulation: Content Analysis %A Han,Eileen %A Lempert,Lauren K %A Vescia,Francesca %A Halpern-Felsher,Bonnie %K e-cigarette %K social media marketing %K Vuse %K adolescents and young adults %K Food and Drug Administration %K FDA %K smoker %K smoking %K smoking device %K tobacco %K social media %K Instagram %K Facebook %K promote %K marketing %K mobile phone %D 2024 %7 27.12.2024 %9 %J JMIR Form Res %G English %X Background: Electronic cigarettes (e-cigarettes) are the most used form of tobacco products among adolescents and young adults, and Vuse is one of the most popular brands of e-cigarettes among US adolescents. In October 2021, Vuse Solo became the first e-cigarette brand to receive marketing granted orders (MGOs) from the US Food and Drug Administration (FDA), authorizing its marketing and their tobacco-flavored pods. Vuse Ciro and Vuse Vibe, and their tobacco-only (“original”) e-liquids, were authorized for marketing in May 2022 and Vuse Alto tobacco-flavored devices were authorized in July 2024. These marketing authorizations are contingent upon the company adhering to the MGOs’ stated marketing restrictions, including reducing exposure and appeal to youth via digital, radio, television, print, and point-of-sale advertising. Objective: In this study, we analyzed the official social media channels of Vuse (Instagram and Facebook) to examine how Vuse marketed its products on social media and whether these marketing posts contain potentially youth-appealing themes. Methods: We conducted content analysis of the official RJ Reynolds Vapor Company Instagram and Facebook accounts. We collected all posts from October 10, 2019, when RJ Reynolds Vapor Company submitted its premarket tobacco product application to the FDA, to February 21, 2022, to cover the first winter holiday season after the MGO. Two coders developed the codebook with 17 themes based on the Content Appealing to Youth index to capture the posts’ characteristics and potentially youth-appealing content. We calculated the percentage of posts in which each code was present. Results: A total of 439 unique posts were identified. During this study’s period, there were no posts on Instagram or Facebook marketing Vuse Solo (the authorized product at that time). Instead, Vuse Alto (unauthorized to date of study) was heavily marketed, with 59.5% (n=261) of the posts specifically mentioning the product name. Further, “Vuse” more generally was marketed on social media without differentiating between the authorized and unauthorized products (n=182, 41.5%). The marketing messages contained several potentially youth-appealing themes including creativity or innovation (n=189, 43.1%), individuality or freedom (n=106, 24.2%), and themes related to art (n=150, 34.2%), music (n=77, 17.5%), sports (n=125, 28.5%), nature (with n=49, 11.2% of the posts containing flora imageries), alcohol imagery (n=10, 2.3%), and technology (n=6, 1.4%). Conclusions: Although Vuse Alto e-cigarettes had not yet obtained FDA marketing authorization during the 28 months of data collection, they were the primary Vuse e-cigarette devices marketed on social media. Vuse social media posts use themes that are appealing to and likely promote youth use, including creativity and innovation, individuality or freedom, arts and music, nature, technology, and alcohol imagery. The FDA should (1) prohibit companies from comarketing unauthorized products alongside authorized products, and (2) exercise enforcement against even authorized products that are marketed using youth-appealing features. %R 10.2196/54661 %U https://formative.jmir.org/2024/1/e54661 %U https://doi.org/10.2196/54661 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63685 %T Improving Blood Pressure Control and Tobacco Use Cessation Intervention In Primary Care: Protocol for the Alabama Cardiovascular Cooperative Heart Health Improvement Project %A Foti,Kathryn %A Hubbard,Demetria %A Smith,Kimberly A %A Hearld,Larry %A Richman,Joshua %A Horton,Trudi %A Parker,Sharon %A Roughton,Dodey %A Craft,Macie %A Clarkson,Stephen A %A Jackson,Elizabeth A %A Cherrington,Andrea L %+ Department of Epidemiology, University of Alabama at Birmingham, 1655 University Blvd, 230-L, Birmingham, AL, 35294, United States, 1 2059347911, kfoti@uab.edu %K hypertension %K primary care %K quality improvement %K tobacco use %K smoking cessation %K healthcare quality %K quality of care %K risk modification %K cardiovascular disease prevention %D 2024 %7 20.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Alabama has the second highest rate of cardiovascular disease (CVD) mortality of any US state and a high prevalence of CVD risk factors such as hypertension, diabetes, obesity, and smoking. Within the state, there are disparities in CVD outcomes and risk factors by race or ethnicity and geography. Many primary care practices do not have the capacity for full-scale quality improvement (QI) initiatives. The Alabama Cardiovascular Cooperative (ALCC), which includes academic and community stakeholders, was formed to support primary care practices to implement QI initiatives to improve cardiovascular health. The ALCC is implementing a Heart Health Improvement Project (HHIP) in primary care practices with suboptimal rates of blood pressure (BP) control and tobacco use screening. Objective: The study aimed to support primary care practices to increase BP control among adults with hypertension and increase rates of tobacco use screening and cessation intervention. Methods: We are using a type 1 hybrid design to test the effects of the HHIP on BP control among adults with hypertension and tobacco use screening and cessation intervention, while collecting information on implementation. Primary care practices were recruited through existing practice networks and additional electronic and in-person outreach. To ensure participation from a broad range of clinics, we required at least 50% of practices to be Federally Qualified Health Centers or look-alikes and to include representation from practices in rural areas. At baseline, we collected information about practice characteristics and preintervention rates of BP control and tobacco use screening and cessation intervention. The QI intervention includes quarterly activities conducted over a 12-month period. The HHIP uses a multipronged approach to QI, including practice facilitation and technical assistance, on-site and e-learning, and improvement through data transparency. We will conduct a pre-post analysis to estimate the effects of the HHIP and whether there is an enduring change in outcomes after the 12 months of HHIP activities beyond what would be expected due to secular trends. Results: Practice recruitment took place between April 2021 and October 2022. After contacting 417 primary care practices, 51 were enrolled, including 28 Federally Qualified Health Centers or look-alikes; 47 practices implemented the HHIP. Among 45 practices that completed the baseline survey, 11 (24%) were solo practices, while 28 (62%) had 1-5 clinicians, and 6 (13%) had 6 or more clinicians. The median number of patient visits per year was 5819 (IQR 3707.3-8630.5). Practices had been in operation for a mean of 19.2 (SD 13.0) years. At baseline, the mean BP control rate was 49.6% and the rate of tobacco use screening and cessation intervention was 67.4%. Conclusions: If successful, the ALCC and HHIP may improve the implementation of evidence-based guidelines in primary care and, subsequently, cardiovascular health and health equity in the state of Alabama. International Registered Report Identifier (IRRID): DERR1-10.2196/63685 %M 39706585 %R 10.2196/63685 %U https://www.researchprotocols.org/2024/1/e63685 %U https://doi.org/10.2196/63685 %U http://www.ncbi.nlm.nih.gov/pubmed/39706585 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e47730 %T Targeting Key Risk Factors for Cardiovascular Disease in At-Risk Individuals: Developing a Digital, Personalized, and Real-Time Intervention to Facilitate Smoking Cessation and Physical Activity %A Versluis,Anke %A Penfornis,Kristell M %A van der Burg,Sven A %A Scheltinga,Bouke L %A van Vliet,Milon H M %A Albers,Nele %A Meijer,Eline %+ Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 712568433, E.Meijer@lumc.nl %K smoking %K physical activity %K virtual coach %K eHealth %K development %K collaboration %K conversational agent %K risk factor %K cardiovascular disease %K CVD %K digital %K smoking cessation %K intervention %D 2024 %7 20.12.2024 %9 Viewpoint %J JMIR Cardio %G English %X Health care is under pressure due to an aging population with an increasing prevalence of chronic diseases, including cardiovascular disease. Smoking and physical inactivity are 2 key preventable risk factors for cardiovascular disease. Yet, as with most health behaviors, they are difficult to change. In the interdisciplinary Perfect Fit project, scientists from different fields join forces to develop an evidence-based virtual coach (VC) that supports smokers in quitting smoking and increasing their physical activity. In this Viewpoint paper, intervention content, design, and implementation, as well as lessons learned, are presented to support other research groups working on similar projects. A total of 6 different approaches were used and combined to support the development of the Perfect Fit VC. The approaches used are (1) literature reviews, (2) empirical studies, (3) collaboration with end users, (4) content and technical development sprints, (5) interdisciplinary collaboration, and (6) iterative proof-of-concept implementation. The Perfect Fit intervention integrates evidence-based behavior change techniques with new techniques focused on identity change, big data science, sensor technology, and personalized real-time coaching. Intervention content of the virtual coaching matches the individual needs of the end users. Lessons learned include ways to optimally implement and tailor interactions with the VC (eg, clearly explain why the user is asked for input and tailor the timing and frequency of the intervention components). Concerning the development process, lessons learned include strategies for effective interdisciplinary collaboration and technical development (eg, finding a good balance between end users’ wishes and legal possibilities). The Perfect Fit development process was collaborative, iterative, and challenging at times. Our experiences and lessons learned can inspire and benefit others. Advanced, evidence-based digital interventions, such as Perfect Fit, can contribute to a healthy society while alleviating health care burden. %M 39705698 %R 10.2196/47730 %U https://cardio.jmir.org/2024/1/e47730 %U https://doi.org/10.2196/47730 %U http://www.ncbi.nlm.nih.gov/pubmed/39705698 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e57271 %T Unveiling the Influence of AI on Advancements in Respiratory Care: Narrative Review %A Alqahtani,Mohammed M %A Alanazi,Abdullah M M %A Algarni,Saleh S %A Aljohani,Hassan %A Alenezi,Faraj K %A F Alotaibi,Tareq %A Alotaibi,Mansour %A K Alqahtani,Mobarak %A Alahmari,Mushabbab %A S Alwadeai,Khalid %A M Alghamdi,Saeed %A Almeshari,Mohammed A %A Alshammari,Turki Faleh %A Mumenah,Noora %A Al Harbi,Ebtihal %A Al Nufaiei,Ziyad F %A Alhuthail,Eyas %A Alzahrani,Esam %A Alahmadi,Husam %A Alarifi,Abdulaziz %A Zaidan,Amal %A T Ismaeil,Taha %+ Department of Respiratory Therapy, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, MC-3129, PO Box 3660, Riyadh, 11481, Saudi Arabia, 966 501407856, Qahtanimoh@ksau-hs.edu.sa %K artificial intelligence %K AI %K respiratory care %K machine learning %K digital health %K narrative review %D 2024 %7 20.12.2024 %9 Review %J Interact J Med Res %G English %X Background: Artificial intelligence is experiencing rapid growth, with continual innovation and advancements in the health care field. Objective: This study aims to evaluate the application of artificial intelligence technologies across various domains of respiratory care. Methods: We conducted a narrative review to examine the latest advancements in the use of artificial intelligence in the field of respiratory care. The search was independently conducted by respiratory care experts, each focusing on their respective scope of practice and area of interest. Results: This review illuminates the diverse applications of artificial intelligence, highlighting its use in areas associated with respiratory care. Artificial intelligence is harnessed across various areas in this field, including pulmonary diagnostics, respiratory care research, critical care or mechanical ventilation, pulmonary rehabilitation, telehealth, public health or health promotion, sleep clinics, home care, smoking or vaping behavior, and neonates and pediatrics. With its multifaceted utility, artificial intelligence can enhance the field of respiratory care, potentially leading to superior health outcomes for individuals under this extensive umbrella. Conclusions: As artificial intelligence advances, elevating academic standards in the respiratory care profession becomes imperative, allowing practitioners to contribute to research and understand artificial intelligence’s impact on respiratory care. The permanent integration of artificial intelligence into respiratory care creates the need for respiratory therapists to positively influence its progression. By participating in artificial intelligence development, respiratory therapists can augment their clinical capabilities, knowledge, and patient outcomes. %M 39705080 %R 10.2196/57271 %U https://www.i-jmr.org/2024/1/e57271 %U https://doi.org/10.2196/57271 %U http://www.ncbi.nlm.nih.gov/pubmed/39705080 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59888 %T Don’t Forget the Humble Text Message: 25 Years of Text Messaging in Health %A Dobson,Rosie %A Whittaker,Robyn %A Abroms,Lorien C %A Bramley,Dale %A Free,Caroline %A McRobbie,Hayden %A Stowell,Melanie %A Rodgers,Anthony %+ School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand, 64 93737599, r.dobson@auckland.ac.nz %K text messaging %K messaging %K SMS %K texting %K mHealth %K mobile health %D 2024 %7 17.12.2024 %9 Viewpoint %J J Med Internet Res %G English %X Since the early studies exploring the use of SMS text messaging for health intervention, text messaging has played a pivotal role in the advancement of mobile health. As an intervention modality, text messaging has provided vital learnings for the design and delivery of interventions, particularly in low-resource settings. Despite the advances in technology over the last 25 years, text messaging is still being used in largely the same way to deliver health information, behavior change interventions, and support. The strong, consistent evidence for the benefits of this type of intervention has made text messaging a routine part of health interventions around the world. Key to its success is its simplicity, alongside the benefit of being arguably the most accessible form of consumer digital health intervention. Text message interventions are well suited for public health interventions due to their low cost, vast reach, frequent use, high read rates, and ability to be tailored and personalized. Furthermore, the nature of text messaging interventions makes them ideal for the delivery of multilingual, culturally tailored interventions, which is important in the context of increasing cultural diversity in many countries internationally. Indeed, studies assessing text message–based health interventions have shown them to be effective across sociodemographic and ethnic groups and have led to their adoption into national-level health promotion programs. With a growing focus on artificial intelligence, robotics, sensors, and other advances in digital health, there is an opportunity to integrate these technologies into text messaging programs. Simultaneously, it is essential that equity remains at the forefront for digital health researchers, developers, and implementers. Ensuring digital health solutions address inequities in health experienced across the world while taking action to maximize digital inclusion will ensure the true potential of digital health is realized. Text messaging has the potential to continue to play a pivotal role in the delivery of equitable digital health tools to communities around the world for many years to come. Further new technologies can build on the humble text message, leveraging its success to advance the field of digital health. This Viewpoint presents a retrospective of text messaging in health, drawing on the example of text message–based interventions for smoking cessation, and presents evidence for the continued relevance of this mobile health modality in 2025 and beyond. %M 39689299 %R 10.2196/59888 %U https://www.jmir.org/2024/1/e59888 %U https://doi.org/10.2196/59888 %U http://www.ncbi.nlm.nih.gov/pubmed/39689299 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60184 %T From Doubt to Confidence—Overcoming Fraudulent Submissions by Bots and Other Takers of a Web-Based Survey %A Hardesty,Jeffrey J %A Crespi,Elizabeth %A Sinamo,Joshua K %A Nian,Qinghua %A Breland,Alison %A Eissenberg,Thomas %A Kennedy,Ryan David %A Cohen,Joanna E %+ Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins University, Fourth Floor, 2213 McElderry St, Baltimore, MD, 21205, United States, 1 410 641 4537, jhardesty@jhu.edu %K fake data %K recruitment %K online survey %K internet survey %K challenges %K data integrity %K data quality %K e-cigs %K tobacco control %K longitudinal survey %K web-based survey %K e-cigarette %K vaping %K smoking %K smoke %K cessation %K prevalence %K data collection %K United States %K US %K adult %K VAPER %K Vaping and Patterns of E-cigarette Use Research %D 2024 %7 16.12.2024 %9 Viewpoint %J J Med Internet Res %G English %X In 2019, we launched a web-based longitudinal survey of adults who frequently use e-cigarettes, called the Vaping and Patterns of E-cigarette Use Research (VAPER) Study. The initial attempt to collect survey data failed due to fraudulent survey submissions, likely submitted by survey bots and other survey takers. This paper chronicles the journey from that setback to the successful completion of 5 waves of data collection. The section “Naïve Beginnings” examines the study preparation phase, identifying the events, decisions, and assumptions that contributed to the failure (eg, allowing anonymous survey takers to submit surveys and overreliance on a third-party’s proprietary fraud detection tool to identify participants attempting to submit multiple surveys). “A 5-Alarm Fire and Subsequent Investigation” summarizes the warning signs that suggested fraudulent survey submissions had compromised the data integrity after the initial survey launched (eg, an unanticipated acceleration in recruitment and a voicemail alleging fraudulent receipt of multiple gift codes). This section also covers the investigation process, along with conclusions regarding how the methodology was exploited (eg, clearing cookies and using virtual private networks) and the extent of the issue (ie, only 363/1624, 22.4% of the survey completions were likely valid). “Building More Resilient Methodology” details the vulnerabilities and threats that likely compromised the initial survey attempt (eg, anonymity and survey bots); the corresponding mitigation strategies and their benefits and limitations (eg, personal record verification platforms, IP address matching, virtual private network detection services, and CAPTCHA [Completely Automated Public Turing test to tell Computers and Humans Apart]); and the array of strategies that were implemented in future survey attempts. “Staying Vigilant” recounts the identification and management of an additional threat that emerged despite the implementation of an array of mitigation strategies, underscoring the need for ongoing vigilance and adaptability. While the precise nature of the threat remains unknown, the evidence suggested multiple fraudulent surveys were submitted by a single or connected entities, who likely did not possess e-cigarettes. To mitigate the chance of reoccurrence, participants were required to submit an authentic photo of their most used e-cigarette. Finally, in “Reflection 4 Years Later,” we share insights after completing 5 waves of data collection without additional threats or vulnerabilities uncovered that necessitated the application of further mitigation strategies. Reflections include reasons for confidence in the data’s integrity, the scalability and cost-effectiveness of the study protocols, and the potential introduction of sampling bias through recruitment and mitigation strategies. By sharing our journey, we aim to provide valuable insights for researchers facing similar challenges with web-based surveys and those seeking to minimize such challenges a priori. Our experiences highlight the importance of proactive measures, continuous monitoring, and adaptive problem-solving to ensure the integrity of data collected from participants recruited from web-based platforms. %M 39680887 %R 10.2196/60184 %U https://www.jmir.org/2024/1/e60184 %U https://doi.org/10.2196/60184 %U http://www.ncbi.nlm.nih.gov/pubmed/39680887 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60677 %T A Gender-Informed Smoking Cessation App for Women: Protocol for an Acceptability and Feasibility Study %A Melamed,Osnat C %A Mehra,Kamna %A Panda,Roshni %A Minian,Nadia %A Veldhuizen,Scott %A Zawertailo,Laurie %A Buckley,Leslie %A Maslej,Marta %A Greaves,Lorraine %A Brabete,Andreea C %A Rose,Jonathan %A Ratto,Matt %A Selby,Peter %+ INTREPID Lab, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J1H4, Canada, 1 4165358501 ext 36019, osnat.melamed@camh.ca %K smoking cessation %K mHealth %K co-development %K feasibility %K smoking %K mobile app %K cigarette smoking %K tobacco cessation %K gender-informed design %K app design %K women's health %K behavior change %K health behavior change %K mobile phone %D 2024 %7 10.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco smoking remains the leading preventable cause of death and disease among women. Quitting smoking offers numerous health benefits; however, women tend to have less success than men when attempting to quit. This discrepancy is partly due to sex- and gender-related factors, including the lower effectiveness of smoking cessation medication and the presence of unique motives for smoking and barriers to quitting among women. Despite the gendered nature of smoking, most smoking cessation apps are gender-neutral and fail to address women’s specific needs. Objective: This study aims to test the acceptability and feasibility of a smartphone app that delivers gender-informed content to support women in quitting smoking. Methods: We co-developed a smoking cessation app specifically tailored for women, named My Change Plan-Women (MCP-W). This app builds upon our previous gender-neutral app, MCP, by retaining its content grounded in behavioral change techniques aimed at supporting tobacco reduction and cessation. This includes goal setting for quitting, identifying triggers to smoking, creating coping strategies, tracking cigarettes and cravings, and assessing financial savings from quitting smoking. The MCP-W app contains additional gender-informed content that acknowledges barriers to quitting, such as coping with stress, having smokers in one’s social circle, and managing unpleasant emotions. This content is delivered through testimonials and animated videos. This study is a prospective, single-group, mixed methods investigation in which 30 women smokers will trial the app for a period of 28 days. Once participants provide informed consent, they will complete a baseline survey and download the app on their smartphones. After 28 days, participants will complete follow-up surveys. Acceptability will be assessed using the Theoretical Framework of Acceptability, which evaluates whether participants perceive the app as helpful in changing their smoking. The app will be deemed acceptable if the majority of participants rate it as such, and feasible if the majority of the participants use it for at least 7 days. Furthermore, after the 28-day trial period, participants will complete a semistructured interview regarding their experience with the app and suggestions for improvement. Results: Development of the MCP-W app was completed in September 2023. Participant recruitment for testing of the app commenced in February 2024 and was completed in July 2024. We will analyze the data upon completion of data collection from all 30 participants. We expect to share the results of this acceptability trial in the middle of 2025. Conclusions: Offering smoking cessation support tailored specifically to address the unique needs of women through a smartphone app represents a novel approach. This study will test whether women who smoke perceive this approach to be acceptable and feasible in their journey toward smoking cessation. International Registered Report Identifier (IRRID): DERR1-10.2196/60677 %M 39433391 %R 10.2196/60677 %U https://www.researchprotocols.org/2024/1/e60677 %U https://doi.org/10.2196/60677 %U http://www.ncbi.nlm.nih.gov/pubmed/39433391 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e57718 %T Google Trends Assessment of Keywords Related to Smoking and Smoking Cessation During the COVID-19 Pandemic in 4 European Countries: Retrospective Analysis %A Jagomast,Tobias %A Finck,Jule %A Tangemann-Münstedt,Imke %A Auth,Katharina %A Drömann,Daniel %A Franzen,Klaas F %+ Airway Research Center North, Deutsches Zentrum für Lungenforschung, Wöhrendamm 80, Großhansdorf, 22927, Germany, 49 45150075562, klaas.franzen@uni-luebeck.de %K internet %K coronavirus %K COVID-19 %K SARS-CoV-2 %K pandemics %K public health %K smoking cessation %K tobacco products %K Google Trends %K relative search volume %K Europe %K online %K search %K smoking %K addiction %K quit %K cessation %K trend %K cluster %K public interest %K lockdown %K vaccination %K spread %K incidence %D 2024 %7 3.12.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Smoking is a modifiable risk factor for SARS-CoV-2 infection. Evidence of smoking behavior during the pandemic is ambiguous. Most investigations report an increase in smoking. In this context, Google Trends data monitor real-time public information–seeking behavior and are therefore useful to characterize smoking-related interest over the trajectory of the pandemic. Objective: This study aimed to use Google Trends data to evaluate the effect of the pandemic on public interest in smoking-related topics with a focus on lockdowns, vaccination campaigns, and incidence. Methods: The weekly relative search volume was retrieved from Google Trends for England, Germany, Italy, and Spain from December 31, 2017, to April 18, 2021. Data were collected for keywords concerning consumption, cessation, and treatment. The relative search volume before and during the pandemic was compared, and general trends were evaluated using the Wilcoxon rank-sum test. Short-term changes and hereby temporal clusters linked to lockdowns or vaccination campaigns were addressed by the flexible spatial scan statistics proposed by Takahashi and colleagues. Subsequently, the numbers of clusters after the onset of the pandemic were compared by chi-square test. Results: Country-wise minor differences were observed while 3 overarching trends prevailed. First, regarding cessation, the statistical comparison revealed a significant decline in interest for 58% (7/12) of related keywords, and fewer clusters were present during the pandemic. Second, concerning consumption, significantly reduced relative search volume was observed for 58% (7/12) of keywords, while treatment-related keywords exhibited heterogeneous trends. Third, substantial clusters of increased interest were sparsely linked to lockdowns, vaccination campaigns, or incidence. Conclusions: This study reports a substantial decline in overall relative search volume and clusters for cessation interest. These results underline the importance of intensifying cessation aid during times of crisis. Lockdowns, vaccination, and incidence had less impact on information-seeking behavior. Other public measures that positively affect smoking behavior remain to be determined. %M 39626237 %R 10.2196/57718 %U https://ojphi.jmir.org/2024/1/e57718 %U https://doi.org/10.2196/57718 %U http://www.ncbi.nlm.nih.gov/pubmed/39626237 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54248 %T Predicting Early Dropout in a Digital Tobacco Cessation Intervention: Replication and Extension Study %A Yu,Linda Q %A Amato,Michael S %A Papandonatos,George D %A Cha,Sarah %A Graham,Amanda L %+ Innovations Center, Truth Initiative, 900 G St NW Fourth Floor, Washington, DC, 20001, United States, 1 2024545938, agraham@truthinitiative.org %K digital interventions %K attrition %K engagement %K dropout %K tobacco %K smoking %K cessation %K mobile health %K internet %K mobile phone %D 2024 %7 27.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Detecting early dropout from digital interventions is crucial for developing strategies to enhance user retention and improve health-related behavioral outcomes. Bricker and colleagues proposed a single metric that accurately predicted early dropout from 4 digital tobacco cessation interventions based on log-in data in the initial week after registration. Generalization of this method to additional interventions and modalities would strengthen confidence in the approach and facilitate additional research drawing on it to increase user retention. Objective: This study had two research questions (RQ): RQ1—can the study by Bricker and colleagues be replicated using data from a large-scale observational, multimodal intervention to predict early dropout? and RQ2—can first-week engagement patterns identify users at the greatest risk for early dropout, to inform development of potential “rescue” interventions? Methods: Data from web users were drawn from EX, a freely available, multimodal digital intervention for tobacco cessation (N=70,265). First-week engagement was operationalized as any website page views or SMS text message responses within 1 week after registration. Early dropout was defined as having no subsequent engagement after that initial week through 1 year. First, a multivariate regression model was used to predict early dropout. Model predictors were dichotomous measures of engagement in each of the initial 6 days (days 2-7) following registration (day 1). Next, 6 univariate regression models were compared in terms of their discrimination ability to predict early dropout. The sole predictor of each model was a dichotomous measure of whether users had reengaged with the intervention by a particular day of the first week (calculated separately for each of 2-7 days). Results: For RQ1, the area under the receiver operating characteristic curve (AUC) of the multivariate model in predicting dropout after 1 week was 0.72 (95% CI 0.71-0.73), which was within the range of AUC metrics found in the study by Bricker and colleagues. For RQ2, the AUCs of the univariate models increased with each successive day until day 4 (0.66, 95% CI 0.65-0.67). The sensitivity of the models decreased (range 0.79-0.59) and the specificity increased (range 0.48-0.73) with each successive day. Conclusions: This study provides independent validation of the use of first-week engagement to predict early dropout, demonstrating that the method generalizes across intervention modalities and engagement metrics. As digital intervention researchers continue to address the challenges of low engagement and early dropout, these results suggest that first-week engagement is a useful construct with predictive validity that is robust across interventions and definitions. Future research should explore the applicability and efficiency of this model to develop interventions to increase retention and improve health behavioral outcomes. %M 39602788 %R 10.2196/54248 %U https://www.jmir.org/2024/1/e54248 %U https://doi.org/10.2196/54248 %U http://www.ncbi.nlm.nih.gov/pubmed/39602788 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57747 %T Short-Form Video Informed Consent Compared With Written Consent for Adolescents and Young Adults: Randomized Experiment %A Afolabi,Aliyyat %A Cheung,Elaine %A Lyu,Joanne Chen %A Ling,Pamela M %+ Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, CA, 94143-1390, United States, 1 4155148627, Pamela.Ling@ucsf.edu %K health communication %K video informed consent %K randomized experiment %K informed consent %K adolescent %K video %K consent %K e-cigarette %K vaping %K health research %K social media %K vaping cessation %K smoking cessation %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents and young adults have the highest prevalence of e-cigarette use (“vaping”), but they are difficult to enroll in health research studies. Previous studies have found that video consent can improve comprehension and make informed consent procedures more accessible, but the videos in previous studies are much longer than videos on contemporary social media platforms that are popular among young people. Objective: This study aimed to examine the effectiveness of a short-form (90-second) video consent compared with a standard written consent for a vaping cessation study for adolescents and young adults. Methods: We conducted a web-based experiment with 435 adolescents and young adults (aged 13-24 years) recruited by a web-based survey research provider. Each participant was randomly assigned to view either a short-form video consent or a written consent form describing a behavioral study of a social media–based vaping cessation program. Participants completed a postexposure survey measuring three outcomes: (1) comprehension of the consent information, (2) satisfaction with the consent process, and (3) willingness to participate in the described study. Independent sample 2-tailed t tests and chi-square tests were conducted to compare the outcomes between the 2 groups. Results: In total, 435 cases comprised the final analytic sample (video: n=215, 49.4%; written: n=220, 50.6%). There was no significant difference in characteristics between the 2 groups (all P>.05). Participants who watched the short-form video completed the consent review and postconsent survey process in less time (average 4.5 minutes) than those in the written consent group (5.1 minutes). A total of 83.2% (179/215) of the participants in the video consent condition reported satisfaction with the overall consent process compared with 76.3% (168/220) in the written consent condition (P=.047). There was no difference in the ability to complete consent unassisted and satisfaction with the amount of time between study conditions. There was no difference in the composite measure of overall comprehension, although in individual measures, participants who watched the short-form video consent performed better in 4 measures of comprehension about risk, privacy, and procedures, while participants who read the written document consent had better comprehension of 2 measures of study procedures. There was no difference between the groups in willingness to participate in the described study. Conclusions: Short-form informed consent videos had similar comprehension and satisfaction with the consent procedure among adolescents and young adults. Short-form informed consent videos may be a feasible and acceptable alternative to the standard written consent process, although video and written consent forms have different strengths with respect to comprehension. Because they match how young people consume media, short-form videos may be particularly well suited for adolescents and young adults participating in research. %M 39576682 %R 10.2196/57747 %U https://formative.jmir.org/2024/1/e57747 %U https://doi.org/10.2196/57747 %U http://www.ncbi.nlm.nih.gov/pubmed/39576682 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56999 %T Presenting and Evaluating a Smartwatch-Based Intervention for Smoking Relapse (StopWatch): Feasibility and Acceptability Study %A Stone,Chris %A Essery,Rosie %A Matthews,Joe %A Naughton,Felix %A Munafo,Marcus %A Attwood,Angela %A Skinner,Andy %+ School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, United Kingdom, 44 01174555910, chris.stone@bristol.ac.uk %K smoking %K smoking cessation %K passive detection %K just-in-time intervention %K JITAI %K relapse prevention %K relapse %K smartwatch %K wearable technology %K wearable %K mobile health %K mHealth %K mobile phone %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the benefits of smoking cessation, maintaining abstinence during a quit attempt is difficult, and most attempts result in relapse. Innovative, evidence-based methods of preventing relapse are needed. We present a smartwatch-based relapse prevention system that uses passive detection of smoking to trigger just-in-time smoking cessation support. Objective: This study aims to evaluate the feasibility of hosting just-in-time smoking cessation support on a smartwatch and the acceptability of the “StopWatch” intervention on this platform. Methods: The person-based approach for intervention development was used to design the StopWatch smoking relapse prevention intervention. Intervention delivery was triggered by an algorithm identifying hand movements characteristic of smoking from the smartwatch’s motion sensors, and the system-generated intervention messages (co-designed by smokers) were delivered on the smartwatch screen. A total of 18 smokers tested the intervention over a 2-week period, and at the end of this period, they provided qualitative feedback on the acceptability of both the intervention and the smartwatch platform. Results: Participants reported that the smartwatch intervention increased their awareness of smoking and motivated them to quit. System-generated intervention messages were generally felt to be relevant and timely. There were some challenges with battery life that had implications for intervention adherence, and the bulkiness of the device and the notification style reduced some participants’ acceptability of the smartwatch platform. Conclusions: Our findings indicate our smoking relapse prevention intervention and the use of a smartwatch as a platform to host a just-in-time behavior change intervention are both feasible and acceptable to most (12/18, 66%) participants as a relapse prevention intervention, but we identify some concerns around the physical limitations of the smartwatch device. In particular, the bulkiness of the device and the battery capacity present risks to adherence to the intervention and the potential for missed detections. We recommend that a longer-term efficacy trial be carried out as the next step. %M 39570656 %R 10.2196/56999 %U https://formative.jmir.org/2024/1/e56999 %U https://doi.org/10.2196/56999 %U http://www.ncbi.nlm.nih.gov/pubmed/39570656 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e67749 %T Author's Reply: Expanding the Scope: Reflections on Digital Smoking Cessation Strategies for Diverse Age Groups %A Fahey,Margaret C %+ Department of Psychology, Middle Tennessee State University, Academic Classroom Building, Murfreesboro, TN, 37130, United States, 1 615 898 5949, mfahey@mtsu.edu %K digital smoking cessation %K age group comparisons %K behavioral health intervention %K older adult %K cigarette %K tobacco %K quitting %K telehealth %K behavioral health %K public health %D 2024 %7 18.11.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %R 10.2196/67749 %U https://www.jmir.org/2024/1/e67749 %U https://doi.org/10.2196/67749 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e65929 %T Expanding the Scope: Reflections on Digital Smoking Cessation Strategies for Diverse Age Groups %A Wei,Bin %A Hu,Xin %A Wu,XiaoRong %+ The First Affiliated Hospital, Jiangxi Medical College, Nanchang University, No. 17, Yongwai Zhengjie, Donghu District, Nanchang, Jiangxi, 330000, China, 86 13617093259, wxr98021@126.com %K digital smoking cessation %K age group comparisons %K behavioral health interventions %K older adults %K digital cessation treatment %K cigarettes %K tobacco %K quit %K telehealth %K behavioral health %K public health %D 2024 %7 18.11.2024 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 39556825 %R 10.2196/65929 %U https://www.jmir.org/2024/1/e65929 %U https://doi.org/10.2196/65929 %U http://www.ncbi.nlm.nih.gov/pubmed/39556825 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50963 %T Effectiveness of the Offer of the Smoke Free Smartphone App Compared With No Intervention for Smoking Cessation: Pragmatic Randomized Controlled Trial %A Jackson,Sarah %A Kale,Dimitra %A Beard,Emma %A Perski,Olga %A West,Robert %A Brown,Jamie %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, United Kingdom, 44 2076795634, s.e.jackson@ucl.ac.uk %K randomized controlled trial %K smartphone app %K smoking cessation %K digital intervention %K tobacco %K mobile phone %D 2024 %7 15.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital technologies offer the potential for low-cost, scalable delivery of interventions to promote smoking cessation. Objective: We aimed to evaluate the effectiveness of the offer of Smoke Free—an evidence-informed, widely used app—for smoking cessation versus no support. Methods: In this 2-arm randomized controlled trial, 3143 motivated adult smokers were recruited online between August 2020 and April 2021 and randomized to receive an offer of the Smoke Free app plus follow-up (intervention arm) versus follow-up only (comparator arm). Both groups were shown a brief message at the end of the baseline questionnaire encouraging them to make a quit attempt. The primary outcome was self-reported 6-month continuous abstinence assessed 7 months after randomization. Secondary outcomes included quit attempts in the first month post randomization, 3-month continuous abstinence assessed at 4 months, and 6-month continuous abstinence at 7 months among those who made a quit attempt. The primary analysis was performed on an intention-to-treat (ITT) analysis basis. Sensitivity analyses included (1) restricting the intervention group to those who took up the offer of the app, (2) using complete cases, and (3) using multiple imputation. Results: The effective follow-up rate for 7 months was 41.9%. The primary analysis showed no evidence of a benefit of the intervention on rates of 6-month continuous abstinence (intervention 6.8% vs comparator 7.0%; relative risk 0.97, 95% CI 0.75-1.26). Analyses of all secondary outcomes also showed no evidence of a benefit. Similar results were observed on complete cases and using multiple imputation. When the intervention group was restricted to those who took up the offer of the app (n=395, 25.3%), participants in the intervention group were 80% more likely to report 6-month continuous abstinence (12.7% vs 7.0%; relative risk 1.80, 95% CI 1.30-2.45). Equivalent subgroup analyses produced similar results on the secondary outcomes. These differences persisted after adjustment for key baseline characteristics. Conclusions: Among motivated smokers provided with very brief advice to quit, the offer of the Smoke Free app did not have a detectable benefit for cessation compared with follow-up only. However, the app increased quit rates when smokers randomized to receive the app downloaded it. Trial Registration: ISRCTN ISRCTN85785540; https://www.isrctn.com/ISRCTN85785540 International Registered Report Identifier (IRRID): RR2-https://onlinelibrary.wiley.com/doi/full/10.1111/add.14652 %M 39546331 %R 10.2196/50963 %U https://www.jmir.org/2024/1/e50963 %U https://doi.org/10.2196/50963 %U http://www.ncbi.nlm.nih.gov/pubmed/39546331 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51870 %T Concurrent Mentions of Vaping and Alcohol on Twitter: Latent Dirichlet Analysis %A Ranker,Lynsie R %A Tofu,David Assefa %A Lu,Manyuan %A Wu,Jiaxi %A Bhatnagar,Aruni %A Robertson,Rose Marie %A Wijaya,Derry %A Hong,Traci %A Fetterman,Jessica L %A Xuan,Ziming %+ Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Crosstown Center, 4th Floor, Boston, MA, 02215, United States, 1 617 358 2310, lranker@bu.edu %K e-cigarettes %K alcohol %K social media %K vape %K tweet %K vaping %K alcohol use %K co-use %K substance use disorder %K social networking site %K insight %K regulation %K youth %K vaping policy %D 2024 %7 12.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Co-use of alcohol and e-cigarettes (often called vaping) has been linked with long-term health outcomes, including increased risk for substance use disorder. Co-use may have been exacerbated by the COVID-19 pandemic. Social networking sites may offer insights into current perspectives on polysubstance use. Objective: The aims of this study were to investigate concurrent mentions of vaping and alcohol on Twitter (subsequently rebranded X) during a time of changing vaping regulations in the United States and the emergence of the COVID-19 pandemic. Methods: Tweets including both vape- and alcohol-related terms posted between October 2019 and September 2020 were analyzed using latent Dirichlet allocation modeling. Distinct topics were identified and described. Results: Three topics were identified across 6437 tweets: (1) flavors and flavor ban (n=3334, 51.8% of tweets), (2) co-use discourse (n=1119, 17.4%), and (3) availability and access regulation (n=1984, 30.8%). Co-use discussions often portrayed co-use as positive and prosocial. Tweets focused on regulation often used alcohol regulations for comparison. Some focused on the perceived overregulation of vaping (compared to alcohol), while others supported limiting youth access but not at the expense of adult access (eg, stronger age verification over product bans). Across topics, vaping was typically portrayed as less harmful than alcohol use. The benefits of flavors for adult smoking cessation were also discussed. The distribution of topics across time varied across both pre– and post–regulatory change and pre– and post–COVID-19 pandemic declaration periods, suggesting shifts in topic focus salience across time. Conclusions: Co-use discussions on social media during this time of regulatory change and social upheaval typically portrayed both vaping and alcohol use in a positive light. It also included debates surrounding the differences in regulation of the 2 substances—particularly as it related to limiting youth access. Emergent themes from the analysis suggest that alcohol was perceived as more harmful but less regulated and more accessible to underage youth than vaping products. Frequent discussions and comparisons of the 2 substances as it relates to their regulation emphasize the still-evolving vaping policy landscape. Social media content analyses during times of change may help regulators and policy makers to better understand and respond to common concerns and potential misconceptions surrounding drug-related policies and accessibility. %M 39531640 %R 10.2196/51870 %U https://www.jmir.org/2024/1/e51870 %U https://doi.org/10.2196/51870 %U http://www.ncbi.nlm.nih.gov/pubmed/39531640 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e60713 %T Considerations for Future Research and Methodological Clarifications on Smoking Behavior Change and Heart Failure Risk in Patients With Type 2 Diabetes %A Malinovská,Jana %A Michalec,Juraj %A Brož,Jan %K type 2 diabetes %K smoking %K heart failure %K cardiovascular disease %K smoking cessation %D 2024 %7 12.11.2024 %9 %J JMIR Public Health Surveill %G English %X %R 10.2196/60713 %U https://publichealth.jmir.org/2024/1/e60713 %U https://doi.org/10.2196/60713 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51594 %T Social Media Marketing Strategies for Electronic Cigarettes: Content Analysis of Chinese Weibo Accounts %A Zhou,Xinyi %A Hao,Xinyu %A Chen,Yuhang %A Deng,Hui %A Fang,Ling %A Zhang,Lingyun %A Yan,Xiaotao %A Zheng,Pinpin %A Wang,Fan %+ Fudan Development Institute, Fudan University, Think Tank Building, Room 415, 220 Handan Road, Shanghai, 200433, China, 86 21 55664081, wangfan512@126.com %K e-cigarette %K marketing strategy %K social media %K teenagers %K content analysis %D 2024 %7 7.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: E-cigarettes have gained popularity among teenagers due to extensive marketing strategies on social media platforms. This widespread promotion is a risk factor, as it fosters more positive attitudes toward e-cigarette use among teenagers and increases the perception that using e-cigarettes is normal. Therefore, the marketing of e-cigarettes on social media is a serious global health concern, and its strategies and impact should be clearly identified. Objective: This study examined how e-cigarette companies popularize their products via Weibo and identified the specific strategies influencing the effectiveness of their marketing. Methods: In phase 1, we conducted a search on Qcc.com and identified 32 e-cigarette brands with active Weibo accounts between October 1 and December 31, 2020, along with 863 Weibo posts. The data were investigated through content analysis. The codebook was developed into four categories: (1) product and features, (2) sales and promotions, (3) social contact and interaction, and (4) restrictions and warnings. To further understand the factors influencing e-cigarette brand marketing, we conducted a multiple linear regression analysis. Results: Marketing tactics by e-cigarette companies on Chinese social media were documented, including emphasizing attractive product features, using trendy characters, implicit promotions, downplaying health concerns, and engaging with Weibo users in various ways. Out of 863 posts, 449 (52%) mentioned product characteristics. In 313 (36.3%) posts, visible figures were used to attract attention. Product promotion was absent in 762 (88.3%) posts, and purchase channels were not mentioned in 790 (98.3%) posts. Social interaction–related posts received attention (n=548, 63.5%), particularly those featuring hashtag content (n=538, 62.3%). Most posts did not include claims for restrictions on teenagers' purchases or use (n=687, 79.6%) or information on health warnings (n=839, 97.2%). Multiple linear regression analysis identified marketing strategies that effectively increase the exposure of e-cigarette posts on Weibo. Posts including engagement via posts encouraging reposts, comments, and likes (P<.001) and engagement topics related to e-cigarette brands were positively correlated with the number of reposts (P=.009). Posts highlighting nonmonetary incentives (P=.004), posts with age restriction statements (P<.001), engaging via stories and idea collection (P<.001), and engagement topics related to products (P<.001) and current affairs (P=.002) had a positive effect on the number of comments. Engagement topics related to brands (P<.001) or interactive sweepstakes (P<.001) had a positive effect on the number of likes. Conclusions: E-cigarette posts on Weibo that focus on product features and social interaction attract public attention, especially from teenagers. Stricter regulations and monitoring should be adopted to restrict the social media marketing of e-cigarettes. %M 39509702 %R 10.2196/51594 %U https://www.jmir.org/2024/1/e51594 %U https://doi.org/10.2196/51594 %U http://www.ncbi.nlm.nih.gov/pubmed/39509702 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e63296 %T Risk Perception and Knowledge Following a Social Game–Based Tobacco Prevention Program for Adolescents: Pilot Randomized Comparative Trial %A Khalil,Georges %A Ramirez,Erica %A Khan,Meerah %A Zhao,Bairu %A Ribeiro,Nuno %A Balian,Patrick %+ Department of Health Outcomes and Biomedical Informatics, University of Florida, Malachowsky Hall for Data Science and Information Technology, 1889 Museum Rd, Suite 7000, Gainesville, FL, 32603, United States, 1 3526279467, gkhalil@ufl.edu %K tobacco prevention %K vaping %K combustible tobacco %K risk perception %K adolescent %K games %K social interaction %D 2024 %7 5.11.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Adolescence is a critical developmental stage that is particularly vulnerable to the initiation of tobacco use. Despite the well-documented health risks associated with tobacco use, it remains prevalent among adolescents. Games for health are a promising strategy for tobacco prevention, using experiential and social learning theories to enhance engagement and improve behavior change. Objective: This pilot study aims to (1) compare the social game–based program Storm-Heroes to a nonsocial program regarding adolescents’ personal and social experiences and (2) examine how these experiences predict higher tobacco knowledge and perceived risks of vaping and conventional tobacco use. Methods: In a cluster-randomized comparative design, 4 after-school sites (N=79 adolescents) were recruited in person and randomized in a single-blinded format to 1 of 2 interventions: the social game Storm-Heroes (44/79, 56%) or the nonsocial program A Smoking Prevention Interactive Experience (ASPIRE; 35/79, 44%). A study team member supervised both interventions. Data were collected at baseline, immediate follow-up, and a 1.5-month follow-up (45/74, 61% retained). Repeated measures mixed effects models were conducted. Results: A total of 45 participants continued until the 1.5-month follow-up. Participants in the Strom-Heroes group were more likely to increase their perceived risk of vaping (B=0.40; P<.001), perceived risk of conventional tobacco use (B=0.35; P=.046), and tobacco knowledge (B=1.63; P<.001) than those in the control condition. The usability level of the program was related to a higher perceived risk of vaping (B=0.16; P=.003) and conventional tobacco use (B=0.16; P=.02) by follow-up. Attention to the program was also related to higher perceived risk of vaping (B=0.12; P=.002) and conventional tobacco use (B=0.14; P<.001). Distraction was not related to either perceived risk of vaping (P=.15) or perceived risk of conventional tobacco use (P=.71). In contrast, both more attention (B=0.60; P<.001) and less distraction (B=–0.37; P<.001) were related to higher tobacco knowledge. Conclusions: The increased perceived risk of vaping and conventional tobacco among Storm-Heroes participants aligns with the program’s goals of improving participants’ awareness of the risks associated with tobacco use and their tobacco knowledge. However, distraction weakened the effect of the program on tobacco knowledge, indicating that emphasis needs to be placed on minimizing distraction for better outcomes. With the results of this study, researchers can work to advance the current version of Storm-Heroes and amplify engagement in the program to improve its potential for preventing adolescents’ initiation of tobacco use. Trial Registration: ClinicalTrials.gov NCT02703597; https://clinicaltrials.gov/study/NCT02703597 %M 39499912 %R 10.2196/63296 %U https://games.jmir.org/2024/1/e63296 %U https://doi.org/10.2196/63296 %U http://www.ncbi.nlm.nih.gov/pubmed/39499912 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55311 %T The Validity of Impressions as a Media Dose Metric in a Tobacco Public Education Campaign Evaluation: Observational Study %A Davis,Kevin %A Curry,Laurel %A Bradfield,Brian %A Stupplebeen,David A %A Williams,Rebecca J %A Soria,Sandra %A Lautsch,Julie %+ RTI International, 701 13th St. NW, Ste 750, Washington, DC, 20005, United States, 1 202 728 2086, lcurry@rti.org %K communication %K public education %K tobacco %K media %K public health %D 2024 %7 5.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Evaluation research increasingly needs alternatives to target or gross rating points to comprehensively measure total exposure to modern multichannel public education campaigns that use multiple channels, including TV, radio, digital video, and paid social media, among others. Ratings data typically only capture delivery of broadcast media (TV and radio) and excludes other channels. Studies are needed to validate objective cross-channel metrics such as impressions against self-reported exposure to campaign messages. Objective: This study aimed to examine whether higher a volume of total media campaign impressions is predictive of individual-level self-reported campaign exposure in California. Methods: We analyzed over 3 years of advertisement impressions from the California Tobacco Prevention Program’s statewide tobacco education campaigns from August 2019 through December 2022. Impressions data varied across designated market areas (DMAs) and across time. These data were merged to individual respondents from 45 waves of panel survey data of Californians aged 18-55 years (N=151,649). Impressions were merged to respondents based on respondents’ DMAs and time of survey completion. We used logistic regression to estimate the odds of respondents’ campaign recall as a function of cumulative and past 3-month impressions delivered to each respondent’s DMA. Results: Cumulative impressions were positively and significantly associated with recall of each of the Flavors Hook Kids (odds ratio [OR] 1.15, P<.001), Dark Balloons and Apartment (OR 1.20, P<.001), We Are Not Profit (OR 1.36, P<.001), Tell Your Story (E-cigarette, or Vaping, product use Associated Lung Injury; OR 1.06, P<.05), and Thrown Away and Little Big Lies (OR 1.05, P<.01) campaigns. Impressions delivered in the past 3 months were associated with recall of the Flavors Hook Kids (OR 1.13, P<.001), Dark Balloons and Apartment (OR 1.08, P<.001), We Are Not Profit (OR 1.14, P<.001), and Thrown Away and Little Big Lies (OR 1.04, P<.001) campaigns. Past 3-month impressions were not significantly associated with Tell Your Story campaign recall. Overall, magnitudes of these associations were greater for cumulative impressions. We visualize recall based on postestimation predicted values from our multivariate logistic regression models. Conclusions: Variation in cumulative impressions for California Tobacco Prevention Program’s long-term multichannel tobacco education campaign is predictive of increased self-reported campaign recall, suggesting that impressions may be a valid proxy for potential campaign exposure. The use of impressions for purposes of evaluating public education campaigns may help address current methodological limitations arising from the fragmented nature of modern multichannel media campaigns. %M 39499542 %R 10.2196/55311 %U https://www.jmir.org/2024/1/e55311 %U https://doi.org/10.2196/55311 %U http://www.ncbi.nlm.nih.gov/pubmed/39499542 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e52383 %T Sensors for Smoking Detection in Epidemiological Research: Scoping Review %A Favara,Giuliana %A Barchitta,Martina %A Maugeri,Andrea %A Magnano San Lio,Roberta %A Agodi,Antonella %+ Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Via Santa Sofia 87, Catania, 95123, Italy, 39 0953782183, agodia@unict.it %K smoking %K tobacco smoke %K smoke exposure %K cigarette smoking %K wearable sensor %K public health %D 2024 %7 30.10.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The use of wearable sensors is being explored as a challenging way to accurately identify smoking behaviors by measuring physiological and environmental factors in real-life settings. Although they hold potential benefits for aiding smoking cessation, no single wearable device currently achieves high accuracy in detecting smoking events. Furthermore, it is crucial to emphasize that this area of study is dynamic and requires ongoing updates. Objective: This scoping review aims to map the scientific literature for identifying the main sensors developed or used for tobacco smoke detection, with a specific focus on wearable sensors, as well as describe their key features and categorize them by type. Methods: According to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) protocol, an electronic search was conducted on the PubMed, MEDLINE, and Web of Science databases, using the following keywords: (“biosensors” OR “biosensor” OR “sensors” OR “sensor” OR “wearable”) AND (“smoking” OR “smoke”). Results: Among a total of 37 studies included in this scoping review published between 2012 and March 2024, 16 described sensors based on wearable bands, 15 described multisensory systems, and 6 described other strategies to detect tobacco smoke exposure. Included studies provided details about the design or application of wearable sensors based on an elastic band to detect different aspects of tobacco smoke exposure (eg, arm, wrist, and finger movements, and lighting events). Some studies proposed a system composed of different sensor modalities (eg, Personal Automatic Cigarette Tracker [PACT], PACT 2.0, and AutoSense). Conclusions: Our scoping review has revealed both the obstacles and opportunities linked to wearable devices, offering valuable insights for future research initiatives. Tackling the recognized challenges and delving into potential avenues for enhancement could elevate wearable devices into even more effective tools for aiding smoking cessation. In this context, continuous research is essential to fine-tune and optimize these devices, guaranteeing their practicality and reliability in real-world applications. %M 39476379 %R 10.2196/52383 %U https://mhealth.jmir.org/2024/1/e52383 %U https://doi.org/10.2196/52383 %U http://www.ncbi.nlm.nih.gov/pubmed/39476379 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57839 %T Evaluating the Impact of a Game (Inner Dragon) on User Engagement Within a Leading Smartphone App for Smoking Cessation: Randomized Controlled Trial %A White,Justin S %A Toussaert,Séverine %A Raiff,Bethany R %A Salem,Marie K %A Chiang,Amy Yunyu %A Crane,David %A Warrender,Edward %A Lyles,Courtney R %A Abroms,Lorien C %A Westmaas,J Lee %A Thrul,Johannes %+ Department of Health Law, Policy and Management, Boston University School of Public Health, Talbot Building - 249W, 715 Albany Street, Boston, MA, 02118, United States, 1 617 358 1916, juswhite@bu.edu %K smoking cessation %K mobile app %K games for health %K gamification %K engagement %K randomized controlled trial %K mobile phone %D 2024 %7 30.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone apps are a convenient, low-cost approach to delivering smoking cessation support to large numbers of individuals. Yet, the apps are susceptible to low rates of user engagement and retention. Objective: This study aims to test the effects of a new game module (called Inner Dragon) integrated into Smoke Free (23 Limited), a leading smoking cessation app with established efficacy. The primary outcomes measured user engagement with the app. Methods: A 2-arm, parallel-group, randomized controlled trial was conducted in the United States with an 8-week follow-up. Adult individuals who smoked ≥1 cigarettes daily and planned to quit smoking within 7 days were recruited and randomized (N=500), with equal allocation. Both groups received free access to the original Smoke Free app with “core” features of its smoking cessation program (eg, a diary and craving log). The treated group received additional access to the integrated Inner Dragon game that incorporated several game mechanics designed to increase user engagement. User engagement outcomes were the number of unique app sessions, average minutes per session, days with a session, and program adherence. Self-reported and verified smoking abstinence and app satisfaction were also assessed. The main analysis estimated the intention-to-treat effect of access to Inner Dragon on each outcome. Further analyses assessed effect modification by participant characteristics and the association of intensity of game use with program adherence and abstinence. Results: Overall, user engagement was greater for treated versus control participants: they had 5.3 more sessions of Smoke Free (mean 29.6, SD 36.5 sessions vs mean 24.3, SD 37.9 sessions; P=.06), 0.8 more minutes per session (mean 6.9, SD 5.4 min vs mean 6.1, SD 5.2 min; P=.047), and 3.4 more days with a session (mean 14.3, SD 15.3 days vs mean 11.9, SD 14.3 days; P=.03). Program adherence, based on the number of times core features of the original Smoke Free app were used, was higher for treated versus control participants (mean 29.4, SD 41.3 times vs mean 22.6, SD 35.6 times; P=.03). Self-reported 7-day and 30-day point-prevalence abstinence and verified 7-day point-prevalence abstinence at 8 weeks did not significantly differ by study group. The mean repeated 1-day prevalence of quitting was higher among the treated group versus the control group (mean 17.3%, SD 25.6 vs mean 12.4%, SD 21.3; P=.01). App satisfaction and the motivation to (stay) quit did not differ by study group. Higher intensity of game use was associated with increased program adherence and self-reported abstinence. Conclusions: Findings suggest that the Inner Dragon game increased user engagement and program adherence. Additional refinements to the game design may clarify whether the game increases abstinence rates. Overall, it is feasible to deploy games and gamification to enhance user engagement in existing smoking cessation interventions. Trial Registration: ClinicalTrials.gov NCT05227027; https://clinicaltrials.gov/study/NCT05227027 %M 39475840 %R 10.2196/57839 %U https://www.jmir.org/2024/1/e57839 %U https://doi.org/10.2196/57839 %U http://www.ncbi.nlm.nih.gov/pubmed/39475840 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55239 %T Initial Evaluation of Acceptability, Engagement, and Effectiveness of the MO App to Provide Tailored and Comprehensive Support for Smoking Cessation: Development and Usability Study %A Zhou,Shuo %A Brunetta,Paul %A Silvasstar,Joshva %A Feldman,Greg %A Oromi,Nicolas %A Bull,Sheana %+ Department of Communication Studies, School of Communication and System Health Lab, Hong Kong Baptist University, 913, No. 5 Hereford Rd, KL, Hong Kong, China (Hong Kong), 852 34118230, shuozhou@hkbu.edu.hk %K smoking cessation %K tobacco %K mobile phone app %K mHealth %K mobile health %K iterative design %K feasibility %K acceptability %K engagement %K efficacy %K mobile phone %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the growing availability of smoking cessation apps, low engagement and cessation rates have remained a significant challenge. To address this issue, we used a user-centered design to iteratively develop a mobile app (MO) to provide comprehensive, tailored, and evidence-based content to support smokers in their quitting journey. Objective: This study examined the acceptability, use, and preliminary efficacy of the MO app for smoking cessation. Specifically, we sought to understand smokers’ preferred features, engagement, and satisfaction with MO; identify concerns in using the app and ways to improve the app; and evaluate its smoking cessation outcomes. Methods: Through 3 cohorts, we recruited 10, 12, and 85 adult smokers who attempted to quit smoking to pilot-test the MO app between December 2019 and July 2022. Participants were instructed to complete a baseline survey, interact with the app for 6 weeks, and fill in a postsurvey at week 6. Participants in cohort 3 completed an additional postsurvey at week 12. Participants’ app use was tracked and analyzed. The primary outcome measures were participants’ 7-day point prevalence abstinence at 6 and 12 weeks. Results: Participants reported high levels of satisfaction with the MO app across all 3 cohorts, rating it between 4.40 and 4.76 on a scale of 5 for acceptability. Users engaged with app activities for an average of 89 to 159 times over 35 days. The most liked features of the app included “quit plan,” “tracking,” “reminders and notifications,” “MOtalks,” and “motivational quotes.” The 7-day point prevalence abstinence rate of the modified intention to treat population in cohort 3 was 58% at 6 weeks and 52% at 12 weeks. Those who interacted more frequently with app features and engaged with more diverse activities were more likely to maintain abstinence at weeks 6 and 12. For each additional time logged into the app, the odds of staying abstinent at week 12 increased by 5% (odds ratio [OR] 1.05, 95% CI 1.01-1.08). Participants who earned >5000 points during app use also had higher odds of quitting at both 6 weeks (OR 3.12, 95% CI 1.25-7.75) and 12 weeks (OR 4.65, 95% CI 1.83-11.76), compared with those who earned <5000 points. Conclusions: Our study demonstrated that MO is a feasible mobile phone app with high acceptability and usability and can effectively deliver smoking cessation support to individuals who want to quit. Implications for developing and evaluating mobile phone apps for smoking cessation are discussed. %M 39471372 %R 10.2196/55239 %U https://mhealth.jmir.org/2024/1/e55239 %U https://doi.org/10.2196/55239 %U http://www.ncbi.nlm.nih.gov/pubmed/39471372 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57376 %T Outcomes of a Comprehensive Mobile Vaping Cessation Program in Adults Who Vape Daily: Cohort Study %A Marler,Jennifer D %A Fujii,Craig A %A Utley,MacKenzie T %A Balbierz,Daniel J %A Galanko,Joseph A %A Utley,David S %+ Pivot Health Technologies, Inc, 1010 Commercial St, Suite C, San Carlos, CA, 94070, United States, 1 4082145545, marler@pivot.co %K app %K digital health %K mobile health %K mHealth %K mobile apps %K smartphone %K vaping %K vaping cessation %K mobile phone %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, e-cigarettes, or vapes, are the second most commonly used tobacco product. Despite abundant smartphone app–based cigarette cessation programs, there are few such programs for vaping and even fewer supporting data. Objective: This exploratory, prospective, single-arm, remote cohort study of the Pivot vaping cessation program assessed enrollment and questionnaire completion rates, participant engagement and retention, changes in attitudes toward quitting vaping, changes in vaping behavior, and participant feedback. We aimed to establish early data to inform program improvements and future study design. Methods: American adults aged ≥21 years who vaped daily, reported ≥5 vape sessions per day, and planned to quit vaping within 6 months were recruited on the web. Data were self-reported via app- and web-based questionnaires. Outcomes included engagement and retention (ie, weeks in the program, number of Pivot app openings, and number of messages sent to the coach), vaping attitudes (ie, success in quitting and difficulty staying quit), vaping behavior (ie, quit attempts, Penn State Electronic Cigarette Dependence Index, 7- and 30-day point-prevalence abstinence [PPA], and continuous abstinence [defined as ≥7-day PPA at 12 weeks+30-day PPA at 26 weeks+0 vaping sessions since 12 weeks]), and participant feedback. Results: In total, 73 participants onboarded (intention-to-treat sample); 68 (93%) completed the 12- and 26-week questionnaires (completer samples). On average, participants were active in Pivot for 13.8 (SD 7.3) weeks, had 87.3 (SD 99.9) app sessions, and sent 37.6 (SD 42.3) messages to their coach over 26 weeks. Mean success in quitting and difficulty staying quit (scale of 1-10) improved from baseline to 12 weeks—4.9 (SD 2.9) to 7.0 (SD 3.0) and 4.0 (SD 2.8) to 6.2 (SD 3.1), respectively (P<.001 in both cases). Most participants (64/73, 88%) made ≥1 quit attempt. At 26 weeks, intention-to-treat 7-day PPA, 30-day PPA, and continuous abstinence rates were 48% (35/73), 45% (33/73), and 30% (22/73), respectively. In total, 45% (33/73) of the participants did not achieve 7-day PPA at 26 weeks; their mean Penn State Electronic Cigarette Dependence Index score decreased from baseline (13.9, SD 3.1) to 26 weeks (10.8, SD 4.5; mean change –3.2, SD 3.9; P<.001); 48% (16/33) of these participants improved in the e-cigarette dependence category. At 2 weeks, 72% (51/71) of respondents reported that using Pivot increased their motivation to quit vaping; at 4 weeks, 79% (55/70) reported using Pivot decreased the amount they vaped per day. Conclusions: In this first evaluation of Pivot in adult daily vapers, questionnaire completion rates were >90%, average program engagement duration was approximately 14 weeks, and most participants reported increased motivation to quit vaping. These and early cessation outcomes herein suggest a role for Pivot in vaping cessation and will inform associated future study and program improvements. %M 39331522 %R 10.2196/57376 %U https://formative.jmir.org/2024/1/e57376 %U https://doi.org/10.2196/57376 %U http://www.ncbi.nlm.nih.gov/pubmed/39331522 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52129 %T Examining Quitting Experiences on Quit Vaping Subreddits From 2015 to 2021: Content Analysis %A Kierstead,Elexis %A Silver,Nathan %A Amato,Michael %+ Truth Initiative, 900 G St NW, Washington, DC, 20006, United States, 1 2024545746, lkierstead@truthinitiative.org %K quitting vaping, social media, tobacco policy %K cessation %K e-cigarette %K electronic cigarette %K smoking %K vaping %K cessation programs %K social support %K peer support %D 2024 %7 25.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the prevalence of vaping nicotine, most nicotine cessation research remains focused on smoking cigarettes. However, the lived experience of quitting smoking is different from quitting vaping. As a result, research examining the unique experiences of those quitting vaping can better inform quitting resources and cessation programs specific to e-cigarette use. Examining Reddit forums (ie, subreddits) dedicated to the topics of quitting vaping nicotine can provide insight into the discussion around experiences on quitting vaping. Prior literature examining limited discussions around quitting vaping on Reddit has identified the sharing of barriers and facilitators for quitting, but more research is needed to investigate the content comprehensively across all subreddits. Objective: The objective of this study is to examine content across quit vaping subreddits since their inception to better understand quitting vaping within the context of the expanding nicotine market. Methods: All posts from January 2015 to October 2021 were scraped from all quit vaping subreddits: r/QuittingJuul, r/QuitVaping, r/quit_vaping, and r/stopvaping (N=7110). Rolling weekly average post volume was calculated. A codebook informed by a latent Dirichlet allocation topic model was developed to characterize themes in a subsample of 695 randomly selected posts. Frequencies and percentages of posts containing each coded theme were assessed along with the number of upvotes and comments. Results: Post volume increased across all subreddits over time, spiking from August – September of 2019 when vaping lung injury emerged. Just over 52% of posts discussed seeking social support and 16.83% discussed providing social support. Posts providing support received the most positive engagements (i.e. upvotes) of all coded categories. Posts also discussed physical and psychological symptoms of withdrawal (30.65% and 18.85%, respectively), strategies for quitting including: quitting cold turkey (38.33%), using alternative nicotine products (17%), and tapering down nicotine content (10.50%). Most posts shared a personal narrative (92.37%) and some discussed quit motivation (28.20%) and relapse (14.99%). Conclusions: This work identifies a desire for peer-to-peer support for quitting vaping, which reinforces existing literature and highlights characteristics of quitting vaping specific to a changing nicotine product environment. Given that posts providing social support were the most upvoted, this suggests that subreddit contributors are seeking support from their peers when discussing quitting vaping. Additionally, this analysis shows the sharing of barriers and facilitators for quitting, supporting findings from prior exploration of quit vaping subreddits. Finally, quitting vaping in an ever-growing nicotine market has led to the evolution of vaping-specific quit methods such as tapering down nicotine content. These findings have direct implications for quit vaping product implementation and development. %M 39454194 %R 10.2196/52129 %U https://www.jmir.org/2024/1/e52129 %U https://doi.org/10.2196/52129 %U http://www.ncbi.nlm.nih.gov/pubmed/39454194 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53938 %T Discussion of Heated Tobacco Products on Twitter Following IQOS’s Modified-Risk Tobacco Product Authorization and US Import Ban: Content Analysis %A Kim,Minji %A Vassey,Julia %A Li,Dongmei %A Galimov,Artur %A Han,Eileen %A Kirkpatrick,Matthew G %A Stanton,Cassandra A %A Ozga,Jenny E %A Lee,Sarah %A Unger,Jennifer B %+ Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 554, Columbia, SC, 29208, United States, 1 803 777 1904, minjikim@sc.edu %K heated tobacco products %K IQOS %K social media %K Twitter %K tobacco control %K modified-risk tobacco product authorization %K MRTP authorization %K tobacco regulatory science %K import ban %K observational study %K public opinion %K content analysis %D 2024 %7 24.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Understanding public opinions about emerging tobacco products is important to inform future interventions and regulatory decisions. Heated tobacco products (HTPs) are an emerging tobacco product category promoted by the tobacco industry as a “better alternative” to combustible cigarettes. Philip Morris International’s IQOS is leading the global HTP market and recently has been subject to important policy events, including the US Food and Drug Administration’s (FDA) modified-risk tobacco product (MRTP) authorization (July 2020) and the US import ban (November 2021). Although limited in their legal implications outside the United States, these policy events have been quoted in global news outlets and Philip Morris International’s promotional communications, showing how they may potentially impact global tobacco regulation. Given the impending return of IQOS to the US market, understanding how the policy events were received through social media discourse will provide valuable insights to inform global tobacco control policy. Objective: This study aims to examine HTP-related social media discourse around important policy events. Methods: We analyzed HTP-related posts on Twitter during the time period that included IQOS’s MRTP authorization in the United States and the US import ban, examining personal testimonial, news/information, and direct marketing/retail tweets separately. We also examined how the tweets discussed health and policy. A total of 10,454 public English tweets (posted from June 2020 to December 2021) were collected using HTP-related keywords. We randomly sampled 2796 (26.7%) tweets and conducted a content analysis. We used pairwise co-occurrence analyses to evaluate connections across themes. Results: Tweet volumes peaked around IQOS-related policy events. Among all tweets, personal testimonials were the most common (1613/2796, 57.7%), followed by news/information (862/2796, 30.8%) and direct marketing/retail (321/2796, 11%). Among personal testimonials, more tweets were positive (495/1613, 30.7%) than negative (372/1613, 23.1%), often comparing the health risks of HTPs with cigarettes (402/1613, 24.9%) or vaping products (252/1613, 15.6%). Approximately 10% (31/321) of the direct marketing/retail tweets promoted international delivery, suggesting cross-border promotion. More than a quarter of tweets (809/2796, 28.9%) discussed US and global policy, including misinterpretation about IQOS being a “safer” tobacco product after the US FDA’s MRTP authorization. Neutral testimonials mentioning the IQOS brand (634/1613, 39.3%) and discussing policy (378/1613, 23.4%) showed the largest pairwise co-occurrence. Conclusions: Results suggest the need for careful communication about the meaning of MRTP authorizations and relative risks of tobacco products. Many tweets expressed HTP-favorable opinions referring to reduced health risks, even though the US FDA has denied marketing of the HTP with reduced risk claims. The popularity of social media as an information source with global reach poses unique challenges in health communication and health policies. While many countries restrict tobacco marketing via the web, our results suggest that retailers may circumvent such regulations by operating overseas. %M 39446431 %R 10.2196/53938 %U https://www.jmir.org/2024/1/e53938 %U https://doi.org/10.2196/53938 %U http://www.ncbi.nlm.nih.gov/pubmed/39446431 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63156 %T Desires and Needs for Quitting Both e-Cigarettes and Cigarettes Among Young Adults: Formative Qualitative Study Informing the Development of a Smartphone Intervention for Dual Tobacco Cessation %A Nguyen,Nhung %A Koester,Kimberly A %A Tran,Christine %A Ling,Pamela M %+ Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Ave, San Francisco, CA, 94502, United States, 1 6508889207, Nhung.Nguyen@ucsf.edu %K smoking cessation %K vaping cessation %K mHealth intervention %K mobile health %K e-cigarettes %K cigarettes %K smartphone intervention %K nicotine dependence %K additive adverse health effects %K tobacco cessation %D 2024 %7 22.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Dual use of both e-cigarettes and cigarettes is popular among young adults and may lead to greater nicotine dependence and additive adverse health effects than single-product use. However, existing cessation programs target quitting either e-cigarettes or cigarettes, highlighting a need for interventions to help young adults quit both products (ie, dual tobacco cessation). Objective: This formative study is part of a larger project to develop a smartphone intervention for dual tobacco cessation among young adults. This study aimed to (1) explore desires for and experiences with quitting both e-cigarettes and cigarettes and (2) identify needs and preferences for dual tobacco cessation intervention programming. Methods: Semistructured interviews were conducted to elicit the need for and experience with dual tobacco cessation among 14 young adults (18-29 years old) recruited through Instagram (Meta) advertisements in 2023. We conducted a thematic analysis to identify common themes related to quitting experiences and cessation needs. Results: Participants expressed a strong desire for dual tobacco cessation and had attempted to quit both tobacco products, mostly “cold turkey.” The priority product for quitting first varied by the individual’s perceived harm or level of consumption. Targets for dual tobacco cessation interventions included (1) highlighting the health effects of dual tobacco use compared with single product use, (2) providing cessation support to quit one prioritized product while cutting down the other product with the explicit goal to quit both, (3) emphasizing unique facilitators and barriers to quitting each product (eg, unpleasant smell of cigarettes facilitating smoking cessation and accessibility and flavors of e-cigarettes hindering vaping cessation), and (4) addressing co-use of tobacco with alcohol or cannabis. Participants wanted personalized interventions through smartphone apps that would tailor support to their tobacco use patterns and unique quitting goals and needs. They also suggested presenting intervention content in multimedia (eg, videos, graphic pictures, quizzes, and games) to increase engagement. Conclusions: This study provides important insights into young adults’ experiences, needs, and preferences for dual tobacco product cessation. We highlight important targets for future smartphone apps to deliver personalized and tailored support to meet the heterogeneous needs and preferences of young people who want to quit using both e-cigarettes and cigarettes. %M 39437386 %R 10.2196/63156 %U https://formative.jmir.org/2024/1/e63156 %U https://doi.org/10.2196/63156 %U http://www.ncbi.nlm.nih.gov/pubmed/39437386 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58203 %T The Rutgers Omnibus Study: Protocol for Quarterly Web-Based Surveys to Promote Rapid Tobacco Research %A Bover Manderski,Michelle T %A Young,William J %A Ganz,Ollie %A Delnevo,Cristine D %+ Institute for Nicotine and Tobacco Studies, Rutgers Biomedical and Health Sciences (Rutgers Health), Rutgers, The State University of New Jersey, 303 George Street, Suite 405, New Brunswick, NJ, 08901, United States, 1 732 235 9727, bovermi@ints.rutgers.edu %K survey %K tobacco %K nicotine %K young adults %K adults %K protocol %K Rutgers Omnibus Study %K Amazon Mechanical Turk %K MTurk %D 2024 %7 16.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Rapid and flexible data collection efforts are necessary for effective monitoring and research on tobacco and nicotine product use in a constantly evolving marketplace. The Rutgers Omnibus Survey (1) provides timely data on awareness and use of new and emerging tobacco products among adults in a rapid manner, (2) provides a platform for measurement experiments to help develop and refine measures of tobacco use that reflect the current marketplace, and (3) generates pilot data for grant applications and scientific manuscripts. Objective: This study aims to document the first 2 years of the Rutgers Omnibus Study through the reporting of methodology, fielding summaries, and sample characteristics. Methods: Launched in February 2022 and fielded quarterly thereafter, we survey convenience samples of 2000 to 3000 US adults aged 18-45 years recruited from Amazon Mechanical Turk (MTurk) using the MTurk Toolkit by CloudResearch. The questionnaire includes core and rotating modules and is designed to take approximately 10 minutes to complete through Qualtrics. The fielding duration is approximately 10 days per wave. Each wave includes both unique and repeating participants, and responses can be linked across waves by an anonymous ID. Results: Sample sizes ranged from 2082 (wave 8, December 2023) to 2989 (wave 1, February 2022), and the 8-wave longitudinal dataset included 10,334 participants, of whom 2477 had 3 or more data points. The cost per complete at each wave was low, ranging from US $2.46 to US $3.27 across waves. Key demographics were consistent across waves and similar to that of the general population, while tobacco product trial and past–30-day use were generally higher. Conclusions: The Rutgers Omnibus Study is a quarterly survey that is effective for rapidly assessing the use of emerging tobacco and nicotine products and can also be leveraged to conduct survey experiments, generate pilot data, and address both cross-sectional and longitudinal research questions. International Registered Report Identifier (IRRID): RR1-10.2196/58203 %M 39413372 %R 10.2196/58203 %U https://www.researchprotocols.org/2024/1/e58203 %U https://doi.org/10.2196/58203 %U http://www.ncbi.nlm.nih.gov/pubmed/39413372 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58221 %T Perceptions of the Use of Mobile Technologies for Smoking Cessation: Focus Group Study With Individuals of Low Socioeconomic Status Who Smoke %A Wakeman,Michael %A Tesfaye,Lydia %A Gregory,Tim %A Leahy,Erin %A Kendrick,Brandon %A El-Toukhy,Sherine %+ Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 11545 Rockville Pike, Rockville, MD, 20852, United States, 1 3015944743, sherine.el-toukhy@nih.gov %K smoking cessation %K social determinants of health %K mhealth %K apps %K qualitative research %K young adults %D 2024 %7 11.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of mobile technologies to deliver behavioral health interventions, including smoking cessation support, has grown. Users’ perceptions are important determinants of the adoption and use of new technologies. However, little is known about users’ perceptions of mobile technologies as smoking cessation aids, particularly among disadvantaged individuals who smoke. Objective: This study aimed to examine the acceptance of mobile technologies for smoking cessation among young adults with low socioeconomic status who smoke. Methods: In total, 38 current cigarette smokers, 18 to 29 years old, who wanted to quit and did not have a 4-year college degree nor were enrolled in a 4-year college, participated in 12 semistructured digital focus groups. The moderation guide was guided by the Unified Theory of Acceptance and Use of Technology. Discussions were audio recorded, transcribed verbatim, and coded for the Unified Theory of Acceptance and Use of Technology constructs (ie, effort expectancy, facilitating conditions, performance expectancy, and social influence), sentiment (ie, negative, neutral, and positive), and purpose of using mobile technologies (ie, lifestyle and health management and smoking cessation) following a deductive thematic analysis approach. Results: Participants had positive experiences using mobile technologies for lifestyle and health management, primarily for fitness and dietary purposes. Salient themes were facilitating conditions of use (44/80, 55%), with prior experiences and costs subthemes, followed by perceived usefulness of mobile technologies in helping users attain health goals (22/80, 27.50%), which were generally positive. Ease of use (11/80, 13.75%) and social influences (3/80, 3.75%) were minimally discussed. Conversely, participants had limited awareness of smoking cessation uses of mobile technologies, which was the primary barrier under facilitating conditions discussed (33/51, 64.70%). Participants expressed skepticism about the usefulness of mobile technologies in helping them quit smoking (14/51, 27.45%). Effort expectancy was not discussed, given participants’ limited prior use. Social influences on mobile technology use for smoking cessation were minimally discussed (4/51, 7.84%). Conclusions: The use of mobile technologies for smoking cessation was unknown to young adults with low socioeconomic status who smoke. To reduce cigarette smoking and associated health disparities, increasing awareness and use of evidence-based mobile-based smoking cessation interventions are needed. Smoking cessation interventions should incorporate features perceived as useful and easy to use to capitalize on positive user experiences and the acceptability of mobile technologies for lifestyle and health management. %M 39392684 %R 10.2196/58221 %U https://formative.jmir.org/2024/1/e58221 %U https://doi.org/10.2196/58221 %U http://www.ncbi.nlm.nih.gov/pubmed/39392684 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e51025 %T Feasibility and Engagement of a Mobile App Preparation Program (Kwit) for Smoking Cessation in an Ecological Context: Quantitative Study %A Bustamante Perez,Luz Adriana %A Romo,Lucia %A Zerhouni,Oulmann %+ Laboratoire EA 4430-Clinique Psychanalyse Developpement, Department of Psychology, University of Paris Nanterre, 200 avenue de la République, Nanterre, 92001, France, 33 783192547, adriana.bustamante93@gmail.com %K smoking cessation %K digital intervention %K behavior change techniques %K attrition rate %K mobile app %K preparation program %K motivation %K quit smoking %K ecological settings %K mobile phone %D 2024 %7 2.10.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps can facilitate access to effective treatment and therapeutic information services. However, the real-world effectiveness of mobile apps for smoking cessation and their potential impact in everyday settings remain unclear. Objective: In an ecological context, this study aimed to estimate the engagement rate of a mobile app–based smoking cessation preparation program and its potential impact on users’ willingness, ability, and readiness to quit smoking. Methods: A total of 2331 “organic users” (ie, users who discover and install a mobile app on their own, without any prompts) chose 1 of 2 program versions of the mobile app (Kwit): the basic version or the premium version. Both versions were identical in design, with 4 more evidence-based content items and strategies in the premium version. Outcomes were analyzed based on automated data registered in the app (engagement rate, motivation to quit, motivation type, motivation levels, and satisfaction level). Mann-Whitney and χ2 tests were used to compare the results of both groups. Results: As expected, in the ecological context, a high dropout rate was observed at different moments. A significant difference was observed between the 2 versions (n=2331; χ21=5.4; P=.02), with a proportionally higher engagement rate in the premium version (premium=4.7% vs basic=2%). Likewise, differences were also observed between the 2 groups in terms of reasons to quit (n=2331; χ24=19; P≤.001; V=0.08), motivation type (n=2331; χ27=14.7; P=.04), and motivation level. Users of the app’s premium version more frequently reported “well-being” (23.3% vs 17.9%) and “planning a pregnancy” (7.4% vs 4.4%) as their primary reasons for quitting smoking compared to those with the basic version. Moreover, they reported being more likely to be driven in the smoking cessation process by intrinsic motivation (premium=28% vs basic=20.4%), as well as feeling significantly more willing (z score=156,055; P≤.001; Cohen d=0.15), able (z score=172,905; P=.04; Cohen d=0.09), and ready (z score=166,390; P=.005; Cohen d=0.12) to stop smoking than users who had the basic version before completion of the preparation program. Among participants who finished each version of the program (premium: 9/189, 4.8%; basic: 47/2142, 2.19%), significant improvements in motivation levels were observed in both groups, although in different areas for each group (willingness levels for the premium group and ability for the basic group). Conclusions: These results suggest that even in ecological contexts where engagement rates are meager, the Kwit preparation program can address ambivalence by increasing willingness to change, self-confidence, and readiness to quit among its users, especially those who feel less able to do so. Further development and evaluations are needed to better understand determinants for regular mobile health apps. %M 39357053 %R 10.2196/51025 %U https://mhealth.jmir.org/2024/1/e51025 %U https://doi.org/10.2196/51025 %U http://www.ncbi.nlm.nih.gov/pubmed/39357053 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57970 %T Understanding e-Cigarette Addictiveness: Triangulation of Focus Group and Netnographic Data %A Andreas,Marike %A Grundinger,Nadja %A Wolber,Nadine %A Szafran,Daria %A Görig,Tatiana %A Mons,Ute %A Lohner,Valerie %A Vollstädt-Klein,Sabine %A Schneider,Sven %+ Division of Public Health, Social and Preventive Medicine, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl-Straße 13-17, Mannheim, 68167, Germany, 49 621 383 71814, marikeandreas@gmail.com %K e-cigarettes %K online forums %K netnographic analysis %K addictive %K addiction %K smoking cessation %K smoker %K user %K focus group %K nicotine %K public health %K prevalence %K smoking behavior %D 2024 %7 1.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Numerous studies have shown that e-cigarettes are addictive. For example, we previously showed that users of e-cigarette online forums discuss experiences of addiction in a netnographic analysis. However, it is unclear what makes e-cigarettes addictive apart from nicotine. In a focus group analysis, we recently identified 3 unique features of e-cigarettes that users linked to experiences of addiction: the pleasant taste, unobtrusiveness, and unlimited usability of e-cigarettes. Objective: This study aimed to validate the previously identified features of e-cigarette addictive potential by triangulating data from the netnographic analysis and focus group discussions. Methods: Drawing on a netnographic analysis of 3 popular, German-language e-cigarette forums, we studied whether experiences of addiction were linked to specific e-cigarette features. We included 451 threads in the analysis that had been coded for addictive experiences in a previous study by our team. First, we conducted a deductive analysis with preregistered codes to determine whether the features of pleasant taste, unobtrusiveness, and unlimited usability were mentioned in relation to the addictive potential of e-cigarettes in the online forums. Second, an inductive approach was chosen to identify further possible addictive features of e-cigarettes. Results: Our deductive analysis confirmed that the features highlighted in our previous focus group study (pleasant taste, unobtrusiveness, and unlimited usability) were also frequently discussed in online forums in connection to addictive symptoms. In addition, our inductive analysis identified nicotine dosage as a significant feature linked to addiction. Users reported varying their nicotine doses for different reasons, leading to the identification of four distinct user types based on dosing patterns: (1) high doses for intermittent, (2) high doses for constant use, (3) low doses for constant use, and (4) switching between high and low doses depending on the situation. Conclusions: Our comprehensive analysis of online forum threads revealed that users’ experiences of addiction are linked to 4 specific features unique to e-cigarettes: pleasant taste, unobtrusiveness, unlimited usability, and nicotine dosage. Recognizing these addictive features of e-cigarettes is crucial for designing cessation programs and informing public health policies to reduce the addictiveness of e-cigarettes. %M 39353183 %R 10.2196/57970 %U https://www.jmir.org/2024/1/e57970 %U https://doi.org/10.2196/57970 %U http://www.ncbi.nlm.nih.gov/pubmed/39353183 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e53778 %T Generation of Backward-Looking Complex Reflections for a Motivational Interviewing–Based Smoking Cessation Chatbot Using GPT-4: Algorithm Development and Validation %A Kumar,Ash Tanuj %A Wang,Cindy %A Dong,Alec %A Rose,Jonathan %K motivational interviewing %K smoking cessation %K therapy %K automated therapy %K natural language processing %K large language models %K GPT-4 %K chatbot %K dialogue agent %K reflections %K reflection generation %K smoking %K cessation %K ChatGPT %K smokers %K smoker %K effectiveness %K messages %D 2024 %7 26.9.2024 %9 %J JMIR Ment Health %G English %X Background: Motivational interviewing (MI) is a therapeutic technique that has been successful in helping smokers reduce smoking but has limited accessibility due to the high cost and low availability of clinicians. To address this, the MIBot project has sought to develop a chatbot that emulates an MI session with a client with the specific goal of moving an ambivalent smoker toward the direction of quitting. One key element of an MI conversation is reflective listening, where a therapist expresses their understanding of what the client has said by uttering a reflection that encourages the client to continue their thought process. Complex reflections link the client’s responses to relevant ideas and facts to enhance this contemplation. Backward-looking complex reflections (BLCRs) link the client’s most recent response to a relevant selection of the client’s previous statements. Our current chatbot can generate complex reflections—but not BLCRs—using large language models (LLMs) such as GPT-2, which allows the generation of unique, human-like messages customized to client responses. Recent advancements in these models, such as the introduction of GPT-4, provide a novel way to generate complex text by feeding the models instructions and conversational history directly, making this a promising approach to generate BLCRs. Objective: This study aims to develop a method to generate BLCRs for an MI-based smoking cessation chatbot and to measure the method’s effectiveness. Methods: LLMs such as GPT-4 can be stimulated to produce specific types of responses to their inputs by “asking” them with an English-based description of the desired output. These descriptions are called prompts, and the goal of writing a description that causes an LLM to generate the required output is termed prompt engineering. We evolved an instruction to prompt GPT-4 to generate a BLCR, given the portions of the transcript of the conversation up to the point where the reflection was needed. The approach was tested on 50 previously collected MIBot transcripts of conversations with smokers and was used to generate a total of 150 reflections. The quality of the reflections was rated on a 4-point scale by 3 independent raters to determine whether they met specific criteria for acceptability. Results: Of the 150 generated reflections, 132 (88%) met the level of acceptability. The remaining 18 (12%) had one or more flaws that made them inappropriate as BLCRs. The 3 raters had pairwise agreement on 80% to 88% of these scores. Conclusions: The method presented to generate BLCRs is good enough to be used as one source of reflections in an MI-style conversation but would need an automatic checker to eliminate the unacceptable ones. This work illustrates the power of the new LLMs to generate therapeutic client-specific responses under the command of a language-based specification. %R 10.2196/53778 %U https://mental.jmir.org/2024/1/e53778 %U https://doi.org/10.2196/53778 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e53899 %T Public Perception of the Tobacco 21 Amendment on Twitter in the United States: Observational Study %A Schneller-Najm,Liane M %A Xie,Zidian %A Chen,Jiarui %A Lee,Sarah %A Xu,Emily %A Li,Dongmei %+ Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Elm and Carlton Streets, Buffalo, NY, 14203, United States, 1 716 845 5881, Liane.Najm@RoswellPark.org %K tobacco policy %K tobacco regulation %K social media %K tobacco use %K tobacco %K health belief %K sentiment analysis %K smoking %K cigarettes %K social media analysis %K vaping %K e-cigarettes %K health behavior %K public opinion %D 2024 %7 25.9.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Following the signing of the Tobacco 21 Amendment (T21) in December 2019 to raise the minimum legal age for the sale of tobacco products from 18 to 21 years in the United States, there is a need to monitor public responses and potential unintended consequences. Social media platforms, such as Twitter (subsequently rebranded as X), can provide rich data on public perceptions. Objective: This study contributes to the literature using Twitter data to assess the knowledge and beliefs of T21. Methods: Twitter data were collected from November 2019 to February 2021 using the Twitter streaming application programming interface with keywords related to vaping or e-cigarettes, such as “vape,” “ecig,” etc. The temporal trend of the T21 discussion on Twitter was examined using the mean number of daily T21-related tweets. Inductive methods were used to manually code the tweets into different sentiment groups (positive, neutral, and negative) based on the attitude expressed toward the policy by 3 coders with high interrater reliability. Topics discussed were examined within each sentiment group through theme analyses. Results: Among the collected 3197 tweets, 2169 tweets were related to T21, of which 444 tweets (20.5%) showed a positive attitude, 736 (33.9%) showed a negative attitude, and 989 (45.6%) showed a neutral attitude. The temporal trend showed a clear peak in the number of tweets around January 2020, following the enactment of this legislation. For positive tweets, the most frequent topics were “avoidance of further regulation” (120/444, 27%), “Enforce T21” (110/444, 24.8%), and “health benefits” (81/444, 18.2%). For negative tweets, the most frequent topics were “general disagreement or frustration” (207/736, 28.1%) and “will still use tobacco” (188/736, 25.5%). Neutral tweets were primarily “public service announcements (PSA) or news posts” (782/989, 79.1%). Conclusions: Overall, we find that one-third of tweets displayed a negative attitude toward T21 during the study period. Many were frustrated with T21 and reported that underage consumers could still obtain products. Social media data provide a timely opportunity to monitor public perceptions and responses to regulatory actions. Continued monitoring can inform enforcement efforts and potential unintended consequences of T21. %M 39321452 %R 10.2196/53899 %U https://infodemiology.jmir.org/2024/1/e53899 %U https://doi.org/10.2196/53899 %U http://www.ncbi.nlm.nih.gov/pubmed/39321452 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e63193 %T Association Between Cigarette and Bidi Purchase Behavior (Loose vs Pack) and Health Warning Label Exposure: Findings From the Tobacco Control Policy India Survey and In-Depth Interviews With People Who Smoke %A Sakhuja,Mayank %A Friedman,Daniela B %A Macauda,Mark M %A Hebert,James R %A Pednekar,Mangesh S %A Gupta,Prakash C %A Fong,Geoffrey T %A Thrasher,James F %+ UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 323A Rosenau Hall CB #7440, Chapel Hill, NC, 27599, United States, 1 8034468063, msakhuja@unc.edu %K loose cigarettes %K singles %K health warning labels %K tobacco control %K India %K mixed methods %K purchase behavior %K tobacco users %K cigarette %K qualitative research %K thematic analysis %K prevention %K health promotion %K public health %D 2024 %7 25.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The sale of loose cigarettes or bidis can undermine the purpose of requiring health warning labels (HWLs) on cigarette packs and bidi bundles by diminishing their visibility and legibility. Objective: This mixed-methods study aims to examine the association between purchase behavior (loose vs pack or bundle), HWL exposure, and responses to HWLs among Indian adults who smoke. Methods: Data were analyzed from the 2018-2019 India Tobacco Control Policy Survey and from 28 in-depth interviews conducted with Indian adults who smoked in 2022. The Tobacco Control Policy Survey sample included tobacco users who bought cigarettes (n=643) or bidis (n=730), either loose or in packs or bundles at their last purchase. Ordinal regression models were fit separately for cigarettes and bidis, whereby HWL variables (noticing HWLs, reading and looking closely at HWLs, forgoing a cigarette or bidi because of HWLs, thinking about health risks of smoking, and thinking about quitting smoking cigarettes or bidis because of HWLs) were regressed on last purchase (loose vs packs or bundles). In-depth interviews with participants from Delhi and Mumbai who purchased loose cigarettes in the last month were conducted, and thematic analysis was used to analyze the interview data. Results: Survey findings indicated that about 74.3% (478/643) of cigarette users and 11.8% (86/730) of bidi users reported having bought loose sticks at their last purchase. Those who purchased loose cigarettes (vs packs) noticed HWLs less often (estimate –0.830, 95% CI –1.197 to –0.463, P<.001), whereas those who purchased loose bidis (vs bundles) read and looked closely at HWLs (estimate 0.646, 95% CI 0.013-1.279, P=.046), thought about the harms of bidi smoking (estimate 1.200, 95% CI 0.597-1.802, P<.001), and thought about quitting bidi smoking (estimate 0.871, 95% CI 0.282-1.461, P=.004) more often. Interview findings indicated lower exposure to HWLs among those who purchased loose cigarettes, primarily due to vendors distributing loose cigarettes without showing the original cigarette pack, storing them in separate containers, and consumers’ preference for foreign-made cigarette brands, which often lack HWLs. While participants were generally aware of the contents of HWLs, many deliberately avoided them when purchasing loose cigarettes. In addition, they believed that loose cigarette purchases reduced the HWLs’ potential to deliver consistent reminders about the harmful effects of cigarette smoking due to reduced exposure, an effect more common among those who purchased packs. Participants also noted that vendors, especially small ones, did not display statutory health warnings at their point of sale, further limiting exposure to warning messages. Conclusions: Survey and interview findings indicated that those who purchased loose cigarettes noticed HWLs less often. Loose purchases likely decrease the frequency of exposure to HWLs’ reminders about the harmful effects of smoking, potentially reducing the effectiveness of HWLs. %M 39320944 %R 10.2196/63193 %U https://publichealth.jmir.org/2024/1/e63193 %U https://doi.org/10.2196/63193 %U http://www.ncbi.nlm.nih.gov/pubmed/39320944 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58636 %T Chatbot-Led Support Combined With Counselor-Led Support on Smoking Cessation in China: Protocol for a Pilot Randomized Controlled Trial %A Weng,Xue %A Yin,Hua %A Liu,Kefeng %A Song,Chuyu %A Xie,Jiali %A Guo,Ningyuan %A Wang,Man Ping %+ Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, No.18, Jinfeng Road, Tangjiawan, Zhuhai, 519087, China, 86 (0756)3621259, xueweng@bnu.edu.cn %K chatbot %K smoking cessation %K mHealth %K mobile phone %K campus %K China %D 2024 %7 23.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: China has a large population of smokers, with half of them dependent on tobacco and in need of cessation assistance, indicating the need for mobile health (mHealth) to provide cessation support. Objective: The study aims to assess the feasibility and preliminary effectiveness of combining chatbot-led support with counselor-led support for smoking cessation among community smokers in China. Methods: This is a 2-arm, parallel, assessor-blinded, pilot randomized controlled trial nested in a smoke-free campus campaign in Zhuhai, China. All participants will receive brief face-to-face cessation advice and group cessation support led by a chatbot embedded in WeChat. In addition, participants in the intervention group will receive personalized WeChat-based counseling from trained counselors. Follow-up will occur at 1, 3, and 6 months after treatment initiation. The primary smoking outcome is bioverified abstinence (exhaled carbon monoxide <4 parts per million or salivary cotinine <30 ng/mL) at 6 months. Secondary outcomes include self-reported 7-day point prevalence of abstinence, smoking reduction rate, and quit attempts. Feasibility outcomes include eligibility rate, consent rate, intervention engagement, and retention rate. An intention-to-treat approach and regression models will be used for primary analyses. Results: Participant recruitment began in March 2023, and the intervention began in April 2023. The data collection was completed in June 2024. The results of the study will be published in peer-reviewed journals and presented at international conferences. Conclusions: This study will provide novel insights into the feasibility and preliminary effectiveness of a chatbot-led intervention for smoking cessation in China. The findings of this study will inform the development and optimization of mHealth interventions for smoking cessation in China and other low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT05777005; https://clinicaltrials.gov/study/NCT05777005 International Registered Report Identifier (IRRID): DERR1-10.2196/58636 %M 39312291 %R 10.2196/58636 %U https://www.researchprotocols.org/2024/1/e58636 %U https://doi.org/10.2196/58636 %U http://www.ncbi.nlm.nih.gov/pubmed/39312291 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58335 %T Patterns of Use and Withdrawal Syndrome in Dual Cannabis and Tobacco Users (DuCATA_GAM-CAT): Protocol for a Mixed Methods Study %A Saura,Judith %A Feliu,Ariadna %A Enríquez-Mestre,Marta %A Fu,Marcela %A Ballbè,Montse %A Castellano,Yolanda %A Pla,Margarida %A Rosa,Nathalia %A Radeva,Petia %A Maestre-González,Elena %A Cabezas,Carmen %A Colom,Joan %A Suelves,Josep M %A Mondon,Silvia %A Barrio,Pablo %A Andreu,Magalí %A Raich,Antònia %A Bernabeu,Jordi %A Vilaplana,Jordi %A Roca Tutusaus,Xavier %A Guydish,Joseph %A Fernández,Esteve %A Martínez,Cristina %+ Tobacco Control Unit, Cancer Control and Prevention Program, Institut Català d’Oncologia, WHO Collaborating Center On Tobacco Control, Avinguda de la Granvia de l’Hospitalet 199, L'Hospitalet de Llobregat, Barcelona, 08908, Spain, 34 932607733, efernandez@iconcologia.net %K cannabis %K tobacco %K substance abuse %K withdrawal symptoms %K mobile phone %K protocol %K addiction %K pattern use %K withdrawal syndrome %K mixed method %K participatory %K qualitative study %K focus groups %K cannabis use disorder %K clinicians %K researchers %K predictive analysis %D 2024 %7 19.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Approximately 1 in 6 cannabis users develop a cannabis use disorder (CUD) and the odds increase to 1 in 2 for daily users. Objective: The Dual use of Cannabis and Tobacco Monitoreing through a Gamified Web app (DuCATA_GAM-CaT) project aims to identify cannabis-tobacco patterns of use and withdrawal symptoms among individuals with CUD who are attending substance abuse programs. Methods: The project uses a mixed methods approach consisting of 3 studies. First, a participatory qualitative study involves focus groups comprising individuals with CUD, clinicians, project researchers, and an expert gamification company to co-design a gamified web app. Second, a longitudinal prospective study to follow up individuals over 6 weeks with CUD attending substance abuse programs . Participants report their cannabis-tobacco usage patterns, type and frequency of tobacco use, nicotine dependence, withdrawal symptoms, psychoemotional factors, and motivation to quit both substances. Predictive analysis techniques are used to analyze clinical, demographic, psychological, and environmental data to predict the probability of achieving abstinence. Third, homogeneous focus groups to explore participants’ experiences during their CUD treatment. Results: By June 2024, the project had completed the first study, defining eligible cannabis user profiles, developed the initial web app prototype, and initiated recruitment across 10 centers, with 74 participants enrolled, aiming to reach 150 participants in total. Conclusions: All participants are required to provide informed consent, and their information is kept confidential and anonymized following confidentiality rules. The research team is committed to disseminating the results obtained to professional and patient groups, as well as informing public health agents, to positively influence political and social decision makers and design programmers. Additionally, we aim to prioritize the publication of the results in high-impact journals specialized in drug abuse, public health, and health care services research. Trial Registration: ClinicalTrials.gov NCT05512091; https://clinicaltrials.gov/study/NCT05512091 International Registered Report Identifier (IRRID): DERR1-10.2196/58335 %M 39298750 %R 10.2196/58335 %U https://www.researchprotocols.org/2024/1/e58335 %U https://doi.org/10.2196/58335 %U http://www.ncbi.nlm.nih.gov/pubmed/39298750 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56371 %T Public Perceptions of the Food and Drug Administration's Regulatory Authority Over Synthetic Nicotine on Twitter: Observational Study %A Zou,Jonathan %A Feliciano,Juan Ramon %A Xie,Zidian %A Li,Dongmei %+ Department of Clinical and Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard Cu 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K FDA %K synthetic nicotine %K omnibus %K Twitter %K Food and Drug Administration %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Omnibus Budget Bill, known as H. R. 2471, passed through Congress on March 10, 2022, and was eventually signed by President Biden on March 15, 2022. This bill amended the Federal Food, Drug, and Cosmetic Act granting the Food and Drug Administration (FDA) regulatory authority over synthetic nicotine. Objective: This study aims to examine the public perceptions of the Omnibus Bill that regulates synthetic nicotine products as tobacco products on Twitter (rebranded as X). Methods: Through the X streaming application programming interface, we collected and identified 964 tweets related to the Omnibus Bill on synthetic nicotine between March 8, 2022, and April 13, 2022. The longitudinal trend was used to examine the discussions related to the bill over time. An inductive method was used for the content analysis of related tweets. By hand-coding 200 randomly selected tweets by 2 human coders respectively with high interrater reliability, the codebook was developed for relevance, major topics, and attitude to the bill, which was used to single-code the rest of the tweets. Results: Between March 8, 2022, and April 13, 2022, we identified 964 tweets related to the Omnibus Bill regulating synthetic nicotine. Our longitudinal trend analysis showed a spike in the number of tweets related to the bill during the immediate period following the bill’s introduction, with roughly half of the tweets identified being posted between March 8 and 11, 2022. A majority of the tweets (497/964, 51.56%) had a negative sentiment toward the bill, while a much smaller percentage of tweets (164/964, 17.01%) had a positive sentiment toward the bill. Around 31.43% (303/964) of all tweets were categorized as objective news or questions about the bill. The most popular topic for opposing the bill was users believing that this bill would lead users back to smoking (145/497, 29.18%), followed by negative implications for small vape businesses (122/497, 24.55%) and government or FDA mistrust (94/497, 18.91%). The most popular topic for supporting the bill was that this bill would take a dangerous tobacco product targeted at teens off the market (94/164, 57.32%). Conclusions: We observed a more negative sentiment toward the bill on X, largely due to users believing it would lead users back to smoking and negatively impact small vape businesses. This study provides insight into public perceptions and discussions of this bill on X and adds valuable information for future regulations on alternative nicotine products. %M 39298747 %R 10.2196/56371 %U https://formative.jmir.org/2024/1/e56371 %U https://doi.org/10.2196/56371 %U http://www.ncbi.nlm.nih.gov/pubmed/39298747 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e58260 %T e-Cigarettes, Smoking Cessation, and Weight Change: Retrospective Secondary Analysis of the Evaluating the Efficacy of e-Cigarette Use for Smoking Cessation Trial %A Lyzwinski,Lynnette %A Dong,Meichen %A Wolfinger,Russell D %A Filion,Kristian B %A Eisenberg,Mark J %+ Centre for Clinical Epidemiology, Lady Davis Institute, McGill University, 3755 Côte Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada, 1 (514) 340 8222, lynnette.lyzwinski@mail.mcgill.ca %K nicotine %K smoking cessation %K e-cigarettes %K vaping %K weight change %K weight gain %D 2024 %7 16.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: While smoking cessation has been linked to substantial weight gain, the potential influence of e-cigarettes on weight changes among individuals who use these devices to quit smoking is not fully understood. Objective: This study aims to reanalyze data from the Evaluating the Efficacy of e-Cigarette Use for Smoking Cessation (E3) trial to assess the causal effects of e-cigarette use on change in body weight. Methods: This is a secondary analysis of the E3 trial in which participants were randomized into 3 groups: nicotine e-cigarettes plus counseling, nonnicotine e-cigarettes plus counseling, and counseling alone. With adjustment for baseline variables and the follow-up smoking abstinence status, weight changes were compared between the groups from baseline to 12 weeks’ follow-up. Intention-to-treat and as-treated analyses were conducted using doubly robust estimation. Further causal analysis used 2 different propensity scoring methods to estimate causal regression curves for 4 smoking-related continuous variables. We evaluated 5 different subsets of data for each method. Selection bias was addressed, and missing data were imputed by the machine learning method extreme gradient boosting (XGBoost). Results: A total of 257 individuals with measured weight at week 12 (mean age: 52, SD 12 y; women: n=122, 47.5%) were included. Across the 3 treatment groups, of the 257 participants, 204 (79.4%) who continued to smoke had, on average, largely unchanged weight at 12 weeks, with comparable mean weight gain ranging from –0.24 kg to 0.33 kg, while 53 (20.6%) smoking-abstinent participants gained weight, with a mean weight gain ranging from 2.05 kg to 2.70 kg. After adjustment, our analyses showed that the 2 e-cigarette arms exhibited a mean gain of 0.56 kg versus the counseling alone arm. The causal regression curves analysis also showed no strong evidence supporting a causal relationship between weight gain and the 3 e-cigarette–related variables. e-Cigarettes have small and variable causal effects on weight gain associated with smoking cessation. Conclusions: In the E3 trial, e-cigarettes seemed to have minimal effects on mitigating the weight gain observed in individuals who smoke and subsequently quit at 3 months. However, given the modest sample size and the potential underuse of e-cigarettes among those randomized to the e-cigarette treatment arms, these results need to be replicated in large, adequately powered trials. Trial Registration: ClinicalTrials.gov NCT02417467; https://www.clinicaltrials.gov/study/NCT02417467 %M 39283667 %R 10.2196/58260 %U https://publichealth.jmir.org/2024/1/e58260 %U https://doi.org/10.2196/58260 %U http://www.ncbi.nlm.nih.gov/pubmed/39283667 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60325 %T Patterns of Use of e-Cigarettes and Their Respiratory Effects: Protocol for an Umbrella Review %A La Rosa,Giusy Rita Maria %A Polosa,Riccardo %A O’Leary,Renée %+ Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia, 89, Catania, 95123, Italy, 39 095 478 1124, giusy.larosa@unict.it %K dual use %K electronic nicotine delivery systems %K naïve use %K respiratory %K smoking cessation %K umbrella review %D 2024 %7 4.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Electronic nicotine delivery systems (ENDS)—e-cigarettes or vapes—have been shown to substantially reduce or eliminate many toxins compared with cigarette smoke, but simultaneously ENDS use also produces their own unique toxins. Yet the patterns of use among people who use ENDS are not homogeneous. Some people who use ENDS also smoke cigarettes (dual use). Other people who formerly smoked cigarettes are completely substituting ENDS (exclusive use). A small number of people who have never smoked cigarettes are using ENDS (naïve use of nicotine). Each of these patterns of use results in different exposures to toxins. Unfortunately, epidemiological studies routinely group together any ENDS use regardless of other tobacco use. Objective: This umbrella review primarily aims to present all the evidence available on the respiratory effects of ENDS use by adults based on their pattern of use: dual use, exclusive use, and naïve use. With each of these patterns of use, are there benefits, no changes, or harmful effects on respiratory functioning? Our objective is to provide clinicians with a detailed analysis of how different patterns of ENDS use impact respiratory functioning and to point to the best sources of evidence. Methods: This umbrella review follows the Methods for Overviews of Reviews framework and the PRIOR (Preferred Reporting Items for Overviews of Reviews) statement. Systematic reviews published since 2019 will be searched across 4 databases and 3 gray literature sources. Additional searches will include citation chasing, references lists, and referrals from respiratory specialists. The quality of included reviews will be evaluated using the AMSTAR2 (A Measurement Tool to Assess Systematic Reviews) checklist. We will document biases in 3 areas: protocol deviations, biases from the Oxford Catalogue of Bias, and internal data discrepancies. Two reviewers will independently conduct the search and quality assessments. Our analysis will focus on reviews rated as moderate or high confidence by AMSTAR2. We will use the Vote Counting Direction of Effect method to manage expected data heterogeneity, assessing whether ENDS use is beneficial or detrimental, or has no effect on respiratory functions based on the pattern of use. Results: The review is expected to be completed by December 2024. The database search was concluded in April 2024, and data extraction and bias assessment were completed in June 2024. The analysis phase is planned to be completed by October 2024. Conclusions: A thorough and comprehensive assessment of the evidence will better inform the contentious debate over the respiratory effects of ENDS providing much needed clarity by linking their effects to specific usage patterns. This analysis is particularly crucial in understanding the risks associated with continued cigarette smoking. Trial Registration: PROSPERO CRD42024540034; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=540034 International Registered Report Identifier (IRRID): DERR1-10.2196/60325 %M 39230946 %R 10.2196/60325 %U https://www.researchprotocols.org/2024/1/e60325 %U https://doi.org/10.2196/60325 %U http://www.ncbi.nlm.nih.gov/pubmed/39230946 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57236 %T Adapting and Evaluating a Brief Advice Tobacco Cessation Intervention in High-reach, Low-resource Settings in India: Protocol for a Cluster Randomized Controlled Trial %A Mahtani,Sitara L %A Viswanath,Kasisomayajula %A Gupte,Himanshu A %A Mandal,Gauri %A Jagiasi,Dinesh %A Chawla,Ratandeep %A D'Costa,Marina %A Xuan,Ziming %A Minsky,Sara %A Ramanadhan,Shoba %+ Dana-Farber Cancer Institute, 450 Brookline Avenue, LW, 6th Floor, Boston, MA, 02215, United States, 1 617 582 9487, sitara_mahtani@dfci.harvard.edu %K tobacco use Cessation %K India %K resource-limited settings %K task-shifting %K counseling %K nonprofit organizations %K dental health services %K tuberculosis %K social media %K mobile app %D 2024 %7 3.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: About 1.35 million deaths annually are attributed to tobacco use in India. The main challenge, given the magnitude of tobacco use and limited resources, is delivering cessation support at scale, low cost, and through a coordinated cross-system effort; one such example being brief advice interventions. However, highly credentialed staff to identify and counsel tobacco users are scarce. Task-shifting is an important opportunity for scaling these interventions. Objective: The LifeFirst SWASTH (Supporting Wellbeing among Adults by Stopping Tobacco Habit) program—adapted from the LifeFirst program (developed by the Narotam Sekhsaria Foundation, Mumbai, India)—is a tobacco cessation program focusing on lower-socioeconomic status patients in Mumbai receiving private health care. This parallel-arm, cluster randomized controlled trial investigates whether the LifeFirst SWASTH program increases tobacco cessation rates in low-resource, high-reach health care settings in Mumbai. Methods: This study will target tuberculosis-specific nongovernmental organizations (NGOs), dental clinics, and NGOs implementing general health programs serving lower-socioeconomic status patients. Intervention arm patients will receive a pamphlet explaining tobacco’s harmful effects. Practitioners will be trained to deliver brief cessation advice, and interested patients will be referred to a Narotam Sekhsaria Foundation counselor for free telephone counseling for 6 months. Control arm patients will receive the same pamphlet but not brief advice or counseling. Practitioners will have a customized mobile app to facilitate intervention delivery. Practitioners will also have access to a peer network through WhatsApp. The primary outcome is a 30-day point prevalence abstinence from tobacco. Secondary outcomes for patients and practitioners relate to intervention implementation. Results: The study was funded in June 2020. Due to the COVID-19 pandemic, the study experienced some delays, and practitioner recruitment commenced in November 2023. As of July 2024, all practitioners have been recruited, and practitioner recruitment and training are complete. Furthermore, 36% (1687/4688) of patients have been recruited. Conclusions: It is hypothesized that those patients who participated in the LifeFirst SWASTH program will be more likely to have been abstinent from tobacco for 30 consecutive days by the end of 6 months or at least decreased their tobacco use. LifeFirst SWASTH, if found to be effective in terms of cessation outcomes and implementation, has the potential to be scaled to other settings in India and other low- and middle-income countries. The study will be conducted in low-resource settings and will reach many patients, which will increase the impact if scaled. It will use task-shifting and an app that can be tailored to different settings, also enabling scalability. Findings will build the literature for translating evidence-based interventions from high-income countries to low- and middle-income countries and from high- to low-resource settings. Trial Registration: ClinicalTrials.gov NCT05234983; https://clinicaltrials.gov/study/NCT05234983 International Registered Report Identifier (IRRID): DERR1-10.2196/57236 %M 39225384 %R 10.2196/57236 %U https://www.researchprotocols.org/2024/1/e57236 %U https://doi.org/10.2196/57236 %U http://www.ncbi.nlm.nih.gov/pubmed/39225384 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52919 %T Expectations and Preferences for Digital Cessation Treatment: Multimethods Study Among Older Adults Who Smoke Cigarettes %A Fahey,Margaret C %A Carpenter,Mathew J %A O'Neal,Riley %A Pebley,Kinsey %A Schick,Melissa R %A Ware,Emily %A Toll,Benjamin A %A Dahne,Jennifer %+ Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, United States, 1 6158389307, mfahey@mtsu.edu %K older adults %K digital health %K digital cessation treatment %K smoking cessation %K digital cessation %K treatment %K smoke %K cigarettes %K cigarette %K tobacco %K adults %K elderly %K older person %K older people %K aging %K smoking %K smoke %K quit %K quitting %K questionnaire %K telehealth %K treatment %K treatments %K behavioral health %K public health %K mobile phone %D 2024 %7 28.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: To address enduring age-related tobacco disparities, it is critical to promote cessation treatment among older adults (aged 65+ years). Digital health platforms offer opportunities for wide dissemination of evidence-based behavioral cessation support. However, existing digital cessation treatments are not tailored to unique aging-related needs and preferences, resulting in low uptake. Detailed information is needed about how to best adapt these treatments for this age group. Objective: We aimed to collect detailed, hypothesis-generating information about expectations and preferences for cessation digital treatment among older adults who smoke cigarettes. Methods: Semistructured interviews were conducted with adults aged 65+ years currently smoking or who had quit within the past month. Interviews included open-ended questions regarding prior experiences with digital health platforms and expectations and preferences for cessation treatment via various modalities (app-delivered, texting-based, or videoconferencing counseling). Interviews also elicited questions regarding digital modalities that integrated social components (app-delivered social forums and group videoconferencing counseling). Using an iterative, team-based approach, the thematic analysis identified meaningful themes. Interviews were supplemented with quantitative measures assessing sociodemographics, digital literacy, and physical health symptoms. Results: Participants (12/20, 60% men; 15/20, 75% White; 4/20, 20% Black or African American; 1/20, 5% Asian) were currently smoking (17/20, 85%) or had recently quit (3/20, 15%). Thematic analysis identified 3 meaningful themes across all digital modalities: convenience, accessibility, and personalization. Expected benefits of digital platforms included convenient treatment access, without reliance on transportation. Participants preferred treatments to be personalized and deliver content or strategies beyond standard education. Most (17/20, 85%) were unfamiliar with cessation apps but found them appealing given the potential for offering a novel quitting strategy. App ease of use (eg, easy navigation) was preferred. Half (10/20, 50%) would try a texting-based intervention, with many preferring texting with a counselor rather than automated messaging. Most (17/20, 85%) would use videoconferencing and expected this modality to deliver better quality counseling than via telephone. Expected videoconferencing challenges included looking presentable onscreen, technological difficulties, and privacy or security. Videoconferencing was regarded as the most personalized digital treatment, yet benefits unique to app-delivered and texting-based treatments included anonymity and access to treatment 24/7. Participants expected integrating social components into digital treatment to be useful for quit success and social connection, yet were concerned about possible interpersonal challenges. Conclusions: Because a long history of quit attempts and familiarity with standard quitting advice is common among older adults who smoke cigarettes, digital platforms might offer appealing and novel strategies for cessation that are accessible and convenient. Overall, this population was open to trying digital cessation treatments and would prefer that these platforms prioritize ease of use and personalized content. These findings challenge the bias that older adults are uninterested or unwilling to engage with digital treatments for behavioral health. %M 39196628 %R 10.2196/52919 %U https://www.jmir.org/2024/1/e52919 %U https://doi.org/10.2196/52919 %U http://www.ncbi.nlm.nih.gov/pubmed/39196628 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58121 %T Beta Test of a Christian Faith-Based Facebook Intervention for Smoking Cessation in Rural Communities (FaithCore): Development and Usability Study %A Sharma,Pravesh %A Tranby,Brianna %A Kamath,Celia %A Brockman,Tabetha A %A Lenhart,Ned %A Quade,Brian %A Abuan,Nate %A Halom,Martin %A Staples,Jamie %A Young,Colleen %A Brewer,LaPrincess %A Patten,Christi %+ Department of Psychiatry and Psychology, Mayo Clinic Health System, 1221 Whipple St, Eau Claire, WI, 54703, United States, 1 715 838 5369, sharma.pravesh@mayo.edu %K social media %K Facebook %K rural %K smoking %K cessation %K quitline %K community-based participatory research %K CBPR %K FaithCore %K mobile phone %D 2024 %7 26.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals living in rural communities experience substantial geographic and infrastructure barriers to attaining health equity in accessing tobacco use cessation treatment. Social media and other digital platforms offer promising avenues to improve access and overcome engagement challenges in tobacco cessation efforts. Research has also shown a positive correlation between faith-based involvement and a lower likelihood of smoking, which can be used to engage rural communities in these interventions. Objective: This study aimed to develop and beta test a social intervention prototype using a Facebook (Meta Platforms, Inc) group specifically designed for rural smokers seeking evidence-based smoking cessation resources. Methods: We designed a culturally aligned and faith-aligned Facebook group intervention, FaithCore, tailored to engage rural people who smoke in smoking cessation resources. Both intervention content and engagement strategies were guided by community-based participatory research principles. Given the intervention’s focus on end users, that is, rural people who smoked, we conducted a beta test to assess any technical or usability issues of this intervention before any future trials for large-scale implementation. Results: No critical beta test technical and usability issues were noted. Besides, the FaithCore intervention was helpful, easy to understand, and achieved its intended goals. Notably, 90% (9/10) of the participants reported that they tried quitting smoking, while 90% (9/10) reported using or seeking cessation resources discussed within the group. Conclusions: This study shows that social media platform with culturally aligned and faith-aligned content and engagement strategies delivered by trained moderators are promising for smoking cessation interventions in rural communities. Our future step is to conduct a large pilot trial to evaluate the intervention’s effectiveness on smoking cessation outcomes. %M 39186365 %R 10.2196/58121 %U https://formative.jmir.org/2024/1/e58121 %U https://doi.org/10.2196/58121 %U http://www.ncbi.nlm.nih.gov/pubmed/39186365 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e58105 %T Effect of Smoking on the Development of Migraine in Women: Nationwide Cohort Study in South Korea %A Kim,Seung Ae %A Han,Kyungdo %A Choi,Soyoun %A Youn,Michelle Sojung %A Jang,Hyemin %A Lee,Mi Ji %K smoking %K migraine %K premenopausal women %K postmenopausal women %K incidence %K risk %D 2024 %7 23.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Smoking is known to be a significant risk factor for various diseases. Migraine, a condition requiring careful lifestyle management, currently lacks specific guidelines advocating for smoking cessation as a preventive measure. Although cross-sectional studies have suggested a potential link between smoking and an increased risk of migraine, the findings have been inconsistent and conflicting. To date, there has been no longitudinal study which investigated the effect of smoking on the risk of migraine in a prospective setting. Objective: This longitudinal study aimed to investigate the impact of smoking on the incidence of migraine in women and examine the modifying effect of menopausal status. Methods: Using nationally representative National Health Insurance Service (NHIS) data, women aged ≥40 years who participated in national breast cancer screening in 2009 were followed-up until the end of 2019. Baseline data on smoking status (non-, ex-, and current smoker) as well as the duration and amount of cigarette smoking were collected. A Cox proportional hazards regression model was used to examine the independent effect of smoking on the risk of incident migraine after adjusting for demographics, comorbidities, and female reproductive factors. The results were stratified by menopausal status, and an interaction analysis (smoking × menopause) was performed. Results: In total, 1,827,129 women were included in the analysis. Women with a history of smoking exhibited a higher risk of developing migraine, compared with nonsmokers. Specifically, a higher risk of migraine was observed in women with past (adjusted hazard ratio [HR] 1.044, 95% CI 1.000-1.089) and current cigarette use (adjusted HR 1.050, 95% CI, 1.023-1.079) than in nonsmokers. The effect was greater in premenopausal women (adjusted HR 1.140, 95% CI, 1.108-1.172) than in postmenopausal women (adjusted HR 1.045, 95% CI 1.018-1.073; P<.001). The risk increased with an increased amount of smoking, with a greater association in premenopausal women (P<.001). Conclusions: Smoking increases the risk of migraine in women, with a dose-dependent relationship. Menopause modifies this effect. Our findings suggest that smoking is an important modifiable risk factor of migraine, with a higher impact in premenopausal women. The interaction between smoking and estrogen may increase the vulnerability of the migraine brain. %R 10.2196/58105 %U https://publichealth.jmir.org/2024/1/e58105 %U https://doi.org/10.2196/58105 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e54684 %T Feasibility and Acceptability of a Mobile Game to Support Smoking Cessation: Repeated Measures Study %A Goodwin,Shelby %A Nastasi,Jessica A %A Newman,Schyler T %A Rapoza,Darion %A Raiff,Bethany R %+ Department of Psychology, College of Science and Mathematics, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, United States, 1 856 256 4500 ext 53782, raiff@rowan.edu %K mHealth %K mobile health %K smoking cessation %K video game intervention %K mobile phone %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Approximately half of smokers attempt to quit, but 90% of these attempts fail. Video game–based interventions have the potential to address common barriers to evidence-based smoking cessation treatment, including high cost, lack of health care access, and low engagement. Objective: The purpose of this study was to evaluate the feasibility and acceptability of a video game–based smoking cessation intervention called Inspired and its impact on the 7-day smoking point prevalence at the 30-day follow-up. Methods: US adults (n=48) were recruited via the web to use Inspired on their smartphones for 7 weeks. The object of the game was to defend a healing tree against attackers. Levels of the game were unlocked twice daily when participants self-reported the number of cigarettes they smoked since the previous entry. Completion of the levels awarded players in-game currency, which could strengthen in-game abilities. Participants received additional in-game rewards to aid gameplay by submitting either smoking self-reports only or self-reports indicating abstinence, determined through random assignment. In addition, participants completed a web-based survey at intake, week 4, week 7, and the 30-day follow-up. Results: Of the 48 participants, who had an average age of 39.8 (SD 10.7) years, 27 (56%) were female, 4 (8%) Hispanic, 37 (77%) White, and 27 (56%) employed; 26 (54%) earned 20 cigarettes per day) having a lower 30-day prolonged abstinence rate (relative risk=0.91; 95% CI 90.0%-96.2%) compared to lighter smokers. No additional adverse events outside of known nicotine withdrawal symptoms were reported. Conclusions: The nature of web-based surveys and cohort selection allows for extensive unknown biases. However, the efficacy rates of survey respondents who completed the program were high and provide a case for further investigation in the form of randomized controlled trials on the QuitSure tobacco cessation program. %M 38709553 %R 10.2196/49519 %U https://humanfactors.jmir.org/2024/1/e49519 %U https://doi.org/10.2196/49519 %U http://www.ncbi.nlm.nih.gov/pubmed/38709553 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54041 %T Tobacco Smoking or Nicotine Phenotype and Severity of Clinical Presentation at the Emergency Department (SMOPHED): Protocol for a Noninterventional Observational Study %A Campagna,Davide %A Farsalinos,Konstantinos %A Costantino,Giorgio %A Carpinteri,Giuseppe %A Caponnetto,Pasquale %A Cucuzza,Francesca %A Polosa,Riccardo %A , %+ Department of Clinical and Experimental Medicine, University of Catania, Via Santa Sofia, Catania, 95123, Italy, 39 0953782449, davide.campagna@unict.it %K NEWS %K National Early Warning Score %K emergency department %K smoking %K nicotine/tobacco use %K electronic cigarettes %K heated tobacco products %D 2024 %7 24.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the last few years, several nicotine products have become available as alternatives to smoking tobacco. While laboratory and limited clinical studies suggest that these devices are less toxic compared to classic tobacco cigarettes, very little is known about their epidemiological impact. Visiting the emergency department (ED) often represents the first or even the only contact of patients with the health care system. Therefore, a study conducted at the ED to assess the impact of these products on health can be reliable and reflect a real-life setting. Objective: The aim of this noninterventional observational study (SMOPHED study) is to analyze the association between the severity of clinical presentation observed during ED visits among patients using various nicotine products and the subsequent outcomes, specifically hospitalization and mortality. Methods: Outcomes (hospitalization and mortality in the ED) will be examined in relation to various patterns of nicotine products use. We plan to enroll approximately 2000 participants during triage at the ED. These individuals will be characterized based on their patterns of tobacco and nicotine consumption, identified through a specific questionnaire. This categorization will allow for a detailed analysis of how different usage patterns of nicotine products correlate with the clinical diagnosis made during the ED visits and the consequent outcomes. Results: Enrollment into the study started in March 2024. We enrolled a total of 901 participants in 1 month (approximately 300 potential participants did not provide the informed consent to participate). The data will be analyzed by a statistician as soon as the database is completed. Full data will be published by December 2024. Conclusions: There is substantial debate about the harm reduction potential of alternative nicotine products in terms of their smoking-cessation and risk-reduction potential. This study represents an opportunity to document epidemiological data on the link between the use of different types of nicotine products and disease diagnosis and severity during an ED visit, and thus evaluate the harm reduction potential claims for these products. International Registered Report Identifier (IRRID): PRR1-10.2196/54041 %M 38657239 %R 10.2196/54041 %U https://www.researchprotocols.org/2024/1/e54041 %U https://doi.org/10.2196/54041 %U http://www.ncbi.nlm.nih.gov/pubmed/38657239 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52090 %T An Integrated mHealth App for Smoking Cessation in Black Smokers With HIV: Protocol for a Randomized Controlled Trial %A Bizier,Andre %A Jones,Arielle %A Businelle,Michael %A Kezbers,Krista %A Hoeppner,Bettina B %A Giordano,Thomas P %A Thai,Jessica M %A Charles,Jacqueline %A Montgomery,Audrey %A Gallagher,Matthew W %A Cheney,Marshall K %A Zvolensky,Michael %A Garey,Lorra %+ University of Houston, 3695 Cullen Blvd, Fred J. Heyne Building, Suite 126, Houston, TX, United States, 1 7137438056, llgarey@uh.edu %K smoking cessation %K Black %K HIV %K anxiety sensitivity %K mobile health %K mHealth %K just-in-time adaptive intervention %K mobile phone %D 2024 %7 24.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black adults who smoke and have HIV experience immense stressors (eg, racial discrimination and HIV stigma) that impede smoking cessation success and perpetuate smoking-related health disparities. These stressors also place Black adults who smoke and have HIV at an increased risk of elevated interoceptive stress (eg, anxiety and uncomfortable bodily sensations) and smoking to manage symptoms. In turn, this population is more likely to smoke to manage interoceptive stress, which contributes to worse HIV-related outcomes in this group. However, no specialized treatment exists to address smoking cessation, interoceptive stress, and HIV management for Black smokers with HIV. Objective: This study aims to test a culturally adapted and novel mobile intervention that targets combustible cigarette smoking, HIV treatment engagement and adherence, and anxiety sensitivity (a proxy for difficulty and responsivity to interoceptive stress) among Black smokers with HIV (ie, Mobile Anxiety Sensitivity Program for Smoking and HIV [MASP+]). Various culturally tailored components of the app are being evaluated for their ability to help users quit smoking, manage physiological stress, and improve health care management. Methods: This study is a pilot randomized controlled trial in which Black combustible cigarette smokers with HIV (N=72) are being recruited and randomly assigned to use either (1) the National Cancer Institute’s QuitGuide app or (2) MASP+. Study procedures include a web-based prescreener; active intervention period for 6 weeks; smartphone-based assessments, including daily app-based ecological momentary assessments for 6 weeks (4 ecological momentary assessments each day); a video-based qualitative interview using Zoom Video Communications software at week 6 for participants in all study conditions; and smartphone-based follow-up assessments at 0, 1, 2 (quit date), 3, 4, 5, 6, and 28 weeks postbaseline (26 weeks postquitting date). Results: Primary outcomes include biochemically verified 7-day point prevalence of abstinence, HIV-related quality of life, use of antiretroviral therapy, and HIV care appointment adherence at 26 weeks postquitting date. Qualitative data are also being collected and assessed to obtain feedback that will guide further tailoring of app content and evaluation of efficacy. Conclusions: The results of this study will determine whether the MASP+ app serves as a successful aid for combustible cigarette smoking cessation, HIV treatment engagement, and physiological stress outcomes among Black people with HIV infection. If successful, this study will provide evidence for the efficacy of a new means of addressing major mental and physical health difficulties for this high-risk population. If the results are promising, the data from this study will be used to update and tailor the MASP+ app for testing in a fully powered randomized controlled trial that will evaluate its efficacy in real-world behavioral health and social service settings. Trial Registration: ClinicalTrials.gov NCT05709002; https://clinicaltrials.gov/study/NCT05709002 International Registered Report Identifier (IRRID): PRR1-10.2196/52090 %M 38657227 %R 10.2196/52090 %U https://www.researchprotocols.org/2024/1/e52090 %U https://doi.org/10.2196/52090 %U http://www.ncbi.nlm.nih.gov/pubmed/38657227 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55031 %T Digital Interventions for Recreational Cannabis Use Among Young Adults: Systematic Review, Meta-Analysis, and Behavior Change Technique Analysis of Randomized Controlled Studies %A Côté,José %A Chicoine,Gabrielle %A Vinette,Billy %A Auger,Patricia %A Rouleau,Geneviève %A Fontaine,Guillaume %A Jutras-Aswad,Didier %+ Research Centre of the Centre Hospitalier de l’Université de Montréal, 850 Saint-Denis, Montreal, QC, H2X 0A9, Canada, 1 514 890 8000, jose.cote@umontreal.ca %K cannabis %K young adults %K digital intervention %K systematic review %K meta-analysis %K behavior change technique analysis %K mobile phone %D 2024 %7 17.4.2024 %9 Review %J J Med Internet Res %G English %X Background: The high prevalence of cannabis use among young adults poses substantial global health concerns due to the associated acute and long-term health and psychosocial risks. Digital modalities, including websites, digital platforms, and mobile apps, have emerged as promising tools to enhance the accessibility and availability of evidence-based interventions for young adults for cannabis use. However, existing reviews do not consider young adults specifically, combine cannabis-related outcomes with those of many other substances in their meta-analytical results, and do not solely target interventions for cannabis use. Objective: We aimed to evaluate the effectiveness and active ingredients of digital interventions designed specifically for cannabis use among young adults living in the community. Methods: We conducted a systematic search of 7 databases for empirical studies published between database inception and February 13, 2023, assessing the following outcomes: cannabis use (frequency, quantity, or both) and cannabis-related negative consequences. The reference lists of included studies were consulted, and forward citation searching was also conducted. We included randomized studies assessing web- or mobile-based interventions that included a comparator or control group. Studies were excluded if they targeted other substance use (eg, alcohol), did not report cannabis use separately as an outcome, did not include young adults (aged 16-35 y), had unpublished data, were delivered via teleconference through mobile phones and computers or in a hospital-based setting, or involved people with mental health disorders or substance use disorders or dependence. Data were independently extracted by 2 reviewers using a pilot-tested extraction form. Authors were contacted to clarify study details and obtain additional data. The characteristics of the included studies, study participants, digital interventions, and their comparators were summarized. Meta-analysis results were combined using a random-effects model and pooled as standardized mean differences. Results: Of 6606 unique records, 19 (0.29%) were included (n=6710 participants). Half (9/19, 47%) of these articles reported an intervention effect on cannabis use frequency. The digital interventions included in the review were mostly web-based. A total of 184 behavior change techniques were identified across the interventions (range 5-19), and feedback on behavior was the most frequently used (17/19, 89%). Digital interventions for young adults reduced cannabis use frequency at the 3-month follow-up compared to control conditions (including passive and active controls) by −6.79 days of use in the previous month (95% CI −9.59 to −4.00; P<.001). Conclusions: Our results indicate the potential of digital interventions to reduce cannabis use in young adults but raise important questions about what optimal exposure dose could be more effective, both in terms of intervention duration and frequency. Further high-quality research is still needed to investigate the effects of digital interventions on cannabis use among young adults. Trial Registration: PROSPERO CRD42020196959; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=196959 %M 38630515 %R 10.2196/55031 %U https://www.jmir.org/2024/1/e55031 %U https://doi.org/10.2196/55031 %U http://www.ncbi.nlm.nih.gov/pubmed/38630515 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50466 %T Impacts of Smoking Ban Policies on Billiard Hall Sales in South Korea Using Objective Sales Information of a Credit Card Company: Quasi-Experimental Study %A Noh,Jin-Won %A Cheon,Jooyoung %A Seong,Hohyun %A Kwon,Young Dae %A Yoo,Ki-Bong %+ Division of Health Administration, College of Software and Digital Healthcare Convergence, Yonsei University, Yonseidae gil 1, Wonju, 26493, Republic of Korea, 82 33 760 2418, ykbong@yonsei.ac.kr %K smoking ban policy %K indoor sports facility %K South Korea %D 2024 %7 17.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Smoking ban policies (SBPs) are potent health interventions and offer the potential to influence antismoking behavior. The Korean government completely prohibited smoking in indoor sports facilities, including billiard halls, since the government revised the National Health Promotion Act in December 2017. Objective: This study aimed to examine the impact of the SBP on the economic outcomes of indoor sports facilities, particularly billiard halls. Methods: This study used credit card sales data from the largest card company in South Korea. Data are from January 2017 to December 2018. Monthly sales data were examined across 23 administrative neighborhoods in Seoul, the capital city of South Korea. We conducted the interrupted time series model using the fixed effects model and the linear regression with panel-corrected standard errors (PCSE). Results: The sales and transactions of billiard halls were not significantly changed after the introduction of the SBP in the full PCSE models. The R2 of the full PCSE model was 0.967 for sales and 0.981 for transactions. Conclusions: The introduction of the SBP did not result in substantial economic gains or losses in the sales of billiard halls. In addition to existing price-based policies, the enhanced SBP in public-use facilities, such as billiard halls, can have a positive synergistic effect on reducing smoking prevalence and preventing secondhand smoke. Health policy makers can actively expand the application of SBPs and make an effort to enhance social awareness regarding the necessity and benefits of public SBPs for both smokers and the owners of hospitality facilities. %M 38630526 %R 10.2196/50466 %U https://publichealth.jmir.org/2024/1/e50466 %U https://doi.org/10.2196/50466 %U http://www.ncbi.nlm.nih.gov/pubmed/38630526 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e53245 %T Vaping: Public Health, Social Media, and Toxicity %A Sun,Yehao %A Prabhu,Prital %A Li,Dongmei %A McIntosh,Scott %A Rahman,Irfan %+ Department of Environmental Medicine, University of Rochester Medical Center, Box 850, 601 Elmwood Avenue, Rochester, NY, 14642, United States, 1 5852756911, Irfan_Rahman@urmc.rochester.edu %K addiction %K behavior %K behaviors %K device %K devices %K e-cigarette %K e-cigarettes %K effect %K effects %K e-liquid %K flavors %K nicotine %K public health %K social media %K human health %K toxicity %K vape user %K vape %K vaper %K vapers %K vaping %D 2024 %7 11.4.2024 %9 Viewpoint %J Online J Public Health Inform %G English %X This viewpoint aims to provide a comprehensive understanding of vaping from various perspectives that contribute to the invention, development, spread, and consequences of e-cigarette products and vaping. Our analysis showed that the specific characteristics of e-cigarette products as well as marketing strategies, especially social media marketing, fostered the spread of vaping and the subsequent effects on human health and toxicity. We analyzed the components of e-cigarette devices and e-liquids, including the latest variants whose impacts were often overlooked. The different forms of nicotine, including salts and freebase nicotine, tobacco-derived nicotine, tobacco-free nicotine, and cooling agents (WS3 and WS23), have brought more choices for vapers along with more ways for e-cigarette manufacturers to advertise false understandings and present a greater threat to vapers’ health. Our work emphasized the products of brands that have gained significant influence recently, which are contributing to severe public health issues. On the other hand, we also discussed in detail the toxicity of e-liquid components and proposed a toxicity mechanism. We also noticed that nicotine and other chemicals in e-liquids promote each other’s negative effects through the oxidative stress and inflammatory nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) pathway, a mechanism leading to pulmonary symptoms and addiction. The impact of government regulations on the products themselves, including flavor bans or regulations, has been limited. Therefore, we proposed further interventions or harm reduction strategies from a public health perspective. %M 38602734 %R 10.2196/53245 %U https://ojphi.jmir.org/2024/1/e53245 %U https://doi.org/10.2196/53245 %U http://www.ncbi.nlm.nih.gov/pubmed/38602734 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54912 %T Behavioral Activation Mobile App to Motivate Smokers to Quit: Feasibility and Pilot Randomized Controlled Trial %A Borrelli,Belinda %A Bartlett,Y Kiera %A Fulford,Daniel %A Frasco,Greg %A Armitage,Christopher J %A Wearden,Alison %+ Center for Behavioral Science Research, Henry M. Goldman School of Dental Medicine, Boston University, Floor 3, 560 Harrison Ave, Boston, MA, 02118, United States, 1 617 358 3358, belindab@bu.edu %K smoking cessation %K mobile app %K motivation %K depressed mood %K depression %K behavioral activation %K negative affect %K positive affect %K quit smoking %K health behavior change %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Behavioral activation (BA) is an evidence-based treatment for depression that fosters engagement in values-based activities to increase access to positive reinforcement. Depressed mood has been shown to hinder smoking cessation. Objective: This study determined the feasibility and preliminary efficacy of a mobile app to motivate smokers to quit by using BA and integrating motivational messages to quit smoking. Methods: Adult smokers (N=56; mean age 34.5, SD 9.52 years) who were not ready to quit smoking within 30 days were recruited from advertisements and randomized to either 8 weeks of the BA app (set 2 values-based activities per week+motivational messages+feedback on changes in smoking, mood, and values-based activities) or the control group (no app; received resources for quitting smoking). All participants completed the baseline and end-of-treatment web-based questionnaires. Controls also completed weekly web-based assessments, and BA app participants completed assessments through the app. Results: There were no dropouts and only 2 participants in each condition did not complete the end-of-treatment questionnaire. The results demonstrated that it is feasible to recruit smokers who are unmotivated to quit into a smoking cessation induction trial: 86% (57/66) of eligible participants were randomized (BA app: n=27; control: n=29). Participants reported high levels of satisfaction: 80% (20/25) of participants said they would recommend the BA app, there were moderate-to-high scores on the Mobile App Rating Scale, and 88% (22/25) of participants rated the app 3 stars or higher (out of 5). There were high levels of BA app engagement: 96% (26/27) of participants planned activities, and 67% (18/27) of participants planned 7 or more activities. High engagement was found even among those who were at the highest risk for continued smoking (low motivation to quit, low confidence to quit, and high negative affect). The results provided support for the hypothesized relationships between BA constructs: greater pleasant activity completion was associated with greater positive affect (b=0.37, SE 0.21; 95% CI –0.05 to 0.79; P=.08), and greater positive affect tended to predict fewer cigarettes smoked the next day (b=–0.19, SE 0.10; 95% CI –0.39 to 0.01; P=.06). Additionally, a greater number of activities planned was associated with lower negative affect (b=–0.26, SE 0.15; 95% CI –0.55 to 0.04; P=.09). Overall, 16% (4/25) of BA app participants set a quit date versus 4% (1/27) among controls, and there were promising (but not significant) trends for motivation and confidence to quit. Conclusions: The findings suggest that a mobile app intervention can be made appealing to smokers who are unmotivated to quit by focusing on aspects most important to them, such as mood management. This theory-based intervention has shown some initial support for the underlying theoretical constructs, and further efficacy testing is warranted in a fully powered trial. %M 38573739 %R 10.2196/54912 %U https://formative.jmir.org/2024/1/e54912 %U https://doi.org/10.2196/54912 %U http://www.ncbi.nlm.nih.gov/pubmed/38573739 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54236 %T A Global Health Survey of People Who Vape but Never Smoked: Protocol for the VERITAS (Vaping Effects: Real-World International Surveillance) Study %A Zamora Goicoechea,Jeffrey %A Boughner,Allison %A Cirion Lee,Juan José %A Mahajan,Aman %A Yeo,Kurt %A Sproga,Maris %A Patel,Tasmin %A Saitta,Claudio %A Russell,Christopher %A Coughlan,Michael %A Caponnetto,Pasquale %A Polosa,Riccardo %+ Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Via Santa Sofia 89, Catana, 95123, Italy, 39 0954781124, polosa@unict.it %K electronic cigarette %K health effects %K respiratory symptoms %K survey %K real-world use study %K e-cigarette %K e-cigarettes %K smoke %K smoker %K smokers %K smoking %K vape %K vaping %K respiratory %K pulmonary %K cross-sectional %K questionnaire %K questionnaires %K survey %K surveys %D 2024 %7 28.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is only limited information about the health effects of regular vaping. Research on the health status of people who used to smoke faces the challenge that previous smoking may have caused unknown health effects. Only studies of people who vape but have never smoked combustible cigarettes can enable the detection of harms attributable to vaping. Large prospective studies of well-characterized electronic cigarette users with and without a history of combustible cigarette smoking are warranted to establish the long-term effects of regular vaping on respiratory health. Objective: We will conduct a global cross-sectional survey of individuals from 6 world regions. Respiratory symptoms will be assessed using a validated questionnaire—the Respiratory Symptom Experience Scale (RSES). Current vapers who are nonusers of other tobacco or nicotine products will be compared with matched controls who are nonusers of vapes and other tobacco or nicotine products. Methods: This will be a multicountry, cross-sectional internet-based survey of 750 adults aged ≥18 years who satisfy the criteria for inclusion in either a cohort of people who exclusively vape and who are nonusers of other tobacco or nicotine products (“vapers cohort”; target N=500) or a cohort of nonvapers who are also nonusers of other tobacco or nicotine products (“controls cohort”; target N=250). The primary end point of the study is the RSES score. RSES scores of people in the “vapers cohort” will be compared with those of people in the “controls cohort.” Additionally, the study will collect data to characterize patterns of vaping product use among the vapers cohort. Data collection will include information about the age initiation of using vape products, reasons for starting and continuing the use of vape products, specific types of products used, flavors and nicotine strengths of recently used products, as well as the frequency and intensity of product use in the past 30 days. Results: Participant recruitment started in April 2023, and enrollment was completed by November 2023 with 748 participants. Results will be reported in 2024. Conclusions: This will be the first study providing key insights into respiratory health effects associated with using electronic cigarettes in people who vape with no established use of combustible cigarettes or other tobacco or nicotine products. International Registered Report Identifier (IRRID): DERR1-10.2196/54236 %M 38546715 %R 10.2196/54236 %U https://www.researchprotocols.org/2024/1/e54236 %U https://doi.org/10.2196/54236 %U http://www.ncbi.nlm.nih.gov/pubmed/38546715 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56324 %T Effects of Electronic Nicotine Delivery Systems Substitution on Body Weight Status: Protocol for a Systematic Review and Meta-Analysis %A La Rosa,Giusy Rita Maria %A Qureshi,Maria Ahmed %A Frittitta,Lucia %A Anastasi,Erika %A Polosa,Riccardo %+ Department of Clinical and Experimental Medicine, University of Catania, Via S. Sofia, 89, Catania, 95123, Italy, 39 095 4781124, g_larosa92@live.it %K Electronic Nicotine Delivery Systems %K body weight %K smoking cessation %K tobacco harm reduction %K systematic review %K meta-analysis %D 2024 %7 26.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Weight gain following smoking cessation is a well-documented concern, often attributed to the absence of nicotine’s metabolic influence. The adoption of Electronic Nicotine Delivery Systems (ENDS) has been used to achieve smoking cessation, with claims of aiding weight control. However, existing reviews present conflicting conclusions on ENDS’ impact on weight status, necessitating a rigorous evaluation. Objective: We aim to conduct a systematic review with meta-analysis to assess the actual impact of ENDS on weight status in individuals who have ceased or reduced conventional smoking. The primary goal is to provide clinicians with evidence-based insights into the potential effects of ENDS use as a smoking substitute on weight control. Methods: Adhering to PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines, our systematic review will analyze randomized and nonrandomized controlled trials, clinical trials (quasi-experimental), and prospective or retrospective cohort studies on the weight status effects of ENDS among individuals who have either quit or reduced smoking. Searches will include PubMed, Scopus, and Cochrane Library, covering the period from 2010 to January 2024. A gray literature search and supplementary searches will be performed. Data will be extracted independently by 2 reviewers and quality assessments will be conducted concurrently. Quality assessments will use Joanna Briggs Institute tools, 2020 version, along with bias assessments for internal validity and reporting bias based on the Catalogue of Bias. The included studies will be examined for any internal data reporting discrepancies by using Puljak’s checklist. Meta-analysis and subgroup analyses (ie, general ENDS usage, ENDS use coupled with a reduction in smoking exceeding 50%, and exclusive ENDS use for achieving smoking cessation) are planned. Certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. Results: The protocol has been registered in PROSPERO (CRD42023494974) and the entire systematic review is expected to be completed by April 2024. The main goal of this review is to retrieve all current human research studies investigating the influence of ENDS on weight management among individuals who have quit or reduced smoking. Furthermore, the review will assess the quality of these studies and examine potential biases to identify the most dependable evidence available. Dissemination strategies will include traditional journal publications, social media announcements, and a white paper. The latter, available for download and distributed at conferences, aims to reach a broad audience, including clinicians and ENDS users. Conclusions: The review will address the importance of informing health care professionals and patients about the current and robust evidence regarding the effects of transitioning to ENDS for smoking cessation on weight status. Trial Registration: PROSPERO CRD42023494974; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=494974 International Registered Report Identifier (IRRID): PRR1-10.2196/56324 %M 38530329 %R 10.2196/56324 %U https://www.researchprotocols.org/2024/1/e56324 %U https://doi.org/10.2196/56324 %U http://www.ncbi.nlm.nih.gov/pubmed/38530329 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48050 %T Preliminary Efficacy of a Cognitive Behavioral Therapy–Based Smartphone App for Smoking Cessation in China: Randomized Controlled Pilot Trial %A Chen,Shanshan %A Tang,Jinsong %A Wu,Congyang %A Zhang,Ge %A Zhang,Jing %A Liao,Yanhui %+ Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, 310016, China, 86 18814898844, liaoyanhui@zju.edu.cn %K China %K cognitive behavioral therapy %K program acceptability %K randomized controlled trial %K smartphone app %K smoking cessation %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The overall prevalence of cigarette smokers in China is very high, and China’s total cigarette consumption makes up more than 40% of the world’s consumption. In view of the lack of smoking cessation services and social support in China and the effectiveness of mobile phone apps for quitting smoking in other countries, we carried out a smartphone app–based smoking cessation trial in China. Objective: This study aimed to evaluate the efficacy of a cognitive behavioral therapy (CBT)–based smoking cessation smartphone app among smokers seeking treatment in China. Methods: We conducted a randomized controlled, web-based pilot clinical trial in China between February 23 and June 27, 2021. Eligible participants were randomly assigned to the smoking cessation app intervention group or the control group in a ratio of 1:1. The intervention group received the CBT smoking cessation intervention using a smartphone app, and the control group received a “thank you” message. The intervention was 4 weeks long, and the patients were followed up for 4 weeks. The primary outcome was self-reported continuous smoking abstinence at week 4 after the quit date. The secondary outcomes included self-reported 7-day point prevalence of smoking abstinence; reduction of the number of cigarettes smoked per day at weeks 1, 2, 3, and 4; and program acceptability. Results: A total of 973 people were recruited to quit smoking, of whom 262 completed basic information, 56 were excluded, and 206 were randomized and included in the final analysis. There were 189 (91.7%) men and 17 (8.3%) women, with an average age of 34.46 (SD 7.53) years and an average daily smoking rate of 15.93 (SD 7.10) cigarettes/day. We found 30 (29.7%) of the 101 participants in the intervention group and 7 (6.7%) of the 105 participants in the control group reported continuous smoking cessation after the quit date at week 4 (odds ratio 5.92, 95% CI 3.78-9.26; P<.001). The 7-day point prevalence abstinence rate of the intervention group varied from 42.6% (43/101) to 46.5% (47/101) after 1, 2, 3, and 4 weeks, while the control group varied from 18.1% (19/105) to 26.7% (28/105). Compared to the control group, continued smokers consumed 1.5-3.0 fewer cigarettes per day in the intervention group. The overall program got positive user feedback with a high satisfaction rate (66/87, 76%) and an average Mobile Application Rating Scale user version score of 3.46. Conclusions: Our pilot study provided preliminary evidence that the CBT-based smoking cessation smartphone app led to improved smoking quit rates versus control in Chinese smokers. The study demonstrated the CBT-based smartphone app may be an effective and feasible digital treatment model to help smokers quit, which may improve smoking cessation service quality and accessibility in China. Trial Registration: ClinicalTrials.gov NCT04421170; https://clinicaltrials.gov/study/NCT04421170 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-041985 %M 38498030 %R 10.2196/48050 %U https://formative.jmir.org/2024/1/e48050 %U https://doi.org/10.2196/48050 %U http://www.ncbi.nlm.nih.gov/pubmed/38498030 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e51962 %T The Potential of Exercise on Lifestyle and Skin Function: Narrative Review %A Oizumi,Ryosuke %A Sugimoto,Yoshie %A Aibara,Hiromi %+ Faculty of Nursing, Shijonawate gakuen University, Gakuen-cyo, 6-45, Osaka, Daito-shi, 574-0001, Japan, 81 72 813 2601, r-oizumi@un.shijonawate-gakuen.ac.jp %K skin function %K lifestyle %K exercise %K reviews %K knowledge synthesis %K Review methods %K review methodology %K literature review %K literature reviews %K narrative review %K narrative reviews %K skin %K dermatology %K exercise %K physical activity %K fitness %K lifestyles %K smoking %K diet %K sleep %K sugar intake %K life habits %K skin barrier %D 2024 %7 14.3.2024 %9 Review %J JMIR Dermatol %G English %X Background: The skin is an important organ of the human body and has moisturizing and barrier functions. Factors such as sunlight and lifestyle significantly affect these skin functions, with sunlight being extremely damaging. The effects of lifestyle habits such as smoking, diet, and sleep have been studied extensively. It has been found that smoking increases the risk of wrinkles, while excessive fat and sugar intake leads to skin aging. Lack of sleep and stress are also dangerous for the skin’s barrier function. In recent years, the impact of exercise habits on skin function has been a focus of study. Regular exercise is associated with increased blood flow to the skin, elevated skin temperature, and improved skin moisture. Furthermore, it has been shown to improve skin structure and rejuvenate its appearance, possibly through promoting mitochondrial biosynthesis and affecting hormone secretion. Further research is needed to understand the effects of different amounts and content of exercise on the skin. Objective: This study aims to briefly summarize the relationship between lifestyle and skin function and the mechanisms that have been elucidated so far and introduce the expected effects of exercise on skin function. Methods: We conducted a review of the literature using PubMed and Google Scholar repositories for relevant literature published between 2000 and 2022 with the following keywords: exercise, skin, and life habits. Results: Exercise augments the total spectrum power density of cutaneous blood perfusion by a factor of approximately 8, and vasodilation demonstrates an enhancement of approximately 1.5-fold. Regular exercise can also mitigate age-related skin changes by promoting mitochondrial biosynthesis. However, not all exercise impacts are positive; for instance, swimming in chlorinated pools may harm the skin barrier function. Hence, the exercise environment should be considered for its potential effects on the skin. Conclusions: This review demonstrates that exercise can potentially enhance skin function retention. %M 38483460 %R 10.2196/51962 %U https://derma.jmir.org/2024/1/e51962 %U https://doi.org/10.2196/51962 %U http://www.ncbi.nlm.nih.gov/pubmed/38483460 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50741 %T Effects of a Social Media Intervention on Vaping Intentions: Randomized Dose-Response Experiment %A Evans,William Douglas %A Bingenheimer,Jeffrey %A Cantrell,Jennifer %A Kreslake,Jennifer %A Tulsiani,Shreya %A Ichimiya,Megumi %A D'Esterre,Alexander P %A Gerard,Raquel %A Martin,Madeline %A Hair,Elizabeth C %+ Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave NW, Washington, DC, 20052, United States, 1 2023519546, wdevans@gwu.edu %K randomized controlled trial %K e-cigarettes %K vaping %K nicotine %K tobacco control %K social media %K dose-response effects %D 2024 %7 12.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: e-Cigarette use, especially by young adults, is at unacceptably high levels and represents a public health risk factor. Digital media are increasingly being used to deliver antivaping campaigns, but little is known about their effectiveness or the dose-response effects of content delivery. Objective: The objectives of this study were to evaluate (1) the effectiveness of a 60-day antivaping social media intervention in changing vaping use intentions and beliefs related to the stimulus content and (2) the dose-response effects of varying levels of exposure to the intervention on vaping outcomes, including anti-industry beliefs, vaping intentions, and other attitudes and beliefs related to vaping. Methods: Participants were adults aged 18 to 24 years in the United States. They were recruited into the study through Facebook (Meta Platforms) and Instagram (Meta Platforms), completed a baseline survey, and then randomized to 1 of the 5 conditions: 0 (control), 4, 8, 16, and 32 exposures over a 15-day period between each survey wave. Follow-up data were collected 30 and 60 days after randomization. We conducted stratified analyses of the full sample and in subsamples defined by the baseline vaping status (never, former, and current). Stimulus was delivered through Facebook and Instagram in four 15-second social media videos focused on anti-industry beliefs about vaping. The main outcome measures reported in this study were self-reported exposure to social media intervention content, attitudes and beliefs about vaping, and vaping intentions. We estimated a series of multivariate linear regressions in Stata 17 (StataCorp). To capture the dose-response effect, we assigned each study arm a numerical value corresponding to the number of advertisements (exposures) delivered to participants in each arm and used this number as our focal independent variable. In each model, the predictor was the treatment arm to which each participant was assigned. Results: The baseline sample consisted of 1491 participants, and the final analysis sample consisted of 57.28% (854/1491) of the participants retained at the 60-day follow-up. We compared the retained participants with those lost to follow-up and found no statistically significant differences across demographic variables. We found a significant effect of the social media treatment on vaping intentions (β=−0.138, 95% CI −0.266 to −0.010; P=.04) and anti-industry beliefs (β=−0.122, 95% CI 0.008-0.237; P=.04) targeted by the intervention content among current vapers but not among the full sample or other strata. We found no significant effects of self-reported exposure to the stimulus. Conclusions: Social media interventions are a promising approach to preventing vaping among young adults. More research is needed on how to optimize the dosage of such interventions and the extent to which long-term exposure may affect vaping use over time. Trial Registration: ClinicalTrials.gov NCT04867668; https://clinicaltrials.gov/study/NCT04867668 %M 38470468 %R 10.2196/50741 %U https://www.jmir.org/2024/1/e50741 %U https://doi.org/10.2196/50741 %U http://www.ncbi.nlm.nih.gov/pubmed/38470468 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47128 %T Impact of Traditional and New Media on Smoking Intentions and Behaviors: Secondary Analysis of Tasmania’s Tobacco Control Mass Media Campaign Program, 2019-2021 %A Kite,James %A Grunseit,Anne %A Mitchell,Glenn %A Cooper,Pip %A Chan,Lilian %A Huang,Bo-Huei %A Thomas,Margaret %A O'Hara,Blythe %A Smith,Abby %+ Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, The University of Sydney, L6 Charles Perkins Centre (D17), Camperdown, NSW, 2006, Australia, 61 286270838, james.kite@sydney.edu.au %K mass media campaign %K tobacco control %K evaluation %K social media campaign %K social media %K digital platform %K tobacco %K smoking %K survey %D 2024 %7 5.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Tasmania, the smallest state by population in Australia, has a comprehensive tobacco control mass media campaign program that includes traditional (eg, television) and “new” channels (eg, social media), run by Quit Tasmania. The campaign targets adult smokers, in particular men aged 18-44 years, and people from low socioeconomic areas. Objective: This study assesses the impact of the 2019-2021 campaign program on smokers’ awareness of the campaign program, use of Quitline, and smoking-related intentions and behaviors. Methods: We used a tracking survey (conducted 8 times per year, immediately following a burst of campaign activity) to assess campaign recall and recognition, intentions to quit, and behavioral actions taken in response to the campaigns. The sample size was approximately 125 participants at each survey wave, giving a total sample size of 2000 participants over the 2 years. We merged these data with metrics including television target audience rating points, digital and Facebook (Meta) analytics, and Quitline activity data, and conducted regression and time-series modeling. Results: Over the evaluation period, unprompted recall of any Quit Tasmania campaign was 18%, while prompted recognition of the most recent campaign was 50%. Over half (52%) of those who recognized a Quit Tasmania campaign reported that they had performed or considered a quitting-related behavioral action in response to the campaign. In the regression analyses, we found having different creatives within a single campaign burst was associated with higher campaign recall and recognition and an increase in the strength of behavioral actions taken. Higher target audience rating points were associated with higher campaign recall (but not recognition) and an increase in quit intentions, but not an increase in behavioral actions taken. Higher Facebook advertisement reach was associated with lower recall among survey participants, but recognition was higher when digital channels were used. The time-series analyses showed no systematic trends in Quitline activity over the evaluation period, but Quitline activity was higher when Facebook reach and advertisement spending were higher. Conclusions: Our evaluation suggests that a variety of creatives should be used simultaneously and supports the continued use of traditional broadcast channels, including television. However, the impact of television on awareness and behavior may be weakening. Future campaign evaluations should closely monitor the effectiveness of television as a result. We are also one of the first studies to explicitly examine the impact of digital and social media, finding some evidence that they influence quitting-related outcomes. While this evidence is promising for campaign implementation, future evaluations should consider adopting rigorous methods to further investigate this relationship. %M 38441941 %R 10.2196/47128 %U https://www.jmir.org/2024/1/e47128 %U https://doi.org/10.2196/47128 %U http://www.ncbi.nlm.nih.gov/pubmed/38441941 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47570 %T How to Identify e-Cigarette Brands Available in the United States During 2020-2022: Development and Usability Study %A Ma,Shaoying %A Kaareen,Aadeeba %A Park,Hojin %A He,Yanyun %A Jiang,Shuning %A Qiu,Zefeng %A Xie,Zidian %A Li,Dongmei %A Chen,Jian %A O’Connor,Richard J %A Fong,Geoffrey T %A Shang,Ce %+ Center for Tobacco Research, The Ohio State University Wexner Medical Center, 3650 Olentangy River Road, 1st Floor, Suite 110, Columbus, OH, 43214, United States, 1 6148976063, shaoying.ma@osumc.edu %K tobacco %K electronic cigarette %K e-cigarette %K electronic nicotine delivery systems %K electronic nicotine delivery system %K vaping %K market surveillance %K tobacco marketing %D 2024 %7 28.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Prior studies have demonstrated that the e-cigarette market contains a large number of brands. Identifying these existing e-cigarette brands is a key element of market surveillance, which will further assist in policy making and compliance checks. Objective: To facilitate the surveillance of the diverse product landscape in the e-cigarette market, we constructed a semantic database of e-cigarette brands that have appeared in the US market as of 2020-2022. Methods: In order to build the brand database, we searched and compiled e-cigarette brands from a comprehensive list of retail channels and sources, including (1) e-liquid and disposable brands sold in web-based stores, (2) e-cigarette brands sold in brick-and-mortar stores and collected by the Nielsen Retail Scanner Data, (3) e-cigarette brands compiled by Wikipedia, (4) self-reported e-cigarette brands from the 2020 International Tobacco Control Four-Country Smoking and Vaping (ITC 4CV) US survey, and (5) e-cigarette brands on Twitter. We also estimated the top 5 e-cigarette brands by sales volume in brick-and-mortar stores, by the frequency and variety of offerings in web-based shops, and by the frequency of self-reported brands from the 2020 ITC 4CV US survey. Results: As of 2020-2022, a total of 912 e-cigarette brands have been sold by various retail channels. During 2020-2022, the top 5 brands are JUUL, vuse, njoy, blu, and logic in brick-and-mortar stores; blu, king, monster, twist, and air factory for e-liquids in web-based stores; hyde, pod mesh, suorin, vaporlax, and xtra for disposables sold in web-based stores; and smok, aspire, vaporesso, innokin, and eleaf based on self-reported survey data. Conclusions: As the US Food and Drug Administration enforces the premarket tobacco market authorization, many e-cigarette brands may become illegal in the US market. In this context, how e-cigarette brands evolve and consolidate in different retail channels will be critical for understanding the regulatory impacts on product availability. Our semantic database of e-cigarette brands can serve as a useful tool to monitor product and marketplace development, conduct compliance checks, assess manufacturers’ marketing behaviors, and identify regulatory impacts. %M 38416562 %R 10.2196/47570 %U https://formative.jmir.org/2024/1/e47570 %U https://doi.org/10.2196/47570 %U http://www.ncbi.nlm.nih.gov/pubmed/38416562 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53222 %T Changes in Oral Health and Dental Esthetic in Smokers Switching to Combustion-Free Nicotine Alternatives: Protocol for a Multicenter and Prospective Randomized Controlled Trial %A Conte,Gianluca %A Pacino,Sebastiano Antonio %A Urso,Salvatore %A Greiling,Doris %A Caponnetto,Pasquale %A Pedullà,Eugenio %A Generali,Luigi %A Consolo,Ugo %A Checchi,Vittorio %A Gospodaru,Stefan %A Bordeniuc,Gheorghe %A Fala,Valeriu %A Kowalski,Jan %A Nowak,Maciej %A Górska,Renata %A Amaliya,Amaliya %A Chapple,Iain %A Milward,Michael %A Maclure,Robert %A Nardi,Gianna Maria %A Polosa,Riccardo %+ Department of Clinical and Experimental Medicine, University of Catania, via S. Sofia, 78 - Ed. 4, p. 2, Catania, 95123, Italy, 39 0953781566, polosa@unict.it %K electronic cigarettes %K heated tobacco products %K tobacco harm reduction %K smoking %K oral health %K gingivitis %K periodontitis %K Modified Gingival Index %K MGI %K dental plaque imaging %K dental shade %K smartphone %K mobile phone %D 2024 %7 23.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although the detrimental effects of conventional combustible cigarettes on oral health and dental esthetics are well known, there is limited information about the long-term impact of combustion-free nicotine alternatives (C-F NA) such as e-cigarettes or heated tobacco products. Objective: This multicenter, prospective, 3-parallel-arm randomized controlled trial will investigate whether switching from combustible cigarettes to C-F NA will lead to measurable improvements in oral health parameters and dental esthetics over 18 months in adult smokers with limited gum disease. Methods: Regular smokers not intending to quit and without clinical signs of periodontitis will be randomly assigned (1:4 ratio) to either standard of care with brief cessation advice (control group; arm A) or C-F NA use (intervention group; arm B). The study will also include a reference group of never smokers (reference group; arm C). The primary end point is the change in the Modified Gingival Index (MGI) score from baseline between the control arm (arm A) and the intervention arm (arm B) at the 18-month follow-up. In addition, the study will analyze the within- and between-group (arms A, B, and C) changes in MGI assessment, plaque imaging, dental shade quantitation, tooth stain scores, and oral health–related quality of life questionnaires measured at each study time point. All participants will attend a total of 7 clinic visits: screening, enrollment, and randomization (visit 0); baseline visit—day 14 (visit 1); day 90 (visit 2); day 180 (visit 3); day 360 (visit 4); and day 540 (visit 5). This multicenter study will be conducted in 4 dental clinics in 4 countries. The statistical analysis will involve descriptive statistics for continuous and categorical data. Primary end points will undergo tests for normality and, based on distribution, either a 2-sided t test or Mann-Whitney U test. Linear mixed model with random factors center and study arms by center will also be applied. Secondary end points, including MGI assessment and quality of life, will be subjected to similar tests and comparisons. Only if one value of the parameter MGI is missing after day 1, the last available observation will be carried forward. The analysis will be performed on the substituted data. Secondary parameters will not have missing value replacement. Results: Participant recruitment began in October 2021, and enrollment was completed in June 2023. Results will be reported in 2025. Conclusions: This will be the first study to provide key insights into oral health benefits or risks associated with using C-F NA in smokers who are seeking alternatives to cigarette smoking. Trial Registration: ClinicalTrials.gov NCT04649645; https://clinicaltrials.gov/ct2/show/NCT04649645 International Registered Report Identifier (IRRID): DERR1-10.2196/53222 %M 38393754 %R 10.2196/53222 %U https://www.researchprotocols.org/2024/1/e53222 %U https://doi.org/10.2196/53222 %U http://www.ncbi.nlm.nih.gov/pubmed/38393754 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53170 %T Mediating Effect of Tobacco Dependence on the Association Between Maternal Smoking During Pregnancy and Chronic Obstructive Pulmonary Disease: Case-Control Study %A Li,Jinxuan %A Xu,Jianying %A Yang,Lan %A Xu,Yongjian %A Zhang,Xiangyan %A Bai,Chunxue %A Kang,Jian %A Ran,Pixin %A Shen,Huahao %A Wen,Fuqiang %A Huang,Kewu %A Yao,Wanzhen %A Sun,Tieying %A Shan,Guangliang %A Yang,Ting %A Lin,Yingxiang %A Zhu,Jianguo %A Wang,Ruiying %A Shi,Zhihong %A Zhao,Jianping %A Ye,Xianwei %A Song,Yuanlin %A Wang,Qiuyue %A Hou,Gang %A Zhou,Yumin %A Li,Wen %A Ding,Liren %A Wang,Hao %A Chen,Yahong %A Guo,Yanfei %A Xiao,Fei %A Lu,Yong %A Peng,Xiaoxia %A Zhang,Biao %A Wang,Zuomin %A Zhang,Hong %A Bu,Xiaoning %A Zhang,Xiaolei %A An,Li %A Zhang,Shu %A Cao,Zhixin %A Zhan,Qingyuan %A Yang,Yuanhua %A Liang,Lirong %A Cao,Bin %A Dai,Huaping %A Chung,Kian Fan %A Chen,Zhengming %A He,Jiang %A Wu,Sinan %A Xiao,Dan %A Wang,Chen %A , %+ Department of Tobacco Control and Prevention of Respiratory Diseases, Center of Respiratory Medicine, China-Japan Friendship Hospital, Yinghua Street, Beijing, 100029, China, 86 010 8420 5425, danxiao@263.net %K chronic obstructive pulmonary disease %K tobacco dependence %K smoking %K mediating effects %K lung function %D 2024 %7 22.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Maternal smoking during pregnancy (MSDP) is a known risk factor for offspring developing chronic obstructive pulmonary disease (COPD), but the underlying mechanism remains unclear. Objective: This study aimed to explore whether the increased COPD risk associated with MSDP could be attributed to tobacco dependence (TD). Methods: This case-control study used data from the nationwide cross-sectional China Pulmonary Health study, with controls matched for age, sex, and smoking status. TD was defined as smoking within 30 minutes of waking, and the severity of TD was assessed using the Fagerstrom Test for Nicotine Dependence. COPD was diagnosed when the ratio of forced expiratory volume in 1 second to forced vital capacity was <0.7 in a postbronchodilator pulmonary function test according to the 2017 Global Initiative for Chronic Obstructive Lung Disease criteria. Logistic regression was used to examine the correlation between MSDP and COPD, adjusting for age, sex, BMI, educational attainment, place of residence, ethnic background, occupation, childhood passive smoking, residential fine particulate matter, history of childhood pneumonia or bronchitis, average annual household income, and medical history (coronary heart disease, hypertension, and diabetes). Mediation analysis examined TD as a potential mediator in the link between MSDP and COPD risk. The significance of the indirect effect was assessed through 1000 iterations of the “bootstrap” method. Results: The study included 5943 participants (2991 with COPD and 2952 controls). Mothers of the COPD group had higher pregnancy smoking rates (COPD: n=305, 10.20%; controls: n=211, 7.10%; P<.001). TD was more prevalent in the COPD group (COPD: n=582, 40.40%; controls: n=478, 33.90%; P<.001). After adjusting for covariates, MSDP had a significant effect on COPD (β=.097; P<.001). There was an association between MSDP and TD (β=.074; P<.001) as well as between TD and COPD (β=.048; P=.007). Mediation analysis of TD in the MSDP-COPD association showed significant direct and indirect effects (direct: β=.094; P<.001 and indirect: β=.004; P=.03). The indirect effect remains present in the smoking population (direct: β=.120; P<.001 and indirect: β=.002; P=.03). Conclusions: This study highlighted the potential association between MSDP and the risk of COPD in offspring, revealing the mediating role of TD in this association. These findings contribute to a deeper understanding of the impact of prenatal tobacco exposure on lung health, laying the groundwork for the development of relevant prevention and treatment strategies. %M 38386387 %R 10.2196/53170 %U https://publichealth.jmir.org/2024/1/e53170 %U https://doi.org/10.2196/53170 %U http://www.ncbi.nlm.nih.gov/pubmed/38386387 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47040 %T Comparing the Effectiveness of the Blended Delivery Mode With the Face-to-Face Delivery Mode of Smoking Cessation Treatment: Noninferiority Randomized Controlled Trial %A Siemer,Lutz %A Pieterse,Marcel E %A Ben Allouch,Somaya %A Postel,Marloes G %A Brusse-Keizer,Marjolein G J %+ School of Social Work, Saxion University of Applied Sciences, M. H. Tromplaan 28, Enschede, 7513 AB, Netherlands, 31 657459469, l.siemer@saxion.nl %K tobacco %K blended treatment %K smoking cessation %K randomized controlled trial %K effectiveness %K noninferiority %K evaluation %K mobile phone %D 2024 %7 20.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Tobacco consumption is a leading cause of death and disease, killing >8 million people each year. Smoking cessation significantly reduces the risk of developing smoking-related diseases. Although combined treatment for addiction is promising, evidence of its effectiveness is still emerging. Currently, there is no published research comparing the effectiveness of blended smoking cessation treatments (BSCTs) with face-to-face (F2F) treatments, where web-based components replace 50% of the F2F components in blended treatment. Objective: The primary objective of this 2-arm noninferiority randomized controlled trial was to determine whether a BSCT is noninferior to an F2F treatment with identical ingredients in achieving abstinence rates. Methods: This study included 344 individuals who smoke (at least 1 cigarette per day) attending an outpatient smoking cessation clinic in the Netherlands. The participants received either a blended 50% F2F and 50% web-based BSCT or only F2F treatment with similar content and intensity. The primary outcome measure was cotinine-validated abstinence rates from all smoking products at 3 and 15 months after treatment initiation. Additional measures included carbon monoxide–validated point prevalence abstinence; self-reported point prevalence abstinence; and self-reported continuous abstinence rates at 3, 6, 9, and 15 months after treatment initiation. Results: None of the 13 outcomes showed statistically confirmed noninferiority of the BSCT, whereas 4 outcomes showed significantly (P<.001) inferior abstinence rates of the BSCT: cotinine-validated point prevalence abstinence rate at 3 months (difference 12.7, 95% CI 6.2-19.4), self-reported point prevalence abstinence rate at 6 months (difference 19.3, 95% CI 11.5-27.0) and at 15 months (difference 11.7, 95% CI 5.8-17.9), and self-reported continuous abstinence rate at 6 months (difference 13.8, 95% CI 6.8-20.8). The remaining 9 outcomes, including the cotinine-validated point prevalence abstinence rate at 15 months, were inconclusive. Conclusions: In this high-intensity outpatient smoking cessation trial, the blended mode was predominantly less effective than the traditional F2F mode. The results contradict the widely assumed potential benefits of blended treatment and suggest that further research is needed to identify the critical factors in the design of blended interventions. Trial Registration: Netherlands Trial Register 27150; https://onderzoekmetmensen.nl/nl/trial/27150 International Registered Report Identifier (IRRID): RR2-doi.org/10.1186/s12889-016-3851-x %M 38376901 %R 10.2196/47040 %U https://www.jmir.org/2024/1/e47040 %U https://doi.org/10.2196/47040 %U http://www.ncbi.nlm.nih.gov/pubmed/38376901 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50465 %T Efficacy of Digital Outreach Strategies for Collecting Smoking Data: Pragmatic Randomized Trial %A Kearney,Lauren E %A Jansen,Emily %A Kathuria,Hasmeena %A Steiling,Katrina %A Jones,Kayla C %A Walkey,Allan %A Cordella,Nicholas %+ The Pulmonary Center, Boston University, 72 East Concord Street, Boston, MA, 02118, United States, 1 9788070286, lekearn@bu.edu %K electronic health records %K EHR %K informatics %K learning health system %K lung cancer screening %K smoking history %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Tobacco smoking is an important risk factor for disease, but inaccurate smoking history data in the electronic medical record (EMR) limits the reach of lung cancer screening (LCS) and tobacco cessation interventions. Patient-generated health data is a novel approach to documenting smoking history; however, the comparative effectiveness of different approaches is unclear. Objective: We designed a quality improvement intervention to evaluate the effectiveness of portal questionnaires compared to SMS text message–based surveys, to compare message frames, and to evaluate the completeness of patient-generated smoking histories. Methods: We randomly assigned patients aged between 50 and 80 years with a history of tobacco use who identified English as a preferred language and have never undergone LCS to receive an EMR portal questionnaire or a text survey. The portal questionnaire used a “helpfulness” message, while the text survey tested frame types informed by behavior economics (“gain,” “loss,” and “helpfulness”) and nudge messaging. The primary outcome was the response rate for each modality and framing type. Completeness and consistency with documented structured smoking data were also evaluated. Results: Participants were more likely to respond to the text survey (191/1000, 19.1%) compared to the portal questionnaire (35/504, 6.9%). Across all text survey rounds, patients were less responsive to the “helpfulness” frame compared with the “gain” frame (odds ratio [OR] 0.29, 95% CI 0.09-0.91; P<.05) and “loss” frame (OR 0.32, 95% CI 11.8-99.4; P<.05). Compared to the structured data in the EMR, the patient-generated data were significantly more likely to be complete enough to determine LCS eligibility both compared to the portal questionnaire (OR 34.2, 95% CI 3.8-11.1; P<.05) and to the text survey (OR 6.8, 95% CI 3.8-11.1; P<.05). Conclusions: We found that an approach using patient-generated data is a feasible way to engage patients and collect complete smoking histories. Patients are likely to respond to a text survey using “gain” or “loss” framing to report detailed smoking histories. Optimizing an SMS text message approach to collect medical information has implications for preventative and follow-up clinical care beyond smoking histories, LCS, and smoking cessation therapy. %M 38335012 %R 10.2196/50465 %U https://formative.jmir.org/2024/1/e50465 %U https://doi.org/10.2196/50465 %U http://www.ncbi.nlm.nih.gov/pubmed/38335012 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53644 %T Investigation of the Association Between e-Cigarette Smoking and Oral Mucosal Health Status Among Young People: Protocol for a Case-Control Trial %A Cheng,Siyuan %+ Massachusetts College of Pharmacy and Health Sciences, 179 Longwood Avenue, Boston, MA, 02115, United States, 1 617 732 2850, m0496197@stu.mcphs.edu %K oral mucosal lesions %K e-cigarette %K youth %K oral %K moth %K lesion %K lesions %K cigarette %K cigarettes %K smoker %K smoking %K smokers %K smoke %K mucosa %K mucosal %K dental %K dentist %K dentistry %D 2024 %7 26.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Given the paucity of current safety studies related to e-cigarettes, there are no definitive studies on whether e-cigarettes cause oral mucosal lesions or even oral cancer. Although it is still undetermined whether e-cigarettes are harmless, an increasing number of teenagers choose to smoke e-cigarettes and believe that they are not harmful to the human body. Objective: This aims to determine whether e-cigarettes cause damage to the oral mucosa. This study also aims to evaluate the association between e-cigarette smoking and oral mucous membrane lesions in young adults. The objectives are to (1) compare the oral mucosal conditions in participants with and without e-cigarette smoking habits, (2) assess the effect of the amount of e-cigarette smoking on oral mucosal conditions, and (3) assess the effect of the duration of e-cigarette smoking on oral mucosal conditions. Methods: In this prospective study, 304 youths aged 15 to 24 years (n=152, 50% who smoke only e-cigarettes and n=152, 50% who do not smoke e-cigarettes or cigarettes) will be divided into 2 groups for a controlled study. Whether e-cigarettes cause oral mucosal lesions will be verified by comparing the odds of oral mucosal lesions in the 2 experimental groups. For this experiment, the predefined power is 80% (P=.04), and the predefined proportions of groups 1 and 2 are 11% and 2.5%, respectively. Results: This experiment is at the conceptualization phase and has not yet been carried out. Experimenters have not been recruited and no data have been collected. Conclusions: e-Cigarettes are still an unfamiliar topic to the public, and it is still unknown whether they can cause damage to the oral mucosa. This experiment aims to find out whether there is a link between the 2. There are still many limitations in this study, such as the lack of categorization of e-cigarettes and the lack of testing methods for oral mucosal status. These limitations are expected to be addressed in the future as the experiment is formally conducted and further optimized. International Registered Report Identifier (IRRID): PRR1-10.2196/53644 %M 38171545 %R 10.2196/53644 %U https://www.researchprotocols.org/2024/1/e53644 %U https://doi.org/10.2196/53644 %U http://www.ncbi.nlm.nih.gov/pubmed/38171545 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49031 %T Use of Machine Learning Tools in Evidence Synthesis of Tobacco Use Among Sexual and Gender Diverse Populations: Algorithm Development and Validation %A Ma,Shaoying %A Jiang,Shuning %A Yang,Olivia %A Zhang,Xuanzhi %A Fu,Yu %A Zhang,Yusen %A Kaareen,Aadeeba %A Ling,Meng %A Chen,Jian %A Shang,Ce %+ Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, 3650 Olentangy River Road, 1st Floor, Suite 110, Columbus, OH, 43214, United States, 1 6148976063, shaoying.ma@osumc.edu %K machine learning %K natural language processing %K tobacco control %K sexual and gender diverse populations %K lesbian %K gay %K bisexual %K transgender %K queer %K LGBTQ+ %K evidence synthesis %D 2024 %7 24.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: From 2016 to 2021, the volume of peer-reviewed publications related to tobacco has experienced a significant increase. This presents a considerable challenge in efficiently summarizing, synthesizing, and disseminating research findings, especially when it comes to addressing specific target populations, such as the LGBTQ+ (lesbian, gay, bisexual, transgender, queer, intersex, asexual, Two Spirit, and other persons who identify as part of this community) populations. Objective: In order to expedite evidence synthesis and research gap discoveries, this pilot study has the following three aims: (1) to compile a specialized semantic database for tobacco policy research to extract information from journal article abstracts, (2) to develop natural language processing (NLP) algorithms that comprehend the literature on nicotine and tobacco product use among sexual and gender diverse populations, and (3) to compare the discoveries of the NLP algorithms with an ongoing systematic review of tobacco policy research among LGBTQ+ populations. Methods: We built a tobacco research domain–specific semantic database using data from 2993 paper abstracts from 4 leading tobacco-specific journals, with enrichment from other publicly available sources. We then trained an NLP model to extract named entities after learning patterns and relationships between words and their context in text, which further enriched the semantic database. Using this iterative process, we extracted and assessed studies relevant to LGBTQ+ tobacco control issues, further comparing our findings with an ongoing systematic review that also focuses on evidence synthesis for this demographic group. Results: In total, 33 studies were identified as relevant to sexual and gender diverse individuals’ nicotine and tobacco product use. Consistent with the ongoing systematic review, the NLP results showed that there is a scarcity of studies assessing policy impact on this demographic using causal inference methods. In addition, the literature is dominated by US data. We found that the product drawing the most attention in the body of existing research is cigarettes or cigarette smoking and that the number of studies of various age groups is almost evenly distributed between youth or young adults and adults, consistent with the research needs identified by the US health agencies. Conclusions: Our pilot study serves as a compelling demonstration of the capabilities of NLP tools in expediting the processes of evidence synthesis and the identification of research gaps. While future research is needed to statistically test the NLP tool’s performance, there is potential for NLP tools to fundamentally transform the approach to evidence synthesis. %M 38265858 %R 10.2196/49031 %U https://formative.jmir.org/2024/1/e49031 %U https://doi.org/10.2196/49031 %U http://www.ncbi.nlm.nih.gov/pubmed/38265858 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46450 %T Smoking Behavior Change and the Risk of Heart Failure in Patients With Type 2 Diabetes: Nationwide Retrospective Cohort Study %A Yoo,Jung Eun %A Jeong,Su-Min %A Lee,Kyu Na %A Lee,Heesun %A Yoon,Ji Won %A Han,Kyungdo %A Shin,Dong Wook %+ Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea, 82 2 3410 5252, dwshin.md@gmail.com %K smoking %K change in smoking behavior %K cessation %K heart failure %K type 2 diabetes %K diabetes %K cardiovascular disease %K smoking cessation %K smoker %K risk factor %D 2024 %7 10.1.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Heart failure (HF) is one of the most common initial manifestations of cardiovascular disease in patients with type 2 diabetes. Although smoking is an independent risk factor for HF, there is a lack of data for the incidence of HF according to changes in smoking behaviors in patients with type 2 diabetes. Objective: We aimed to examine the association between interval changes in smoking behavior and the risk of HF among patients with type 2 diabetes. Methods: We conducted a retrospective cohort study using the National Health Insurance Service database. We identified 365,352 current smokers with type 2 diabetes who had 2 consecutive health screenings (2009-2012) and followed them until December 31, 2018, for the incident HF. Based on smoking behavior changes between 2 consecutive health screenings, participants were categorized into quitter, reducer I (≥50% reduction) and II (<50% reduction), sustainer (reference group), and increaser groups. Results: During a median follow-up of 5.1 (IQR 4.0-6.1) years, there were 13,879 HF cases (7.8 per 1000 person-years). Compared to sustainers, smoking cessation was associated with lower risks of HF (adjusted hazard ratio [aHR] 0.90, 95% CI0.86-0.95), whereas increasers showed higher risks of HF than sustainers; heavy smokers who increased their level of smoking had a higher risk of HF (aHR 1.13, 95% CI 1.04-1.24). In the case of reducers, the risk of HF was not reduced but rather increased slightly (reducer I: aHR 1.14, 95% CI 1.08-1.21; reducer II: aHR 1.03, 95% CI 0.98-1.09). Consistent results were noted for subgroup analyses including type 2 diabetes severity, age, and sex. Conclusions: Smoking cessation was associated with a lower risk of HF among patients with type 2 diabetes, while increasing smoking amount was associated with a higher risk for HF than in those sustaining their smoking amount. There was no benefit from reduction in smoking amount. %M 38198206 %R 10.2196/46450 %U https://publichealth.jmir.org/2024/1/e46450 %U https://doi.org/10.2196/46450 %U http://www.ncbi.nlm.nih.gov/pubmed/38198206 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51658 %T Effectiveness of the QuitSure Smartphone App for Smoking Cessation: Findings of a Prospective Single Arm Trial %A Pandya,Apurvakumar %A K S,Mythri %A Mishra,Shweta %A Bajaj,Kriti %+ Parul Institute of Public Health, Parul University, At & Post - Limda, Waghodia, Vadodara, 391760, India, 91 9825558237, drapurvakumar@gmail.com %K smoking %K nicotine dependence %K smoking cessation %K QuitSure app %K smartphone application %K mHealth %K mobile health %K app %K apps %K application %K applications %K nicotine %K smoke %K smoker %K quit %K quitting %K cessation %K abstinence %K mobile phone %D 2023 %7 29.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital therapies, especially smartphone apps for active and continuous smoking cessation support, are strongly emerging as an alternative smoking cessation therapy. In the Indian context, there is a growing interest in the use of app-based smoking cessation programs; however, there is limited evidence regarding their effectiveness in achieving long-term continuous abstinence. Objective: This study aimed to evaluate the long-term abstinence effect (up to 30-d abstinence postprogram completion) of a smartphone app, QuitSure, for smoking cessation in active smokers from India. Methods: In this prospective single-arm study, participants who signed up for the QuitSure app were enrolled in this study. The primary end point was the prolonged abstinence (PA) rate from weeks 1 to 4 (day 7 to day 30). Furthermore, data for withdrawal symptoms, relapse reasons, and reasons for not continuing the program were also assessed. Results: The quit rate was calculated considering only the participants who followed up and completed the survey sent to them (per protocol) at day 7 and at day 30, respectively. The PA rate at day 7 was found to be 64.5% (111/172; 95% CI 56% to 72%), and the PA rate at day 30 was found to be 55.8% (72/129; 95% CI 45% to 65%). Within the 7-day abstinence period, 60.4% (67/111) of the participants did not have any withdrawal symptoms. The most common mild withdrawal symptoms were mild sleep disturbance (21/111, 18.9%), mild digestive changes (19/111, 17.1%), and coughing (17/111, 15.3%). Severe withdrawal symptoms were rare, with only 5.4% (6/111) experiencing them. For those achieving 30-day postprogram abstinence, 85% (61/72) had no mild withdrawal symptoms, and 99% (71/72) had no severe withdrawal symptoms. Among successful quitters at day 7, a total of 72.1% (80/111) reported minimal to no cravings, which increased to 88% (63/72) at day 30. Furthermore, 78% (56/72) of those with PA at day 30 reported no change in weight or reduced weight. Among participants experiencing relapse, 48% (28/58) cited intense cravings, 28% (16/58) mentioned facing a tragedy, and 26% (15/58) reported relapsing due to alcohol consumption. The PA rates as a result of the QuitSure program were found to be better than those reported in the results of other smoking-cessation app programs’ studies. Conclusions: The QuitSure app yields high PA rates and ameliorates symptoms associated with smoking cessation. In order to obtain conclusive evidence regarding the effectiveness and efficacy of the QuitSure program, future research should include appropriate control measures. Nevertheless, the QuitSure program can serve as a valuable adjunct to a conventional smoking cessation treatment program to aid sustained abstinence. %M 38157243 %R 10.2196/51658 %U https://formative.jmir.org/2023/1/e51658 %U https://doi.org/10.2196/51658 %U http://www.ncbi.nlm.nih.gov/pubmed/38157243 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48958 %T Developing Mood-Based Computer-Tailored Health Communication for Smoking Cessation: Feasibility Randomized Controlled Trial %A Lee,Donghee N %A Sadasivam,Rajani S %A Stevens,Elise M %+ Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine, UMass Chan Medical School, 368 Plantation St, Worcester, MA, 01605, United States, 1 774 455 4871, donghee.lee10@umassmed.edu %K mood %K smoking cessation messages %K computer-tailored health communication %K innovation %K smoking %K cessation %K digital intervention %K effectiveness %K text mining %K adult %K motivation %D 2023 %7 22.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Computer-tailored health communication (CTHC), a widely used strategy to increase the effectiveness of smoking cessation interventions, is focused on selecting the best messages for an individual. More recently, CTHC interventions have been tested using contextual information such as participants’ current stress or location to adapt message selection. However, mood has not yet been used in CTCH interventions and may increase their effectiveness. Objective: This study aims to examine the association of mood and smoking cessation message effectiveness among adults who currently smoke cigarettes. Methods: In January 2022, we recruited a web-based convenience sample of adults who smoke cigarettes (N=615; mean age 41.13 y). Participants were randomized to 1 of 3 mood conditions (positive, negative, or neutral) and viewed pictures selected from the International Affective Picture System to induce an emotional state within the assigned condition. Participants then viewed smoking cessation messages with topics covering five themes: (1) financial costs or rewards, (2) health, (3) quality of life, (4) challenges of quitting, and (5) motivation or reasons to quit. Following each message, participants completed questions on 3 constructs: message receptivity, perceived relevance, and their motivation to quit. The process was repeated 30 times. We used 1-way ANOVA to estimate the association of the mood condition on these constructs, controlling for demographics, cigarettes per day, and motivation to quit measured during the pretest. We also estimated the association between mood and outcomes for each of the 5 smoking message theme categories. Results: There was an overall statistically significant effect of the mood condition on the motivation to quit outcome (P=.02) but not on the message receptivity (P=.16) and perceived relevance (P=.86) outcomes. Participants in the positive mood condition reported significantly greater motivation to quit compared with those in the negative mood condition (P=.005). Participants in the positive mood condition reported higher motivation to quit after viewing smoking cessation messages in the financial (P=.03), health (P=.01), quality of life (P=.04), and challenges of quitting (P=.03) theme categories. We also compared each mood condition and found that participants in the positive mood condition reported significantly greater motivation to quit after seeing messages in the financial (P=.01), health (P=.003), quality of life (P=.01), and challenges of quitting (P=.01) theme categories than those in the negative mood condition. Conclusions: Our findings suggest that considering mood may be important for future CTHC interventions. Because those in the positive mood state at the time of message exposure were more likely to have greater quitting motivations, smoking cessation CTHC interventions may consider strategies to help improve participants’ mood when delivering these messages. For those in neutral and negative mood states, focusing on certain message themes (health and motivation to quit) may be more effective than other message themes. %M 38133916 %R 10.2196/48958 %U https://formative.jmir.org/2023/1/e48958 %U https://doi.org/10.2196/48958 %U http://www.ncbi.nlm.nih.gov/pubmed/38133916 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49354 %T Exploring Different Incentive Structures Among US Adults Who Use e-Cigarettes to Optimize Retention in Longitudinal Web-Based Surveys: Case Study %A Crespi,Elizabeth %A Heller,Johanna %A Hardesty,Jeffrey J %A Nian,Qinghua %A Sinamo,Joshua K %A Welding,Kevin %A Kennedy,Ryan David %A Cohen,Joanna E %+ Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Baltimore, MD, 21205, United States, 1 410 614 5378, ecrespi2@jhu.edu %K incentive %K conditional incentive %K web-based survey %K longitudinal study %K follow-up %K nicotine %K e-cigarettes %K tobacco %K survey %K retention %K demographics %K case study %K optimization %K adults %D 2023 %7 13.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Longitudinal cohort studies are critical for understanding the evolution of health-influencing behaviors, such as e-cigarette use, over time. Optimizing follow-up rates in longitudinal studies is necessary for ensuring high-quality data with sufficient power for analyses. However, achieving high rates of follow-up in web-based longitudinal studies can be challenging, even when monetary incentives are provided. Objective: This study compares participant progress through a survey and demographics for 2 incentive structures (conditional and hybrid unconditional-conditional) among US adults using e-cigarettes to understand the optimal incentive structure. Methods: The data used in this study are from a web-based longitudinal cohort study (wave 4; July to September 2022) of US adults (aged 21 years or older) who use e-cigarettes ≥5 days per week. Participants (N=1804) invited to the follow-up survey (median completion time=16 minutes) were randomly assigned into 1 of 2 incentive structure groups (n=902 each): (1) conditional (US $30 gift code upon survey completion) and (2) hybrid unconditional-conditional (US $15 gift code prior to survey completion and US $15 gift code upon survey completion). Chi-square tests assessed group differences in participant progress through 5 sequential stages of the survey (started survey, completed screener, deemed eligible, completed survey, and deemed valid) and demographics. Results: Of the 902 participants invited to the follow-up survey in each group, a higher proportion of those in the conditional (662/902, 73.4%) than the hybrid (565/902, 62.6%) group started the survey (P<.001). Of those who started the survey, 643 (97.1%) participants in the conditional group and 548 (97%) participants in the hybrid group completed the screener (P=.89), which was used each wave to ensure participants remained eligible. Of those who completed the screener, 555 (86.3%) participants in the conditional group and 446 (81.4%) participants in the hybrid group were deemed eligible for the survey (P=.02). Of those eligible, 514 (92.6%) participants from the conditional group and 401 (89.9%) participants from the hybrid group completed the survey and were deemed valid after data review (P=.14). Overall, more valid completions were yielded from the conditional (514/902, 57%) than the hybrid group (401/902, 44.5%; P<.001). Among those who validly completed the survey, no significant differences were found by group for gender, income, race, ethnicity, region, e-cigarette use frequency, past 30-day cigarette use, or number of waves previously completed. Conclusions: Providing a US $30 gift code upon survey completion yielded higher rates of survey starts and completions than providing a US $15 gift code both before and after survey completion. These 2 methods yielded participants with similar demographics, suggesting that one approach is not superior in obtaining a balanced sample. Based on this case study, future web-based surveys examining US adults using e-cigarettes could consider providing the full incentive upon completion of the survey. International Registered Report Identifier (IRRID): RR2-10.2196/38732 %M 38090793 %R 10.2196/49354 %U https://www.jmir.org/2023/1/e49354 %U https://doi.org/10.2196/49354 %U http://www.ncbi.nlm.nih.gov/pubmed/38090793 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e52398 %T A Christian Faith-Based Facebook Intervention for Smoking Cessation in Rural Communities (FAITH-CORE): Protocol for a Community Participatory Development Study %A Sharma,Pravesh %A Tranby,Brianna %A Kamath,Celia %A Brockman,Tabetha %A Roche,Anne %A Hammond,Christopher %A Brewer,LaPrincess C %A Sinicrope,Pamela %A Lenhart,Ned %A Quade,Brian %A Abuan,Nate %A Halom,Martin %A Staples,Jamie %A Patten,Christi %+ Psychiatry and Psychology, Mayo Clinic Health System, Mayo Clinic, 1221 Whipple St, Eau Claire, WI, 54703, United States, 1 7158385369, sharma.pravesh@mayo.edu %K community %K participatory %K community-based participatory research %K faith %K smoking cessation %K Facebook %K social media %K mobile phone %D 2023 %7 13.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco smoking remains the leading cause of preventable morbidity and mortality in the United States, with significant rural-urban disparities. Adults who live in rural areas of the United States have among the highest tobacco smoking rates in the nation and experience a higher prevalence of smoking-related deaths and deaths due to chronic diseases for which smoking is a causal risk factor. Barriers to accessing tobacco use cessation treatments are a major contributing factor to these disparities. Adults living in rural areas experience difficulty accessing tobacco cessation services due to geographical challenges, lack of insurance coverage, and lack of health care providers who treat tobacco use disorders. The use of digital technology could be a practical answer to these barriers. Objective: This report describes a protocol for a study whose main objectives are to develop and beta test an innovative intervention that uses a private, moderated Facebook group platform to deliver peer support and faith-based cessation messaging to enhance the reach and uptake of existing evidence-based smoking cessation treatment (EBCT) resources (eg, state quitline coaching programs) for rural adults who smoke. Methods: We will use the Integrated Theory of Health Behavior Change, surface or deep structure frameworks to guide intervention development, and the community-based participatory research (CBPR) approach to identify and engage with community stakeholders. The initial content library of moderator postings (videos and text or image postings) will be developed using existing EBCT material from the Centers for Disease Control and Prevention Tips from Former Smokers Campaign. The content library will feature topics related to quitting smoking, such as coping with cravings and withdrawal and using EBCTs with faith-based message integration (eg, Bible quotes). A community advisory board and a community engagement studio will provide feedback to refine the content library. We will also conduct a beta test of the intervention with 15 rural adults who smoke to assess the recruitment feasibility and preliminary intervention uptake such as engagement, ease of use, usefulness, and satisfaction to further refine the intervention based on participant feedback. Results: The result of this study will create an intervention prototype that will be used for a future randomized controlled trial. Conclusions: Our CBPR project will create a prototype of a Facebook-delivered faith-based messaging and peer support intervention that may assist rural adults who smoke to use EBCT. This study is crucial in establishing a self-sufficient smoking cessation program for the rural community. The project is unique in using a moderated social media platform providing peer support and culturally relevant faith-based content to encourage adult people who smoke to seek treatment and quit smoking. International Registered Report Identifier (IRRID): PRR1-10.2196/52398 %M 38090799 %R 10.2196/52398 %U https://www.researchprotocols.org/2023/1/e52398 %U https://doi.org/10.2196/52398 %U http://www.ncbi.nlm.nih.gov/pubmed/38090799 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e53556 %T AI Conversational Agent to Improve Varenicline Adherence: Protocol for a Mixed Methods Feasibility Study %A Minian,Nadia %A Mehra,Kamna %A Earle,Mackenzie %A Hafuth,Sowsan %A Ting-A-Kee,Ryan %A Rose,Jonathan %A Veldhuizen,Scott %A Zawertailo,Laurie %A Ratto,Matt %A Melamed,Osnat C %A Selby,Peter %+ INTREPID Lab, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J1H1, Canada, 1 4165358501 ext 77420, nadia.minian2@camh.ca %K evaluation %K health bot %K medication adherence %K smoking cessation %K varenicline %K artificial intelligence %K AI %D 2023 %7 11.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Varenicline is a pharmacological intervention for tobacco dependence that is safe and effective in facilitating smoking cessation. Enhanced adherence to varenicline augments the probability of prolonged smoking abstinence. However, research has shown that one-third of people who use varenicline are nonadherent by the second week. There is evidence showing that behavioral support helps with medication adherence. We have designed an artificial intelligence (AI) conversational agent or health bot, called “ChatV,” based on evidence of what works as well as what varenicline is, that can provide these supports. ChatV is an evidence-based, patient- and health care provider–informed health bot to improve adherence to varenicline. ChatV has been programmed to provide medication reminders, answer questions about varenicline and smoking cessation, and track medication intake and the number of cigarettes. Objective: This study aims to explore the feasibility of the ChatV health bot, to examine if it is used as intended, and to determine the appropriateness of proceeding with a randomized controlled trial. Methods: We will conduct a mixed methods feasibility study where we will pilot-test ChatV with 40 participants. Participants will be provided with a standard 12-week varenicline regimen and access to ChatV. Passive data collection will include adoption measures (how often participants use the chatbot, what features they used, when did they use it, etc). In addition, participants will complete questionnaires (at 1, 4, 8, and 12 weeks) assessing self-reported smoking status and varenicline adherence, as well as questions regarding the acceptability, appropriateness, and usability of the chatbot, and participate in an interview assessing acceptability, appropriateness, fidelity, and adoption. We will use “stop, amend, and go” progression criteria for pilot studies to decide if a randomized controlled trial is a reasonable next step and what modifications are required. A health equity lens will be adopted during participant recruitment and data analysis to understand and address the differences in uptake and use of this digital health solution among diverse sociodemographic groups. The taxonomy of implementation outcomes will be used to assess feasibility, that is, acceptability, appropriateness, fidelity, adoption, and usability. In addition, medication adherence and smoking cessation will be measured to assess the preliminary treatment effect. Interview data will be analyzed using the framework analysis method. Results: Participant enrollment for the study will begin in January 2024. Conclusions: By using predetermined progression criteria, the results of this preliminary study will inform the determination of whether to advance toward a larger randomized controlled trial to test the effectiveness of the health bot. Additionally, this study will explore the acceptability, appropriateness, fidelity, adoption, and usability of the health bot. These insights will be instrumental in refining the intervention and the health bot. Trial Registration: ClinicalTrials.gov NCT05997901; https://classic.clinicaltrials.gov/ct2/show/NCT05997901 International Registered Report Identifier (IRRID): PRR1-10.2196/53556 %M 38079201 %R 10.2196/53556 %U https://www.researchprotocols.org/2023/1/e53556 %U https://doi.org/10.2196/53556 %U http://www.ncbi.nlm.nih.gov/pubmed/38079201 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43096 %T Strengths and Limitations of Web-Based Cessation Support for Individuals Who Smoke, Dual Use, or Vape: Qualitative Interview Study %A Struik,Laura %A Christianson,Kyla %A Khan,Shaheer %A Sharma,Ramona H %+ School of Nursing, University of British Columbia Okanagan, ART 140, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 2508647879, laura.struik@ubc.ca %K qualitative research %K tobacco use %K smoking %K vaping %K cessation %K eHealth %K individuals who smoke %K users %K tobacco %K e-cigarettes %K cigarettes %K web-based %K support %K behavioral %K smartphone app %K social media %K mobile phone %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Tobacco use has shifted in recent years, especially with the introduction of e-cigarettes. Despite the current variable and intersecting tobacco product use among tobacco users, most want to quit, which necessitates cessation programs to adapt to these variable trends (vs focusing on combustible cigarettes alone). The use of web-based modalities for cessation support has become quite popular in recent years and has been compounded by the COVID-19 pandemic. Therefore, understanding the current strengths and limitations of existing programs to meet the needs of current various tobacco users is critical for ensuring the saliency of such programs moving forward. Objective: The purpose of this study was to understand the strengths and limitations of web-based cessation support offered through QuitNow to better understand the needs of a variety of end users who smoke, dual use, or vape. Methods: Semistructured interviews were conducted with 36 nicotine product users in British Columbia. Using conventional content analysis methods, we inductively derived descriptive categories and themes related to the strengths and limitations of QuitNow for those who smoke, dual use, or vape. We analyzed the data with the support of NVivo (version 12; QSR International) and Excel (Microsoft Corporation). Results: Participants described several strengths and limitations of QuitNow and provided suggestions for improvement, which fell under 2 broad categories: look and feel and content and features. Shared strengths included the breadth of information and the credible nature of the website. Individuals who smoke were particularly keen about the site having a nonjudgmental feeling. Moreover, compared with individuals who smoke, individuals who dual use and individuals who vape were particularly keen about access to professional quit support (eg, quit coach). Shared limitations included the presence of too much text and the need to create an account. Individuals who dual use and individuals who vape thought that the content was geared toward older adults and indicated that there was a lack of information about vaping and personalized content. Regarding suggestions for improvement, participants stated that the site needed more interaction, intuitive organization, improved interface esthetics, a complementary smartphone app, forum discussion tags, more information for different tobacco user profiles, and user testimonials. Individuals who vape were particularly interested in website user reviews. In addition, individuals who vape were more interested in an intrinsic approach to quitting (eg, mindfulness) compared with extrinsic approaches (eg, material incentives), the latter of which was endorsed by more individuals who dual use and individuals who smoke. Conclusions: The findings of this study provide directions for enhancing the saliency of web-based cessation programs for a variety of tobacco use behaviors that hallmark current tobacco use. %M 38064266 %R 10.2196/43096 %U https://formative.jmir.org/2023/1/e43096 %U https://doi.org/10.2196/43096 %U http://www.ncbi.nlm.nih.gov/pubmed/38064266 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42310 %T Development of a Virtual Human for Supporting Tobacco Cessation During the COVID-19 Pandemic %A Loveys,Kate %A Lloyd,Erica %A Sagar,Mark %A Broadbent,Elizabeth %+ Department of Psychological Medicine, The University of Auckland, Level 3, Building 507, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 93737599 ext 86756, e.broadbent@auckland.ac.nz %K virtual human %K conversational agent %K tobacco cessation %K eHealth %K COVID-19 %K public health %K virtual health worker %K smoking cessation %K artificial intelligence %K AI %K chatbot %K digital health intervention %K web-based health %K mobile phone %D 2023 %7 5.12.2023 %9 Viewpoint %J J Med Internet Res %G English %X People who consume tobacco are at greater risk of developing severe COVID-19. Unfortunately, the COVID-19 pandemic reduced the accessibility of tobacco cessation services as a result of necessary social restrictions. Innovations were urgently needed to support tobacco cessation during the pandemic. Virtual humans are artificially intelligent computer agents with a realistic, humanlike appearance. Virtual humans could be a scalable and engaging way to deliver tobacco cessation information and support. Florence, a virtual human health worker, was developed in collaboration with the World Health Organization to remotely support people toward tobacco cessation during the COVID-19 pandemic. Florence delivers evidence-based information, assists with making quit plans, and directs people to World Health Organization–recommended cessation services in their country. In this viewpoint, we describe the process of developing Florence. The development was influenced by a formative evaluation of data from 115 early users of Florence from 49 countries. In general, Florence was positively perceived; however, changes were requested to aspects of her design and content. In addition, areas for new content were identified (eg, for nonsmoker support persons). Virtual health workers could expand the reach of evidence-based tobacco cessation information and personalized support. However, as they are a new innovation in tobacco cessation, their efficacy, feasibility, and acceptability in this application needs to be evaluated, including in diverse populations. %M 38051571 %R 10.2196/42310 %U https://www.jmir.org/2023/1/e42310 %U https://doi.org/10.2196/42310 %U http://www.ncbi.nlm.nih.gov/pubmed/38051571 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47978 %T A Brief Digital Screening and Intervention Tool for Parental and Adolescent Tobacco and Electronic Cigarette Use in Pediatric Medical Care in Canada: Protocol for a Pilot Randomized Controlled Trial %A Chadi,Nicholas %A Diamant,Emile %A Perez,Tamara %A Al-Saleh,Afnan %A Sylvestre,Marie-Pierre %A O’Loughlin,Jennifer %A Winickoff,Jonathan P %A Drouin,Olivier %+ Division of General Pediatrics, Department of Pediatrics, Sainte-Justine University Hospital Centre, 3175 Chem. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada, 1 514 345 4931 ext 4226, o.drouin@umontreal.ca %K adolescents %K cessation %K e-cigarettes %K parents %K pediatric clinic %K screening %K tobacco %D 2023 %7 30.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Though rates of tobacco smoking have decreased consistently over the past 3 decades, cigarette use remains the top preventable cause of premature death in North America. The Clinical Effort Against Secondhand Smoke Exposure (CEASE) is a medical clinic-based intervention that systematically screens parents for tobacco use and offers them direct access to evidence-based smoking cessation services. While the effectiveness of CEASE for parents who smoke has already been demonstrated in the United States, the CEASE model has not yet been tested in Canada, among parents who use e-cigarettes, or among adolescents who use cigarettes and e-cigarettes. Objective: We aim to demonstrate the feasibility and evaluate the preliminary effectiveness of the CEASE program for parental smoking cessation and its adapted version for adolescent smoking cessation and adolescent and parental vaping cessation. Methods: We will approach parents or guardians of children aged between 0 and 17 years, as well as adolescent patients aged between 14 and 17 years, from a tertiary care pediatric hospital in Montreal, Quebec, Canada, for participation in this single-blinded, pilot randomized controlled trial. Eligible participants are those who report using tobacco cigarettes or e-cigarettes at least once in the last 7 days and present to an outpatient pediatric clinic for a scheduled appointment. Our recruitment target is 100 participants: 50 parents or guardians of children aged 17 years or younger, and 50 adolescents aged between 14 and 17 years. The feasibility of implementation of the CEASE model will be measured by recruitment and retention rates for all 4 participant groups (stratified as follows: parents who use cigarettes, parents who use e-cigarettes exclusively, adolescents who use cigarettes, and adolescents who use e-cigarettes exclusively). Parent and adolescent participants within each group are randomized to the intervention and control groups using a 1:1 ratio through a computer-generated randomization list. Preliminary effectiveness outcomes include self-reported smoking and e-cigarette cessation, use of cessation resources, changes in smoking and e-cigarette use, motivation to quit, and quit attempts among participants. Participants complete electronic questionnaires on a tablet in the clinic at baseline as well as electronic follow-up questionnaires at 1, 3, and 6 months. Individuals reporting successful quit attempts are invited to provide a urine sample for cotinine testing to biochemically confirm quit. Analyses include descriptive statistics as well as exploratory trajectory analyses of smoking, e-cigarette use, and motivation to quit. Results: Research activities began in June 2022. Participant enrollment and data collection began in February 2023 and are expected to be completed in 15 months. Conclusions: There is a strong need for effective and cost-effective smoking and vaping cessation interventions for parents and adolescents. If successful, this study will help inform the preparation of a fully powered randomized controlled trial of CEASE in Canada in these populations. Trial Registration: Clinicaltrials.gov NCT05366790; https://www.clinicaltrials.gov/study/NCT05366790 International Registered Report Identifier (IRRID): DERR1-10.2196/47978 %M 38032712 %R 10.2196/47978 %U https://www.researchprotocols.org/2023/1/e47978 %U https://doi.org/10.2196/47978 %U http://www.ncbi.nlm.nih.gov/pubmed/38032712 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47463 %T The Effect of Interactivity, Tailoring, and Use Intensity on the Effectiveness of an Internet-Based Smoking Cessation Intervention Over a 12-Month Period: Randomized Controlled Trial %A Maiwald,Phillip %A Bischoff,Martina %A Lindinger,Peter %A Tinsel,Iris %A Sehlbrede,Matthias %A Fichtner,Urs Alexander %A Metzner,Gloria %A Schlett,Christian %A Farin-Glattacker,Erik %+ Institute of Medical Biometry and Statistics, Section of Health Care Research and Rehabilitation Research, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Straße 49, Freiburg, 79106, Germany, 49 761 270 72461, martina.bischoff@uniklinik-freiburg.de %K eHealth %K internet-based %K smoking cessation %K interactivity %K tailoring %K use intensity %K randomized controlled trial %K mobile phone %D 2023 %7 21.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth approaches show promising results for smoking cessation (SC). They can improve quit rates, but rigorous research is sparse regarding their effectiveness and the effects of their interactivity, tailoring, and use intensity. Objective: We examined the effectiveness of Techniker Krankenkasse Smoking Cessation Coaching (TK-SCC), an internet-based, tailored, and interactive SC intervention. Our hypotheses were as follows: hypothesis 1, in the intervention group (IG; access to TK-SCC), a clinically relevant number of participants will be abstinent at the 12-month follow-up (T3); hypothesis 2, the number of abstinent participants will be significantly greater in the IG than the control group (CG) at T3; and hypothesis 3, in the IG, more intense use of TK-SCC will be positively associated with abstinence. Methods: Individuals who smoke were randomized into the IG (563/1115, 50.49%) or CG (552/1115, 49.51%), which received a noninteractive, nontailored, and information-only web-based intervention. Data were collected before the intervention, at the postintervention time point (T1), at the 4-month follow-up (T2), and at T3. We tested hypothesis 1 through equivalence tests between the IG’s success rate and success rates of comparable effective interventions reported in 2 current meta-analyses. For hypothesis 2, we conducted binary logistic regressions. For hypothesis 3, we assigned the IG participants to 1 of 4 user types and used binary logistic regressions with user types as the independent variable and smoking abstinence as the dependent variable. Results: In the IG, 11.5% (65/563) and 11.9% (67/563) of participants were smoke free at T1 and T3, respectively. These values were statistically equivalent to the effects in the 2 meta-analyses, which reported 9% (z score=0.64, P=.74) and 10.9% (z score=−0.71, P=.24) success rates, respectively. In the CG, 6.2% (34/552) of the participants were smoke free at T1, which increased up to 8.2% (45/552) at T3. The difference between the IG and CG was statistically significant only at T1 (odds ratio [OR] 2.0, 99% CI 1.1 to 3.6; P=.002), whereas the effect was nonsignificant following α error corrections at T3 (OR 1.6, 99% CI 0.9 to 2.7; P=.02). In the IG, constant users of the program became smoke free significantly more often than rare users of the program (T1: OR 15.0, 99% CI 6.1 to 36.9; P<.001; T3: OR 6.5, 99% CI 2.8 to 15.5; P<.001). Conclusions: TK-SCC is effective for SC. However, its superiority compared with a minimal SC intervention could not be confirmed in the long term. Insufficient implementation of the techniques used and cotreatment bias could explain this outcome. Higher use intensity of TK-SCC was positively related to abstinence. Therefore, additional efforts to motivate users to adhere to intervention use as intended could improve the intervention’s effectiveness. Trial Registration: German Clinical Trials Register DRKS00020249, Universal Trial Number U1111-1245-0273; https://drks.de/search/de/trial/DRKS00020249 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-021-05470-8 %M 37988144 %R 10.2196/47463 %U https://www.jmir.org/2023/1/e47463 %U https://doi.org/10.2196/47463 %U http://www.ncbi.nlm.nih.gov/pubmed/37988144 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e48896 %T Use of e-Cigarettes in Cigarette Smoking Cessation: Secondary Analysis of a Randomized Controlled Trial %A Santiago-Torres,Margarita %A Mull,Kristin E %A Sullivan,Brianna M %A Bricker,Jonathan B %+ Fred Hutchinson Cancer Center, 1100 Fairview Avenue North, Seattle, WA, 98109, United States, 1 2066674780, msantiag@fredhutch.org %K acceptance and commitment therapy %K cigarette smoking %K digital behavioral interventions %K e-cigarettes %K smoking cessation %K smartphone apps %K vaping %K mobile phone %D 2023 %7 9.11.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many adults use e-cigarettes to help them quit cigarette smoking. However, the impact of self-selected use of e-cigarettes on cigarette smoking cessation, particularly when concurrently receiving app-based behavioral interventions, remains unexplored. Objective: This study used data from a randomized trial of 2 smartphone apps to compare 12-month cigarette smoking cessation rates between participants who used e-cigarettes on their own (ie, adopters: n=465) versus those who did not (ie, nonadopters: n=1097). Methods: The study population included all participants who did not use e-cigarettes at baseline. “Adopters” were those who self-reported the use of e-cigarettes at either 3- or 6-month follow-ups. “Nonadopters” were those who self-reported no use of e-cigarettes at either follow-up time point. The primary cessation outcome was self-reported, complete-case, 30-day point prevalence abstinence from cigarette smoking at 12 months. Secondary outcomes were missing-as-smoking and multiple imputation analyses of the primary outcome, prolonged abstinence, and cessation of all nicotine and tobacco products at 12 months. In logistic regression models, we first examined the potential interaction between e-cigarette use and treatment arm (iCanQuit vs QuitGuide) on the primary cessation outcome. Subsequently, we compared 12-month cigarette smoking cessation rates between adopters and nonadopters separately for each app. Results: There was suggestive evidence for an interaction between e-cigarette use and treatment arm on cessation (P=.05). In the iCanQuit arm, 12-month cigarette smoking cessation rates were significantly lower among e-cigarette adopters compared with nonadopters (41/193, 21.2% vs 184/527, 34.9%; P=.003; odds ratio 0.55, 95% CI 0.37-0.81). In contrast, in the QuitGuide arm, 12-month cigarette smoking cessation rates did not differ between adopters and nonadopters (46/246, 18.7% vs 104/522, 19.9%; P=.64; odds ratio 0.91, 95% CI 0.62-1.35). Conclusions: The use of e-cigarettes while concurrently receiving an app-based smoking cessation intervention was associated with either a lower or an unimproved likelihood of quitting cigarette smoking compared to no use. Future behavioral treatments for cigarette smoking cessation should consider including information on the potential consequences of e-cigarette use. Trial Registration: ClinicalTrials.gov NCT02724462; https://clinicaltrials.gov/study/NCT02724462 %M 37943594 %R 10.2196/48896 %U https://mhealth.jmir.org/2023/1/e48896 %U https://doi.org/10.2196/48896 %U http://www.ncbi.nlm.nih.gov/pubmed/37943594 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49809 %T Behavioral Activation–Based Digital Smoking Cessation Intervention for Individuals With Depressive Symptoms: Randomized Clinical Trial %A Dahne,Jennifer %A Wahlquist,Amy E %A Kustanowitz,Jacob %A Natale,Noelle %A Fahey,Margaret %A Graboyes,Evan M %A Diaz,Vanessa A %A Carpenter,Matthew J %+ Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 86 Jonathan Lucas Street, MSC 955, Charleston, SC, 29425, United States, 1 8438762280, dahne@musc.edu %K smoking cessation %K depression %K digital health %K decentralized trial %K mental health %K depressive %K RCT %K randomized %K controlled trial %K smoking %K smoke %K smoker %K quit %K quitting %K cessation %K digital health %K eHealth %K e-health %K NRT %K nicotine %K mobile health %K mHealth %K app %K apps %K application %K applications %D 2023 %7 1.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is common among adults who smoke cigarettes. Existing depression-specific cessation interventions have limited reach and are unlikely to improve smoking prevalence rates among this large subgroup of smokers. Objective: This study aimed to determine whether a mobile app–based intervention tailored for depression paired with a mailed sample of nicotine replacement therapy (NRT) is efficacious for treating depression and promoting smoking cessation. Methods: A 2-arm nationwide remote randomized clinical trial was conducted in the United States. Adults (N=150) with elevated depressive symptoms (Patient Health Questionnaire-8≥10) who smoked were enrolled. The mobile app (“Goal2Quit”) provided behavioral strategies for treating depression and quitting smoking based on Behavioral Activation Treatment for Depression. Goal2Quit participants also received a 2-week sample of combination NRT. Treatment as usual participants received a self-help booklet for quitting smoking that was not tailored for depression. Primary end points included Goal2Quit usability, change in depression (Beck Depression Inventory-II) across 12 weeks, and smoking cessation including reduction in cigarettes per day, incidence of 24-hour quit attempts, floating abstinence, and 7-day point prevalence abstinence (PPA). Results: In total, 150 participants were enrolled between June 25, 2020, and February 23, 2022, of which 80 were female (53.3%) and the mean age was 38.4 (SD 10.3) years. At baseline, participants on average reported moderate depressive symptoms and smoked a mean of 14.7 (SD 7.5) cigarettes per day. Goal2Quit usability was strong with a mean usability rating on the System Usability Scale of 78.5 (SD 16.9), with 70% scoring above the ≥68 cutoff for above-average usability. Retention data for app use were generally strong immediately following trial enrollment and declined in subsequent weeks. Those who received Goal2Quit and the NRT sample reported lower mean depressive symptoms over the trial duration as compared to treatment as usual (difference of mean 3.72, SE 1.37 points less; P=.01). Across time points, all cessation outcomes favored Goal2Quit. Regarding abstinence, Goal2Quit participants reported significantly higher rates of 7-day PPA at weeks 4 (11% vs 0%; P=.02), 8 (7-day PPA: 12% vs 0%; P=.02), and 12 (16% vs 2%; P=.02). Conclusions: A mobile app intervention tailored for depression paired with a sample of NRT was effective for depression treatment and smoking cessation. Findings support the utility of this intervention approach for addressing the currently unmet public health treatment need for tailored, scalable depression-specific cessation treatments. Trial Registration: ClinicalTrials.gov NCT03837379; https://clinicaltrials.gov/ct2/show/NCT03837379 %M 37910157 %R 10.2196/49809 %U https://www.jmir.org/2023/1/e49809 %U https://doi.org/10.2196/49809 %U http://www.ncbi.nlm.nih.gov/pubmed/37910157 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48857 %T Varenicline Combined With Oral Nicotine Replacement Therapy and Smartphone-Based Medication Reminders for Smoking Cessation: Feasibility Randomized Controlled Trial %A Sifat,Munjireen %A Hébert,Emily T %A Ahluwalia,Jasjit S %A Businelle,Michael S %A Waring,Joseph J C %A Frank-Pearce,Summer G %A Bryer,Chase %A Benson,Lizbeth %A Madison,Stefani %A Planas,Lourdes G %A Baranskaya,Irina %A Kendzor,Darla E %+ Tobacco Settlement Endowment Trust Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 215 955 8874, mys519@jefferson.edu %K mHealth %K smartphone-based medication reminders %K varenicline combined with oral nicotine replacement therapy %K smoking cessation %K medication adherence %K smoking %K smoker %K smoke %K cessation %K quit %K quitting %K nicotine %K nicotine replacement therapy %K NRT %K randomized %K controlled trial %K mobile phone %D 2023 %7 27.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Varenicline and oral nicotine replacement therapy (NRT) have each been shown to increase the likelihood of smoking cessation, but their combination has not been studied. In addition, smoking cessation medication adherence is often poor, thus, challenging the ability to evaluate medication efficacy. Objective: This study examined the effects of combined varenicline and oral NRT and smartphone medication reminders on pharmacotherapy adherence and smoking abstinence among adults enrolled in smoking cessation treatment. Methods: A 2×2 factorial design was used. Participants (N=34) were randomized to (1) varenicline + oral NRT (VAR+NRT) or varenicline alone (VAR) and (2) smartphone medication reminder messages (REM) or no reminder messages (NREM) over 13 weeks. Participants assigned to VAR+REM received varenicline reminder prompts, and those assigned to VAR+NRT+REM also received reminders to use oral NRT. The other 2 groups (VAR+NREM and VAR+NRT+NREM) did not receive medication reminders. Participants were not blinded to intervention groups. All participants received tobacco cessation counseling. Smartphone assessments of smoking as well as varenicline and NRT use (if applicable) were prompted daily through the first 12 weeks after a scheduled quit date. Descriptive statistics were generated to characterize the relations between medication and reminder group assignments with daily smoking, daily varenicline adherence, and daily quantity of oral NRT used. Participants completed follow-up assessments for 26 weeks after the quit date. Results: Participants were predominantly White (71%), and half were female (50%). On average, participants were 54.2 (SD 9.4) years of age, they smoked an average of 19.0 (SD 9.0) cigarettes per day and had smoked for 34.6 (SD 12.7) years. Descriptively, participants assigned to VAR+NRT reported more days of smoking abstinence compared to VAR (29.3 vs 26.3 days). Participants assigned to REM reported more days of smoking abstinence than those assigned to NREM (40.5 vs 21.8 days). Participants assigned to REM were adherent to varenicline on more days compared to those assigned to NREM (58.6 vs 40.5 days), and participants assigned to VAR were adherent to varenicline on more days than those assigned to VAR + NRT (50.7 vs 43.3 days). In the subsample of participants assigned to VAR+NRT, participants assigned to REM reported more days where ≥5 pieces of NRT were used than NREM (14.0 vs 7.4 days). Average overall medication adherence (assessed via the Medication Adherence Questionnaire) showed the same pattern as the daily smartphone-based adherence assessments. Conclusions: Preliminary findings indicated that smoking cessation interventions may benefit from incorporating medication reminders and combining varenicline with oral NRT, though combining medications may be associated with poorer adherence. Further study is warranted. Trial Registration: ClinicalTrials.gov NCT03722966; https://classic.clinicaltrials.gov/ct2/show/NCT03722966 %M 37889541 %R 10.2196/48857 %U https://formative.jmir.org/2023/1/e48857 %U https://doi.org/10.2196/48857 %U http://www.ncbi.nlm.nih.gov/pubmed/37889541 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e46243 %T Social Presence, Negative Emotions, and Self-Protective Behavioral Intentions of Nonsmokers in Response to Secondhand Smoking in Virtual Reality: Quasi-Experimental Design %A Liu,Miao %A Zhu,Yicheng %A Xu,Zihan %A Meng,Sitong %+ School of Journalism and Communication, Beijing Normal University, 19 Xinjiekou Outer St. Beijing Normal University, Haidian Dist., Beijing, 100875, China, 86 13436952270, yichengresearch@gmail.com %K virtual reality %K VR %K social presence %K emotions %K secondhand smoking %D 2023 %7 25.10.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: The application of virtual reality (VR) in health care has grown rapidly in China, where approximately half of the population is directly exposed to secondhand smoke (SHS). As VR headsets have become increasingly popular and short video platforms have incorporated 360° videos in China, new formats and opportunities for health campaigns about SHS have emerged. Objective: In a simulated environment of exposure to SHS, this study aims to explore the emotional and behavioral responses to enhanced social presence brought about by VR in contrast to flat-screen videos. It also aims to examine whether and to what extent video modality (360° video vs flat-screen video) and contextual cues (high threat vs low threat) influence psychometric and intentional variables among viewers. Methods: A total of 245 undergraduate and graduate students who were nonsmokers and from a large university in China participated in this study between October 2020 and January 2021. This study created 4 different versions of a SHS experience in a café with a 2 (360° video on a head-mounted display vs flat-screen display) × 2 (high threat vs low threat) experimental design. It developed and tested a path model examining the effects of experience modality and threat levels on social presence, emotions (anger and disgust), and eventually behavioral intentions (staying away and asking for help). Results: We found that both video modality (P<.001) and threat level (P=.005) significantly influenced social presence, whereas the interaction of video modality and threat level did not have a statistically significant effect on social presence (P=.55). Negative emotions mediated the relationships between social presence and SHS-related self-protective behaviors. Specifically, anger positively predicted the intention to ask smokers to stop smoking through the waitress (P<.001). Disgust and fear both positively predicted the intention to stay away from the SHS environment (P<.001 for disgust; P=.002 for fear). Conclusions: This study explored the potential mediating mechanisms that influence individuals’ responses to the risks of SHS in public areas. The results demonstrated that social presence and negative emotions are 2 important mediators that underlie the relationship between video modality and behavioral intention regarding SHS in a VR setting. These findings suggest that an immersive environment could be a better stimulator of anti-SHS emotions and behaviors than flat-screen videos. %M 37878358 %R 10.2196/46243 %U https://games.jmir.org/2023/1/e46243 %U https://doi.org/10.2196/46243 %U http://www.ncbi.nlm.nih.gov/pubmed/37878358 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49558 %T Pilot Testing of an mHealth App for Tobacco Cessation in People Living With HIV: Protocol for a Pilot Randomized Controlled Trial %A Brin,Maeve %A Trujillo,Paul %A Jia,Haomiao %A Cioe,Patricia %A Huang,Ming-Chun %A Chen,Huan %A Qian,Xiaoye %A Xu,Wenyao %A Schnall,Rebecca %+ Columbia University School of Nursing, 560 W 168th St, New York City, NY, 10032, United States, 1 212 342 6886, rb897@cumc.columbia.edu %K addict %K addiction %K app %K application %K applications %K apps %K cessation %K cigar %K cigarette %K cigarettes %K HIV %K mHealth %K mobile health %K quit %K quitting %K randomized controlled trial %K RCT %K smartwatch %K smoker %K smoking cessation %K smoking %K tobacco %D 2023 %7 19.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: An estimated 40% of people living with HIV smoke cigarettes. Although smoking rates in the United States have been declining in recent years, people living with HIV continue to smoke cigarettes at twice the rate of the general population. Mobile health (mHealth) technology is an effective tool for people living with a chronic illness, such as HIV, as currently 84% of households in the United States report that they have a smartphone. Although many studies have used mHealth interventions for smoking cessation, few studies have recruited people living with HIV who smoke. Objective: The objective of the pilot randomized controlled trial (RCT) is to examine the feasibility, acceptability, and preliminary efficacy of the Sense2Quit App as a tool for people living with HIV who are motivated to quit smoking. Methods: The Sense2Quit study is a 2-arm RCT for people living with HIV who smoke cigarettes (n=60). Participants are randomized to either the active intervention condition, which consists of an 8-week supply of nicotine replacement therapy, standard smoking cessation counseling, and access to the Sense2Quit mobile app and smartwatch, or the control condition, which consists of standard smoking cessation counseling and a referral to the New York State Smokers’ Quitline. The Sense2Quit app is a mobile app connected through Bluetooth to a smartwatch that tracks smoking gestures and distinguishes them from other everyday hand movements. In the Sense2Quit app, participants can view their smoking trends, which are recorded through their use of the smartwatch, including how often or how much they smoke and the amount of money that they are spending on cigarettes, watch videos with quitting tips, information, and distractions, play games, set reminders, and communicate with a study team member. Results: Enrollment of study participants began in March 2023 and is expected to end in October 2023. All data collection is expected to be completed by the end of January 2024. This RCT will test the difference in outcomes between the control and intervention arms. The primary outcome will be the percentage of participants with biochemically verified 7-day point prevalence smoking or tobacco abstinence at their 12-week follow-up. Results from this pilot study will be disseminated to the research community following the completion of all data collection. Conclusions: The Sense2Quit study leverages mHealth so that it can help smokers improve their efforts at smoking cessation. Our research has the potential to not only increase quitting rates among people living with HIV who may need a prolonged, tailored intervention but also inform further development of mHealth for people living with HIV. This mHealth study will contribute significant findings to the greater mHealth research community, providing evidence as to how mHealth should be developed and tested among the target population. Trial Registration: ClinicalTrials.gov NCT05609032; https://clinicaltrials.gov/study/NCT05609032 International Registered Report Identifier (IRRID): DERR1-10.2196/49558 %M 37856173 %R 10.2196/49558 %U https://www.researchprotocols.org/2023/1/e49558 %U https://doi.org/10.2196/49558 %U http://www.ncbi.nlm.nih.gov/pubmed/37856173 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e49132 %T A Motivational Interviewing Chatbot With Generative Reflections for Increasing Readiness to Quit Smoking: Iterative Development Study %A Brown,Andrew %A Kumar,Ash Tanuj %A Melamed,Osnat %A Ahmed,Imtihan %A Wang,Yu Hao %A Deza,Arnaud %A Morcos,Marc %A Zhu,Leon %A Maslej,Marta %A Minian,Nadia %A Sujaya,Vidya %A Wolff,Jodi %A Doggett,Olivia %A Iantorno,Mathew %A Ratto,Matt %A Selby,Peter %A Rose,Jonathan %+ The Edward S Rogers Sr Department of Electrical & Computer Engineering, University of Toronto, 10 King's College Rd, Toronto, ON, M5S 3G4, Canada, 1 416 978 6992, jonathan.rose@ece.utoronto.ca %K conversational agents %K chatbots %K behavior change %K smoking cessation %K motivational interviewing %K deep learning %K natural language processing %K transformers %K generative artificial intelligence %K artificial intelligence %K AI %D 2023 %7 17.10.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The motivational interviewing (MI) approach has been shown to help move ambivalent smokers toward the decision to quit smoking. There have been several attempts to broaden access to MI through text-based chatbots. These typically use scripted responses to client statements, but such nonspecific responses have been shown to reduce effectiveness. Recent advances in natural language processing provide a new way to create responses that are specific to a client’s statements, using a generative language model. Objective: This study aimed to design, evolve, and measure the effectiveness of a chatbot system that can guide ambivalent people who smoke toward the decision to quit smoking with MI-style generative reflections. Methods: Over time, 4 different MI chatbot versions were evolved, and each version was tested with a separate group of ambivalent smokers. A total of 349 smokers were recruited through a web-based recruitment platform. The first chatbot version only asked questions without reflections on the answers. The second version asked the questions and provided reflections with an initial version of the reflection generator. The third version used an improved reflection generator, and the fourth version added extended interaction on some of the questions. Participants’ readiness to quit was measured before the conversation and 1 week later using an 11-point scale that measured 3 attributes related to smoking cessation: readiness, confidence, and importance. The number of quit attempts made in the week before the conversation and the week after was surveyed; in addition, participants rated the perceived empathy of the chatbot. The main body of the conversation consists of 5 scripted questions, responses from participants, and (for 3 of the 4 versions) generated reflections. A pretrained transformer-based neural network was fine-tuned on examples of high-quality reflections to generate MI reflections. Results: The increase in average confidence using the nongenerative version was 1.0 (SD 2.0; P=.001), whereas for the 3 generative versions, the increases ranged from 1.2 to 1.3 (SD 2.0-2.3; P<.001). The extended conversation with improved generative reflections was the only version associated with a significant increase in average importance (0.7, SD 2.0; P<.001) and readiness (0.4, SD 1.7; P=.01). The enhanced reflection and extended conversations exhibited significantly better perceived empathy than the nongenerative conversation (P=.02 and P=.004, respectively). The number of quit attempts did not significantly change between the week before the conversation and the week after across all 4 conversations. Conclusions: The results suggest that generative reflections increase the impact of a conversation on readiness to quit smoking 1 week later, although a significant portion of the impact seen so far can be achieved by only asking questions without the reflections. These results support further evolution of the chatbot conversation and can serve as a basis for comparison against more advanced versions. %M 37847539 %R 10.2196/49132 %U https://mental.jmir.org/2023/1/e49132 %U https://doi.org/10.2196/49132 %U http://www.ncbi.nlm.nih.gov/pubmed/37847539 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49668 %T Mobile Phone Text Messages to Support People to Stop Smoking by Switching to Vaping: Codevelopment, Coproduction, and Initial Testing Study %A Sideropoulos,Vassilis %A Vangeli,Eleni %A Naughton,Felix %A Cox,Sharon %A Frings,Daniel %A Notley,Caitlin %A Brown,Jamie %A Kimber,Catherine %A Dawkins,Lynne %+ Department of Psychology & Human Development, IOE, UCL’s Faculty of Education and Society, University College London, 20 Bedford Way, London, WC1H 0AL, United Kingdom, 44 02035495417, v.sideropoulos@ucl.ac.uk %K coproduction %K SMS text messages %K e-cigarette %K smoking %K eHealth %K vaping %K mobile phone %K codevelopment %K text message %D 2023 %7 27.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: SMS text messages are affordable, scalable, and effective smoking cessation interventions. However, there is little research on SMS text message interventions specifically designed to support people who smoke to quit by switching to vaping. Objective: Over 3 phases, with vapers and smokers, we codeveloped and coproduced a mobile phone SMS text message program. The coproduction paradigm allowed us to collaborate with researchers and the community to develop a more relevant, acceptable, and equitable SMS text message program. Methods: In phase 1, we engaged people who vape via Twitter and received 167 responses to our request to write SMS text messages for people who wish to quit smoking by switching to vaping. We screened, adjusted, refined, and themed the messages, resulting in a set of 95 that were mapped against the Capability, Opportunity, and Motivation–Behavior constructs. In phase 2, we evaluated the 95 messages from phase 1 via a web survey where participants (66/202, 32.7% woman) rated up to 20 messages on 7-point Likert scales on 9 constructs: being understandable, clear, believable, helpful, interesting, inoffensive, positive, and enthusiastic and how happy they would be to receive the messages. In phase 3, we implemented the final set of SMS text messages as part of a larger randomized optimization trial, in which 603 participants (mean age 38.33, SD 12.88 years; n=369, 61.2% woman) received SMS text message support and then rated their usefulness and frequency and provided free-text comments at the 12-week follow-up. Results: For phase 2, means and SDs were calculated for each message across the 9 constructs. Those with means below the neutral anchor of 4 or with unfavorable comments were discussed with vapers and further refined or removed. This resulted in a final set of 78 that were mapped against early, mid-, or late stages of quitting to create an order for the messages. For phase 3, a total of 38.5% (232/603) of the participants provided ratings at the 12-week follow-up. In total, 69.8% (162/232) reported that the SMS text messages had been useful, and a significant association between quit rates and usefulness ratings was found (χ21=9.6; P=.002). A content analysis of free-text comments revealed that the 2 most common positive themes were helpful (13/47, 28%) and encouraging (6/47, 13%) and the 2 most common negative themes were too frequent (9/47, 19%) and annoying (4/47, 9%). Conclusions: In this paper, we describe the initial coproduction and codevelopment of a set of SMS text messages to help smokers stop smoking by transitioning to vaping. We encourage researchers to use, further develop, and evaluate the set of SMS text messages and adapt it to target populations and relevant contexts. %M 37756034 %R 10.2196/49668 %U https://formative.jmir.org/2023/1/e49668 %U https://doi.org/10.2196/49668 %U http://www.ncbi.nlm.nih.gov/pubmed/37756034 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e48157 %T Long-Term Outcomes of a Comprehensive Mobile Smoking Cessation Program With Nicotine Replacement Therapy in Adult Smokers: Pilot Randomized Controlled Trial %A Marler,Jennifer D %A Fujii,Craig A %A Utley,MacKenzie T %A Balbierz,Daniel J %A Galanko,Joseph A %A Utley,David S %+ Pivot Health Technologies, Inc, 1010 Commercial St., Suite C, San Carlos, CA, 94070, United States, 1 4082145545, marler@pivot.co %K smoking cessation %K digital health %K smartphone %K digital sensor %K carbon monoxide %K breath sensor %K biofeedback %K mobile apps %K health promotion %K app %K mobile phone %D 2023 %7 18.9.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Increased smartphone ownership has led to the development of mobile smoking cessation programs. Although the related body of evidence, gathered through the conduct of randomized controlled trials (RCTs), has grown in quality and rigor, there is a need for longer-term data to assess associated smoking cessation durability. Objective: The primary aim was to compare smoking cessation outcomes at 52 weeks in adult smokers randomized to a mobile smoking cessation program, Pivot (intervention), versus QuitGuide (control). The secondary aims included comparison of other smoking-related behaviors, outcomes and participant feedback, and exploratory analyses of baseline factors associated with smoking cessation. Methods: In this remote pilot RCT, cigarette smokers in the United States were recruited on the web. Participants were offered 12 weeks of free nicotine replacement therapy (NRT). Data were self-reported via a web-based questionnaire with videoconference biovalidation in participants who reported 7-day point-prevalence abstinence (PPA). Outcomes focused on cessation rates with additional assessment of quit attempts, cigarettes per day (CPD), self-efficacy via the Smoking Abstinence Self-Efficacy Questionnaire, NRT use, and participant feedback. Cessation outcomes included self-reported 7- and 30-day PPA, abstinence from all tobacco products, and continuous abstinence. PPA and continuous abstinence were biovalidated using witnessed breath carbon monoxide samples. Exploratory post hoc regression analyses were performed to identify baseline variables associated with smoking cessation. Results: Participants comprised 188 smokers (n=94, 50% in the Pivot group and n=94, 50% in the QuitGuide group; mean age 46.4, SD 9.2 years; n=104, 55.3% women; n=128, 68.1% White individuals; mean CPD 17.6, SD 9.0). Several cessation rates were higher in the Pivot group (intention to treat): self-reported continuous abstinence was 20% (19/94) versus 9% (8/94; P=.03) for QuitGuide, biochemically confirmed abstinence was 31% (29/94) versus 18% (17/94; P=.04) for QuitGuide, and biochemically confirmed continuous abstinence was 19% (18/94) versus 9% (8/94; P=.046) for QuitGuide. More Pivot participants (93/94, 99% vs 80/94, 85% in the QuitGuide group; P<.001) placed NRT orders (mean 3.3, SD 2.0 vs 1.8, SD 1.6 for QuitGuide; P<.001). Pivot participants had increased self-efficacy via the Smoking Abstinence Self-Efficacy Questionnaire (mean point increase 3.2, SD 7.8, P<.001 vs 1.0, SD 8.5, P=.26 for QuitGuide). QuitGuide participants made more mean quit attempts (7.0, SD 6.3 for Pivot vs 9.5, SD 7.5 for QuitGuide; P=.01). Among those who did not achieve abstinence, QuitGuide participants reported greater CPD reduction (mean −34.6%, SD 35.5% for Pivot vs −46.1%, SD 32.3% for QuitGuide; P=.04). Among those who reported abstinence, 90% (35/39) of Pivot participants and 90% (26/29) of QuitGuide participants indicated that their cessation program helped them quit. Conclusions: This pilot RCT supports the long-term effectiveness of the Pivot mobile smoking cessation program, with abstinence rates durable to 52 weeks. Trial Registration: ClinicalTrials.gov NCT04955639; https://clinicaltrials.gov/ct2/show/NCT04955639 %M 37585282 %R 10.2196/48157 %U https://mhealth.jmir.org/2023/1/e48157 %U https://doi.org/10.2196/48157 %U http://www.ncbi.nlm.nih.gov/pubmed/37585282 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46153 %T Young Adults’ Perceptions of and Intentions to Use Nicotine and Cannabis Vaporizers in Response to e-Cigarette or Vaping-Associated Lung Injury Instagram Posts: Experimental Study %A Llanes,Karla D %A Ling,Pamela M %A Guillory,Jamie %A Vogel,Erin A %+ TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 (405) 271 8001 ext 50493, erin-vogel@ouhsc.edu %K EVALI %K risk perception, nicotine %K cannabis %K e-cigarettes %K young adult %K vaping %K social media %K Instagram %K harmful effect %D 2023 %7 14.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Inhaling aerosolized nicotine and cannabis (colloquially called “vaping”) is prevalent among young adults. Instagram influencers often promote both nicotine and cannabis vaporizer products. However, Instagram posts discouraging the use of both products received national media attention during the 2019 outbreak of e-cigarette or vaping-associated lung injury (EVALI). Objective: This experiment tested the impact of viewing Instagram posts about EVALI, varying in image and text valence, on young adults’ perceived harmfulness of nicotine and cannabis products, perceived risk of nicotine and cannabis vaporizer use, and intentions to use nicotine and cannabis vaporizers in the future. Methods: Participants (N=1229) aged 18-25 (mean 21.40, SD 2.22) years were recruited through Qualtrics Research Services, oversampling for ever-use of nicotine or cannabis vaporizers (618/1229, 50.3%). Participants were randomly assigned to view Instagram posts from young people portraying their experiences of EVALI in a 2 (image valence: positive or negative) × 2 (text valence: positive or negative) between-subjects experiment. Positive images were attractive and aesthetically pleasing selfies. The positive text was supportive and uplifting regarding quitting the use of vaporized products. Negative images and text were graphic and fear inducing. After viewing 3 posts, participants reported the perceived harmfulness of nicotine and cannabis products, the perceived risk of nicotine and cannabis vaporizer use, and intentions to use nicotine and cannabis vaporizers in the future. Ordinal logistic regression models assessed the main effects and interactions of image and text valence on perceived harmfulness and risk. Binary logistic regression models assessed the main effects and interactions of image and text valence on intentions to use nicotine and cannabis vaporizers. Analyses were adjusted for product use history. Results: Compared to viewing positive images, viewing negative images resulted in significantly greater perceived harm of nicotine (P=.02 for disposable pod-based vaporizers and P=.04 for other e-cigarette “mods” devices) and cannabis vaporized products (P=.01), greater perceived risk of nicotine vaporizers (P<.01), and lower odds of intentions to use nicotine (P=.02) but not cannabis (P=.43) vaporizers in the future. There were no significant main effects of text valence on perceived harm, perceived risk, and intentions to use nicotine and cannabis vaporized products. No significant interaction effects of image and text valence were found. Conclusions: Negative imagery in Instagram posts about EVALI may convey the risks of vaporized product use and discourage young adults from this behavior, regardless of the valence of the post’s text. Public health messaging regarding EVALI on Instagram should emphasize the risk of cannabis vaporizer use, as young adults may otherwise believe that only nicotine vaporizer use increases their risk for EVALI. %M 37552552 %R 10.2196/46153 %U https://www.jmir.org/2023/1/e46153 %U https://doi.org/10.2196/46153 %U http://www.ncbi.nlm.nih.gov/pubmed/37552552 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50346 %T Twitter Sentiment About the US Federal Tobacco 21 Law: Mixed Methods Analysis %A Dobbs,Page D %A Boykin,Allison Ames %A Ezike,Nnamdi %A Myers,Aaron J %A Colditz,Jason B %A Primack,Brian A %+ Health, Human Performance and Recreation Department, University of Arkansas, 346 West Ave., Suite 317, Fayetteville, AR, 72701, United States, 1 479 575 2858, pdobbs@uark.edu %K social media %K Twitter %K Tobacco 21 %K mixed methods %K tobacco policy %K sentiment %K tweet %K tweets %K tobacco %K smoke %K smoking %K smoker %K policy %K policies %K law %K regulation %K regulations %K laws %K attitude %K attitudes %K opinion %K opinions %D 2023 %7 31.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: On December 20, 2019, the US “Tobacco 21” law raised the minimum legal sales age of tobacco products to 21 years. Initial research suggests that misinformation about Tobacco 21 circulated via news sources on Twitter and that sentiment about the law was associated with particular types of tobacco products and included discussions about other age-related behaviors. However, underlying themes about this sentiment as well as temporal trends leading up to enactment of the law have not been explored. Objective: This study sought to examine (1) sentiment (pro-, anti-, and neutral policy) about Tobacco 21 on Twitter and (2) volume patterns (number of tweets) of Twitter discussions leading up to the enactment of the federal law. Methods: We collected tweets related to Tobacco 21 posted between September 4, 2019, and December 31, 2019. A 2% subsample of tweets (4628/231,447) was annotated by 2 experienced, trained coders for policy-related information and sentiment. To do this, a codebook was developed using an inductive procedure that outlined the operational definitions and examples for the human coders to annotate sentiment (pro-, anti-, and neutral policy). Following the annotation of the data, the researchers used a thematic analysis to determine emergent themes per sentiment category. The data were then annotated again to capture frequencies of emergent themes. Concurrently, we examined trends in the volume of Tobacco 21–related tweets (weekly rhythms and total number of tweets over the time data were collected) and analyzed the qualitative discussions occurring at those peak times. Results: The most prevalent category of tweets related to Tobacco 21 was neutral policy (514/1113, 46.2%), followed by antipolicy (432/1113, 38.8%); 167 of 1113 (15%) were propolicy or supportive of the law. Key themes identified among neutral tweets were news reports and discussion of political figures, parties, or government involvement in general. Most discussions were generated from news sources and surfaced in the final days before enactment. Tweets opposing Tobacco 21 mentioned that the law was unfair to young audiences who were addicted to nicotine and were skeptical of the law’s efficacy and importance. Methods used to evade the law were found to be represented in both neutral and antipolicy tweets. Propolicy tweets focused on the protection of youth and described the law as a sensible regulatory approach rather than a complete ban of all products or flavored products. Four spikes in daily volume were noted, 2 of which corresponded with political speeches and 2 with the preparation and passage of the legislation. Conclusions: Understanding themes of public sentiment—as well as when Twitter activity is most active—will help public health professionals to optimize health promotion activities to increase community readiness and respond to enforcement needs including education for retailers and the general public. %M 37651169 %R 10.2196/50346 %U https://formative.jmir.org/2023/1/e50346 %U https://doi.org/10.2196/50346 %U http://www.ncbi.nlm.nih.gov/pubmed/37651169 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45223 %T Use of the Smoking Cessation App Ex-Smokers iCoach and Associations With Smoking-Related Outcomes Over Time in a Large Sample of European Smokers: Retrospective Observational Study %A Mansour,Marthe BL %A Busschers,Wim B %A Crone,Mathilde R %A van Asselt,Kristel M %A van Weert,Henk C %A Chavannes,Niels H %A Meijer,Eline %+ Department of General Practice, Academic Medical Centre Amsterdam, Amsterdam University Medical Centres, Meibergdreef 15, Amsterdam, 1105 AZ, Netherlands, 31 654273668, m.b.mansour@amsterdamumc.nl %K smoking cessation app %K digital smoking cessation intervention %K user groups %K trajectories of use patterns %K engagement %K smoking-related outcomes %K smoker characteristics %K European smokers %K mobile phone %D 2023 %7 22.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital interventions are increasingly used to support smoking cessation. Ex-smokers iCoach was a widely available app for smoking cessation used by 404,551 European smokers between June 15, 2011, and June 21, 2013. This provides a unique opportunity to investigate the uptake of a freely available digital smoking cessation intervention and its effects on smoking-related outcomes. Objective: We aimed to investigate whether there were distinct trajectories of iCoach use, examine which baseline characteristics were associated with user groups (based on the intensity of use), and assess if and how these groups were associated with smoking-related outcomes. Methods: Analyses were performed using data from iCoach users registered between June 15, 2011, and June 21, 2013. Smoking-related data were collected at baseline and every 3 months thereafter, with a maximum of 8 follow-ups. First, group-based modeling was applied to detect distinct trajectories of app use. This was performed in a subset of steady users who had completed at least 1 follow-up measurement. Second, ordinal logistic regression was used to assess the baseline characteristics that were associated with user group membership. Finally, generalized estimating equations were used to examine the association between the user groups and smoking status, quitting stage, and self-efficacy over time. Results: Of the 311,567 iCoach users, a subset of 26,785 (8.6%) steady iCoach users were identified and categorized into 4 distinct user groups: low (n=17,422, 65.04%), mild (n=4088, 15.26%), moderate (n=4415, 16.48%), and intensive (n=860, 3.21%) users. Older users and users who found it important to quit smoking had higher odds of more intensive app use, whereas men, employed users, heavy smokers, and users with higher self-efficacy scores had lower odds of more intensive app use. User groups were significantly associated with subsequent smoking status, quitting stage, and self-efficacy over time. For all groups, over time, the probability of being a smoker decreased, whereas the probability of being in an improved quitting stage increased, as did the self-efficacy to quit smoking. For all outcomes, the greatest change was observed between baseline and the first follow-up at 3 months. In the intensive user group, the greatest change was seen between baseline and the 9-month follow-up, with the observed change declining gradually in moderate, mild, and low users. Conclusions: In the subset of steady iCoach users, more intensive app use was associated with higher smoking cessation rates, increased quitting stage, and higher self-efficacy to quit smoking over time. These users seemed to benefit most from the app in the first 3 months of use. Women and older users were more likely to use the app more intensively. Additionally, users who found quitting difficult used the iCoach app more intensively and grew more confident in their ability to quit over time. %M 37606969 %R 10.2196/45223 %U https://www.jmir.org/2023/1/e45223 %U https://doi.org/10.2196/45223 %U http://www.ncbi.nlm.nih.gov/pubmed/37606969 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e46602 %T Developing a Game (Inner Dragon) Within a Leading Smartphone App for Smoking Cessation: Design and Feasibility Evaluation Study %A White,Justin S %A Salem,Marie K %A Toussaert,Séverine %A Westmaas,J Lee %A Raiff,Bethany R %A Crane,David %A Warrender,Edward %A Lyles,Courtney %A Abroms,Lorien %A Thrul,Johannes %+ Philip R Lee Institute for Health Policy Studies, University of California, 490 Illinois Street, Box 0936, San Francisco, CA, 94158, United States, 1 415 476 8045, Justin.White@ucsf.edu %K smoking cessation %K mobile app %K games for health %K gamification %K software design %K feasibility %K mobile phone %D 2023 %7 11.8.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Several stand-alone smartphone apps have used serious games to provide an engaging approach to quitting smoking. So far, the uptake of these games has been modest, and the evidence base for their efficacy in promoting smoking cessation is still evolving. The feasibility of integrating a game into a popular smoking cessation app is unclear. Objective: The aim of this paper was to describe the design and iterative development of the Inner Dragon game within Smoke Free, a smartphone app with proven efficacy, and the results of a single-arm feasibility trial as part of a broad program that seeks to assess the effectiveness of the gamified app for smoking cessation. Methods: In phase 1, the study team undertook a multistep process to design and develop the game, including web-based focus group discussions with end users (n=15). In phase 2, a single-arm study of Smoke Free users who were trying to quit (n=30) was conducted to assess the feasibility and acceptability of the integrated game and to establish the feasibility of the planned procedures for a randomized pilot trial. Results: Phase 1 led to the final design of Inner Dragon, informed by principles from psychology and behavioral economics and incorporating several game mechanics designed to increase user engagement and retention. Inner Dragon users maintain an evolving pet dragon that serves as a virtual avatar for the users’ progress in quitting. The phase-2 study established the feasibility of the study methods. The mean number of app sessions completed per user was 13.8 (SD 13.1; median 8; range 1-46), with a mean duration per session of 5.8 (median 1.1; range 0-81.1) minutes. Overall, three-fourths (18/24, 75%) of the participants entered the Inner Dragon game at least once and had a mean of 2.4 (SD 2.4) sessions of game use. The use of Inner Dragon was positively associated with the total number of app sessions (correlation 0.57). The mean satisfaction score of participants who provided ratings (11/24, 46%) was 4.2 (SD 0.6) on a 5-point scale; however, satisfaction ratings for Inner Dragon were only completed by 13% (3/24) of the participants. Conclusions: Findings supported further development and evaluation of Inner Dragon as a beneficial feature of Smoke Free. The next step of this study is to conduct a randomized pilot trial to determine whether the gamified version of the app increases user engagement over a standard version of the app. %M 37566442 %R 10.2196/46602 %U https://games.jmir.org/2023/1/e46602 %U https://doi.org/10.2196/46602 %U http://www.ncbi.nlm.nih.gov/pubmed/37566442 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47711 %T e-Cigarette Use and the Cessation of Tobacco Cigarette Smoking: Protocol for an Umbrella Review %A O'Leary,Renee %A Polosa,Riccardo %+ Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Via Santa Sofia 89, Torre Biologica 11 piano, Catania, 95123, Italy, 39 3383892673, renee.oleary@eclatrbc.it %K e-cigarettes %K electronic nicotine delivery systems %K ENDS %K umbrella review %K cessation %K systematic reviews %K A Measurement Tool to Assess Systematic Reviews, version 2 %K AMSTAR2 %K review methodology %K systematic %K cigarette %K smoking %K smoker %K quit %K meta-analysis %K meta-analyses %D 2023 %7 10.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Electronic nicotine delivery systems (ENDS), commonly called e-cigarettes, have been examined in clinical studies for their effects on tobacco smoking cessation. In the past 2 years, a dozen or more systematic reviews on ENDS and cigarette smoking cessation have been published that present differing conclusions and recommendations on the use of ENDS. Objective: Our umbrella review aims to synthesize the findings from current systematic reviews to investigate the quit rates and the percentage of participants abstinent from cigarette smoking using ENDS. Additionally, we will examine the quit rates with ENDS in comparison to other established cessation treatments. Methods: The search will retrieve systematic reviews that include both clinical trials and experimental studies on the use of ENDS for smoking cessation. We will also include nonrandomized cohort studies that track ENDS use and the subsequent abstinence from smoking. Databases searches will be conducted in Embase, Scopus, PubMed, and 7 additional registries. Secondary searches will include reference checking, citation chasing, and consultations with topic experts. Two reviewers will perform a title and abstract exclusion followed by a full-paper inclusion process. Data extraction will be conducted by 1 reviewer and completely checked by a second reviewer. Each systematic review will be assessed by 2 reviewers for methodological quality using AMSTAR2 (A Measurement Tool to Assess Systematic Reviews, version 2) and for reporting bias using categories from the Centre for Evidence-Based Medicine’s Catalogue of Bias. Unreported discrepancies between the protocol and the published review will be identified. Results: The umbrella review started on March 1, 2023. At the time of publication, the study selection was being conducted and the pilot testing of the data extraction and bias assessment forms were in progress. The review is expected to be completed by December 31, 2023, followed by the submission of the review for journal publication. A second-order meta-analysis will calculate the range and average of quit rates for ENDS. A vote counting of the direction of effect, based on quit rates, will be used to present the relative effectiveness of ENDS for smoking cessation compared to other cessation treatments (including no treatment). A citation matrix will list primary studies with their bias ratings from all the systematic reviews. The effect of overlapping studies between the systematic reviews will be calculated using the corrected coverage area analysis. A sensitivity analysis will examine the impact of the intensity of cessation treatment on quit rates. Depending on the availability of data, subgroup analyses will be conducted based on participants’ gender, age, prior quit attempts, and nicotine dependence. The strength or weakness of the evidence synthesis will be assessed using a stratification of evidence technique. Reporting bias will be presented with a tabulation of bias indicators. Publication bias will be assessed. Conclusions: The use of ENDS for smoking cessation is a highly controversial subject. Through an exhaustive synthesis of the available data, we will present the quit rates of cigarette smoking cessation obtained with ENDS and how they compare to quit rates obtained from other established cessation treatments. The critical quality and bias assessment of the systematic reviews will indicate the most reliable sources to inform treatment considerations and policy development. Trial Registration: PROSPERO CRD42023406165; https://tinyurl.com/4ekzpbrj International Registered Report Identifier (IRRID): PRR1-10.2196/47711 %M 37561572 %R 10.2196/47711 %U https://www.researchprotocols.org/2023/1/e47711 %U https://doi.org/10.2196/47711 %U http://www.ncbi.nlm.nih.gov/pubmed/37561572 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45111 %T Effectiveness of eHealth Smoking Cessation Interventions: Systematic Review and Meta-Analysis %A Fang,Yichen E %A Zhang,Zhixian %A Wang,Ray %A Yang,Bolu %A Chen,Chen %A Nisa,Claudia %A Tong,Xin %A Yan,Lijing L %+ Global Health Research Center, Duke Kunshan University, 3rd floor, Academic Building, Kunshan, 215316, China, 86 0 512 5777 9988, lijing.yan@duke.edu %K smoking cessation %K systematic review %K meta-analysis %K electronic health %K mobile health %K eHealth %K smoking %K development %K technology-assisted %K effectiveness %K screening %K data extraction %K user %K design %K mobile phone %D 2023 %7 28.7.2023 %9 Review %J J Med Internet Res %G English %X Background: Rapid advancements in eHealth and mobile health (mHealth) technologies have driven researchers to design and evaluate numerous technology-based interventions to promote smoking cessation. The evolving nature of cessation interventions emphasizes a strong need for knowledge synthesis. Objective: This systematic review and meta-analysis aimed to summarize recent evidence from randomized controlled trials regarding the effectiveness of eHealth-based smoking cessation interventions in promoting abstinence and assess nonabstinence outcome indicators, such as cigarette consumption and user satisfaction, via narrative synthesis. Methods: We searched for studies published in English between 2017 and June 30, 2022, in 4 databases: PubMed (including MEDLINE), PsycINFO, Embase, and Cochrane Library. Two independent reviewers performed study screening, data extraction, and quality assessment based on the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework. We pooled comparable studies based on the population, follow-up time, intervention, and control characteristics. Two researchers performed an independent meta-analysis on smoking abstinence using the Sidik-Jonkman random-effects model and log risk ratio (RR) as the effect measurement. For studies not included in the meta-analysis, the outcomes were narratively synthesized. Results: A total of 464 studies were identified through an initial database search after removing duplicates. Following screening and full-text assessments, we deemed 39 studies (n=37,341 participants) eligible for this review. Of these, 28 studies were shortlisted for meta-analysis. According to the meta-analysis, SMS or app text messaging can significantly increase both short-term (3 months) abstinence (log RR=0.50, 95% CI 0.25-0.75; I2=0.72%) and long-term (6 months) abstinence (log RR=0.77, 95% CI 0.49-1.04; I2=8.65%), relative to minimal cessation support. The frequency of texting did not significantly influence treatment outcomes. mHealth apps may significantly increase abstinence in the short term (log RR=0.76, 95% CI 0.09-1.42; I2=88.02%) but not in the long term (log RR=0.15, 95% CI −0.18 to 0.48; I2=80.06%), in contrast to less intensive cessation support. In addition, personalized or interactive interventions showed a moderate increase in cessation for both the short term (log RR=0.62, 95% CI 0.30-0.94; I2=66.50%) and long term (log RR=0.28, 95% CI 0.04-0.53; I2=73.42%). In contrast, studies without any personalized or interactive features had no significant impact. Finally, the treatment effect was similar between trials that used biochemically verified or self-reported abstinence. Among studies reporting outcomes besides abstinence (n=20), a total of 11 studies reported significantly improved nonabstinence outcomes in cigarette consumption (3/14, 21%) or user satisfaction (8/19, 42%). Conclusions: Our review of 39 randomized controlled trials found that recent eHealth interventions might promote smoking cessation, with mHealth being the dominant approach. Despite their success, the effectiveness of such interventions may diminish with time. The design of more personalized interventions could potentially benefit future studies. Trial Registration: PROSPERO CRD42022347104; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=347104 %M 37505802 %R 10.2196/45111 %U https://www.jmir.org/2023/1/e45111 %U https://doi.org/10.2196/45111 %U http://www.ncbi.nlm.nih.gov/pubmed/37505802 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47662 %T Monitoring Cigarette Smoking and Relapse in Young Adults With and Without Remote Biochemical Verification: Randomized Brief Cessation Study %A McClure,Erin A %A Baker,Nathaniel %A Walters,Kyle J %A Tomko,Rachel L %A Carpenter,Matthew J %A Bradley,Elizabeth %A Squeglia,Lindsay M %A Gray,Kevin M %+ Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC, 29425, United States, 1 843 792 7192, mccluree@musc.edu %K technology %K mHealth %K young adults %K cessation %K relapse %K biochemical verification %K cigarette %K smoking %K monitoring %K abstinence %K mobile phone %D 2023 %7 27.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Technological advancements to study young adult smoking, relapse, and to deliver interventions remotely offer conceptual appeal, but the incorporation of technological enhancement must demonstrate benefit over traditional methods without adversely affecting outcomes. Further, integrating remote biochemical verification of smoking and abstinence may yield value in the confirmation of self-reported smoking, in addition to ecologically valid, real-time assessments. Objective: The goal of this study was to evaluate the impact of remote biochemical verification on 24-hour self-reported smoking and biochemical verification agreement, retention, compliance with remote sessions, and abstinence during a brief, 5-week cessation attempt and relapse monitoring phase. Methods: Participants (N=39; aged 18-25 years; mean age 21.6, SD 2.1 years; n=22, 56% male; n=29, 74% White) who smoked cigarettes daily engaged in a 5-week cessation and monitoring study (including a 48-hour quit attempt and provision of tobacco treatment in the form of nicotine replacement therapy, brief cessation counseling, and financial incentives for abstinence during the 2-day quit attempt only). Smoking (cigarettes per day) was self-reported through ecological momentary assessment (EMA) procedures, and participants were randomized to either (1) the inclusion of remote biochemical verification (EMA + remote carbon monoxide [rCO]) 2× per day or (2) in-person, weekly CO (wCO). Groups were compared on the following outcomes: (1) agreement in self-reported smoking and breath carbon monoxide (CO) at common study time points, (2) EMA session compliance, (3) retention in study procedures, and (4) abstinence from smoking during the 2-day quit attempt and at the end of the 5-week study. Results: No significant differences were demonstrated between the rCO group and the wCO (weekly in-person study visit) group on agreement between 24-hour self-reported smoking and breath CO (moderate to poor), compliance with remote sessions, or retention, though these outcomes numerically favored the wCO group. Abstinence was numerically higher in the wCO group after the 2-day quit attempt and significantly different at the end of treatment (day 35), favoring the wCO group. Conclusions: Though study results should be interpreted with caution given the small sample size, findings suggest that the inclusion of rCO breath added to EMA compared to EMA with weekly, in-person CO collection in young adults did not yield benefit and may have even adversely affected outcomes. Our results suggest that technological advancements may improve data accuracy through objective measurement but may also introduce barriers and burdens and could result in higher rates of missing data. The inclusion of technology to inform smoking cessation research and intervention delivery among young adults should consider (1) the research question and necessity of biochemical verification and then (2) how to seamlessly incorporate monitoring into personalized and dynamic systems to avoid the added burden and detrimental effects to compliance and honesty in self-report. %M 37498643 %R 10.2196/47662 %U https://formative.jmir.org/2023/1/e47662 %U https://doi.org/10.2196/47662 %U http://www.ncbi.nlm.nih.gov/pubmed/37498643 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45183 %T Smartphone Apps for Smoking Cessation: Systematic Framework for App Review and Analysis %A Bold,Krysten W %A Garrison,Kathleen A %A DeLucia,Angela %A Horvath,Mark %A Nguyen,Milton %A Camacho,Erica %A Torous,John %+ Department of Psychiatry, Yale School of Medicine, 34 Park Street CMHC, New Haven, CT, 06519, United States, 1 203 974 7603, krysten.bold@yale.edu %K addict %K app review %K application %K apps %K cessation %K cigarette %K digital health %K mhealth %K mobile app %K mobile health %K quit %K review of app %K smartphone app %K smoker %K smoking cessation %K smoking %K tobacco %D 2023 %7 13.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Cigarette smoking is a leading cause of preventable death, and identifying novel treatment approaches to promote smoking cessation is critical for improving public health. With the rise of digital health and mobile apps, these tools offer potential opportunities to address smoking cessation, yet the functionality of these apps and whether they offer scientifically based support for smoking cessation are unknown. Objective: The goal of this research was to use the American Psychiatric Association app evaluation model to evaluate the top-returned apps from Android and Apple app store platforms related to smoking cessation and investigate the common app features available for end users. Methods: We conducted a search of both Android and iOS app stores in July 2021 for apps related to the keywords “smoking,” “tobacco,” “smoke,” and “cigarette” to evaluate apps for smoking cessation. Apps were screened for relevance, and trained raters identified and analyzed features, including accessibility (ie, cost), privacy, clinical foundation, and features of the apps, using a systematic framework of 105 objective questions from the American Psychiatric Association app evaluation model. All app rating data were deposited in mindapps, a publicly accessible database that is continuously updated every 6 months given the dynamic nature of apps available in the marketplace. We characterized apps available in July 2021 and November 2022. Results: We initially identified 389 apps, excluded 161 due to irrelevance and nonfunctioning, and rated 228, including 152 available for Android platforms and 120 available for iOS platforms. Some of the top-returned apps (71/228, 31%) in 2021 were no longer functioning in 2022. Our analysis of rated apps revealed limitations in accessibility and features. While most apps (179/228, 78%) were free to download, over half had costs associated with in-app purchases or full use. Less than 65% (149/228) had a privacy policy addressing the data collected in the app. In terms of intervention features, more than 56% (128/228) of apps allowed the user to set and check in on goals, and more than 46% (106/228) of them provided psychoeducation, although few apps provided evidence-based support for smoking cessation, such as peer support or skill training, including mindfulness and deep breathing, and even fewer provided evidence-based interventions, such as acceptance and commitment therapy or cognitive behavioral therapy. Only 12 apps in 2021 and 11 in 2022 had published studies supporting the feasibility or efficacy for smoking cessation. Conclusions: Numerous smoking cessation apps were identified, but analysis revealed limitations, including high rates of irrelevant and nonfunctioning apps, high rates of turnover, and few apps providing evidence-based support for smoking cessation. Thus, it may be challenging for consumers to identify relevant, evidence-based apps to support smoking cessation in the app store, and a comprehensive evaluation system of mental health apps is critically important. %M 37440305 %R 10.2196/45183 %U https://www.jmir.org/2023/1/e45183 %U https://doi.org/10.2196/45183 %U http://www.ncbi.nlm.nih.gov/pubmed/37440305 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e47058 %T Effects of Tobacco Versus Electronic Cigarette Usage on Nonsuicidal Self-Injury and Suicidality Among Chinese Youth: Cross-Sectional Self-Report Survey Study %A Wang,Yinzhe %A Xu,Shicun %A Zhang,Xiaoqian %A Zhang,Yanwen %A Feng,Yi %A Wang,Yuanyuan %A Chen,Runsen %+ China Center for Aging Studies and Social-Economic Development, Jilin University, Kuang Yaming Bldg, 6th Fl, Changchun, Jilin, China, 86 43185166393, xushicun@jlu.edu.cn %K electronic cigarettes %K tobacco %K conventional cigarettes %K SGM %K nonsuicidal self-injury %K suicidality %K suicidal %K cigarette %K cigarettes %K suicide %K self-harm %K mental health %K sexual minority %K gender minority %K sexual and gender minority %K transgender %K youth %K cross-sectional %K survey %K smoker %K smoking %D 2023 %7 7.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The increase in tobacco/conventional cigarette (CC) and electronic cigarette (EC) usage among Chinese youth has become a growing public health concern. This is the first large-scale study to compare the impact of CC and EC usage on risk for nonsuicidal self-injury (NSSI) and suicidality in cis-heterosexual and sexual and gender minority (SGM) youth populations in China. Objective: This study examines the CC and EC risks for NSSI and suicidality among Chinese youth and compares the extent to which SGM and cis-heterosexual youth’s risks for NSSI and suicidality are influenced by their CC and EC usage and dependence. Methods: A total of 89,342 Chinese participants completed a cross-sectional self-report survey in 2021. Sociodemographic information, sexual orientations, gender identities, CC and EC usage, CC and EC dependence, and risks for suicidality and NSSI were assessed. The Mann-Whitney U test and chi-square test were performed for nonnormally distributed continuous variables and categorical variables, respectively. The multivariable linear regression model was used to examine both the influence of CC and EC usage and CC and EC dependence on NSSI and suicidality as well as the interaction effects of CC and EC usage and CC and EC dependence on NSSI and suicidality by group. Results: The prevalence of CC usage (P<.001) and dependence (P<.001) among SGM participants was lower than that among their cis-heterosexual counterparts. However, the prevalence of EC usage (P=.03) and EC dependence (P<.001) among SGM participants was higher than that among their cis-heterosexual counterparts. The multivariable linear regression model showed that CC dependence and EC dependence had a unique effect on NSSI and suicidality (CCs: B=0.02, P<.001; B=0.09, P<.001; ECs: B=0.05, P<.001; B=0.14, P<.001, respectively). The interaction effects of (1) CC usage and group type on NSSI and suicidality (B=0.34, P<.001; B=0.24, P=.03, respectively) and dual usage and group type on NSSI and suicidality (B=0.54, P<.001; B=0.84, P<.001, respectively) were significant, (2) CC dependence and group type on NSSI were significant (B=0.07, P<.001), and (3) EC dependence and group type on NSSI and suicidality were significant (B=0.04, P<.001; B=0.09, P<.001, respectively). No significant interaction effect was observed between EC usage and group type on NSSI and suicidality (B=0.15, P=.12; B=0.33, P=.32, respectively) and between CC dependence and group type on suicidality (B=–0.01, P=.72). Conclusions: Our study shows evidence of intergroup differences in NSSI and suicidality risks between SGM and cis-heterosexual youth related to CC and EC usage. These findings contribute to the growing literature on CC and EC in cis-heterosexual and SGM populations. Concerted efforts are necessary at a societal level to curb the aggressive marketing strategies of the EC industry and media coverage and to maximize the impact of educational campaigns on EC prevention and intervention among the youth population. %M 37418293 %R 10.2196/47058 %U https://publichealth.jmir.org/2023/1/e47058 %U https://doi.org/10.2196/47058 %U http://www.ncbi.nlm.nih.gov/pubmed/37418293 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42260 %T Exploring the Incentive Function of Virtual Academic Degrees in a Chinese Online Smoking Cessation Community: Qualitative Content Analysis %A Qian,Yuxing %A Liu,Zhenghao %A Lee,Edmund W J %A Wang,Yixi %A Ni,Zhenni %+ School of Information Management, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan, 430072, China, 86 132 0714 8568, zhenghaoliu@whu.edu.cn %K online smoking cessation community %K motivational affordances %K virtual academic degrees %K digital incentives %K content analysis %D 2023 %7 4.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies on online smoking cessation communities (OSCCs) have shown how such networks contribute to members’ health outcomes from behavior influence and social support perspectives. However, these studies rarely considered the incentive function of OSCCs. One of the ways OSCCs motivate smoking cessation behaviors is through digital incentives. Objective: This study aims to explore the incentive function of a novel digital incentive in a Chinese OSCC—the awarding of academic degrees—to promote smoking cessation. It specifically focuses on “Smoking Cessation Bar,” an OSCC in the popular web-based Chinese forum Baidu Tieba. Methods: We collected discussions about the virtual academic degrees (N= 1193) from 540 members of the “Smoking Cessation Bar.” The time frame of the data set was from November 15, 2012, to November 3, 2021. Drawing upon motivational affordances theory, 2 coders qualitatively coded the data. Results: We identified five key topics of discussion, including members’ (1) intention to get virtual academic degrees (n=38, 2.47%), (2) action to apply for the degrees (n=312, 20.27%), (3) feedback on the accomplishment of goals (n=203, 13.19%), (4) interpersonal interaction (n=794, 51.59%), and (5) expression of personal feelings (n=192, 12.48%). Most notably, the results identified underlying social and psychological motivations behind using the forum to discuss obtaining academic degrees for smoking cessation. Specifically, members were found to engage in sharing behavior (n=423, 27.49%) over other forms of interaction such as providing recommendations or encouragement. Moreover, expressions of personal feelings about achieving degrees were generally positive. It was possible that members hid their negative feelings (such as doubt, carelessness, and dislike) in the discussion. Conclusions: The virtual academic degrees in the OSCC created opportunities for self-presentation for participants. They also improved their self-efficacy to persist in smoking cessation by providing progressive challenges. They served as social bonds connecting different community members, triggering interpersonal interactions, and inducing positive feelings. They also helped realize members’ desire to influence or to be influenced by others. Similar nonfinancial rewards could be adopted in various smoking cessation projects to enhance participation and sustainability. %M 37402146 %R 10.2196/42260 %U https://www.jmir.org/2023/1/e42260 %U https://doi.org/10.2196/42260 %U http://www.ncbi.nlm.nih.gov/pubmed/37402146 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48923 %T Ending Tobacco Use Through Interactive Tailored Messaging for Cambodian People With HIV (Project EndIT): Protocol for a Randomized Controlled Trial %A Bui,Thanh Cong %A Hoogland,Charles E %A Chhea,Chhorvann %A Sopheab,Heng %A Ouk,Vichea %A Samreth,Sovannarith %A Hor,Bunleng %A Vidrine,Jennifer I %A Businelle,Michael S %A Shih,Ya Chen Tina %A Sutton,Steven K %A Jones,Sarah R %A Shorey Fennell,Bethany %A Cottrell-Daniels,Cherell %A Frank-Pearce,Summer G %A Ngor,Chamnab %A Kulkarni,Shweta %A Vidrine,Damon J %+ TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway Suite 400, Oklahoma City, OK, 73104, United States, 1 405 271 8001 ext 50559, thanh-c-bui@ouhsc.edu %K smoking cessation %K HIV/AIDS %K cost-effectiveness %K low- and middle-income countries %K Cambodia %K Phase-Based Model %K RCT %K randomized controlled trial %K mHealth %D 2023 %7 29.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence of smoking remains high in many low- and middle-income countries (LMICs), including the Southeast Asian nation of Cambodia. Smoking is especially hazardous for people with HIV. In Cambodia, approximately 43%-65% of men with HIV and 3%-5% of women with HIV smoke cigarettes. Thus, there is a critical need for cost-effective smoking cessation interventions for Cambodian people with HIV. This paper describes the design, methods, and data analysis plans for a randomized controlled trial assessing the efficacy of a theory-based mobile health smoking cessation intervention in Cambodian people with HIV. Objective: This 2-group randomized controlled trial compares the efficacy of a mobile health–based automated messaging (AM) intervention versus standard care (SC) in facilitating smoking cessation among Cambodian people with HIV. Methods: Cambodian people with HIV who currently smoke and are receiving antiretroviral treatment (target, N=800) will be randomized to (1) SC or (2) the AM intervention. SC participants will receive brief advice to quit smoking, written self-help materials, nicotine patches, and will complete weekly app-delivered dietary assessments for 26 weeks. AM participants will receive all SC components (but will complete smoking-related weekly assessments instead of dietary assessments), in addition to a fully automated tailored messaging program driven by the weekly assessments to facilitate smoking cessation. In the Phase-Based Model of smoking cessation, the cessation process is partitioned into 4 phases: motivation, preparation (precessation), cessation (quit date to 2 weeks post quit), and maintenance (up to 6 months post quit). Our AM program targets processes within these phases, including increasing motivation to quit, enhancing self-efficacy, obtaining social support, skills to cope with nicotine withdrawal symptoms and stress, and skills to maintain abstinence. All participants will complete baseline and 3-, 6-, and 12-month in-person follow-up assessments. The primary outcome is biochemically confirmed abstinence at 12 months, with 3- and 6-month abstinence as secondary outcomes. Potential mediators and moderators underlying treatment effects will be explored, and cost-effectiveness will be assessed. Results: This study was approved by all relevant domestic and international institutional and ethical review boards. Participant recruitment commenced in January 2023. Data collection is expected to conclude by the end of 2025. Conclusions: By demonstrating the greater efficacy and cost-effectiveness of AM relative to SC, this study has the potential to transform HIV care in Cambodia and prevent tobacco-related diseases. Furthermore, it may be adapted for use in other Cambodian populations and in other low- and middle-income countries. Ultimately, the AM approach to smoking cessation could greatly improve public health in the developing world and beyond. Trial Registration: ClinicalTrials.gov NCT05746442; https://clinicaltrials.gov/ct2/show/NCT05746442 International Registered Report Identifier (IRRID): PRR1-10.2196/48923 %M 37384390 %R 10.2196/48923 %U https://www.researchprotocols.org/2023/1/e48923 %U https://doi.org/10.2196/48923 %U http://www.ncbi.nlm.nih.gov/pubmed/37384390 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e46155 %T Feasibility, Acceptability, and Potential Impact of a Novel mHealth App for Smokers Ambivalent About Quitting: Randomized Pilot Study %A McClure,Jennifer B %A Heffner,Jaimee L %A Krakauer,Chloe %A Mun,Sophia %A Klasnja,Predrag %A Catz,Sheryl L %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, United States, 1 206 287 2737, Jennifer.B.McClure@kp.org %K ambivalence %K app %K digital health intervention %K mHealth intervention %K mHealth %K motivation %K nicotine %K smoking %K smoking cessation %K tobacco %D 2023 %7 28.6.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most smokers are ambivalent about quitting—they want to quit someday, but not now. Interventions are needed that can engage ambivalent smokers, build their motivation for quitting, and support future quit attempts. Mobile health (mHealth) apps offer a cost-effective platform for such interventions, but research is needed to inform their optimal design and assess their acceptability, feasibility, and potential effectiveness. Objective: This study aims to assess the feasibility, acceptability, and potential impact of a novel mHealth app for smokers who want to quit smoking someday but are ambivalent about quitting in the near term. Methods: We enrolled adults across the United States who smoked more than 10 cigarettes a day and were ambivalent about quitting (n=60). Participants were randomly assigned to 1 of 2 versions of the GEMS app: standard care (SC) versus enhanced care (EC). Both had a similar design and identical evidence-based, best-practice smoking cessation advice and resources, including the ability to earn free nicotine patches. EC also included a series of exercises called experiments designed to help ambivalent smokers clarify their goals, strengthen their motivation, and learn important behavioral skills for changing smoking behavior without making a commitment to quit. Outcomes were analyzed using automated app data and self-reported surveys at 1 and 3 months post enrollment. Results: Participants who installed the app (57/60, 95%) were largely female, White, socioeconomically disadvantaged, and highly nicotine dependent. As expected, key outcomes trended in favor of the EC group. Compared to SC users, EC participants had greater engagement (mean sessions 19.9 for EC vs 7.3 for SC). An intentional quit attempt was reported by 39.3% (11/28) of EC users and 37.9% (11/29) of SC users. Seven-day point prevalence smoking abstinence at the 3-month follow-up was reported by 14.7% (4/28) of EC users and 6.9% (2/29) of SC users. Among participants who earned a free trial of nicotine replacement therapy based on their app usage, 36.4% (8/22) of EC participants and 11.1% (2/18) of SC participants requested the treatment. A total of 17.9% (5/28) of EC and 3.4% (1/29) of SC participants used an in-app feature to access a free tobacco quitline. Other metrics were also promising. EC participants completed an average of 6.9 (SD 3.1) out of 9 experiments. Median helpfulness ratings for completed experiments ranged from 3 to 4 on a 5-point scale. Finally, satisfaction with both app versions was very good (mean 4.1 on a 5-point Likert scale) and 95.3% (41/43) of all respondents would recommend their app version to others. Conclusions: Ambivalent smokers were receptive to the app-based intervention, but the EC version, which combined best-practice cessation advice with self-paced, experiential exercises, was associated with greater use and evidence of behavior change. Further development and evaluation of the EC program is warranted. Trial Registration: ClinicalTrials.gov NCT04560868; https://clinicaltrials.gov/ct2/show/NCT04560868 %M 37379059 %R 10.2196/46155 %U https://mhealth.jmir.org/2023/1/e46155 %U https://doi.org/10.2196/46155 %U http://www.ncbi.nlm.nih.gov/pubmed/37379059 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48898 %T Testing the Efficacy of a Scalable Telephone-Delivered Guided Imagery Tobacco Cessation Treatment: Protocol for a Randomized Clinical Trial %A Gordon,Judith S %A Armin,Julie S %A Giacobbi Jr,Peter %A Hsu,Chiu-Hsieh %A Marano,Kari %A Sheffer,Christine E %+ College of Nursing, University of Arizona, 1305 N Martin Avenue, Tucson, AZ, 85718, United States, 1 520 6264970, judithg@email.arizona.edu %K tobacco %K smoking %K treatment %K integrative health %K guided imagery %K behavior change %K telephone %K mobile phone %D 2023 %7 23.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco use continues to be a leading preventable cause of death and disease in the United States, accounting for >480,000 deaths each year. Although treatments for tobacco use are effective for many, there is substantial variability in outcomes, and these approaches are not effective for all individuals seeking to quit smoking cigarettes. New, effective therapeutic approaches are needed to meet the preferences of people who want to stop smoking. Guided imagery (GI) is a mind-body technique that involves the guided visualization of specific mental images, which is enhanced with other sensory modalities and emotions. Preliminary evidence provides initial support for the use of GI as a treatment for cigarette smoking. Meta-analyses have shown that standard treatment for cigarette smoking delivered over the telephone via quitlines is effective. A telephone-based intervention that uses GI might provide another effective treatment option and increase the reach and effectiveness of quitlines. Objective: This study aims to test the efficacy of Be Smoke Free, a telephone-delivered GI treatment for smoking cessation. Methods: This multisite randomized clinical trial (RCT) will compare a novel telephone-delivered GI tobacco cessation treatment with a standard evidence-based behavioral treatment. The study will be conducted over 5 years. In phase 1, we refined protocols and procedures for the New York State and West Virginia sites for use in the RCT. During phase 2, we will conduct an RCT with 1200 participants: 600 (50%) recruited via quitlines and 600 (50%) recruited via population-based methods. Participants will be randomly assigned to either the GI condition or the behavioral condition; both treatments will be delivered by trained study coaches located at the University of Arizona. Assessments will be conducted at baseline and 3 and 6 months after enrollment by University of Arizona research staff. The primary outcome will be self-reported 30-day point prevalence abstinence 6 months after enrollment. Secondary outcomes include biochemically verified 7-day point prevalence abstinence 6 months after enrollment. Results: Recruitment in West Virginia and New York began in October 2022. As of March 31, 2023, a total of 242 participants had been enrolled. Follow-up assessments began in November 2022. As of March 31, 2023, of the 118 eligible participants, 97 (82.2%) had completed the 3-month assessment, and 93% (26/28) of eligible participants had completed the 6-month assessment. Biochemical verification and qualitative interviews began in April 2023. Recruitment will continue through 2025 and follow-up assessments through 2026. Primary results are expected to be published in 2027. Conclusions: The Be Smoke Free study is a first-of-its-kind RCT that incorporates GI into telephone-based tobacco cessation treatment. If successful, Be Smoke Free will have substantial benefits for the long-term health of people who use tobacco across the United States. Trial Registration: ClinicalTrials.gov NCT05277831; https://clinicaltrials.gov/ct2/show/NCT05277831 International Registered Report Identifier (IRRID): PRR1-10.2196/48898 %M 37351932 %R 10.2196/48898 %U https://www.researchprotocols.org/2023/1/e48898 %U https://doi.org/10.2196/48898 %U http://www.ncbi.nlm.nih.gov/pubmed/37351932 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39487 %T The Effects of Scheduled Smoking Reduction and Precessation Nicotine Replacement Therapy on Smoking Cessation: Randomized Controlled Trial With Compliance %A Cinciripini,Paul M %A Minnix,Jennifer A %A Robinson,Jason D %A Kypriotakis,George %A Cui,Yong %A Blalock,Janice A %A Lam,Cho Y %A Wetter,David W %+ Department of Behavioral Science, University of Texas MD Anderson Cancer Center, 1155 Pressler St., Houston, TX, 77030, United States, 1 281 908 6782, gkypriotakis@mdanderson.org %K gradual reduction %K scheduled smoking %K nicotine replacement therapy %K smoking cessation %K compliance %K mobile phone %D 2023 %7 20.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking remains a major public health problem, and it is important to provide a variety of efficacious and appealing options to encourage smokers to quit smoking. Scheduled smoking is a method of gradual reduction, preparing smokers to quit by systematically reducing cigarette consumption according to a predetermined schedule that increases the time between cigarette consumption. Gradual reduction may be preferred to abrupt quitting, but the efficacy of this cessation approach is unclear. Objective: This study aims, first, to evaluate the overall effectiveness of scheduled smoking alone, or in combination with precessation nicotine replacement therapy (NRT), versus standard NRT starting on the quit date with no prior smoking reduction and, second, to evaluate the impact of schedule compliance on the effectiveness of the intervention. Methods: A total of 916 participants recruited from the Houston metropolitan area were randomly assigned to 1 of the following 3 groups: scheduled smoking plus a precessation nicotine patch (n=306, 33.4%), scheduled smoking only with no precessation patch (n=309, 33.7%), and enhanced usual care (n=301, 32.9%) control. The primary abstinence outcomes were carbon monoxide–verified, self-reported, 7-day point prevalence abstinence at 2 and 4 weeks after the quit date. Unadjusted and adjusted logistic regression analyses were performed to evaluate the intervention effect. Scheduled smoking was implemented using a handheld device for 3 weeks before quitting. This trial was not registered because data collection began before July 1, 2005. Results: Results for the first aim showed no overall differences in abstinence among the 3 groups in both the unadjusted and adjusted models. However, the results for the second aim showed a clear effect on abstinence by schedule compliance at 2 and 4 weeks and 6 months after quitting (odds ratio [OR] 2.01, 95% CI 1.31-3.07), 4 weeks (OR 1.58, 95% CI 1.05-2.38), and 6 months (OR 1.68, 95% CI 1.04-2.64), with the differences at 2 and 4 weeks after quitting being the most robust. We also found that scheduled smoking was related to a reduction in nicotine withdrawal, negative affect, and craving when compared with the controls. Conclusions: Scheduled smoking, when combined with precessation use of NRT, can result in significantly higher abstinence rates than usual care (abrupt quitting with NRT), particularly in the early postquit phase (2 and 4 weeks after cessation) when smokers are compliant with the procedure. Scheduled smoking also produced a better overall quitting experience by reducing symptoms of nicotine withdrawal and craving, in comparison with usual care, which could encourage future quit attempts. Studies in this area should focus on the use of counseling or other methods to improve adherence. %M 37338956 %R 10.2196/39487 %U https://formative.jmir.org/2023/1/e39487 %U https://doi.org/10.2196/39487 %U http://www.ncbi.nlm.nih.gov/pubmed/37338956 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e43990 %T Using Smartphone Survey and GPS Data to Inform Smoking Cessation Intervention Delivery: Case Study %A Luken,Amanda %A Desjardins,Michael R %A Moran,Meghan B %A Mendelson,Tamar %A Zipunnikov,Vadim %A Kirchner,Thomas R %A Naughton,Felix %A Latkin,Carl %A Thrul,Johannes %+ Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway, Baltimore, MD, 21205, United States, 1 732 690 2886, aluken95@gmail.com %K adult %K application %K case study %K cessation %K delivery %K GIS %K GPS %K health interventions %K mHealth %K mobile phone %K smartphone application %K smartphone %K smoker %K smoking cessation %K smoking %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Interest in quitting smoking is common among young adults who smoke, but it can prove challenging. Although evidence-based smoking cessation interventions exist and are effective, a lack of access to these interventions specifically designed for young adults remains a major barrier for this population to successfully quit smoking. Therefore, researchers have begun to develop modern, smartphone-based interventions to deliver smoking cessation messages at the appropriate place and time for an individual. A promising approach is the delivery of interventions using geofences—spatial buffers around high-risk locations for smoking that trigger intervention messages when an individual’s phone enters the perimeter. Despite growth in personalized and ubiquitous smoking cessation interventions, few studies have incorporated spatial methods to optimize intervention delivery using place and time information. Objective: This study demonstrates an exploratory method of generating person-specific geofences around high-risk areas for smoking by presenting 4 case studies using a combination of self-reported smartphone-based surveys and passively tracked location data. The study also examines which geofence construction method could inform a subsequent study design that will automate the process of deploying coping messages when young adults enter geofence boundaries. Methods: Data came from an ecological momentary assessment study with young adult smokers conducted from 2016 to 2017 in the San Francisco Bay area. Participants reported smoking and nonsmoking events through a smartphone app for 30 days, and GPS data was recorded by the app. We sampled 4 cases along ecological momentary assessment compliance quartiles and constructed person-specific geofences around locations with self-reported smoking events for each 3-hour time interval using zones with normalized mean kernel density estimates exceeding 0.7. We assessed the percentage of smoking events captured within geofences constructed for 3 types of zones (census blocks, 500 ft2 fishnet grids, and 1000 ft2 fishnet grids). Descriptive comparisons were made across the 4 cases to better understand the strengths and limitations of each geofence construction method. Results: The number of reported past 30-day smoking events ranged from 12 to 177 for the 4 cases. Each 3-hour geofence for 3 of the 4 cases captured over 50% of smoking events. The 1000 ft2 fishnet grid captured the highest percentage of smoking events compared to census blocks across the 4 cases. Across 3-hour periods except for 3:00 AM-5:59 AM for 1 case, geofences contained an average of 36.4%-100% of smoking events. Findings showed that fishnet grid geofences may capture more smoking events compared to census blocks. Conclusions: Our findings suggest that this geofence construction method can identify high-risk smoking situations by time and place and has potential for generating individually tailored geofences for smoking cessation intervention delivery. In a subsequent smartphone-based smoking cessation intervention study, we plan to use fishnet grid geofences to inform the delivery of intervention messages. %M 37327031 %R 10.2196/43990 %U https://mhealth.jmir.org/2023/1/e43990 %U https://doi.org/10.2196/43990 %U http://www.ncbi.nlm.nih.gov/pubmed/37327031 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43603 %T Black Smokers’ Preferences for Features of a Smoking Cessation App: Qualitative Study %A Enyioha,Chineme %A Loufman,Larissa M %A Grewe,Mary E %A Cené,Crystal W %A Khairat,Saif %A Goldstein,Adam O %A Kistler,Christine E %+ Department of Family Medicine, University of North Carolina at Chapel Hill, 590 Manning Drive, Chapel Hill, NC, 27599, United States, 1 9842155048, chineme_enyioha@med.unc.edu %K mobile health apps %K smoking cessation %K Black smokers %K smoking %K mobile health %K intervention %K application %K development %K online research %K interview %K functionality %K social network %D 2023 %7 30.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) interventions for smoking cessation have grown extensively over the last few years. Although these interventions improve cessation rates, studies of these interventions consistently lack sufficient Black smokers; hence knowledge of features that make mHealth interventions attractive to Black smokers is limited. Identifying features of mHealth interventions for smoking cessation preferred by Black smokers is critical to developing an intervention that they are likely to use. This may in turn address smoking cessation challenges and barriers to care, which may reduce smoking-related disparities that currently exist. Objective: This study aims to identify features of mHealth interventions that appeal to Black smokers using an evidence-based app developed by the National Cancer Institute, QuitGuide, as a reference. Methods: We recruited Black adult smokers from national web-based research panels with a focus on the Southeastern United States. Participants were asked to download and use QuitGuide for at least a week before participation in remote individual interviews. Participants gave their opinions about features of the QuitGuide app and other mHealth apps they may have used in the past and suggestions for future apps. Results: Of the 18 participants, 78% (n=14) were women, with age ranging from 32 to 65 years. Themes within five major areas relevant for developing a future mHealth smoking cessation app emerged from the individual interviews: (1) content needs including health and financial benefits of quitting, testimonials from individuals who were successful in quitting, and strategies for quitting; (2) format needs such as images, ability to interact with and respond to elements within the app, and links to other helpful resources; (3) functionality including tracking of smoking behavior and symptoms, provision of tailored feedback and reminders to users, and an app that allows for personalization of functions; (4) social network, such as connecting with friends and family through the app, connecting with other users on social media, and connecting with a smoking cessation coach or therapist; and (5) the need for inclusivity for Black individuals, which may be accomplished through the inclusion of smoking-related information and health statistics specific for Black individuals, the inclusion of testimonials from Black celebrities who successfully quit, and the inclusion of cultural relevance in messages contained in the app. Conclusions: Certain features of mHealth interventions for smoking cessation were highly preferred by Black smokers based on their use of a preexisting mHealth app, QuitGuide. Some of these preferences are similar to those already identified by the general population, whereas preferences for increasing the inclusivity of the app are more specific to Black smokers. These findings can serve as the groundwork for a large-scale experiment to evaluate preferences with a larger sample size and can be applied in developing mHealth apps that Black smokers may be more likely to use. %M 37252777 %R 10.2196/43603 %U https://formative.jmir.org/2023/1/e43603 %U https://doi.org/10.2196/43603 %U http://www.ncbi.nlm.nih.gov/pubmed/37252777 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44979 %T A Financial Incentives Program to Promote Smoking Cessation Among Recently Hospitalized Individuals: Feasibility and Acceptability Study %A Shusterman,Sara %A Villarreal-Calderon,Rodolfo %A Gunawan,Adrian %A Gallardo Foreman,Alexis %A O'Donnell,Charles %A Wakeman,Cornelia %A Javeed,Hadi %A Keteyian,Jacob %A Howard,Jinesa %A Bulekova,Katia %A de Silva,Shalen %A Campbell,Trevor %A Lasser,Karen %A Kathuria,Hasmeena %+ Boston University Chobanian & Avedisian School of Medicine, 725 Albany Street, Boston, MA, 02118, United States, 1 6176583564, sara.shusterman@bmc.org %K financial incentives %K mobile application %K smoking cessation %K tobacco treatment intervention %D 2023 %7 29.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Hospitalization is an opportunity to engage underserved individuals in tobacco treatment who may not otherwise have access to it. Tobacco treatment interventions that begin during hospitalization and continue for at least 1 postdischarge month are effective in promoting smoking cessation. However, there is low usage of postdischarge tobacco treatment services. Financial incentives for smoking cessation are an intervention in which participants receive incentives, such as cash payments or vouchers for goods, to encourage individuals to stop smoking or to reward individuals for maintaining abstinence. Objective: We sought to determine the feasibility and acceptability of a novel postdischarge financial incentive intervention that uses a smartphone application paired to measurements of exhaled carbon monoxide (CO) concentration levels to promote smoking cessation in individuals who smoke cigarettes. Methods: We collaborated with Vincere Health, Inc. to tailor their mobile application that uses facial recognition features, a portable breath test CO monitor, and smartphone technology to deliver financial incentives to a participant’s digital wallet after the completion of each CO test. The program includes 3 racks. Track 1: Noncontingent incentives for conducting CO tests. Track 2: Combination of noncontingent and contingent incentives for CO levels <10 parts per million (ppm). Track 3: Contingent incentives only for CO levels <10 ppm. After obtaining informed consent, we pilot-tested the program from September to November 2020 with a convenience sample of 33 hospitalized individuals at Boston Medical Center, a large safety-net hospital in New England. Participants received text reminders to conduct CO tests twice daily for 30 days postdischarge. We collected data on engagement, CO levels, and incentives earned. We measured feasibility and acceptability quantitatively and qualitatively at 2 and 4 weeks. Results: Seventy-six percent (25/33) completed the program and 61% (20/33) conducted at least 1 breath test each week. Seven patients had consecutive CO levels <10 ppm during the last 7 days of the program. Engagement with the financial incentive intervention as well as in-treatment abstinence was highest in Track 3 that delivered financial incentives contingent on CO levels <10 ppm. Participants reported high program satisfaction and that the intervention helped motivate smoking cessation. Participants suggested increasing program duration to at least 3 months and adding supplemental text messaging to increase motivation to stop smoking. Conclusions: Financial incentives paired to measurements of exhaled CO concentration levels is a novel smartphone-based tobacco cessation approach that is feasible and acceptable. Future studies should examine the efficacy of the intervention after it is refined to add a counseling or text-messaging component. %M 37247216 %R 10.2196/44979 %U https://formative.jmir.org/2023/1/e44979 %U https://doi.org/10.2196/44979 %U http://www.ncbi.nlm.nih.gov/pubmed/37247216 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44787 %T Promoting Evidence-Based Tobacco Cessation Treatment in Community Mental Health Clinics: Protocol for a Prepost Intervention Study %A Dickerson,Faith %A Goldsholl,Stacy %A Yuan,Christina T %A Dalcin,Arlene %A Eidman,Benjamin %A Minahan,Eva %A Gennusa 3rd,Joseph V %A Mace,Elizabeth %A Cullen,Bernadette %A Evins,A Eden %A Cather,Corinne %A Wang,Nae-Yuh %A McGinty,Emma M %A Daumit,Gail L %+ Department of Psychology, Sheppard Pratt, 6501 North Charles Street, Baltimore, MD, 21204, United States, 1 4109384359, fdickerson@sheppardpratt.org %K coaching %K expert consultation %K implementation %K motivational interviewing %K self-efficacy %K serious mental illness %K smoking cessation %K system-level intervention %K tobacco dependence %D 2023 %7 12.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco smoking is highly prevalent among persons with serious mental illness (SMI) and is the largest contributor to premature mortality in this population. Evidence-based smoking cessation therapy with medications and behavioral counseling is effective for persons with SMI, but few receive this treatment. Mental health providers have extensive experience working with clients with SMI and frequent treatment contacts, making them well positioned to deliver smoking cessation treatment. However, few mental health providers feel adequately trained to deliver this treatment, and many providers believe that smokers with SMI are not interested in quitting or have concerns about the safety of smoking cessation pharmacotherapy, despite substantial evidence to the contrary. Objective: We present the protocol for the pilot “IMPACT” (Implementing Action for Tobacco Smoking Cessation Treatment) study, which aims to pilot test a multicomponent implementation intervention to increase the delivery of evidence-based tobacco smoking cessation treatment in community mental health clinics. Methods: We are using a prepost observational design to examine the effects of an implementation intervention designed to improve mental health providers’ delivery of the following four evidence-based practices related to smoking cessation treatment: (1) assessment of smoking status, (2) assessment of willingness to quit, (3) behavioral counseling, and (4) pharmacotherapy prescribing. To overcome key barriers related to providers’ knowledge and self-efficacy of smoking cessation treatment, the study will leverage implementation strategies including (1) real-time and web-based training for mental health providers about evidence-based smoking cessation treatment and motivational interviewing, including an avatar practice module; (2) a tobacco smoking treatment protocol; (3) expert consultation; (4) coaching; and (5) organizational strategy meetings. We will use surveys and in-depth interviews to assess the implementation intervention’s effects on providers’ knowledge and self-efficacy, the mechanisms of change targeted by the intervention, as well as providers’ perceptions of the acceptability, appropriateness, and feasibility of both the evidence-based practices and implementation strategies. We will use data on care delivery to assess providers’ implementation of evidence-based smoking cessation practices. Results: The IMPACT study is being conducted at 5 clinic sites. More than 50 providers have been enrolled, exceeding our recruitment target. The study is ongoing. Conclusions: In order for persons with SMI to realize the benefits of smoking cessation treatment, it is important for clinicians to implement evidence-based practices successfully. This pilot study will result in a set of training modules, implementation tools, and resources for clinicians working in community mental health clinics to address tobacco smoking with their clients. Trial Registration: ClinicalTrials.gov NCT04796961; https://clinicaltrials.gov/ct2/show/NCT04796961 Trial Registration: ClinicalTrials.gov NCT04796961; https://clinicaltrials.gov/ct2/show/NCT04796961 International Registered Report Identifier (IRRID): DERR1-10.2196/44787 %M 37171851 %R 10.2196/44787 %U https://www.researchprotocols.org/2023/1/e44787 %U https://doi.org/10.2196/44787 %U http://www.ncbi.nlm.nih.gov/pubmed/37171851 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44840 %T Utilization and Effectiveness of a Message-Based Tobacco Cessation Program (mCessation) in the Chinese General Population: Longitudinal, Real-world Study %A Su,Zheng %A Wei,Xiaowen %A Cheng,Anqi %A Zhou,Xinmei %A Li,Jinxuan %A Qin,Rui %A Liu,Yi %A Xia,Xin %A Song,Qingqing %A Liu,Zhao %A Zhao,Liang %A Xiao,Dan %A Wang,Chen %+ Department of Tobacco Control and Prevention of Respiratory Diseases, China-Japan Friendship Hospital, Center of Respiratory Medicine, District Chaoyang, Beijing, 100021, China, 86 868 420 5425, danxiao@263.net %K smoking cessation %K real-world evidence %K text message %K general population %D 2023 %7 2.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Randomized controlled trials on text message interventions for smoking cessation have shown they are effective and recommended for tobacco control. However, the effectiveness in real-world settings is largely unknown, especially in low- and middle-income countries. Objective: This study aimed to provide real-world evidence about the utilization and effectiveness of a message-based tobacco cessation program (mCessation) in China. Methods: From May 2021 to September 2022, 16,746 people from the general population participated in the mCessation program provided by the World Health Organization. All participants received text messages on smoking cessation via instant messaging for 6 months, and they were also required to report smoking status. We randomly selected 2500 participants and interviewed them by telephone to determine the 7-day point prevalence abstinence rate at 6 months. Descriptive statistics were used to analyze population characteristics and abstinence rate. Logistic regression analysis was performed to explore risk factors for the abstinence rate. Results: Among the 2500 participants, the mean age was 35 years, and most (2407/2500, 96.20%) were male. The prevalence of tobacco dependence and light degree of tobacco dependence were 85.70% (2142/2500) and 89.10% (2228/2500), respectively. For respondents (953/2500, 38.10%), the 7-day point prevalence abstinence rate at 6 months was 21.90% (209/953). Participants older than 40 years or with tobacco dependence had significantly higher abstinence rates than those who were younger than 30 years old (odds ratio [OR] 1.77, 95% CI 1.06-3.29) or without dependence (OR 1.64, 95% CI 1.08-2.51), respectively. However, married people or heavily dependent smokers tended to find it more difficult to successfully quit smoking compared with unmarried people (OR 0.57, 95% CI 0.34-0.93) or lightly dependent smokers (OR 0.16, 95% CI 0.02-0.98), respectively. Conclusions: In a real-world setting, mCessation China was generally acceptable to men and lightly dependent smokers, and it could help 1 in 5 smokers aged 18 years to 67 years quit smoking. However, strategies to increase awareness of young and married adults may improve implementation and abstinence rates. %M 37129934 %R 10.2196/44840 %U https://www.jmir.org/2023/1/e44840 %U https://doi.org/10.2196/44840 %U http://www.ncbi.nlm.nih.gov/pubmed/37129934 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41911 %T A Personalized Mobile Cessation Intervention to Promote Smokers From the Preparation Stage to the Action Stage: Double-blind Randomized Controlled Trial %A Lin,Haoxiang %A Wang,Ying %A Xing,Yanling %A Han,Yinglian %A Zhang,Chengqian %A Luo,Ting %A Chang,Chun %+ School of Public Health, Peking University, 38 Xueyuanlu, Beijing, 100191, China, 86 13641338346, changchun@bjmu.edu.cn %K smoking cessation %K mobile health %K health education %K smoking %K behavior intervention %K behavior change %K support %K text message %K personalized %K smoking abstinence %K health behavior %K health promotion %D 2023 %7 26.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Most mobile cessation studies have found that such interventions have a higher quitting rate than interventions providing minimal smoking cessation support. However, why such interventions are effective has been almost unstudied by researchers. Objective: This paper describes the principles of the personalized mobile cessation intervention-based WeChat app and used generalized estimated equations to assess why a personalized mobile cessation intervention was more likely to promote smokers from the preparation stage to the action stage than a nonpersonalized intervention. Methods: This is a 2-arm, double-blind, randomized controlled trial in five cities in China. The intervention group received a personalized mobile cessation intervention. The control group received a nonpersonalized SMS text message smoking cessation intervention. All information was sent by the WeChat app. The outcomes were the change in protection motivation theory construct scores and the change in transtheoretical model stages. Results: A total of 722 participants were randomly assigned to the intervention or control group. Compared with those who received the nonpersonalized SMS text message intervention, smokers who received the personalized intervention presented lower intrinsic rewards, extrinsic rewards, and response costs. Intrinsic rewards were determinants of stage change, thus explaining why the intervention group was more likely to promote smokers from the preparation stage to the action stage (odds ratio 2.65, 95% CI 1.41-4.98). Conclusions: This study identified the psychological determinants at different stages to facilitate smokers moving forward to the next stage of quitting behavior and provides a framework to explore why a smoking cessation intervention is effective. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100041942; https://tinyurl.com/2hhx4m7f %M 37099360 %R 10.2196/41911 %U https://www.jmir.org/2023/1/e41911 %U https://doi.org/10.2196/41911 %U http://www.ncbi.nlm.nih.gov/pubmed/37099360 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43242 %T The Effectiveness of Smartphone App–Based Interventions for Assisting Smoking Cessation: Systematic Review and Meta-analysis %A Guo,Yi-Qiang %A Chen,Yuling %A Dabbs,Annette DeVito %A Wu,Ying %+ School of Nursing, Capital Medical University, 10 You-an-men Wai Xi-tou-tiao, Feng-tai District, Beijing, 100069, China, 86 10 8391 1766, helenywu@vip.163.com %K smartphone app %K smoking cessation %K meta-analysis %K eHealth %K mHealth %K smoking %K application %K intervention %K effectiveness %K electronic %K adult %K pharmacotherapy %D 2023 %7 20.4.2023 %9 Review %J J Med Internet Res %G English %X Background: Smoking is a leading cause of premature death globally. Quitting smoking reduces the risk of all-cause mortality by 11%-34%. Smartphone app–based smoking cessation (SASC) interventions have been developed and are widely used. However, the evidence for the effectiveness of smartphone-based interventions for smoking cessation is currently equivocal. Objective: The purpose of this study was to synthesize the evidence for the effectiveness of smartphone app–based interventions for smoking cessation. Methods: We conducted a systematic review and meta-analysis of the effectiveness of smartphone interventions for smoking cessation based on the Cochrane methodology. An electronic literature search was performed using the Cochrane Library, Web of Science, PubMed, Embase, PsycINFO, China National Knowledge Infrastructure, and Wanfang databases to identify published papers in English or Chinese (there was no time limit regarding the publication date). The outcome was the smoking abstinence rate, which was either a 7-day point prevalence abstinence rate or a continuous abstinence rate. Results: A total of 9 randomized controlled trials involving 12,967 adults were selected for the final analysis. The selected studies from 6 countries (the United States, Spain, France, Switzerland, Canada, and Japan) were included in the meta-analysis between 2018 and 2022. Pooled effect sizes (across all follow-up time points) revealed no difference between the smartphone app group and the comparators (standard care, SMS text messaging intervention, web-based intervention, smoking cessation counseling, or apps as placebos without real function; odds ratio [OR] 1.25, 95% CI 0.99-1.56, P=.06, I2=73.6%). Based on the subanalyses, 6 trials comparing smartphone app interventions to comparator interventions reported no significant differences in effectiveness (OR 1.03, 95% CI 0.85-1.26, P=.74, I2=57.1%). However, the 3 trials that evaluated the combination of smartphone interventions combined with pharmacotherapy compared to pharmacotherapy alone found higher smoking abstinence rates in the combined intervention (OR 1.79, 95% CI 1.38-2.33, P=.74, I2=7.4%). All SASC interventions with higher levels of adherence were significantly more effective (OR 1.48, 95% CI 1.20-1.84, P<.001, I2=24.5%). Conclusions: This systematic review and meta-analysis did not support the effectiveness of delivering smartphone-based interventions alone to achieve higher smoking abstinence rates. However, the efficacy of smartphone-based interventions increased when combined with pharmacotherapy-based smoking cessation approaches. Trial Registration: PROSPERO CRD42021267615; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=267615 %M 37079352 %R 10.2196/43242 %U https://www.jmir.org/2023/1/e43242 %U https://doi.org/10.2196/43242 %U http://www.ncbi.nlm.nih.gov/pubmed/37079352 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e40913 %T Potential Impact of the COVID-19 Pandemic on Public Perception of Water Pipes on Reddit: Observational Study %A Zheng,Zihe %A Xie,Zidian %A Goniewicz,Maciej %A Rahman,Irfan %A Li,Dongmei %+ Department of Clinical and Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard Cu 420708, Rochester, NY, 14642-0001, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K water pipes %K Reddit %K COVID-19 %K COVID-19 pandemic %K public perception %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Socializing is one of the main motivations for water pipe smoking. Restrictions on social gatherings during the COVID-19 pandemic might have influenced water pipe smokers’ behaviors. As one of the most popular social media platforms, Reddit has been used to study public opinions and user experiences. Objective: In this study, we aimed to examine the influence of the COVID-19 pandemic on public perception and discussion of water pipe tobacco smoking using Reddit data. Methods: We collected Reddit posts between December 1, 2018, and June 30, 2021, from a Reddit archive (PushShift) using keywords such as “waterpipe,” “hookah,” and “shisha.” We examined the temporal trend in Reddit posts mentioning water pipes and different locations (such as homes and lounges or bars). The temporal trend was further tested using interrupted time series analysis. Sentiment analysis was performed to study the change in sentiment of water pipe–related posts before and during the pandemic. Topic modeling using latent Dirichlet allocation (LDA) was used to examine major topics discussed in water pipe–related posts before and during the pandemic. Results: A total of 45,765 nonpromotion water pipe–related Reddit posts were collected and used for data analysis. We found that the weekly number of Reddit posts mentioning water pipes significantly increased at the beginning of the COVID-19 pandemic (P<.001), and gradually decreased afterward (P<.001). In contrast, Reddit posts mentioning water pipes and lounges or bars showed an opposite trend. Compared to the period before the COVID-19 pandemic, the average number of Reddit posts mentioning lounges or bars was lower at the beginning of the pandemic but gradually increased afterward, while the average number of Reddit posts mentioning the word “home” remained similar during the COVID-19 pandemic (P=.29). While water pipe–related posts with a positive sentiment were dominant (12,526/21,182, 59.14% before the pandemic; 14,686/24,583, 59.74% after the pandemic), there was no change in the proportion of water pipe–related posts with different sentiments before and during the pandemic (P=.19, P=.26, and P=.65 for positive, negative, and neutral posts, respectively). Most topics related to water pipes on Reddit were similar before and during the pandemic. There were more discussions about the opening and closing of hookah lounges or bars during the pandemic. Conclusions: This study provides a first evaluation of the possible impact of the COVID-19 pandemic on public perceptions of and discussions about water pipes on Reddit. %M 37124245 %R 10.2196/40913 %U https://infodemiology.jmir.org/2023/1/e40913 %U https://doi.org/10.2196/40913 %U http://www.ncbi.nlm.nih.gov/pubmed/37124245 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44036 %T A New Questionnaire to Assess Respiratory Symptoms (The Respiratory Symptom Experience Scale): Quantitative Psychometric Assessment and Validation Study %A Shiffman,Saul %A McCaffrey,Stacey A %A Hannon,Michael J %A Goldenson,Nicholas I %A Black,Ryan A %+ PinneyAssociates, Inc, 201 N Craig St, Suite 320, Pittsburgh, PA, 15213, United States, 1 4126875677, shiffman@pinneyassociates.com %K measure development %K respiratory symptoms %K COPD %K e-cigarettes %K electronic nicotine delivery system %K ENDS %K smoking %K respiratory disease %K respiratory health %K health intervention %K questionnaire %K validation %K validate %K development %K respiratory %K pulmonary %K lung %K smoker %K smoking %D 2023 %7 14.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Smokers often experience respiratory symptoms (eg, morning cough), and those who stop smoking, including those who do so by switching completely to electronic nicotine delivery systems (ENDS), may experience reductions in symptoms. Existing respiratory symptom questionnaires may not be suitable for studying these changes, as they are intended for patient populations, such as those with chronic obstructive pulmonary disease (COPD). Objective: This study aimed to develop a respiratory symptom questionnaire appropriate for current smokers and for assessing changes when smokers stop smoking. Methods: The Respiratory Symptom Experience Scale (RSES) was derived from existing instruments and subject matter expert input and refined through cognitive debriefing interviews (n=49). Next, for purposes of the quantitative psychometric evaluation, the RSES was administered to smokers (n=202), former smokers (no tobacco use in >6 months; n=200), and switchers (n=208, smokers who switched to ENDS for >6 months), all of whom had smoked for at least 10 years (mean age 33 years). Participants, who averaged 62 (SD 12) years of age, included 28% (173/610) with respiratory allergy symptoms and 17% (104/610) with COPD. Test-retest reliability was assessed by repeat assessment after 1 week in 128 participants. Results: A generalized partial credit model confirmed that the response options were ordered, and a parallel analysis using principal components confirmed that the scale was unidimensional. With allowance for 2 sets of correlated errors between pairs of items, a 1-factor graded response model fit the data. Discrimination parameters were approximately 1 or greater for all items. Scale reliability was 0.80 or higher across a broad range of severity (standardized scores −0.40 to 3.00). Test-retest reliability (absolute intraclass correlation) was good, at 0.89. RSES convergent validity was supported by substantial differences (Cohen d=0.74) between those with and without a diagnosis of respiratory disease (averaging 0.57 points, indicating that differences of this size or smaller represent meaningful differences). RSES scores also strongly differentiated those with and without COPD (d=1.52). Smokers’ RSES scores were significantly higher than former smokers’ scores (P<.001). Switchers’ RSES scores were significantly lower than smokers’ scores (P<.001) and no different from former smokers’ scores (P=.34). Conclusions: The RSES fills an important gap in the existing toolkit of respiratory symptom questionnaires; it is a reliable and valid tool to assess respiratory symptoms in adult current and former smokers, including those who have switched to noncombusted nicotine products. This suggests that the scale is sensitive to respiratory symptoms that develop in smokers and to their remission when smokers quit or switch to noncombusted nicotine products intended to reduce the harm of smoking. The findings also suggest that switching from cigarettes to ENDS may improve respiratory health. %M 37058347 %R 10.2196/44036 %U https://formative.jmir.org/2023/1/e44036 %U https://doi.org/10.2196/44036 %U http://www.ncbi.nlm.nih.gov/pubmed/37058347 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44503 %T An Avatar-Led Web-Based and SMS Text Message Smoking Cessation Program for Socioeconomically Disadvantaged Veterans: Pilot Randomized Controlled Trial %A Heffner,Jaimee L %A Kelly,Megan M %A Reilly,Erin D %A Reece,Scott G %A Claudio,Tracy %A Serfozo,Edit %A Baker,Kelsey %A Watson,Noreen L %A Karekla,Maria %+ Fred Hutchinson Cancer Center, 1100 Fairview Ave N, M3-B232 PO Box 19024, Seattle, WA, 98109, United States, 1 2066677314, jheffner@fredhutch.org %K embodied agent %K tobacco cessation %K nicotine dependence %K mobile health %K mHealth %D 2023 %7 14.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the declining prevalence of cigarette smoking in the United States, socioeconomically disadvantaged veterans receiving care from the Veterans Health Administration have a high prevalence of smoking. Currently, available treatment options for these veterans focus on tobacco users who are ready to quit and have limited reach. Consequently, there is a great need for accessible, effective smoking cessation interventions for veterans at all levels of readiness to quit smoking. Objective: To address these needs, we developed Vet Flexiquit, a web-based Acceptance and Commitment Therapy program for veterans, and evaluated its acceptability (primary aim), efficacy, and impact on theory-based change processes relative to the National Cancer Institute’s SmokefreeVET program in a pilot randomized controlled trial. Methods: Participants (N=49) were randomized 1:1 to receive either the Vet Flexiquit (n=25) or SmokefreeVET (n=24) web program. Both groups received SMS text messages as part of the intervention for 6 weeks. Both interventions are fully automated and self-guided. Primary outcome data were collected at 3 months after the randomization. Self-reported smoking abstinence was biochemically verified using saliva cotinine. Multivariable logistic regression, negative binomial regression, and linear regression models were used to evaluate the association between the treatment arm and outcomes of interest. Results: Acceptability, as measured by overall treatment satisfaction, was high and similar across treatment arms: 100% (17/17) for Vet Flexiquit and 95% (18/19) for SmokefreeVET. Acceptability, as measured by utilization, was more modest (log-ins: M=3.7 for Vet Flexiquit and M=3.2 for SmokefreeVET). There were no statistically significant differences between treatment arms for any acceptability measures. Similarly, there were no statistically significant differences between treatment arms in the secondary outcomes of smoking cessation or change in Acceptance and Commitment Therapy’s theory-based processes. In open-ended survey responses, some veterans in both treatment arms expressed interest in having support from a professional or peer to enhance their experience, as well as an expanded SMS text messaging program. Conclusions: Both programs had high ratings of acceptability, limited utilization, and a similar impact on cessation and cessation processes. Taken together with the qualitative data suggesting that additional support may enhance participants’ experience of both programs, these preliminary findings suggest that the programs may have similar outcomes among veterans who are looking for a digital cessation treatment option and that integrating provider or peer support and enhancing the SMS text messaging program holds promise as a means of boosting engagement and outcomes for both programs. Trial Registration: ClinicalTrials.gov NCT04502524; https://clinicaltrials.gov/ct2/show/NCT04502524 %M 37058346 %R 10.2196/44503 %U https://formative.jmir.org/2023/1/e44503 %U https://doi.org/10.2196/44503 %U http://www.ncbi.nlm.nih.gov/pubmed/37058346 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43512 %T Examining Visual Attention to Tobacco Marketing Materials Among Young Adult Smokers: Protocol for a Remote Webcam-Based Eye-Tracking Experiment %A Chen-Sankey,Julia %A Elhabashy,Maryam %A Gratale,Stefanie %A Geller,Jason %A Mercincavage,Melissa %A Strasser,Andrew A %A Delnevo,Cristine D %A Jeong,Michelle %A Wackowski,Olivia A %+ Center for Tobacco Studies, School of Public Health, Rutgers Biomedical and Health Sciences, 303 George St. Room 525, New Brunswick, NJ, 08901, United States, 1 838 932 1855, jc.sankey@rutgers.edu %K eye tracking %K remote eye tracking %K e-cigarette marketing %K young adults %K mobile phone %D 2023 %7 13.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Eye tracking provides an objective way to measure attention, which can advance researchers’ and policy makers’ understanding of tobacco marketing influences. The development of remote webcam-based eye-tracking technology, integrated with web-based crowdsourcing studies, may be a cost-effective and time-efficient alternative to laboratory-based eye-tracking methods. However, research is needed to evaluate the utility of remote eye-tracking methods. Objective: This study aimed to detail the process of designing a remote webcam-based eye-tracking experiment and provide data on associations between participant characteristics and the outcomes of experiment completion. Methods: A total of 2023 young adult (aged 18-34 years) cigarette smokers in the United States were recruited to complete a web-based survey that included a 90-second remote eye-tracking experiment that examined attention to e-cigarette marketing materials. Primary outcome measures assessed the completion of the remote eye-tracking experiment—specifically, experiment initiated versus not initiated, experiment completed versus not completed, and usable versus nonusable eye-tracking data generated. Multivariable logistic regressions examined the associations between outcome measures and participants’ sociodemographic backgrounds, tobacco use history, and electronic devices (mobile vs desktop) used during the experiment. Results: Study recruitment began on April 14, 2022, and ended on May 3, 2022. Of the 2023 survey participants, 1887 (93.28%) initiated the experiment, and 777 (38.41%) completed the experiment. Of the 777 participants who completed the experiment, 381 (49%) generated usable data. Results from the full regression models show that non-Hispanic Black participants (adjusted odds ratio [AOR] 0.64, 95% CI 0.45-0.91) were less likely to complete the eye-tracking experiment than non-Hispanic White participants. In addition, female (vs male) participants (AOR 1.46, 95% CI 1.01-2.11), those currently using (vs not using) e-cigarettes (AOR 2.08, 95% CI 1.13-3.82), and those who used mobile (vs desktop) devices (AOR 5.10, 95% CI 3.05-8.52) were more likely to generate usable eye-tracking data. Conclusions: Young adult participants were willing to try remote eye-tracking technology, and nearly half of those who completed the experiment generated usable eye-tracking data (381/777, 49%). Thus, we believe that the use of remote eye-tracking tools, integrated with crowdsourcing recruitment, can be a useful approach for the tobacco regulatory science research community to collect high-quality, large-scale eye-tracking data in a timely fashion and thereby address research questions related to the ever-evolving tobacco marketing landscape. It would be useful to investigate techniques to enhance completion rates and data usability. International Registered Report Identifier (IRRID): RR1-10.2196/43512 %M 37052989 %R 10.2196/43512 %U https://www.researchprotocols.org/2023/1/e43512 %U https://doi.org/10.2196/43512 %U http://www.ncbi.nlm.nih.gov/pubmed/37052989 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e42218 %T Influence of User Profile Attributes on e-Cigarette–Related Searches on YouTube: Machine Learning Clustering and Classification %A Murthy,Dhiraj %A Lee,Juhan %A Dashtian,Hassan %A Kong,Grace %+ Computational Media Lab, School of Journalism and Media, Moody College of Communication, The University of Texas at Austin, 300 W Dean Keeton (A0900), Austin, TX, 78712, United States, 1 512 471 5775, dhiraj.murthy@austin.utexas.edu %K electronic cigarettes %K electronic nicotine delivery systems %K ENDS %K tobacco products %K YouTube %K social media %K minority groups %K exposure %K youth %K behavior %K user %K machine learning %K policy %D 2023 %7 12.4.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The proliferation of e-cigarette content on YouTube is concerning because of its possible effect on youth use behaviors. YouTube has a personalized search and recommendation algorithm that derives attributes from a user’s profile, such as age and sex. However, little is known about whether e-cigarette content is shown differently based on user characteristics. Objective: The aim of this study was to understand the influence of age and sex attributes of user profiles on e-cigarette–related YouTube search results. Methods: We created 16 fictitious YouTube profiles with ages of 16 and 24 years, sex (female and male), and ethnicity/race to search for 18 e-cigarette–related search terms. We used unsupervised (k-means clustering and classification) and supervised (graph convolutional network) machine learning and network analysis to characterize the variation in the search results of each profile. We further examined whether user attributes may play a role in e-cigarette–related content exposure by using networks and degree centrality. Results: We analyzed 4201 nonduplicate videos. Our k-means clustering suggested that the videos could be clustered into 3 categories. The graph convolutional network achieved high accuracy (0.72). Videos were classified based on content into 4 categories: product review (49.3%), health information (15.1%), instruction (26.9%), and other (8.5%). Underage users were exposed mostly to instructional videos (37.5%), with some indication that more female 16-year-old profiles were exposed to this content, while young adult age groups (24 years) were exposed mostly to product review videos (39.2%). Conclusions: Our results indicate that demographic attributes factor into YouTube’s algorithmic systems in the context of e-cigarette–related queries on YouTube. Specifically, differences in the age and sex attributes of user profiles do result in variance in both the videos presented in YouTube search results as well as in the types of these videos. We find that underage profiles were exposed to e-cigarette content despite YouTube’s age-restriction policy that ostensibly prohibits certain e-cigarette content. Greater enforcement of policies to restrict youth access to e-cigarette content is needed. %M 37124246 %R 10.2196/42218 %U https://infodemiology.jmir.org/2023/1/e42218 %U https://doi.org/10.2196/42218 %U http://www.ncbi.nlm.nih.gov/pubmed/37124246 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42346 %T Characterizing e-Cigarette–Related Videos on TikTok: Observational Study %A Xie,Zidian %A Xue,Siyu %A Gao,Yankun %A Li,Dongmei %+ Department of Clinical and Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard Cu 420708, Rochester, NY, 14642-0001, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K e-cigarette %K TikTok %K video %K provaping %K antivaping %D 2023 %7 5.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: As a popular social networking platform for sharing short videos, TikTok has been widely used for sharing e-cigarettes or vaping-related videos, especially among the youth. Objective: This study aims to characterize e-cigarette or vaping-related videos and their user engagement on TikTok through descriptive analysis. Methods: From TikTok, a total of 417 short videos, posted between October 4, 2018, and February 27, 2021, were collected using e-cigarette or vaping-related hashtags. Two human coders independently hand-coded the video category and the attitude toward vaping (provaping or antivaping) for each vaping-related video. The social media user engagement measures (eg, the comment count, like count, and share count) for each video category were compared within provaping and antivaping groups. The user accounts posting these videos were also characterized. Results: Among 417 vaping-related TikTok videos, 387 (92.8%) were provaping, and 30 (7.2%) were antivaping videos. Among provaping TikTok videos, the most popular category is vaping tricks (n=107, 27.65%), followed by advertisement (n=85, 21.95%), customization (n=75, 19.38%), TikTok trend (n=70, 18.09%), others (n=44, 11.37%), and education (n=6, 1.55%). By comparison, videos showing the TikTok trend had significantly higher user engagement (like count per video) than other provaping videos. Antivaping videos included 15 (50%) videos with the TikTok trend, 10 (33.33%) videos on education, and 5 (16.67%) videos about others. Videos with education have a significantly lower number of likes than other antivaping videos. Most TikTok users posting vaping-related videos are personal accounts (119/203, 58.62%). Conclusions: Vaping-related TikTok videos are dominated by provaping videos focusing on vaping tricks, advertisement, customization, and TikTok trend. Videos with the TikTok trend have higher user engagement than other video categories. Our findings provide important information on vaping-related videos shared on TikTok and their user engagement levels, which might provide valuable guidance on future policy making, such as possible restrictions on provaping videos posted on TikTok, as well as how to effectively communicate with the public about the potential health risks of vaping. %M 37018026 %R 10.2196/42346 %U https://formative.jmir.org/2023/1/e42346 %U https://doi.org/10.2196/42346 %U http://www.ncbi.nlm.nih.gov/pubmed/37018026 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42628 %T Comparing the Effectiveness, Tolerability, and Acceptability of Heated Tobacco Products and Refillable Electronic Cigarettes for Cigarette Substitution (CEASEFIRE): Randomized Controlled Trial %A Caponnetto,Pasquale %A Campagna,Davide %A Maglia,Marilena %A Benfatto,Francesca %A Emma,Rosalia %A Caruso,Massimo %A Caci,Grazia %A Busà,Barbara %A Pennisi,Alfio %A Ceracchi,Maurizio %A Migliore,Marcello %A Signorelli,Maria %+ Center of Excellence for the Acceleration of Harm Reduction, University of Catania, Via Santa Sofia, Catania, Italy, 39 0954781124, p.caponnetto@unict.it %K harm reduction %K heat not burn %K electronic cigarettes %K smoking cessation %K smoking reduction %K e-cigarette %K public health %K psychological well-being %D 2023 %7 4.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: People who smoke and who face challenges trying to quit or wish to continue to smoke may benefit by switching from traditional cigarettes to noncombustible nicotine delivery alternatives, such as heated tobacco products (HTPs) and electronic cigarettes (ECs). HTPs and ECs are being increasingly used to quit smoking, but there are limited data about their effectiveness. Objective: We conducted the first randomized controlled trial comparing quit rates between HTPs and ECs among people who smoke and do not intend to quit. Methods: We conducted a 12-week randomized noninferiority switching trial to compare effectiveness, tolerability, and product satisfaction between HTPs (IQOS 2.4 Plus) and refillable ECs (JustFog Q16) among people who do not intend to quit. The cessation intervention included motivational counseling. The primary endpoint of the study was the carbon monoxide–confirmed continuous abstinence rate from week 4 to week 12 (CAR weeks 4-12). The secondary endpoints included the continuous self-reported ≥50% reduction in cigarette consumption rate (continuous reduction rate) from week 4 to week 12 (CRR weeks 4-12) and 7-day point prevalence of smoking abstinence. Results: A total of 211 participants completed the study. High quit rates (CAR weeks 4-12) of 39.1% (43/110) and 30.8% (33/107) were observed for IQOS-HTP and JustFog-EC, respectively. The between-group difference for the CAR weeks 4-12 was not significant (P=.20). The CRR weeks 4-12 values for IQOS-HTP and JustFog-EC were 46.4% (51/110) and 39.3% (42/107), respectively, and the between-group difference was not significant (P=.24). At week 12, the 7-day point prevalence of smoking abstinence values for IQOS-HTP and JustFog-EC were 54.5% (60/110) and 41.1% (44/107), respectively. The most frequent adverse events were cough and reduced physical fitness. Both study products elicited a moderately pleasant user experience, and the between-group difference was not significant. A clinically relevant improvement in exercise tolerance was observed after switching to the combustion-free products under investigation. Risk perception for conventional cigarettes was consistently higher than that for the combustion-free study products under investigation. Conclusions: Switching to HTPs elicited a marked reduction in cigarette consumption among people who smoke and do not intend to quit, which was comparable to refillable ECs. User experience and risk perception were similar between the HTPs and ECs under investigation. HTPs may be a useful addition to the arsenal of reduced-risk alternatives for tobacco cigarettes and may contribute to smoking cessation. However, longer follow-up studies are required to confirm significant and prolonged abstinence from smoking and to determine whether our results can be generalized outside smoking cessation services offering high levels of support. Trial Registration: ClinicalTrials.gov NCT03569748; https://clinicaltrials.gov/ct2/show/NCT03569748 %M 37014673 %R 10.2196/42628 %U https://publichealth.jmir.org/2023/1/e42628 %U https://doi.org/10.2196/42628 %U http://www.ncbi.nlm.nih.gov/pubmed/37014673 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44146 %T Acceptance and Commitment Therapy Wellness Program for Latine Adults Who Smoke and Have Psychological Distress: Protocol for a Feasibility Study %A Correa-Fernández,Virmarie %A Blalock,Janice A %A Piper,Megan E %A Canino,Glorisa %A Wetter,David W %+ Department of Psychological, Health, & Learning Sciences, University of Houston, 3657 Cullen Blvd. #491 (Farish Hall), Houston, TX, 77204, United States, 1 7137430334, vcorreaf@central.uh.edu %K acceptance and commitment therapy %K Hispanic or Latine %K smoking %K telehealth %D 2023 %7 4.4.2023 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Tobacco smoking is a major independent risk factor for chronic disease, and the prevalence of smoking among people with behavioral health disorders is 2-fold in comparison with the general population. Smoking rates remain high for various subgroups within the Latine community, the largest ethnic minority group in the United States. Acceptance and commitment therapy (ACT) is a theoretically sound and clinically validated therapeutic approach for several behavioral health conditions with growing evidence of its effectiveness for smoking cessation. Unfortunately, the evidence of ACT effectiveness for smoking cessation among Latine individuals is scarce, and none of the existing studies have tested a culturally targeted intervention for this population. Objective: This study aims to address the co-occurrence of smoking and mood-related challenges among Latine adults via the development and testing of a culturally tailored ACT-based wellness program: Project PRESENT. Methods: This study entails 2 phases. Phase 1 consists of the intervention development. Phase 2 entails the pilot testing of the behavioral intervention along with the administration of baseline and follow-up measures to 38 participants. Primary outcomes include feasibility of recruitment and retention, and treatment acceptability. Secondary outcomes are smoking status and depression and anxiety scores at end of treatment and 1-month follow-up. Results: This study received institutional review board approval. Phase 1 outputs were the health counselors’ treatment manual and participant guide. Recruitment was completed in 2021. Phase 2 outcomes will be determined after project implementation and data analyses are complete, which are expected by May 2023. Conclusions: Findings from this study will determine the feasibility and acceptability of an ACT-based, culturally relevant intervention for Latine adults who smoke and have probable depression and/or anxiety. We expect feasibility of recruitment, retention and treatment acceptability, and reductions in smoking status, depression, and anxiety. If feasible and acceptable, the study will inform large-scale trials, which will ultimately contribute to narrowing the gap between research and clinical practice for the co-occurrence of smoking and psychological distress among Latine adults. International Registered Report Identifier (IRRID): DERR1-10.2196/44146 %M 37014678 %R 10.2196/44146 %U https://www.researchprotocols.org/2023/1/e44146 %U https://doi.org/10.2196/44146 %U http://www.ncbi.nlm.nih.gov/pubmed/37014678 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44041 %T Development of a Conversational Agent for Individuals Ambivalent About Quitting Smoking: Protocol for a Proof-of-Concept Study %A Nair,Uma S %A Greene,Karah %A Marhefka,Stephanie %A Kosyluk,Kristin %A Galea,Jerome T %+ College of Nursing, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL, 33612, United States, 1 813 974 2578, nairu@usf.edu %K cigarettes %K conversational agent %K mhealth %K smoking cessation %D 2023 %7 31.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cigarette smoking is the leading preventable cause of disease and death in the United States. Despite the availability of a plethora of evidence-based smoking cessation resources, less than one-third of individuals who smoke seek cessation services, and individuals using these services are often those who are actively contemplating quitting smoking. There is a distinct dearth of low-cost, scalable interventions to support smokers not ready to quit (ambivalent smokers). Such interventions can assist in gradually promoting smoking behavior changes in this target population until motivation to quit arises, at which time they can be navigated to existing evidence-based smoking cessation interventions. Conversational agents or chatbots could provide cessation education and support to ambivalent smokers to build motivation and navigate them to evidence-based resources when ready to quit. Objective: The goal of our study is to test the proof-of-concept of the development and preliminary feasibility and acceptability of a smoking cessation support chatbot. Methods: We will accomplish our study aims in 2 phases. In phase 1, we will survey 300 ambivalent smokers to determine their preferences and priorities for a smoking cessation support chatbot. A “forced-choice experiment” will be administered to understand participants’ preferred characteristics (attributes) of the proposed chatbot prototype. The data gathered will be used to program the prototype. In phase 2, we will invite 25 individuals who smoke to use the developed prototype. For this phase, participants will receive an overview of the chatbot and be encouraged to use the chatbot and engage and interact with the programmed attributes and components for a 2-week period. Results: At the end of phase 1, we anticipate identifying key attributes that ambivalent smokers prefer in a smoking cessation support chatbot. At the end of phase 2, chatbot acceptability and feasibility will be assessed. The study was funded in June 2022, and data collection for both phases of the study is currently ongoing. We expect study results to be published by December 2023. Conclusions: Study results will yield a smoking behavior change chatbot prototype developed for ambivalent smokers that will be ready for efficacy testing in a larger study. International Registered Report Identifier (IRRID): DERR1-10.2196/44041 %M 37000505 %R 10.2196/44041 %U https://www.researchprotocols.org/2023/1/e44041 %U https://doi.org/10.2196/44041 %U http://www.ncbi.nlm.nih.gov/pubmed/37000505 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40782 %T Trends in Exposure to Secondhand Smoke Among Adolescents in China From 2013-2014 to 2019: Two Repeated National Cross-sectional Surveys %A Ma,Chuanwei %A Huang,Yayang %A Li,Sixuan %A Zhao,Min %A Zeng,Xinying %A Di,Xinbo %A Magnussen,Costan G %A Xi,Bo %A Liu,Shiwei %+ Tobacco Control Office, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Beijing, 100050, China, 86 1063185150, shiwei_liu@aliyun.com %K secondhand smoke exposure %K trends %K adolescents %K China %K secondhand smoke %K youth %D 2023 %7 24.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: It is well-known that secondhand smoke exposure in childhood or adolescence is positively associated with morbidity and mortality. However, less is known about the current status of and most recent trends in secondhand smoke exposure among adolescents in China. Objective: We aimed to assess recent changes in the prevalence of secondhand smoke exposure among adolescents in China using nationally representative data. Methods: We used data from 2 repeated national cross-sectional surveys conducted in 2013-2014 and 2019. A total of 155,117 students (median age 13.5 years) in 2013-2014 and 147,270 students (median age 13.1 years) in 2019 were included in this study. Sociodemographic factors and secondhand smoke exposure information were collected via a standardized questionnaire. Exposure was defined as secondhand smoke exposure ≥1 day during the past 7 days at home or in public places. Other frequencies of secondhand smoke exposure (ie, ≥3 days, ≥5 days, and every day) during the past 7 days were also assessed. The weighted prevalence of secondhand smoke exposure was calculated according to the complex sample design for surveys. Results: The prevalence of secondhand smoke exposure in any place (home or public places ≥1 day during the past 7 days) decreased from 2013-2014 (72.9%, 95% CI 71.5%-74.3%) to 2019 (63.2%, 95% CI 62%-64.5%), as did exposure at home (2013-2014: 44.4%, 95% CI 43.1%-45.7%; 2019: 34.1%, 95% CI 33.1%-35.2%) and in public places (2013-2014: 68.3%, 95% CI 66.9%-69.6%; 2019: 57.3%, 95% CI 56%-58.6%). The prevalence of secondhand smoke exposure decreased with increased gross domestic product per capita in each of the 2 survey years irrespective of exposure frequency or location. The prevalence of exposure at other frequencies (ie, ≥3 days, ≥5 days, or every day during the past 7 days) also decreased in any place, at home, and in public places. Secondhand smoke exposure was associated with higher school grade level (ninth vs seventh grade: odds ratio [OR] 1.76, 95% CI 1.68-1.84), gender (boys vs girls: OR 1.18, 95% CI 1.15-1.22), urban status (urban vs rural: OR 1.10, 95% CI 1.01-1.19), and cigarette smoking (yes vs no: OR 6.67, 95% CI 5.83-7.62). Conclusions: Although the prevalence of secondhand smoke exposure among Chinese adolescents declined from 2013-2014 to 2019, it remains unacceptably high. More effective strategies and stronger action are needed in China to further, and dramatically, curb secondhand smoke exposure among adolescents. %M 36961497 %R 10.2196/40782 %U https://publichealth.jmir.org/2023/1/e40782 %U https://doi.org/10.2196/40782 %U http://www.ncbi.nlm.nih.gov/pubmed/36961497 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40177 %T Monitoring and Combating Waterpipe Tobacco Smoking Through Surveillance and Taxation %A Saad,Randa K %A Maiteh,Adna %A Nakkash,Rima %A Salloum,Ramzi G %A Chalak,Ali %A Abu-Rmeileh,Niveen M E %A Khader,Yousef %A Al Nsour,Mohannad %+ Global Health Development | Eastern Mediterranean Public Health Network, Abdallah Ben Abbas St 42, Amman, 11196, Jordan, 962 781665060, randaksaad@gmail.com %K waterpipe tobacco %K smoking %K tobacco taxation %K Global Tobacco Surveillance System %K GTSS %K Eastern Mediterranean Region %K tobacco %K public health %K surveillance %K taxation %D 2023 %7 23.3.2023 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Waterpipe tobacco smoking (WTS) is a traditional tobacco use method that originated in the Eastern Mediterranean Region (EMR) and has resurged in recent decades. WTS rates in the EMR are the highest worldwide, especially among youth, exceeding cigarette-smoking rates in select jurisdictions. Despite its documented harm, the growing prevalence of WTS has been met with a poor regulatory response globally. At the epicenter of the WTS epidemic, countries in the EMR are in urgent need of effective tobacco control strategies that consider the particularities of WTS. A roundtable session, titled “Monitoring and Combating WTS Through Taxation and the Global Tobacco Surveillance System (GTSS),” was held as part of the 7th Eastern Mediterranean Public Health Network’s regional conference. The session provided an overview of evidence to date about WTS policy control, the taxation of WTS, volumetric choice experiments for tobacco control research, and monitoring WTS patterns and control policies among adults and youth through the GTSS. The session highlighted the need to update the regulation of WTS in the current global tobacco control policy frameworks and the need for developing tailored, evidence-based, and WTS-specific regulations to complement current tobacco control policy frameworks. Raising taxes to increase the price of tobacco products is the single most effective tobacco control measure, and these taxes can fund expanded government health programs. The effectiveness of taxation can be measured via volumetric choice experiments, which allow for the estimation of a complete set of own-price and cross-price elasticities that are instrumental for fiscal policy simulations. Finally, the surveillance of WTS (for example, through the GTSS) is critical to informing policy and decision makers. The Global Youth Tobacco Survey (GYTS) and Global Adult Tobacco Survey (GATS) are 2 GTSS products that provide nationally representative data among students aged 13-15 years and persons ≥15 years, respectively. %M 36951907 %R 10.2196/40177 %U https://publichealth.jmir.org/2023/1/e40177 %U https://doi.org/10.2196/40177 %U http://www.ncbi.nlm.nih.gov/pubmed/36951907 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42776 %T The Usefulness of a Smartphone App–Based Smoking Cessation Program for Conventional Cigarette Users, Heated Tobacco Product Users, and Dual Users: Retrospective Study %A Noda,Yuko %A So,Ryuhei %A Sonoda,Misaki %A Tabuchi,Takahiro %A Nomura,Akihiro %+ Department of Biomedical Informatics, CureApp Institute, 4136-1 Azayakozawa, Nagakura, Karuizawa, 389-0111, Japan, 81 9087019830, akihiro.nomura@cureapp.institute %K smoking cessation %K nicotine dependence %K digital therapeutics %K telemedicine %K telecare %K mobile phone %K smoking cessation program %K online counseling %K online therapy %K heated tobacco product %K HTP %D 2023 %7 17.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Heated tobacco products (HTPs) are widespread in Japan, and smoking cessation of such products has become an important issue owing to the spread of harmful effects from HTPs. The efficacy of online digital therapy has been reported in smoking cessation treatment; however, we have limited evidence of online smoking cessation programs for HTP users. Objective: In this study, we evaluate the usefulness of the Ascure program for HTP users (defined as exclusive HTP use or dual use of HTP and cigarettes) compared with exclusive cigarette users. Methods: This was a retrospective study. We recruited adult smokers participating in the Ascure online smoking cessation program in Japan from June 2019 to February 2021. The Ascure smartphone app provided four elements: (1) educational video tutorials to enhance the understanding of nicotine dependence, (2) a personalized to-do list for behavior change, (3) a digital diary for record keeping, and (4) interactive chat sessions for relief from cravings or withdrawal symptoms. The primary outcome was the continuous abstinence rate (CAR) at weeks 21 to 24, biochemically validated using salivary cotinine testing. We considered those who dropped out of the program as smoking cessation failures. We analyzed the primary outcome using inverse probability weighting against tobacco product type estimated by multinomial propensity scores. We also assessed CAR at weeks 9 to 12 and program adherence. Results: We analyzed data from 2952 participants, including 52% (1524/3478) in the cigarette group, 35% (1038/3478) in the HTP group, and 13% (390/3478) in the dual-use group, who had a mean age of 43.4 (SD 10.8) years and included 17% (513/2952) women. CAR at weeks 21 to 24 showed that exclusive HTP users were more likely to stop tobacco use than exclusive cigarette smokers (CAR 52.6% for cigarette users vs CAR 64.8% for HTP users; odds ratio [OR] 1.17, 95% CI 1.12-1.22; P<.001). There was no significant difference between the exclusive cigarette users and the dual users (CAR 52.6% for cigarette users vs CAR 48.7% for dual users; OR 0.99, 95% CI 0.93-1.05; P=.77). CAR at weeks 9 to 12 was 56.7% (95% CI 54.2%-59.2%) for the exclusive cigarette users, 68.3% (95% CI 65.5%-71.1%) for the exclusive HTP users, and 58.2% (95% CI 53.3%-63.1%) for the dual users. The program adherence rate at week 24 was 70.7% overall (68.4% for cigarette users, 75% for HTP users, and 67.9% for dual users). Conclusions: Exclusive HTP users had higher CARs and adherence compared with exclusive cigarette users, indicating a higher affinity for the Ascure online smoking cessation program. This program might be a useful smoking cessation option for HTP users, as well as for cigarette smokers. %M 36930197 %R 10.2196/42776 %U https://www.jmir.org/2023/1/e42776 %U https://doi.org/10.2196/42776 %U http://www.ncbi.nlm.nih.gov/pubmed/36930197 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e41182 %T The Impact of Digital Health on Smoking Cessation %A Cobos-Campos,Raquel %A Cordero-Guevara,Jose Aurelio %A Apiñaniz,Antxon %A de Lafuente,Arantza Sáez %A Bermúdez Ampudia,Cristina %A Argaluza Escudero,Julene %A Pérez Llanos,Iraida %A Parraza Diez,Naiara %+ Epidemiology and Public Health Group, Bioaraba Health Research Institute, José Atxotegi s/n, Vitoria-Gasteiz, 01009, Spain, 34 680953032, raquelcobos1976@gmail.com %K smoking cessation %K smoking %K cessation %K smoker %K quit %K care delivery %K service delivery %K health technology %K mHealth %K mobile applications %K mobile health %K digital health %K mobile app %K health app %K smartphone %K health service %K eHealth %K trend %D 2023 %7 15.3.2023 %9 Viewpoint %J Interact J Med Res %G English %X Background: Smartphones have become useful tools for medicine, with the use of specific apps making it possible to bring health care closer to inaccessible areas, continuously monitor a patient's pathology at any time and place, promote healthy habits, and ultimately improve patients’ quality of life and the efficiency of the health care system. Since 2020, the use of smartphones has reached unprecedented levels. There are more than 350,000 health apps, according to a 2021 IQVIA Institute report, that address, among other things, the management of patient appointments; communication among different services or professionals; the promotion of lifestyle changes related to adopting healthy habits; and the monitoring of different pathologies and chronic conditions, including smoking cessation. The number of mobile apps for quitting smoking is high. As early as 2017, a total of 177 unique smoking cessation–relevant apps were identified in the iPhone App Store, 139 were identified in Google Play, 70 were identified in the BlackBerry app store, and 55 were identified in the Windows Phone Store, but very few have adequate scientific support. It seems clear that efforts are needed to assess the quality of these apps, as well as their effectiveness in different population groups, to have tools that offer added value to standard practices. Objective: This viewpoint aims to highlight the benefits of mobile health (mHealth) and its potential as an adjuvant tool in health care. Methods: A review of literature and other data sources was performed in order to show the current status of mobile apps that can offer support for smoking cessation. For this purpose, the PubMed, Embase, and Cochrane databases were explored between May and November 2022. Results: In terms of smoking cessation, mHealth has become a powerful coadjuvant tool that allows health workers to perform exhaustive follow-ups for the process of quitting tobacco and provide support anytime and anywhere. mHealth tools are effective for different groups of smokers (eg, pregnant women, patients with chronic obstructive pulmonary disease, patients with mental illness, and the general population) and are cost-effective, generating savings for the health system. However, there are some patient characteristics that can predict the success of using mobile apps in the smoking cessation process, such as the lower age of patients, dependence on tobacco, the number of quit attempts, and the previous use of mobile apps, among others. Therefore, it is preferable to offer these tools to patients with a higher probability of quitting tobacco. Conclusions: mHealth is a promising tool for helping smokers in the smoking cessation process. There is a need for well-designed clinical studies and economic evaluations to jointly assess the effectiveness of new interventions in different population groups, as well as their impact on health care resources. %M 36920468 %R 10.2196/41182 %U https://www.i-jmr.org/2023/1/e41182 %U https://doi.org/10.2196/41182 %U http://www.ncbi.nlm.nih.gov/pubmed/36920468 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43334 %T Characterizing Heated Tobacco Products Marketing on Instagram: Observational Study %A Chen,Jiarui %A Xue,Siyu %A Xie,Zidian %A Li,Dongmei %+ Department of Clinical and Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard Cu 420708, Rochester, NY, 14642-0001, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K IQOS %K Instagram %K heated tobacco products %K web-based tobacco marketing %D 2023 %7 15.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Heated tobacco products (HTPs), including I Quit Ordinary Smoking (IQOS), are new tobacco products that use an electronic device to heat compressed tobacco leaves to generate an aerosol for consumers to inhale. Marketing of HTPs is prevalent on Instagram, a popular social media platform. Objective: This study aims to characterize posts related to HTPs on Instagram and their associations with user engagement. Methods: Through the Instagram application programming interface, 979 Instagram posts were collected using keywords related to HTPs, such as “IQOS” and “heat-not-burn.” Among them, 596 posts were related to IQOS and other HTP marketing. The codebook was developed from a randomly selected 200 posts on the post content by hand coding, which was applied to the remaining 396 Instagram posts. Summary statistics were calculated, and statistical hypothesis testing was conducted to understand the popularity of Instagram posts on HTPs. Negative binomial regression models were applied to identify Instagram post characteristics associated with user engagement (eg, count). Results: Among Instagram posts related to HTP marketing (N=596), “product display” was dominant (n=550, 92.28%), followed by “brand promotion” (n=41, 6.88%), and “others” (n=5, 0.84%). Among posts within “product display,” “device only” was the most popular (n=338, 61.45%), followed by “heatstick only” (n=80, 14.55%), “accessory” (n=66, 12%), “device and heatstick” (n=56, 10.18%), and “capsule” (n=10, 1.82%). A univariate negative binomial regression model with pairwise comparisons across “product display” types showed that the number of likes for posts with HTP heatsticks was significantly lower compared to posts with HTP devices, accessories, and device-heatstick sets. Multivariate negative binomial regression models showed that HTP-related Instagram posts with a model or lifestyle elements (;=.60, 95% CI 0.36-0.84) or without obvious product advertising information (=.69, 95% CI 0.49-0.89) received more likes. Conclusions: It is shown that posts with product displays were dominant among HTP-related posts on Instagram. Posts with model or lifestyle elements are associated with high user engagement, which might be one of the web-based marketing strategies of HTPs. %M 36920463 %R 10.2196/43334 %U https://formative.jmir.org/2023/1/e43334 %U https://doi.org/10.2196/43334 %U http://www.ncbi.nlm.nih.gov/pubmed/36920463 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43586 %T Disparity in Lung Cancer Screening Among Smokers and Nonsmokers in China: Prospective Cohort Study %A Wang,Le %A Wang,Youqing %A Wang,Fei %A Gao,Yumeng %A Fang,Zhimei %A Gong,Weiwei %A Li,Huizhang %A Zhu,Chen %A Chen,Yaoyao %A Shi,Lei %A Du,Lingbin %A Li,Ni %+ Department of Cancer Prevention, Zhejiang Cancer Hospital, Institute of Basic Medicine and Cancer (IBMC), Chinese Academy of Sciences, No.1 East Banshan Road, Gongshu District, Hangzhou, 310022, China, 86 571 88122219, dulb@zjcc.org.cn %K lung cancer %K screening %K smoker %K nonsmoker %D 2023 %7 14.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Low-dose computed tomography (LDCT) screening is effective in reducing lung cancer mortality in smokers; however, the evidence in nonsmokers is scarce. Objective: This study aimed to evaluate the participant rate and effectiveness of one-off LDCT screening for lung cancer among smokers and nonsmokers. Methods: A population-based prospective cohort study was performed to enroll participants aged between 40 and 74 years from 2013 to 2019 from 4 cities in Zhejiang Province, China. Participants who were evaluated as having a high risk of lung cancer from an established risk score model were recommended to undergo LDCT screening. Follow-up outcomes were retrieved on June 30, 2020. The uptake rate of LDCT screening for evaluated high-risk participants and the detection rate of early-stage lung cancer (stage 0-I) were calculated. The lung cancer incidence, lung cancer mortality, and all-cause mortality were compared between the screened and nonscreened groups. Results: At baseline, 62.56% (18,818/30,079) of smokers and 6% (5483/91,455) of nonsmokers were identified as high risk (P<.001), of whom 41.9% (7885/18,818) and 66.31% (3636/5483) underwent LDCT screening (P<.001), respectively. After a median follow-up of 5.1 years, 1100 lung cancer cases and 456 all-cause death cases (116 lung cancer death cases) were traced. The proportion of early-stage lung cancer among smokers was 60.3% (173/287), which was lower than the proportion of 80.3% (476/593) among nonsmokers (P<.001). Among smokers, a higher proportion was found in the screened group (72/106, 67.9%) than the nonscreened group (56/114, 49.1%; P=.005), whereas no significance was found (42/44, 96% vs 10/12, 83%; P=.20) among nonsmokers. Compared with participants who were not screened, LDCT screening in smokers significantly increased lung cancer incidence (hazard ratio [HR] 1.39, 95% CI 1.09-1.76; P=.007) but reduced lung cancer mortality (HR 0.52, 95% CI 0.28-0.96; P=.04) and all-cause mortality (HR 0.47, 95% CI 0.32-0.69; P<.001). Among nonsmokers, no significant results were found for lung cancer incidence (P=.06), all-cause mortality (P=.89), and lung cancer mortality (P=.17). Conclusions: LDCT screening effectively reduces lung cancer and all-cause mortality among high-risk smokers. Further efforts to define high-risk populations and explore adequate lung cancer screening modalities for nonsmokers are needed. %M 36917151 %R 10.2196/43586 %U https://publichealth.jmir.org/2023/1/e43586 %U https://doi.org/10.2196/43586 %U http://www.ncbi.nlm.nih.gov/pubmed/36917151 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e41969 %T Compliance With the US Food and Drug Administration’s Guidelines for Health Warning Labels and Engagement in Little Cigar and Cigarillo Content: Computer Vision Analysis of Instagram Posts %A Wu,Jiaxi %A Origgi,Juan Manuel %A Ranker,Lynsie R %A Bhatnagar,Aruni %A Robertson,Rose Marie %A Xuan,Ziming %A Wijaya,Derry %A Hong,Traci %A Fetterman,Jessica L %+ Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University Chobanian & Avedisian School of Medicine, 700 Albany Street, W-602A, Boston, MA, 02118, United States, 1 6173587544, jefetter@bu.edu %K tobacco %K cigar %K little cigar %K cigarillo %K Instagram %K social media %K influencer promotion %K tobacco advertising %K health warning %K machine learning %K computer vision %K warning label %K health label %K health promotion %K advertising %K advertise %K smoking %K smoker %K algorithm %K visualization %D 2023 %7 14.3.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Health warnings in tobacco advertisements provide health information while also increasing the perceived risks of tobacco use. However, existing federal laws requiring warnings on advertisements for tobacco products do not specify whether the rules apply to social media promotions. Objective: This study aims to examine the current state of influencer promotions of little cigars and cigarillos (LCCs) on Instagram and the use of health warnings in influencer promotions. Methods: Instagram influencers were identified as those who were tagged by any of the 3 leading LCC brand Instagram pages between 2018 and 2021. Posts from identified influencers, which mentioned one of the three brands were considered LCC influencer promotions. A novel Warning Label Multi-Layer Image Identification computer vision algorithm was developed to measure the presence and properties of health warnings in a sample of 889 influencer posts. Negative binomial regressions were performed to examine the associations of health warning properties with post engagement (number of likes and comments). Results: The Warning Label Multi-Layer Image Identification algorithm was 99.3% accurate in detecting the presence of health warnings. Only 8.2% (n=73) of LCC influencer posts included a health warning. Influencer posts that contained health warnings received fewer likes (incidence rate ratio 0.59, P<.001, 95% CI 0.48-0.71) and fewer comments (incidence rate ratio 0.46, P<.001, 95% CI 0.31-0.67). Conclusions: Health warnings are rarely used by influencers tagged by LCC brands’ Instagram accounts. Very few influencer posts met the US Food and Drug Administration’s health warning requirement of size and placement for tobacco advertising. The presence of a health warning was associated with lower social media engagement. Our study provides support for the implementation of comparable health warning requirements to social media tobacco promotions. Using an innovative computer vision approach to detect health warning labels in influencer promotions on social media is a novel strategy for monitoring health warning compliance in social media tobacco promotions. %M 37113379 %R 10.2196/41969 %U https://infodemiology.jmir.org/2023/1/e41969 %U https://doi.org/10.2196/41969 %U http://www.ncbi.nlm.nih.gov/pubmed/37113379 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e35045 %T Comparison of a Daily Smartphone App and Retrospective Questionnaire Measures of Adherence to Nicotine Replacement Therapy Among Pregnant Women: Observational Study %A Emery,Joanne %A Huang,Yue %A Naughton,Felix %A Cooper,Sue %A McDaid,Lisa %A Dickinson,Anne %A Clark,Miranda %A Kinahan-Goodwin,Darren %A Thomson,Ross %A Phillips,Lucy %A Lewis,Sarah %A Coleman,Tim %+ School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom, 44 1603 456161, joanne.emery@uea.ac.uk %K smoking cessation %K pregnancy %K nicotine replacement therapy %K treatment adherence measurement %K smartphone app %K questionnaires %K ecological momentary assessment %K mHealth %K mobile health %K smoking %K nicotine %D 2023 %7 7.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Few studies have investigated how to best measure adherence to smoking cessation medications, but continuous usage measures are recommended. Objective: In this first study of its kind, we compared methods for measuring adherence to nicotine replacement therapy (NRT) among pregnant women, investigating the completeness and validity of data collected from daily assessments using a smartphone app versus data collected from retrospective questionnaires. Methods: Women aged ≥16 years who were daily smokers and <25 weeks pregnant were offered smoking-cessation counseling and encouraged to use NRT. For 28 days after setting a quit date (QD), women were asked to report NRT use daily to a smartphone app and to questionnaires administered in person or remotely at 7 and 28 days. For both data collection methods, we provided up to £25 (~US $30) as compensation for the time taken providing research data. Data completeness and NRT use reported to the app and in questionnaires were compared. For each method, we also correlated mean daily nicotine doses reported within 7 days of the QD with Day 7 saliva cotinine concentrations. Results: Of the 438 women assessed for eligibility, 40 participated and 35 accepted NRT. More participants (31/35) submitted NRT usage data to the app by Day 28 (median 25, IQR 11 days) than completed the Day 28 questionnaire (24/35) or either of the two questionnaires (27/35). Data submitted to the app showed a lower reported duration of NRT use compared to that indicated in the questionnaire (median for app 24 days, IQR 10.25; median for questionnaire 28 days, IQR 4.75; P=.007), and there appeared to be specific cases of overreporting to the questionnaire. Mean daily nicotine doses between the QD and Day 7 were lower when calculated using app data (median for app 40 mg, IQR 52.1; median for questionnaire 40 mg, IQR 63.1; P=.001), and some large outliers were evident for the questionnaire. Mean daily nicotine doses, adjusted for cigarettes smoked, were not associated with cotinine concentrations for either method (app rs=0.184, P=.55; questionnaire rs=0.031, P=.92), but the small sample size meant that the analysis was likely underpowered. Conclusions: Daily assessment of NRT use via a smartphone app facilitated more complete data (a higher response rate) than questionnaires, and reporting rates over 28 days were encouraging among pregnant women. App data had better face validity; retrospective questionnaires appeared to overestimate NRT use for some participants. %M 36881452 %R 10.2196/35045 %U https://formative.jmir.org/2023/1/e35045 %U https://doi.org/10.2196/35045 %U http://www.ncbi.nlm.nih.gov/pubmed/36881452 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e38732 %T The Vaping and Patterns of e-Cigarette Use Research Study: Protocol for a Web-Based Cohort Study %A Hardesty,Jeffrey J %A Crespi,Elizabeth %A Nian,Qinghua %A Sinamo,Joshua K %A Breland,Alison B %A Eissenberg,Thomas %A Welding,Kevin %A Kennedy,Ryan David %A Cohen,Joanna E %+ Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElddery St, Fourth Floor, Baltimore, MD, 21205, United States, 1 410 502 8835, jhardesty@jhu.edu %K internet %K web-based %K cohort %K survey %K e-cigarettes %K electronic nicotine delivery systems %K ENDS %K tobacco %K recruitment %K data collection %K strategies %K lessons learned %K mobile phone %D 2023 %7 2.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: In total, 3.2% of American adults report using e-cigarettes every day or some days. The Vaping and Patterns of E-cigarette Use Research (VAPER) Study is a web-based longitudinal survey designed to observe patterns in device and liquid use that suggest the benefits and unintended consequences of potential e-cigarette regulations. The heterogeneity of the e-cigarette devices and liquids on the market, the customizability of the devices and liquids, and the lack of standardized reporting requirements result in unique measurement challenges. Furthermore, bots and survey takers who submit falsified responses are threats to data integrity that require mitigation strategies. Objective: This paper aims to describe the protocols for 3 waves of the VAPER Study and discuss recruitment and data processing experiences and lessons learned, including the benefits and limitations of bot- and fraudulent survey taker–related strategies. Methods: American adults (aged ≥21 years) who use e-cigarettes ≥5 days per week are recruited from up to 404 Craigslist catchment areas covering all 50 states. The questionnaire measures and skip logic are designed to accommodate marketplace heterogeneity and user customization (eg, different skip logic pathways for different device types and customizations). To reduce reliance on self-report data, we also require participants to submit a photo of their device. All data are collected using REDCap (Research Electronic Data Capture; Vanderbilt University). Incentives are US $10 Amazon gift codes delivered by mail to new participants and electronically to returning participants. Those lost to follow-up are replaced. Several strategies are applied to maximize the odds that participants who receive incentives are not bots and are likely to possess an e-cigarette (eg, required identity check and photo of a device). Results: In total, 3 waves of data were collected between 2020 and 2021 (wave 1: n=1209; wave 2: n=1218; wave 3: n=1254). Retention from waves 1 to 2 was 51.94% (628/1209), and 37.55% (454/1209) of the wave 1 sample completed all 3 waves. These data were mostly generalizable to daily e-cigarette users in the United States, and poststratification weights were generated for future analyses. Our data offer a detailed examination of users’ device features and specifications, liquid characteristics, and key behaviors, which can provide more insights into the benefits and unintended consequences of potential regulations. Conclusions: Relative to existing e-cigarette cohort studies, this study methodology has some advantages, including efficient recruitment of a lower-prevalence population and collection of detailed data relevant to tobacco regulatory science (eg, device wattage). The web-based nature of the study requires several bot- and fraudulent survey taker–related risk-mitigation strategies, which can be time-intensive. When these risks are addressed, web-based cohort studies can be successful. We will continue to explore methods for maximizing recruitment efficiency, data quality, and participant retention in subsequent waves. International Registered Report Identifier (IRRID): DERR1-10.2196/38732 %M 36862467 %R 10.2196/38732 %U https://www.researchprotocols.org/2023/1/e38732 %U https://doi.org/10.2196/38732 %U http://www.ncbi.nlm.nih.gov/pubmed/36862467 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e40736 %T Associations Between Product Type and Intensity of Tobacco and Cannabis Co-use on the Same Day Among Young Adult Smokers: Smartphone-Based Daily-Diary Study %A Nguyen,Nhung %A Thrul,Johannes %A Neilands,Torsten B %A Ling,Pamela M %+ Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Ave, San Francisco, CA, 94143, United States, 1 415 476 2265, Nhung.Nguyen@ucsf.edu %K tobacco %K cannabis %K substance co-use %K young adults %K intensive longitudinal data %K EMA %K mHealth %K smartphone-based data collection %K data collection %K smartphone data %K substance use %D 2023 %7 20.2.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Co-use of tobacco and cannabis is highly prevalent among young US adults. Same-day co-use of tobacco and cannabis (ie, use of both substances on the same day) may increase the extent of use and negative health consequences among young adults. However, much remains unknown about same-day co-use of tobacco and cannabis, in part due to challenges in measuring this complex behavior. Nuanced understanding of tobacco and cannabis co-use in terms of specific products and intensity (ie, quantity of tobacco and cannabis use within a day) is critical to inform prevention and intervention efforts. Objective: We used a daily-diary data collection method via smartphone to capture occurrence of tobacco and cannabis co-use within a day. We examined (1) whether the same route of administration would facilitate co-use of 2 substances on the same day and (2) whether participants would use more tobacco on a day when they use more cannabis. Methods: This smartphone-based study collected 2891 daily assessments from 147 cigarette smokers (aged 18-26 years, n=76, 51.7% female) during 30 consecutive days. Daily assessments measured type (ie, cigarette, cigarillo, or e-cigarette) and intensity (ie, number of cigarettes or cigarillos smoked or number of times vaping e-cigarettes per day) of tobacco use and type (ie, combustible, vaporized, or edible) and intensity (ie, number of times used per day) of cannabis use. We estimated multilevel models to examine day-level associations between types of cannabis use and each type of tobacco use, as well as day-level associations between intensities of using cannabis and tobacco. All models controlled for demographic covariates, day-level alcohol use, and time effects (ie, study day and weekend vs weekday). Results: Same-day co-use was reported in 989 of the total 2891 daily assessments (34.2%). Co-use of cigarettes and combustible cannabis (885 of the 2891 daily assessments; 30.6%) was most commonly reported. Participants had higher odds of using cigarettes (adjusted odds ratio [AOR] 1.92, 95% CI 1.31-2.81) and cigarillos (AOR 244.29, 95% CI 35.51-1680.62) on days when they used combustible cannabis. Notably, participants had higher odds of using e-cigarettes on days when they used vaporized cannabis (AOR 23.21, 95% CI 8.66-62.24). Participants reported a greater intensity of using cigarettes (AOR 1.35, 95% CI 1.23-1.48), cigarillos (AOR 2.04, 95% CI 1.70-2.46), and e-cigarettes (AOR 1.48, 95% CI 1.16-1.88) on days when they used more cannabis. Conclusions: Types and intensities of tobacco and cannabis use within a day among young adult smokers were positively correlated, including co-use of vaporized products. Prevention and intervention efforts should address co-use and pay attention to all forms of use and timeframes of co-use (eg, within a day or at the same time), including co-use of e-cigarettes and vaporized cannabis, to reduce negative health outcomes. %M 36806440 %R 10.2196/40736 %U https://mhealth.jmir.org/2023/1/e40736 %U https://doi.org/10.2196/40736 %U http://www.ncbi.nlm.nih.gov/pubmed/36806440 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39146 %T Tobacco-Derived Nicotine Pouch Brands and Marketing Messages on Internet and Traditional Media: Content Analysis %A Ling,Pamela M %A Hrywna,Mary %A Talbot,Eugene M %A Lewis,M Jane %+ Center for Tobacco Control Research and Education and Division of General Internal Medicine, University of California San Francisco, 530 Parnassus Ave, Suite 366, San Francisco, CA, 94143, United States, 1 4155148627, pamela.ling@ucsf.edu %K nicotine pouch %K marketing %K tobacco industry %K web-based advertising %K advertising %K advertisement %K smoking %K tobacco %K nicotine %K smoker %K addiction %K industry %K industrial %K economic %K economy %K commercial %K commerce %K consumer %D 2023 %7 15.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Nicotine pouches and lozenges are increasingly available in the United States, and sales are growing. The brands of nicotine pouch products with the largest market share are produced by tobacco companies. Objective: The aim of this study is to examine the marketing of 5 oral nicotine products sold by tobacco companies. Methods: Internet, radio, television, print, and web-based display advertisements between January 2019 and March 2020 for 6 brands of nicotine pouches and lozenges were identified through commercially available marketing surveillance systems supplemented by a manual search of trade press and a review of brand websites. A total of 711 advertisements (122 unique) were analyzed to identify characteristics, themes, marketing strategies, and target audiences, and qualitatively compared by brand. All 5 brand websites were also analyzed. Coders examined the entirety of each advertisement or website for products, marketing claims, and features and recorded the presence or absence of 27 marketing claims and lifestyle elements. Results: All 6 brands of nicotine pouch products spent a total of US $11.2 million on advertising in 2019, with the most (US $10.7 million) spent by the brand Velo, and 86.1% (n=105) of the unique advertisements were web-based. Of the 711 total nicotine pouch advertisements run in 2019, the 2 brands Velo (n=407, 57%) and ZYN (n=303, 42%) dominated. These brands also made the greatest number of advertising claims in general. These claims focused on novelty, modernity, and use in a variety of contexts, including urban contexts, workplaces, transportation, and leisure activities. Of the 122 unique advertisements, ZYN’s most common claims were to be “tobacco-free,” featuring many flavors or varieties, and modern. Velo was the only brand to include urban contexts (n=14, 38.9% of advertisements) or freedom (n=8, 22.2%); Velo advertisements portrayed use in the workplace (n=15, 41.7%), bars or clubs (n=5, 13.9%), leisure activities (n=4, 11.1%), transportation (n=4, 11.1%), sports (n=3, 8.3%), cooking (n=2, 5.6%), and with alcohol (n=1, 2.8%). Velo and ZYN also included most of the images of people, including women and people of color. The 36 Velo ads included people in advertising in 77.8% (n=28) of advertisements, and of those advertisements with identifiable people, 40% (n=4) were young adults and 50% (n=5) were middle-aged. About one-third (n=11, 35.5%) of the 31 unique ZYN advertisements included people, and most identifiable models appeared to be young adults. Brands such as Rogue, Revel, Dryft, and on! focused mainly on product features. All nicotine pouch products made either tobacco-free, smoke-free, spit-free, or vape-free claims. The most common claim overall was “tobacco-free,” found in advertisements from Rogue (1/1, 100%), ZYN (30/31, 96.8%), Velo (19/36, 52.8%), and Dryft (1/3, 33.3%), but not Revel. Conclusions: Nicotine pouches and lozenges may expand the nicotine market as tobacco-free claims alleviate concerns about health harms and advertising features a greater diversity of people and contexts than typical smokeless tobacco advertising. The market leaders and highest-spending brands, ZYN and Velo, included more lifestyle claims. Surveillance of nicotine pouch marketing and uptake, including influence on tobacco use behaviors, is necessary. %M 36790840 %R 10.2196/39146 %U https://formative.jmir.org/2023/1/e39146 %U https://doi.org/10.2196/39146 %U http://www.ncbi.nlm.nih.gov/pubmed/36790840 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e40867 %T Testing the Outcomes of a Smoking Cessation Smartphone App for Nondaily Smokers: Protocol for a Proof-of-concept Randomized Controlled Trial %A Hoeppner,Bettina B %A Siegel,Kaitlyn R %A Dickerman,Sarah R %A Todi,Akshiti A %A Kahler,Christopher W %A Park,Elyse R %A Hoeppner,Susanne S %+ Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 151 Merrimac Street, 6th Floor, Boston, MA, 02114, United States, 1 617 643 1988, bhoeppner@mgh.harvard.edu %K mobile health %K mHealth %K smartphone %K smartphone app %K smoking %K smoking cessation %K nondaily smoking %K positive psychology %K happiness %K positive affect %K clinical trial %K feasibility %K acceptability %K app use %K mobile phone %D 2023 %7 14.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Nondaily smoking is a widespread, increasingly prevalent pattern of smoking, particularly in ethnic minority and vulnerable populations. To date, no effective treatment approach for this type of smokers has been identified. Objective: This study aims to use a randomized controlled trial to evaluate proof-of-concept markers of the Smiling instead of Smoking (SiS) app, a smoking cessation smartphone app designed specifically for nondaily smokers. This app was developed iteratively and is now in its third version. Previous studies have demonstrated acceptability and feasibility when participants were onboarded in person (study 1) and remotely (study 2) and showed within-person changes in line with hypothesized mechanisms of change. This is the first randomized test of this app. Methods: In total, 225 adult nondaily smokers will be asked to undertake a quit attempt while using smoking cessation support materials for a period of 7 weeks. Participants will be randomized to use the SiS smartphone app, the National Cancer Institute smartphone app QuitGuide, or the National Cancer Institute smoking cessation brochure “Clearing the Air.” Participants will take part in a 15-minute scripted onboarding phone call during which study staff will introduce participants to their support materials. Survey links will be sent 2, 6, 12, and 24 weeks after the participants’ initially chosen quit date. The primary outcome is self-efficacy to remain abstinent from smoking at treatment end, measured using the Smoking Self-Efficacy Questionnaire. Secondary outcomes cover several domains relevant to treatment development and implementation: treatment acceptability (eg, satisfaction with smoking cessation support, measured using the Client Satisfaction Questionnaire, and app usability, measured using the System Usability Scale); treatment feasibility (eg, measured using the number of days participants used the SiS or QuitGuide app during the prescribed treatment period); and, in an exploratory way, treatment efficacy assessed using self-reported 30-day point prevalence abstinence. Results: Recruitment began in January 2021 and ended June 2022. The final 24-week follow-up was completed in January 2023. This trial is funded by the American Cancer Society. Conclusions: This study is designed to test whether the prescribed use of the SiS app results in greater self-efficacy to abstain from smoking in nondaily smokers than commonly recommended alternative treatments and whether the SiS app treatment is acceptable and feasible. Positive results will mean that the SiS app warrants testing in a large-scale randomized controlled trial to test its effectiveness in supporting smoking cessation in nondaily smokers. The design of this study also provides insights into issues pertinent to smoking cessation smartphone app treatment development and implementation by measuring, in a randomized design, markers of treatment satisfaction, engagement with the technology and content of the treatment, and adherence to the treatment plan. Trial Registration: ClinicalTrials.gov NCT04672239; https://clinicaltrials.gov/ct2/show/NCT04672239 International Registered Report Identifier (IRRID): DERR1-10.2196/40867 %M 36787172 %R 10.2196/40867 %U https://www.researchprotocols.org/2023/1/e40867 %U https://doi.org/10.2196/40867 %U http://www.ncbi.nlm.nih.gov/pubmed/36787172 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42863 %T Social Media Data Mining of Antitobacco Campaign Messages: Machine Learning Analysis of Facebook Posts %A Lin,Shuo-Yu %A Cheng,Xiaolu %A Zhang,Jun %A Yannam,Jaya Sindhu %A Barnes,Andrew J %A Koch,J Randy %A Hayes,Rashelle %A Gimm,Gilbert %A Zhao,Xiaoquan %A Purohit,Hemant %A Xue,Hong %+ Department of Health Administration and Policy, College of Public Health, George Mason University, 4400 University Dr, Fairfax, Fairfax, VA, 22030, United States, 1 703 993 9833, hxue4@gmu.edu %K tobacco control %K social media campaign %K content analysis %K natural language processing %K topic modeling %K social media %K public health %K tobacco %K youth %K Facebook %K engagement %K use %K smoking %D 2023 %7 13.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media platforms provide a valuable source of public health information, as one-third of US adults seek specific health information online. Many antitobacco campaigns have recognized such trends among youth and have shifted their advertising time and effort toward digital platforms. Timely evidence is needed to inform the adaptation of antitobacco campaigns to changing social media platforms. Objective: In this study, we conducted a content analysis of major antitobacco campaigns on Facebook using machine learning and natural language processing (NLP) methods, as well as a traditional approach, to investigate the factors that may influence effective antismoking information dissemination and user engagement. Methods: We collected 3515 posts and 28,125 associated comments from 7 large national and local antitobacco campaigns on Facebook between 2018 and 2021, including the Real Cost, Truth, CDC Tobacco Free (formally known as Tips from Former Smokers, where “CDC” refers to the Centers for Disease Control and Prevention), the Tobacco Prevention Toolkit, Behind the Haze VA, the Campaign for Tobacco-Free Kids, and Smoke Free US campaigns. NLP methods were used for content analysis, including parsimonious rule–based models for sentiment analysis and topic modeling. Logistic regression models were fitted to examine the relationship of antismoking message-framing strategies and viewer responses and engagement. Results: We found that large campaigns from government and nonprofit organizations had more user engagements compared to local and smaller campaigns. Facebook users were more likely to engage in negatively framed campaign posts. Negative posts tended to receive more negative comments (odds ratio [OR] 1.40, 95% CI 1.20-1.65). Positively framed posts generated more negative comments (OR 1.41, 95% CI 1.19-1.66) as well as positive comments (OR 1.29, 95% CI 1.13-1.48). Our content analysis and topic modeling uncovered that the most popular campaign posts tended to be informational (ie, providing new information), where the key phrases included talking about harmful chemicals (n=43, 43%) as well as the risk to pets (n=17, 17%). Conclusions: Facebook users tend to engage more in antitobacco educational campaigns that are framed negatively. The most popular campaign posts are those providing new information, with key phrases and topics discussing harmful chemicals and risks of secondhand smoke for pets. Educational campaign designers can use such insights to increase the reach of antismoking campaigns and promote behavioral changes. %M 36780224 %R 10.2196/42863 %U https://www.jmir.org/2023/1/e42863 %U https://doi.org/10.2196/42863 %U http://www.ncbi.nlm.nih.gov/pubmed/36780224 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42706 %T Public Perceptions of the Food and Drug Administration’s Proposed Rules Prohibiting Menthol Cigarettes on Twitter: Observational Study %A Zhou,Runtao %A Tang,Qihang %A Xie,Zidian %A Li,Dongmei %+ Department of Clinical and Translational Research, University of Rochester Medical Center, Saunders Research Building 1.265, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K menthol cigarettes %K Food and Drug Administration %K FDA %K FDA's proposed rules %K Twitter %K perception %D 2023 %7 10.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: On April 28, 2022, the Food and Drug Administration (FDA) proposed rules that prohibited all menthol-flavored cigarettes and other flavored cigars to prevent the initiation of tobacco use in youth and reduce tobacco-related diseases and death. Objective: The objective of this study was to investigate public perceptions of the FDA’s proposed menthol cigarette rules on Twitter. Methods: Through the Twitter streaming application programming interface, tobacco-related tweets were collected between April 28, 2022, and May 27, 2022, using a set of keywords, such as smoking, cigarette, and nicotine. Furthermore, 1941 tweets related to the FDA’s proposed menthol cigarette rules were extracted. Based on 300 randomly selected example tweets, the codebook for the attitudes toward the FDA’s proposed rules and related topics was developed by 2 researchers and was used to label the rest of the tweets. Results: Among tweets related to the FDA’s proposed menthol cigarette rules, 536 (27.61%) showed a positive attitude, 443 (22.82%) had a negative attitude, and 962 (49.56%) had a neutral attitude toward the proposed rules. Social justice (210/536, 39%) and health issues (117/536, 22%) were two major topics in tweets with a positive attitude. For tweets with a negative attitude, alternative tobacco or nicotine products (127/443, 29%) and racial discrimination (84/536, 16%) were two of the most popular topics. Conclusions: In general, the public had a positive attitude toward the FDA’s proposed menthol cigarette rules. Our study provides important information to the FDA on the public perceptions of the proposed menthol cigarette rules, which will be helpful for future FDA regulations on menthol cigarettes. %M 36763414 %R 10.2196/42706 %U https://formative.jmir.org/2023/1/e42706 %U https://doi.org/10.2196/42706 %U http://www.ncbi.nlm.nih.gov/pubmed/36763414 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43175 %T Actual Use Behavior Assessment of a Novel Puff Recording Electronic Nicotine Delivery System: Observation Study %A Gao,Xiang %A Humberstone,Liam %A Liu,Yatao %+ Scientific Horizons Consulting, 5270 California Ave, Suite 300, Irvine, CA, 92617, United States, 1 5106798062, xiang.gao@scientifichorizonsconsulting.com %K e-cigarettes %K electronic nicotine delivery system %K behavior assessment %K nicotine addiction %K PR-ENDS %D 2023 %7 8.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Compared with combustible cigarettes, electronic cigarettes (e-cigarettes) can deliver a sufficient amount of nicotine with a significantly reduced emission of toxicants, which renders them as potential harm reduction candidates for tobacco and smoking replacement. However, the use of e-cigarettes is not harm free and the long-term health effect of using e-cigarettes is yet to be established. Given the high prevalence of e-cigarette use across the globe and its potential health concerns, it is imperative to conduct actual use behavior assessments to better understand how e-cigarettes are being consumed in real-world conditions. However, with the currently available technologies, there is still a lack of noninvasive, noninterventional, and convenient instruments for the real-time and real-world use behavior monitoring of e-cigarette product use. Novel technology-based systems that do not primarily rely on self-report or intrusive measurements to monitor e-cigarette use behaviors are therefore highly desired. Objective: The primary goal of this study is to investigate the e-cigarette actual use behaviors in the real world via a novel puff recording electronic nicotine delivery system (PR-ENDS). Specifically, we aim to analyze and summarize the survey and PR-ENDS use data and to study the relationships and effects of different factors on these variables. Methods: In real-world conditions, 61 enrolled UK e-cigarette users were instructed to use PR-ENDS as the primary source of nicotine with their selected e-liquids for at least 3 weeks (21 days). A baseline survey was conducted to collect information about participants’ demographics and nicotine use history (cigarette and ENDS). The puff data (ie, puff number, puff duration for each puff, device power, e-liquid nicotine concentrations) were directly recorded by PR-ENDS and uploaded to the cloud for further analyses. The nicotine emission and nicotine consumption were estimated based on recorded puff data. Results: Middle-aged adults with a nicotine history represented the major user profile during the PR-ENDS trial. A wide range of device power and e-liquid nicotine concentrations was applied and their combinations during actual use were found to be rather complex. Various puff parameters (ie, puff duration, puff number, nicotine emission) were assessed with contributing factors from device, e-liquid, and user nicotine history in different effect sizes. The real-time observation revealed substantial intra- and interindividual variabilities in PR-ENDS use behaviors. The use pattern of a quick adaptation followed by consistent product use was recognized for at least 3 weeks during actual use. Conclusions: The actual use behavior assessment of PR-ENDS was conducted as a proof-of-concept application. The complex interactions of product attributes and significant intra- and interindividual variabilities in e-cigarette use behaviors provided new insights of compensatory behavior, which can inspire future studies in the field of nicotine addiction and abuse liability behavior assessment. %M 36592426 %R 10.2196/43175 %U https://formative.jmir.org/2023/1/e43175 %U https://doi.org/10.2196/43175 %U http://www.ncbi.nlm.nih.gov/pubmed/36592426 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e39975 %T Engagement With Gamification Elements in a Smoking Cessation App and Short-term Smoking Abstinence: Quantitative Assessment %A Rajani,Nikita B %A Bustamante,Luz %A Weth,Dominik %A Romo,Lucia %A Mastellos,Nikolaos %A Filippidis,Filippos T %+ Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London, W6 8RP, United Kingdom, 44 7427615928, nikita.rajani14@imperial.ac.uk %K gamification %K smoking cessation %K smoking abstinence %K mHealth %K mobile apps %K mobile phone %K smartphone %K digital health %K user engagement %K cognitive outcome %K self-support %K in-app metrics %D 2023 %7 1.2.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Gamification in smoking cessation apps has been found to improve cognitive outcomes associated with higher odds of quitting. Although some research has shown that gamification can also positively impact behavioral outcomes such as smoking cessation, studies have largely focused on physical activity and mental health. Only a few studies have explored the effects of gamification on smoking cessation outcomes, of which the majority have adopted qualitative methodologies and/or assessed engagement with apps using self-report. Objective: This study aimed to explore levels of user engagement with gamification features in a smoking cessation app via in-app metrics. Specifically, the objective of this paper was to investigate whether higher engagement with gamification features is associated with the likelihood of quitting in the short term. Methods: Data from a larger online study that recruited smokers seeking to quit were analyzed to address the objectives presented in this paper. The study took place between June 2019 and July 2020, and participants were primarily recruited via social media posts. Participants who met the eligibility criteria used 1 of 2 mobile apps for smoking cessation. In-app metrics shared by the developer of one of the smoking cessation apps, called Kwit, were used to assess engagement with gamification features. Out of 58 participants who used the Kwit app, 14 were excluded due to missing data or low engagement with the app (ie, not opening the app once a week). For the remaining 44 participants, mean (SD) values were calculated for engagement with the app using in-app metrics. A logistic regression model was used to investigate the association between engagement with gamification and 7-day smoking abstinence. Results: In total, data from 44 participants who used the Kwit app were analyzed. The majority of participants were male, married, and employed. Almost 30% (n=13) of participants self-reported successful 7-day abstinence at the end of the study. On average, the Kwit app was opened almost 31 (SD 39) times during the 4-week study period, with the diary feature used the most often (mean 22.8, SD 49.3). Moreover, it was found that each additional level unlocked was associated with approximately 22% higher odds of achieving 7-day abstinence after controlling for other factors such as age and gender (odds ratio 1.22, 95% CI 1.01-1.47). Conclusions: This study highlights the likely positive effects of certain gamification elements such as levels and achievements on short-term smoking abstinence. Although more robust research with a larger sample size is needed, this research highlights the important role that gamification features integrated into mobile apps can play in facilitating and supporting health behavior change. %M 36724003 %R 10.2196/39975 %U https://games.jmir.org/2023/1/e39975 %U https://doi.org/10.2196/39975 %U http://www.ncbi.nlm.nih.gov/pubmed/36724003 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42956 %T Supporting Youth Vaping Cessation With the Crush the Crave Smartphone App: Protocol for a Randomized Controlled Trial %A Sanchez,Sherald %A Deck,Alicia %A Baskerville,Neill Bruce %A Chaiton,Michael %+ Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, 33 Ursula Franklin St, Toronto, ON, M5S 2S1, Canada, 1 416 435 8501, Michael.Chaiton@camh.ca %K e-cigarettes %K vaping cessation %K youth and young adult health %K adult %K youth %K effectiveness %K smartphone %K application %K vaping %K cessation %K assessment %K intervention %D 2023 %7 27.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The use of e-cigarettes, or vaping, has increased exponentially in the past decade, particularly among youth. Emerging evidence indicates growing nicotine dependence among youth, revealing historically higher rates of dependence among current e-cigarette users compared to rates seen in earlier research. Despite the urgent need for youth vaping cessation interventions, there is limited knowledge about the process of vaping cessation, and few evidence-based interventions are available to young people seeking support. A notable literature review on vaping cessation resources for young people recommended technology-based interventions, such as smartphone apps and SMS text messaging services, as a promising area of vaping cessation research and intervention development. Objective: The primary aim of our study is to determine the effectiveness of the Crush the Crave app in supporting vaping cessation among youth recruited to the intervention arm via comparison with an assessment-only control group. The primary hypothesis is that participants in the intervention group—those using Crush the Crave—will be more likely to be abstinent at the 6-month follow-up point than participants in the assessment-only control arm. Methods: A 2-arm, single-blind, parallel randomized controlled trial will be conducted over 12 months. Study invitations will be sent to 600 youth (age: 16-18 years) and young adult (age: 19-29 years) e-cigarette users and randomized between an intervention arm, which will be using Crush the Crave (n=300), and an assessment-only control arm (n=300) in a 1:1 ratio. The primary hypothesis is that participants in the intervention group—those using Crush the Crave—will be more likely to be abstinent at the 6-month follow-up point. Results: Study recruitment began on March 4, 2022. Recruitment is anticipated to be completed in December 2022. Conclusions: This protocol describes one of the first-ever randomized controlled trial studies to evaluate the effectiveness of an app-based intervention for supporting vaping cessation among youth aged 16 to 18 years and young adults aged 19 to 29 years. The findings from our trial will help increase our understanding of the process of vaping cessation among youth and provide evidence on the effectiveness of an app-based intervention in helping young people quit vaping. The trial results will also have implications in the development of current and future approaches to youth vaping cessation. Trial Registration: OSF Registries osf.io/hmd87; https://doi.org/10.17605/OSF.IO/HMD87 International Registered Report Identifier (IRRID): DERR1-10.2196/42956 %M 36705967 %R 10.2196/42956 %U https://www.researchprotocols.org/2023/1/e42956 %U https://doi.org/10.2196/42956 %U http://www.ncbi.nlm.nih.gov/pubmed/36705967 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43629 %T Can a Single Variable Predict Early Dropout From Digital Health Interventions? Comparison of Predictive Models From Two Large Randomized Trials %A Bricker,Jonathan %A Miao,Zhen %A Mull,Kristin %A Santiago-Torres,Margarita %A Vock,David M %+ Division of Public Health Sciences, Fred Hutch Cancer Center, 1100 Fairview Avenue North, M3-B232, Seattle, WA, 98109, United States, 1 2066675000, jbricker@fredhutch.org %K acceptance and commitment therapy %K ACT %K attrition %K digital interventions %K dropout %K eHealth %K engagement %K iCanQuit %K mobile health %K mHealth %K QuitGuide %K smartphone apps %K smoking %K tobacco %K trajectories %K mobile phone %D 2023 %7 20.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: A single generalizable metric that accurately predicts early dropout from digital health interventions has the potential to readily inform intervention targets and treatment augmentations that could boost retention and intervention outcomes. We recently identified a type of early dropout from digital health interventions for smoking cessation, specifically, users who logged in during the first week of the intervention and had little to no activity thereafter. These users also had a substantially lower smoking cessation rate with our iCanQuit smoking cessation app compared with users who used the app for longer periods. Objective: This study aimed to explore whether log-in count data, using standard statistical methods, can precisely predict whether an individual will become an iCanQuit early dropout while validating the approach using other statistical methods and randomized trial data from 3 other digital interventions for smoking cessation (combined randomized N=4529). Methods: Standard logistic regression models were used to predict early dropouts for individuals receiving the iCanQuit smoking cessation intervention app, the National Cancer Institute QuitGuide smoking cessation intervention app, the WebQuit.org smoking cessation intervention website, and the Smokefree.gov smoking cessation intervention website. The main predictors were the number of times a participant logged in per day during the first 7 days following randomization. The area under the curve (AUC) assessed the performance of the logistic regression models, which were compared with decision trees, support vector machine, and neural network models. We also examined whether 13 baseline variables that included a variety of demographics (eg, race and ethnicity, gender, and age) and smoking characteristics (eg, use of e-cigarettes and confidence in being smoke free) might improve this prediction. Results: The AUC for each logistic regression model using only the first 7 days of log-in count variables was 0.94 (95% CI 0.90-0.97) for iCanQuit, 0.88 (95% CI 0.83-0.93) for QuitGuide, 0.85 (95% CI 0.80-0.88) for WebQuit.org, and 0.60 (95% CI 0.54-0.66) for Smokefree.gov. Replacing logistic regression models with more complex decision trees, support vector machines, or neural network models did not significantly increase the AUC, nor did including additional baseline variables as predictors. The sensitivity and specificity were generally good, and they were excellent for iCanQuit (ie, 0.91 and 0.85, respectively, at the 0.5 classification threshold). Conclusions: Logistic regression models using only the first 7 days of log-in count data were generally good at predicting early dropouts. These models performed well when using simple, automated, and readily available log-in count data, whereas including self-reported baseline variables did not improve the prediction. The results will inform the early identification of people at risk of early dropout from digital health interventions with the goal of intervening further by providing them with augmented treatments to increase their retention and, ultimately, their intervention outcomes. %M 36662550 %R 10.2196/43629 %U https://www.jmir.org/2023/1/e43629 %U https://doi.org/10.2196/43629 %U http://www.ncbi.nlm.nih.gov/pubmed/36662550 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42544 %T A Novel Puff Recording Electronic Nicotine Delivery System for Assessing Naturalistic Puff Topography and Nicotine Consumption During Ad Libitum Use: Ancillary Study %A Gao,Xiang %A Fewx,Melody %A Sprock,John %A Jiang,Huanhuan %A Gao,Yong %A Liu,Yatao %+ Scientific Horizons Consulting, 5270 California Avenue, Irvine, CA, 92617, United States, 1 5106798062, xiang.gao@scientifichorizonsconsulting.com %K electronic nicotine delivery system %K electronic cigarettes %K puff topography %K nicotine consumption %K ad libitum use %D 2023 %7 16.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Assessing the naturalistic puff topography and associated nicotine consumption during e-cigarette use is important as such information will not only unveil how these products are being consumed in real-world conditions, but also enable investigators and regulatory bodies to conduct quantitative, accurate, and realistic harmful exposure and nicotine abuse liability risk assessments based on actual e-cigarette use. Conventional approaches cannot accurately, conveniently, and noninvasively determine e-cigarette puff topography in a natural use environment. Thus, novel technology-enabled systems that do not primarily rely on self-report mechanisms or intrusive measurements to monitor e-cigarette product use behaviors are highly desired. Objective: This study aimed to explore and demonstrate the feasibility of a novel puff recording electronic nicotine delivery system (PR-ENDS) device for measuring naturalistic puff topography and estimating nicotine consumption during the ad libitum use of products among smokers and vapers. Methods: An ancillary data analysis based on a completed parent study was conducted. The parent study was a 1-way randomized controlled open-label puff topography and nicotine pharmacokinetic assessment carried out in 24 healthy adults (12 smokers and 12 vapers). Participants were assigned a randomized product use sequence of a PR-ENDS device within 5 site visits for both controlled and ad libitum product use sessions. Blood samples were obtained for plasma nicotine analysis, and questionnaires were administered at various time points. During the ad libitum use session, puff topography was measured using a Clinical Research Support System (CReSS) device as a benchmark, as well as the PR-ENDS device with a built-in puff recording feature. Results: There were no significant differences in representative puff topography parameters (number of puffs, total puff duration, and average puff duration) between the PR-ENDS and CReSS devices at the populational level across different device powers, e-liquid nicotine strengths, and flavors. The nicotine consumption estimated by the PR-ENDS device suggested that this device can be employed as a convenient monitoring tool for estimating nicotine use without measuring e-liquid weight loss between puffs. The linear relationship between nicotine consumption estimated by the PR-ENDS device and the pharmacokinetic parameter AUCad lib (plasma concentration-time curve for 1-hour ad libitum use) substantiated the potential of using this device as a pragmatic, noninvasive, and convenient means for estimating nicotine intake in the human body without blood collection. Conclusions: The novel PR-ENDS device was feasible for assessing naturalistic puff topography and estimating nicotine consumption and intake in the human body during ad libitum use. Several key factors can influence users’ puff topography, including device power levels, e-liquid nicotine strengths, and flavors. The study results pave the way for further research in the real-time measurement of naturalistic puff topography and puffing behaviors in the real world. %M 36542679 %R 10.2196/42544 %U https://formative.jmir.org/2023/1/e42544 %U https://doi.org/10.2196/42544 %U http://www.ncbi.nlm.nih.gov/pubmed/36542679 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41669 %T Addictive Potential of e-Cigarettes as Reported in e-Cigarette Online Forums: Netnographic Analysis of Subjective Experiences %A Szafran,Daria %A Görig,Tatiana %A Vollstädt-Klein,Sabine %A Grundinger,Nadja %A Mons,Ute %A Lohner,Valerie %A Schneider,Sven %A Andreas,Marike %+ Division of Public Health, Social and Preventive Medicine, Center for Preventive Medicine and Digital Health, Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl-Straße 7-11, Mannheim, 68167, Germany, 49 621 383 ext 71814, marike.andreas@medma.uni-heidelberg.de %K e-cigarette %K addiction %K netnographic analysis %K smoking %K tobacco %K substance use %K vaping %D 2023 %7 6.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: While e-cigarettes usually contain nicotine, their addictive potential is not yet fully understood. We hypothesized that if e-cigarettes are addictive, users will experience typical symptoms of addiction. Objective: The aim of our study was to investigate whether and how e-cigarette users report signs of addiction. Methods: We identified 3 large German-language e-cigarette online forums via a systematic Google search. Based on a netnographic approach, we used deductive content analysis to investigate relevant posts in these forums. Netnography has the advantage of limiting the social desirability bias that prevails in face-to-face research, such as focus groups. The data were coded according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) criteria for tobacco use disorder, adapted for e-cigarettes. The DSM-5 criteria were used to portray a broad spectrum of possible experiences of addiction. Results: Overall, 5337 threads in 3 forums were screened, and 451 threads containing relevant information were included in the analysis. Users reported experiences consistent with the DSM-5 criteria, such as craving e-cigarettes, excessive time spent vaping, and health issues related to e-cigarette use. However, our analysis also showed that users reported the absence of typical tobacco use disorder criteria, such as successful attempts to reduce the nicotine dosage. For most themes, reports of their absence were more frequent than of their presence. The absence of perceived addiction was mostly reported in contrast to prior tobacco smoking. Conclusions: This is the first study to use a netnographic approach to explore unfiltered self-reports of experiences of e-cigarette addiction by users in online forums. As hypothesized, some but not all users reported subjective experiences that corresponded to the criteria of tobacco use disorder as defined by the DSM-5. Nevertheless, subjective reports also indicated that many e-cigarette users felt in control of their behavior, especially in contrast to their prior use of tobacco cigarettes. The finding that some e-cigarette users subjectively experience addiction highlights the need for effective cessation programs to support users who experience their e-cigarette use as burdensome. This research can guide the refinement of instruments to assess e-cigarette addiction and guide cessation programs. International Registered Report Identifier (IRRID): RR2-10.1186/s40359-021-00682-8 %M 36607713 %R 10.2196/41669 %U https://www.jmir.org/2023/1/e41669 %U https://doi.org/10.2196/41669 %U http://www.ncbi.nlm.nih.gov/pubmed/36607713 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e40657 %T The Global, Regional, and National Burdens of Cervical Cancer Attributable to Smoking From 1990 to 2019: Population-Based Study %A Yuan,Ruixia %A Ren,Fang %A Xie,Yingying %A Li,Kaixiang %A Tong,Zhuang %+ Clinical Big Data Center, the First Affiliated Hospital of Zhengzhou University, No 1 East Jianshe Road, Erqi District, Zhengzhou, 450052, China, 86 15638523311, ttongzhuang@126.com %K global burden of disease %K cervical cancer %K smoking women %K time trends %D 2022 %7 23.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Cervical cancer is the fourth most common cause of cancer death in women worldwide. Smoking is one of the risk factors for cervical cancer. Understanding the global distribution of the disease burden of cervical cancer attributable to smoking and related changes is of clear significance for the prevention and control of cervical cancer in key populations and for tobacco control. As far as we know, research on the burden of cervical cancer attributable to smoking is lacking. Objective: We estimated the disease burden and mortality of cervical cancer attributable to smoking and related trends over time at the global, regional, and national levels. Methods: Data were obtained from the Global Burden of Disease study website. Age-standardized rates were used to facilitate comparisons of mortality and disability-adjusted life years (DALYs) at different levels. The estimated annual percentage change (EAPC) was used to assess trends in the age-standardized mortality rate (ASMR) and the age-standardized DALY rate (ASDR). A Pearson correlation analysis was used to evaluate correlations between the sociodemographic index and the age-standardized rates. Results: In 2019, there were 30,136.65 (95% uncertainty interval [UI]: 14,945.09-49,639.87) cervical cancer–related deaths and 893,735.25 (95% UI 469,201.51-1,440,050.85) cervical cancer–related DALYs attributable to smoking. From 1990 to 2019, the global burden of cervical cancer attributable to smoking showed a decreasing trend around the world; the EAPCs for ASMR and ASDR were –2.11 (95% CI –2.16 to –2.06) and –2.22 (95% CI –2.26 to –2.18), respectively. In terms of age characteristics, in 2019, an upward trend was observed for age in the mortality of cervical cancer attributable to smoking. Analysis of the trend in DALYs with age revealed an initially increasing and then decreasing trend. From 1990 to 2019, the burden of disease in different age groups showed a downward trend. Among 204 countries, 180 countries showed downward trends, 10 countries showed upward trends, and the burden was stable in 14 countries. The Pearson correlation analysis revealed a significant negative correlation between sociodemographic index and the age-standardized rates of cervical cancer attributable to smoking (ρ=–0.228, P<.001 for ASMR and ρ=–0.223, P<.001 for ASDR). Conclusions: An increase over time in the absolute number of cervical cancer deaths and DALYs attributable to smoking and a decrease over time in the ASMR and ASDR for cervical cancer attributable to smoking were observed in the overall population, and differences in these variables were also observed between countries and regions. More attention should be paid to cervical cancer prevention and screening in women who smoke, especially in low- and middle-income countries. %M 36563035 %R 10.2196/40657 %U https://publichealth.jmir.org/2022/12/e40657 %U https://doi.org/10.2196/40657 %U http://www.ncbi.nlm.nih.gov/pubmed/36563035 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e42619 %T Predicting Smoking Prevalence in Japan Using Search Volumes in an Internet Search Engine: Infodemiology Study %A Taira,Kazuya %A Itaya,Takahiro %A Fujita,Sumio %+ Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, 53, Shogoinkawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan, 81 075 751 3927, taira.kazuya.5m@kyoto-u.ac.jp %K health policy %K internet use %K quality indicators %K search engine %K smoking %K tobacco use %K public health %K infodemiology %K smoking trend %K health indicator %K health promotion %D 2022 %7 14.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Tobacco smoking is an important public health issue and a core indicator of public health policy worldwide. However, global pandemics and natural disasters have prevented surveys from being conducted. Objective: The purpose of this study was to predict smoking prevalence by prefecture and sex in Japan using Internet search trends. Methods: This study used the infodemiology approach. The outcome variable was smoking prevalence by prefecture, obtained from national surveys. The predictor variables were the search volumes on Yahoo! Japan Search. We collected the search volumes for queries related to terms from the thesaurus of the Japanese medical article database Ichu-shi. Predictor variables were converted to per capita values and standardized as z scores. For smoking prevalence, the values for 2016 and 2019 were used, and for search volume, the values for the April 1 to March 31 fiscal year (FY) 1 year prior to the survey (ie, FY 2015 and FY 2018) were used. Partial correlation coefficients, adjusted for data year, were calculated between smoking prevalence and search volume, and a regression analysis using a generalized linear mixed model with random effects was conducted for each prefecture. Several models were tested, including a model that included all search queries, a variable reduction method, and one that excluded cigarette product names. The best model was selected with the Akaike information criterion corrected (AICC) for small sample size and the Bayesian information criterion (BIC). We compared the predicted and actual smoking prevalence in 2016 and 2019 based on the best model and predicted the smoking prevalence in 2022. Results: The partial correlation coefficients for men showed that 9 search queries had significant correlations with smoking prevalence, including cigarette (r=–0.417, P<.001), cigar in kanji (r=–0.412, P<.001), and cigar in katakana (r=-0.399, P<.001). For women, five search queries had significant correlations, including vape (r=0.335, P=.001), quitting smoking (r=0.288, P=.005), and cigar (r=0.286, P=.006). The models with all search queries were the best models for both AICC and BIC scores. Scatter plots of actual and estimated smoking prevalence in 2016 and 2019 confirmed a relatively high degree of agreement. The average estimated smoking prevalence in 2022 in the 47 prefectures for the total sample was 23.492% (95% CI 21.617%-25.367%), showing an increasing trend, with an average of 29.024% (95% CI 27.218%-30.830%) for men and 8.793% (95% CI 7.531%-10.054%) for women. Conclusions: This study suggests that the search volume of tobacco-related queries in internet search engines can predict smoking prevalence by prefecture and sex in Japan. These findings will enable the development of low-cost, timely, and crisis-resistant health indicators that will enable the evaluation of health measures and contribute to improved public health. %M 36515993 %R 10.2196/42619 %U https://www.jmir.org/2022/12/e42619 %U https://doi.org/10.2196/42619 %U http://www.ncbi.nlm.nih.gov/pubmed/36515993 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e39460 %T Topics and Sentiment Surrounding Vaping on Twitter and Reddit During the 2019 e-Cigarette and Vaping Use–Associated Lung Injury Outbreak: Comparative Study %A Wu,Dezhi %A Kasson,Erin %A Singh,Avineet Kumar %A Ren,Yang %A Kaiser,Nina %A Huang,Ming %A Cavazos-Rehg,Patricia A %+ Department of Artificial Intelligence and Informatics, Mayo Clinic, 200 1st St SW, Rochester, MN, 55902, United States, 1 507 538 3287, Huang.Ming@mayo.edu %K vaping %K e-cigarette %K social media %K Twitter %K Reddit %K e-cigarette and vaping use–associated lung injury %K EVALI %K sentiment analysis %K topic analysis %D 2022 %7 13.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaping or e-cigarette use has become dramatically more popular in the United States in recent years. e-Cigarette and vaping use–associated lung injury (EVALI) cases caused an increase in hospitalizations and deaths in 2019, and many instances were later linked to unregulated products. Previous literature has leveraged social media data for surveillance of health topics. Individuals are willing to share mental health experiences and other personal stories on social media platforms where they feel a sense of community, reduced stigma, and empowerment. Objective: This study aimed to compare vaping-related content on 2 popular social media platforms (ie, Twitter and Reddit) to explore the context surrounding vaping during the 2019 EVALI outbreak and to support the feasibility of using data from both social platforms to develop in-depth and intelligent vaping detection models on social media. Methods: Data were extracted from both Twitter (316,620 tweets) and Reddit (17,320 posts) from July 2019 to September 2019 at the peak of the EVALI crisis. High-throughput computational analyses (sentiment analysis and topic analysis) were conducted. In addition, in-depth manual content analyses were performed and compared with computational analyses of content on both platforms (577 tweets and 613 posts). Results: Vaping-related posts and unique users on Twitter and Reddit increased from July 2019 to September 2019, with the average post per user increasing from 1.68 to 1.81 on Twitter and 1.19 to 1.21 on Reddit. Computational analyses found the number of positive sentiment posts to be higher on Reddit (P<.001, 95% CI 0.4305-0.4475) and the number of negative posts to be higher on Twitter (P<.001, 95% CI –0.4289 to −0.4111). These results were consistent with the clinical content analyses results indicating that negative sentiment posts were higher on Twitter (273/577, 47.3%) than Reddit (184/613, 30%). Furthermore, topics prevalent on both platforms by keywords and based on manual post reviews included mentions of youth, marketing or regulation, marijuana, and interest in quitting. Conclusions: Post content and trending topics overlapped on both Twitter and Reddit during the EVALI period in 2019. However, crucial differences in user type and content keywords were also found, including more frequent mentions of health-related keywords on Twitter and more negative health outcomes from vaping mentioned on both Reddit and Twitter. Use of both computational and clinical content analyses is critical to not only identify signals of public health trends among vaping-related social media content but also to provide context for vaping risks and behaviors. By leveraging the strengths of both Twitter and Reddit as publicly available data sources, this research may provide technical and clinical insights to inform automatic detection of social media users who are vaping and may benefit from digital intervention and proactive outreach strategies on these platforms. %M 36512403 %R 10.2196/39460 %U https://www.jmir.org/2022/12/e39460 %U https://doi.org/10.2196/39460 %U http://www.ncbi.nlm.nih.gov/pubmed/36512403 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e42553 %T A Text-Based Smoking Cessation Intervention for Sexual and Gender Minority Groups: Protocol for a Feasibility Trial %A Tami-Maury,Irene %A Klaff,Rebecca %A Hussin,Allison %A Smith,Nathan Grant %A Chang,Shine %A McNeill,Lorna %A Reitzel,Lorraine R %A Shete,Sanjay %A Abroms,Lorien C %+ School of Public Health, The University of Texas Health Science Center at Houston, Reuel A Stallones Building, 6th Fl, 1200 Pressler Street, Houston, TX, 77030, United States, 1 713 500 9174, irene.tami@uth.tmc.edu %K smoking cessation %K sexual and gender minorities %K LGBTQ+ %K SMS text messaging %K mobile health %K mHealth %D 2022 %7 9.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking among sexual and gender minority (SGM) groups, which include lesbian, gay, bisexual, transgender, and queer individuals, has been reported to be highly prevalent. This is attributed to several factors, including minority-specific stress and targeted tobacco marketing. Therefore, this population is at an increased risk for tobacco-related diseases. SMS text messaging programs have been found to be effective for smoking cessation and appeal to traditionally hard-to-reach populations over other interventions. It has also been suggested that targeted and tailored interventions could be more effective among SGM smokers because they can be designed to assure a safe, validating health care environment that enhances receptivity to cessation. Objective: The aim of this study is to develop SmokefreeSGM, a text-based smoking cessation program tailored to and tested among SGM smokers. Methods: The study consists of three phases, culminating in a feasibility trial. In Phase 1, our research team will collaborate with a Community Advisory Board to develop and pretest the design of SmokefreeSGM. In Phase 2, the tailored text messaging program will be beta tested among 16 SGM smokers. Our research team will use a mixed-methods approach to collect and analyze data from participants who will inform the refinement of SmokefreeSGM. In Phase 3, a feasibility trial will be conducted among 80 SGM smokers either enrolled in SmokefreeSGM or SmokefreeTXT, the original text-based program developed by the National Cancer Institute for the general population. Our research team will examine recruitment, retention, and smoking abstinence rates at 1-, 3-, and 6-month follow-up. Additionally, a qualitative interview will be conducted among 32 participants to evaluate the feasibility and acceptability of the programs (SmokefreeSGM and SmokefreeTXT). Results: This study received approval from The University of Texas Health Science Center at Houston Committee for the Protection of Human Subjects to begin research on August 21, 2020. Recruitment for the beta testing of SmokefreeSGM (Phase 2) began in January 2022. We estimate that the feasibility trial (Phase 3) will begin in September 2022 and that results will be available in December 2023. Conclusions: Findings from this research effort will help reduce tobacco-related health disparities among SGM smokers by determining the feasibility and acceptability of SmokefreeSGM, an SGM-tailored smoking cessation intervention. Trial Registration: ClinicalTrials.gov NCT05029362; https://clinicaltrials.gov/ct2/show/NCT05029362 International Registered Report Identifier (IRRID): DERR1-10.2196/42553 %M 36485022 %R 10.2196/42553 %U https://www.researchprotocols.org/2022/12/e42553 %U https://doi.org/10.2196/42553 %U http://www.ncbi.nlm.nih.gov/pubmed/36485022 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e42241 %T Monitoring and Identifying Emerging e-Cigarette Brands and Flavors on Twitter: Observational Study %A Tang,Qihang %A Zhou,Runtao %A Xie,Zidian %A Li,Dongmei %+ Department of Clinical & Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642, United States, 1 808 554 2956, Dongmei_Li@urmc.rochester.edu %K e-cigarettes %K brand %K flavor %K Twitter %D 2022 %7 5.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Flavored electronic cigarettes (e-cigarettes) have become very popular in recent years. e-Cigarette users like to share their e-cigarette products and e-cigarette use (vaping) experiences on social media. e-Cigarette marketing and promotions are also prevalent online. Objective: This study aims to develop a method to identify new e-cigarette brands and flavors mentioned on Twitter and to monitor e-cigarette brands and flavors mentioned on Twitter from May 2021 to December 2021. Methods: We collected 1.9 million tweets related to e-cigarettes between May 3, 2021, and December 31, 2021, by using the Twitter streaming application programming interface. Commercial and noncommercial tweets were characterized based on promotion-related keywords. We developed a depletion method to identify new e-cigarette brands by removing the keywords that already existed in the reference data set (Twitter data related to e-cigarettes from May 3, 2021, to August 31, 2021) or our previously identified brand list from the keywords in the target data set (e-cigarette–related Twitter data from September 1, 2021, to December 31, 2021), followed by a manual Google search to identify new e-cigarette brands. To identify new e-cigarette flavors, we constructed a flavor keyword list based on our previously collected e-cigarette flavor names, which were used to identify potential tweet segments that contain at least one of the e-cigarette flavor keywords. Tweets or tweet segments with flavor keywords but not any known flavor names were marked as potential new flavor candidates, which were further verified by a web-based search. The longitudinal trends in the number of tweets mentioning e-cigarette brands and flavors were examined in both commercial and noncommercial tweets. Results: Through our developed methods, we identified 34 new e-cigarette brands and 97 new e-cigarette flavors from commercial tweets as well as 56 new e-cigarette brands and 164 new e-cigarette flavors from noncommercial tweets. The longitudinal trend of the e-cigarette brands showed that JUUL was the most popular e-cigarette brand mentioned on Twitter; however, there was a decreasing trend in the mention of JUUL over time on Twitter. Menthol flavor was the most popular e-cigarette flavor mentioned in the commercial tweets, whereas mango flavor was the most popular e-cigarette flavor mentioned in the noncommercial tweets during our study period. Conclusions: Our proposed methods can successfully identify new e-cigarette brands and flavors mentioned on Twitter. Twitter data can be used for monitoring the dynamic changes in the popularity of e-cigarette brands and flavors. %M 36469415 %R 10.2196/42241 %U https://formative.jmir.org/2022/12/e42241 %U https://doi.org/10.2196/42241 %U http://www.ncbi.nlm.nih.gov/pubmed/36469415 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e42538 %T Perceptions and Aspirations Toward Peer Mentoring in Social Media–Based Electronic Cigarette Cessation Interventions for Adolescents and Young Adults: Focus Group Study %A Lyu,Joanne Chen %A Afolabi,Aliyyat %A White,Justin S %A Ling,Pamela M %+ Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Ave, San Francisco, CA, 94143-1390, United States, 1 415 502 4181, chenjoanne.lyu@ucsf.edu %K peer mentoring %K electronic nicotine delivery systems %K cessation %K social media %K adolescents and young adults %D 2022 %7 1.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media offer a promising channel to deliver e-cigarette cessation interventions to adolescents and young adults (AYAs); however, interventions delivered on social media face challenges of low participant retention and decreased engagement over time. Peer mentoring has the potential to ameliorate these challenges. Objective: The aim of this study was to understand, from both the mentee and potential mentor perspective, the needs, expectations, and concerns of AYAs regarding peer mentoring to inform the development of social media–based peer mentoring interventions for e-cigarette cessation among AYAs. Methods: Seven focus groups, including four mentee groups and three potential mentor groups, were conducted with 26 AYAs who had prior experience with e-cigarette use and attempts to quit in the context of a social media–based e-cigarette cessation intervention. Discussion focused on preferred characteristics of peer mentors, expectations about peer mentoring, mentoring mode, mentor training, incentives for peer mentors, preferred social media platforms for intervention delivery, supervision, and concerns. Focus group transcripts were coded and analyzed using a thematic analysis approach. Results: Overall, participants were receptive to peer mentoring in social media–based cessation interventions and believed they could be helpful in assisting e-cigarette cessation. Participants identified the most important characteristics of peer mentors to be of similar age and to be abstinent from e-cigarette use. Participants expected peer mentors would share personal experiences, provide emotional support, and send check-ins and reminders. Peer mentors supporting a group of mentees in combination with one-on-one mentoring as needed was the preferred mentoring mode. A group of 10 mentees with a mentor:mentee ratio of 1:3-5 was deemed acceptable for most participants. Participants expressed that mentor training should include emotional intelligence, communication skills, and the scientific evidence about e-cigarettes. Although monetary incentives were not the main motivating factor for being a peer mentor, they were viewed as a good way to compensate mentors’ time. Instagram was considered an appropriate social media platform to deliver a peer-mentored intervention due to its functionality. Participants did not express many privacy concerns about social media–based peer mentoring, but mentioned that boundaries and community agreements should be set to keep relationships professional. Conclusions: This study reflects the needs and preferences of young people for a peer mentoring intervention to complement a social media program to support e-cigarette cessation. The next step will be to establish the feasibility, acceptability, and preliminary efficacy of such a peer mentoring program. %M 36454628 %R 10.2196/42538 %U https://formative.jmir.org/2022/12/e42538 %U https://doi.org/10.2196/42538 %U http://www.ncbi.nlm.nih.gov/pubmed/36454628 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e41785 %T Ice Flavor–Related Discussions on Twitter: Content Analysis %A Galimov,Artur %A Vassey,Julia %A Galstyan,Ellen %A Unger,Jennifer B %A Kirkpatrick,Matthew G %A Allem,Jon-Patrick %+ Department of Population and Public Health Sciences, Keck School of Medicine of University of Southern California, 1845 N Soto St, Los Angeles, CA, 90089-9239, United States, 1 858 603 0812, allem@usc.edu %K electronic cigarettes %K Twitter %K social media %K ice flavors %K tobacco policy %K public health %K infodemiology %K FDA %K tobacco %K smoking %K vaping %K e-cigarette %K public %D 2022 %7 30.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The US Food and Drug Administration (FDA) recently restricted characterizing flavors in tobacco products. As a result, ice hybrid–flavored e-cigarettes, which combine a cooling flavor with fruit or other flavors (eg, banana ice), emerged on the market. Like menthol, ice-flavored e-cigarettes produce a cooling sensory experience. It is unclear if ice hybrid–flavored e-cigarettes should be considered characterizing flavors or menthol, limiting regulatory action. Monitoring the public’s conversations about ice-flavored e-cigarettes on Twitter may help inform the tobacco control community about these products and contribute to the US FDA policy targets in the future. Objective: This study documented the themes pertaining to vaping and ice flavor–related conversations on Twitter. Our goal was to identify key conversation trends and ascertain users’ recent experiences with ice-flavored e-cigarette products. Methods: Posts containing vaping-related (eg, “vape,” “ecig,” “e-juice,” or “e-cigarette”) and ice-related (ie, “Ice,” “Cool,” “Frost,” and “Arctic”) terms were collected from Twitter’s streaming application programming interface from January 1 to July 21, 2021. After removing retweets, a random sample of posts (N=2001) was selected, with 590 posts included in the content analysis. Themes were developed through an inductive approach. Theme co-occurrence was also examined. Results: Many of the 590 posts were marked as (or consisted of) marketing material (n=306, 51.9%), contained positive personal testimonials (n=180, 30.5%), and mentioned disposable pods (n=117, 19.8%). Other themes had relatively low prevalence in the sample: neutral personal testimonials (n=45, 7.6%), cannabidiol products (n=41, 7%), negative personal testimonials (n=41, 7%), “official” flavor description (n=37, 6.3%), ice-flavored JUUL (n=19, 3.2%), information seeking (n=14, 2.4%), and comparison to combustible tobacco (n=10, 1.7%). The most common co-occurring themes in a single tweet were related to marketing and disposable pods (n=73, 12.4%). Conclusions: Our findings offer insight into the public’s experience with and understanding of ice-flavored e-cigarette products. Ice-flavored e-cigarette products are actively marketed on Twitter, and the messages about them are positive. Public health education campaigns on the harms of flavored e-cigarettes may help to reduce positive social norms about ice-flavored products. Future studies should evaluate the relationship between exposure to personal testimonials of ice-flavored vaping products and curiosity, harm perceptions, and experimentation with these products among priority populations. %M 36449326 %R 10.2196/41785 %U https://www.jmir.org/2022/11/e41785 %U https://doi.org/10.2196/41785 %U http://www.ncbi.nlm.nih.gov/pubmed/36449326 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e41658 %T Outcomes of a Comprehensive Mobile Smoking Cessation Program With Nicotine Replacement Therapy in Adult Smokers: Pilot Randomized Controlled Trial %A Marler,Jennifer D %A Fujii,Craig A %A Utley,MacKenzie T %A Balbierz,Daniel J %A Galanko,Joseph A %A Utley,David S %+ Pivot Health Technologies Inc., 1010 Commercial St., Suite C, San Carlos, CA, 94070, United States, 1 4157577696, marler@pivot.co %K smoking cessation %K digital health %K smartphone %K digital sensor %K carbon monoxide %K breath sensor %K biofeedback %K mobile apps %K health promotion %K app %K mobile phone %D 2022 %7 24.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cigarette smoking remains the leading cause of preventable illness and death, underscoring ongoing need for evidence-based solutions. Pivot, a US Clinical Practice Guideline–based mobile smoking cessation program, comprises a personal carbon monoxide breath sensor; a smartphone app; in-app, text-based human-provided coaching; nicotine replacement therapy; and a moderated web-based community. Promising Pivot cohort studies have established the foundation for comparative assessment. Objective: This study aimed to compare engagement, retention, attitudes toward quitting smoking, smoking behavior, and participant feedback between Pivot and QuitGuide, a US Clinical Practice Guideline–based smoking cessation smartphone app from the National Cancer Institute. Methods: In this remote pilot randomized controlled trial, cigarette smokers in the United States were recruited on the web and randomized to Pivot or QuitGuide. Participants were offered 12 weeks of free nicotine replacement therapy. Data were self-reported via weekly web-based questionnaires for 12 weeks and at 26 weeks. Outcomes included engagement and retention, attitudes toward quitting smoking, smoking behavior, and participant feedback. The primary outcome was self-reported app openings at 12 weeks. Cessation outcomes included self-reported 7- and 30-day point prevalence abstinence (PPA), abstinence from all tobacco products, and continuous abstinence at 12 and 26 weeks. PPA and continuous abstinence were biovalidated via breath carbon monoxide samples. Results: Participants comprised 188 smokers (94 Pivot and 94 QuitGuide): mean age 46.4 (SD 9.2) years, 104 (55.3%) women, 128 (68.1%) White individuals, and mean cigarettes per day 17.6 (SD 9.0). Engagement via mean “total app openings through 12 weeks” (primary outcome) was Pivot, 157.9 (SD 210.6) versus QuitGuide, 86.5 (SD 66.3; P<.001). Self-reported 7-day PPA at 12 and 26 weeks was Pivot, 35% (33/94) versus QuitGuide, 28% (26/94; intention to treat [ITT]: P=.28) and Pivot, 36% (34/94) versus QuitGuide, 27% (25/94; ITT: P=.12), respectively. Self-reported 30-day PPA at 12 and 26 weeks was Pivot, 29% (27/94) versus QuitGuide, 22% (21/94; ITT: P=.32) and Pivot, 32% (30/94) versus QuitGuide, 22% (21/94; ITT: P=.12), respectively. The biovalidated abstinence rate at 12 weeks was Pivot, 29% (27/94) versus QuitGuide, 13% (12/94; ITT: P=.008). Biovalidated continuous abstinence at 26 weeks was Pivot, 21% (20/94) versus QuitGuide, 10% (9/94; ITT: P=.03). Participant feedback, including ease of setup, impact on smoking, and likelihood of program recommendation were favorable for Pivot. Conclusions: In this randomized controlled trial comparing the app-based smoking cessation programs Pivot and QuitGuide, Pivot participants had higher engagement and biovalidated cessation rates and more favorable user feedback at 12 and 26 weeks. These findings support Pivot as an effective, durable mobile smoking cessation program. Trial Registration: ClinicalTrials.gov NCT04955639; https://clinicaltrials.gov/ct2/show/NCT04955639 %M 36257323 %R 10.2196/41658 %U https://mhealth.jmir.org/2022/11/e41658 %U https://doi.org/10.2196/41658 %U http://www.ncbi.nlm.nih.gov/pubmed/36257323 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e42441 %T Themes in TikTok Videos Featuring Little Cigars and Cigarillos: Content Analysis %A Vassey,Julia %A Donaldson,Scott I %A Dormanesh,Allison %A Allem,Jon-Patrick %+ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, 3rd Floor, SSB 312D, 1845 N Soto St, Los Angeles, CA, 90032, United States, 1 323 442 7921, allem@usc.edu %K cigarillo %K little cigar %K social media %K TikTok %K video %K cigar %K cigarette %K smoker %K smoking %K tobacco %K social media %K content analysis %K youth %K young adult %K adolescent %K user generated content %D 2022 %7 16.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Little cigars and cigarillos (LCCs) are popular tobacco products among youth (ie, adolescents and young adults). A variety of LCC-related promotional and user-generated content is present on social media. However, research on LCC-related posts on social media has been largely focused on platforms that are primarily text- or image-based, such as Twitter and Instagram. Objective: This study analyzed LCC-related content on TikTok, an audio and video–based platform popular among youth. Methods: Publicly available posts (N=811) that contained the LCC-related hashtags #swishersweets or #backwoods were collected on TikTok from January 2019 to May 2021. Metadata were also collected, including numbers of likes, comments, shares, and views per video. Using an inductive approach, a codebook consisting of 26 themes was developed to help summarize the underlying themes evident in the TikTok videos and corresponding captions. A pairwise co-occurrence analysis of themes was also conducted to evaluate connections among themes. Results: Among the 811 posts, the LCC presence theme (ie, a visible LCC) occurred in the most prominent number of posts (n=661, 81.5%), followed by music (n=559, 68.9%), youth (n=332, 40.9%), humor (n=263, 32.4%), LCC use (n=242, 29.8%), flavors (n=232, 28.6%), branding (n=182, 22.4%), paraphernalia (n=137, 16.9%), blunt rolling (n=94, 11.6%), and price (n=84, 10.4%). Product reviews had the highest engagement, with a median 44 (mean 2857, range 36,499) likes and median 491 (mean 15,711, range 193,590) views; followed by product comparisons, with a median 44 (mean 1920, range 36,500) likes and median 671 (mean 11,277, range 193,798) views. Promotions had the lowest engagement, with a median 4 (mean 8, range 34) likes and median 78 (mean 213, range 1131) views. The most prevalent themes co-occurring with LCC presence were (1) music (434/811, 53.5%), (2) youth (264/811, 32.6%), (3) humor (219/811, 27%), (4) flavors (214/811, 26.4%), and (5) LCC use (207/811, 25.5%). Conclusions: LCC-related marketing and user-generated content was present on TikTok, including videos showing youth discussing, displaying, or using LCCs. Such content may be in violation of TikTok’s community guidelines prohibiting the display, promotion, or posting of tobacco-related content on its platform, including the display of possession or consumption of tobacco by a minor. Further improvement in the enforcement of TikTok community guidelines and additional scrutiny from public health policy makers may be necessary for protecting youth from future exposure to tobacco-related posts. Observational and experimental studies are needed to understand the impact of exposure to LCC-related videos on attitudes and behaviors related to LCC use among youth. Finally, there may be a need for engaging antitobacco videos that appeal to youth on TikTok to counter the protobacco content on this platform. %M 36383406 %R 10.2196/42441 %U https://www.jmir.org/2022/11/e42441 %U https://doi.org/10.2196/42441 %U http://www.ncbi.nlm.nih.gov/pubmed/36383406 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e38206 %T Automated Digital Interventions and Smoking Cessation: Systematic Review and Meta-analysis Relating Efficiency to a Psychological Theory of Intervention Perspective %A Sha,Leihao %A Yang,Xia %A Deng,Renhao %A Wang,Wen %A Tao,YuJie %A Cao,HaiLing %A Ma,Qianshu %A Wang,Hao %A Nie,Yirou %A Leng,Siqi %A Lv,Qiuyue %A Li,Xiaojing %A Wang,Huiyao %A Meng,Yajing %A Xu,Jiajun %A Greenshaw,Andrew J %A Li,Tao %A Guo,Wan-jun %+ Mental Health Center and Sichuan Clinical Medical Research Center for Mental Disorders, West China Hospital of Sichuan University, No. 28 Dianxin South St, Chengdu, 610041, China, 86 28 8542356, guowjcn@163.com %K smoking cessation %K automated %K digital intervention %K psychological theory %K meta-analysis %K systematic review %K public health %K side effects %K interventions %K randomized controlled trial %K self-help %D 2022 %7 16.11.2022 %9 Review %J J Med Internet Res %G English %X Background: Smoking remains a highly significant preventable global public health problem. In this context, digital interventions offer great advantages in terms of a lack of biological side effects, possibility of automatic delivery, and consequent human resource savings relative to traditional interventions. Such interventions have been studied in randomized controlled trials (RCTs) but have not been systematically reviewed with the inclusion of text-based and multiplatform-based interventions. In addition, this area has not been evaluated from the perspective of the psychological theoretical basis of intervention. Objective: The aim of this paper is to assess the efficiency of digital interventions in RCT studies of smoking cessation and to evaluate the effectiveness of the strategies used for digital interventions. Methods: An electronic search of RCTs was conducted using PubMed, Embase, and the Cochrane Library by June 30, 2021. Eligible studies had to compare automated digital intervention (ADI) to the use of a self-help guideline or no intervention. Participants were current smokers (aged 16 years or older). As the main outcome, abstinence after endpoint was extracted from the studies. Systematic review and meta-analysis were conducted to assess the efficiency of ADIs. Metaregressions were conducted to assess the relationship between intervention theory and effectiveness. Results: A total of 19 trials (15,472 participants) were included in the analysis. The overall abstinence rate (95% CI) at the endpoint was 17.8% (17.0-18.7). The overall risk ratio of the intervention group compared to the controls at the endpoint was 17.8% (17.0-18.7). Cochrane risk-of-bias tool for randomized trials (ROB 2) suggested that most of the studies had a low risk of bias (56.3%). Psychological theory–related constructs or predictors, which refer to other theory-based concepts (rather than only behavioral theory) such as craving or anxiety, are associated with effectiveness. Conclusions: This study found that ADI had a clear positive effect compared to self-help guidelines or to no intervention, and effectiveness was associated with theory-related constructs or predictors. ADIs should be promoted by policy makers and clinical practitioners to address the huge gap between the need for smoking cessation and availability of traditional treatment resources. Possible increases in ADI efficiency may be achieved by optimally integrating psychotherapeutic theories and techniques. Trial Registration: PROSPERO CRD42021256593; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256593 %M 36383408 %R 10.2196/38206 %U https://www.jmir.org/2022/11/e38206 %U https://doi.org/10.2196/38206 %U http://www.ncbi.nlm.nih.gov/pubmed/36383408 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e35974 %T Consumer-Generated Discourse on Cannabis as a Medicine: Scoping Review of Techniques %A Khademi Habibabadi,Sedigheh %A Hallinan,Christine %A Bonomo,Yvonne %A Conway,Mike %+ Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Grattan Street, Parkville, Victoria, Melbourne, 3010, Australia, 61 405761879, sedigh.khademi@unimelb.edu.au %K social media %K data mining %K internet and the web technology %K consumer-generated data %K medicinal cannabis %K medical marijuana %D 2022 %7 16.11.2022 %9 Review %J J Med Internet Res %G English %X Background: Medicinal cannabis is increasingly being used for a variety of physical and mental health conditions. Social media and web-based health platforms provide valuable, real-time, and cost-effective surveillance resources for gleaning insights regarding individuals who use cannabis for medicinal purposes. This is particularly important considering that the evidence for the optimal use of medicinal cannabis is still emerging. Despite the web-based marketing of medicinal cannabis to consumers, currently, there is no robust regulatory framework to measure clinical health benefits or individual experiences of adverse events. In a previous study, we conducted a systematic scoping review of studies that contained themes of the medicinal use of cannabis and used data from social media and search engine results. This study analyzed the methodological approaches and limitations of these studies. Objective: We aimed to examine research approaches and study methodologies that use web-based user-generated text to study the use of cannabis as a medicine. Methods: We searched MEDLINE, Scopus, Web of Science, and Embase databases for primary studies in the English language from January 1974 to April 2022. Studies were included if they aimed to understand web-based user-generated text related to health conditions where cannabis is used as a medicine or where health was mentioned in general cannabis-related conversations. Results: We included 42 articles in this review. In these articles, Twitter was used 3 times more than other computer-generated sources, including Reddit, web-based forums, GoFundMe, YouTube, and Google Trends. Analytical methods included sentiment assessment, thematic analysis (manual and automatic), social network analysis, and geographic analysis. Conclusions: This study is the first to review techniques used by research on consumer-generated text for understanding cannabis as a medicine. It is increasingly evident that consumer-generated data offer opportunities for a greater understanding of individual behavior and population health outcomes. However, research using these data has some limitations that include difficulties in establishing sample representativeness and a lack of methodological best practices. To address these limitations, deidentified annotated data sources should be made publicly available, researchers should determine the origins of posts (organizations, bots, power users, or ordinary individuals), and powerful analytical techniques should be used. %M 36383417 %R 10.2196/35974 %U https://www.jmir.org/2022/11/e35974 %U https://doi.org/10.2196/35974 %U http://www.ncbi.nlm.nih.gov/pubmed/36383417 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e40907 %T Use of a Rapid Qualitative Method to Inform the Development of a Text Messaging Intervention for People With Serious Mental Illness Who Smoke: Formative Research Study %A Nagawa,Catherine S %A Lane,Ian A %A McKay,Colleen E %A Kamberi,Ariana %A Shenette,Lisa L %A Kelly,Megan M %A Davis,Maryann %A Sadasivam,Rajani S %+ Department of Population and Quantitative Health Sciences, UMass Chan Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 508 856 8999, cnagawa@mgh.harvard.edu %K serious mental illness %K mental disorder %K psychiatric disorder %K tobacco use %K smoking cessation %K text messaging %K intervention %K smoking %K mental health %K virtual %K COVID-19 %K pandemic %K symptom %D 2022 %7 7.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: People with serious mental illness are disproportionately affected by smoking and face barriers to accessing smoking cessation treatments in mental health treatment settings. Text-based interventions are cost-effective and represent a widely accessible approach to providing smoking cessation support. Objective: We aimed to identify key factors for adapting text-based cessation interventions for people with serious mental illness who smoke. Methods: We recruited 24 adults from mental health programs who had a serious mental illness and currently smoked cigarettes or had quit smoking within the past 5 years. We then conducted virtual qualitative interviews between November 2020 and August 2021. Data were analyzed using the rapid thematic analytic approach. Results: We identified the following 3 major themes: (1) interplay between smoking and having a serious mental illness, (2) social contextual factors of smoking in adults with serious mental illness, and (3) smoking and quitting behaviors similar to the general population. Participants reported barriers and facilitators to quitting across the 3 themes. Within the “interplay between smoking and having a serious mental illness” theme, barriers included smoking to manage stress and mental health symptoms, and facilitators to quitting included the awareness of the harm of smoking on mental health and patient-provider discussions on smoking and mental health. In the “social contextual factors of smoking in adults with serious mental illness” theme, barriers included high social acceptability of smoking among peers. Positive support and the combined social stigma of smoking and having a mental health condition outside of peer groups motivated individuals to quit. Some participants indicated that low exposure to other smokers during the COVID-19 pandemic helped them to engage in cessation efforts. In the “smoking and quitting behaviors similar to the general population” theme, barriers included smoking after eating, having coffee, drinking alcohol, and experiencing negative social support, and facilitators included health concerns, improvement in the general quality of life, and use of evidence-based tobacco treatments when available. Conclusions: People with serious mental illness often smoke to cope with intense emotional states, manage mental health symptoms, or maintain social bonds. Text message content emphasizing equally effective and less harmful ways for stress reduction and mental health symptom management may improve quit rates in individuals with serious mental illness. %M 36342765 %R 10.2196/40907 %U https://formative.jmir.org/2022/11/e40907 %U https://doi.org/10.2196/40907 %U http://www.ncbi.nlm.nih.gov/pubmed/36342765 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e30327 %T Internet-Based Intervention Compared to Brief Intervention for Smoking Cessation in Brazil: Pilot Study %A Machado,Nathalia Munck %A Gomide,Henrique Pinto %A Bernardino,Heder Soares %A Ronzani,Telmo Mota %+ Department of Population Health, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, United States, 1 8163287381, nmachado@kumc.edu %K smoking cessation %K internet-based intervention %K digital intervention %K mobile health %K mHealth %K tobacco %K addiction %K public health %K digital intervention %K substance use %D 2022 %7 3.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is still the leading cause of preventable death. Governments and health care providers should make available more accessible resources to help tobacco users stop. Objective: This study describes a pilot longitudinal study that evaluated the efficacy of an internet-based intervention compared to the brief intervention for smoking cessation among Brazilians. Methods: Eligible participants were recruited and randomly allocated to one of the two interventions. Measures were drawn by comparing cessation rates, motivation scores, and sought treatment between groups, assessed 1 and 3 months after the intervention. Inferential analysis was performed to compare the participants’ characteristics, and the intention to treat was calculated. Results: A total of 49 smokers were enrolled in this study (n=25, 51% in the brief intervention group; n=24, 49% in the internet-based intervention group). Mean age was 44.5 (SD 13.3) years; most were male (n=29, 59.2%), had elementary school (n=22, 44.9%), smoked 14.5 cigarettes per day on average (SD 8.6), and had a mean score of 4.65 for nicotine dependence and 5.7 for motivation to quit. Moreover, 35 (71%) participants answered follow-up 1, and 19 (39%) answered follow-up 2. The results showed similar rates of cessation and reduction for both intervention groups. Conclusions: The internet-based intervention was slightly more effective for smoking cessation, while the brief intervention was more effective in reducing the number of cigarettes smoked per day. This difference was small and had no statistical significance even after adjusting for intention-to-treat analysis. These results should be interpreted with caution, especially due to the small sample size. %M 36326817 %R 10.2196/30327 %U https://formative.jmir.org/2022/11/e30327 %U https://doi.org/10.2196/30327 %U http://www.ncbi.nlm.nih.gov/pubmed/36326817 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e39785 %T Biomarkers of Exposure and Potential Harm in Exclusive Users of Nicotine Pouches and Current, Former, and Never Smokers: Protocol for a Cross-sectional Clinical Study %A Azzopardi,David %A Haswell,Linsey Ellen %A Frosina,Justin %A McEwan,Michael %A Gale,Nathan %A Thissen,Jesse %A Meichanetzidis,Filimon %A Hardie,George %+ British American Tobacco (Investments) Limited, R&D Centre, Regents Park Road, Southampton, SO15 8TL, United Kingdom, 44 2380588802, david_azzopardi@bat.com %K biomarkers of exposure %K biomarkers of potential harm %K nicotine pouches %K tobacco harm reduction %K cross-sectional clinical study %D 2022 %7 6.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco harm reduction (THR) aims to reduce the health burden of cigarettes by encouraging smokers to switch to using alternative tobacco or nicotine products. Nicotine pouches (NPs) are smokeless, tobacco-free, oral products that may be beneficial as part of a THR strategy. Objective: This 2-center, cross-sectional confinement study conducted in Denmark and Sweden aimed to determine whether biomarkers of exposure (BoEs) to tobacco toxicants and biomarkers of potential harm (BoPHs) in exclusive users of NPs show favorable differences compared with current smokers. Methods: Participants were healthy NP users (target n=100) and current, former, or never smokers (target n=40 each), as confirmed by urinary cotinine and exhaled carbon monoxide concentrations. During a 24-hour confinement period, participants were asked to use their usual product (NP or cigarette) as normal, and BoEs and BoPHs were measured in blood and 24-hour urine samples, with compliance determined using anabasine, anatabine, and N-(2-cyanoethyl)valine. BoEs and BoPHs were compared between NP users and current, former, and never smokers. Urinary total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (BoE to nicotine-derived nitrosamine ketone) and urinary 8-epi-prostaglandin F2α type III, exhaled nitric oxide, blood carboxyhemoglobin, white blood cell count, soluble intercellular adhesion molecule-1, and high-density lipoprotein cholesterol (BoPHs) were evaluated as primary outcomes. Other measures included urinary 11-dehydrothromboxane B2, forced expiratory volume, carotid intima-media thickness, self-reported quality of life, and oral health. Results: The results of this study were received in mid-2022 and will be published in late 2022 to early 2023. Conclusions: The results of this study will provide information on toxicant exposure and biomarkers associated with the development of smoking-related diseases among users of NPs compared with smokers, as well as on the potential role of NPs in THR. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) ISRCTN16988167; https://www.isrctn.com/ISRCTN16988167 International Registered Report Identifier (IRRID): DERR1-10.2196/39785 %M 36201395 %R 10.2196/39785 %U https://www.researchprotocols.org/2022/10/e39785 %U https://doi.org/10.2196/39785 %U http://www.ncbi.nlm.nih.gov/pubmed/36201395 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e37900 %T The Impact of a Clinical Decision Support System for Addressing Physical Activity and Healthy Eating During Smoking Cessation Treatment: Hybrid Type I Randomized Controlled Trial %A Minian,Nadia %A Lingam,Mathangee %A Moineddin,Rahim %A Thorpe,Kevin E %A Veldhuizen,Scott %A Dragonetti,Rosa %A Zawertailo,Laurie %A Taylor,Valerie H %A Hahn,Margaret %A deRuiter,Wayne K %A Melamed,Osnat C %A Selby,Peter %+ Nicotine Dependence Service, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada, 1 416 535 8501 ext 36859, peter.selby@camh.ca %K smoking cessation %K physical activity %K healthy eating %K clinical decision support system %K Canada %K diet %K intervention %K smoking %K primary care %K program %K treatment %K clinical decision support %K health behavior %D 2022 %7 30.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: People who smoke have other risk factors for chronic diseases, such as low levels of physical activity and poor diet. Clinical decision support systems (CDSSs) might help health care practitioners integrate interventions for diet and physical activity into their smoking cessation programming but could worsen quit rates. Objective: The aims of this study are to assess the effects of the addition of a CDSS for physical activity and diet on smoking cessation outcomes and to assess the implementation of the study. Methods: We conducted a pragmatic hybrid type I effectiveness-implementation trial with 232 team-based primary care practices in Ontario, Canada, from November 2019 to May 2021. We used a 2-arm randomized controlled trial comparing a CDSS addressing physical activity and diet to treatment as usual and used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework to measure implementation outcomes. The primary outcome was self-reported 7-day tobacco abstinence at 6 months. Results: We enrolled 5331 participants in the study. Of these, 2732 (51.2%) were randomized to the intervention group and 2599 (48.8%) to the control group. At the 6-month follow-up, 29.7% (634/2137) of respondents in the intervention arm and 27.3% (552/2020) in the control arm reported abstinence from tobacco. After multiple imputation, the absolute group difference was 2.1% (95% CI −0.5 to 4.6; F1,1000.42=2.43; P=.12). Mean exercise minutes changed from 32 (SD 44.7) to 110 (SD 196.1) in the intervention arm and from 32 (SD 45.1) to 113 (SD 195.1) in the control arm (group effect: B=−3.7 minutes; 95% CI −17.8 to 10.4; P=.61). Servings of fruit and vegetables changed from 2.64 servings to 2.42 servings in the intervention group and from 2.52 servings to 2.45 servings in the control group (incidence rate ratio for intervention group=0.98; 95% CI 0.93-1.02; P=.35). Conclusions: A CDSS for physical activity and diet may be added to a smoking cessation program without affecting the outcomes. Further research is needed to improve the impact of integrated health promotion interventions in primary care smoking cessation programs. Trial Registration: ClinicalTrials.gov NCT04223336 https://www.clinicaltrials.gov/ct2/show/NCT04223336 International Registered Report Identifier (IRRID): RR2-10.2196/19157 %M 36178716 %R 10.2196/37900 %U https://www.jmir.org/2022/9/e37900 %U https://doi.org/10.2196/37900 %U http://www.ncbi.nlm.nih.gov/pubmed/36178716 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e35556 %T Chatbots for Smoking Cessation: Scoping Review %A Whittaker,Robyn %A Dobson,Rosie %A Garner,Katie %+ National Institute for Health Innovation, University of Auckland, 22-30 Park Ave, Grafton, Auckland, 1142, New Zealand, 64 9373 7599, r.whittaker@auckland.ac.nz %K chatbot %K conversational agent %K COVID-19 %K smoking cessation %D 2022 %7 26.9.2022 %9 Review %J J Med Internet Res %G English %X Background: Despite significant progress in reducing tobacco use over the past 2 decades, tobacco still kills over 8 million people every year. Digital interventions, such as text messaging, have been found to help people quit smoking. Chatbots, or conversational agents, are new digital tools that mimic instantaneous human conversation and therefore could extend the effectiveness of text messaging. Objective: This scoping review aims to assess the extent of research in the chatbot literature for smoking cessation and provide recommendations for future research in this area. Methods: Relevant studies were identified through searches conducted in Embase, MEDLINE, APA PsycINFO, Google Scholar, and Scopus, as well as additional searches on JMIR, Cochrane Library, Lancet Digital Health, and Digital Medicine. Studies were considered if they were conducted with tobacco smokers, were conducted between 2000 and 2021, were available in English, and included a chatbot intervention. Results: Of 323 studies identified, 10 studies were included in the review (3 framework articles, 1 study protocol, 2 pilot studies, 2 trials, and 2 randomized controlled trials). Most studies noted some benefits related to smoking cessation and participant engagement; however, outcome measures varied considerably. The quality of the studies overall was low, with methodological issues and low follow-up rates. Conclusions: More research is needed to make a firm conclusion about the efficacy of chatbots for smoking cessation. Researchers need to provide more in-depth descriptions of chatbot functionality, mode of delivery, and theoretical underpinnings. Consistency in language and terminology would also assist in reviews of what approaches work across the field. %M 36095295 %R 10.2196/35556 %U https://www.jmir.org/2022/9/e35556 %U https://doi.org/10.2196/35556 %U http://www.ncbi.nlm.nih.gov/pubmed/36095295 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e40331 %T The Influence of Provaping “Gatewatchers” on the Dissemination of COVID-19 Misinformation on Twitter: Analysis of Twitter Discourse Regarding Nicotine and the COVID-19 Pandemic %A Silver,Nathan %A Kierstead,Elexis %A Kostygina,Ganna %A Tran,Hy %A Briggs,Jodie %A Emery,Sherry %A Schillo,Barbara %+ Schroeder Institute, Truth Initiative, 900 G St NW, Washington, DC, 20006, United States, 1 2024545555, nsilver@truthinitiative.org %K social media %K tobacco %K COVID-19 %K nicotine %K misinformation %K Twitter %K information %K infodemiology %K vaping %K therapeutic %K influence %K environment %K harmful %K consequences %D 2022 %7 22.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a lot of misinformation about a potential protective role of nicotine against COVID-19 spread on Twitter despite significant evidence to the contrary. We need to examine the role of vape advocates in the dissemination of such information through the lens of the gatewatching framework, which posits that top users can amplify and exert a disproportionate influence over the dissemination of certain content through curating, sharing, or, in the case of Twitter, retweeting it, serving more as a vector for misinformation rather than the source. Objective: This research examines the Twitter discourse at the intersection of COVID-19 and tobacco (1) to identify the extent to which the most outspoken contributors to this conversation self-identify as vaping advocates and (2) to understand how and to what extent these vape advocates serve as gatewatchers through disseminating content about a therapeutic role of tobacco, nicotine, or vaping against COVID-19. Methods: Tweets about tobacco, nicotine, or vaping and COVID-19 (N=1,420,271) posted during the first 9 months of the pandemic (January-September 2020) were identified from within a larger corpus of tobacco-related tweets using validated keyword filters. The top posters (ie, tweeters and retweeters) were identified and characterized, along with the most shared Uniform Resource Locators (URLs), most used hashtags, and the 1000 most retweeted posts. Finally, we examined the role of both top users and vape advocates in retweeting the most retweeted posts about the therapeutic role of nicotine, tobacco, or vaping against COVID-19. Results: Vape advocates comprised between 49.7% (n=81) of top 163 and 88% (n=22) of top 25 users discussing COVID-19 and tobacco on Twitter. Content about the ability of tobacco, nicotine, or vaping to treat or prevent COVID-19 was disseminated broadly, accounting for 22.5% (n=57) of the most shared URLs and 10% (n=107) of the most retweeted tweets. Finally, among top users, retweets comprised an average of 78.6% of the posts from vape advocates compared to 53.1% from others (z=3.34, P<.001). Vape advocates were also more likely to retweet the top tweeted posts about a therapeutic role of nicotine, with 63% (n=51) of vape advocates retweeting at least 1 post compared to 40.3% (n=29) of other top users (z=2.80, P=.01). Conclusions: Provaping users dominated discussions of tobacco use during the COVID-19 pandemic on Twitter and were instrumental in disseminating the most retweeted posts about a potential therapeutic role of tobacco use against the virus. Subsequent research is needed to better understand the extent of this influence and how to mitigate the influence of vape advocates over the broader narrative of tobacco regulation on Twitter. %M 36070451 %R 10.2196/40331 %U https://www.jmir.org/2022/9/e40331 %U https://doi.org/10.2196/40331 %U http://www.ncbi.nlm.nih.gov/pubmed/36070451 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e38663 %T Proactive Electronic Visits for Smoking Cessation and Chronic Obstructive Pulmonary Disease Screening in Primary Care: Randomized Controlled Trial of Feasibility, Acceptability, and Efficacy %A Dahne,Jennifer %A Player,Marty S %A Strange,Charlie %A Carpenter,Matthew J %A Ford,Dee W %A King,Kathryn %A Miller,Sarah %A Kruis,Ryan %A Hawes,Elizabeth %A Hidalgo,Johanna E %A Diaz,Vanessa A %+ Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, MSC 955, 86 Jonathan Lucas Street, Charleston, SC, 29425, United States, 1 843 876 2280, dahne@musc.edu %K electronic visits %K e-visit %K COPD %K chronic obstructive pulmonary disease %K smoking cessation %K telehealth %K electronic health record %K patient portal %K EHR %K feasibility %K efficacy %K intervention %K screening %K diagnosis %K prevention %K treatment %K management %K acceptability %K pulmonary %K function %D 2022 %7 30.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Most smokers with chronic obstructive pulmonary disease (COPD) have not yet been diagnosed, a statistic that has remained unchanged for over two decades. A dual-focused telehealth intervention that promotes smoking cessation, while also facilitating COPD screening, could help address national priorities to improve the diagnosis, prevention, treatment, and management of COPD. The purpose of this study was to preliminarily evaluate an integrated asynchronous smoking cessation and COPD screening e-visit (electronic visit) that could be delivered proactively to adult smokers at risk for COPD, who are treated within primary care. Objective: The aims of this study were (1) to examine e-visit feasibility and acceptability, particularly as compared to in-lab diagnostic pulmonary function testing (PFT), and (2) to examine the efficacy of smoking cessation e-visits relative to treatment as usual (TAU), all within primary care. Methods: In a randomized clinical trial, 125 primary care patients who smoke were randomized 2:1 to receive either proactive e-visits or TAU. Participants randomized to the e-visit condition were screened for COPD symptoms via the COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE). Those with scores ≥2 were invited to complete both home spirometry and in-lab PFTs, in addition to two smoking cessation e-visits. Smoking cessation e-visits assessed smoking history and motivation to quit and included completion of an algorithm to determine the best Food and Drug Administration–approved cessation medication to prescribe. Primary outcomes included measures related to (1) e-visit acceptability, feasibility, and treatment metrics; (2) smoking cessation outcomes (cessation medication use, 24-hour quit attempts, smoking reduction ≥50%, self-reported abstinence, and biochemically confirmed abstinence); and (3) COPD screening outcomes. Results: Of 85 participants assigned to the e-visits, 64 (75.3%) were invited to complete home spirometry and in-lab PFTs based on CAPTURE. Among those eligible for spirometry, 76.6% (49/64) completed home spirometry, and 35.9% (23/64) completed in-lab PFTs. At 1 month, all cessation outcomes favored the e-visit, with a significant effect for cessation medication use (odds ratio [OR]=3.22). At 3 months, all cessation outcomes except for 24-hour quit attempts favored the e-visit, with significant effects for cessation medication use (OR=3.96) and smoking reduction (OR=3.09). Conclusions: A proactive, asynchronous e-visit for smoking cessation and COPD screening may offer a feasible, efficacious approach for broad interventions within primary care. Trial Registration: ClinicalTrials.gov NCT04155073; https://clinicaltrials.gov/ct2/show/NCT04155073 %M 36040766 %R 10.2196/38663 %U https://www.jmir.org/2022/8/e38663 %U https://doi.org/10.2196/38663 %U http://www.ncbi.nlm.nih.gov/pubmed/36040766 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 8 %P e38174 %T Perceptions and Discussions of Snus on Twitter: Observational Study %A Chen,Jiarui %A Xue,Siyu %A Xie,Zidian %A Li,Dongmei %+ Department of Clinical & Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 585 276 7285, Dongmei_Li@urmc.rochester.edu %K snus %K Twitter %K sentiment %K topic modeling %K smokeless tobacco products %D 2022 %7 29.8.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: With the increasing popularity of snus, it is essential to understand the public perception of this oral tobacco product. Twitter—a popular social media platform that is being used to share personal experiences and opinions—provides an ideal data source for studying the public perception of snus. Objective: This study aims to examine public perceptions and discussions of snus on Twitter. Methods: Twitter posts (tweets) about snus were collected through the Twitter streaming application programming interface from March 11, 2021, to February 26, 2022. A temporal analysis was conducted to examine the change in number of snus-related tweets over time. A sentiment analysis was conducted to examine the sentiments of snus-related tweets. Topic modeling was applied to tweets to determine popular topics. Finally, a keyword search and hand-coding were used to understand the health symptoms mentioned in snus-related tweets. Results: The sentiment analysis showed that the proportion of snus-related tweets with a positive sentiment was significantly higher than the proportion of negative sentiment tweets (4341/11,631, 37.32% vs 3094/11,631, 26.60%; P<.001). The topic modeling analysis revealed that positive tweets focused on snus’s harm reduction and snus use being an alternative to smoking, while negative tweets focused on health concerns related to snus. Mouth and respiratory symptoms were the most mentioned health symptoms in snus-related tweets. Conclusions: This study examined the public perception of snus and popular snus-related topics discussed on Twitter, thus providing a guide for policy makers with regard to the future formulation and adjustment of tobacco regulation policies. %M 36036970 %R 10.2196/38174 %U https://medinform.jmir.org/2022/8/e38174 %U https://doi.org/10.2196/38174 %U http://www.ncbi.nlm.nih.gov/pubmed/36036970 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e38470 %T The Measurement of Dose and Response for Smoking Behavior Change Interventions in the Digital Age: Systematic Review %A Ichimiya,Megumi %A Gerard,Raquel %A Mills,Sarah %A Brodsky,Alexa %A Cantrell,Jennifer %A Evans,W Douglas %+ Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, NW, Washington, DC, 20052, United States, 1 202 994 7400, imegumi7@gwu.edu %K digital health %K digital media %K social media %K behavior change interventions %K smoking %K vaping %K dose-response %K telehealth %K mobile health %K mHealth %K mobile phone %D 2022 %7 25.8.2022 %9 Review %J J Med Internet Res %G English %X Background: There is little consensus regarding effective digital health interventions for diverse populations, which is due in part to the difficulty of quantifying the impact of various media and content and the lack of consensus on evaluating dosage and outcomes. In particular, digital smoking behavior change intervention is an area where consistency of measurement has been a challenge because of emerging products and rapid policy changes. This study reviewed the contents and outcomes of digital smoking interventions and the consistency of reporting to inform future research. Objective: This study aims to systematically review digital smoking behavior change interventions and evaluate the consistency in measuring and reporting intervention contents, channels, and dose and response outcomes. Methods: PubMed, Embase, Scopus, PsycINFO, and PAIS databases were used to search the literature between January and May 2021. General and journal-based searches were combined. All records were imported into Covidence systematic review software (Veritas Health Innovation) and duplicates were removed. Titles and abstracts were screened by 4 trained reviewers to identify eligible full-text literature. The data synthesis scheme was designed based on the concept that exposure to digital interventions can be divided into intended doses that were planned by the intervention and enacted doses that were completed by participants. The intended dose comprised the frequency and length of the interventions, and the enacted dose was assessed as the engagement. Response measures were assessed for behaviors, intentions, and psychosocial outcomes. Measurements of the dose-response relationship were reviewed for all studies. Results: A total of 2916 articles were identified through a database search. Of these 2916 articles, the title and abstract review yielded 324 (11.11%) articles for possible eligibility, and 19 (0.65%) articles on digital smoking behavior change interventions were ultimately included for data extraction and synthesis. The analysis revealed a lack of prevention studies (0/19, 0%) and dose-response studies (3/19, 16%). Of the 19 studies, 6 (32%) reported multiple behavioral measures, and 5 (23%) reported multiple psychosocial measures as outcomes. For dosage measures, 37% (7/19) of studies used frequency of exposure, and 21% (4/19) of studies mentioned the length of exposure. The assessment of clarity of reporting revealed that the duration of intervention and data collection tended to be reported vaguely in the literature. Conclusions: This review revealed a lack of studies assessing the effects of digital media interventions on smoking outcomes. Data synthesis showed that measurement and reporting were inconsistent across studies, illustrating current challenges in this field. Although most studies focused on reporting outcomes, the measurement of exposure, including intended and enacted doses, was unclear in a large proportion of studies. Clear and consistent reporting of both outcomes and exposures is needed to develop further evidence in intervention research on digital smoking behavior change. %M 36006682 %R 10.2196/38470 %U https://www.jmir.org/2022/8/e38470 %U https://doi.org/10.2196/38470 %U http://www.ncbi.nlm.nih.gov/pubmed/36006682 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 3 %P e37526 %T A Multimethod Evaluation of Tobacco Treatment Trial Recruitment Messages for Current Smokers Recently Diagnosed With Cancer: Pilot Factorial Randomized Controlled Trial %A Neil,Jordan M %A Senecal,Christian %A Ballini,Lauren %A Chang,Yuchiao %A Goshe,Brett %A Flores,Efren %A Ostroff,Jamie S %A Park,Elyse R %+ Tobacco Settlement Endowment Trust Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Oklahoma City, OK, 73102, United States, 1 (405) 271 4000, jordan-neil@ouhsc.edu %K teachable moment %K cancer %K tobacco treatment trial %K smoking %K message framing %K recruitment %D 2022 %7 24.8.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: A cancer diagnosis can catalyze motivation to quit smoking. Tobacco treatment trials offer cessation resources but have low accrual rates. Digital outreach may improve accrual, but knowledge of how best to recruit smokers with recent diagnoses is limited. Objective: This study aims to identify the message frames that were most effective in promoting intent to talk to a physician about participating in a tobacco treatment trial for smokers recently diagnosed with cancer. Methods: From February to April 2019, current smokers diagnosed within the past 24 months were recruited from a national web-based panel for a multimethod pilot randomized trial (N=99). Participants were randomized to a 2×3 plus control factorial design that tested 3 unique message frames: proximal versus distal threats of smoking, costs of continued smoking versus benefits of quitting, and gains of participating versus losses of not participating in a tobacco treatment trial. The primary outcome was intent to talk to a physician about participating in a tobacco treatment trial. In phase 1, the main effect within each message factor level was examined using ANOVA and compared with the control condition. Other message evaluation and effectiveness measures were collected and explored in a multivariable model predicting intent to talk to a physician. In phase 2, open-text evaluations of the messages were analyzed using natural language processing software (Leximancer) to generate a thematic concept map and Linguistic Inquiry Word Count to identify and compare the prevalence of linguistic markers among message factors. Results: Of the 99 participants, 76 (77%) completed the intervention. Participants who received the cost of continued smoking frame were significantly more likely to intend to talk to their physician about participating in a tobacco treatment trial than those who received the benefits of the quitting frame (mean costs 5.13, SD 1.70 vs mean benefits 4.23, SD 1.86; P=.04). Participants who received the proximal risks of continued smoking frame were significantly more likely to seek more information about participating (mean distal 4.83, SD 1.61 vs mean proximal 5.55, SD 1.15; P=.04), and those who received the losses of not participating frame reported significantly improved perceptions of smoking cessation research (mean gain 3.98, SD 0.83 vs mean loss 4.38, SD 0.78; P=.01). Male participants (P=.006) and those with greater message relevancy (P=.001) were significantly more likely to intend to talk to their physician. Participants’ perceptions of their smoking habits, as well as their motivation to quit smoking, were prevalent themes in the open-text data. Differences in the percentages of affective words across message frames were identified. Conclusions: Multimethod approaches are needed to develop evidence-based recruitment messages for patients recently diagnosed with cancer. Future tobacco treatment trials should evaluate the effectiveness of different message frames on smoker enrollment rates. Trial Registration: Clinicaltrials.gov NCT05471284; https://clinicaltrials.gov/ct2/show/NCT05471284 %M 36001378 %R 10.2196/37526 %U https://cancer.jmir.org/2022/3/e37526 %U https://doi.org/10.2196/37526 %U http://www.ncbi.nlm.nih.gov/pubmed/36001378 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e37573 %T Designing Studies to Inform Tobacco Harm Reduction: Learnings From an Oral Nicotine Pouch Actual Use Pilot Study %A Campbell,Chris %A Feehan,Michael %A Kanitscheider,Claudia %A Makena,Patrudu S %A Cai,Jenny %A Baxter,Sarah A %+ RAI Services Company, 401 N Main St, Winston-Salem, NC, 27101, United States, 1 336 741 0541, campbec5@rjrt.com %K harm reduction %K pilot %K nicotine pouch %K actual use %K electronic diary %K smartphone %K survey %K combustible cigarette %K smoking reduction %K remote monitoring %D 2022 %7 19.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Introduction of new tobacco products in the United States, including those that may be lower on the risk continuum than traditional combustible cigarettes, requires premarket authorization by the US Food and Drug Administration and information on the potential impact of the products on consumer behaviors. Efficient recruitment and data capture processes are needed to collect relevant information in a near-to-real-world environment. Objective: The aim of this pilot study was to develop and test a protocol for an actual use study of a new tobacco product. The product included in this study was a commercially available oral nicotine pouch. Through the process of study design and execution, learnings were garnered to inform the design, execution, analysis, and report writing of future full-scale actual use studies with tobacco products. Methods: A small sample (n=100) of healthy adult daily smokers of 7 or more cigarettes per day were recruited to participate in an 8-week prospective observational study conducted at 4 geographically dispersed sites in the United States. A smartphone-based customized electronic diary (eDiary) was employed to capture daily tobacco product use, including 1 week of baseline smoking and 6 weeks during which participants were provided with oral nicotine pouches for use as desired. Results: Online screening procedures with follow-up telephone interviews and on-site enrollment were successfully implemented. Of 100 participants, 97 completed the study, with more than half (59/99, 60%) identifying as dual- or poly-users of cigarettes and other types of tobacco products at baseline. There was more than 90% (91-93/99, 92%-94%) compliance with daily eDiary reporting, and the majority (92/99, 93%) of participants expressed satisfaction with the study processes. Product use data from the eDiary indicated that after an initial period of trial use, pouches per day increased among those continuing to use the products, while per day average cigarette consumption decreased for 82% (79/97) of all study participants. At the end of the week 6, 16% (15/97) of participants had reduced their cigarette consumption by more than half. Conclusions: The design of this study, including recruiting, enrollment, eDiary use, and oversight, was successfully implemented through the application of a detailed protocol, a user-friendly eDiary, electronically administered questionnaires, and remote monitoring procedures. High-resolution information was obtained on prospective changes in tobacco product use patterns in the context of availability of a new tobacco product. Future, larger actual use studies will provide important evidence supporting the role that alternatives to combustible cigarettes may play in smoking reduction and/or cessation and lowering the population health burden of tobacco and nicotine-containing products. %M 35984682 %R 10.2196/37573 %U https://formative.jmir.org/2022/8/e37573 %U https://doi.org/10.2196/37573 %U http://www.ncbi.nlm.nih.gov/pubmed/35984682 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e39208 %T Smoking Cessation Smartphone App Use Over Time: Predicting 12-Month Cessation Outcomes in a 2-Arm Randomized Trial %A Bricker,Jonathan B %A Mull,Kristin E %A Santiago-Torres,Margarita %A Miao,Zhen %A Perski,Olga %A Di,Chongzhi %+ Division of Public Health Sciences, Fred Hutch Cancer Center, 1100 Fairview Avenue North, M3-B232, Seattle, WA, 98109, United States, 1 2066675074, jbricker@fredhutch.org %K acceptance and commitment therapy %K ACT %K digital interventions %K eHealth %K engagement %K iCanQuit %K QuitGuide %K mobile health %K mHealth %K smartphone apps %K trajectories %K tobacco %K smoking %K mobile phone %D 2022 %7 18.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Little is known about how individuals engage over time with smartphone app interventions and whether this engagement predicts health outcomes. Objective: In the context of a randomized trial comparing 2 smartphone apps for smoking cessation, this study aimed to determine distinct groups of smartphone app log-in trajectories over a 6-month period, their association with smoking cessation outcomes at 12 months, and baseline user characteristics that predict data-driven trajectory group membership. Methods: Functional clustering of 182 consecutive days of smoothed log-in data from both arms of a large (N=2415) randomized trial of 2 smartphone apps for smoking cessation (iCanQuit and QuitGuide) was used to identify distinct trajectory groups. Logistic regression was used to determine the association of group membership with the primary outcome of 30-day point prevalence of smoking abstinence at 12 months. Finally, the baseline characteristics associated with group membership were examined using logistic and multinomial logistic regression. The analyses were conducted separately for each app. Results: For iCanQuit, participants were clustered into 3 groups: “1-week users” (610/1069, 57.06%), “4-week users” (303/1069, 28.34%), and “26-week users” (156/1069, 14.59%). For smoking cessation rates at the 12-month follow-up, compared with 1-week users, 4-week users had 50% higher odds of cessation (30% vs 23%; odds ratio [OR] 1.50, 95% CI 1.05-2.14; P=.03), whereas 26-week users had 397% higher odds (56% vs 23%; OR 4.97, 95% CI 3.31-7.52; P<.001). For QuitGuide, participants were clustered into 2 groups: “1-week users” (695/1064, 65.32%) and “3-week users” (369/1064, 34.68%). The difference in the odds of being abstinent at 12 months for 3-week users versus 1-week users was minimal (23% vs 21%; OR 1.16, 95% CI 0.84-1.62; P=.37). Different baseline characteristics predicted the trajectory group membership for each app. Conclusions: Patterns of 1-, 3-, and 4-week smartphone app use for smoking cessation may be common in how people engage in digital health interventions. There were significantly higher odds of quitting smoking among 4-week users and especially among 26-week users of the iCanQuit app. To improve study outcomes, strategies for detecting users who disengage early from these interventions (1-week users) and proactively offering them a more intensive intervention could be fruitful. %M 35831180 %R 10.2196/39208 %U https://www.jmir.org/2022/8/e39208 %U https://doi.org/10.2196/39208 %U http://www.ncbi.nlm.nih.gov/pubmed/35831180 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e28626 %T A Smoking Cessation Mobile App for Persons Living With HIV: Preliminary Efficacy and Feasibility Study %A Schnall,Rebecca %A Liu,Jianfang %A Alvarez,Gabriella %A Porras,Tiffany %A Ganzhorn,Sarah %A Boerner,Samantha %A Huang,Ming-Chun %A Trujillo,Paul %A Cioe,Patricia %+ Columbia University School of Nursing, 560 West 168th Street, New York, NY, 10032, United States, 1 212 342 6886, rb897@columbia.edu %K HIV %K mHealth %K smoking cessation %K intervention %K smoking %K persons with HIV %K pilot %K pilot test %K mobile app %K smartwatch %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of smoking in the United States general population has gradually declined to the lowest rate ever recorded; however, this has not been true for persons with HIV. Objective: We conducted a pilot test to assess the feasibility and efficacy of the Lumme Quit Smoking mobile app and smartwatch combination with sensing capabilities to improve smoking cessation in persons with HIV. Methods: A total of 40 participants were enrolled in the study and randomly assigned 1:1 to the control arm, which received an 8-week supply of nicotine replacement therapy, a 30-minute smoking cessation counseling session, and weekly check-in calls with study staff, or to the intervention arm, which additionally received the Lumme Quit Smoking app and smartwatch. Results: Of the 40 participants enrolled, 37 completed the follow-up study assessments and 16 used the app every day during the 56-day period. During the 6-month recruitment and enrollment period, 122 people were screened for eligibility, with 67.2% (82/122) deemed ineligible. Smoking criteria and incompatible tech were the major reasons for ineligibility. There was no difference in the proportion of 7-day point prevalence abstinence by study arm and no significant decrease in exhaled carbon monoxide for the intervention and control arms separately. However, the average exhaled carbon monoxide decreased over time when analyzing both arms together (P=.02). Conclusions: Results suggest excellent feasibility and acceptability of using a smoking sensor app among this smoking population. The knowledge gained from this research will enable the scientific community, clinicians, and community stakeholders to improve tobacco cessation outcomes for persons with HIV. Trial Registration: ClinicalTrials.gov NCT04808609; https://clinicaltrials.gov/ct2/show/NCT04808609 %M 35980739 %R 10.2196/28626 %U https://formative.jmir.org/2022/8/e28626 %U https://doi.org/10.2196/28626 %U http://www.ncbi.nlm.nih.gov/pubmed/35980739 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e38268 %T Users’ Modifications to Electronic Nicotine Delivery Systems: Content Analysis of YouTube Video Comments %A Li,Yachao %A Ashley,David L %A Popova,Lucy %+ School of Public Health, Georgia State University, 140 Decatur Street, Atlanta, GA, 30302, United States, 1 404 413 9338, lpopova1@gsu.edu %K ENDS modifications %K YouTube %K comments %K vaping %K content analysis %D 2022 %7 12.8.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: User modifications can alter the toxicity and addictiveness of electronic nicotine delivery systems (ENDSs). YouTube has been a major platform where ENDS users obtain and share information about ENDS modifications. Past research has examined the content and characteristics of ENDS modification videos. Objective: This study aims to analyze the video comments to understand the viewers’ reactions to these videos. Methods: We identified 168 YouTube videos depicting ENDS modifications. Each video’s top 20 most liked comments were retrieved. The final sample included 2859 comments. A content analysis identified major themes of the comment content. Results: Most comments were directed to creators and interacted with others: 952/2859 (33.30%) expressed appreciation, 135/2859 (4.72%) requested more videos, 462/2859 (16.16%) asked for clarification, and 67/2859 (2.34%) inquired about product purchases. In addition, comments mentioned viewers’ experiences of ENDS modifications (430/2859, 15.04%) and tobacco use (167/2859, 5.84%); about 198/2859 (6.93%) also indicated intentions to modify ENDSs and 34/2859 (1.19%) mentioned that they were “newbies.” Moreover, comments included modification knowledge: 346/2859 (12.10%) provided additional information, 227/2859 (7.94%) mentioned newly learned knowledge, and 162/2859 (5.67%) criticized the videos. Furthermore, few comments mentioned the dangers of ENDS modifications (136/2859, 4.76%) and tobacco use (7/2859, 0.24%). Lastly, among the 15 comments explicitly mentioning regulations, 13/2859 (0.45%) were against and 2/2859 (0.07%) were supportive of regulations. Conclusions: The results indicated acceptance and popularity of ENDS modifications and suggested that the videos might motivate current and new users to alter their devices. Few comments mentioned the risks and regulations. Regulatory research and agencies should be aware of online ENDS modification information and understand its impacts on users. %M 35992739 %R 10.2196/38268 %U https://infodemiology.jmir.org/2022/2/e38268 %U https://doi.org/10.2196/38268 %U http://www.ncbi.nlm.nih.gov/pubmed/35992739 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e35688 %T Mindfulness-Based Smoking Cessation Delivered Through Telehealth and Text Messaging for Low-Income Smokers: Protocol for a Randomized Controlled Trial %A Spears,Claire A %A Mhende,Josephine %A Hawkins,China %A Do,Vuong Van %A Hayat,Matthew J %A Eriksen,Michael P %A Hedeker,Donald %A Abroms,Lorien C %A Wetter,David W %+ Department of Health Policy & Behavioral Sciences, School of Public Health, Georgia State University, 140 Decatur Street SE, Atlanta, GA, 30303, United States, 1 404 413 9335, cspears@gsu.edu %K mobile health %K mHealth %K telehealth %K SMS text messaging %K mindfulness %K smoking cessation %K tobacco %K health disparities %K mobile phone %D 2022 %7 1.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco use is the leading cause of preventable morbidity and mortality. Adults with low income and members of certain racial and ethnic minority groups are less likely to quit, and therefore, they experience profound tobacco-related health disparities. Mindfulness training can increase the rates of smoking cessation and lapse recovery, and telehealth and SMS text messaging have the potential to provide more accessible treatment. Objective: This study aims to test the efficacy of delivering mindfulness-based smoking cessation treatment through text messaging (iQuit Mindfully) and telehealth (group videoconferencing), both as stand-alone interventions and in combination. In addition, it aims to examine the underlying mechanisms of mindfulness treatment. Methods: In this 2×2 randomized controlled trial, participants are randomized into 1 of 4 groups based on assignment to iQuit Mindfully text messages (yes or no) and mindfulness videoconference groups (yes or no). The primary outcomes are biochemically verified smoking abstinence at 8, 12, and 24 weeks after the start of treatment. Secondary outcomes include the frequency of home mindfulness practice and self-reported levels of mindfulness, emotions, craving, withdrawal, dependence, self-efficacy, and social support. Results: Recruitment, treatment, and assessment began in spring and summer 2021, and data collection is expected to continue through spring 2024. Conclusions: This project aims to improve smoking cessation outcomes for low-income, racially and ethnically diverse smokers through mindfulness-based telehealth group counseling and text messaging support. We also aim to advance the scientific study of the mechanisms of action of mindfulness treatment, which could inform the development of more efficacious and efficient treatments to reduce tobacco disparities. Trial Registration: Clinicaltrials.gov NCT04965181; https://clinicaltrials.gov/ct2/show/NCT04965181 International Registered Report Identifier (IRRID): PRR1-10.2196/35688 %M 35916707 %R 10.2196/35688 %U https://www.researchprotocols.org/2022/8/e35688 %U https://doi.org/10.2196/35688 %U http://www.ncbi.nlm.nih.gov/pubmed/35916707 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e38234 %T Feature-Level Analysis of a Smoking Cessation Smartphone App Based on a Positive Psychology Approach: Prospective Observational Study %A Hoepper,Bettina B %A Siegel,Kaitlyn R %A Carlon,Hannah A %A Kahler,Christopher W %A Park,Elyse R %A Taylor,Steven Trevor %A Simpson,Hazel V %A Hoeppner,Susanne S %+ Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, 6th Floor, 151 Merrimac St, Boston, MA, 02114, United States, 1 617 643 1988, bhoeppner@mgh.harvard.edu %K mHealth %K smartphone %K smartphone app %K smoking %K smoking cessation %K nondaily smoking %K positive psychology %K happiness %K positive affect %K clinical trial %K feasibility %K acceptability %K app usage %K mobile health %D 2022 %7 28.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking cessation smartphone apps have emerged as highly accessible tools to support smoking cessation efforts. It is unknown how specific app features contribute to user engagement over time and relate to smoking outcomes. Objective: To provide a feature-level analysis of the Smiling Instead of Smoking app (version 2) and to link feature use to subsequent smoking cessation. Methods: Nondaily smokers (N=100) used the app for a period of 49 days (1 week before quitting and 6 weeks after quitting). Participants self-reported 30-day point-prevalence abstinence at the end of this period and at a 6-month follow up (the survey response rate was 94% and 89% at these points, respectively). Self-reported 30-day point prevalence abstinence rates were 40% at the end of treatment and 56% at the 6-month follow up. The app engaged users in both positive psychology content and traditional behavioral smoking cessation content. The app sent push notifications to prompt participants to complete prescribed content (ie, a “happiness exercise” every day and a “behavioral challenge” to use the app’s smoking cessation tools on 15 out of 49 days). Actions that participants took within the app were timestamped and recorded. Results: Participants used the app on 24.7 (SD 13.8) days out of the 49 prescribed days, interacting with the happiness content on more days than the smoking content (23.8, SD 13.8 days vs 17.8, SD 10.3 days; t99=9.28 [2-tailed]; P<.001). The prescribed content was frequently completed (45% of happiness exercises; 57% of behavioral challenges) and ad libitum tools were used on ≤7 days. Most participants used each ad libitum smoking cessation tool at least once, with higher use of personalized content (≥92% used “strategies,” “cigarette log,” “smoke alarms,” and “personal reasons”) than purely didactic content (79% viewed “benefits of quitting smoking”). The number of days participants used the app significantly predicted 30-day point-prevalence abstinence at the end of treatment (odds ratio [OR] 1.05, 95% CI 1.02-1.09; P=.002) and at the 6-month follow up (OR 1.04, 95% CI 1.008-1.07; P=.01). The number of days participants engaged with the happiness content significantly predicted smoking abstinence at the end of treatment (OR 1.05, 95% CI 1.02-1.08; P=.002) and at the 6-month follow up (OR 1.04, 95% CI 1.007-1.07; P=.02). This effect was not significant for the number of days participants engaged with the smoking cessation content of the app, either at the end of treatment (OR 1.04, 95% CI 0.996-1.08, P=.08) or at the 6-month follow up (OR 1.02, 95% CI 0.98-1.06; P=.29). Conclusions: Greater app usage predicted greater odds of self-reported 30-day point-prevalence abstinence at both the end of treatment and over the long term, suggesting that the app had a therapeutic benefit. Positive psychology content and prescriptive clarity may promote sustained app engagement over time. Trial Registration: ClinicalTrials.gov NCT03951766; https://clinicaltrials.gov/ct2/show/NCT03951766 %M 35900835 %R 10.2196/38234 %U https://formative.jmir.org/2022/7/e38234 %U https://doi.org/10.2196/38234 %U http://www.ncbi.nlm.nih.gov/pubmed/35900835 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e38156 %T Developing the Message Assessment Scale for Tobacco Prevention Campaigns: Cross-sectional Validation Study %A Rath,Jessica M %A Perks,Siobhan N %A Williams,Kenneshia N %A Budnik,Tracy %A Geraci,John %A Vallone,Donna M %A Hair,Elizabeth C %+ Truth Initiative Schroeder Institute, 900 G St. NW, Fourth Floor, Washington, DC, 20001, United States, 1 2404545555, jrath@truthinitiative.org %K communication %K youth/young adults %K scales %K message %K behavior %K health %K campaign %K tobacco %K smoking cessation %K prevention %K youth %K young adults %K data %K data analysis %D 2022 %7 26.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mass media campaigns are effective for influencing a broad range of health behaviors. Prior to launching a campaign, developers often conduct ad testing to help identify the strengths and weaknesses of the message executions among the campaign’s target audience. This process allows for changes to be made to ads, making them more relevant to or better received by the target audience before they are finalized. To assess the effectiveness of an ad’s message and execution, campaign ads are often rated using a single item or multiple items on a scale, and scores are calculated. Endorsement of a 6-item perceived message effectiveness (PME) scale, defined as the practice of using a target audience’s evaluative ratings to inform message selection, is one approach commonly used to select messages for antitobacco campaigns; however, the 6-item PME scale often does not produce enough specificity to make important decisions on ad optimization. In addition, the PME scale is typically used with adult populations for smoking cessation messages. Objective: This study includes the development of the Message Assessment Scale, a new tobacco prevention message testing scale for youth and young adults. Methods: Data were derived from numerous cross-sectional surveys designed to test the relevance and potential efficacy of antitobacco truth campaign ads. Participants aged 15-24 years (N=6108) responded to a set of 12 core attitudinal items, including relevance (both personal and cultural) as well as comprehension of the ad’s main message. Results: Analyses were completed in two phases. In phase I, mean scores were calculated for each of the 12 attitudinal items by ad type, with higher scores indicating more endorsement of the item. Next, all items were submitted to exploratory factor analysis. A four-factor model fit was revealed and verified with confirmatory factor analysis, resulting in the following constructs: personally relevant, culturally relevant, the strength of messaging, and negative attributes. In phase II, ads were categorized by performance (high/medium/low), and constructs identified in phase I were correlated with key campaign outcomes (ie, main fact agreement and likelihood to vape). Phase II confirmed that the four constructs identified in phase I were all significantly correlated with main fact agreement and vape intentions. Conclusions: Findings from this study advance the field by establishing an expanded set of validated items to comprehensively assess the potential effectiveness of advertising executions. This set of items expands the portfolio of ad testing measures for ads focused on tobacco use prevention. Findings can inform how best to optimize ad executions and message delivery for health behavior campaigns, particularly those focused on tobacco use prevention among youth and young adult populations. %M 35881429 %R 10.2196/38156 %U https://formative.jmir.org/2022/7/e38156 %U https://doi.org/10.2196/38156 %U http://www.ncbi.nlm.nih.gov/pubmed/35881429 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 2 %P e37412 %T Exploring Factors That Predict Marketing of e-Cigarette Products on Twitter: Infodemiology Approach Using Time Series %A Ezike,Nnamdi C %A Ames Boykin,Allison %A Dobbs,Page D %A Mai,Huy %A Primack,Brian A %+ College of Education and Health Professions, University of Arkansas, 751 W Maple Street, Fayetteville, AR, 72701, United States, 1 479 575 3586, ncezike@uark.edu %K tobacco %K electronic cigarettes %K social media %K marketing %K time series %K youth %K young adults %K infodemiology %K infoveillance %K digital marketing %K advertising %K Twitter %K promote %K e-cigarette %D 2022 %7 22.7.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Electronic nicotine delivery systems (known as electronic cigarettes or e-cigarettes) increase risk for adverse health outcomes among naïve tobacco users, particularly youth and young adults. This vulnerable population is also at risk for exposed brand marketing and advertisement of e-cigarettes on social media. Understanding predictors of how e-cigarette manufacturers conduct social media advertising and marketing could benefit public health approaches to addressing e-cigarette use. Objective: This study documents factors that predict changes in daily frequency of commercial tweets about e-cigarettes using time series modeling techniques. Methods: We analyzed data on the daily frequency of commercial tweets about e-cigarettes collected between January 1, 2017, and December 31, 2020. We fit the data to an autoregressive integrated moving average (ARIMA) model and unobserved components model (UCM). Four measures assessed model prediction accuracy. Predictors in the UCM include days with events related to the US Food and Drug Administration (FDA), non-FDA-related events with significant importance such as academic or news announcements, weekday versus weekend, and the period when JUUL maintained an active Twitter account (ie, actively tweeting from their corporate Twitter account) versus when JUUL stopped tweeting. Results: When the 2 statistical models were fit to the data, the results indicate that the UCM was the best modeling technique for our data. All 4 predictors included in the UCM were significant predictors of the daily frequency of commercial tweets about e-cigarettes. On average, brand advertisement and marketing of e-cigarettes on Twitter was higher by more than 150 advertisements on days with FDA-related events compared to days without FDA events. Similarly, more than 40 commercial tweets about e-cigarettes were, on average, recorded on days with important non-FDA events compared to days without such events. We also found that there were more commercial tweets about e-cigarettes on weekdays than on weekends and more commercial tweets when JUUL maintained an active Twitter account. Conclusions: e-Cigarette companies promote their products on Twitter. Commercial tweets were significantly more likely to be posted on days with important FDA announcements, which may alter the narrative about information shared by the FDA. There remains a need for regulation of digital marketing of e-cigarette products in the United States. %M 37113447 %R 10.2196/37412 %U https://infodemiology.jmir.org/2022/2/e37412 %U https://doi.org/10.2196/37412 %U http://www.ncbi.nlm.nih.gov/pubmed/37113447 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e37071 %T Perceptions of Oral Nicotine Pouches on Reddit: Observational Study %A Shao,Yihan %A Zou,Jonathan %A Xie,Zidian %A Mayne,Rachel Grana %A Ossip,Deborah J %A Rahman,Irfan %A McIntosh,Scott %A Li,Dongmei %+ Department of Clinical & Translational Research, University of Rochester Medical Center, CU 420708, 265 Crittenden Boulevard, Rochester, NY, 14642, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K oral nicotine pouches %K Reddit %K perception %K nicotine %K social media %K sentiment %K public opinion %K user experience %K attitude %K content analysis %K tobacco %K smoking %K cessation %K quit %K smoker %K information seeking %K information sharing %K vaping %D 2022 %7 15.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Oral nicotine pouches are a new form of tobacco-free nicotine products launched in recent years with a variety of flavors. Objective: This study aims to examine the public perceptions and discussions of oral nicotine pouches on Reddit, a popular social media platform for sharing user experiences. Methods: Between February 15, 2019, and February 12, 2021, a total of 2410 Reddit posts related to oral nicotine pouches were obtained over a 2-year period. After the removal of unrelated or commercial posts, 653 Reddit posts related to oral nicotine pouches remained. Topics and sentiments related to oral nicotine pouches on Reddit were hand coded. Results: The number of Reddit posts related to oral nicotine pouches increased during the study period. Content analysis showed that the most popular topic was “sharing product information and user experience” (366/653, 56%), in which sharing oral nicotine pouch products and user experiences were dominant. The next popular topic was “asking product-related questions” (product properties and product recommendations; 115/653, 17.6%), followed by “quitting nicotine products” such as vaping or smoking through use of oral nicotine pouches or quitting the oral nicotine pouches themselves (83/653, 12.7%) and “discussing oral nicotine pouch–related health” symptoms or concerns related to oral nicotine pouches (74/653, 11.3%). The least popular topic was “legality and permissions” related to oral nicotine pouches (15/653, 2.3%). In addition, a greater number of Reddit posts described positive attitudes compared to negative attitudes toward oral nicotine pouches (354/653, 54.2% vs 101/653, 15.5%; P<.001). Conclusions: Reddit posts overall had a positive attitude toward oral nicotine pouches and users were actively sharing product and user experiences. Our study provides the first insight on up-to-date oral nicotine pouch discussions on social media. %M 35838764 %R 10.2196/37071 %U https://www.jmir.org/2022/7/e37071 %U https://doi.org/10.2196/37071 %U http://www.ncbi.nlm.nih.gov/pubmed/35838764 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e34246 %T Effects of an Explicit Value Clarification Method With Computer-Tailored Advice on the Effectiveness of a Web-Based Smoking Cessation Decision Aid: Findings From a Randomized Controlled Trial %A Gültzow,Thomas %A Smit,Eline Suzanne %A Crutzen,Rik %A Jolani,Shahab %A Hoving,Ciska %A Dirksen,Carmen D %+ Department of Work & Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 433881511, thomas.gultzow@maastrichtuniversity.nl %K digital health %K decision-making %K decision support technique %K decision aid %K smoking %K smoking cessation %K informed decision-making %K decision support %K decision support tool %K eHealth %K evidence-based medicine %K value clarification method %D 2022 %7 15.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Smoking continues to be a driver of mortality. Various forms of evidence-based cessation assistance exist; however, their use is limited. The choice between them may also induce decisional conflict. Offering decision aids (DAs) may be beneficial; however, insights into their effective elements are lacking. Objective: This study tested the added value of an effective element (ie, an “explicit value clarification method” paired with computer-tailored advice indicating the most fitting cessation assistance) of a web-based smoking cessation DA. Methods: A web-based randomized controlled trial was conducted among smokers motivated to stop smoking within 6 months. The intervention group received a DA with the aforementioned elements, and the control group received the same DA without these elements. The primary outcome measure was 7-day point prevalence abstinence 6 months after baseline (time point 3 [t=3]). Secondary outcome measures were 7-day point prevalence of abstinence 1 month after baseline (time point 2 [t=2]), evidence-based cessation assistance use (t=2 and t=3), and decisional conflict (immediately after DA; time point 1). Logistic and linear regression analyses were performed to assess the outcomes. Analyses were conducted following 2 (decisional conflict) and 3 (smoking cessation) outcome scenarios: complete cases, worst-case scenario (assuming that dropouts still smoked), and multiple imputations. A priori sample size calculation indicated that 796 participants were needed. The participants were mainly recruited on the web (eg, social media). All the data were self-reported. Results: Overall, 2375 participants were randomized (intervention n=1164, 49.01%), of whom 599 (25.22%; intervention n=275, 45.91%) completed the DAs, and 276 (11.62%; intervention n=143, 51.81%), 97 (4.08%; intervention n=54, 55.67%), and 103 (4.34%; intervention n=56, 54.37%) completed time point 1, t=2, and t=3, respectively. More participants stopped smoking in the intervention group (23/63, 37%) than in the control group (14/52, 27%) after 6 months; however, this was only statistically significant in the worst-case scenario (crude P=.02; adjusted P=.04). Effects on the secondary outcomes were only observed for smoking abstinence after 1 month (15/55, 27%, compared with 7/46, 15%, in the crude and adjusted models, respectively; P=.02) and for cessation assistance uptake after 1 month (26/56, 46% compared with 18/47, 38% only in the crude model; P=.04) and 6 months (38/61, 62% compared with 26/50, 52%; crude P=.01; adjusted P=.02) but only in the worst-case scenario. Nonuse attrition was 34.19% higher in the intervention group than in the control group (P<.001). Conclusions: Currently, we cannot confidently recommend the inclusion of explicit value clarification methods and computer-tailored advice. However, they might result in higher nonuse attrition rates, thereby limiting their potential. As a lack of statistical power may have influenced the outcomes, we recommend replicating this study with some adaptations based on the lessons learned. Trial Registration: Netherlands Trial Register NL8270; https://www.trialregister.nl/trial/8270 International Registered Report Identifier (IRRID): RR2-10.2196/21772 %M 35838773 %R 10.2196/34246 %U https://www.jmir.org/2022/7/e34246 %U https://doi.org/10.2196/34246 %U http://www.ncbi.nlm.nih.gov/pubmed/35838773 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e34271 %T Novel Implementation Strategy to Electronically Screen and Signpost Patients to Health Behavior Apps: Mixed Methods Implementation Study (OptiMine Study) %A Khadjesari,Zarnie %A Brown,Tracey J %A Ramsey,Alex T %A Goodfellow,Henry %A El-Toukhy,Sherine %A Abroms,Lorien C %A Jopling,Helena %A Dierker Viik,Arden %A Amato,Michael S %+ Behavioural and Implementation Science Research Group, School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom, 44 01603457648, Z.Khadjesari@uea.ac.uk %K electronic health record %K EHR %K alcohol reduction %K electronic messages %K proactive messages %K proactive outreach %K smoking cessation %K tobacco use %K alcohol use %K alcohol %K smoking %K mobile health %K mHealth %K mobile app %D 2022 %7 11.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Behavior change apps have the potential to provide individual support on a population scale at low cost, but they face numerous barriers to implementation. Electronic health records (EHRs) in acute care hospitals provide a valuable resource for identifying patients at risk, who may benefit from behavior change apps. A novel, emerging implementation strategy is to use digital technologies not only for providing support to help-seeking individuals but also for signposting patients at risk to support services (also called proactive referral in the United States). Objective: The OptiMine study aimed to increase the reach of behavior change apps by implementing electronic signposting for smoking cessation and alcohol reduction in a large, at-risk population that was identified through an acute care hospital EHR. Methods: This 3-phase, mixed methods implementation study assessed the acceptability, feasibility, and reach of electronic signposting to behavior change apps by using a hospital’s EHR system to identify patients who are at risk. Phase 1 explored the acceptability of the implementation strategy among the patients and staff through focus groups. Phase 2 investigated the feasibility of using the hospital EHR to identify patients with target risk behaviors and contact them via SMS text message, email, or patient portal. Phase 3 assessed the impact of SMS text messages sent to patients who were identified as smokers or risky drinkers, which signposted them to behavior change apps. The primary outcome was the proportion of participants who clicked on the embedded link in the SMS text message to access information about the apps. The acceptability of the SMS text messages among the patients who had received them was also explored in a web-based survey. Results: Our electronic signposting strategy—using SMS text messages to promote health behavior change apps to patients at risk—was found to be acceptable and feasible and had good reach. The hospital sent 1526 SMS text messages, signposting patients to either the National Health Service Smokefree or Drink Free Days apps. A total of 13.56% (207/1526) of the patients clicked on the embedded link to the apps, which exceeded our 5% a priori success criterion. Patients and staff contributed to the SMS text message content and delivery approach, which were perceived as acceptable before and after the delivery of the SMS text messages. The feasibility of the SMS text message format was determined and the target population was identified by mining the EHR. Conclusions: The OptiMine study demonstrated the proof of concept for this novel implementation strategy, which used SMS text messages to signpost at-risk individuals to behavior change apps at scale. The level of reach exceeded our a priori success criterion in a non–help-seeking population of patients receiving unsolicited SMS text messages, disconnected from hospital visits. International Registered Report Identifier (IRRID): RR2-10.2196/23669 %M 35816374 %R 10.2196/34271 %U https://formative.jmir.org/2022/7/e34271 %U https://doi.org/10.2196/34271 %U http://www.ncbi.nlm.nih.gov/pubmed/35816374 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e34114 %T Investigating the Impact of the New York State Flavor Ban on e-Cigarette–Related Discussions on Twitter: Observational Study %A Gao,Yankun %A Xie,Zidian %A Li,Dongmei %+ University of Rochester Medical Center, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K New York State flavor ban %K e-cigarettes %K twitter %K topic modeling %K sentiment analysis %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: On May 18, 2020, the New York State Department of Health implemented a statewide flavor ban to prohibit the sales of all flavored vapor products, except for tobacco or any other authorized flavor. Objective: This study aims to investigate the discussion changes in e-cigarette–related tweets over time with the implementation of the New York State flavor ban. Methods: Through the Twitter streaming application programming interface, 59,883 e-cigarette–related tweets were collected within the New York State from February 6, 2020, to May 17, 2020 (period 1, before the implementation of the flavor ban), May 18, 2020-June 30, 2020 (period 2, between the implementation of the flavor ban and the online sales ban), July 1, 2020-September 15, 2020 (period 3, the short term after the online sales ban), and September 16, 2020-November 30, 2020 (period 4, the long term after the online sales ban). Sentiment analysis and topic modeling were conducted to investigate the changes in public attitudes and discussions in e-cigarette–related tweets. The popularity of different e-cigarette flavor categories was compared before and after the implementation of the New York State flavor ban. Results: Our results showed that the proportion of e-cigarette–related tweets with negative sentiment significantly decreased (4305/13,246, 32.5% vs 3855/14,455, 26.67%, P<.001), and tweets with positive sentiment significantly increased (5246/13,246, 39.6% vs 7038/14,455, 48.69%, P<.001) in period 4 compared to period 3. “Teens and nicotine products” was the most frequently discussed e-cigarette–related topic in the negative tweets. In contrast, “nicotine products and quitting” was more prevalent in positive tweets. The proportion of tweets mentioning mint and menthol flavors significantly increased right after the flavor ban and decreased to lower levels over time. The proportions of fruit and sweet flavors were most frequently mentioned in period 1, decreased in period 2, and dominated again in period 4. Conclusions: The proportion of e-cigarette–related tweets with different attitudes and frequently discussed flavor categories changed over time after the implementation of the New York State ban of flavored vaping products. This change indicated a potential impact of the flavor ban on public discussions of flavored e-cigarettes. %M 35802417 %R 10.2196/34114 %U https://publichealth.jmir.org/2022/7/e34114 %U https://doi.org/10.2196/34114 %U http://www.ncbi.nlm.nih.gov/pubmed/35802417 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e36869 %T Exploring Users’ Experiences With a Quick-Response Chatbot Within a Popular Smoking Cessation Smartphone App: Semistructured Interview Study %A Alphonse,Alice %A Stewart,Kezia %A Brown,Jamie %A Perski,Olga %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 0207679 ext 1258, olga.perski@ucl.ac.uk %K chatbot %K conversational agent %K engagement %K smartphone app %K smoking cessation %K accountability %K mobile phone %D 2022 %7 7.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Engagement with smartphone apps for smoking cessation tends to be low. Chatbots (ie, software that enables conversations with users) offer a promising means of increasing engagement. Objective: We aimed to explore smokers’ experiences with a quick-response chatbot (Quit Coach) implemented within a popular smoking cessation app and identify factors that influence users’ engagement with Quit Coach. Methods: In-depth, one-to-one, semistructured qualitative interviews were conducted with adult, past-year smokers who had voluntarily used Quit Coach in a recent smoking cessation attempt (5/14, 36%) and current smokers who agreed to download and use Quit Coach for a minimum of 2 weeks to support a new cessation attempt (9/14, 64%). Verbal reports were audio recorded, transcribed verbatim, and analyzed within a constructivist theoretical framework using inductive thematic analysis. Results: A total of 3 high-order themes were generated to capture users’ experiences and engagement with Quit Coach: anthropomorphism of and accountability to Quit Coach (ie, users ascribing human-like characteristics and thoughts to the chatbot, which helped foster a sense of accountability to it), Quit Coach’s interaction style and format (eg, positive and motivational tone of voice and quick and easy-to-complete check-ins), and users’ perceived need for support (ie, chatbot engagement was motivated by seeking distraction from cravings or support to maintain motivation to stay quit). Conclusions: Anthropomorphism of a quick-response chatbot implemented within a popular smoking cessation app appeared to be enabled by its interaction style and format and users’ perceived need for support, which may have given rise to feelings of accountability and increased engagement. %M 35797093 %R 10.2196/36869 %U https://formative.jmir.org/2022/7/e36869 %U https://doi.org/10.2196/36869 %U http://www.ncbi.nlm.nih.gov/pubmed/35797093 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e38626 %T Psychological Effects of Aromatherapy on Smokers With Depressive Tendencies During Smoking Cessation Treatment: Protocol for a Pre-Post Single-Arm Clinical Trial %A Hata,Akiko %A Komiyama,Maki %A Yasoda,Akihiro %A Wada,Hiromichi %A Yamakage,Hajime %A Satoh-Asahara,Noriko %A Morimoto,Tatsuya %A Takahashi,Yuko %A Hasegawa,Koji %+ Clinical Research Institute, National Hospital Organization Kyoto Medical Center, 1-1, fukakusamukaihata-cho, fushimi-ku, Kyoto, 612-8555, Japan, 81 756419161, ako0717@gmail.com %K smoking cessation %K aromatherapy %K depression %K cardiovascular risk %K inhaler %K complementary and alternative medicine %D 2022 %7 7.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cessation of smoking can markedly reduce the incidence of cardiovascular disease, improve health economics, and benefit society. Aromatherapy has the potential to be a novel option as an adjuvant therapy for smoking cessation that may alleviate depressive symptoms. However, research on the efficacy of aromatherapy as an adjuvant therapy for smoking cessation is scarce. Objective: The aim of this study was to examine the potential effects of aromatherapy on psychological states in smokers with depressive tendencies and to determine if it is reasonable to proceed to the next step (ie, a phase III trial). Methods: This is a pre-post single-arm clinical trial. Smokers with depression will be subjected to aromatherapy during smoking cessation treatment for 12 weeks. We will evaluate changes in scores on the Zung Self-Rating Depression Scale and the Profile of Mood States from pretreatment screening to 4 weeks and 12 weeks after the start of aromatherapy. Moreover, we will compare the group treated with aromatherapy with the group that received standard treatment in our previous randomized controlled trial (ie, the control group in that study). Furthermore, we will compare successful smoking cessation rates after 12 weeks. In addition, we will conduct an exploratory analysis of the efficacy of aromatherapy. The target sample size is 100, which is the number of subjects expected to be enrolled in this study during the 2-year study period. Results: This study was approved by the Kyoto Medical Center Institutional Review Board (IRB approval No. 19-016). Enrollment started on July 1, 2019. As of May 2022, 76 patients have been recruited. In the original plan, recruitment should have been finished on June 30, 2021. However, the number of subjects decreased due to the COVID-19 pandemic, and the study inclusion period was extended by 1 year (ie, until the end of June 2022) with the approval of the IRB on May 17, 2021. Analyses of the results will be completed subsequently. Conclusions: This study has some limitations. This is not a rigorous validation study because it compares the same subjects who received standard treatment in a previous study. Moreover, the sample size and methods of statistical analysis were not fully set with prior consideration of statistical rigor. To address these limitations, we plan to conduct a phase III trial that will reflect the exploratory findings of this study. This is the first study to evaluate the psychological effects of aromatherapy during a smoking cessation program, and it may help improve the quality of treatment for smoking cessation in the future. Trial Registration: UMIN Clinical Trials Registry UMIN000043102; https://tinyurl.com/tn3hvt9w International Registered Report Identifier (IRRID): DERR1-10.2196/38626 %M 35797095 %R 10.2196/38626 %U https://www.researchprotocols.org/2022/7/e38626 %U https://doi.org/10.2196/38626 %U http://www.ncbi.nlm.nih.gov/pubmed/35797095 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36091 %T Development of a WeChat-based Mobile Messaging Smoking Cessation Intervention for Chinese Immigrant Smokers: Qualitative Interview Study %A Jiang,Nan %A Rogers,Erin S %A Cupertino,Paula %A Zhao,Xiaoquan %A Cartujano-Barrera,Francisco %A Lyu,Joanne Chen %A Hu,Lu %A Sherman,Scott E %+ Department of Population Health, Grossman School of Medicine, New York University, 180 Madison Ave, Rm #17-54, New York, NY, 10016, United States, 1 646 501 3553, Nan.Jiang@nyulangone.org %K smoking cessation %K text messaging %K mobile health %K Chinese American %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking remains a major public health issue among Chinese immigrants. Smoking cessation programs that focus on this population are scarce and have a limited population-level impact due to their low reach. Mobile messaging interventions have the potential to reach large audiences and expand smokers’ access to smoking cessation treatment. Objective: This study describes the development of a culturally and linguistically appropriate mobile messaging smoking cessation intervention for Chinese immigrant smokers delivered via WeChat, the most frequently used social media platform among Chinese people globally. Methods: This study had 2 phases. In phase 1, we developed a mobile message library based on social cognitive theory and the US Clinical Practice Guidelines for Treating Tobacco Use and Dependence. We culturally adapted messages from 2 social cognitive theory-based text messaging smoking cessation programs (SmokefreeTXT and Decídetexto). We also developed new messages targeting smokers who were not ready to quit smoking and novel content addressing Chinese immigrant smokers’ barriers to quitting and common misconceptions related to willpower and nicotine replacement therapy. In phase 2, we conducted in-depth interviews with 20 Chinese immigrant smokers (including 7 women) in New York City between July and August 2021. The interviews explored the participants’ smoking and quitting experiences followed by assessment of the text messages. Participants reviewed 17 text messages (6 educational messages, 3 self-efficacy messages, and 8 skill messages) via WeChat and rated to what extent the messages enhanced their motivation to quit, promoted confidence in quitting, and increased awareness about quitting strategies. The interviews sought feedback on poorly rated messages, explored participant preferences for content, length, and format, discussed their concerns with WeChat cessation intervention, and solicited recommendations for frequency and timing of messages. Results: Overall, participants reported that the messages enhanced their motivation to quit, offered encouragement, and made them more informed about how to quit. Participants particularly liked the messages about the harms of smoking and strategies for quitting. They reported barriers to applying some of the quitting strategies, including coping with stress and staying abstinent at work. Participants expressed strong interest in the WeChat mobile messaging cessation intervention and commented on its potential to expand their access to smoking cessation treatment. Conclusions: Mobile messages are well accepted by Chinese immigrant smokers. Research is needed to assess the feasibility, acceptability, and efficacy of WeChat mobile messaging smoking cessation interventions for promoting abstinence among Chinese immigrant smokers. %M 35771603 %R 10.2196/36091 %U https://formative.jmir.org/2022/6/e36091 %U https://doi.org/10.2196/36091 %U http://www.ncbi.nlm.nih.gov/pubmed/35771603 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e34863 %T Effectiveness of Recruitment Strategies of Latino Smokers: Secondary Analysis of a Mobile Health Smoking Cessation Randomized Clinical Trial %A Arana-Chicas,Evelyn %A Cartujano-Barrera,Francisco %A Rieth,Katherine K %A Richter,Kimber K %A Ellerbeck,Edward F %A Cox,Lisa Sanderson %A Graves,Kristi D %A Diaz,Francisco J %A Catley,Delwyn %A Cupertino,Ana Paula %+ Department of Surgery, University of Rochester School of Medicine & Dentistry, 265 Crittenden Blvd, Rochester, NY, 14642, United States, 1 585 287 4217, Evelyn_Arana@urmc.rochester.edu %K smoking cessation %K Latino health, Latino recruitment %K health disparities %K participant recruitment %D 2022 %7 27.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Latinos remain disproportionately underrepresented in clinical trials, comprising only 2%-3% of research participants. In order to address health disparities, it is critically important to increase enrollment of Latino smokers in smoking cessation trials. There is limited research examining effective recruitment strategies for this population. Objective: The purpose of this study was to compare the effectiveness of direct versus mass and high- versus low-effort recruitment strategies on recruitment and retention of Latino smokers to a randomized smoking cessation trial. We also examine how the type of recruitment might have influenced the characteristics of enrolled participants. Methods: Latino smokers were enrolled into Decídetexto from 4 states—New Jersey, Kansas, Missouri, and New York. Participants were recruited from August 2018 until March 2021. Mass recruitment strategies included English and Spanish advertisements to the Latino community via flyers, Facebook ads, newspapers, television, radio, church bulletins, and our Decídetexto website. Direct, high-effort strategies included referrals from clinics or community-based organizations with whom we partnered, in-person community outreach, and patient registry calls. Direct, low-effort strategies included texting or emailing pre-existing lists of patients who smoked. A team of trained bilingual (English and Spanish) recruiters from 9 different Spanish-speaking countries of origin conducted recruitment, assessed eligibility, and enrolled participants into the trial. Results: Of 1112 individuals who were screened, 895 (80.5%) met eligibility criteria, and 457 (457/895, 51.1%) enrolled in the trial. Within the pool of screened individuals, those recruited by low-effort recruitment strategies (both mass and direct) were significantly more likely to be eligible (odds ratio [OR] 1.67, 95% CI 1.01-2.76 and OR 1.70, 95% CI 0.98-2.96, respectively) and enrolled in the trial (OR 2.60, 95% CI 1.81-3.73 and OR 3.02, 95% CI 2.03-4.51, respectively) compared with those enrolled by direct, high-effort strategies. Among participants enrolled, the retention rates at 3 months and 6 months among participants recruited via low-effort strategies (both mass and direct) were similar to participants recruited via direct, high-effort methods. Compared with enrolled participants recruited via direct (high- and low-effort) strategies, participants recruited via mass strategies were less likely to have health insurance (44.0% vs 71.2% and 71.7%, respectively; P<.001), lived fewer years in the United States (22.4 years vs 32.4 years and 30.3 years, respectively; P<.001), more likely to be 1st generation (92.7% vs 76.5% and 77.5%, respectively; P=.007), more likely to primarily speak Spanish (89.3% vs 65.8% and 66.3%, respectively), and more likely to be at high risk for alcohol abuse (5.8 mean score vs 3.8 mean score and 3.9 mean score, respectively; P<.001). Conclusions: Although most participants were recruited via direct, high-effort strategies, direct low-effort recruitment strategies yielded a screening pool more likely to be eligible for the trial. Mass recruitment strategies were associated with fewer acculturated enrollees with lower access to health services—groups who might benefit a great deal from the intervention. Trial Registration: ClinicalTrials.gov identifier: NCT03586596; https://clinicaltrials.gov/ct2/show/NCT03586596 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2020.106188 %M 35759320 %R 10.2196/34863 %U https://www.jmir.org/2022/6/e34863 %U https://doi.org/10.2196/34863 %U http://www.ncbi.nlm.nih.gov/pubmed/35759320 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e34273 %T Effectiveness of a Conversational Chatbot (Dejal@bot) for the Adult Population to Quit Smoking: Pragmatic, Multicenter, Controlled, Randomized Clinical Trial in Primary Care %A Olano-Espinosa,Eduardo %A Avila-Tomas,Jose Francisco %A Minue-Lorenzo,Cesar %A Matilla-Pardo,Blanca %A Serrano Serrano,María Encarnación %A Martinez-Suberviola,F Javier %A Gil-Conesa,Mario %A Del Cura-González,Isabel %A , %+ Healthcare Center Los Castillos, Madrid Health Service, Calle Carballino 25, Alcorcón, 28924, Spain, 34 679325778, e.oeoeoeoe@gmail.com %K smoking %K tobacco cessation %K primary care %K smartphone use %K chatbot %K dialog systems %K artificial intelligence %K tobacco %K mHealth %K primary care %D 2022 %7 27.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Tobacco addiction is the leading cause of preventable morbidity and mortality worldwide, but only 1 in 20 cessation attempts is supervised by a health professional. The potential advantages of mobile health (mHealth) can circumvent this problem and facilitate tobacco cessation interventions for public health systems. Given its easy scalability to large populations and great potential, chatbots are a potentially useful complement to usual treatment. Objective: This study aims to assess the effectiveness of an evidence-based intervention to quit smoking via a chatbot in smartphones compared with usual clinical practice in primary care. Methods: This is a pragmatic, multicenter, controlled, and randomized clinical trial involving 34 primary health care centers within the Madrid Health Service (Spain). Smokers over the age of 18 years who attended on-site consultation and accepted help to quit tobacco were recruited by their doctor or nurse and randomly allocated to receive usual care (control group [CG]) or an evidence-based chatbot intervention (intervention group [IG]). The interventions in both arms were based on the 5A’s (ie, Ask, Advise, Assess, Assist, and Arrange) in the US Clinical Practice Guideline, which combines behavioral and pharmacological treatments and is structured in several follow-up appointments. The primary outcome was continuous abstinence from smoking that was biochemically validated after 6 months by the collaborators. The outcome analysis was blinded to allocation of patients, although participants were unblinded to group assignment. An intention-to-treat analysis, using the baseline-observation-carried-forward approach for missing data, and logistic regression models with robust estimators were employed for assessing the primary outcomes. Results: The trial was conducted between October 1, 2018, and March 31, 2019. The sample included 513 patients (242 in the IG and 271 in the CG), with an average age of 49.8 (SD 10.82) years and gender ratio of 59.3% (304/513) women and 40.7% (209/513) men. Of them, 232 patients (45.2%) completed the follow-up, 104/242 (42.9%) in the IG and 128/271 (47.2%) in the CG. In the intention-to-treat analysis, the biochemically validated abstinence rate at 6 months was higher in the IG (63/242, 26%) compared with that in the CG (51/271, 18.8%; odds ratio 1.52, 95% CI 1.00-2.31; P=.05). After adjusting for basal CO-oximetry and bupropion intake, no substantial changes were observed (odds ratio 1.52, 95% CI 0.99-2.33; P=.05; pseudo-R2=0.045). In the IG, 61.2% (148/242) of users accessed the chatbot, average chatbot-patient interaction time was 121 (95% CI 121.1-140.0) minutes, and average number of contacts was 45.56 (SD 36.32). Conclusions: A treatment including a chatbot for helping with tobacco cessation was more effective than usual clinical practice in primary care. However, this outcome was at the limit of statistical significance, and therefore these promising results must be interpreted with caution. Trial Registration: Clinicaltrials.gov NCT 03445507; https://tinyurl.com/mrnfcmtd International Registered Report Identifier (IRRID): RR2-10.1186/s12911-019-0972-z %M 35759328 %R 10.2196/34273 %U https://mhealth.jmir.org/2022/6/e34273 %U https://doi.org/10.2196/34273 %U http://www.ncbi.nlm.nih.gov/pubmed/35759328 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e28059 %T Direct Outreach in Bars and Clubs to Enroll Cigarette Smokers in Mobile Cessation Services: Exploratory Study %A Chalela,Patricia %A McAlister,Alfred L %A Despres,Cliff %A Muñoz,Edgar %A Sukumaran,Pramod %A Akopian,David %A Kaghyan,Sahak %A Trujillo,Jesus %A Ramirez,Amelie G %+ Institute for Health Promotion Research, University of Texas Health Science Center at San Antonio, Suite 1000, 7411 John Smith Drive, San Antonio, TX, 78229, United States, 1 210 562 6500, ramirezag@uthscsa.edu %K smoking cessation %K young adults %K Latinos %K mobile intervention %K direct recruitment %D 2022 %7 2.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Cigarette smoking and alcohol use are well known to be concomitant behaviors, but there is a lack of studies related to recruitment of smokers for mobile cessation services at places where alcohol is consumed, such as bars and clubs. Adapting recruitment strategies to expand the reach of cessation programs to where tobacco users are located may help decrease the health-equity gap in tobacco control by improving reach and enrollment of underserved smokers residing in low-income and rural areas who are not reached by traditional cessation services. Objective: The purpose of this exploratory study was to assess the feasibility of direct outreach in bars, clubs, and restaurants to recruit smokers to Quitxt, our mobile smoking cessation service. Quitxt is delivered through SMS text messaging or Facebook Messenger. Methods: We collaborated with an advertising agency to conduct in-person recruitment of young adult smokers aged 18-29 years, focusing on urban and rural Spanish-speaking Latino participants, as well as English-speaking rural White and African American participants. Street team members were recruited and trained in a 4-hour session, including a brief introduction to the public health impacts of cigarette smoking and the aims of the project. The street teams made direct, face-to-face contact with smokers in and near smoking areas at 25 bars, clubs, and other venues frequented by young smokers in urban San Antonio and nearby rural areas. Results: The 3923 interactions by the street teams produced 335 (8.5%) program enrollments. Most participants were English speakers with a mean age of 29.2 (SD 10.6) years and smoked a mean of 8.5 (SD 6.2) cigarettes per day. Among users who responded to questions on gender and ethnicity, 66% (70/106) were women and 56% (60/107) were Hispanic/Latino. Among users ready to make a quit attempt, 22% (17/77) reported 1 tobacco-free day and 16% (10/62) reported maintaining cessation to achieve 1 week without smoking. The response rate to later follow-up questions was low. Conclusions: Direct outreach in bars and clubs is a useful method for connecting young adult cigarette smokers with mobile cessation services. However, further research is needed to learn more about how mobile services can influence long-term smoking cessation among those recruited through direct outreach, as well as to test the use of incentives in obtaining more useful response rates. %M 35653173 %R 10.2196/28059 %U https://formative.jmir.org/2022/6/e28059 %U https://doi.org/10.2196/28059 %U http://www.ncbi.nlm.nih.gov/pubmed/35653173 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e38905 %T An Integrated mHealth App for Smoking Cessation in Black Smokers With Anxiety: Protocol for a Randomized Controlled Trial %A Businelle,Michael S %A Garey,Lorra %A Gallagher,Matthew W %A Hébert,Emily T %A Vujanovic,Anka %A Alexander,Adam %A Kezbers,Krista %A Matoska,Cameron %A Robison,Jillian %A Montgomery,Audrey %A Zvolensky,Michael J %+ TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, United States, 1 405 271 8001 ext 50460, michael-businelle@ouhsc.edu %K smoking cessation %K treatment %K Black %K African American %K anxiety sensitivity %K mHealth %K just-in-time adaptive intervention %K mobile phone %D 2022 %7 30.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black smokers have greater difficulty in quitting and higher rates of smoking-related diseases and disabilities than the general population. The smoking disparities experienced by this group are, in part, a consequence of multiple chronic life stressors (eg, racial discrimination) that engender increased exposure to interoceptive stress symptoms (eg, anxiety), which can ultimately lead to smoking as a means of immediate emotion regulation. Objective: This study aimed to culturally adapt and initially test a novel mobile intervention (ie, Mobile Anxiety Sensitivity Program for Smoking [MASP]) that targets anxiety sensitivity (AS; a proxy for difficulty and responsivity to interoceptive stress) among Black smokers. The MASP intervention is culturally informed to address interoceptive stress management difficulties among Black smokers and is thus hypothesized to facilitate smoking cessation. Methods: In phase 1, a total of 25 Black smokers with elevated AS will be administered MASP for 6 weeks. Following the completion of phase 1, we will further refine the MASP based on qualitative and quantitative data from participants to produce the final MASP iteration. In phase 2, a total of 200 Black smokers with elevated AS will be enrolled and randomly assigned to receive nicotine replacement therapy and either the smartphone-based National Cancer Institute QuitGuide app for standard mobile smoking cessation treatment or the MASP intervention. All participants in phases 1 and 2 will be enrolled remotely and will complete a web-based study screener; smartphone-based baseline assessment; daily smartphone-based ecological momentary assessments for 6 weeks; phone-based end-of-treatment qualitative interviews; and smartphone-based follow-up assessments at postbaseline weeks 1, 2 (quit date), 3, 4, 5, 6, 28, and 54 (weeks 28 and 54 follow-ups will be completed by phase 2 participants only). The MASP intervention is intended to offset barriers to treatment and encourage treatment engagement via smartphones. Results: This project was funded in September 2020. Phase 1 data collection began in January 2022. Phase 2 data collection is scheduled to begin in July 2022. Conclusions: If successful, data from this study will support culturally informed treatment approaches for Black smokers and, pending findings of efficacy, provide an evidence-based mobile intervention for smoking cessation that is ready for dissemination and implementation. Trial Registration: ClinicalTrials.gov NCT04838236; https://clinicaltrials.gov/ct2/show/NCT04838236 International Registered Report Identifier (IRRID): DERR1-10.2196/38905 %M 35635746 %R 10.2196/38905 %U https://www.researchprotocols.org/2022/5/e38905 %U https://doi.org/10.2196/38905 %U http://www.ncbi.nlm.nih.gov/pubmed/35635746 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e36215 %T COVID-19 and Tweets About Quitting Cigarette Smoking: Topic Model Analysis of Twitter Posts 2018-2020 %A Westmaas,J Lee %A Masters,Matthew %A Bandi,Priti %A Majmundar,Anuja %A Asare,Samuel %A Diver,W Ryan %+ Population Science Department, American Cancer Society, 3380 Chastain Meadows Pkwy NW Suite 200, Kennesaw, GA, 30144, United States, 1 404 909 4338, lee.westmaas@cancer.org %K COVID-19 %K machine learning %K pandemic %K quit smoking %K topic model analysis %K Twitter %K social media %K smoking cessation %K latent Dirichlet allocation %K tweet %K public health %D 2022 %7 16.5.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The risk of infection and severity of illness by SARS-CoV-2 infection is elevated for people who smoke cigarettes and may motivate quitting. Organic public conversations on Twitter about quitting smoking could provide insight into quitting motivations or behaviors associated with the pandemic. Objective: This study explored key topics of conversation about quitting cigarette smoking and examined their trajectory during 2018-2020. Methods: Topic model analysis with latent Dirichlet allocation (LDA) identified themes in US tweets with the term “quit smoking.” The model was trained on posts from 2018 and was then applied to tweets posted in 2019 and 2020. Analysis of variance and follow-up pairwise tests were used to compare the daily frequency of tweets within and across years by quarter. Results: The mean numbers of daily tweets on quitting smoking in 2018, 2019, and 2020 were 133 (SD 36.2), 145 (SD 69.4), and 127 (SD 32.6), respectively. Six topics were extracted: (1) need to quit, (2) personal experiences, (3) electronic cigarettes (e-cigarettes), (4) advice/success, (5) quitting as a component of general health behavior change, and (6) clinics/services. Overall, the pandemic was not associated with changes in posts about quitting; instead, New Year’s resolutions and the 2019 e-cigarette or vaping use–associated lung injury (EVALI) epidemic were more plausible explanations for observed changes within and across years. Fewer second-quarter posts in 2020 for the topic e-cigarettes may reflect lower pandemic-related quitting interest, whereas fourth-quarter increases in 2020 for other topics pointed to a late-year upswing. Conclusions: Twitter posts suggest that the pandemic did not generate greater interest in quitting smoking, but possibly a decrease in motivation when the rate of infections was increasing in the second quarter of 2020. Public health authorities may wish to craft messages for specific Twitter audiences (eg, using hashtags) to motivate quitting during pandemics. %M 35611092 %R 10.2196/36215 %U https://infodemiology.jmir.org/2022/1/e36215 %U https://doi.org/10.2196/36215 %U http://www.ncbi.nlm.nih.gov/pubmed/35611092 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e35408 %T eHealth Interventions Targeting Poor Diet, Alcohol Use, Tobacco Smoking, and Vaping Among Disadvantaged Youth: Protocol for a Systematic Review %A Egan,Lyra %A Gardner,Lauren Anne %A Newton,Nicola %A Champion,Katrina %+ The Matilda Centre for Research in Mental Health and Substance Use, University of Sydney, Level 6, Jane Foss Russell Building (G02), University of Sydney, Sydney, 2006, Australia, 61 2 9114 4753, lyra.egan@sydney.edu.au %K eHealth %K adolescent %K health promotion %K diet %K alcohol %K smoking %K vaping %K socioeconomic status %K remoteness %K rural %K disadvantage %D 2022 %7 13.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic disease burden is higher among disadvantaged populations. Preventing lifestyle risk behaviors such as poor diet, alcohol use, tobacco smoking, and vaping in adolescence is critical for reducing the risk of chronic disease and related harms in adolescence and adulthood. Although eHealth interventions are a promising prevention approach among the general population, it is unclear whether they adequately serve adolescents from disadvantaged backgrounds such as those living in geographically remote or lower socioeconomic areas. Objective: This is the first systematic review to identify, evaluate, and synthesize evidence for the effectiveness of eHealth interventions targeting adolescents living in geographically remote or lower socioeconomic areas in preventing poor diet, alcohol use, tobacco smoking, and vaping. Methods: A systematic search will be conducted in 7 electronic databases: the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PROSPERO, MEDLINE (Ovid), Embase (Ovid), Scopus, and PsycInfo (Ovid). The search will be limited to eHealth-based experimental studies (ie, randomized controlled trials and quasi-experimental studies) targeting diet, alcohol use, tobacco smoking, and vaping among adolescents (aged 10-19 years). Eligible studies will be those reporting on at least one marker of socioeconomic status (eg, social class, household income, parental occupation status, parental education, and family affluence) or geographical remoteness (eg, living in rural, regional, and remote areas, or living outside major metropolitan centers). One reviewer will screen all studies for eligibility, of which 25% will be double-screened. Data will be extracted and summarized in a narrative synthesis. Risk of bias will be assessed using the Cochrane Revised Risk of Bias Tool. Results: As of December 2021, the title and abstract screening of 3216 articles was completed, and the full-text review was underway. The systematic review is expected to be completed in 2022. Conclusions: This systematic review will provide an in-depth understanding of effective eHealth interventions targeting poor diet, alcohol use, tobacco smoking, and vaping among adolescents living in geographically remote or lower socioeconomic areas and the factors that contribute to their effectiveness. This in turn will provide critical knowledge to improve future interventions delivered to these populations. Trial Registration: PROSPERO CRD42021294119; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=294119 International Registered Report Identifier (IRRID): PRR1-10.2196/35408 %M 35560002 %R 10.2196/35408 %U https://www.researchprotocols.org/2022/5/e35408 %U https://doi.org/10.2196/35408 %U http://www.ncbi.nlm.nih.gov/pubmed/35560002 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33656 %T Agreement Between Self-reports and Photos to Assess e-Cigarette Device and Liquid Characteristics in Wave 1 of the Vaping and Patterns of e-Cigarette Use Research Study: Web-Based Longitudinal Cohort Study %A Crespi,Elizabeth %A Hardesty,Jeffrey J %A Nian,Qinghua %A Sinamo,Joshua %A Welding,Kevin %A Kennedy,Ryan David %A Cohen,Joanna E %+ Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Baltimore, MD, 21205, United States, 1 410 614 5378, ecrespi2@jhu.edu %K tobacco %K e-cigarette %K methodology %K internet %K photo %K survey %K self-report %D 2022 %7 27.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: e-Cigarette device and liquid characteristics are highly customizable; these characteristics impact nicotine delivery and exposure to toxic constituents. It is critical to understand optimal methods for measuring these characteristics to accurately assess their impacts on user behavior and health. Objective: To inform future survey development, we assessed the agreement between responses from survey participants (self-reports) and photos uploaded by participants and the quantity of usable data derived from each approach. Methods: Adult regular e-cigarette users (≥5 days per week) aged ≥21 years (N=1209) were asked questions about and submitted photos of their most used e-cigarette device (1209/1209, 100%) and liquid (1132/1209, 93.63%). Device variables assessed included brand, model, reusability, refillability, display, and adjustable power. Liquid variables included brand, flavor, nicotine concentration, nicotine formulation, and bottle size. For each variable, percentage agreement was calculated where self-report and photo data were available. Krippendorff α and intraclass correlation coefficient (ICC) were calculated for categorical and continuous variables, respectively. Results were stratified by device (disposable, reusable with disposable pods or cartridges, and reusable with refillable pods, cartridges, or tanks) and liquid (customized and noncustomized) type. The sample size for each calculation ranged from 3.89% (47/1209; model of disposable devices) to 95.12% (1150/1209; device reusability). Results: Percentage agreement between photos and self-reports was substantial to very high across device and liquid types for all variables except nicotine concentration. These results are consistent with Krippendorff α calculations, except where prevalence bias was suspected. ICC results for nicotine concentration and bottle size were lower than percentage agreement, likely because ICC accounts for the level of disagreement between values. Agreement varied by device and liquid type. For example, percentage agreement for device brand was higher among users of reusable devices (94%) than among users of disposable devices (75%). Low percentage agreement may result from poor participant knowledge of characteristics, user modifications of devices inconsistent with manufacturer-intended use, inaccurate or incomplete information on websites, or photo submissions that are not a participant’s most used device or liquid. The number of excluded values (eg, self-report was “don’t know” or no photo submitted) differed between self-reports and photos; for questions asked to participants, self-reports had more usable data than photos for all variables except device model and nicotine formulation. Conclusions: Photos and self-reports yield data of similar accuracy for most variables assessed in this study: device brand, device model, reusability, adjustable power, display, refillability, liquid brand, flavor, and bottle size. Self-reports provided more data for all variables except device model and nicotine formulation. Using these approaches simultaneously may optimize data quantity and quality. Future research should examine how to assess nicotine concentration and variables not included in this study (eg, wattage and resistance) and the resource requirements of these approaches. %M 35475727 %R 10.2196/33656 %U https://www.jmir.org/2022/4/e33656 %U https://doi.org/10.2196/33656 %U http://www.ncbi.nlm.nih.gov/pubmed/35475727 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e32960 %T Formative Provider Testing of a New Encounter Decision Aid for Smoking Cessation: Questionnaire Study %A Hollanda De Sa Neto,Herul %A Habfast-Robertson,Ines %A Hempel-Bruder,Christina %A Durand,Marie-Anne %A Jacot-Sadowski,Isabelle %A Khazaal,Yasser %A Berlin,Ivan %A Selby,Kevin %+ Center for Primary Care and Public Health (Unisanté), Rue de Bugnon 44, Lausanne, 1010, Switzerland, 41 79 556 67 53, kevin.selby@unisante.ch %K decision aid %K smoking cessation %K electronic tool %K shared decision-making %D 2022 %7 20.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking cessation is an essential part of preventing and reducing the risk of smoking-associated morbidity and mortality. However, there is often little time to discuss smoking cessation in primary care. Decision aids (DAs) designed for clinic visits (encounter DAs) need to be clear, short, and concise to optimize therapeutic education, increase interaction, and improve the therapeutic alliance. Such a DA for smoking cessation could potentially improve counseling and increase the use of pharmacological treatments. Objective: We aimed to collect feedback on an electronic encounter DA that facilitates physician-patient interaction and shared decision-making for smoking cessation in primary care. Methods: We developed an electronic, encounter DA (howtoquit.ch) from a paper version created by our team in 2017 following user-centered design principles. The DA is a 1-page interactive website presenting and comparing medications for tobacco cessation and electronic cigarettes. Each smoking cessation medication has a drop down menu that presents additional information, a video demonstration, and prescribing information for physicians. To test the DA, we submitted a questionnaire to approximately 20 general practitioner residents of an academic general medicine department, 5 general practitioners, and 6 experts in the field of smoking cessation. The questionnaire consisted of 4 multiple-choice and 2 free-text questions assessing the usability or acceptability of the DA, the acquisition of new knowledge for practitioners, the perceived utility in supporting shared decision-making, perceived strengths and weaknesses, and whether the participants would recommend the tool to other clinicians. Results: In all, 6 residents, 3 general practitioners in private practice, and 2 tobacco cessation experts completed the questionnaire (N=11), with 4 additional experts providing open-text feedback. On the 11 questionnaires, the DA was rated as practical and intuitive (mean 4.6/5), and providers felt it supported shared decision-making (mean 4.4/5), as comparisons were readily possible. Inclusion of explanatory videos was seen as a bonus. Several changes were suggested, like grouping together similar medications and adding a landing page to briefly explain the site. Changes were implemented according to end-user comments. Conclusions: The overall assessment of the encounter DA by a group of physicians and experts was positive. The ultimate objective is to have the tool deployed and easily accessible for all to use. %M 35442200 %R 10.2196/32960 %U https://formative.jmir.org/2022/4/e32960 %U https://doi.org/10.2196/32960 %U http://www.ncbi.nlm.nih.gov/pubmed/35442200 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e32628 %T Process and Information Needs When Searching for and Selecting Apps for Smoking Cessation: Qualitative Study Using Contextual Inquiry %A Hendriks,Ylva %A Peek,Sebastiaan %A Kaptein,Maurits %A Bongers,Inge %+ Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, PO Box 90153, Tilburg, 5000 LE, Netherlands, 31 13 466 4892, ylva.hendriks@tilburguniversity.edu %K mHealth and eHealth %K contextual inquiry %K decision-making %K mobile app search and selection %K apps for smoking cessation %K mobile apps %K mobile phone %D 2022 %7 14.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Hundreds of apps are available to support people in their quest to quit smoking. It has been hypothesized that selecting an app from a sizable volume without any aid can be overwhelming and difficult. However, little is known about how people choose apps for smoking cessation and what exactly people want to know about an app before choosing to install it. Understanding the decision-making process may ultimately be helpful in creating tools to help people meaningfully select apps. Objective: The aim of this study is to obtain insights into the process of searching and selecting mobile apps for smoking cessation and map the range of actions and the accompanying reasons during the search, focusing on the information needs and experiences of those who aim to find an app. Methods: Contextual inquiries were conducted with 10 Dutch adults wanting to quit smoking by using an app. During the inquiries, we observed people as they chose an app. In addition, 2 weeks later, there was a short semistructured follow-up interview over the phone. Through convenience and purposive sampling, we included participants differing in gender, age, and educational level. We used thematic analysis to analyze the transcribed interviews and leveraged a combination of video and audio recordings to understand what is involved in searching and selecting apps for smoking cessation. Results: The process of finding smoking cessation apps is comprehensive: participants explored, evaluated, and searched for information; imagined using functions; compared apps; assessed the trustworthiness of apps and information; and made several decisions while navigating the internet and app stores. During the search, the participants gained knowledge of apps and developed clearer ideas about their wishes and requirements. Confidence and trust in these apps to help quitting remained quite low or even decreased. Although the process was predominantly a positive experience, the whole process took time and energy and caused negative emotions such as frustration and disappointment for some participants. In addition, without the participants realizing it, errors in information processing occurred, which affected the choices they made. All participants chose an app with the explicit intention of using it. After 2 weeks, of the 10 participants, 6 had used the app, of whom only 1 extensively. Conclusions: Finding an app in the current app stores that contains functions and features expected to help in quitting smoking takes considerable time and energy, can be a negative experience, and is prone to errors in information processing that affect decision-making. Therefore, we advise the further development of decision aids, such as advanced filters, recommender systems and curated health app portals, and make a number of concrete recommendations for the design of such systems. %M 35436217 %R 10.2196/32628 %U https://humanfactors.jmir.org/2022/2/e32628 %U https://doi.org/10.2196/32628 %U http://www.ncbi.nlm.nih.gov/pubmed/35436217 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e26335 %T Discussions and Misinformation About Electronic Nicotine Delivery Systems and COVID-19: Qualitative Analysis of Twitter Content %A Sidani,Jaime E %A Hoffman,Beth %A Colditz,Jason B %A Wolynn,Riley %A Hsiao,Lily %A Chu,Kar-Hai %A Rose,Jason J %A Shensa,Ariel %A Davis,Esa %A Primack,Brian %+ Center for Social Dynamics and Community Health, Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, 130 DeSoto Street, Pittsburgh, PA, 15261, United States, 1 412 383 0733, jaime.sidani@pitt.edu %K COVID-19 %K coronavirus %K e-cigarette %K electronic nicotine delivery systems %K Twitter %K social media %K misinformation %K discussion %K public health %K communication %K concern %K severity %K conspiracy %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Misinformation and conspiracy theories related to COVID-19 and electronic nicotine delivery systems (ENDS) are increasing. Some of this may stem from early reports suggesting a lower risk of severe COVID-19 in nicotine users. Additionally, a common conspiracy is that the e-cigarette or vaping product use–associated lung injury (EVALI) outbreak of 2019 was actually an early presentation of COVID-19. This may have important public health ramifications for both COVID-19 control and ENDS use. Objective: Twitter is an ideal tool for analyzing real-time public discussions related to both ENDS and COVID-19. This study seeks to collect and classify Twitter messages (“tweets”) related to ENDS and COVID-19 to inform public health messaging. Methods: Approximately 2.1 million tweets matching ENDS-related keywords were collected from March 1, 2020, through June 30, 2020, and were then filtered for COVID-19–related keywords, resulting in 67,321 original tweets. A 5% (n=3366) subsample was obtained for human coding using a systematically developed codebook. Tweets were coded for relevance to the topic and four overarching categories. Results: A total of 1930 (57.3%) tweets were coded as relevant to the research topic. Half (n=1008, 52.2%) of these discussed a perceived association between ENDS use and COVID-19 susceptibility or severity, with 42.4% (n=818) suggesting that ENDS use is associated with worse COVID-19 symptoms. One-quarter (n=479, 24.8%) of tweets discussed the perceived similarity/dissimilarity of COVID-19 and EVALI, and 13.8% (n=266) discussed ENDS use behavior. Misinformation and conspiracy theories were present throughout all coding categories. Conclusions: Discussions about ENDS use and COVID-19 on Twitter frequently highlight concerns about the susceptibility and severity of COVID-19 for ENDS users; however, many contain misinformation and conspiracy theories. Public health messaging should capitalize on these concerns and amplify accurate Twitter messaging. %M 35311684 %R 10.2196/26335 %U https://formative.jmir.org/2022/4/e26335 %U https://doi.org/10.2196/26335 %U http://www.ncbi.nlm.nih.gov/pubmed/35311684 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e32242 %T Health Care Professionals’ Clinical Skills to Address Vaping and e-Cigarette Use by Patients: Needs and Interest Questionnaire Study %A Metcalf,Mary %A Rossie,Karen %A Stokes,Katie %A Tanner,Bradley %+ Clinical Tools, Inc, 101-A Market Street, Chapel Hill, NC, 27516-0460, United States, 1 919 960 8118, metcalf@clinicaltools.com %K clinical skills %K vaping %K e-cigarettes %K nicotine %K brief interventions %K addiction treatment %K health care professionals %K continuing education %D 2022 %7 11.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Widespread vaping and e-cigarette use is a relatively new phenomenon. Youth vaping peaked in 2019, with over 25% of high school students currently vaping. e-Cigarettes are used where smoking is not permitted or as an alternative smoking cessation treatment instead of Food and Drug Administration–approved options. Vaping and e-cigarette use has the potential to harm health, including causing adverse respiratory effects and nicotine addiction. Health care professionals need skills training to help their patients with this relatively new and evolving health problem. Objective: The aim of this study is to understand health care professionals’ training needs in this subject area to determine the focus for web-based continuing education training. Methods: We reviewed the literature on clinical aspects of vaping and e-cigarette use. Using the results and our experience in substance use continuing education, we created a list of key clinical skills and surveyed health care professionals about their training needs. We also asked about their interest in a list of related topics. We recruited individuals who completed our web-based courses on substance use, members of health care professional–related groups, and experts who had published an article on the subject. Half of the 31 health care professionals who completed the survey were physicians and the remainder were primarily nurses, social workers, and counselors. Participants self-identified as nonexperts (n=25) and experts (n=6) on vaping. Results: Participants who were nonexperts on average agreed or strongly agreed that they needed training in each of 8 clinical skills (n=25; range 3.7-4.4 agreement out of 5). The top two skills were recommending treatments for patients (4.4 out of 5, SD 0.49) and evaluating and treating the health effects of vaping and e-cigarette use (4.4 out of 5, SD 0.50). Experts agreed on the importance of training for health care professionals in all skills but rated the need for training higher than nonexperts for each topic. Over half of the participating health care professionals (44%-80%) were interested in nearly all (9/10, 90%) vaping-related topics on a checklist. The topics participants were most interested in were the pros and cons of vaping versus smoking and the health effects of second- and third-hand vaping. Primary care physicians showed more interest in vaping-related topics than nonprimary care physicians (t13=2.17; P=.02). Conclusions: This study confirmed gaps in health care professionals’ vaping-related clinical skills identified in the literature by identifying a perceived need for training in related skills and health care professionals’ interest in key topics related to vaping prevention and cessation. This study provides specific guidance on which clinical skills training is most needed and which topics are most interesting to health care professionals. %M 35404264 %R 10.2196/32242 %U https://formative.jmir.org/2022/4/e32242 %U https://doi.org/10.2196/32242 %U http://www.ncbi.nlm.nih.gov/pubmed/35404264 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e33640 %T Preferences for Mobile-Supported e-Cigarette Cessation Interventions Among Young Adults: Qualitative Descriptive Study %A Huma,Zil E %A Struik,Laura %A Bottorff,Joan L %A Hasan,Mohammad Khalad %+ School of Nursing, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V1V7, Canada, 1 2508078000, laura.struik@ubc.ca %K qualitative research %K electronic nicotine delivery systems %K e-cigarette %K cessation %K young adults %K smartphone apps %K mHealth %K mobile phone %D 2022 %7 1.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the steady rise in electronic cigarette (e-cigarette) uptake among young adults, increasingly more young people want to quit. Given the popularity of smartphones among young adults, mobile-based e-cigarette cessation interventions hold significant promise. Smartphone apps are particularly promising due to their varied and complex capabilities to engage end users. However, evidence around young adults’ preferences and expectations from an e-cigarette cessation smartphone app remains unexplored. Objective: The purpose of this study was to take an initial step toward understanding young adults’ preferences and perceptions on app-based e-cigarette cessation interventions. Methods: Using a qualitative descriptive approach, we interviewed 12 young adults who used e-cigarettes and wanted to quit. We inductively derived themes using the framework analysis approach and NVivo 12 qualitative data analysis software. Results: All participants agreed that a smartphone app for supporting cessation was desirable. In addition, we found 4 key themes related to their preferences for app components: (1) flexible personalization (being able to enter and modify goals); (2) e-cigarette behavior tracking (progress and benefits of quitting); (3) safely managed social support (moderated and anonymous); and (4) positively framed notifications (encouraging and motivational messages). Some gender-based differences indicate that women were more likely to use e-cigarettes to cope with stress, preferred more aesthetic tailoring in the app, and were less likely to quit cold turkey compared with men. Conclusions: The findings provide direction for the development and testing of app-based e-cigarette cessation interventions for young adults. %M 35363140 %R 10.2196/33640 %U https://formative.jmir.org/2022/4/e33640 %U https://doi.org/10.2196/33640 %U http://www.ncbi.nlm.nih.gov/pubmed/35363140 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34050 %T Content Analysis of Nicotine Poisoning (Nic Sick) Videos on TikTok: Retrospective Observational Infodemiology Study %A Purushothaman,Vidya %A McMann,Tiana %A Nali,Matthew %A Li,Zhuoran %A Cuomo,Raphael %A Mackey,Tim K %+ Department of Anthropology, University of California San Diego, 9500 Gilman Drive, Postal Code: 0505, La Jolla, CA, 92093, United States, 1 9514914161, tmackey@ucsd.edu %K nic sick %K vaping %K tobacco %K social media %K TikTok %K content analysis %K smoking %K nicotine %K e-cigarette %K adverse effects %K public health %K infodemiology %D 2022 %7 30.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: TikTok is a microvideo social media platform currently experiencing rapid growth and with 60% of its monthly users between the ages of 16 and 24 years. Increased exposure to e-cigarette content on social media may influence patterns of use, including the risk of overconsumption and possible nicotine poisoning, when users engage in trending challenges online. However, there is limited research assessing the characteristics of nicotine poisoning–related content posted on social media. Objective: We aimed to assess the characteristics of content on TikTok that is associated with a popular nicotine poisoning–related hashtag. Methods: We collected TikTok posts associated with the hashtag #nicsick, using a Python programming package (Selenium) and used an inductive coding approach to analyze video content and characteristics of interest. Videos were manually annotated to generate a codebook of the nicotine sickness–related themes. Statistical analysis was used to compare user engagement characteristics and video length in content with and without active nicotine sickness TikTok topics. Results: A total of 132 TikTok videos associated with the hashtag #nicsick were manually coded, with 52.3% (69/132) identified as discussing firsthand and secondhand reports of suspected nicotine poisoning symptoms and experiences. More than one-third of nicotine poisoning–related content (26/69, 37.68%) portrayed active vaping by users, which included content with vaping behavior such as vaping tricks and overconsumption, and 43% (30/69) of recorded users self-reported experiencing nicotine sickness, poisoning, or adverse events such as vomiting following nicotine consumption. The average follower count of users posting content related to nicotine sickness was significantly higher than that for users posting content unrelated to nicotine sickness (W=2350.5, P=.03). Conclusions: TikTok users openly discuss experiences, both firsthand and secondhand, with nicotine adverse events via the #nicsick hashtag including reports of overconsumption resulting in sickness. These study results suggest that there is a need to assess the utility of digital surveillance on emerging social media platforms for vaping adverse events, particularly on sites popular among youth and young adults. As vaping product use-patterns continue to evolve, digital adverse event detection likely represents an important tool to supplement traditional methods of public health surveillance (such as poison control center prevalence numbers). %M 35353056 %R 10.2196/34050 %U https://www.jmir.org/2022/3/e34050 %U https://doi.org/10.2196/34050 %U http://www.ncbi.nlm.nih.gov/pubmed/35353056 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e25697 %T Perception of the Food and Drug Administration Electronic Cigarette Flavor Enforcement Policy on Twitter: Observational Study %A Lu,Xinyi %A Sun,Li %A Xie,Zidian %A Li,Dongmei %+ Department of Clinical & Translational Research, University of Rochester Medical Center, Saunders Research Building 1.303J, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K electronic cigarette %K FDA flavor enforcement policy %K Twitter %K Food and Drug Administration %K enforcement %K policy %K e-cigarettes %K e-cigarette flavor %K tobacco flavors %K prohibit %K sale %D 2022 %7 29.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: On January 2, 2020, the US Food and Drug Administration (FDA) released the electronic cigarette (e-cigarette) flavor enforcement policy to prohibit the sale of all flavored cartridge–based e-cigarettes, except for menthol and tobacco flavors. Objective: This research aimed to examine the public perception of this FDA flavor enforcement policy and its impact on the public perception of e-cigarettes on Twitter. Methods: A total of 2,341,660 e-cigarette–related tweets and 190,490 FDA flavor enforcement policy–related tweets in the United States were collected from Twitter before (between June 13 and August 22, 2019) and after (between January 2 and March 30, 2020) the announcement of the FDA flavor enforcement policy. Sentiment analysis was conducted to detect the changes in the public perceptions of the policy and e-cigarettes on Twitter. Topic modeling was used for finding frequently discussed topics about e-cigarettes. Results: The proportion of negative sentiment tweets about e-cigarettes significantly increased after the announcement of the FDA flavor enforcement policy compared with before the announcement of the policy. In contrast, the overall sentiment toward the FDA flavor enforcement policy became less negative. The FDA flavor enforcement policy was the most popular topic associated with e-cigarettes after the announcement of the FDA flavor enforcement policy. Twitter users who discussed about e-cigarettes started to talk about other alternative ways of getting e-cigarettes after the FDA flavor enforcement policy. Conclusions: Twitter users’ perceptions of e-cigarettes became more negative after the announcement of the FDA flavor enforcement policy. %M 35348461 %R 10.2196/25697 %U https://publichealth.jmir.org/2022/3/e25697 %U https://doi.org/10.2196/25697 %U http://www.ncbi.nlm.nih.gov/pubmed/35348461 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e31309 %T Smartphone Apps for Vaping Cessation: Quality Assessment and Content Analysis %A Sanchez,Sherald %A Kundu,Anasua %A Limanto,Elizabeth %A Selby,Peter %A Baskerville,Neill Bruce %A Chaiton,Michael %+ Institute of Medical Science, Termerty Faculty of Medicine, University of Toronto, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada, 1 416 535 8501 ext 32005, Sherald.Sanchez@utoronto.ca %K e-cigarettes %K vaping %K cessation %K mHealth interventions %D 2022 %7 28.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As the prevalence of electronic cigarette (e-cigarette) use, or vaping, continues to grow, particularly among young people, so does the need for research and interventions to address vaping. Objective: This study examines the quality of free vaping cessation apps, their contents and features, popularity among users, and adherence to evidence-based principles. Methods: A systematic search of existing apps for vaping cessation was conducted in December 2020. Eligible apps were free, in English, and included features specifically targeting vaping cessation. Each app included in the analysis was used daily for at least seven consecutive days, assessed using the Mobile App Rating Scale, and rated by at least two authors (AK, EL, or SS) based on adherence to evidence-based practices. Intraclass correlation coefficient (ICC) estimates were computed to assess interrater reliability (excellent agreement; ICC 0.92; 95% CI 0.78-0.98). Results: A total of 8 apps were included in the quality assessment and content analysis: 3 were developed specifically for vaping cessation and 5 focused on smoking cessation while also claiming to address vaping cessation. The mean of app quality total scores was 3.66 out of 5. Existing vaping cessation apps employ similar approaches to smoking cessation apps. However, they are very low in number and have limited features developed specifically for vaping cessation. Conclusions: Given the lack of vaping cessation interventions at a time when they are urgently needed, smartphone apps are potentially valuable tools. Therefore, it is recommended that these apps apply evidence-based practices and undergo rigorous evaluations that can assess their quality, contents and features, and popularity among users. Through this process, we can improve our understanding of how apps can be effective in helping users quit vaping. %M 35343904 %R 10.2196/31309 %U https://mhealth.jmir.org/2022/3/e31309 %U https://doi.org/10.2196/31309 %U http://www.ncbi.nlm.nih.gov/pubmed/35343904 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e27894 %T Puff Bars, Tobacco Policy Evasion, and Nicotine Dependence: Content Analysis of Tweets %A Chu,Kar-Hai %A Hershey,Tina B %A Hoffman,Beth L %A Wolynn,Riley %A Colditz,Jason B %A Sidani,Jaime E %A Primack,Brian A %+ Graduate School of Public Health, University of Pittsburgh, 130 DeSoto Street, Pittsburgh, PA, 15261, United States, 1 4126922578, chuk@pitt.edu %K tobacco %K policy %K social media %K e-cigarette %K twitter %K mHealth %K dependence %K addiction %K nicotine %D 2022 %7 25.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Puff Bars are e-cigarettes that continued marketing flavored products by exploiting the US Food and Drug Administration exemption for disposable devices. Objective: This study aimed to examine discussions related to Puff Bar on Twitter to identify tobacco regulation and policy themes as well as unanticipated outcomes of regulatory loopholes. Methods: Of 8519 original tweets related to Puff Bar collected from July 13, 2020, to August 13, 2020, a random 20% subsample (n=2661) was selected for qualitative coding of topics related to nicotine dependence and tobacco policy. Results: Of the human-coded tweets, 2123 (80.2%) were coded as relevant to Puff Bar as the main topic. Of those tweets, 698 (32.9%) discussed tobacco policy, including flavors (n=320, 45.9%), regulations (n=124, 17.8%), purchases (n=117, 16.8%), and other products (n=110, 15.8%). Approximately 22% (n=480) of the tweets referenced dependence, including lack of access (n=273, 56.9%), appetite suppression (n=59, 12.3%), frequent use (n=47, 9.8%), and self-reported dependence (n=110, 22.9%). Conclusions: This study adds to the growing evidence base that the US Food and Drug Administration ban of e-cigarette flavors did not reduce interest, but rather shifted the discussion to brands utilizing a loophole that allowed flavored products to continue to be sold in disposable devices. Until comprehensive tobacco policy legislation is developed, new products or loopholes will continue to supply nicotine demand. %M 35333188 %R 10.2196/27894 %U https://www.jmir.org/2022/3/e27894 %U https://doi.org/10.2196/27894 %U http://www.ncbi.nlm.nih.gov/pubmed/35333188 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e30949 %T Identifying Video Game Preferences Among Adults Interested in Quitting Smoking Cigarettes: Survey Study %A Upton,Caitlyn R %A Nastasi,Jessica A %A Raiff,Bethany R %+ Department of Psychology, College of Science and Mathematics, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, United States, 1 (856) 256 4500 ext 5, raiff@rowan.edu %K genres %K popular games %K smoking cessation %K video games %K smartphone %K mobile phone %D 2022 %7 24.3.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Smoking is the most prevalent cause of morbidity and mortality in the United States. Although most individuals who smoke express a desire to quit smoking, only a small percentage are successful. Serious games have become popular in health sectors as a potential avenue for delivering a scalable treatment that is both accessible and engaging for the smoking population. Several smoking cessation games have already been developed, but these games feature a broad range of gameplay elements and are not necessarily based on existing video game preferences in the general or smoking population. Objective: To better inform treatment development, this study aims to evaluate video game genre preferences among treatment-seeking individuals who smoke (N=473). Methods: Participants responded to a screening survey to enroll in a larger, serious game intervention for smoking cessation. During this screening survey, participants were asked to disclose their favorite video games, which resulted in 277 unique game titles. These titles were coded for genre categories based on publisher listings and game features. The genres were then analyzed for the frequency of reporting overall and across age groups. Results: Action, Role-Playing, and Action-Adventure were the most reported genres among adults aged ≤34 years; Action, Action-Adventure, and Logic were the most reported genres among adults aged 35-44 years; and Logic and Action were the most reported genres among adults aged ≥45 years. Conclusions: These data indicate that treatment-seeking individuals who smoke have different game preferences across age groups, and the data provide novel information to inform the development of future serious games targeting the smoking population that are tailored to the preferences of their age group. Trial Registration: ClinicalTrials.gov NCT03929003; https://clinicaltrials.gov/ct2/show/NCT03929003 %M 35323116 %R 10.2196/30949 %U https://games.jmir.org/2022/1/e30949 %U https://doi.org/10.2196/30949 %U http://www.ncbi.nlm.nih.gov/pubmed/35323116 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e31040 %T Comparing Reminders Sent via SMS Text Messaging and Email for Improving Adherence to an Electronic Health Program: Randomized Controlled Trial %A Kulhánek,Adam %A Lukavska,Katerina %A Gabrhelík,Roman %A Novák,Daniel %A Burda,Václav %A Prokop,Jindřich %A Holter,Marianne T S %A Brendryen,Håvar %+ Department of Addictology, General University Hospital in Prague, Apolinářská 4, Prague, 12000, Czech Republic, 420 224 968 273, katerina.lukavska@lf1.cuni.cz %K eHealth %K randomized controlled trial %K adherence %K reminders %K SMS text messaging %K email %K smoking cessation %K text message %D 2022 %7 18.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: eHealth interventions can help people change behavior (eg, quit smoking). Reminders sent via SMS text messaging or email may improve the adherence to web-based programs and increase the probability of successful behavior change; however, it is unclear whether their efficiency is affected by the modality of the communication channel. Objective: A 2-armed randomized control trial was conducted to compare the effect of providing reminders via SMS text messaging versus email on the adherence to an eHealth program for smoking cessation and on the probability to initiate a quit attempt. Methods: Smokers were recruited via an internet-based advertisement. A total of 591 participants who diverted from intended use of the program (ie, failed to log on to a session) were automatically randomized to the experimental (SMS text messaging reminder, n=304) or the active comparator (email reminder, n=287) group. Results: Unexpectedly, we found that the mode of reminder delivery did not significantly affect either the adherence, namely the number of completed program sessions, with the SMS text messaging reminder group showing a mean of 4.30 (SD 3.24) and the email reminder group showing a mean of 4.36 (SD 3.27) (t586=0.197, P=.84, and Cohen d=0.016), or the outcome, namely the quit smoking attempt rate (34.2% in the SMS text messaging group vs 31.7% in the email group; χ21=0.4, P=.52). Secondary analyses showed that age, gender, and education had significant effects on program adherence and education on the outcome. Moreover, we found a significant interaction effect between the mode of reminder delivery and gender on program adherence, suggesting that the effectiveness of SMS text message reminders might be different for females and males. However, this particular finding should be treated with care as it was based on post hoc subgroup analysis. Conclusions: This study indicates that the modality of user reminders to log on increased neither the program adherence nor the probability of quitting smoking. This suggests that program developers may save costs using emails instead of SMS text messaging reminders. Trial Registration: ClinicalTrials.gov NCT03276767; https://clinicaltrials.gov/ct2/show/ NCT03276767 %M 35302945 %R 10.2196/31040 %U https://mhealth.jmir.org/2022/3/e31040 %U https://doi.org/10.2196/31040 %U http://www.ncbi.nlm.nih.gov/pubmed/35302945 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32342 %T User Experiences With an SMS Text Messaging Program for Smoking Cessation: Qualitative Study %A Budenz,Alexandra %A Coa,Kisha %A Grenen,Emily %A Keefe,Brian %A Sanders,Amy %A Wiseman,Kara P %A Roditis,Maria %+ ICF, 9300 Lee Hwy, Fairfax, VA, 22031, United States, 1 301 572 0369, Emily.Grenen@icfnext.com %K smoking cessation %K text messaging interventions %K qualitative research %K mobile phone %D 2022 %7 18.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health strategies for smoking cessation (eg, SMS text messaging–based interventions) have been shown to be effective in helping smokers quit. However, further research is needed to better understand user experiences with these platforms. Objective: This qualitative study aims to explore the experiences of real-world users of a publicly available smoking cessation program (SmokefreeTXT). Methods: Semistructured phone interviews were conducted with 36 SmokefreeTXT users between March and July 2014. Of these 36 participants, 50% (18/36) of participants completed the SmokefreeTXT program (ie, did not opt out of the program before the 6- to 8-week completion period), and 50% (18/36) did not complete the program (ie, requested to opt out of the program before the completion period). Interview questions focused on smoking behaviors, quitting history, opinions on the program’s content and structure, answering assessment questions, using keywords, reasons for opting out, and perceived usefulness of the program for quitting smoking. A thematic content analysis was conducted, with a focus on themes to increase program engagement and optimization. Results: The findings highlighted features of the program that participants found beneficial, as well as some elements that showed opportunities for improvement to boost program retention and successful cessation. Specifically, most participants found the SmokefreeTXT program to be convenient and supportive of cessation; however, some found the messages to be repetitive and reported a desire for more flexibility based on their readiness to quit and cessation progress. We also found that program completion did not necessarily indicate successful smoking cessation and that program opt out, which might be interpreted as a less positive outcome, may occur because of successful cessation. Finally, several participants reported using SmokefreeTXT together with other evidence-based cessation methods or non–evidence-based strategies. Conclusions: Qualitative interviews with real-world SmokefreeTXT users showed high program acceptability, engagement with program features, and perceived utility for smoking cessation. Our findings directly informed several program updates, such as adding an adaptive quit date feature and offering supplemental information on live support services for users who prefer human interaction during the cessation process. The study has implications for other digital tobacco cessation interventions and highlights important topics that warrant future research, such as the relationship between program engagement (eg, opt out and retention) and successful cessation. %M 35302505 %R 10.2196/32342 %U https://formative.jmir.org/2022/3/e32342 %U https://doi.org/10.2196/32342 %U http://www.ncbi.nlm.nih.gov/pubmed/35302505 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e27588 %T Effectiveness, Cost-effectiveness, and Cost-Utility of a Digital Smoking Cessation Intervention for Cancer Survivors: Health Economic Evaluation and Outcomes of a Pragmatic Randomized Controlled Trial %A Mujcic,Ajla %A Blankers,Matthijs %A Boon,Brigitte %A Verdonck-de Leeuw,Irma M %A Smit,Filip %A van Laar,Margriet %A Engels,Rutger %+ Erasmus School of Social and Behavioural Sciences, Erasmus University, Burgemeester Oudlaan 50, Rotterdam, 3062PA, Netherlands, 31 30 29 59 256, amujcic@trimbos.nl %K smoking cessation %K cancer survivors %K effectiveness %K cost-effectiveness %K eHealth %D 2022 %7 17.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Smoking cessation (SC) interventions may contribute to better treatment outcomes and the general well-being of cancer survivors. Objective: This study aims to evaluate the effectiveness, cost-effectiveness, and cost-utility of a digital interactive SC intervention compared with a noninteractive web-based information brochure for cancer survivors. Methods: A health economic evaluation alongside a pragmatic 2-arm parallel-group randomized controlled trial was conducted with follow-ups at 3, 6, and 12 months. The study was conducted in the Netherlands over the internet from November 2016 to September 2019. The participants were Dutch adult smoking cancer survivors with the intention to quit smoking. In total, 165 participants were included and analyzed: 83 (50.3%) in the MyCourse group and 82 (49.7%) in the control group. In the intervention group, participants had access to a newly developed, digital, minimally guided SC intervention (MyCourse-Quit Smoking). Control group participants received a noninteractive web-based information brochure on SC. Both groups received unrestricted access to usual care. The primary outcome was self-reported 7-day smoking abstinence at the 6-month follow-up. Secondary outcomes were quality-adjusted life years gained, number of cigarettes smoked, nicotine dependence, and treatment satisfaction. For the health economic evaluation, intervention costs, health care costs, and costs stemming from productivity losses were assessed over a 12-month horizon. Results: At the 6-month follow-up, the quit rates were 28% (23/83) and 26% (21/82) in the MyCourse and control groups, respectively (odds ratio 0.47, 95% CI 0.03-7.86; P=.60). In both groups, nicotine dependence scores were reduced at 12 months, and the number of smoked cigarettes was reduced by approximately half. The number of cigarettes decreased more over time, and the MyCourse group demonstrated a significantly greater reduction at the 12-month follow-up (incidence rate ratio 0.87; 95% CI 0.76-1.00; P=.04). Intervention costs were estimated at US $193 per participant for the MyCourse group and US $74 for the control group. The mean per-participant societal costs were US $25,329 (SD US $29,137) and US $21,836 (SD US $25,792), respectively. In the cost-utility analysis, MyCourse was not preferred over the control group from a societal perspective. With smoking behavior as the outcome, the MyCourse group led to marginally better results per reduced pack-year against higher societal costs, with a mean incremental cost-effectiveness ratio of US $52,067 (95% CI US $32,515-US $81,346). Conclusions: At 6 months, there was no evidence of a differential effect on cessation rates; in both groups, approximately a quarter of the cancer survivors quit smoking and their number of cigarettes smoked was reduced by half. At 12 months, the MyCourse intervention led to a greater reduction in the number of smoked cigarettes, albeit at higher costs than for the control group. No evidence was found for a differential effect on quality-adjusted life years. Trial Registration: The Netherlands Trial Register NTR6011; https://www.trialregister.nl/trial/5434 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-018-4206-z %M 35297777 %R 10.2196/27588 %U https://www.jmir.org/2022/3/e27588 %U https://doi.org/10.2196/27588 %U http://www.ncbi.nlm.nih.gov/pubmed/35297777 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e32499 %T Analysis of Demographic Characteristics of Users of a Free Tobacco Cessation Smartphone App: Observational Study %A Fradkin,Nick %A Zbikowski,Susan M %A Christensen,Trevor %+ Office of Healthy and Safe Communities, Division of Prevention and Community Health, Washington State Department of Health, PO Box 47848, Olympia, WA, 98504-7848, United States, 1 602 326 3439, nfradkin@gmail.com %K mobile applications %K mHealth %K eHealth %K smartphone app %K tobacco %K smoking cessation %K public health %K smoking %K application %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Tobacco use continues to be the leading preventable cause of death, disease, and disability in the United States. Since 2000, Washington state has offered free tobacco “quitline” services to help its residents stop using tobacco. In 2015, the state began offering free access to a tobacco cessation smartphone app to absorb excess quitline demand. Since most publicly funded tobacco cessation programs are designed to provide access to populations disproportionately impacted by tobacco use, it is important to consider who these public health interventions reach. Objective: The aim of this study is to understand who used a free cessation app and the extent to which users represented populations disproportionately impacted by tobacco use. Methods: This is an observational study of 1280 adult Washington state residents who registered for and activated the cessation app. Demographic data were collected as part of the sign-up process, examined using standard descriptive measures, and assessed against state-level surveillance data for representativeness. Results: Participants were primarily non-Hispanic White (978/1218, 80.3%), identified as female (780/1236, 63.1%), were between ages 25-54 years (903/1186, 76.1%), had at least some college education (836/1222, 68.4%), and reported a household income under US $50,000 (742/1055, 70.3%). Fewer respondents were from rural counties (359/1220, 29.4%); identified as lesbian, gay, bisexual, pansexual, queer, questioning, or asexual (LGBQA; 153/1222, 12.5%); were uninsured (147/1206, 12.2%); or were currently pregnant, planning pregnancy, or breastfeeding (42/624, 6.7%). However, relative to available state data for tobacco users, there was high representation of women, 35- to 54-year-olds, college graduates, and LGBQA individuals, as well as individuals with low household income, poor mental health, Medicaid insurance, and those residing in rural counties. Conclusions: A diverse population of tobacco users will use a free cessation app, including some demographic groups disproportionately impacted by tobacco use. With high reach and high efficacy, it is possible to address health disparities associated with tobacco use and dependence treatment among certain underserved and at-risk groups. %M 35262491 %R 10.2196/32499 %U https://publichealth.jmir.org/2022/3/e32499 %U https://doi.org/10.2196/32499 %U http://www.ncbi.nlm.nih.gov/pubmed/35262491 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e35234 %T The Behavior Change Techniques Used in Canadian Online Smoking Cessation Programs: Content Analysis %A Struik,Laura %A Rodberg,Danielle %A Sharma,Ramona H %+ School of Nursing, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 2508078000, laura.struik@ubc.ca %K content analysis %K smoking cessation %K internet %K behavior change technique %K mental health %K smoking %K online program %K website %K government %K federal %K provincial %D 2022 %7 1.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Smoking rates in Canada remain unacceptably high, and cessation rates have stalled in recent years. Online cessation programs, touted for their ability to reach many different populations anytime, have shown promise in their efficacy. The Government of Canada has therefore funded provincial and national smoking cessation websites countrywide. However, little is known about the behavior change techniques (BCTs) that underpin the content of these websites, which is key to establishing the quality of the websites, as well as a way forward for evaluation. Objective: The purpose of this study, therefore, is to apply the BCTTv1 taxonomy to Canadian provincial and federal websites, and to determine which BCTs they use. Methods: A total of 12 government-funded websites across Canada were included for analysis. Using deductive content analysis and through training in applying the BCTTv1 taxonomy, the website content was coded according to the 93 BCTs across the 16 BCT categories. Results: Of the 16 BCT categories, 14 were present within the websites. The most widely represented BCT categories (used in all 12 websites) included goals and planning, social support, natural consequences, and regulation. Implementation of BCTs within these categories varied across the sites. Conclusions: Analyzing the content of online smoking cessation websites using the BCTTv1 taxonomy is an appropriate method for identifying the behavior change content of these programs. The findings offer programmers and researchers tangible directions for prioritizing and enhancing provincial and national smoking cessation programs, and an evaluation framework to assess smoking cessation outcomes in relation to the web-based content. %M 35230253 %R 10.2196/35234 %U https://mental.jmir.org/2022/3/e35234 %U https://doi.org/10.2196/35234 %U http://www.ncbi.nlm.nih.gov/pubmed/35230253 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e19877 %T Use of a Smartphone Self-assessment App for a Tobacco-Induced Disease (COPD, Cardiovascular Diseases, Cancer) Screening Strategy and to Encourage Smoking Cessation: Observational Study %A Stavaux,Edouard %A Goupil,François %A Barreau,Guillaume %A Septans,Anne Lise %A Dautzenberg,Bertrand %A Foulet-Rogé,Armelle %A Padilla,Norbert %A Urban,Thierry %A Denis,Fabrice %+ Institut Inter-Regional de Cancérologie Jean Bernard, 9 rue Beauverger, Le Mans, 72000, France, 33 684190480, f.denis@ilcgroupe.fr %K smoking cessation %K mobile health %K self-assessment, lung cancer %K early detection %K tobacco-induced pathologies %D 2022 %7 23.2.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Patient self-assessment via a mobile app detects actionable symptoms and has been shown to detect lung cancer relapses early, thereby lengthening survival. Objective: The purpose of this study was to assess the incidence of chief symptoms associated with the main tobacco-induced pathologies in both current and ex-smokers through a self-assessment smartphone app and to evaluate the app’s capacity to encourage users to quit smoking or reduce consumption, as well as its impact on early lung cancer stages at the time of diagnosis. Methods: Current and ex-smokers were recruited through an advertising campaign in Sarthe county (France) proposing the free download of a smartphone app. App users were asked to answer 13 questions related to symptoms associated with tobacco-induced diseases (chronic obstructive pulmonary disease [COPD], cardiovascular diseases, cancer). In the event of any positive answer, a message was displayed recommending the user to consult a physician. In addition, they were asked about smoking cessation intention before and after answering these 13 questions. Finally, incidence of stage 1 or 2 lung cancers diagnosed during the launch period of our application was evaluated by comparing data from various sources to those from the same period during the previous year. Results: Of the 5671 users who were eligible for evaluation, an alert was sent to the majority (4118/5671, 72.6%), with a higher incidence for current smokers (2833/3679, 77.0% vs 1298/1992, 65.2%; P<.001). The most frequent symptoms triggering the notifications were fatigue (2023/5671, 35.7%), cough (1658/5671, 29.2%), dyspnea (1502/5671, 26.5%), and persistent chest pain (1286/5671, 22.7%). Of the current smokers, 14.0% (515/3679) showed symptoms suggesting COPD, 15.5% (571/3679) showed symptoms suggesting stable angina, 12.4% (455/3679) probably had lower extremity artery disease, and 6.8% (249/3679) had possible cancer. Of the users, 36.5% (1343/3679) claimed that they thought about quitting smoking, and 48.7% (1795/3679) had thought about reducing their consumption. Surgery-eligible stage 1 and 2 lung cancer incidence was 24% (14/58) during the study period versus 9% (5/54) during the previous year in Sarthe county (P=.04), whereas it remained unchanged in the neighboring county of Maine-et-Loire. Conclusions: A majority of current and ex-smokers showed worrying symptoms, and the use of a self-assessment smartphone app may drive a majority of smokers toward the intention of smoking cessation or decreasing consumption. A randomized study should be performed to confirm this intention and to support the potential increase of symptomatic lung cancer detection at early, surgery-accessible stages. Trial Registration: ClinicalTrials.gov NCT04048954; https://www.clinicaltrials.gov/ct2/show/NCT04048954 %M 35195530 %R 10.2196/19877 %U https://publichealth.jmir.org/2022/2/e19877 %U https://doi.org/10.2196/19877 %U http://www.ncbi.nlm.nih.gov/pubmed/35195530 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e28159 %T Characterizing and Modeling Smoking Behavior Using Automatic Smoking Event Detection and Mobile Surveys in Naturalistic Environments: Observational Study %A Zhai,DongHui %A van Stiphout,Ruud %A Schiavone,Giuseppina %A De Raedt,Walter %A Van Hoof,Chris %+ imec at OnePlanet Research Center, Bronland 10, Wageningen, 6708WH, Netherlands, 31 317 745 801, ruud.vanstiphout@imec.nl %K smoking behavior modeling %K ambulatory study %K wearable sensors %K temporal patterns of smoking %K Poisson mixed-effects model %K mobile phone %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There are 1.1 billion smokers worldwide, and each year, more than 8 million die prematurely because of cigarette smoking. More than half of current smokers make a serious quit every year. Nonetheless, 90% of unaided quitters relapse within the first 4 weeks of quitting due to the lack of limited access to cost-effective and efficient smoking cessation tools in their daily lives. Objective: This study aims to enable quantified monitoring of ambulatory smoking behavior 24/7 in real life by using continuous and automatic measurement techniques and identifying and characterizing smoking patterns using longitudinal contextual signals. This work also intends to provide guidance and insights into the design and deployment of technology-enabled smoking cessation applications in naturalistic environments. Methods: A 4-week observational study consisting of 46 smokers was conducted in both working and personal life environments. An electric lighter and a smartphone with an experimental app were used to track smoking events and acquire concurrent contextual signals. In addition, the app was used to prompt smoking-contingent ecological momentary assessment (EMA) surveys. The smoking rate was assessed based on the timestamps of smoking and linked statistically to demographics, time, and EMA surveys. A Poisson mixed-effects model to predict smoking rate in 1-hour windows was developed to assess the contribution of each predictor. Results: In total, 8639 cigarettes and 1839 EMA surveys were tracked over 902 participant days. Most smokers were found to have an inaccurate and often biased estimate of their daily smoking rate compared with the measured smoking rate. Specifically, 74% (34/46) of the smokers made more than one (mean 4.7, SD 4.2 cigarettes per day) wrong estimate, and 70% (32/46) of the smokers overestimated it. On the basis of the timestamp of the tracked smoking events, smoking rates were visualized at different hours and were found to gradually increase and peak at 6 PM in the day. In addition, a 1- to 2-hour shift in smoking patterns was observed between weekdays and weekends. When moderate and heavy smokers were compared with light smokers, their ages (P<.05), Fagerström Test of Nicotine Dependence (P=.01), craving level (P<.001), enjoyment of cigarettes (P<.001), difficulty resisting smoking (P<.001), emotional valence (P<.001), and arousal (P<.001) were all found to be significantly different. In the Poisson mixed-effects model, the number of cigarettes smoked in a 1-hour time window was highly dependent on the smoking status of an individual (P<.001) and was explained by hour (P=.02) and age (P=.005). Conclusions: This study reported the high potential and challenges of using an electronic lighter for smoking annotation and smoking-triggered EMAs in an ambulant environment. These results also validate the techniques for smoking behavior monitoring and pave the way for the design and deployment of technology-enabled smoking cessation applications. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028284 %M 35179512 %R 10.2196/28159 %U https://mhealth.jmir.org/2022/2/e28159 %U https://doi.org/10.2196/28159 %U http://www.ncbi.nlm.nih.gov/pubmed/35179512 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 2 %P e17268 %T Classification of Smoking Cessation Apps: Quality Review and Content Analysis %A Seo,Suin %A Cho,Sung-Il %A Yoon,Wonjeong %A Lee,Cheol Min %+ Department of Epidemiology, Graduate School of Public Health, Seoul National University, 1, Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 2 880 2717, persontime@hotmail.com %K smoking cessation %K app %K type %K content and functions %K MARS %K quality %K score %K mobile phone %D 2022 %7 17.2.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many people use apps for smoking cessation, and the effectiveness of these apps has been proven in several studies. However, no study has classified these apps and only few studies have analyzed the characteristics of these apps that influence their quality. Objective: The purpose of this study was to analyze the content and the quality of smoking cessation apps by type and identify the characteristics that affect their overall quality. Methods: Two app marketplaces (App Store and Google Play) were searched in January 2018, and the search was completed by May 2020. The search terms used were “stop smoking,” “quit smoking,” and “smoking cessation.” The apps were categorized into 3 types (combined, multifunctional, and informational). The tailored guideline of Clinical Practice Guideline for Treating Tobacco Use and Dependence was utilized for evaluating app content (or functions), and the Mobile App Rating Scale (MARS) was used to evaluate the quality. Chi-square test was performed for the general characteristics, and one-way analysis of variance was performed for MARS analysis. To identify the general features of the apps that could be associated with the MARS and content scores, multiple regression analysis was done. All analyses were performed using SAS software (ver. 9.3). Results: Among 1543 apps, 104 apps met the selection criteria of this study. These 104 apps were categorized as combined type (n=44), functional type (n=31), or informational type (n=29). A large amount of content specified in the guideline was included in the apps, most notably in the combined type, followed by the multifunctional and informational type; the MARS scores followed the same order (3.64, 3.26, and 3.0, respectively). Regression analysis showed that the sector in which the developer was situated and the feedback channel with the developer had a significant impact on both the content and MARS scores. In addition, problematic apps such as those made by unknown developers or copied and single-function apps were shown to have a large market share. Conclusions: This study is the first to evaluate the content and quality of smoking cessation apps by classification. The combined type had higher-quality content and functionality than other app types. The app developer type and feedback channel with the app developer had a significant impact on the overall quality of the apps. In addition, problematic apps and single-function apps were shown to have a large market share. Our results will contribute to the use and development of better smoking cessation apps after considering the problems identified in this study. %M 35175213 %R 10.2196/17268 %U https://mhealth.jmir.org/2022/2/e17268 %U https://doi.org/10.2196/17268 %U http://www.ncbi.nlm.nih.gov/pubmed/35175213 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e28704 %T Lessons Learned From Beta-Testing a Facebook Group Prototype to Promote Treatment Use in the “Connecting Alaska Native People to Quit Smoking” (CAN Quit) Study %A Sinicrope,Pamela S %A Young,Colleen D %A Resnicow,Ken %A Merritt,Zoe T %A McConnell,Clara R %A Hughes,Christine A %A Koller,Kathryn R %A Bock,Martha J %A Decker,Paul A %A Flanagan,Christie A %A Meade,Crystal D %A Thomas,Timothy K %A Prochaska,Judith J %A Patten,Christi A %+ Behavioral Health Research Program, Department of Psychiatry and Psychology, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, United States, 1 507 284 2511, Sinicrope.Pamela@mayo.edu %K Web 2.0 %K social media %K Facebook %K Alaska Native %K American Indian %K Alaska %K smoking %K cessation %K cancer prevention %K Quitline %K mobile phone %D 2022 %7 17.2.2022 %9 Viewpoint %J J Med Internet Res %G English %X Social media provides an effective tool to reach, engage, and connect smokers in cessation efforts. Our team developed a Facebook group, CAN Quit (Connecting Alaska Native People to Quit smoking), to promote use of evidence-based smoking cessation resources for Alaska Native people living in Alaska, which are underused despite their effectiveness. Often separated by geography and climate, Alaska Native people prefer group-based approaches for tobacco cessation that support their culture and values. Such preferences make Alaska Native people candidates for social media–based interventions that promote connection. This viewpoint discusses the steps involved and lessons learned in building and beta-testing our Facebook group prototype, which will then be evaluated in a pilot randomized controlled trial. We describe the process of training moderators to facilitate group engagement and foster community, and we describe how we developed and tested our intervention prototype and Facebook group. All parts of the prototype were designed to facilitate use of evidence-based cessation treatments. We include recommendations for best practices with the hope that lessons learned from the CAN Quit prototype could provide a model for others to create similar platforms that benefit Alaska Native and American Indian people in the context of smoking cessation. %M 35175208 %R 10.2196/28704 %U https://www.jmir.org/2022/2/e28704 %U https://doi.org/10.2196/28704 %U http://www.ncbi.nlm.nih.gov/pubmed/35175208 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e32243 %T Using Virtual Reality to Induce and Assess Objective Correlates of Nicotine Craving: Paradigm Development Study %A Liu,Weichen %A Andrade,Gianna %A Schulze,Jurgen %A Doran,Neal %A Courtney,Kelly E %+ Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States, 1 858 534 5157, kecourtney@health.ucsd.edu %K nicotine %K craving %K cue-exposure %K virtual reality %K attentional bias %K pupillometry %K development %K smoking %K addiction %K eye-tracking %D 2022 %7 15.2.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Craving is a clinically important phenotype for the development and maintenance of nicotine addiction. Virtual reality (VR) paradigms are successful in eliciting cue-induced subjective craving and may even elicit stronger craving than traditional picture-cue methods. However, few studies have leveraged the advances of this technology to improve the assessment of craving. Objective: This report details the development of a novel, translatable VR paradigm designed to both elicit nicotine craving and assess multiple eye-related characteristics as potential objective correlates of craving. Methods: A VR paradigm was developed, which includes three Active scenes with nicotine and tobacco product (NTP) cues present, and three Neutral scenes devoid of NTP cues. A pilot sample (N=31) of NTP users underwent the paradigm and completed subjective measures of nicotine craving, sense of presence in the VR paradigm, and VR-related sickness. Eye-gaze fixation time (“attentional bias”) and pupil diameter toward Active versus Neutral cues, as well as spontaneous blink rate during the Active and Neutral scenes, were recorded. Results: The NTP Cue VR paradigm was found to elicit a moderate sense of presence (mean Igroup Presence Questionnaire score 60.05, SD 9.66) and low VR-related sickness (mean Virtual Reality Sickness Questionnaire score 16.25, SD 13.94). Scene-specific effects on attentional bias and pupil diameter were observed, with two of the three Active scenes eliciting greater NTP versus control cue attentional bias and pupil diameter (Cohen d=0.30-0.92). The spontaneous blink rate metrics did not differ across Active and Neutral scenes. Conclusions: This report outlines the development of the NTP Cue VR paradigm. Our results support the potential of this paradigm as an effective laboratory-based cue-exposure task and provide early evidence of the utility of attentional bias and pupillometry, as measured during VR, as useful markers for nicotine addiction. %M 35166685 %R 10.2196/32243 %U https://games.jmir.org/2022/1/e32243 %U https://doi.org/10.2196/32243 %U http://www.ncbi.nlm.nih.gov/pubmed/35166685 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e25216 %T Public Reactions to the New York State Policy on Flavored Electronic Cigarettes on Twitter: Observational Study %A Sun,Li %A Lu,Xinyi %A Xie,Zidian %A Li,Dongmei %+ Department of Clinical & Translational Research, University of Rochester Medical Center, Saunders Research Building 1.303J, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K New York State policy %K flavored e-cigarettes %K Twitter %K social media %K vaping %K e-cigarette %D 2022 %7 3.2.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Flavored electronic cigarettes (e-cigarettes) have become popular in recent years, especially among youth and young adults. To address the epidemic of e-cigarettes, New York State approved a ban on sales of most flavored vaping products other than tobacco and menthol flavors on September 17, 2019. Objective: This study aims to examine the attitude of Twitter users to the policy on flavored e-cigarettes in New York State and the impact of this policy on public perceptions of e-cigarettes. This study also compares the attitudes and topics between New York Twitter users and Twitter users from other states who were not directly affected by this policy. Methods: Tweets related to e-cigarettes and the New York State policy on flavored e-cigarettes were collected using the Twitter streaming application programming interface from June 2019 to December 2019. Tweets from New York State and those from other states that did not have a flavored e-cigarette policy were extracted. Sentiment analysis was applied to analyze the proportion of negative and positive tweets about e-cigarettes or the flavor policy. Topic modeling was applied to e-cigarette–related data sets and New York flavor policy–related data sets to identify the most frequent topics before and after the announcement of the New York State policy. Results: We found that the average number of tweets related to e-cigarettes and the New York State policy on flavored e-cigarettes increased in both New York State and other states after the flavor policy announcement. Sentiment analysis revealed that after the announcement of the New York State flavor policy, in both New York State and other states, the proportion of negative tweets on e-cigarettes increased from 34.07% (4531/13,299) to 44.58% (18,451/41,390) and from 32.48% (14,320/44,090) to 44.40% (64,262/144,734), respectively, while positive tweets decreased significantly from 39.03% (5191/13,299) to 32.86% (13,601/41,390) and from 42.78% (18,863/44,090) to 33.93% (49,105/144,734), respectively. The majority of tweets related to the New York State flavor policy were negative both before and after the announcement of this policy in both New York (87/98, 89% and 3810/4565, 83.46%, respectively) and other states (200/255, 78.4% and 12,695/15,569, 81.54%, respectively), while New York State had a higher proportion of negative tweets than other states. Topic modeling results demonstrated that teenage vaping and health problems were the most discussed topics associated with e-cigarettes. Conclusions: Public attitudes toward e-cigarettes became more negative on Twitter after New York State announced the policy on flavored e-cigarettes. Twitter users in other states that did not have such a policy on flavored e-cigarettes paid close attention to the New York State flavor policy. This study provides some valuable information about the potential impact of the flavored e-cigarettes policy in New York State on public attitudes toward flavored e-cigarettes. %M 35113035 %R 10.2196/25216 %U https://publichealth.jmir.org/2022/2/e25216 %U https://doi.org/10.2196/25216 %U http://www.ncbi.nlm.nih.gov/pubmed/35113035 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e30679 %T An Exploration of e-Cigarette–Related Search Items on YouTube: Network Analysis %A Dashtian,Hassan %A Murthy,Dhiraj %A Kong,Grace %+ The Computational Media Lab and School of Journalism and Media, The University of Texas at Austin, 300 W. Dean Keeton (A0900), Austin, TX, 78712-1069, United States, 1 512 471 5775, Dhiraj.Murthy@austin.utexas.edu %K electronic nicotine delivery systems %K vaping %K social media %K search engine %K natural language processing %K social network analysis %D 2022 %7 27.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: e-Cigarette use among youth is high, which may be due in part to pro–e-cigarette content on social media such as YouTube. YouTube is also a valuable resource for learning about e-cigarette use, trends, marketing, and e-cigarette user perceptions. However, there is a lack of understanding on how similar e-cigarette–related search items result in similar or relatively mutually exclusive search results. This study uses novel methods to evaluate the relationship between e-cigarette–related search items and results. Objective: The aim of this study is to apply network modeling and rule-based classification to characterize the relationships between e-cigarette–related search items on YouTube and gauge the level of importance of each search item as part of an e-cigarette information network on YouTube. Methods: We used 16 fictitious YouTube profiles to retrieve 4201 distinct videos from 18 keywords related to e-cigarettes. We used network modeling to represent the relationships between the search items. Moreover, we developed a rule-based classification approach to classify videos. We used betweenness centrality (BC) and correlations between nodes (ie, search items) to help us gain knowledge of the underlying structure of the information network. Results: By modeling search items and videos as a network, we observed that broad search items such as e-cig had the most connections to other search items, and specific search items such as cigalike had the least connections. Search items with similar words (eg, vape and vaping) and search items with similar meaning (eg, e-liquid and e-juice) yielded a high degree of connectedness. We also found that each node had 18 (SD 34.8) connections (common videos) on average. BC indicated that general search items such as electronic cigarette and vaping had high importance in the network (BC=0.00836). Our rule-based classification sorted videos into four categories: e-cigarette devices (34%-57%), cannabis vaping (16%-28%), e-liquid (14%-37%), and other (8%-22%). Conclusions: Our findings indicate that search items on YouTube have unique relationships that vary in strength and importance. Our methods can not only be used to successfully identify the important, overlapping, and unique e-cigarette–related search items but also help determine which search items are more likely to act as a gateway to e-cigarette–related content. %M 35084353 %R 10.2196/30679 %U https://www.jmir.org/2022/1/e30679 %U https://doi.org/10.2196/30679 %U http://www.ncbi.nlm.nih.gov/pubmed/35084353 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e29718 %T Health-Related Quality of Life Among Pregnant Women With Pre-pregnancy Smoking and Smoking Cessation During Pregnancy in China: National Cross-sectional Study %A Hu,Kadi %A Zou,Shiqian %A Zhang,Casper JP %A Wu,Huailiang %A Akinwunmi,Babatunde %A Wang,Zilian %A Ming,Wai-Kit %+ Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, To Yuen Building, 31 To Yuen Street, Hong Kong, China, 852 34426956, wkming2@cityu.edu.hk %K health-related quality of life %K pregnant women %K smoking status %K pre-pregnancy smoking %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Previous studies have hardly explored the influence of pre-pregnancy smoking and smoking cessation during pregnancy on the health-related quality of life (HRQoL) of pregnant women, which is a topic that need to be addressed. In addition, pregnant women in China constitute a big population in the largest developing country of the world and cannot be neglected. Objective: This study aims to evaluate the HRQoL of pregnant women in China with different smoking statuses and further estimate the association between pre-pregnancy smoking, smoking cessation, and the HRQoL. Methods: A nationwide cross-sectional study was conducted to determine the association between different smoking statuses (smoking currently, quit smoking, never smoking) and the HRQoL in pregnant women across mainland China. A web-based questionnaire was delivered through the Banmi Online Maternity School platform, including questions about demographics, smoking status, and the HRQoL. EuroQoL Group’s 5-dimension 5-level (EQ-5D-5L) scale with EuroQoL Group’s visual analog scale (EQ-VAS) was used for measuring the HRQoL. Ethical approval was granted by the institutional review board of the First Affiliated Hospital of Sun Yat-sen University (ICE-2017-296). Results: From August to September 2019, a total of 16,483 participants from 31 provinces were included, of which 93 (0.56%) were smokers, 731 (4.43%) were ex-smokers, and 15,659 (95%) were nonsmokers. Nonsmokers had the highest EQ-VAS score (mean 84.49, SD 14.84), smokers had the lowest EQ-VAS score (mean 77.38, SD 21.99), and the EQ-VAS score for ex-smokers was in between (mean 81.04, SD 17.68). A significant difference in EQ-VAS scores was detected between nonsmokers and ex-smokers (P<.001), which indicated that pre-pregnancy smoking does have a negative impact on the HRQoL (EQ-VAS) of pregnant women. Compared with nonsmokers, ex-smokers suffered from more anxiety/depression problems (P=.001, odds ratio [OR] 1.29, 95% CI 1.12-1.50). Among ex-smokers, the increased cigarette consumption was associated with a lower EQ-5D index (P=.007) and EQ-VAS score (P=.01) of pregnant women. Compared to smokers, no significant difference was found in the ex-smokers’ EQ-5D index and EQ-VAS score (P=.33). Conclusions: Smoking history is associated with a lower HRQoL in pregnant Chinese women. Pre-pregnancy smoking is related to a lower HRQoL (EQ-VAS) and a higher incidence of depression/anxiety problems. Smoking cessation during pregnancy does not significantly improve the HRQoL of pregnant Chinese women. Among ex-smokers, the more cigarettes they smoke, the lower HRQoL they have during pregnancy. We suggest that the Chinese government should strengthen the education on quitting smoking and avoiding second-hand smoke for women who have pregnancy plans and their family members. %M 35072649 %R 10.2196/29718 %U https://publichealth.jmir.org/2022/1/e29718 %U https://doi.org/10.2196/29718 %U http://www.ncbi.nlm.nih.gov/pubmed/35072649 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e30257 %T Identifying Electronic Nicotine Delivery System Brands and Flavors on Instagram: Natural Language Processing Analysis %A Chew,Rob %A Wenger,Michael %A Guillory,Jamie %A Nonnemaker,James %A Kim,Annice %+ Center for Data Science, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, United States, 1 919 541 5823, rchew@rti.org %K named entity recognition %K ENDS %K social media %K brands %K flavors %D 2022 %7 18.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic nicotine delivery system (ENDS) brands, such as JUUL, used social media as a key component of their marketing strategy, which led to massive sales growth from 2015 to 2018. During this time, ENDS use rapidly increased among youths and young adults, with flavored products being particularly popular among these groups. Objective: The aim of our study is to develop a named entity recognition (NER) model to identify potential emerging vaping brands and flavors from Instagram post text. NER is a natural language processing task for identifying specific types of words (entities) in text based on the characteristics of the entity and surrounding words. Methods: NER models were trained on a labeled data set of 2272 Instagram posts coded for ENDS brands and flavors. We compared three types of NER models—conditional random fields, a residual convolutional neural network, and a fine-tuned distilled bidirectional encoder representations from transformers (FTDB) network—to identify brands and flavors in Instagram posts with key model outcomes of precision, recall, and F1 scores. We used data from Nielsen scanner sales and Wikipedia to create benchmark dictionaries to determine whether brands from established ENDS brand and flavor lists were mentioned in the Instagram posts in our sample. To prevent overfitting, we performed 5-fold cross-validation and reported the mean and SD of the model validation metrics across the folds. Results: For brands, the residual convolutional neural network exhibited the highest mean precision (0.797, SD 0.084), and the FTDB exhibited the highest mean recall (0.869, SD 0.103). For flavors, the FTDB exhibited both the highest mean precision (0.860, SD 0.055) and recall (0.801, SD 0.091). All NER models outperformed the benchmark brand and flavor dictionary look-ups on mean precision, recall, and F1. Comparing between the benchmark brand lists, the larger Wikipedia list outperformed the Nielsen list in both precision and recall. Conclusions: Our findings suggest that NER models correctly identified ENDS brands and flavors in Instagram posts at rates competitive with, or better than, others in the published literature. Brands identified during manual annotation showed little overlap with those in Nielsen scanner data, suggesting that NER models may capture emerging brands with limited sales and distribution. NER models address the challenges of manual brand identification and can be used to support future infodemiology and infoveillance studies. Brands identified on social media should be cross-validated with Nielsen and other data sources to differentiate emerging brands that have become established from those with limited sales and distribution. %M 35040793 %R 10.2196/30257 %U https://www.jmir.org/2022/1/e30257 %U https://doi.org/10.2196/30257 %U http://www.ncbi.nlm.nih.gov/pubmed/35040793 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e34429 %T Assessment of Social Support and Quitting Smoking in an Online Community Forum: Study Involving Content Analysis %A Struik,Laura %A Khan,Shaheer %A Assoiants,Artem %A Sharma,Ramona H %+ School of Nursing, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 2508079972, laura.struik@ubc.ca %K qualitative research %K smoking cessation %K social media %K social support %K smoking %K tobacco use %K tobacco %K online forum %D 2022 %7 13.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: A key factor in successfully reducing and quitting smoking, as well as preventing smoking relapse is access to and engagement with social support. Recent technological advances have made it possible for smokers to access social support via online community forums. While community forums associated with smoking cessation interventions are now common practice, there is a gap in understanding how and when the different types of social support identified by Cutrona and Suhr (1992) (emotional, esteem, informational, tangible, and network) are exchanged on such forums. Community forums that entail “superusers” (a key marker of a successful forum), like QuitNow, are ripe for exploring and leveraging promising social support exchanges on these platforms. Objective: The purpose of this study was to characterize the posts made on the QuitNow community forum at different stages in the quit journey, and determine when and how the social support constructs are present within the posts. Methods: A total of 506 posts (including original and response posts) were collected. Using conventional content analysis, the original posts were coded inductively to generate categories and subcategories, and the responses were coded deductively according to the 5 types of social support. Data were analyzed using Microsoft Excel software. Results: Overall, individuals were most heavily engaged on the forum during the first month of quitting, which then tapered off in the subsequent months. In relation to the original posts, the majority of them fit into the categories of sharing quit successes, quit struggles, updates, quit strategies, and desires to quit. Asking for advice and describing smoke-free benefits were the least represented categories. In relation to the responses, encouragement (emotional), compliment (esteem), and suggestion/advice (informational) consistently remained the most prominent types of support throughout all quit stages. Companionship (network) maintained a steady downward trajectory over time. Conclusions: The findings of this study highlight the complexity of how and when different types of social support are exchanged on the QuitNow community forum. These findings provide directions for how social support can be more strategically employed and leveraged in these online contexts to support smoking cessation. %M 35023834 %R 10.2196/34429 %U https://formative.jmir.org/2022/1/e34429 %U https://doi.org/10.2196/34429 %U http://www.ncbi.nlm.nih.gov/pubmed/35023834 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e34530 %T A Web-Based Alcohol and Other Drug Prevention Program (Strong & Deadly Futures) for Aboriginal and Torres Strait Islander School Students: Protocol for a Cluster Randomized Controlled Trial %A Stapinski,Lexine %A Routledge,Kylie %A Snijder,Mieke %A Doyle,Michael %A Champion,Katrina %A Chapman,Cath %A Ward,James %A Baumgart,Amanda %A Lee,K S Kylie %A Teesson,Maree %A Newton,Nicola %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Lvl 6, Jane Foss Russell Building G02, Darlington, 2006, Australia, 61 286279039, lexine.stapinski@sydney.edu.au %K Aboriginal and Torres Strait Islander %K prevention %K alcohol %K tobacco %K substance use %K universal prevention %K well-being %K harm minimization %K Indigenous %K web-based %D 2022 %7 7.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: There are no available school-based alcohol and drug prevention programs with evidence of effectiveness among Aboriginal and Torres Strait Islander youth. To address this, we codeveloped the Strong & Deadly Futures well-being and alcohol and drug prevention program in partnership with an Indigenous creative design agency and 4 Australian schools. Objective: This paper presents the protocol to evaluate the effectiveness of Strong & Deadly Futures in reducing alcohol and other drug use and improving well-being among Aboriginal and Torres Strait Islander youth. Methods: The target sample will be 960 year 7 and 8 students from 24 secondary schools in Australia, of which approximately 40% (384/960) will identify as Aboriginal or Torres Strait Islander. The study design is a 2-group, parallel cluster randomized controlled trial with allocation concealment. Recruited schools will be block randomized (ratio 1:1), stratified by geographical remoteness, by an independent statistician. Schools will be randomized to receive Strong & Deadly Futures, a web-based alcohol and drug prevention and social and emotional well-being program that delivers curriculum-aligned content over 6 lessons via an illustrated story, or health education as usual (control). Control schools will be supported to implement Strong & Deadly Futures following trial completion. Surveys will be administered at baseline, 6 weeks, 12 months, and 24 months (primary end point) post baseline. Primary outcomes are alcohol use (adapted from the National Drug Strategy Household Survey), tobacco use (Standard High School Youth Risk Behavior Survey), and psychological distress (Kessler-5 Psychological Distress Scale). Secondary outcomes are alcohol and drug knowledge and intentions, alcohol-related harms, binge drinking, cannabis use, well-being, empowerment, appreciation of cultural diversity, and truancy. Results: The trial was funded by the National Health and Medical Research Council in January 2019, approved by the Human Research Ethics Committee of the University of Sydney (2020/039, April 2020), the Aboriginal Health and Medical Research Council of New South Wales (1620/19, February 2020), the Western Australian Aboriginal Health Ethics Committee (998, October 2021), and the ethics committees of each participating school, including the New South Wales Department of Education (2020170, June 2020), Catholic Education Western Australia (RP2020/39, November 2020), and the Queensland Department of Education (550/27/2390, August 2021). Projected dates of data collection are 2022-2024, and we expect to publish the results in 2025. A total of 24 schools have been recruited as of submission of the manuscript. Conclusions: This will be the first cluster randomized controlled trial of a culturally inclusive, school-based alcohol and drug prevention program for Aboriginal and Torres Strait Islander youth; therefore, it has significant potential to address alcohol and other drug harms among Aboriginal and Torres Strait Islander youth. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001038987; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380038&isReview=true International Registered Report Identifier (IRRID): PRR1-10.2196/34530 %M 34994696 %R 10.2196/34530 %U https://www.researchprotocols.org/2022/1/e34530 %U https://doi.org/10.2196/34530 %U http://www.ncbi.nlm.nih.gov/pubmed/34994696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e22582 %T A Smartphone App for Attentional Bias Retraining in Smokers: Mixed Methods Pilot Study %A Choo,Carol C %A Tan,Yi Zhuang %A Zhang,Melvyn W B %+ Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Level 18 Family Medicine and Primary Care, Singapore, 308322, Singapore, 65 63892000, melvynzhangweibin@gmail.com %K attentional bias retraining %K smartphone app %K mixed methods %K smoking %K mobile phone %D 2022 %7 3.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is a global health threat. Attentional bias influences smoking behaviors. Although attentional bias retraining has shown benefits and recent advances in technology suggest that attentional bias retraining can be delivered via smartphone apps, there is a paucity of research on this topic. Objective: This study aims to address this gap by exploring the use of attentional bias retraining via a novel smartphone app using a mixed methods pilot study. In the quantitative phase, it is hypothesized that participants in the training group who undertake attentional bias retraining via the app should have decreased levels of attentional bias, subjective craving, and smoking frequency, compared with those in the control group who do not undertake attentional bias retraining. The qualitative phase explores how the participants perceive and experience the novel app. Methods: In all, 10 adult smokers (3 females and 7 males) between the ages of 26 and 56 years (mean 34.4 years, SD 9.97 years) were recruited. The participants were randomly allocated to the training and control groups. In weeks 1 and 3, participants from both groups attempted the standard visual probe task and rated their smoking frequency and subjective craving. In week 2, the participants in the training group attempted the modified visual probe task. After week 3, participants from both groups were interviewed about their views and experiences of the novel app. Results: The results of the quantitative analysis did not support this study’s hypothesis. The qualitative data were analyzed using thematic analysis. The results yielded 5 themes: ease, helpfulness, unhelpful aspects, barriers, and refinement. Conclusions: Findings from the qualitative study were consistent with those from previous studies on health-related smartphone apps. The qualitative results were helpful in understanding the user perspectives and experiences of the novel app, indicating that future research in this innovative area is necessary. %M 34982037 %R 10.2196/22582 %U https://formative.jmir.org/2022/1/e22582 %U https://doi.org/10.2196/22582 %U http://www.ncbi.nlm.nih.gov/pubmed/34982037 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e34502 %T Evaluation of the Efficacy of a Smoking Cessation Intervention for Cervical Cancer Survivors and Women With High-Grade Cervical Dysplasia: Protocol for a Randomized Controlled Trial %A Jones,Sarah R %A Vidrine,Damon J %A Wetter,David W %A Shih,Ya-Chen Tina %A Sutton,Steven K %A Ramondetta,Lois M %A Elting,Linda S %A Walker,Joan L %A Smith,Katie M %A Frank-Pearce,Summer G %A Li,Yisheng %A Simmons,Vani N %A Vidrine,Jennifer I %+ Tobacco Research & Intervention Program, Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4115 E Fowler Avenue, Tampa, FL, 33617, United States, 1 813 745 8764, jennifer.vidrine@moffitt.org %K smoking cessation %K cervical cancer %K cancer survivor %K motivation %K tobacco treatment %K cancer %K smoking %K RCT %K randomized controlled trial %K cognitive behavior %K intervention %D 2021 %7 30.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence of smoking among cervical cancer survivors is strikingly high, yet no smoking cessation interventions to date have specifically targeted this population. This paper describes the study design, methods, and data analysis plans for a randomized clinical trial designed to evaluate the efficacy of a theoretically and empirically based Motivation And Problem Solving (MAPS) approach for promoting and facilitating smoking cessation among cervical cancer survivors. MAPS is a comprehensive, dynamic, and holistic intervention that incorporates empirically supported cognitive behavioral and social cognitive theory–based treatment strategies within an overarching motivational framework. MAPS is designed to be appropriate for all smokers regardless of their motivation to change and views motivation as dynamically fluctuating from moment to moment throughout the behavior change process. Objective: This 2-group randomized controlled trial compares the efficacy of standard treatment to MAPS in facilitating smoking cessation among women with a history of high-grade cervical dysplasia or cervical cancer. Methods: Participants (N=202) are current smokers with a history of high-grade cervical dysplasia or cervical cancer recruited nationally and randomly assigned to one of two treatment conditions: (1) standard treatment (ST) or (2) MAPS. ST consists of repeated letters referring participants to their state’s tobacco cessation quitline, standard self-help materials, and free nicotine replacement therapy when ready to quit. MAPS has all ST components along with 6 proactive telephone counseling sessions delivered over 12 months. The primary outcome is abstinence from tobacco at 18 months. Secondary outcomes include abstinence over time across all assessment points, abstinence at other individual assessment time points, quit attempts, cigarettes per day, and use of state quitlines. Hypothesized treatment mechanisms and cost-effectiveness will also be evaluated. Results: This study was approved by the institutional review boards at the University of Texas MD Anderson Cancer Center, the University of Oklahoma Health Sciences Center, and Moffitt Cancer Center. Participant enrollment concluded at Moffitt Cancer Center in January 2020, and follow-up data collection was completed in July 2021. Data analysis is ongoing. Conclusions: This study will yield crucial information regarding the efficacy and cost-effectiveness of a MAPS approach for smoking cessation tailored to the specific needs of women with a history of high-grade cervical dysplasia or cervical cancer. Findings indicating that MAPS has substantially greater efficacy than existing evidence-based tobacco cessation treatments would have tremendous public health significance. Trial Registration: ClinicalTrials.gov NCT02157610; https://clinicaltrials.gov/ct2/show/NCT02157610 International Registered Report Identifier (IRRID): DERR1-10.2196/34502 %M 34967755 %R 10.2196/34502 %U https://www.researchprotocols.org/2021/12/e34502 %U https://doi.org/10.2196/34502 %U http://www.ncbi.nlm.nih.gov/pubmed/34967755 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e28042 %T Examining Twitter Discourse on Electronic Cigarette and Tobacco Consumption During National Cancer Prevention Month in 2018: Topic Modeling and Geospatial Analysis %A Lu,Jiahui %A Lee,Edmund W J %+ School of New Media and Communication, Tianjin University, No 92 Weijin Road, Tianjin, 300072, China, 86 18222418810, lujiahui@tju.edu.cn %K electronic cigarette %K smoking %K lung cancer %K Twitter %K national cancer prevention month %K policy %K topic modeling %K cessation %K e-cigarette %K cancer %K social media %K eHealth %K cancer prevention %K tweets %K public health %D 2021 %7 29.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Examining public perception of tobacco products is critical for effective tobacco policy making and public education outreach. While the link between traditional tobacco products and lung cancer is well established, it is not known how the public perceives the association between electronic cigarettes (e-cigarettes) and lung cancer. In addition, it is unclear how members of the public interact with official messages during cancer campaigns on tobacco consumption and lung cancer. Objective: In this study, we aimed to analyze e-cigarette and smoking tweets in the context of lung cancer during National Cancer Prevention Month in 2018 and examine how e-cigarette and traditional tobacco product discussions relate to implementation of tobacco control policies across different states in the United States. Methods: We mined tweets that contained the term “lung cancer” on Twitter from February to March 2018. The data set contained 13,946 publicly available tweets that occurred during National Cancer Prevention Month (February 2018), and 10,153 tweets that occurred during March 2018. E-cigarette–related and smoking-related tweets were retrieved, using topic modeling and geospatial analysis. Results: Debates on harmfulness (454/915, 49.7%), personal experiences (316/915, 34.5%), and e-cigarette risks (145/915, 15.8%) were the major themes of e-cigarette tweets related to lung cancer. Policy discussions (2251/3870, 58.1%), smoking risks (843/3870, 21.8%), and personal experiences (776/3870, 20.1%) were the major themes of smoking tweets related to lung cancer. Geospatial analysis showed that discussion on e-cigarette risks was positively correlated with the number of state-level smoke-free policies enacted for e-cigarettes. In particular, the number of indoor and on campus smoke-free policies was related to the number of tweets on e-cigarette risks (smoke-free indoor, r49=0.33, P=.02; smoke-free campus, r49=0.32, P=.02). The total number of e-cigarette policies was also positively related to the number of tweets on e-cigarette risks (r49=0.32, P=.02). In contrast, the number of smoking policies was not significantly associated with any of the smoking themes in the lung cancer discourse (P>.13). Conclusions: Though people recognized the importance of traditional tobacco control policies in reducing lung cancer incidences, their views on e-cigarette risks were divided, and discussions on the importance of e-cigarette policy control were missing from public discourse. Findings suggest the need for health organizations to continuously engage the public in discussions on the potential health risks of e-cigarettes and raise awareness of the insidious lobbying efforts from the tobacco industry. %M 34964716 %R 10.2196/28042 %U https://www.jmir.org/2021/12/e28042 %U https://doi.org/10.2196/28042 %U http://www.ncbi.nlm.nih.gov/pubmed/34964716 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e33331 %T Campus Smoking Policies and Smoking-Related Twitter Posts Originating From California Public Universities: Retrospective Study %A Yang,Joshua S %A Cuomo,Raphael E %A Purushothaman,Vidya %A Nali,Matthew %A Shah,Neal %A Bardier,Cortni %A Obradovich,Nick %A Mackey,Tim %+ Global Health Program, Department of Anthropology, University of California, San Diego, 9500 Gilman Drive, Mail Code 0505, La Jolla, CA, 92093, United States, 1 9514914161, tkmackey@ucsd.edu %K tobacco-free policies %K social media %K colleges and universities %K smoking %K smoking %K smoking policy %K campus policy %K tobacco use %K Twitter analysis %K smoke-free %K tobacco-free %K Twitter %K college students %K students %K campus %K health policy %D 2021 %7 24.12.2021 %9 Short Paper %J JMIR Form Res %G English %X Background: The number of colleges and universities with smoke- or tobacco-free campus policies has been increasing. The effects of campus smoking policies on overall sentiment, particularly among young adult populations, are more difficult to assess owing to the changing tobacco and e-cigarette product landscape and differential attitudes toward policy implementation and enforcement. Objective: The goal of the study was to retrospectively assess the campus climate toward tobacco use by comparing tweets from California universities with and those without smoke- or tobacco-free campus policies. Methods: Geolocated Twitter posts from 2015 were collected using the Twitter public application programming interface in combination with cloud computing services on Amazon Web Services. Posts were filtered for tobacco products and behavior-related keywords. A total of 42,877,339 posts were collected from 2015, with 2837 originating from a University of California or California State University system campus, and 758 of these manually verified as being about smoking. Chi-square tests were conducted to determine if there were significant differences in tweet user sentiments between campuses that were smoke- or tobacco-free (all University of California campuses and California State University, Fullerton) compared to those that were not. A separate content analysis of tweets included in chi-square tests was conducted to identify major themes by campus smoking policy status. Results: The percentage of positive sentiment tweets toward tobacco use was higher on campuses without a smoke- or tobacco-free campus policy than on campuses with a smoke- or tobacco-free campus policy (76.7% vs 66.4%, P=.03). Higher positive sentiment on campuses without a smoke- or tobacco-free campus policy may have been driven by general comments about one’s own smoking behavior and comments about smoking as a general behavior. Positive sentiment tweets originating from campuses without a smoke- or tobacco-free policy had greater variation in tweet type, which may have also contributed to differences in sentiment among universities. Conclusions: Our study introduces preliminary data suggesting that campus smoke- and tobacco-free policies are associated with a reduction in positive sentiment toward smoking. However, continued expressions and intentions to smoke and reports of one’s own smoking among Twitter users suggest a need for more research to better understand the dynamics between implementation of smoke- and tobacco-free policies and resulting tobacco behavioral sentiment. %M 34951597 %R 10.2196/33331 %U https://formative.jmir.org/2021/12/e33331 %U https://doi.org/10.2196/33331 %U http://www.ncbi.nlm.nih.gov/pubmed/34951597 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e27183 %T Smokers’ Likelihood to Engage With Information and Misinformation on Twitter About the Relative Harms of e-Cigarette Use: Results From a Randomized Controlled Trial %A Liu,Jessica %A Wright,Caroline %A Williams,Philippa %A Elizarova,Olga %A Dahne,Jennifer %A Bian,Jiang %A Zhao,Yunpeng %A Tan,Andy S L %+ Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States, 1 7149289866, jessica_liu@g.harvard.edu %K e-cigarettes %K misinformation %K Twitter %K social media %D 2021 %7 21.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Information and misinformation on the internet about e-cigarette harms may increase smokers’ misperceptions of e-cigarettes. There is limited research on smokers’ engagement with information and misinformation about e-cigarettes on social media. Objective: This study assessed smokers’ likelihood to engage with—defined as replying, retweeting, liking, and sharing—tweets that contain information and misinformation and uncertainty about the harms of e-cigarettes. Methods: We conducted a web-based randomized controlled trial among 2400 UK and US adult smokers who did not vape in the past 30 days. Participants were randomly assigned to view four tweets in one of four conditions: (1) e-cigarettes are as harmful or more harmful than smoking, (2) e-cigarettes are completely harmless, (3) uncertainty about e-cigarette harms, or (4) control (physical activity). The outcome measure was participants’ likelihood of engaging with tweets, which comprised the sum of whether they would reply, retweet, like, and share each tweet. We fitted Poisson regression models to predict the likelihood of engagement with tweets among 974 Twitter users and 1287 non-Twitter social media users, adjusting for covariates and stratified by UK and US participants. Results: Among Twitter users, participants were more likely to engage with tweets in condition 1 (e-cigarettes are as harmful or more harmful than smoking) than in condition 2 (e-cigarettes are completely harmless). Among other social media users, participants were more likely to likely to engage with tweets in condition 1 than in conditions 2 and 3 (e-cigarettes are completely harmless and uncertainty about e-cigarette harms). Conclusions: Tweets stating information and misinformation that e-cigarettes were as harmful or more harmful than smoking regular cigarettes may receive higher engagement than tweets indicating e-cigarettes were completely harmless. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 16082420; https://doi.org/10.1186/ISRCTN16082420 %M 34931999 %R 10.2196/27183 %U https://publichealth.jmir.org/2021/12/e27183 %U https://doi.org/10.2196/27183 %U http://www.ncbi.nlm.nih.gov/pubmed/34931999 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e31275 %T Global Melanoma Correlations With Obesity, Smoking, and Alcohol Consumption %A Batta,Nisha %A Shangraw,Sarah %A Nicklawsky,Andrew %A Yamauchi,Takeshi %A Zhai,Zili %A Ravindran Menon,Dinoop %A Gao,Dexiang %A Dellavalle,Robert P %A Fujita,Mayumi %+ Department of Dermatology, University of Colorado Anschutz Medical Campus, 12801 E. 17th Avenue, RC-1 South, Rm 4124, Aurora, CO, 80045, United States, 1 303 724 4045, mayumi.fujita@cuanschutz.edu %K melanoma incidence %K melanoma mortality %K non-UV risk factors %K obesity %K alcohol consumption %K smoking %K wine %K World Health Organization %K WHO %K Global Cancer Observatory %K GCO %K Global Health Observatory %K GHO %K aldehyde dehydrogenase 2 %K ALDH2 %K polymorphism %D 2021 %7 13.12.2021 %9 Research Letter %J JMIR Dermatol %G English %X %M 35990801 %R 10.2196/31275 %U https://derma.jmir.org/2021/2/e31275 %U https://doi.org/10.2196/31275 %U http://www.ncbi.nlm.nih.gov/pubmed/35990801 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e29011 %T Difficulty Regulating Social Media Content of Age-Restricted Products: Comparing JUUL’s Official Twitter Timeline and Social Media Content About JUUL %A Valdez,Danny %A Unger,Jennifer B %+ Department of Applied Health Science, Indiana University School of Public Health, 1025 E 7th Street, #111, Bloomington, IN, 47405, United States, 1 8128551561, danvald@iu.edu %K social media %K JUUL %K underage marketing %K LDA %K Latent Dirichlet Allocation %K topic models %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: In 2018, JUUL Labs Inc, a popular e-cigarette manufacturer, announced it would substantially limit its social media presence in compliance with the Food and Drug Administration’s (FDA) call to curb underage e-cigarette use. However, shortly after the announcement, a series of JUUL-related hashtags emerged on various social media platforms, calling the effectiveness of the FDA’s regulations into question. Objective: The purpose of this study is to determine whether hashtags remain a common venue to market age-restricted products on social media. Methods: We used Twitter’s standard application programming interface to download the 3200 most-recent tweets originating from JUUL Labs Inc’s official Twitter Account (@JUULVapor), and a series of tweets (n=28,989) from other Twitter users containing either #JUUL or mentioned JUUL in the tweet text. We ran exploratory (10×10) and iterative Latent Dirichlet Allocation (LDA) topic models to compare @JUULVapor’s content versus our hashtag corpus. We qualitatively deliberated topic meanings and substantiated our interpretations with tweets from either corpus. Results: The topic models generated for @JUULVapor’s timeline seemingly alluded to compliance with the FDA’s call to prohibit marketing of age-restricted products on social media. However, the topic models generated for the hashtag corpus of tweets from other Twitter users contained several references to flavors, vaping paraphernalia, and illicit drugs, which may be appealing to younger audiences. Conclusions: Our findings underscore the complicated nature of social media regulation. Although JUUL Labs Inc seemingly complied with the FDA to limit its social media presence, JUUL and other e-cigarette manufacturers are still discussed openly in social media spaces. Much discourse about JUUL and e-cigarettes is spread via hashtags, which allow messages to reach a wide audience quickly. This suggests that social media regulations on manufacturers cannot prevent e-cigarette users, influencers, or marketers from spreading information about e-cigarette attributes that appeal to the youth, such as flavors. Stricter protocols are needed to regulate discourse about age-restricted products on social media. %M 37114198 %R 10.2196/29011 %U https://infodemiology.jmir.org/2021/1/e29011 %U https://doi.org/10.2196/29011 %U http://www.ncbi.nlm.nih.gov/pubmed/37114198 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29600 %T Characteristics of and User Engagement With Antivaping Posts on Instagram: Observational Study %A Gao,Yankun %A Xie,Zidian %A Sun,Li %A Xu,Chenliang %A Li,Dongmei %+ Department of Clinical & Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 585 276 7285, Dongmei_Li@urmc.rochester.edu %K anti-vaping %K Instagram %K user engagement %K e-cigarettes %K vaping %K social media %K content analysis %K public health %K lung health %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although government agencies acknowledge that messages about the adverse health effects of e-cigarette use should be promoted on social media, effectively delivering those health messages is challenging. Instagram is one of the most popular social media platforms among US youth and young adults, and it has been used to educate the public about the potential harm of vaping through antivaping posts. Objective: We aim to analyze the characteristics of and user engagement with antivaping posts on Instagram to inform future message development and information delivery. Methods: A total of 11,322 Instagram posts were collected from November 18, 2019, to January 2, 2020, by using antivaping hashtags including #novape, #novaping, #stopvaping, #dontvape, #antivaping, #quitvaping, #antivape, #stopjuuling, #dontvapeonthepizza, and #escapethevape. Among those posts, 1025 posts were randomly selected and 500 antivaping posts were further identified by hand coding. The image type, image content, and account type of antivaping posts were hand coded, the text information in the caption was explored by topic modeling, and the user engagement of each category was compared. Results: Analyses found that antivaping images of the educational/warning type were the most common (253/500; 50.6%). The average likes of the educational/warning type (15 likes/post) were significantly lower than the catchphrase image type (these emphasized a slogan such as “athletesdontvape” in the image; 32.5 likes/post; P<.001). The majority of the antivaping posts contained the image content element text (n=332, 66.4%), followed by the image content element people/person (n=110, 22%). The images containing people/person elements (32.8 likes/post) had more likes than the images containing other elements (13.8-21.1 likes/post). The captions of the antivaping Instagram posts covered topics including “lung health,” “teen vaping,” “stop vaping,” and “vaping death cases.” Among the 500 antivaping Instagram posts, while most posts were from the antivaping community (n=177, 35.4%) and personal account types (n=182, 36.4%), the antivaping community account type had the highest average number of posts (1.69 posts/account). However, there was no difference in the number of likes among different account types. Conclusions: Multiple features of antivaping Instagram posts may be related to user engagement and perception. This study identified the critical elements associated with high user engagement, which could be used to design antivaping posts to deliver health-related information more efficiently. %M 34842553 %R 10.2196/29600 %U https://publichealth.jmir.org/2021/11/e29600 %U https://doi.org/10.2196/29600 %U http://www.ncbi.nlm.nih.gov/pubmed/34842553 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e25618 %T Mobile Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Randomized Trial of Project Debunk %A Prokhorov,Alexander V %A Calabro,Karen Sue %A Arya,Ashish %A Russell,Sophia %A Czerniak,Katarzyna W %A Botello,Gabrielle C %A Chen,Minxing %A Yuan,Ying %A Perez,Adriana %A Vidrine,Damon J %A Perry,Cheryl L %A Khalil,Georges Elias %+ Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Clinical and Translational Science Building, 2004 Mowry Road Office 2252, Gainesville, FL, 32610, United States, 1 3522948415, gkhalil@ufl.edu %K tobacco use %K risk communication %K text messaging %K message framing %K regulatory science %K young adults %K vaping %K mobile phone %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of new and emerging tobacco products (NETPs) and conventional tobacco products (CTPs) has been linked to several alarming medical conditions among young adults (YAs). Considering that 96% of YAs own mobile phones, SMS text messaging may be an effective strategy for tobacco risk communication. Objective: Project Debunk is a community-based randomized trial aiming to identify specific types of messages that effectively improve perceived NETP and CTP risk among YAs in community colleges. Methods: With YAs recruited offline from 3 campuses at the Houston Community College (September 2016 to July 2017), we conducted a 6-month randomized trial with 8 arms based on the combination of 3 message categories: framing (gain-framed vs loss-framed), depth (simple vs complex), and appeal (emotional vs rational). Participants received fully automated web-based SMS text messages in two 30-day campaigns (2 messages per day). We conducted repeated-measures mixed-effect models stratified by message type received, predicting perceived CTP and NETP risks. Owing to multiple testing with 7 models, an association was deemed significant for P<.007 (.05 divided by 7). Results: A total of 636 participants completed the baseline survey, were randomized to 1 of 8 conditions (between 73 and 86 participants per condition), and received messages from both campaigns. By the 2-month post campaign 2 assessment point, 70.1% (446/636) completed all outcome measures. By the end of both campaigns, participants had a significant increase in perceived NETP risk over time (P<.001); however, participants had a marginal increase in perceived CTP risk (P=.008). Separately for each group, there was a significant increase in perceived NETP risk among participants who received rational messages (P=.005), those who received emotional messages (P=.006), those who received simple messages (P=.003), and those who received gain-framed messages (P=.003). Conclusions: In this trial, YAs had an increase in perceived NETP risk. However, with stratification, we observed a significant increase in perceived NETP risk upon exposure to rational, emotional, simple, and gain-framed messages. In addition, YAs generally had an increase in perceived CTP risk and presented nonsignificant but observable improvement upon exposure to emotional, complex, and loss-framed messages. With the results of this study, researchers and practitioners implementing mobile health programs may take advantage of our tailored messages through larger technology-based programs such as smartphone apps and social media campaigns. Trial Registration: ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480 International Registered Report Identifier (IRRID): RR2-10.2196/10977 %M 34822339 %R 10.2196/25618 %U https://mhealth.jmir.org/2021/11/e25618 %U https://doi.org/10.2196/25618 %U http://www.ncbi.nlm.nih.gov/pubmed/34822339 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 13 %N 3 %P e29945 %T Developing Graphic Messages for Vaping Prevention Among Black and Latino Adolescents: Participatory Research Approach %A Cartujano-Barrera,Francisco %A Azogini,Chiamaka %A McIntosh,Scott %A Bansal-Travers,Maansi %A Ossip,Deborah J %A Cupertino,Ana Paula %+ Department of Public Health Sciences, University of Rochester Medical Center, 265 Crittenden Blvd, Box 420644, Rochester, NY, 14642, United States, 1 585 298 2031, Francisco_cartujano@urmc.rochester.edu %K vaping %K electronic cigarettes %K adolescents %K Latino %K Black %D 2021 %7 23.11.2021 %9 Original Paper %J J Particip Med %G English %X Background: As an important transition stage in human development, adolescence is a critical window for vaping prevention. There is a substantial gap in communication research on vaping prevention among racial and ethnic minority groups. Their representation is essential to develop, implement, and disseminate innovative and effective interventions for vaping prevention. Objective: The aim of this study is to describe the participatory research (PR) procedures used with Black and Latino adolescents to develop culturally and linguistically appropriate graphic messages for vaping prevention. Methods: This PR study used a qualitative, user-centered design method. We conducted a series of focus groups with 16 Black and Latino adolescents to develop culturally and linguistically appropriate graphic messages for vaping prevention. The biobehavioral model of nicotine addiction provided a framework for the development of the graphic messages. Participants met 4 times to provide iterative feedback on the graphic messages until they reached a consensus on overall quality and content. Results: At baseline, the participants’ mean age was 15.4 years (SD 1.4). Of the participants, 50% (8/16) were female, 88% (14/16) were heterosexual, 56% (9/16) were Black/African American, and 44% (7/16) were Hispanic/Latino. A total of 12 of the 16 participants (75%) chose to participate in the English sessions. Participants decided to create four types of graphic messages: (1) financial reward, (2) health reward, (3) social norms, and (4) self-efficacy. Meeting 4 times with the 4 groups provided sufficient opportunities for iterative feedback on the graphic messages to reach a consensus on overall quality and content. Conclusions: It is feasible and practical to build PR among Black and Latino adolescents focused on vaping prevention. Adolescents added innovation and creativity to the development of culturally and linguistically appropriate graphic messages for vaping prevention. Appropriate staffing, funding, and approaches are key for successful PR efforts among Black and Latino adolescents. Future research is needed to evaluate the impact of the graphic messages on vaping prevention. %M 34812734 %R 10.2196/29945 %U https://jopm.jmir.org/2021/3/e29945 %U https://doi.org/10.2196/29945 %U http://www.ncbi.nlm.nih.gov/pubmed/34812734 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e31908 %T Promoting Safe Sleep, Tobacco Cessation, and Breastfeeding to Rural Women During the COVID-19 Pandemic: Quasi-Experimental Study %A Ahlers-Schmidt,Carolyn R %A Schunn,Christy %A Hervey,Ashley M %A Torres,Maria %A Nelson,Jill Elizabeth V %+ Center for Research for Infant Birth and Survival, University of Kansas School of Medicine-Wichita, 3242 E. Murdock St., Suite 602, Wichita, KS, United States, 1 3169627923, cschmidt3@kumc.edu %K COVID-19 %K SIDS %K sudden infant death syndrome %K safe sleep %K tobacco cessation %K breastfeeding %K virtual education %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Safe Sleep Community Baby Showers address strategies to prevent sleep-related infant deaths. Due to the COVID-19 pandemic, these events transitioned from in-person to virtual. Objective: This study describes outcomes of transitioning Safe Sleep Community Baby Showers to a virtual format and compares outcomes to previous in-person events. Methods: Participants from four rural Kansas counties were emailed the presurvey, provided educational materials (videos, livestream, or digital documents), and completed a postsurvey. Those who completed both surveys received a portable crib and wearable blanket. Within-group comparisons were assessed between pre- and postsurveys; between-group comparisons (virtual vs in-person) were assessed by postsurveys. Results: Based on data from 145 in-person and 74 virtual participants, virtual participants were more likely to be married (P<.001) and have private insurance (P<.001), and were less likely to report tobacco use (P<.001). Both event formats significantly increased knowledge and intentions regarding safe sleep and avoidance of secondhand smoke (all P≤.001). Breastfeeding intentions did not change. Differences were observed between in-person and virtual meetings regarding confidence in the ability to avoid secondhand smoke (in-person: 121/144, 84% vs virtual: 53/74, 72%; P=.03), intention to breastfeed ≥6 months (in-person: 79/128, 62% vs virtual: 52/66, 79%; P=.008), and confidence in the ability to breastfeed ≥6 months (in-person: 58/123, 47% vs virtual: 44/69, 64%; P=.02). Conclusions: Although both event formats demonstrated increased knowledge/intentions to follow safe sleep recommendations, virtual events may further marginalize groups who are at high risk for poor birth outcomes. Strategies to increase technology access, recruit priority populations, and ensure disparities are not exacerbated will be critical for the implementation of future virtual events. %M 34550075 %R 10.2196/31908 %U https://pediatrics.jmir.org/2021/4/e31908 %U https://doi.org/10.2196/31908 %U http://www.ncbi.nlm.nih.gov/pubmed/34550075 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e32285 %T Seroepidemiological Survey on the Impact of Smoking on SARS-CoV-2 Infection and COVID-19 Outcomes: Protocol for the Troina Study %A Polosa,Riccardo %A Tomaselli,Venera %A Ferrara,Pietro %A Romeo,Alba Corina %A Rust,Sonja %A Saitta,Daniela %A Caraci,Filippo %A Romano,Corrado %A Thangaraju,Murugesan %A Zuccarello,Pietro %A Rose,Jed %A Cantone,Giulio Giacomo %A Ferrante,Margherita %A Belsey,Jonathan %A Cibella,Fabio %A Interlandi,Elisa %A Ferri,Raffaele %+ Institute of Internal Medicine, Azienda Ospedaliera Universitaria “Policlinico - V. Emanuele”, Via S Sofia, 78, Catania, 95123, Italy, 39 0953781566, polosa@unict.it %K antibody persistence %K cotinine %K COVID-19 %K SARS-CoV-2 %K seroprevalence %K smoking impact %K smoking status %D 2021 %7 22.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: After the global spread of SARS-CoV-2, research has highlighted several aspects of the pandemic, focusing on clinical features and risk factors associated with infection and disease severity. However, emerging results on the role of smoking in SARS-CoV-2 infection susceptibility or COVID-19 outcomes are conflicting, and their robustness remains uncertain. Objective: In this context, this study aims at quantifying the proportion of SARS-CoV-2 antibody seroprevalence, studying the changes in antibody levels over time, and analyzing the association between the biochemically verified smoking status and SARS-CoV-2 infection. Methods: The research design involves a 6-month prospective cohort study with a serial sampling of the same individuals. Each participant will be surveyed about their demographics and COVID-19–related information, and blood sampling will be collected upon recruitment and at specified follow-up time points (ie, after 8 and 24 weeks). Blood samples will be screened for the presence of SARS-CoV-2–specific antibodies and serum cotinine, being the latter of the principal metabolite of nicotine, which will be used to assess participants’ smoking status. Results: The study is ongoing. It aims to find a higher antibody prevalence in individuals at high risk for viral exposure (ie, health care personnel) and to refine current estimates on the association between smoking status and SARS-CoV-2/COVID-19. Conclusions: The added value of this research is that the current smoking status of the population to be studied will be biochemically verified to avoid the bias associated with self-reported smoking status. As such, the results from this survey may provide an actionable metric to study the role of smoking in SARS-CoV-2 infection and COVID-19 outcomes, and therefore to implement the most appropriate public health measures to control the pandemic. Results may also serve as a reference for future clinical research, and the methodology could be exploited in public health sectors and policies. International Registered Report Identifier (IRRID): DERR1-10.2196/32285 %M 34678752 %R 10.2196/32285 %U https://www.researchprotocols.org/2021/11/e32285 %U https://doi.org/10.2196/32285 %U http://www.ncbi.nlm.nih.gov/pubmed/34678752 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e32167 %T Pragmatics to Reveal Intent in Social Media Peer Interactions: Mixed Methods Study %A Singh,Tavleen %A Olivares,Sofia %A Cohen,Trevor %A Cobb,Nathan %A Wang,Jing %A Franklin,Amy %A Myneni,Sahiti %+ School of Biomedical Informatics, University of Texas Health Science Center, 7000 Fannin Street, Houston, TX, 77030, United States, 1 713 500 3900, tavleen.kaur.ranjit.singh@uth.tmc.edu %K online health communities %K diabetes self-management %K tobacco cessation %K speech acts %K behavior change %K communication themes %D 2021 %7 17.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Online health communities (OHCs) have emerged as the leading venues for behavior change and health-related information seeking. The soul and success of these digital platforms lie in their ability to foster social togetherness and a sense of community by providing personalized support. However, we have a minimal understanding of how conversational posts in these settings lead to collaborative societies and ultimately result in positive health changes through social influence. Objective: Our objective is to develop a content-specific and intent-sensitive methodological framework for analyzing peer interactions in OHCs. Methods: We developed and applied a mixed-methods approach to understand the manifestation of expressions in peer interactions in OHCs. We applied our approach to describe online social dialogue in the context of two online communities, QuitNet (QN) and the American Diabetes Association (ADA) support community. A total of 3011 randomly selected peer interactions (n=2005 from QN, n=1006 from ADA) were analyzed. Specifically, we conducted thematic analysis to characterize communication content and linguistic expressions (speech acts) embedded within the two data sets. We also developed an empirical user persona based on their engagement levels and behavior profiles. Further, we examined the association between speech acts and communication themes across observed tiers of user engagement and self-reported behavior profiles using the chi-square test or the Fisher test. Results: Although social support, the most prevalent communication theme in both communities, was expressed in several subtle manners, the prevalence of emotions was higher in the tobacco cessation community and assertions were higher in the diabetes self-management (DSM) community. Specific communication theme-speech act relationships were revealed, such as the social support theme was significantly associated (P<.05) with 9 speech acts from a total of 10 speech acts (ie, assertion, commissive, declarative, desire, directive, expressive, question, stance, and statement) within the QN community. Only four speech acts (ie, commissive, emotion, expressive, and stance) were significantly associated (P<.05) with the social support theme in the ADA community. The speech acts were also significantly associated with the users’ abstinence status within the QN community and with the users’ lifestyle status within the ADA community (P<.05). Conclusions: Such an overlay of communication intent implicit in online peer interactions alongside content-specific theory-linked characterizations of social media discourse can inform the development of effective digital health technologies in the field of health promotion and behavior change. Our analysis revealed a rich gradient of expressions across a standardized thematic vocabulary, with a distinct variation in emotional and informational needs, depending on the behavioral and disease management profiles within and across the communities. This signifies the need and opportunities for coupling pragmatic messaging in digital therapeutics and care management pathways for personalized support. %M 34787578 %R 10.2196/32167 %U https://www.jmir.org/2021/11/e32167 %U https://doi.org/10.2196/32167 %U http://www.ncbi.nlm.nih.gov/pubmed/34787578 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29760 %T A Smoking Cessation App for Nondaily Smokers (Version 2 of the Smiling Instead of Smoking App): Acceptability and Feasibility Study %A Hoeppner,Bettina B %A Siegel,Kaitlyn R %A Carlon,Hannah A %A Kahler,Christopher W %A Park,Elyse R %A Hoeppner,Susanne S %+ Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, 151 Merrimac Street, 6th Floor, Boston, MA, 02114, United States, 1 617 643 1988, bhoeppner@mgh.harvard.edu %K nondaily %K smoking cessation %K smartphone app %K positive psychology %K mHealth %K happiness %K mobile phone %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent evidence highlights the significant detrimental impact of nondaily smoking on health and its disproportionate prevalence in underserved populations; however, little work has been done to develop treatments specifically geared toward quitting nondaily smoking. Objective: This study aims to test the feasibility, acceptability, and conceptual underpinnings of version 2 of the Smiling Instead of Smoking (SiS2) smartphone app, which was developed specifically for nondaily smokers and uses a positive psychology approach. Methods: In a prospective, single-group study, nondaily smokers (N=100) were prescribed use of the SiS2 app for 7 weeks while undergoing a quit attempt. The app assigned daily positive psychology exercises and behavioral tasks every 2 to 3 days, which guided smokers through using the smoking cessation tools offered in the app. Participants answered surveys at baseline and at 2, 6, 12, and 24 weeks postquit. Feasibility was evaluated based on app use and acceptability based on survey responses. The underlying conceptual framework was tested by examining whether theorized within-person changes occurred from baseline to end of treatment on scales measuring self-efficacy, desire to smoke, and processing of self-relevant health information (ie, pros and cons of smoking, importance of the pros and cons of quitting, and motivation). Results: Participants used the SiS2 app on an average of 24.7 (SD 13.8) days out of the 49 prescribed days. At the end of treatment, most participants rated the functions of the app as very easy to use (eg, 70/95, 74% regarding cigarette log and 59/95, 62% regarding happiness exercises). The average score on the System Usability Scale was 79.8 (SD 17.3; A grade; A+ ≥84.1, B+ <78.8). Most participants reported that the app helped them in their quit attempt (83/95, 87%), and helped them stay positive while quitting (78/95, 82%). Large effects were found for within-person decreases in the desire to smoke (b=−1.5, 95% CI −1.9 to −1.1; P<.001; gav=1.01), the importance of the pros of smoking (b=-20.7, 95% CI −27.2 to −14.3; P<.001; gav=0.83), and perceived psychoactive benefits of smoking (b=−0.8, 95% CI −1.0 to −0.5; P<.001; gav=0.80). Medium effects were found for increases in self-efficacy for remaining abstinent when encountering internal (b=13.1, 95% CI 7.6 to 18.7; P<.001; gav=0.53) and external (b=11.2, 95% CI 6.1 to 16.1; P<.001; gav=0.49) smoking cues. Smaller effects, contrary to expectations, were found for decreases in motivation to quit smoking (P=.005) and the perceived importance of the pros of quitting (P=.009). Self-reported 30-day point prevalence abstinence rates were 40%, 56%, and 56% at 6, 12, and 24 weeks after the quit day, respectively. Conclusions: The SiS2 app was feasible and acceptable, showed promising changes in constructs relevant to smoking cessation, and had high self-reported quit rates by nondaily smokers. The SiS2 app warrants testing in a randomized controlled trial. %M 34787577 %R 10.2196/29760 %U https://formative.jmir.org/2021/11/e29760 %U https://doi.org/10.2196/29760 %U http://www.ncbi.nlm.nih.gov/pubmed/34787577 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e33183 %T Evaluating the Efficacy of Automated Smoking Treatment for People With HIV: Protocol for a Randomized Controlled Trial %A Vidrine,Damon J %A Bui,Thanh C %A Businelle,Michael S %A Shih,Ya-Chen Tina %A Sutton,Steven K %A Shahani,Lokesh %A Hoover,Diana Stewart %A Bowles,Kristina %A Vidrine,Jennifer I %+ Department of Health Outcomes and Behavior, Moffitt Cancer Center, 4115 E Fowler Avenue, Tampa, FL, 33617, United States, 1 813 745 7937, damon.vidrine@moffitt.org %K smoking cessation %K health disparities %K HIV/AIDS %K mHealth %K mobile phone %D 2021 %7 17.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking prevalence rates among people with HIV are nearly 3 times higher than those in the general population. Nevertheless, few smoking cessation trials targeting smokers with HIV have been reported in the literature. Efforts to develop and evaluate sustainable, low-cost, and evidence-based cessation interventions for people with HIV are needed. Given the widespread proliferation of mobile phones, the potential of using mobile health apps to improve the reach and efficacy of cessation interventions is promising, but evidence of efficacy is lacking, particularly among people with HIV. Objective: This study will consist of a 2-group randomized controlled trial to evaluate a fully automated smartphone intervention for people with HIV seeking cessation treatment. Methods: Participants (N=500) will be randomized to receive either standard treatment (ST; 250/500, 50%) or automated treatment (AT; 250/500, 50%). ST participants will be connected to the Florida Quitline and will receive nicotine replacement therapy in the form of transdermal patches and lozenges. This approach, referred to as Ask Advise Connect, was developed by our team and has been implemented in numerous health systems. ST will be compared with AT, a fully automated behavioral treatment approach. AT participants will receive nicotine replacement therapy and an interactive smartphone-based intervention that comprises individually tailored audiovisual and text content. The major goal is to determine whether AT performs better in terms of facilitating long-term smoking abstinence than the more resource-intensive ST approach. Our primary aim is to evaluate the efficacy of AT in facilitating smoking cessation among people with HIV. As a secondary aim, we will explore potential mediators and moderators and conduct economic evaluations to assess the cost and cost-effectiveness of AT compared with ST. Results: The intervention content has been developed and finalized. Recruitment and enrollment will begin in the fall of 2021. Conclusions: There is a critical need for efficacious, cost-effective, and sustainable cessation treatments for people with HIV who smoke. The AT intervention was designed to help fill this need. If efficacy is established, the AT approach will be readily adoptable by HIV clinics and community-based organizations, and it will offer an efficient way to allocate limited public health resources to tobacco control interventions. Trial Registration: ClinicalTrials.gov NCT05014282; https://clinicaltrials.gov/ct2/show/NCT05014282 International Registered Report Identifier (IRRID): PRR1-10.2196/33183 %M 34787590 %R 10.2196/33183 %U https://www.researchprotocols.org/2021/11/e33183 %U https://doi.org/10.2196/33183 %U http://www.ncbi.nlm.nih.gov/pubmed/34787590 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e32521 %T Smartband-Based Automatic Smoking Detection and Real-time Mindfulness Intervention: Protocol for a Feasibility Trial %A Horvath,Mark %A Grutman,Aurora %A O'Malley,Stephanie S %A Gueorguieva,Ralitza %A Khan,Nashmia %A Brewer,Judson A %A Garrison,Kathleen A %+ Department of Psychiatry, Yale School of Medicine, 1 Church Street #730, New Haven, CT, 06510, United States, 1 4152608618, kathleen.garrison@yale.edu %K smartband %K smartphone %K smoking %K mindfulness %K craving %K mHealth %D 2021 %7 16.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking is the leading cause of preventable death in the United States. Smoking cessation interventions delivered by smartphone apps are a promising tool for helping smokers quit. However, currently available smartphone apps for smoking cessation have not exploited their unique potential advantages to aid quitting. Notably, few to no available apps use wearable technologies, most apps require users to self-report their smoking, and few to no apps deliver treatment automatically contingent upon smoking. Objective: This pilot trial tests the feasibility of using a smartband and smartphone to monitor and detect smoking and deliver brief mindfulness interventions in real time to reduce smoking. Methods: Daily smokers (N=100, ≥5 cigarettes per day) wear a smartband for 60 days to monitor and detect smoking, notify them about their smoking events in real time, and deliver real-time brief mindfulness exercises triggered by detected smoking events or targeted at predicted smoking events. Smokers set a quit date at 30 days. A three-step intervention to reduce smoking is tested. First, participants wear a smartband to monitor and detect smoking, and notify them of smoking events in real time to bring awareness to smoking and triggers for 21 days. Next, a “mindful smoking” exercise is triggered by detected smoking events to bring a clear recognition of the actual effects of smoking for 7 days. Finally, after their quit date, a “RAIN” (recognize, allow, investigate, nonidentification) exercise is delivered to predicted smoking events (based on the initial 3 weeks of tracking smoking data) to help smokers learn to work mindfully with cravings rather than smoke for 30 days. The primary outcomes are feasibility measures of treatment fidelity, adherence, and acceptability. The secondary outcomes are smoking rates at end of treatment. Results: Recruitment for this trial started in May 2021 and will continue until November 2021 or until enrollment is completed. Data monitoring and management are ongoing for enrolled participants. The final 60-day end of treatment data is anticipated in January 2022. We expect that all trial results will be available in April 2022. Conclusions: Findings will provide data and information on the feasibility of using a smartband and smartphone to monitor and detect smoking and deliver real-time brief mindfulness interventions, and whether the intervention warrants additional testing for smoking cessation. Trial Registration: ClinicalTrials.gov NCT03995225; https://clinicaltrials.gov/ct2/show/NCT03995225 International Registered Report Identifier (IRRID): DERR1-10.2196/32521 %M 34783663 %R 10.2196/32521 %U https://www.researchprotocols.org/2021/11/e32521 %U https://doi.org/10.2196/32521 %U http://www.ncbi.nlm.nih.gov/pubmed/34783663 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e32847 %T Mechanisms of Smartphone Apps for Cigarette Smoking Cessation: Results of a Serial Mediation Model From the iCanQuit Randomized Trial %A Bricker,Jonathan B %A Levin,Michael %A Lappalainen,Raimo %A Mull,Kristin %A Sullivan,Brianna %A Santiago-Torres,Margarita %+ Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M3-B232, Seattle, WA, 98109, United States, 1 2066675074, jbricker@fredhutch.org %K mediation %K engagement %K digital %K mHealth: smartphone %K acceptance %K smoking %K cessation %K app %K randomized controlled trial %K model %K intervention %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Engagement with digital interventions is a well-known predictor of treatment outcomes, but this knowledge has had limited actionable value. Instead, learning why engagement with digital interventions impact treatment outcomes can lead to targeted improvements in their efficacy. Objective: This study aimed to test a serial mediation model of an Acceptance and Commitment Therapy (ACT) smartphone intervention for smoking cessation. Methods: In this randomized controlled trial, participants (N=2415) from 50 US states were assigned to the ACT-based smartphone intervention (iCanQuit) or comparison smartphone intervention (QuitGuide). Their engagement with the apps (primary measure: number of logins) was measured during the first 3 months, ACT processes were measured at baseline and 3 months (acceptance of internal cues to smoke, valued living), and smoking cessation was measured at 12 months with 87% follow-up retention. Results: There was a significant serial mediation effect of iCanQuit on smoking cessation through multiple indicators of intervention engagement (ie, total number of logins, total number of minutes used, and total number of unique days of use) and in turn through increases in mean acceptance of internal cues to smoke from baseline to 3 months. Analyses of the acceptance subscales showed that the mediation was through acceptance of physical sensations and emotions, but not acceptance of thoughts. There was no evidence that the effect of the iCanQuit intervention was mediated through changes in valued living. Conclusions: In this first study of serial mediators underlying the efficacy of smartphone apps for smoking cessation, our results suggest the effect of the iCanQuit ACT-based smartphone app on smoking cessation was mediated through multiple indicators of engagement and in turn through increases in the acceptance of physical sensations and emotions that cue smoking. Trial Registration: Clinical Trials.gov NCT02724462; https://clinicaltrials.gov/ct2/show/NCT02724462 %M 34751662 %R 10.2196/32847 %U https://mhealth.jmir.org/2021/11/e32847 %U https://doi.org/10.2196/32847 %U http://www.ncbi.nlm.nih.gov/pubmed/34751662 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28929 %T A Case Study of an SMS Text Message Community Panel Survey and Its Potential for Use During the COVID-19 Pandemic %A Chan,Lilian %A El-Haddad,Nouhad %A Freeman,Becky %A O'Hara,Blythe J %A Woodland,Lisa %A Harris-Roxas,Ben %+ Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, The University of Sydney, John Hopkins Drive, Camperdown, 2006, Australia, 61 286277554, lilian.chan@sydney.edu.au %K data collection %K mobile phone %K short message service %K tobacco %K COVID-19 %K survey %D 2021 %7 3.11.2021 %9 Viewpoint %J JMIR Form Res %G English %X During the COVID-19 pandemic many traditional methods of data collection, such as intercept surveys or focus groups, are not feasible. This paper proposes that establishing community panels through SMS text messages may be a useful method during the pandemic, by describing a case study of how an innovative SMS text message community panel was used for the “Shisha No Thanks” project to collect data from young adults of Arabic-speaking background about their attitudes on the harms of waterpipe smoking. Participants were asked to complete an initial recruitment survey, and then subsequently sent 1 survey question per week. The study recruited 133 participants to the SMS text message community panel and the mean response rate for each question was 73.0% (97.1/133) (range 76/133 [57.1%] to 112/133 [84.2%]). The SMS text message community panel approach is not suited for all populations, nor for all types of inquiry, particularly due to limitations of the type of responses that it allows and the required access to mobile devices. However, it is a rapid method for data collection, and therefore during the COVID-19 pandemic, it can provide service providers and policymakers with timely information to inform public health responses. In addition, this method negates the need for in-person interactions and allows for longitudinal data collection. It may be useful in supplementing other community needs assessment activities, and may be particularly relevant for people who are considered to be more difficult to reach, particularly young people, culturally and linguistically diverse communities, and other groups that might otherwise be missed by traditional methods. %M 34612824 %R 10.2196/28929 %U https://formative.jmir.org/2021/11/e28929 %U https://doi.org/10.2196/28929 %U http://www.ncbi.nlm.nih.gov/pubmed/34612824 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e27875 %T Prediction of Smoking Risk From Repeated Sampling of Environmental Images: Model Validation %A Engelhard,Matthew M %A D'Arcy,Joshua %A Oliver,Jason A %A Kozink,Rachel %A McClernon,F Joseph %+ Department of Biostatistics & Bioinformatics, Duke University School of Medicine, 2608 Erwin Rd, Durham, NC, 27705, United States, 1 919 613 3665, m.engelhard@duke.edu %K smoking %K smoking cessation %K machine learning %K computer vision %K digital health %K eHealth %K behavior %K CNN %K neural network %K artificial intelligence %K AI %K images %K environment %K ecological momentary assessment %K mobile health %K mHealth %K mobile phone %D 2021 %7 1.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Viewing their habitual smoking environments increases smokers’ craving and smoking behaviors in laboratory settings. A deep learning approach can differentiate between habitual smoking versus nonsmoking environments, suggesting that it may be possible to predict environment-associated smoking risk from continuously acquired images of smokers’ daily environments. Objective: In this study, we aim to predict environment-associated risk from continuously acquired images of smokers’ daily environments. We also aim to understand how model performance varies by location type, as reported by participants. Methods: Smokers from Durham, North Carolina and surrounding areas completed ecological momentary assessments both immediately after smoking and at randomly selected times throughout the day for 2 weeks. At each assessment, participants took a picture of their current environment and completed a questionnaire on smoking, craving, and the environmental setting. A convolutional neural network–based model was trained to predict smoking, craving, whether smoking was permitted in the current environment and whether the participant was outside based on images of participants’ daily environments, the time since their last cigarette, and baseline data on daily smoking habits. Prediction performance, quantified using the area under the receiver operating characteristic curve (AUC) and average precision (AP), was assessed for out-of-sample prediction as well as personalized models trained on images from days 1 to 10. The models were optimized for mobile devices and implemented as a smartphone app. Results: A total of 48 participants completed the study, and 8008 images were acquired. The personalized models were highly effective in predicting smoking risk (AUC=0.827; AP=0.882), craving (AUC=0.837; AP=0.798), whether smoking was permitted in the current environment (AUC=0.932; AP=0.981), and whether the participant was outside (AUC=0.977; AP=0.956). The out-of-sample models were also effective in predicting smoking risk (AUC=0.723; AP=0.785), whether smoking was permitted in the current environment (AUC=0.815; AP=0.937), and whether the participant was outside (AUC=0.949; AP=0.922); however, they were not effective in predicting craving (AUC=0.522; AP=0.427). Omitting image features reduced AUC by over 0.1 when predicting all outcomes except craving. Prediction of smoking was more effective for participants whose self-reported location type was more variable (Spearman ρ=0.48; P=.001). Conclusions: Images of daily environments can be used to effectively predict smoking risk. Model personalization, achieved by incorporating information about daily smoking habits and training on participant-specific images, further improves prediction performance. Environment-associated smoking risk can be assessed in real time on a mobile device and can be incorporated into device-based smoking cessation interventions. %M 34723819 %R 10.2196/27875 %U https://www.jmir.org/2021/11/e27875 %U https://doi.org/10.2196/27875 %U http://www.ncbi.nlm.nih.gov/pubmed/34723819 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e28069 %T Characterizing Vaping Industry Political Influence and Mobilization on Facebook: Social Network Analysis %A Haupt,Michael Robert %A Xu,Qing %A Yang,Joshua %A Cai,Mingxiang %A Mackey,Tim K %+ Global Health Program, Department of Anthropology, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, United States, 1 951 491 4161, tmackey@ucsd.edu %K vaping %K alternative tobacco industry %K e-cigarettes %K Facebook %K social network analysis %K social networks %K ehealth %K health policy %D 2021 %7 29.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In response to recent policy efforts to regulate tobacco and vaping products, the vaping industry has been aggressive in mobilizing opposition by using a network of manufacturers, trade associations, and tobacco user communities, and by appealing to the general public. One strategy the alternative tobacco industry uses to mobilize political action is coordinating on social media platforms, such as the social networking site Facebook. However, few studies have specifically assessed how platforms such as Facebook are used to influence public sentiment and attitudes towards tobacco control policy. Objective: This study used social network analysis to examine how the alternative tobacco industry uses Facebook to mobilize online users to influence tobacco control policy outcomes with a focus on the state of California. Methods: Data were collected from local and national alternative tobacco Facebook groups that had affiliations with activities in the state of California. Network ties were constructed based on users’ reactions to posts (eg, “like” and “love”) and comments to characterize political mobilization networks. Results: Findings show that alternative tobacco industry employees were more likely to engage within these networks and that these employees were also more likely to be influential members (ie, be more active) in the network. Comparisons between subnetworks show that communication within the local alternative tobacco advocacy group network was less dense and more centralized in contrast to a national advocacy group that had overall higher levels of engagement among members. A timeline analysis found that a higher number of influential posts that disseminated widely across networks occurred during e-cigarette–related legislative events, suggesting strategic online engagement and increased mobilization of online activity for the purposes of influencing policy outcomes. Conclusions: Results from this study provide important insights into how tobacco industry–related advocacy groups leverage the Facebook platform to mobilize their online constituents in an effort to influence public perceptions and coordinate to defeat tobacco control efforts at the local, state, and federal level. Study results reveal one part of a vast network of socially enabled alternative tobacco industry actors and constituents that use Facebook as a mobilization point to support goals of the alternative tobacco industry. %M 34714245 %R 10.2196/28069 %U https://www.jmir.org/2021/10/e28069 %U https://doi.org/10.2196/28069 %U http://www.ncbi.nlm.nih.gov/pubmed/34714245 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e26280 %T The Development of a Web-Based Tobacco Tracker Tool to Crowdsource Campus Environmental Reports for Smoke and Tobacco–Free College Policies: Mixed Methods Study %A Loureiro,Sabrina F %A Pulvers,Kim %A Gosdin,Melissa M %A Clift,Keavagh %A Rice,Myra %A Tong,Elisa K %+ Department of Internal Medicine, University of California Davis, 4150 V Street, Suite 2400, Sacramento, CA, 95817, United States, 1 (916) 734 7005, ektong@ucdavis.edu %K tobacco cessation %K college smoke and tobacco–free policies %K crowdsourcing %K environmental reporting %K public health %K smoke and tobacco research %D 2021 %7 29.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: College campuses in the United States have begun implementing smoke and tobacco–free policies to discourage the use of tobacco. Smoke and tobacco–free policies, however, are contingent upon effective policy enforcement. Objective: This study aimed to develop an empirically derived web-based tracking tool (Tracker) for crowdsourcing campus environmental reports of tobacco use and waste to support smoke and tobacco–free college policies. Methods: An exploratory sequential mixed methods approach was utilized to inform the development and evaluation of Tracker. In October 2018, three focus groups across 2 California universities were conducted and themes were analyzed, guiding Tracker development. After 1 year of implementation, users were asked in April 2020 to complete a survey about their experience. Results: In the focus groups, two major themes emerged: barriers and facilitators to tool utilization. Further Tracker development was guided by focus group input to address these barriers (eg, information, policing, and logistical concerns) and facilitators (eg, environmental motivators and positive reinforcement). Amongst 1163 Tracker reports, those who completed the user survey (n=316) reported that the top motivations for using the tool had been having a cleaner environment (212/316, 79%) and health concerns (185/316, 69%). Conclusions: Environmental concerns, a motivator that emerged in focus groups, shaped Tracker’s development and was cited by the majority of users surveyed as a top motivator for utilization. %M 34714248 %R 10.2196/26280 %U https://www.jmir.org/2021/10/e26280 %U https://doi.org/10.2196/26280 %U http://www.ncbi.nlm.nih.gov/pubmed/34714248 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30681 %T Videos With the Hashtag #vaping on TikTok and Implications for Informed Decision-making by Adolescents: Descriptive Study %A Basch,Corey H %A Fera,Joseph %A Pellicane,Alessia %A Basch,Charles E %+ William Paterson University, 300 Pompton Rd, Wayne, NJ, 07470, United States, 1 973 720 2603, baschc@wpunj.edu %K vaping %K TikTok %K social media %K misinformation %K decision-making %K adolescents %K young adults %K e-cigarettes %K public health %K informed decision-making %D 2021 %7 25.10.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite the public health importance of vaping and the widespread use of TikTok by adolescents and young adults, research is lacking on the nature and scope of vaping content on this networking service. Objective: The purpose of this study is to describe the content of TikTok videos related to vaping. Methods: By searching the hashtag #vaping in the discover feature, ~478.4 million views were seen during the time of data collection. The first 100 relevant videos under that hashtag were used in this study. Relevance was determined by simply noting if the video was related in any way to vaping. Coding consisted of several categories directly related to vaping and additional categories, including the number of likes, comments, and views, and if the video involved music, humor, or dance. Results: The 100 videos included in the sample garnered 156,331,347 views; 20,335,800 likes; and 296,460 comments. The majority of the videos (n=59) used music and over one-third (n=37) used humor. The only content category observed in the majority of the videos sampled was the promotion of vaping, which was included in 57 videos that garnered over 74 million views (47.5% of cumulative views). A total of 42% (n=42) of the 100 videos sampled featured someone vaping or in the presence of vape pens, and these videos garnered over 22% (>35 million) of the total views. Conclusions: It is necessary for public health agencies to improve understanding of the nature and content of videos that attract viewers’ attention and harness the strength of this communication channel to promote informed decision-making about vaping. %M 34694231 %R 10.2196/30681 %U https://pediatrics.jmir.org/2021/4/e30681 %U https://doi.org/10.2196/30681 %U http://www.ncbi.nlm.nih.gov/pubmed/34694231 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e28303 %T e-Cigarette Cessation: Content Analysis of a Quit Vaping Community on Reddit %A Struik,Laura %A Yang,Youjin %+ School of Nursing, Department of Health and Social Development, University of British Columbia Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 2508079972, laura.struik@ubc.ca %K qualitative research %K electronic nicotine delivery systems %K vaping %K cessation %K social media %D 2021 %7 25.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: e-Cigarette use, also known as vaping, has increased dramatically over the past few years, especially among younger demographics. However, researchers have found that a large number of e-cigarette users want to quit. Little is known about the unique aspects of vaping cessation, which is critical to informing the development of relevant resources and interventions for e-cigarette users who want to quit. Social media forums such as Reddit provide opportunities to understand the experiences of behavior change such as quitting vaping from the perspective of end users. Objective: This study aims to examine a quit vaping subreddit to understand how e-cigarette users are experiencing and approaching vaping cessation. Specifically, we examine methods used to approach quitting, reasons for quitting, and barriers and facilitators to quitting. Methods: A total of 1228 posts were collected. The posts were inductively coded to generate categories and subcategories using conventional content analysis. Data were analyzed using the NVivo 12 qualitative data analysis software. Results: Most users reported a preference for approaching quitting through gradual reduction, particularly through the use of their own devices by tapering the nicotine content. Their reasons for quitting were primarily related to experiencing negative physical consequences associated with vaping, especially in relation to their lungs (eg, tight chest), and tired of feeling stuck to the vape because of nicotine addiction. Top barriers to quitting were related to withdrawal symptoms and intensity of addiction. The top facilitators to quitting were related to using distraction techniques (eg, hobby, gaming, and mindfulness exercises), as well as having a positive mindset. Conclusions: The findings of this study reveal unique aspects that encompass the process of quitting vaping. These findings have significant implications for both policy and intervention development. %M 34694229 %R 10.2196/28303 %U https://www.jmir.org/2021/10/e28303 %U https://doi.org/10.2196/28303 %U http://www.ncbi.nlm.nih.gov/pubmed/34694229 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e29913 %T Six-Month Outcomes from the NEXit Junior Trial of a Text Messaging Smoking Cessation Intervention for High School Students: Randomized Controlled Trial With Bayesian Analysis %A Bendtsen,Marcus %A Bendtsen,Preben %A Müssener,Ulrika %+ Department of Health, Medicine and Caring Sciences, Linköping University, Building 511, Linköping, 58183, Sweden, 46 13286975, marcus.bendtsen@liu.se %K smoking %K cessation %K text messaging %K high school %K randomized controlled trial %K intervention %K student %K young adult %K teenager %K outcome %K Bayesian %K Sweden %K prevalence %K lifestyle %K behavior %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The prevalence of daily or occasional smoking among high school students in Sweden was approximately 20% in 2019, which is problematic since lifestyle behaviors are established in adolescence and track into adulthood. The Nicotine Exit (NEXit) Junior trial was conducted in response to a lack of evidence for the effects of text message smoking cessation interventions among high school students in Sweden. Objective: The aim of this study was to estimate the 3- and 6-month effects of a text messaging intervention among high school students in Sweden on smoking cessation outcomes. Methods: A 2-arm, single-blind randomized controlled trial was employed to estimate the effects of the intervention on smoking cessation in comparison to treatment as usual. Participants were recruited from high schools in Sweden using advertising and promotion by school staff from January 10, 2018, to January 10, 2019. Weekly or daily smokers who were willing to make a quit attempt were eligible for inclusion. Prolonged abstinence and point prevalence of smoking cessation were measured at 3 and 6 months after randomization. Results: Complete case analysis was possible on 57.9% (310/535) of the participants at 6 months, with no observed statistically significant effect on 5-month prolonged abstinence (odds ratio [OR] 1.27, 95% CI 0.73-2.20; P=.39) or 4-week smoking cessation (OR 1.42; 95% CI 0.83-2.46; P=.20). Sensitivity analyses using imputation yielded similar findings. Unplanned Bayesian analyses showed that the effects of the intervention were in the anticipated direction. The findings were limited by the risk of bias induced by high attrition (42.1%). The trial recruited high school students in a pragmatic setting and included both weekly and daily smokers; thus, generalization to the target population is more direct compared with findings obtained under more strict study procedures. Conclusions: Higher than expected attrition rates to follow-up 6 months after randomization led to null hypothesis tests being underpowered; however, unplanned Bayesian analyses found that the effects of the intervention were in the anticipated direction. Future trials of smoking cessation interventions targeting high school students should aim to prepare strategies for increasing retention to mid- and long-term follow-up. Trial Registration: IRCTN Registry ISRCTN15396225; https://www.isrctn.com/ISRCTN15396225 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-3028-2 %M 34673532 %R 10.2196/29913 %U https://mhealth.jmir.org/2021/10/e29913 %U https://doi.org/10.2196/29913 %U http://www.ncbi.nlm.nih.gov/pubmed/34673532 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e32365 %T Understanding Uptake of Digital Health Products: Methodology Tutorial for a Discrete Choice Experiment Using the Bayesian Efficient Design %A Szinay,Dorothy %A Cameron,Rory %A Naughton,Felix %A Whitty,Jennifer A %A Brown,Jamie %A Jones,Andy %+ Behavioural and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich Research Park Earlham Road, Norwich, NR4 7TJ, United Kingdom, 44 1603593064, d.szinay@uea.ac.uk %K discrete choice experiment %K stated preference methods %K mHealth %K digital health %K quantitative methodology %K uptake %K engagement %K methodology %K preference %K Bayesian %K design %K tutorial %K qualitative %K user preference %D 2021 %7 11.10.2021 %9 Tutorial %J J Med Internet Res %G English %X Understanding the preferences of potential users of digital health products is beneficial for digital health policy and planning. Stated preference methods could help elicit individuals’ preferences in the absence of observational data. A discrete choice experiment (DCE) is a commonly used stated preference method—a quantitative methodology that argues that individuals make trade-offs when engaging in a decision by choosing an alternative of a product or a service that offers the greatest utility, or benefit. This methodology is widely used in health economics in situations in which revealed preferences are difficult to collect but is much less used in the field of digital health. This paper outlines the stages involved in developing a DCE. As a case study, it uses the application of a DCE to reveal preferences in targeting the uptake of smoking cessation apps. It describes the establishment of attributes, the construction of choice tasks of 2 or more alternatives, and the development of the experimental design. This tutorial offers a guide for researchers with no prior knowledge of this research technique. %M 34633290 %R 10.2196/32365 %U https://www.jmir.org/2021/10/e32365 %U https://doi.org/10.2196/32365 %U http://www.ncbi.nlm.nih.gov/pubmed/34633290 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e27478 %T Adaptation and Assessment of a Text Messaging Smoking Cessation Intervention in Vietnam: Pilot Randomized Controlled Trial %A Jiang,Nan %A Nguyen,Nam %A Siman,Nina %A Cleland,Charles M %A Nguyen,Trang %A Doan,Hue Thi %A Abroms,Lorien C %A Shelley,Donna R %+ Department of Population Health, Grossman School of Medicine, New York University, 180 Madison Ave, Room #17-54, New York, NY, 10016, United States, 1 646 501 3553, Nan.Jiang@nyulangone.org %K smoking cessation %K text messaging %K mHealth %K mobile health %K low- and middle-income country %K smoking %K developing countries %K SMS %K Vietnam %D 2021 %7 8.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text message (ie, short message service, SMS) smoking cessation interventions have demonstrated efficacy in high-income countries but are less well studied in low- and middle-income countries, including Vietnam. Objective: The goal of the research is to assess the feasibility, acceptability, and preliminary efficacy of a fully automated bidirectional SMS cessation intervention adapted for Vietnamese smokers. Methods: The study was conducted in 3 phases. In phase 1, we adapted the SMS library from US-based SMS cessation programs (ie, SmokefreeTXT and Text2Quit). The adaptation process consisted of 7 focus groups with 58 smokers to provide data on culturally relevant patterns of tobacco use and assess message preferences. In phase 2, we conducted a single-arm pilot test of the SMS intervention with 40 smokers followed by in-depth interviews with 10 participants to inform additional changes to the SMS library. In phase 3, we conducted a 2-arm pilot randomized controlled trial (RCT) with 100 smokers. Participants received either the SMS program (intervention; n=50) or weekly text assessment on smoking status (control; n=50). The 6-week SMS program consisted of a 2-week prequit period and a 4-week postquit period. Participants received 2 to 4 automated messages per day. The main outcomes were engagement and acceptability which were assessed at 6 weeks (end of intervention). We assessed biochemically confirmed smoking abstinence at 6 weeks and 12 weeks. Postintervention in-depth interviews explored user experiences among a random sample of 16 participants in the intervention arm. Results: Participants in both arms reported high levels of engagement and acceptability. Participants reported using the program for an average of 36.4 (SD 3.4) days for the intervention arm and 36.0 (SD 3.9) days for the control arm. Four of the 50 participants in the intervention arm (8%) reset the quit date and 19 (38%) texted the keyword TIPS. The majority of participants in both arms reported that they always or usually read the text messages. Compared to the control arm, a higher proportion of participants in the intervention arm reported being satisfied with the program (98% [49/50] vs 82% [41/50]). Biochemically verified abstinence was higher in the intervention arm at 6 weeks (20% [10/50] vs 2% [1/50]; P=.01), but the effect was not significant at 12 weeks (12% [6/50] vs 6% [3/50]; P=.49). In-depth interviews conducted after the RCT suggested additional modifications to enhance the program including tailoring the timing of messages, adding more opportunities to interact with the program, and placing a greater emphasis on messages that described the harms of smoking. Conclusions: The study supported the feasibility and acceptability of an SMS program adapted for Vietnamese smokers. Future studies need to assess whether, with additional modifications, the program is associated with prolonged abstinence. Trial Registration: ClinicalTrials.gov NCT03219541; https://clinicaltrials.gov/ct2/show/NCT03219541 %M 34623318 %R 10.2196/27478 %U https://mhealth.jmir.org/2021/10/e27478 %U https://doi.org/10.2196/27478 %U http://www.ncbi.nlm.nih.gov/pubmed/34623318 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 4 %P e24984 %T Secondhand Smoke Exposure of Expectant Mothers in China: Factoring in the Role of Culture in Data Collection %A Su,Zhaohui %A McDonnell,Dean %A Abbas,Jaffar %A Shi,Lili %A Cai,Yuyang %A Yang,Ling %+ Center on Smart and Connected Health Technologies, Mays Cancer Center, School of Nursing, University of Texas Health San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States, 1 5128399965, szh@utexas.edu %K cancer %K secondhand smoking %K secondhand smoke %K expectant mothers %K pregnant women %K China %K transitional Chinese culture %K “doing the month” %K smoking %K pregnancy %K women %K China %K culture %K behavior %D 2021 %7 7.10.2021 %9 Viewpoint %J JMIR Cancer %G English %X Cancer is the leading cause of death worldwide. Tobacco smoking, including secondhand smoking, causes cancer and is responsible for over 22% of global cancer deaths. The adverse impacts of secondhand smoke are more pronounced for expectant mothers, and can deteriorate both mothers’ and infants’ health and well-being. Research suggests that secondhand smoke significantly increases expectant mothers’ risk of miscarriage, cancer, and other chronic disease conditions, and exposes their unborn babies to an increased likelihood of having life-long poor health. In China, a pregnant woman’s family members, such as her husband, parents, or in-laws, are the most likely people to be smoking around her. Due to traditional Chinese cultural practices, even though some expectant mothers understand the harm of secondhand smoke, they may be reluctant to report their family members’ smoking behaviors. Resulting in severe underreporting, this compromises health experts’ ability to understand the severity of the issue. This paper proposes a novel approach to measure secondhand smoke exposure of pregnant women in the Chinese context. The proposed system could act as a stepping stone that inspires creative methods to help researchers more accurately measure secondhand smoking rates of expectant mothers in China. This, in turn, could help health experts better establish cancer control measures for expectant mothers and decrease their cancer risk. %M 34617907 %R 10.2196/24984 %U https://cancer.jmir.org/2021/4/e24984 %U https://doi.org/10.2196/24984 %U http://www.ncbi.nlm.nih.gov/pubmed/34617907 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30947 %T mHealth Messaging to Motivate Quitline Use and Quitting: Protocol for a Community-Based Randomized Controlled Trial in Rural Vietnam %A Larkin,Celine %A Wijesundara,Jessica %A Nguyen,Hoa L %A Ha,Duc Anh %A Vuong,Anh %A Nguyen,Cuong Kieu %A Amante,Daniel %A Ngo,Chau Quy %A Phan,Phuong Thu %A Pham,Quyen Thi Le %A Nguyen,Binh Ngoc %A Nguyen,Anh Thi Phuong %A Nguyen,Phuong Thi Thu %A Person,Sharina %A Allison,Jeroan J %A Houston,Thomas K %A Sadasivam,Rajani %+ Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 5084211436, celine.larkin@umassmed.edu %K tobacco cessation %K smoking cessation %K mHealth %K global health %K Vietnam %K randomized controlled trial %D 2021 %7 7.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco kills more than 8 million people each year, mostly in low- and middle-income countries. In Vietnam, 1 in every 2 male adults smokes tobacco. Vietnam has set up telephone Quitline counseling that is available to all smokers, but it is underused. We previously developed an automated and effective motivational text messaging system to support smoking cessation among US smokers. Objective: The aim of this study is to adapt the aforementioned system for rural Vietnamese smokers to promote cessation of tobacco use, both directly and by increasing the use of telephone Quitline counseling services and nicotine replacement therapy. Moreover, we seek to enhance research and health service capacity in Vietnam. Methods: We are testing the effectiveness of our culturally adapted motivational text messaging system by using a community-based randomized controlled trial design (N=600). Participants were randomly allocated to the intervention (regular motivational and assessment text messages) or control condition (assessment text messages only) for a period of 6 months. Trial recruitment took place in four communes in the Hung Yen province in the Red River Delta region of Vietnam. Recruitment events were advertised to the local community, facilitated by community health workers, and occurred in the commune health center. We are assessing the impact of the texting system on 6-month self-reported and biochemically verified smoking cessation, as well as smoking self-efficacy, uptake of the Quitline, and use of nicotine replacement therapy. In addition to conducting the trial, the research team also provided ongoing training and consultation with the Quitline during the study period. Results: Site preparation, staff training, intervention adaptation, participant recruitment, and baseline data collection were completed. The study was funded in August 2017; it was reviewed and approved by the University of Massachusetts Medical School Institutional Review Board in 2017. Recruitment began in November 2018. A total of 750 participants were recruited from four communes, and 700 (93.3%) participants completed follow-up by March 2021. An analysis of the trial results is in progress; results are expected to be published in late 2022. Conclusions: This study examines the effectiveness of mobile health interventions for smoking in rural areas in low- and middle-income countries, which can be implemented nationwide if proven effective. In addition, it also facilitates significant collaboration and capacity building among a variety of international partners, including researchers, policy makers, Quitline counselors, and community health workers. Trial Registration: ClinicalTrials.gov NCT03567993; https://clinicaltrials.gov/ct2/show/NCT03567993. International Registered Report Identifier (IRRID): DERR1-10.2196/30947 %M 34617915 %R 10.2196/30947 %U https://www.researchprotocols.org/2021/10/e30947 %U https://doi.org/10.2196/30947 %U http://www.ncbi.nlm.nih.gov/pubmed/34617915 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e27417 %T Smoking Protective and Risk Factors Among Transgender and Gender-Expansive Individuals (Project SPRING): Qualitative Study Using Digital Photovoice %A Tan,Andy SL %A Gazarian,Priscilla K %A Darwish,Sabreen %A Hanby,Elaine %A Farnham,Bethany C %A Koroma-Coker,Faith A %A Potter,Jennifer %A Ballout,Suha %+ Annenberg School for Communication, University of Pennsylvania, 3620 Walnut Street, Annenberg School at UPenn, Philadelphia, PA, 19104, United States, 1 4436161129, andy.tan@asc.upenn.edu %K transgender and gender expansive populations %K tobacco-related health disparities %K United States %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Transgender and gender-expansive (TGE) adults are twice as likely to smoke cigarettes than cisgender individuals. There is a critical gap in research on effective and culturally sensitive approaches to reduce smoking prevalence among TGE adults. Objective: This study aims to qualitatively examine the risk and protective factors of cigarette smoking among TGE adults through real-world exemplars. Methods: We conducted a digital photovoice study among a purposeful sample of 47 TGE adults aged ≥18 years and currently smoking in the United States (March 2019-April 2020). Participants uploaded photos daily that depicted smoking risk and protective factors they experienced over 21 days on either private Facebook or Instagram groups. Next, we conducted separate focus group discussions to explore the experiences of these factors among a subset of participants from each group. We analyzed participants’ photos, captions, and focus group transcripts and generated themes associated with smoking risk and protective factors. Results: We identified 6 major themes of risk and protective factors of smoking among TGE individuals: experience of stress, gender affirmation, health consciousness, social influences, routine behaviors, and environmental cues. We describe and illustrate each theme using exemplar photos and quotes. Conclusions: The findings of this study will inform future community-engaged research to develop culturally tailored interventions to reduce smoking prevalence among TGE individuals. %M 34612842 %R 10.2196/27417 %U https://publichealth.jmir.org/2021/10/e27417 %U https://doi.org/10.2196/27417 %U http://www.ncbi.nlm.nih.gov/pubmed/34612842 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27801 %T Remote Patient Monitoring and Incentives to Support Smoking Cessation Among Pregnant and Postpartum Medicaid Members: Three Randomized Controlled Pilot Studies %A Joyce,Caroline M %A Saulsgiver,Kathryn %A Mohanty,Salini %A Bachireddy,Chethan %A Molfetta,Carin %A Steffy,Mary %A Yoder,Alice %A Buttenheim,Alison M %+ Department of Epidemiology, Faculty of Medicine, McGill University, 845 Sherbrooke Street W, Montreal, QC, H3A 0G4, Canada, 1 514 398 6258, Caroline.joyce@mail.mcgill.ca %K maternal smoking %K smoking cessation %K financial incentives %K smoking %K pregnant %K postpartum %K incentives %K mHealth %K mobile health %K mobile phone %K smart devices %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking rates among low-income individuals, including those eligible for Medicaid, have not shown the same decrease that is observed among high-income individuals. The rate of smoking among pregnant women enrolled in Medicaid is almost twice that among privately insured women, which leads to significant disparities in birth outcomes and a disproportionate cost burden placed on Medicaid. Several states have identified maternal smoking as a key target for improving birth outcomes and reducing health care expenditures; however, efficacious, cost-effective, and feasible cessation programs have been elusive. Objective: This study aims to examine the feasibility, acceptability, and effectiveness of a smartwatch-enabled, incentive-based smoking cessation program for Medicaid-eligible pregnant smokers. Methods: Pilot 1 included a randomized pilot study of smartwatch-enabled remote monitoring versus no remote monitoring for 12 weeks. Those in the intervention group also received the SmokeBeat program. Pilot 2 included a randomized pilot study of pay-to-wear versus pay-to-quit for 4 weeks. Those in a pay-to-wear program could earn daily incentives for wearing the smartwatch, whereas those in pay-to-quit program could earn daily incentives if they wore the smartwatch and abstained from smoking. Pilot 3, similar to pilot 2, had higher incentives and a duration of 3 weeks. Results: For pilot 1 (N=27), self-reported cigarettes per week among the intervention group declined by 15.1 (SD 27) cigarettes over the study; a similar reduction was observed in the control group with a decrease of 17.2 (SD 19) cigarettes. For pilot 2 (N=8), self-reported cigarettes per week among the pay-to-wear group decreased by 43 cigarettes (SD 12.6); a similar reduction was seen in the pay-to-quit group, with an average of 31 (SD 45.6) fewer cigarettes smoked per week. For pilot 3 (N=4), one participant in the pay-to-quit group abstained from smoking for the full study duration and received full incentives. Conclusions: Decreases in smoking were observed in both the control and intervention groups during all pilots. The use of the SmokeBeat program did not significantly improve cessation. The SmokeBeat program, remote cotinine testing, and remote delivery of financial incentives were considered feasible and acceptable. Implementation challenges remain for providing evidence-based cessation incentives to low-income pregnant smokers. The feasibility and acceptability of the SmokeBeat program were moderately high. Moreover, the feasibility and acceptability of remote cotinine testing and the remotely delivered contingent financial incentives were successful. Trial Registration: ClinicalTrials.gov NCT03209557; https://clinicaltrials.gov/ct2/show/NCT03209557. %M 34591023 %R 10.2196/27801 %U https://formative.jmir.org/2021/9/e27801 %U https://doi.org/10.2196/27801 %U http://www.ncbi.nlm.nih.gov/pubmed/34591023 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28037 %T Acceptability Evaluation of the Use of Virtual Reality Games in Smoking-Prevention Education for High School Students: Prospective Observational Study %A Guo,Jong-Long %A Hsu,Hsiao-Pei %A Lai,Tzu-Ming %A Lin,Mei-Ling %A Chung,Chih-Ming %A Huang,Chiu-Mieh %+ Institute of Clinical Nursing, College of Nursing, National Yang Ming Chiao Tung University, No.155, Sec.2, Linong Street, Taipei, 112, Taiwan, 886 2 28267362, cmhuang2021@nycu.edu.tw %K behavioral intention %K ARCS motivation model %K persuasiveness %K smoking prevention %K educational games %D 2021 %7 28.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Alternative forms of cigarettes, such as electronic cigarettes (e-cigarettes), are becoming increasingly common among adolescents. Many high schools now provide smoking-prevention education in an attempt to minimize the potential negative health effects and illness burdens e-cigarettes may induce in adolescents. However, it is often difficult to motivate young students to engage with traditional education regarding the harmful effects of tobacco; thus, the development of alternative approaches may be required. Objective: In this study, we aimed to conduct an acceptability evaluation of educational virtual reality games designed to support smoking-prevention measures. We based the acceptability evaluation on the following two experience types: game-playing and content-learning experiences. The paths by which these experience types affect the intention to abstain from smoking were also examined. Methods: We applied a prospective observational study design. We developed educational games based on three-dimensional virtual reality technology, in which participants operated joysticks to complete challenge tasks. To increase the possibility of the games fostering motivation to abstain from smoking, the ARCS motivational model (comprising attention, relevance, confidence, and satisfaction) was used as a framework during the games’ design. We measured the participants’ game-playing experiences by inquiring about the strength of the ARCS elements; content-learning experiences were measured using overall knowledge improvement and the perceived persuasiveness of the content. A total of 130 students participated in the program. Study hypotheses for this evaluation were derived from a literature review. We used partial least squares structural equation modeling to examine the proposed hypotheses. Results: Based on the responses of the students to questionnaire items concerning attention, relevance, confidence, and satisfaction in the context of the games, most students agreed or strongly agreed that the educational games were motivational, and that their game-playing experiences were positive. Regarding content-learning experiences, there was a significant improvement in knowledge (t129=25.67, P<.001), and most students perceived themselves as being persuaded to abstain from smoking. Attention, relevance, and satisfaction significantly influenced perceived persuasiveness (t=3.19, P<.001; t=4.28, P<.001; and t=3.49, P<.001, respectively); however, confidence did not (t=0.42, P=.67). Perceived persuasiveness, relevance, and satisfaction significantly influenced the intention to abstain from smoking (t=3.57, P<.001). In addition to directly affecting the intention to abstain from smoking, indirect effects were observed from both relevance and satisfaction to intention via perceived persuasiveness (t=2.87, P=.004 and t=2.11, P=.04, respectively). However, intention was not significantly influenced by knowledge improvement. Conclusions: Our findings revealed that the educational games were positively accepted by the participating students. This indicates that the integration of the ARCS framework and persuasive strategies is applicable for smoking-prevention education. We recommend that the games be included as teaching materials for smoking-prevention education. %M 34581679 %R 10.2196/28037 %U https://www.jmir.org/2021/9/e28037 %U https://doi.org/10.2196/28037 %U http://www.ncbi.nlm.nih.gov/pubmed/34581679 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e25883 %T Evaluating Outcomes of a Social Media–Based Peer and Clinician-Supported Smoking Cessation Program in Preventing Smoking Relapse: Mixed Methods Case Study %A Isse,Naohi %A Tachibana,Yuki %A Kinoshita,Makiko %A Fetters,Michael D %+ Department of General Medicine, Ako Municipal Hospital, 1090 Nakahiro, Ako, 6780232, Japan, 81 791 433 222, issenaohi@yahoo.co.jp %K communication %K mixed methods case study research %K online social networking %K smoking cessation %K smoking relapse %D 2021 %7 20.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking relapse prevention after completion of a smoking cessation program is highly germane to reducing smoking rates. Objective: The purpose of this study was to evaluate the 1-year outcomes of a social media–based and peer and clinician-supported smoking cessation program on Facebook and examine communication patterns that could support smoking cessation and identify risk of relapse. Methods: We used a mixed methods case study evaluation approach featuring a single-case holistic design. We recruited volunteers who signed up after successful completion of a 12-week clinical smoking cessation program in a general medicine department in Japan. Participants contemporaneously accessed a closed Facebook page, and we analyzed their posts including text and emoticons. We used joint display analysis, which involved iterative structuring and restructuring construct-specific tables with both types of data to find the most effective approach for integrating the quantitative results with the qualitative results of content analysis. Results: One successful participant and 2 relapsed participants were analyzed to explore the specific patterns of postings prior to relapse. Decisive comments about quitting smoking were common among participants, but encouraging messages for peers were more common from the successful participant. Comments seeking social support and reassurance were warning signs of relapse. Conflicted comments also may be a warning sign of relapse risk. Conclusions: These findings based on a mixed methods case study of a social media platform supporting smoking cessation could be used to guide messaging in other online social networking service communities after a smoking cessation program to help reduce smoking relapse. Trial Registration: UMIN Clinical Trials Registry UMIN000031172; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000035595 %M 34542412 %R 10.2196/25883 %U https://formative.jmir.org/2021/9/e25883 %U https://doi.org/10.2196/25883 %U http://www.ncbi.nlm.nih.gov/pubmed/34542412 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e24307 %T Virtual Reality Technology Use in Cigarette Craving and Smoking Interventions (I “Virtually” Quit): Systematic Review %A Keijsers,Merel %A Vega-Corredor,Maria Cecilia %A Tomintz,Melanie %A Hoermann,Simon %+ School of Product Design, College of Engineering, University of Canterbury, 9 Engineering Road, Christchurch, 8041, New Zealand, 64 3 369 2457, simon.hoermann@canterbury.ac.nz %K virtual reality technology %K nicotine dependency %K nicotine addiction %K smoking addiction %K smoking intervention %K smoking therapy %K Electronic Nicotine Delivery Systems %D 2021 %7 17.9.2021 %9 Review %J J Med Internet Res %G English %X Background: Over the last 2 decades, virtual reality technologies (VRTs) have been proposed as a way to enhance and improve smoking cessation therapy. Objective: This systematic review aims to evaluate and summarize the current knowledge on the application of VRT in various smoking cessation therapies, as well as to explore potential directions for future research and intervention development. Methods: A literature review of smoking interventions using VRT was conducted. Results: Not all intervention studies included an alternative therapy or a placebo condition against which the effectiveness of the intervention could be benchmarked, or a follow-up measure to ensure that the effects were lasting. Virtual reality (VR) cue exposure therapy was the most extensively studied intervention, but its effect on long-term smoking behavior was inconsistent. Behavioral therapies such as a VR approach-avoidance task or gamified interventions were less common but reported positive results. Notably, only 1 study combined Electronic Nicotine Delivery Devices with VRT. Conclusions: The inclusion of a behavioral component, as is done in the VR approach-avoidance task and gamified interventions, may be an interesting avenue for future research on smoking interventions. As Electronic Nicotine Delivery Devices are still the subject of much controversy, their potential to support smoking cessation remains unclear. For future research, behavioral or multicomponent interventions are promising avenues of exploration. Future studies should improve their validity by comparing their intervention group with at least 1 alternative or placebo control group, as well as incorporating follow-up measures. %M 34533471 %R 10.2196/24307 %U https://www.jmir.org/2021/9/e24307 %U https://doi.org/10.2196/24307 %U http://www.ncbi.nlm.nih.gov/pubmed/34533471 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27162 %T Effectiveness of a Dyadic Buddy App for Smoking Cessation: Randomized Controlled Trial %A Schwaninger,Philipp %A Berli,Corina %A Scholz,Urte %A Lüscher,Janina %+ Applied Social and Health Psychology, Department of Psychology, University of Zurich, Binzmühlestrasse 14/14, Zurich, 8050, Switzerland, 41 44 635 72 25, philipp.schwaninger@psychologie.uzh.ch %K mHealth %K smartphone app %K smoking cessation %K buddy %K social support %K mobile phone %D 2021 %7 9.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Tobacco smoking is one of the biggest public health threats. Smartphone apps offer new promising opportunities for supporting smoking cessation in real time. This randomized controlled trial investigated the effectiveness of an app that encourages individuals to quit smoking with the help of a social network member (buddy) in daily life. Objective: The objective of this study is to test the effectiveness of the SmokeFree buddy app compared with a control group with self-reported smoking abstinence and carbon monoxide (CO)–verified smoking abstinence as primary outcomes and self-reports of smoked cigarettes per day (CPD) as a secondary outcome. Methods: A total of 162 adults who smoked participated in this single-blind, two-arm, parallel-group, intensive longitudinal randomized controlled trial. Around a self-set quit date (ie, 7 days before the self-set quit date and 20 days after) and 6 months later, participants of the intervention and control groups reported on daily smoking abstinence and CPD in end-of-day diaries. Daily smoking abstinence was verified via daily exhaled CO assessments. This assessment was administered via an app displaying results of exhaled CO, thus addressing self-monitoring in both groups. In addition, participants in the intervention group used the SmokeFree buddy app, a multicomponent app that facilitates social support from a buddy of choice. Results: A significant reduction in CPD from baseline to the 6-month follow-up was observed among participants in both groups. Multilevel analyses revealed no significant intervention effect on self-reported and CO-verified daily smoking abstinence at the quit date and 3 weeks later. However, CPD was lower at the quit date and 3 weeks later in the intervention group than in the control group. No significant differences between groups were found for any outcome measures 6 months after the quit date. Overall, low app engagement and low perceived usefulness were observed. Conclusions: Despite some encouraging short-term findings on the amount of smoking, the SmokeFree buddy app did not have beneficial effects on smoking abstinence over and above the self-monitoring control condition. Future studies should examine whether and what support processes can be effectively stimulated and how app use can be improved to better achieve this goal. Trial Registration: ISRCTN Registry 11154315; https://www.isrctn.com/ISRCTN11154315 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-019-7723-z %M 34499045 %R 10.2196/27162 %U https://www.jmir.org/2021/9/e27162 %U https://doi.org/10.2196/27162 %U http://www.ncbi.nlm.nih.gov/pubmed/34499045 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e24408 %T Image Processing for Public Health Surveillance of Tobacco Point-of-Sale Advertising: Machine Learning–Based Methodology %A English,Ned %A Anesetti-Rothermel,Andrew %A Zhao,Chang %A Latterner,Andrew %A Benson,Adam F %A Herman,Peter %A Emery,Sherry %A Schneider,Jordan %A Rose,Shyanika W %A Patel,Minal %A Schillo,Barbara A %+ NORC at the University of Chicago, 55 E Monroe St, Ste 3100, Chicago, IL, 60603, United States, 1 3127594010, english-ned@norc.org %K machine learning %K image classification %K convolutional neural network %K object detection %K crowdsourcing %K tobacco point of sale %K public health surveillance %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: With a rapidly evolving tobacco retail environment, it is increasingly necessary to understand the point-of-sale (POS) advertising environment as part of tobacco surveillance and control. Advances in machine learning and image processing suggest the ability for more efficient and nuanced data capture than previously available. Objective: The study aims to use machine learning algorithms to discover the presence of tobacco advertising in photographs of tobacco POS advertising and their location in the photograph. Methods: We first collected images of the interiors of tobacco retailers in West Virginia and the District of Columbia during 2016 and 2018. The clearest photographs were selected and used to create a training and test data set. We then used a pretrained image classification network model, Inception V3, to discover the presence of tobacco logos and a unified object detection system, You Only Look Once V3, to identify logo locations. Results: Our model was successful in identifying the presence of advertising within images, with a classification accuracy of over 75% for 8 of the 42 brands. Discovering the location of logos within a given photograph was more challenging because of the relatively small training data set, resulting in a mean average precision score of 0.72 and an intersection over union score of 0.62. Conclusions: Our research provides preliminary evidence for a novel methodological approach that tobacco researchers and other public health practitioners can apply in the collection and processing of data for tobacco or other POS surveillance efforts. The resulting surveillance information can inform policy adoption, implementation, and enforcement. Limitations notwithstanding, our analysis shows the promise of using machine learning as part of a suite of tools to understand the tobacco retail environment, make policy recommendations, and design public health interventions at the municipal or other jurisdictional scale. %M 34448700 %R 10.2196/24408 %U https://www.jmir.org/2021/8/e24408 %U https://doi.org/10.2196/24408 %U http://www.ncbi.nlm.nih.gov/pubmed/34448700 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e24112 %T Mobile Health for Smoking Cessation Among Disadvantaged Young Women During and After Pregnancy: User-Centered Design and Usability Study %A Derksen,Marloes E %A Jaspers,Monique WM %A van Strijp,Sander %A Fransen,Mirjam P %+ Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 20 5664494, m.e.derksen@amsterdamumc.nl %K think aloud %K heuristic evaluation %K usability %K mHealth %K game elements %K smoking prevention %K user-centered design %K mobile phone %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking prevalence during and after pregnancy remains high among socioeconomically disadvantaged women. Mobile health (mHealth) apps with game and social support elements seem promising to support smoking cessation. Objective: This study aims to describe the user-centered design and usability evaluation of Kindle, an mHealth app with game and social support elements, to support disadvantaged young women during and after pregnancy through the first stages of smoking cessation. Methods: Disadvantaged women (n=9), members of their social networks (n=4), and nurses supporting these women (n=51) were informants throughout the iterative prototype development of Kindle according to the International Organization for Standardization 9241-11:2018. Specific phases included understanding the context of use through secondary analysis of qualitative interview data (phase 1), establishing the user and organizational requirements (phase 2), production of design solutions (phase 3), and usability inspection of the prototype through a heuristic evaluation (3 experts) along with user testing by a think aloud method (5 disadvantaged women and 5 nurses; phase 4). Usability problems were categorized according to the principles of the Healthcare Information and Management Systems Society. Results: Phase 1 resulted in an understanding of the VoorZorg program and the needs of VoorZorg nurses and clients (eg, focus on early stages of change and building new supportive networks to aid clients in smoking cessation). In phase 2, we established requirements (n=22; eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring at early stages of change in smoking cessation). Phase 3 resulted in a prototype of Kindle, combining the interface for nurses and clients, including the following functionalities: personal goal setting with earning points; secured chat function between nurses and other clients; and tips, diary, and profile creation. The heuristic evaluation and thinking aloud method in phase 4 revealed 78 usability problems in the interfaces. Most usability problems concerned simplicity (eg, unclear clickable button) and naturalness (eg, unclear icon). Conclusions: The user-centered design and usability testing of the mHealth app Kindle yielded useful insights. The involvement of end users, specifically socioeconomically disadvantaged women during and after their pregnancy, resulted in a prototype that met their needs and requirements (eg, mHealth app, secure communication between nurses and clients, easy-to-use interfaces, inclusion of game elements, and tailoring to the early stages of change in smoking cessation) to achieve readiness for smoking cessation. Moreover, the usability evaluation by end users and experts revealed unique usability problems for this population. These insights allow for further optimization of Kindle and encourage future studies to engage disadvantaged populations in all phases of mHealth intervention design and usability testing. %M 34346895 %R 10.2196/24112 %U https://formative.jmir.org/2021/8/e24112 %U https://doi.org/10.2196/24112 %U http://www.ncbi.nlm.nih.gov/pubmed/34346895 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e30241 %T An Avatar-Led Digital Smoking Cessation Program for Sexual and Gender Minority Young Adults: Intervention Development and Results of a Single-Arm Pilot Trial %A Heffner,Jaimee L %A Watson,Noreen L %A Serfozo,Edit %A Kelly,Megan M %A Reilly,Erin D %A Kim,Daniella %A Baker,Kelsey %A Scout,N F N %A Karekla,Maria %+ Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, Seattle, WA, 98109, United States, 1 2066677314, jheffner@fredhutch.org %K LGBT %K embodied agent %K tobacco cessation %K nicotine dependence %K user-centered design %K avatar %K digital health %K minority %K young adult %K teenager %K smoking %K cessation %K intervention %K development %K pilot trial %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual and gender minority young adults have a high prevalence of smoking and unique barriers to accessing tobacco treatment. Objective: To address these challenges as well as their preferences for sexual and gender minority–targeted interventions and digital programs, we developed and evaluated the acceptability, preliminary efficacy, and impact on theory-based change processes of an acceptance and commitment therapy–based digital program called Empowered, Queer, Quitting, and Living (EQQUAL). Methods: Participants (n=22) of a single-arm trial conducted to evaluate the program were young adults, age 18 to 30 years, who self-identified as sexual and gender minority individuals and smoked at least one cigarette per day. All participants received access to the EQQUAL program. Participants completed web-based surveys at baseline and at a follow-up 2 months after enrollment. We verified self-reported smoking abstinence with biochemical testing; missing data were counted as smoking or using tobacco. Results: For young adults who logged in at least once (n=18), the mean number of log-ins was 5.5 (SD 3.6), mean number of sessions completed was 3.1 (SD 2.6), and 39% (7/18) completed all 6 sessions. Overall, 93% of participants (14/15) were satisfied with the EQQUAL program, 100% (15/15) found it easy to use, and 100% (15/15) said it helped them be clearer about how to quit. Abstinence from smoking or using tobacco was confirmed with biochemical testing for 23% of participants (5/22). Both quantitative and qualitative results suggested a positive overall response to the avatar guide, with areas for future improvement largely centered on the avatar’s appearance and movements. Conclusions: Treatment acceptability of EQQUAL was very promising. The rate of abstinence, which was biochemically confirmed, was 3 times higher than that of the only other digital program to date that has targeted sexual and gender minority young adults and 6 to 13 times higher than those of nontargeted digital smoking interventions among sexual and gender minority young adults. Planned improvements for the next iteration of the program include making the avatar’s movements more natural; offering multiple avatar guides with different on characteristics such as race, ethnicity, and gender identity from which to choose; and providing a support forum for users to connect anonymously with peers. %M 34328430 %R 10.2196/30241 %U https://formative.jmir.org/2021/7/e30241 %U https://doi.org/10.2196/30241 %U http://www.ncbi.nlm.nih.gov/pubmed/34328430 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e25390 %T Integrated Smoking Cessation for Smokers With Serious Mental Illness: Protocol for a Convergent Mixed Methods Implementation Evaluation Study %A Schnitzer,Kristina %A Maravić,Melissa Culhane %A Arntz,Diana %A Phillips,Nathaniel L %A Pachas,Gladys %A Evins,A Eden %A Fetters,Michael %+ Center for Addiction Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States, 1 6177262000, kschnitzer@partners.org %K mixed methods implementation evaluation %K pharmacotherapeutic smoking cessation aids %K serious mental illness %K smoking cessation %K tobacco %D 2021 %7 27.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco smoking is associated with significant morbidity and premature mortality in individuals with serious mental illness. A 2-year pragmatic clinical trial (PCORI PCS-1504-30472) that enrolled 1100 individuals with serious mental illness in the greater Boston area was conducted to test 2 interventions for tobacco cessation for individuals with serious mental illness: (1) academic detailing, which delivers education to primary care providers and highlights first-line pharmacotherapy for smoking cessation, and (2) provision of community health worker support to smoker participants. Implementing and scaling this intervention in other settings will require the systematic identification of barriers and facilitators, as well as the identification of relevant subgroups, effective and unique components, and setting-specific factors. Objective: This protocol outlines the proposed mixed methods evaluation of the pragmatic clinical trial to (1) identify barriers and facilitators to effective implementation of the interventions, (2) examine group differences among primary care physicians, and (3) identify barriers that stakeholders such as clinical, payor, and policy leaders would anticipate to impact the implementation of effective components of the intervention. Methods: Qualitative interviews will be conducted with all study community health workers and selected smoker participants, primary care providers, and other stakeholders. Measures of performance and engagement will guide purposive sampling. The Consolidated Framework for Implementation Research will guide qualitative data collection and analysis in accordance with the following framework approach: (1) familiarization, (2) identifying a thematic framework, (3) indexing, (4) charting, and (5) mapping and interpretation. Joint display analyses will be constructed to analyze and draw conclusions across the quantitative and qualitative data. Results: The 3-year cluster-randomized trial has concluded, and the analysis of primary outcomes is underway. Results from the pragmatic trial and this mixed methods implementation evaluation will be used to help disseminate, scale, and expand a systems intervention. Conclusions: The results of this mixed methods implementation evaluation will inform strategies for dissemination and solutions to potential barriers to the implementation of interventions from a smoking cessation trial for individuals with serious mental illness. International Registered Report Identifier (IRRID): DERR1-10.2196/25390 %M 34313603 %R 10.2196/25390 %U https://www.researchprotocols.org/2021/7/e25390 %U https://doi.org/10.2196/25390 %U http://www.ncbi.nlm.nih.gov/pubmed/34313603 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e26854 %T Tobacco Control Policy Simulation Models: Protocol for a Systematic Methodological Review %A Huang,Vincy %A Head,Anna %A Hyseni,Lirije %A O'Flaherty,Martin %A Buchan,Iain %A Capewell,Simon %A Kypridemos,Chris %+ Department of Public Health, Policy and Systems, University of Liverpool, Whelan Building, Liverpool, L69 3GB, United Kingdom, 44 01517952664, vincyhwj@liverpool.ac.uk %K smoking %K modeling %K health policy %K policy making %K systematic review %D 2021 %7 26.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco control models are mathematical models predicting tobacco-related outcomes in defined populations. The policy simulation model is considered as a subcategory of tobacco control models simulating the potential outcomes of tobacco control policy options. However, we could not identify any existing tool specifically designed to assess the quality of tobacco control models. Objective: The aims of this systematic methodology review are to: (1) identify best modeling practices, (2) highlight common pitfalls, and (3) develop recommendations to assess the quality of tobacco control policy simulation models. Crucially, these recommendations can empower model users to assess the quality of current and future modeling studies, potentially leading to better tobacco policy decision-making for the public. This protocol describes the planned systematic review stages, paper inclusion and exclusion criteria, data extraction, and analysis. Methods: Two reviewers searched five databases (Embase, EconLit, PsycINFO, PubMed, and CINAHL Plus) to identify eligible studies published between July 2013 and August 2019. We included papers projecting tobacco-related outcomes with a focus on tobacco control policies in any population and setting. Eligible papers were independently screened by two reviewers. The data extraction form was designed and piloted to extract model structure, data sources, transparency, validation, and other qualities. We will use a narrative synthesis to present the results by summarizing model trends, analyzing model approaches, and reporting data input and result quality. We will propose recommendations to assess the quality of tobacco control policy simulation models using the findings from this review and related literature. Results: Data collection is in progress. Results are expected to be completed and submitted for publication by April 2021. Conclusions: This systematic methodological review will summarize the best practices and pitfalls existing among tobacco control policy simulation models and present a recommendation list of a high-quality tobacco control simulation model. A more standardized and quality-assured tobacco control policy simulation model will benefit modelers, policymakers, and the public on both model building and decision making. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020178146; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020178146 International Registered Report Identifier (IRRID): DERR1-10.2196/26854 %M 34309577 %R 10.2196/26854 %U https://www.researchprotocols.org/2021/7/e26854 %U https://doi.org/10.2196/26854 %U http://www.ncbi.nlm.nih.gov/pubmed/34309577 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e25926 %T Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial %A Mhende,Josephine %A Bell,Sharrill A %A Cottrell-Daniels,Cherell %A Luong,Jackie %A Streiff,Micah %A Dannenfelser,Mark %A Hayat,Matthew J %A Spears,Claire Adams %+ Georgia State University, 140 Decatur Street, Suite 400, Atlanta, GA, 30303, United States, 1 404 413 9335, cspears@gsu.edu %K acceptability %K addiction %K African American %K cessation %K COVID-19 %K feasibility %K income %K low socioeconomic status %K mHealth %K mindfulness %K minority %K smoking %K SMS %K text messaging %K treatment %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is the leading cause of premature death, and low-income adults experience disproportionate burden from tobacco. Mindfulness interventions show promise for improving smoking cessation. A text messaging program “iQuit Mindfully” was developed to deliver just-in-time support for quitting smoking among low-income adults. A pilot study of iQuit Mindfully was conducted in spring 2020, during the COVID-19 pandemic, among low-income and predominantly African American smokers. Objective: This pilot study examined the acceptability and feasibility of delivering Mindfulness-Based Addiction Treatment via mHealth during the COVID-19 pandemic. Methods: Participants were adult cigarette smokers (n=23), of whom 8 (34.8%) were female, 19 (82.6%) were African American, and 18 (78.3%) had an annual income of .29). Augmented reality images were found on average to be realistic (mean [SD] score 6.49 [3.11]) and have good environmental coexistence (mean [SD] score 6.93 [3.04]) and user coexistence (mean [SD] score 6.38 [3.27]) on the 10-point scale. Participant interviews revealed some areas of excellence (eg, details of the lit cigarette) and areas for improvement (eg, stability of images, lighting). Conclusions: All images were generally perceived as being realistic and well-integrated into the environment. However, the smoking augmented reality images produced higher urge to smoke than the neutral augmented reality images. In total, our findings support the potential utility of augmented reality for cue exposure therapy. Future directions and next steps are discussed. %M 33382377 %R 10.2196/21643 %U http://mhealth.jmir.org/2020/12/e21643/ %U https://doi.org/10.2196/21643 %U http://www.ncbi.nlm.nih.gov/pubmed/33382377 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e23669 %T Mining Electronic Health Records to Promote the Reach of Digital Interventions for Cancer Prevention Through Proactive Electronic Outreach: Protocol for the Mixed Methods OptiMine Study %A Amato,Michael S %A El-Toukhy,Sherine %A Abroms,Lorien C %A Goodfellow,Henry %A Ramsey,Alex T %A Brown,Tracey %A Jopling,Helena %A Khadjesari,Zarnie %+ Behavioural and Implementation Science research group, School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, United Kingdom, 44 1603 59 7648, Z.Khadjesari@uea.ac.uk %K EHR %K electronic health record %K smoking cessation %K alcohol reduction %K proactive outreach %K proactive messages %K electronic messages %D 2020 %7 31.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital behavior change interventions have demonstrated effectiveness for smoking cessation and reducing alcohol intake, which ultimately reduce cancer risk. Leveraging electronic health records (EHR) to identify at-risk patients and increasing the reach of digital interventions through proactive electronic outreach provide a novel approach that may increase the number of individuals who engage with evidence-based treatment. Objective: This study aims to increase the reach of digital behavior change interventions by implementing a proactive electronic message system for smoking cessation and alcohol reduction among a large, at-risk population identified through an acute hospital EHR. Methods: This protocol describes a 3-phase, mixed-methods implementation study to assess the acceptability, feasibility, and reach of a proactive electronic message system to digital interventions using a hospital’s EHR system to identify eligible patients. In Phase 1, we will conduct focus group discussions with patients and hospital staff to assess the overall acceptability of the electronic message system. In Phase 2, we will conduct a descriptive analysis of the patient population in the hospital EHR regarding target risk behaviors and other person-level characteristics to determine the project’s feasibility and potential reach. In Phase 3, we will send proactive messages to patients identified as smokers or risky drinkers. Messages will encourage and provide access to behavior change mobile apps via an embedded link; the primary outcome will be the proportion of participants who click on the link to access information about the apps. Results: At the time of initial protocol submission, data collection was complete, but analysis had not begun. This study was funded by Cancer Research UK from April 2019 to March 2020. Health Research Authority approval was granted in June 2019. Conclusions: Increasing the reach of digital behavior change interventions can improve population health by reducing the burden of preventable death and disease. International Registered Report Identifier (IRRID): DERR1-10.2196/23669 %M 33382041 %R 10.2196/23669 %U http://www.researchprotocols.org/2020/12/e23669/ %U https://doi.org/10.2196/23669 %U http://www.ncbi.nlm.nih.gov/pubmed/33382041 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e21772 %T An Autonomy-Supportive Online Decision Aid to Assist Smokers in Choosing Evidence-Based Cessation Assistance: Development Process and Protocol of a Randomized Controlled Trial %A Gültzow,Thomas %A Smit,Eline Suzanne %A Hudales,Raesita %A Knapen,Vera %A Rademakers,Jany %A Dirksen,Carmen D %A Hoving,Ciska %+ Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, P O Box 616, Maastricht, 6200 MD, Netherlands, 31 433882402, thomas.gultzow@maastrichtuniversity.nl %K digital health %K decision making %K decision support technique %K decision aids %K smoking %K smoking cessation %K informed decision making %D 2020 %7 15.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Decision aids (DAs) may be used to facilitate an autonomous, informed decision to cease smoking and promote the uptake of evidence-based cessation assistance (ie, behavioral support, nicotine replacement therapy, or prescription medication). However, knowledge is lacking regarding their effective elements and (cost-)effectiveness. Objective: We describe the development process of an online DA (called “VISOR”) that helps smokers to choose evidence-based cessation assistance. Additionally, we provide a description of the protocol of an ongoing randomized controlled trial in which the DA containing an explicit value clarification method (VCM) and tailored advice is compared with a DA without an explicit VCM and tailored advice. Methods: The development of “VISOR” was based on the International Patient Decision Aid Standards guidelines. Viewpoints of end users (collected through 20 interviews with smokers) and clinical and scientific experts (assessed using 2 Delphi studies with 24 scientists and 38 clinicians) were assessed regarding cessation tool decision making and preferred DA content. These findings, together with principles from the Self-Determination Theory, served as input for the development of the online DA. A first DA prototype was alpha-tested in September 2019 and beta-tested for usability in December 2019; feedback was incorporated and resulted in a final version. The final DA contains (1) an information section, (2) an optional knowledge quiz, (3) a brief smoking assessment, (4) intuitive decision, (5) intermediate advice, (6) an explicit VCM, (7) tailored advice, and (8) access information. A randomized controlled trial is currently being conducted to assess the DA’s (cost-)effectiveness compared to a DA that does not include the explicit VCM and the tailored advice; specifically, the DA’s effect on smoking abstinence, uptake of evidence-based cessation assistance, smoking abstinence mediated through uptake of evidence-based cessation assistance, and decisional conflict are investigated. Participants are randomly allocated to receive access to 1 of the 2 DAs and are asked to complete 5 questionnaires (including the baseline questionnaire) over a period of 12 months. To evaluate the effects of the DA on the outcome measures, logistic and linear regression analyses as well as mediation analyses will be carried out. An economic evaluation will be performed to assess the cost-effectiveness. Results: Data regarding the effect of the VISOR DA are currently being collected, and data collection is expected to be concluded in 2021. Conclusions: By making use of an iterative process that integrated different stakeholders’ perspectives (including end users), we were able to systematically design an evidence-based DA. The study will contribute to the current knowledge regarding smoking cessation DA application, the added value of explicit VCMs, and the effect of behavioral and informed decision-making outcomes. Trial Registration: Netherlands Trial Register NL8270; https://www.trialregister.nl/trial/8270 International Registered Report Identifier (IRRID): DERR1-10.2196/21772 %M 33320096 %R 10.2196/21772 %U http://www.researchprotocols.org/2020/12/e21772/ %U https://doi.org/10.2196/21772 %U http://www.ncbi.nlm.nih.gov/pubmed/33320096 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 4 %P e23734 %T Effects of a Mobile App Called Quittr, Which Utilizes Premium Currency and Games Features, on Improving Engagement With Smoking Cessation Intervention: Pilot Randomized Controlled Trial %A Bindoff,Ivan %A Ling,Tristan R %A Gee,Peter %A Geelan,Benjamin %A Ferguson,Stuart G %A Peterson,Gregory M %+ School of Pharmacy and Pharmacology, University of Tasmania, 1 Churchill Ave, Sandy Bay, 7005, Australia, 61 408528276, Ivan.Bindoff@utas.edu.au %K smoking %K cessation %K Quittr %K engagement %K retention %K churn %K cigarette %K mHealth %K game %D 2020 %7 14.12.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Numerous mobile health (mHealth) apps have been developed to support smokers attempting to quit smoking. Although these apps have been reported to be successful, only modest improvements in the quit rate have been measured. It has been proposed that efforts to improve user engagement and retention may improve the quit rate further. Owing to the high cost of smoking-related disease, it is considered worthwhile to pursue even small improvements. Objective: The aim of this study was to test a novel smartphone app that leverages premium currency strategies developed by the mobile games industry in an attempt to improve engagement and retention with a smoking cessation intervention. Methods: We designed and developed a smoking cessation app called “Quittr” in line with previously developed smoking cessation mHealth apps. In addition to this established framework, we added a stand-alone fully featured city-building clicker-style game called “Tappy Town,” and a premium virtual currency called “QuitCoins.” The user earns QuitCoins for using the app in a way that contributes positively toward their quit attempt, and they can redeem these coins in Tappy Town for bonuses. To establish whether these features improved engagement and retention, we ran a 5-month randomized controlled trial where the intervention group had the full app with the extra games features, while the control group had the standard app only. Recruitment was performed via web-based advertising. Participants (N=175) had no direct contact with the researchers or other support staff. Results: No significant differences in terms of engagement, retention, or smoking outcomes were found between the control and intervention groups. However, survey data indicated that the majority of the participants valued Tappy Town (10/17, 59%) and the QuitCoins rewards system (13/17, 77%). Usage data also suggested that Tappy Town was widely played and was generally appealing to users (mean total time spent in app, control group: 797 seconds vs intervention group: 3502 seconds, P<.001). Analysis of the results suggests that users in the intervention group may have been negatively affected by the aspects of the chosen design, and some theories were explored to explain this unexpected outcome. Conclusions: Although the novel features of the Quittr app failed to improve the key outcomes measured in this study, there were enough positive indications to warrant further exploration of the concept. Additional research will be required to identify and correct any design flaws that may have adversely affected our participants before a follow-up study can be completed. Trial Registration: Australian and New Zealand Clinical Trials Register ACTRN12617000491369; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372661&isReview=true %M 33315016 %R 10.2196/23734 %U http://games.jmir.org/2020/4/e23734/ %U https://doi.org/10.2196/23734 %U http://www.ncbi.nlm.nih.gov/pubmed/33315016 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e16927 %T Facebook-Based Social Marketing to Reduce Smoking in Australia’s First Nations Communities: An Analysis of Reach, Shares, and Likes %A Hefler,Marita %A Kerrigan,Vicki %A Grunseit,Anne %A Freeman,Becky %A Kite,James %A Thomas,David P %+ Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina, 0810, Australia, 61 889468517, marita.hefler@menzies.edu.au %K social media %K tobacco %K Australia %K indigenous peoples %K smoking %K health promotion %D 2020 %7 10.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Facebook is widely used by Australia’s First Nations people and has significant potential to promote health. However, evidence-based guidelines for its use in health promotion are lacking. Smoking prevalence among Australia’s First Nations people is nearly 3 times higher than other Australians. Locally designed programs in Aboriginal Community Controlled Health Services (ACCHOs) to reduce smoking often use Facebook. Objective: This study reports on an analysis of the reach and engagement of Facebook posts with smoking prevention and cessation messages posted by ACCHOs in the Northern Territory, Australia. Methods: Each service posted tobacco control content at least weekly for approximately 6 months. Posts were coded for the following variables: service posted, tailored First Nations Australian content, local or nonlocally produced content, video or nonvideo, communication technique, and emotional appeal. The overall reach, shares, and reactions were calculated. Results: Compared with posts developed by the health services, posts with content created by other sources had greater reach (adjusted incident rate ratio [IRR] 1.92, 95% CI 1.03-3.59). Similarly, reactions to posts (IRR 1.89, 95% CI 1.40-2.56) and shared posts (IRR 2.17, 95% CI 1.31-3.61) with content created by other sources also had more reactions, after controlling for reach, as did posts with local First Nations content compared with posts with no First Nations content (IRR 1.71, 95% CI 1.21-2.34). Conclusions: Facebook posts with nonlocally produced content can be an important component of a social media campaign run by local health organizations. With the exception of nonlocally produced content, we did not find a definitive set of characteristics that were clearly associated with reach, shares, and reactions. Beyond reach, shares, and likes, further research is needed to understand the extent that social media content can influence health behavior. %M 33300883 %R 10.2196/16927 %U http://www.jmir.org/2020/12/e16927/ %U https://doi.org/10.2196/16927 %U http://www.ncbi.nlm.nih.gov/pubmed/33300883 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e19603 %T Effects of Unfiltered Cigarettes on Smoking Behavior and Toxicant Exposure: Protocol for a Randomized Crossover Clinical Trial %A Oren,Eyal %A Pulvers,Kim %A Romero,Devan R %A Barber,Casey %A Carter,Erika %A Tracy,Laree A %A Novotny,Thomas E %+ Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive Mail Code 4162, San Diego, CA, 92182-4124, United States, 1 6195940964, eoren@sdsu.edu %K nicotine %K tobacco %K topography %K exposure %K policy %K environmental %D 2020 %7 8.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Plastic filters on cigarette butts are a widespread source of nonbiodegradable, toxic environmental waste. State and local legislation to ban the sale of single-use cigarettes may be considered to prevent this waste, but scientific evidence on the impact of switching smokers to unfiltered cigarettes on smoking behavior and toxicant exposures is needed to inform this policy. We have designed an open-label, randomized, 9-week, crossover clinical trial of adult filtered-cigarette smokers who switch to unfiltered cigarettes. Objective: Our objective is to understand the impact of switching smokers of filtered cigarettes to unfiltered cigarettes on smoking behavior and toxic exposures. Methods: This trial involves a 1-week baseline period; a 2-week period of smoking filtered or unfiltered cigarettes, where groups are randomly assigned; a 3-week washout period; another 1-week baseline period; and a 2-week crossover period of smoking the opposite condition (ie, filtered or unfiltered cigarettes) for a sufficient sample size of 40 participants. We will determine changes in (1) observed topography (ie, puff count, interpuff interval, and puff volume) and cigarettes smoked per day, via butt counts and self-report, (2) expired carbon monoxide and excretion of urinary cotinine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, and volatile organic compounds, and (3) participants’ knowledge and attitudes toward unfiltered cigarettes, satisfaction with smoking, and intention to quit if they were not able to smoke filtered cigarettes. Results: This study was funded in June 2018 and approved by the relevant Institutional Review Boards in July 2018. This study has enrolled 37 participants as of October 2020. Data analysis is currently underway, and trial results are expected to be published in spring 2021. Conclusions: This pilot proof-of-principle study will inform the design of a larger, future research project that can provide robust scientific evidence on our research question. Such a large study could inform possible state or local legislation to ban the sale of single-use filtered cigarettes in order to mitigate the environmental impact of discarded single-use plastic filters. Trial Registration: ClinicalTrials.gov NCT03749876; https://clinicaltrials.gov/ct2/show/NCT03749876 International Registered Report Identifier (IRRID): DERR1-10.2196/19603 %M 33289680 %R 10.2196/19603 %U https://www.researchprotocols.org/2020/12/e19603 %U https://doi.org/10.2196/19603 %U http://www.ncbi.nlm.nih.gov/pubmed/33289680 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e20649 %T Public Response to a Social Media Tobacco Prevention Campaign: Content Analysis %A Majmundar,Anuja %A Le,NamQuyen %A Moran,Meghan Bridgid %A Unger,Jennifer B %A Reuter,Katja %+ Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N Soto St, Los Angeles, CA, 90032, United States, 1 (800) 872 2273, katja.reuter@gmail.com %K social media %K health campaign %K tobacco %K online %K health communication %K internet %K Twitter %K Facebook %K Instagram %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Prior research suggests that social media–based public health campaigns are often targeted by countercampaigns. Objective: Using reactance theory as the theoretical framework, this research characterizes the nature of public response to tobacco prevention messages disseminated via a social media–based campaign. We also examine whether agreement with the prevention messages is associated with comment tone and nature of the contribution to the overall discussion. Methods: User comments to tobacco prevention messages, posted between April 19, 2017 and July 12, 2017, were extracted from Twitter, Facebook, and Instagram. Two coders categorized comments in terms of tone, agreement with message, nature of contribution, mentions of government agency and regulation, promotional or spam comments, and format of comment. Chi-square analyses tested associations between agreement with the message and tone of the public response and the nature of contributions to the discussions. Results: Of the 1242 comments received (Twitter: n=1004; Facebook: n=176; Instagram: n=62), many comments used a negative tone (42.75%) and disagreed with the health messages (39.77%), while the majority made healthy contributions to the discussions (84.38%). Only 0.56% of messages mentioned government agencies, and only 0.48% of the comments were antiregulation. Comments employing a positive tone (84.13%) or making healthy contributions (69.11%) were more likely to agree with the campaign messages (P=0.01). Comments employing a negative tone (71.25%) or making toxic contributions (36.26%) generally disagreed with the messages (P=0.01). Conclusions: The majority of user comments in response to a tobacco prevention campaign made healthy contributions. Our findings encourage the use of social media to promote dialogue about controversial health topics such as smoking. However, toxicity was characteristic of comments that disagreed with the health messages. Managing negative and toxic comments on social media is a crucial issue for social media–based tobacco prevention campaigns to consider. %M 33284120 %R 10.2196/20649 %U http://publichealth.jmir.org/2020/4/e20649/ %U https://doi.org/10.2196/20649 %U http://www.ncbi.nlm.nih.gov/pubmed/33284120 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e14344 %T Internet-Delivered Tobacco Treatment for People Using Cannabis: A Randomized Trial in Two Australian Cannabis Clinics %A Hindson,Josephine %A Hanstock,Tanya %A Dunlop,Adrian %A Kay-Lambkin,Frances %+ University of Newcastle, University Dr, Callaghan, Australia, 61 416204031, frances.kaylambkin@newcastle.edu.au %K tobacco %K cannabis %K help-seeking behavior %K internet-based intervention %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Tobacco use is disproportionately higher in people who smoke cannabis than in the general population, increasing the severity of dependence for cannabis use, decreasing the likelihood of successful quit attempts for both cannabis and tobacco, and increasing the risk of relapse for both substances. Opportunities to address tobacco use in people using cannabis are being missed. Objective: This study aims to investigate the feasibility of engaging tobacco smokers who were accessing treatment for cannabis, with a tobacco-focused internet-based Healthy Lifestyle Program (iHeLP; 4 modules). It was hypothesized that iHeLP completion would be associated with decreases in tobacco use and improved quality of life (QoL) and psychological health. It was also hypothesized that iHeLP completion would be higher in those who additionally received telephone support. Given that iHeLP aimed to improve healthy lifestyle behaviors, it was also hypothesized that there would be reductions in cannabis use. Methods: A total of 13 smokers seeking treatment for cannabis use were randomly allocated to iHeLP alone or iHeLP plus telephone support. Participants were engaged in iHeLP over 8 weeks and completed a 12-week follow-up assessment. Results: Results from 10 participants who completed the follow-up indicated that the acceptability of iHeLP was high-very high in terms of general satisfaction, appropriateness of services, effectiveness, and met need. Additional telephone support increased modal module completion rates for iHeLP from 0 to 2 but did not provide any other significant advantages over iHeLP alone in terms of cannabis use, tobacco use, QoL, or psychological health. Participants in the iHeLP-alone condition (n=4) reported a mean reduction of 5.5 (SD 9.00) tobacco cigarettes per day between baseline and follow-up, with a concomitant mean reduction in expired carbon monoxide (CO) of 5.5 parts per million (ppm, SD 6.91). The iHeLP plus telephone support group (n=6) reported a mean reduction of 1.13 (SD 4.88) tobacco cigarettes per day and a mean reduction of 9.337 ppm of expired CO (SD 5.65). A urinalysis indicated that abstinence from cannabis was achieved by 2 participants in the iHeLP-alone group and three participants in the iHeLP plus telephone support group. Between baseline and follow-up assessments, iHeLP-alone participants reported a mean reduction in days of use of cannabis in the prior month of 6.17 days (SD 13.30). The average reduction in the number of days of cannabis use for the iHeLP plus telephone support group was also 6.17 days (SD 13.59). Conclusions: Despite the small sample size, this study provides preliminary support for the use of internet-delivered, tobacco-focused interventions in tobacco smokers seeking treatment for cannabis use. %M 33284121 %R 10.2196/14344 %U https://formative.jmir.org/2020/12/e14344 %U https://doi.org/10.2196/14344 %U http://www.ncbi.nlm.nih.gov/pubmed/33284121 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e23579 %T How Internet Contracts Impact Research: Content Analysis of Terms of Service on Consumer Product Websites %A Weiger,Caitlin %A Smith,Katherine C %A Cohen,Joanna E %A Dredze,Mark %A Moran,Meghan Bridgid %+ Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, United States, 1 (410) 955 3543, cweiger2@jhmi.edu %K marketing %K contracts %K internet %K jurisprudence %K ethics %D 2020 %7 2.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Companies use brand websites as a promotional tool to engage consumers on the web, which can increase product use. Given that some products are harmful to the health of consumers, it is important for marketing associated with these products to be subject to public health surveillance. However, terms of service (TOS) governing the use of brand website content may impede such important research. Objective: The aim of this study is to explore the TOS for brand websites with public health significance to assess possible legal and ethical challenges for conducting research on consumer product websites. Methods: Using Statista, we purposefully constructed a sample of 15 leading American tobacco, alcohol, psychiatric pharmaceutical, fast-food, and gun brands that have associated websites. We developed and implemented a structured coding system for the TOS on these websites and coded for the presence versus absence of different types of restriction that might impact the ability to conduct research. Results: All TOS stated that by accessing the website, users agreed to abide by the TOS (15/15, 100%). A total of 11 out of 15 (73%) websites had age restrictions in their TOS. All alcohol brand websites (5/15, 33%) required users to enter their age or date of birth before viewing website content. Both websites for tobacco brands (2/15, 13%) further required that users register and verify their age and identity to access any website content and agree that they use tobacco products. Only one website (1/15, 7%) allowed users to display, download, copy, distribute, and translate the website content as long as it was for personal and not commercial use. A total of 33% (5/15) of TOS unconditionally prohibited or put substantial restrictions on all of these activities and/or failed to specify if they were allowed or prohibited. Moreover, 87% (13/15) of TOS indicated that website access could be restricted at any time. A total of 73% (11/15) of websites specified that violating TOS could result in deleting user content from the website, revoking access by having the user’s Internet Protocol address blocked, terminating log-in credentials, or enforcing legal action resulting in civil or criminal penalties. Conclusions: TOS create complications for public health surveillance related to e-marketing on brand websites. Recent court opinions have reduced the risk of federal criminal charges for violating TOS on public websites, but this risk remains unclear for private websites. The public health community needs to establish standards to guide and protect researchers from the possibility of legal repercussions related to such efforts. %M 33263555 %R 10.2196/23579 %U http://publichealth.jmir.org/2020/4/e23579/ %U https://doi.org/10.2196/23579 %U http://www.ncbi.nlm.nih.gov/pubmed/33263555 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 4 %P e18528 %T Using Serious Games for Antismoking Health Campaigns: Experimental Study %A Kim,Jihyun %A Song,Hayeon %A Merrill Jr,Kelly %A Jung,Younbo %A Kwon,Remi Junghuem %+ Sungkyunkwan University, 25-2 Sungkyunkwan-ro, Jongno-gu, Seoul, 03063, Republic of Korea, 82 2 740 1870, Hayeon.song@gmail.com %K fear appeals %K serious games %K smoking %K entertainment education %K susceptibility %D 2020 %7 2.12.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Serious games for health have been gaining in popularity among scholars and practitioners. However, there remain a few questions to be addressed. Objective: This study tests the effects of a serious game and fear appeals on smoking-related outcomes. More specifically, this research aims to understand how serious games function as a more effective vehicle for a health campaign than a traditional medium, such as a print-based pamphlet. Further, while serious games utilize a variety of persuasive strategies in the game’s content, it is not clear whether fear appeals, which are widely used persuasive-message strategies for health, can be an effective strategy in serious games. Thus, we are testing the effect of fear appeals in a serious game. Methods: We created a computer game and a print brochure to educate participants about the risks of smoking. More specifically, a flash-based single-player game was developed in which players were asked to avoid cigarettes in the gameplay context. We also developed an online brochure based on existing smoking-related brochures at a university health center; antismoking messages on the computer game and in the brochure were comparable. Then, an experiment using a 2 (media type: game vs. print) x 2 (fearful image: fear vs. no-fear) between-subjects design was conducted. The study recruitment was announced to undergraduate students enrolled in a large, public Midwestern university in the United States. After a screening test, a total of 72 smokers, who reported smoking in the past 30 days, participated in the experiment. Results: Overall, gameplay, when compared to print-based pamphlets, had greater impacts on attitudes toward smoking and the intention to quit smoking. Further, the game’s persuasive effects were especially pronounced when messages contained fear appeals. When fearful images were presented, participants in the game condition reported significantly more negative attitudes toward social smoking than those in the print condition [F(1,67)=7.28; P=.009; ηp2=0.10]. However, in the no-fear condition, there was no significant difference between the conditions [F(1,67)=0.25; P=.620]. Similarly, the intention to quit smoking [F(1,67)=4.64; P=.035; ηp2=0.07] and susceptibility [F(1,67)=6.92; P=.011; ηp2=0.09] were also significantly different between the conditions, but only when fear appeals were used. Conclusions: This study extends fear appeal research by investigating the effects of different media types. It offers empirical evidence that a serious game can be an effective vehicle for fear appeals. %M 33263549 %R 10.2196/18528 %U http://games.jmir.org/2020/4/e18528/ %U https://doi.org/10.2196/18528 %U http://www.ncbi.nlm.nih.gov/pubmed/33263549 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e18809 %T Evaluation of the MoMba Live Long Remote Smoking Detection System During and After Pregnancy: Development and Usability Study %A Valencia,Stephanie %A Callinan,Laura %A Shic,Frederick %A Smith,Megan %+ Department of Psychiatry, Yale University School of Medicine, 230 South Frontage Road, New Haven, CT, 06519, United States, 1 203 764 8655, megan.smith@yale.edu %K breath carbon monoxide %K contingency management %K smoking cessation %K pregnancy %K mobile-based sensor %K mobile phone %D 2020 %7 24.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The smoking relapse rate during the first 12 months after pregnancy is around 80% in the United States. Delivering remote smoking cessation interventions to women in the postpartum period can reduce the burden associated with frequent office visits and can enable remote communication and support. Developing reliable, remote, smoking measuring instruments is a crucial step in achieving this vision. Objective: The study presents the evaluation of the MoMba Live Long system, a smartphone-based breath carbon monoxide (CO) meter and a custom iOS smartphone app. We report on how our smoking detection system worked in a controlled office environment and in an out-of-office environment to examine its potential to deliver a remote contingency management intervention. Methods: In-office breath tests were completed using both the MoMba Live Long system and a commercial monitor, the piCO+ Smokerlyzer. In addition, each participant provided a urine test for smoking status validation through cotinine. We used in-office test data to verify the validity of the MoMba Live Long smoking detection system. We also collected out-of-office tests to assess how the system worked remotely and enabled user verification. Pregnant adult women in their second or third trimester participated in the study for a period of 12 weeks. This study was carried out in the United States. Results: Analyses of in-office tests included 143 breath tests contributed from 10 participants. CO readings between the MoMba Live Long system and the piCO+ were highly correlated (r=.94). In addition, the MoMba Live Long system accurately distinguished smokers from nonsmokers with a sensitivity of 0.91 and a specificity of 0.94 when the piCO+ was used as a gold standard, and a sensitivity of 0.81 and specificity of 1.0 when cotinine in urine was used to confirm smoking status. All participants indicated that the system was easy to use. Conclusions: Relatively inexpensive portable and internet-connected CO monitors can enable remote smoking status detection in a wide variety of nonclinical settings with reliable and valid measures comparable to a commercially available CO monitor. Trial Registration: ClinicalTrials.gov NCT02237898; https://clinicaltrials.gov/ct2/show/NCT02237898 %M 33231550 %R 10.2196/18809 %U https://mhealth.jmir.org/2020/11/e18809 %U https://doi.org/10.2196/18809 %U http://www.ncbi.nlm.nih.gov/pubmed/33231550 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e17156 %T Mobile Apps to Reduce Tobacco, Alcohol, and Illicit Drug Use: Systematic Review of the First Decade %A Staiger,Petra Karin %A O'Donnell,Renee %A Liknaitzky,Paul %A Bush,Rachel %A Milward,Joanna %+ School of Psychology, Deakin University, Faculty of Health, Locked Bag 20000, Geelong, 3220, Australia, 61 3 9244 6876, petra.staiger@deakin.edu.au %K smartphone app %K mobile phone %K mobile app %K problematic substance use %K addiction %K systematic review %K mHealth %K ecological momentary intervention %K alcohol %K tobacco %K smoking %K illicit drugs %D 2020 %7 24.11.2020 %9 Review %J J Med Internet Res %G English %X Background: Mobile apps for problematic substance use have the potential to bypass common barriers to treatment seeking. Ten years following the release of the first app targeting problematic tobacco, alcohol, and illicit drug use, their effectiveness, use, and acceptability remains unclear. Objective: This study aims to conduct a systematic literature review of trials evaluating mobile app interventions for problematic tobacco, alcohol, and illicit drug use. Methods: The review was conducted according to recommended guidelines. Relevant databases were searched, and articles were included if the mobile app study was a controlled intervention trial and reported alcohol, tobacco, or illicit drug consumption as outcomes. Results: A total of 20 studies met eligibility criteria across a range of substances: alcohol (n=11), tobacco (n=6), alcohol and tobacco (n=1), illicit drugs (n=1), and illicit drugs and alcohol (n=1). Samples included the general community, university students, and clinical patients. The analyzed intervention sample sizes ranged from 22 to 14,228, and content was considerably diverse, from simple stand-alone apps delivering self-monitoring or psychoeducation to multicomponent apps with interactive features and audio content, or used as adjuncts alongside face-to-face treatment. Intervention duration ranged from 1 to 35 weeks, with notifications ranging from none to multiple times per day. A total of 6 of the 20 app interventions reported significant reductions in substance use at post or follow-up compared with a comparison condition, with small to moderate effect sizes. Furthermore, two other app interventions reported significant reductions during the intervention but not at post treatment, and a third reported a significant interaction of two app intervention components. Conclusions: Although most app interventions were associated with reductions in problematic substance use, less than one-third were significantly better than the comparison conditions at post treatment. A total of 5 out of the 6 apps that reported intervention effects targeted alcohol (of those, one targeted alcohol and illicit drugs and another alcohol and tobacco) and 1 targeted tobacco. Moreover, 3 out of 6 apps included feedback (eg, personalized) and 2 had high risk of bias, 1 some risk, and 3 low risk. All 6 apps included interventions of 6 weeks or longer. Common study limitations were small sample sizes; risk of bias; lack of relevant details; and, in some cases, poorly balanced comparison conditions. Appropriately powered trials are required to understand which app interventions are most effective, length of engagement required, and subgroups most likely to benefit. In sum, evidence to date for the effectiveness of apps targeting problematic substance use is not compelling, although the heterogeneous comparison conditions and trial designs across studies limit the ability to compare efficacy between apps. We discuss potential approaches that can help ascertain whether the promise of mobile app interventions for problematic substance use can be fulfilled. %M 33231555 %R 10.2196/17156 %U http://www.jmir.org/2020/11/e17156/ %U https://doi.org/10.2196/17156 %U http://www.ncbi.nlm.nih.gov/pubmed/33231555 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20009 %T Vaping-Related Mobile Apps Available in the Google Play Store After the Apple Ban: Content Review %A Meacham,Meredith C %A Vogel,Erin A %A Thrul,Johannes %+ Department of Psychiatry and Behavioral Sciences, University of California San Francisco, 401 Parnassus Ave, San Francisco, CA, 94143, United States, 1 415 206 4253, Meredith.Meacham@ucsf.edu %K vaping %K mobile apps %K nicotine %K cannabis %D 2020 %7 13.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In response to health concerns about vaping devices (eg, youth nicotine use, lung injury), Apple removed 181 previously approved vaping-related apps from the App Store in November 2019. This policy change may lessen youth exposure to content that glamorizes vaping; however, it may also block important sources of information and vaping device control for adults seeking to use vaping devices safely. Objective: Understanding the types of nicotine and cannabis vaping–related apps still available in the competing Google Play Store can shed light on how digital apps may reflect information available to consumers. Methods: In December 2019, we searched the Google Play Store for vaping-related apps using the keywords "vape" and "vaping" and reviewed the first 100 apps presented in the results. We reviewed app titles, descriptions, screenshots, and metadata to categorize the intended substance (nicotine or cannabis/tetrahydrocannabinol) and the app’s purpose. The most installed apps in each purpose category were downloaded and evaluated for quality and usability with the Mobile App Rating Scale. Results: Of the first 100 apps, 79 were related to vaping. Of these 79 apps, 43 (54%) were specific to nicotine, 3 (4%) were specific to cannabis, 1 (1%) was intended for either, and for the remaining 31 (39%), the intended substance was unclear. The most common purposes of the apps were making do-it-yourself e-liquids (28/79, 35%) or coils (25/79, 32%), games/entertainment (19/79, 24%), social networking (16/79, 20%), and shopping for vaping products (15/79, 19%). Of the 79 apps, at least 4 apps (5%) paired with vaping devices to control temperature or dose settings, 8 apps (10%) claimed to help people quit smoking using vaping, and 2 apps (3%) had the goal of helping people quit vaping. Conclusions: The majority of vaping-related apps in the Google Play Store had features either to help users continue vaping, such as information for modifying devices, or to maintain interest in vaping. Few apps were for controlling device settings or assisting with quitting smoking or vaping. Assuming that these Google Play Store apps were similar in content to the Apple App Store apps that were removed, it appears that Apple’s ban would have a minimal effect on people who vape with the intention of quitting smoking or who are seeking information about safer vaping via mobile apps. %M 33185565 %R 10.2196/20009 %U http://www.jmir.org/2020/11/e20009/ %U https://doi.org/10.2196/20009 %U http://www.ncbi.nlm.nih.gov/pubmed/33185565 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e21963 %T Electronic Cigarette–Related Contents on Instagram: Observational Study and Exploratory Analysis %A Gao,Yankun %A Xie,Zidian %A Sun,Li %A Xu,Chenliang %A Li,Dongmei %+ University of Rochester Medical Center, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K electronic cigarettes %K infodemiology %K Instagram %K user engagement %K exploratory %K smoking %K e-cig %K social media %K vape %K vaping %K risk %K public health %D 2020 %7 5.11.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Instagram is a popular social networking platform for users to upload pictures sharing their experiences. Instagram has been widely used by vaping companies and stores to promote electronic cigarettes (e-cigarettes), as well as by public health entities to communicate the risks of e-cigarette use (vaping) to the public. Objective: We aimed to characterize current vaping-related content on Instagram through descriptive analyses. Methods: From Instagram, 42,951 posts were collected using vaping-related hashtags in November 2019. The posts were grouped as (1) pro-vaping, (2) vaping warning, (3) neutral to vaping, and (4) not related to vaping based on the attitudes to vaping expressed within the posts. From these Instagram posts and the corresponding 18,786 unique Instagram user accounts, 200 pro-vaping and 200 vaping-warning posts as well as 200 pro-vaping and 200 vaping-warning user accounts were randomly selected for hand coding. Furthermore, follower counts and media counts of the Instagram user accounts as well as the “like” counts and hashtags of the posts were compared between pro-vaping and vaping-warning groups. Results: There were more posts in the pro-vaping group (41,412 posts) than there were in the vaping-warning group (1539 posts). The majority of pro-vaping images were product display images (163/200, 81.5%), and the most popular image type in vaping-warning posts was educational (95/200, 47.5%). The highest proportion of pro-vaping user account type was vaping store (110/189, 58.1%), and the store account type had the highest mean number of posts (10.33 posts/account). The top 3 vaping-warning user account types were personal (79/155, 51%), vaping-warning community (37/155, 23.9%), and community (35/155, 22.6%), of which the vaping-warning community had the highest mean number of posts (3.68 posts/account). Pro-vaping user accounts had more followers (median 850) and media (median 232) than vaping-warning user accounts had (follower count: median 191; media count: 92). Pro-vaping posts had more “likes” (median 22) and hashtags (mean 20.39) than vaping-warning posts had (“like” count: median 12; hashtags: mean 7.16). Conclusions: Instagram is dominated by pro-vaping content, and pro-vaping posts and user accounts seem to have more user engagement than vaping-warning accounts have. These results highlight the importance of regulating e-cigarette posts on social media and the urgency of identifying effective communication content and message delivery methods with the public about the health effects of e-cigarettes to ameliorate the epidemic of vaping in youth. %M 33151157 %R 10.2196/21963 %U http://publichealth.jmir.org/2020/4/e21963/ %U https://doi.org/10.2196/21963 %U http://www.ncbi.nlm.nih.gov/pubmed/33151157 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e15577 %T E-Cigarette Promotion on Twitter in Australia: Content Analysis of Tweets %A McCausland,Kahlia %A Maycock,Bruce %A Leaver,Tama %A Wolf,Katharina %A Freeman,Becky %A Thomson,Katie %A Jancey,Jonine %+ Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, 6102, Australia, 61 92667382, kahlia.mccausland@curtin.edu.au %K electronic cigarette %K e-cigarette %K electronic nicotine delivery systems %K vaping %K vape %K social media %K twitter %K content analysis %K public health %K public policy %D 2020 %7 5.11.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The sale of electronic cigarettes (e-cigarettes) containing nicotine is prohibited in all Australian states and territories; yet, the growing availability and convenience of the internet enable the promotion and exposure of e-cigarettes across countries. Social media’s increasing pervasiveness has provided a powerful avenue to market products and influence social norms and risk behaviors. At present, there is no evidence of how e-cigarettes and vaping are promoted on social media in Australia. Objective: This study aimed to investigate how e-cigarettes are portrayed and promoted on Twitter through a content analysis of vaping-related tweets containing an image posted and retweeted by Australian users and how the portrayal and promotion have emerged and trended over time. Methods: In total, we analyzed 1303 tweets and accompanying images from 2012, 2014, 2016, and 2018 collected through the Tracking Infrastructure for Social Media Analysis (TrISMA), a contemporary technical and organizational infrastructure for the tracking of public communication by Australian users of social media, via a list of 15 popular e-cigarette–related terms. Results: Despite Australia’s cautious approach toward e-cigarettes and the limited evidence supporting them as an efficacious smoking cessation aid, it is evident that there is a concerted effort by some Twitter users to promote these devices as a health-conducive (91/129, 70.5%), smoking cessation product (266/1303, 20.41%). Further, Twitter is being used in an attempt to circumvent Australian regulation and advocate for a more liberal approach to personal vaporizers (90/1303, 6.90%). A sizeable proportion of posts was dedicated to selling or promoting vape products (347/1303, 26.63%), and 19.95% (260/1303) were found to be business listings. These posts used methods to try and expand their clientele further than immediate followers by touting competitions and giveaways, with those wanting to enter having to perform a sequence of steps such as liking, tagging, and reposting, ultimately exposing the post among the user’s network and to others not necessarily interested in vaping. Conclusions: The borderless nature of social media presents a clear challenge for enforcing Article 13 of the World Health Organization Framework Convention on Tobacco Control, which requires all ratifying nations to implement a ban on tobacco advertising, promotion, and sponsorship. Countering the advertising and promotion of these products is a public health challenge that will require cross-border cooperation with other World Health Organization Framework Convention on Tobacco Control parties. Further research aimed at developing strategies to counter the advertising and promotion of e-cigarettes is therefore needed. %M 33151159 %R 10.2196/15577 %U http://publichealth.jmir.org/2020/4/e15577/ %U https://doi.org/10.2196/15577 %U http://www.ncbi.nlm.nih.gov/pubmed/33151159 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20251 %T Engaging Unmotivated Smokers to Move Toward Quitting: Design of Motivational Interviewing–Based Chatbot Through Iterative Interactions %A Almusharraf,Fahad %A Rose,Jonathan %A Selby,Peter %+ The Edward S. Rogers Sr. Department of Electrical & Computer Engineering, Faculty of Applied Science & Engineering, University of Toronto, 10 King's College Road, Toronto, ON, M5S 3G4, Canada, 1 4169786992, jonathan.rose@ece.utoronto.ca %K smoking cessation %K motivational interviewing %K chatbot %K natural language processing %D 2020 %7 3.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: At any given time, most smokers in a population are ambivalent with no motivation to quit. Motivational interviewing (MI) is an evidence-based technique that aims to elicit change in ambivalent smokers. MI practitioners are scarce and expensive, and smokers are difficult to reach. Smokers are potentially reachable through the web, and if an automated chatbot could emulate an MI conversation, it could form the basis of a low-cost and scalable intervention motivating smokers to quit. Objective: The primary goal of this study is to design, train, and test an automated MI-based chatbot capable of eliciting reflection in a conversation with cigarette smokers. This study describes the process of collecting training data to improve the chatbot’s ability to generate MI-oriented responses, particularly reflections and summary statements. The secondary goal of this study is to observe the effects on participants through voluntary feedback given after completing a conversation with the chatbot. Methods: An interdisciplinary collaboration between an MI expert and experts in computer engineering and natural language processing (NLP) co-designed the conversation and algorithms underlying the chatbot. A sample of 121 adult cigarette smokers in 11 successive groups were recruited from a web-based platform for a single-arm prospective iterative design study. The chatbot was designed to stimulate reflections on the pros and cons of smoking using MI’s running head start technique. Participants were also asked to confirm the chatbot’s classification of their free-form responses to measure the classification accuracy of the underlying NLP models. Each group provided responses that were used to train the chatbot for the next group. Results: A total of 6568 responses from 121 participants in 11 successive groups over 14 weeks were received. From these responses, we were able to isolate 21 unique reasons for and against smoking and the relative frequency of each. The gradual collection of responses as inputs and smoking reasons as labels over the 11 iterations improved the F1 score of the classification within the chatbot from 0.63 in the first group to 0.82 in the final group. The mean time spent by each participant interacting with the chatbot was 21.3 (SD 14.0) min (minimum 6.4 and maximum 89.2). We also found that 34.7% (42/121) of participants enjoyed the interaction with the chatbot, and 8.3% (10/121) of participants noted explicit smoking cessation benefits from the conversation in voluntary feedback that did not solicit this explicitly. Conclusions: Recruiting ambivalent smokers through the web is a viable method to train a chatbot to increase accuracy in reflection and summary statements, the building blocks of MI. A new set of 21 smoking reasons (both for and against) has been identified. Initial feedback from smokers on the experience shows promise toward using it in an intervention. %M 33141095 %R 10.2196/20251 %U https://www.jmir.org/2020/11/e20251 %U https://doi.org/10.2196/20251 %U http://www.ncbi.nlm.nih.gov/pubmed/33141095 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e21100 %T Tobacco-Free Duo Adult-Child Contract for Prevention of Tobacco Use Among Adolescents and Parents: Protocol for a Mixed-Design Evaluation %A Galanti,Maria Rosaria %A Pulkki-Brännström,Anni-Maria %A Nilsson,Maria %+ Centre for Epidemiology and Community Health, Solnavägen 1E, Stockholm , Sweden, 46 704718984, rosaria.galanti@ki.se %K tobacco use %K prevention %K school %K social influence %K public commitment %K cluster randomized trial %K observational study %D 2020 %7 29.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Universal tobacco-prevention programs targeting youths usually involve significant adults, who are assumed to be important social influences. Commitment not to use tobacco, or to quit use, as a formal contract between an adolescent and a significant adult is a preventive model that has not been widely practiced or explored and has been formally evaluated even less. In this paper, we present the rationale and protocol for the evaluation of the Swedish Tobacco-free Duo program, a multicomponent school-based program the core of which rests on a formal agreement between an adolescent and an adult. The adolescent’s commitment mainly concerns avoiding the onset of any tobacco use while the adult commits to support the adolescent in staying tobacco free, being a role model by not using tobacco themselves. Objective: To assess (1) whether Tobacco-free Duo is superior to an education-only program in preventing smoking onset among adolescents and promoting cessation among their parents, (2) whether exposure to core components (adult-child agreement) entails more positive effects than exposure to other components, (3) the impact of the program on whole school tobacco use, (4) potential negative side effects, and (5) school-level factors related to fidelity of the program’s implementation. Methods: A mixed-design approach was developed. First, a cluster randomized controlled trial was designed with schools randomly assigned to either the comprehensive multicomponent program or its educational component only. Primary outcome at the adolescent level was identified as not having tried tobacco during the 3-year junior high school compulsory grades (12-15 years of age). An intention-to-treat cohort-wise approach and an as-treated approach complemented with a whole school repeated cross-sectional approach was devised as analytical methods of the trial data. Second, an observational study was added in order to compare smoking incidence in the schools participating in the experiment with that of a convenience sample of schools that were not part of the experimental study. Diverse secondary outcomes at both adolescent and adult levels were also included. Results: The study was approved by the Umeå Regional Ethics Review Board (registration number 2017/255-31) in 2017. Recruitment of schools started in fall 2017 and continued until June 2018. In total, 43 schools were recruited to the experimental study, and 16 schools were recruited to the observational study. Data collection started in the fall 2018, is ongoing, and is planned to be finished in spring 2021. Conclusions: Methodological, ethical, and practical implications of the evaluation protocol were discussed, especially the advantage of combining several sources of data, to triangulate the study questions. The results of these studies will help revise the agenda of this program as well as those of similar programs. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 52858080; https://doi.org/10.1186/ISRCTN52858080 International Registered Report Identifier (IRRID): DERR1-10.2196/21100 %M 33000762 %R 10.2196/21100 %U http://www.researchprotocols.org/2020/10/e21100/ %U https://doi.org/10.2196/21100 %U http://www.ncbi.nlm.nih.gov/pubmed/33000762 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e17522 %T Mobile Social Network–Based Smoking Cessation Intervention for Chinese Male Smokers: Pilot Randomized Controlled Trial %A Chen,Jinsong %A Ho,Elsie %A Jiang,Yannan %A Whittaker,Robyn %A Yang,Tingzhong %A Bullen,Christopher %+ National Institute for Health Innovation, School of Population Health, University of Auckland, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand, 64 0220951065, jinsong.chen@auckland.ac.nz %K mHealth %K mobile smoking cessation %K social network-based intervention %K smoking cessation %K public health %K gamified health interventions %D 2020 %7 23.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Around 2 million Chinese people, mostly men, die annually from tobacco-related diseases; yet, fewer than 8% of Chinese smokers ever receive any smoking cessation support. Objective: This study aimed to test the preliminary effectiveness and feasibility for a mobile social network (WeChat)–based smoking cessation intervention (SCAMPI program) among Chinese male smokers. Methods: Chinese male smokers aged 25-44 years were recruited online from WeChat, the most widely used social media platform in China. Individuals using other smoking cessation interventions or who lacked capacity to provide online informed consent were excluded. Participants were randomly assigned (1:1) to intervention or control groups. Neither participants nor researchers were masked to assignment. The trial was fully online. All data were collected via WeChat. The intervention group received access to the full-version SCAMPI program, a Chinese-language smoking cessation program based on the Behaviour Change Wheel framework and relevant cessation guidelines. Specific intervention functions used in the program include: planning to help users make quitting plans, calculator to record quitting benefits, calendar to record progress, gamification to facilitate quitting, information about smoking harms, motivational messages to help users overcome urges, standardized tests for users to assess their levels of nicotine dependence and lung health, as well as a social platform to encourage social support between users. The control group had access to a static WeChat page of contacts for standard smoking cessation care. Both groups received incentive credit payments for participating. The primary outcome was 30-day biochemically verified smoking abstinence at 6 weeks after randomization, with missing data treated as not quitting. Secondary outcomes were other smoking status measures, reduction of cigarette consumption, study feasibility (recruitment and retention rate), and acceptability of and satisfaction with the program. Results: The program recorded 5736 visitors over a 13-day recruitment period. We recruited 80 participants who were randomly allocated to two arms (n=40 per arm). At 6 weeks, 36 of 40 (90%) intervention participants and 35 of 40 (88%) control participants provided complete self-reported data on their daily smoking status via WeChat. Biochemically verified smoking abstinence at 6 weeks was determined for 10 of 40 (25%) intervention participants and 2 of 40 (5%) control participants (RR=5, 95% CI 1.2-21.4, P=.03). In the intervention group, the calculator function, motivational messages, and health tests were underused (less than once per week per users). Participants rated their satisfaction with the intervention program as 4.56 out of 5.00. Conclusions: Our program is a novel, accessible, and acceptable smoking cessation intervention for Chinese male smokers. A future trial with a greater sample size and longer follow-up will identify if it is as effective as these preliminary data suggest. Trial Registration: ANZCTR registry, ACTRN12618001089224; https://tinyurl.com/y536n7sx International Registered Report Identifier (IRRID): RR2-18071 %M 33095184 %R 10.2196/17522 %U http://mhealth.jmir.org/2020/10/e17522/ %U https://doi.org/10.2196/17522 %U http://www.ncbi.nlm.nih.gov/pubmed/33095184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e16255 %T Tailored Web-Based Smoking Interventions and Reduced Attrition: Systematic Review and Meta-Analysis %A Shah,Amika %A Chaiton,Michael %A Baliunas,Dolly %A Schwartz,Robert %+ Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5S 2S1, Canada, 1 416 978 7096, michael.chaiton@camh.ca %K internet %K world wide web %K smoking cessation %K web-based intervention %D 2020 %7 19.10.2020 %9 Review %J J Med Internet Res %G English %X Background: The increasing number of internet users presents an opportunity to deliver health interventions to large populations. Despite their potential, many web-based interventions, including those for smoking cessation, face high rates of attrition. Further consideration of how intervention features impact attrition is needed. Objective: The aim of this systematic review is to investigate whether tailored web-based smoking cessation interventions for smokers are associated with reduced rates of attrition compared with active or passive untailored web-based interventions. The outcomes of interest were dropout attrition at 1-, 3-, 6-, and 12-month follow-ups. Methods: Literature searches were conducted in May 2018 and updated in May 2020 on MEDLINE (Medical Literature Analysis and Retrieval System Online), PsycINFO (Psychological Information), EMBASE (Excerpta Medica dataBASE), CINAHL (Cumulated Index to Nursing and Allied Health Literature), Scopus, and the Cochrane Tobacco Addiction Group Specialized Register with the following search terms: smoking cessation, tailored, or web- or internet-based. Included studies were published in English before or in May 2020 using a randomized controlled trial design. Studies were restricted to those with web-based delivery, a tailored intervention group, an untailored control group, and a reported outcome of smoking cessation. Studies were assessed for methodological quality using the Cochrane Risk of Bias tool. Two reviewers independently extracted the study characteristics and the number of participants lost to follow-up for each treatment group. Results: A total of 13 studies were included in the systematic review, of which 11 (85%) were included in the meta-analysis. Tailoring had no statistically significant effect on dropout attrition at 1-month (risk ratio [RR]=1.02, 95% CI 0.95-1.09; P=.58; I2=78%), 3-month (RR=0.99, 95% CI 0.95-1.04; P=.80; I2=73%), 6-month (RR=1.00, 95% CI 0.95-1.05; P=.90; I2=43%), or 12-month (RR=0.97, 95% CI 0.92-1.02; P=.26; I2=28%) follow-ups. Subgroup analyses suggested that there was a statistically significant effect of tailoring between the active and passive subgroups at 1-month (P=.03), 3-month (P<.001), and 6-month (P=.02) follow-ups but not at 12-month follow-up (P=.25). Conclusions: The results suggest that tailoring of web-based smoking cessation interventions may not be associated with reduced rates of dropout attrition at 1-, 3-, 6-, or 12-month follow-ups. Significant differences between studies that include untailored active and passive control groups suggest that the role of tailoring may be more prominent when studies include a passive control group. These findings may be because of variability in the presence of additional features, the definition of smokers used, and the duration of smoking abstinence measured. Future studies should incorporate active web-based controls, compare the impact of different tailoring strategies, and include populations outside of the Western countries. %M 33074158 %R 10.2196/16255 %U https://www.jmir.org/2020/10/e16255 %U https://doi.org/10.2196/16255 %U http://www.ncbi.nlm.nih.gov/pubmed/33074158 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e19804 %T Public Opinion About E-Cigarettes on Chinese Social Media: A Combined Study of Text Mining Analysis and Correspondence Analysis %A Wang,Di %A Lyu,Joanne Chen %A Zhao,Xiaoyu %+ Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Ave, Suite 366, San Francisco, CA, CA 94143-1390, United States, 1 415 502 4181, chenjoanne.lyu@ucsf.edu %K e-cigarettes %K public opinion %K social media %K infodemiology %K infoveillance %K regulation %K China %D 2020 %7 14.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic cigarettes (e-cigarettes) have become increasingly popular. China has accelerated its legislation on e-cigarettes in recent years by issuing two policies to regulate their use: the first on August 26, 2018, and the second on November 1, 2019. Social media provide an efficient platform to access information on the public opinion of e-cigarettes. Objective: To gain insight into how policies have influenced the reaction of the Chinese public to e-cigarettes, this study aims to understand what the Chinese public say about e-cigarettes and how the focus of discussion might have changed in the context of policy implementation. Methods: This study uses a combination of text mining and correspondence analysis to content analyze 1160 e-cigarette–related questions and their corresponding answers from Zhihu, China’s largest question-and-answer platform and one of the country’s most trustworthy social media sources. From January 1, 2017, to December 31, 2019, Python was used to text mine the most frequently used words and phrases in public e-cigarette discussions on Zhihu. The correspondence analysis was used to examine the similarities and differences between high-frequency words and phrases across 3 periods (ie, January 1, 2017, to August 27, 2018; August 28, 2018, to October 31, 2019; and November 1, 2019, to January 1, 2020). Results: The results of the study showed that the consistent themes across time were comparisons with traditional cigarettes, health concerns, and how to choose e-cigarette products. The issuance of government policies on e-cigarettes led to a change in the focus of public discussion. The discussion of e-cigarettes in period 1 mainly focused on the use and experience of e-cigarettes. In period 2, the public’s attention was not only on the substances related to e-cigarettes but also on the smoking cessation functions of e-cigarettes. In period 3, the public shifted their attention to the e-cigarette industry and government policy on the banning of e-cigarette sales to minors. Conclusions: Social media are an informative source, which can help policy makers and public health professionals understand the public’s concerns over and understanding of e-cigarettes. When there was little regulation, public discussion was greatly influenced by industry claims about e-cigarettes; however, once e-cigarette policies were issued, these policies, to a large extent, set the agenda for public discussion. In addition, media reporting of these policies might have greatly influenced the way e-cigarette policies were discussed. Therefore, monitoring e-cigarette discussions on social media and responding to them in a timely manner will both help improve the public’s e-cigarette literacy and facilitate the implementation of e-cigarette–related policies. %M 33052127 %R 10.2196/19804 %U http://www.jmir.org/2020/10/e19804/ %U https://doi.org/10.2196/19804 %U http://www.ncbi.nlm.nih.gov/pubmed/33052127 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e17543 %T E-Cigarette Advocates on Twitter: Content Analysis of Vaping-Related Tweets %A McCausland,Kahlia %A Maycock,Bruce %A Leaver,Tama %A Wolf,Katharina %A Freeman,Becky %A Jancey,Jonine %+ Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, 6102, Australia, 61 92667382, kahlia.mccausland@curtin.edu.au %K electronic nicotine delivery systems %K electronic cigarettes %K e-cigarette %K infodemiology %K infoveillance %K vaping %K Twitter %K social media %K public health %K content analysis %D 2020 %7 14.10.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As the majority of Twitter content is publicly available, the platform has become a rich data source for public health surveillance, providing insights into emergent phenomena, such as vaping. Although there is a growing body of literature that has examined the content of vaping-related tweets, less is known about the people who generate and disseminate these messages and the role of e-cigarette advocates in the promotion of these devices. Objective: This study aimed to identify key conversation trends and patterns over time, and discern the core voices, message frames, and sentiment surrounding e-cigarette discussions on Twitter. Methods: A random sample of data were collected from Australian Twitter users who referenced at least one of 15 identified e-cigarette related keywords during 2012, 2014, 2016, or 2018. Data collection was facilitated by TrISMA (Tracking Infrastructure for Social Media Analysis) and analyzed by content analysis. Results: A sample of 4432 vaping-related tweets posted and retweeted by Australian users was analyzed. Positive sentiment (3754/4432, 84.70%) dominated the discourse surrounding e-cigarettes, and vape retailers and manufacturers (1161/4432, 26.20%), the general public (1079/4432, 24.35%), and e-cigarette advocates (1038/4432, 23.42%) were the most prominent posters. Several tactics were used by e-cigarette advocates to communicate their beliefs, including attempts to frame e-cigarettes as safer than traditional cigarettes, imply that federal government agencies lack sufficient competence or evidence for the policies they endorse about vaping, and denounce as propaganda “gateway” claims of youth progressing from e-cigarettes to combustible tobacco. Some of the most common themes presented in tweets were advertising or promoting e-cigarette products (2040/4432, 46.03%), promoting e-cigarette use or intent to use (970/4432, 21.89%), and discussing the potential of e-cigarettes to be used as a smoking cessation aid or tobacco alternative (716/4432, 16.16%), as well as the perceived health and safety benefits and consequences of e-cigarette use (681/4432, 15.37%). Conclusions: Australian Twitter content does not reflect the country’s current regulatory approach to e-cigarettes. Rather, the conversation on Twitter generally encourages e-cigarette use, promotes vaping as a socially acceptable practice, discredits scientific evidence of health risks, and rallies around the idea that e-cigarettes should largely be outside the bounds of health policy. The one-sided nature of the discussion is concerning, as is the lack of disclosure and transparency, especially among vaping enthusiasts who dominate the majority of e-cigarette discussions on Twitter, where it is unclear if comments are endorsed, sanctioned, or even supported by the industry. %M 33052130 %R 10.2196/17543 %U http://publichealth.jmir.org/2020/4/e17543/ %U https://doi.org/10.2196/17543 %U http://www.ncbi.nlm.nih.gov/pubmed/33052130 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 10 %P e22833 %T Preliminary Outcomes of a Digital Therapeutic Intervention for Smoking Cessation in Adult Smokers: Randomized Controlled Trial %A Webb,Jamie %A Peerbux,Sarrah %A Smittenaar,Peter %A Siddiqui,Sarim %A Sherwani,Yusuf %A Ahmed,Maroof %A MacRae,Hannah %A Puri,Hannah %A Bhalla,Sangita %A Majeed,Azeem %+ Digital Therapeutics Inc, ‍2443 Fillmore St, San Francisco, CA, 94115, United States, 1 650 684 5503, jamie@quitgenius.com %K digital %K smoking %K cessation %K mobile %K randomized controlled trial %K app %K mobile phone %K mHealth %D 2020 %7 6.10.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Tobacco smoking remains the leading cause of preventable death and disease worldwide. Digital interventions delivered through smartphones offer a promising alternative to traditional methods, but little is known about their effectiveness. Objective: Our objective was to test the preliminary effectiveness of Quit Genius, a novel digital therapeutic intervention for smoking cessation. Methods: A 2-arm, single-blinded, parallel-group randomized controlled trial design was used. Participants were recruited via referrals from primary care practices and social media advertisements in the United Kingdom. A total of 556 adult smokers (aged 18 years or older) smoking at least 5 cigarettes a day for the past year were recruited. Of these, 530 were included for the final analysis. Participants were randomized to one of 2 interventions. Treatment consisted of a digital therapeutic intervention for smoking cessation consisting of a smartphone app delivering cognitive behavioral therapy content, one-to-one coaching, craving tools, and tracking capabilities. The control intervention was very brief advice along the Ask, Advise, Act model. All participants were offered nicotine replacement therapy for 3 months. Participants in a random half of each arm were pseudorandomly assigned a carbon monoxide device for biochemical verification. Outcomes were self-reported via phone or online. The primary outcome was self-reported 7-day point prevalence abstinence at 4 weeks post quit date. Results: A total of 556 participants were randomized (treatment: n=277; control: n=279). The intention-to-treat analysis included 530 participants (n=265 in each arm; 11 excluded for randomization before trial registration and 15 for protocol violations at baseline visit). By the quit date (an average of 16 days after randomization), 89.1% (236/265) of those in the treatment arm were still actively engaged. At the time of the primary outcome, 74.0% (196/265) of participants were still engaging with the app. At 4 weeks post quit date, 44.5% (118/265) of participants in the treatment arm had not smoked in the preceding 7 days compared with 28.7% (76/265) in the control group (risk ratio 1.55, 95% CI 1.23-1.96; P<.001; intention-to-treat, n=530). Self-reported 7-day abstinence agreed with carbon monoxide measurement (carbon monoxide <10 ppm) in 96% of cases (80/83) where carbon monoxide readings were available. No harmful effects of the intervention were observed. Conclusions: The Quit Genius digital therapeutic intervention is a superior treatment in achieving smoking cessation 4 weeks post quit date compared with very brief advice. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 65853476; https://www.isrctn.com/ISRCTN65853476 %M 33021488 %R 10.2196/22833 %U https://mental.jmir.org/2020/10/e22833 %U https://doi.org/10.2196/22833 %U http://www.ncbi.nlm.nih.gov/pubmed/33021488 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 10 %P e19860 %T Perceptions of Mobile Apps for Smoking Cessation Among Young People in Community Mental Health Care: Qualitative Study %A Gowarty,Minda A %A Kung,Nathan J %A Maher,Ashley E %A Longacre,Meghan R %A Brunette,Mary F %+ Departments of Internal Medicine and Community and Family Medicine, Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, United States, 1 6036536868, minda.a.gowarty@hitchcock.org %K smoking cessation %K mHealth %K serious mental illness %K smartphone application %K digital health %K psychiatric illness %K tobacco treatment %D 2020 %7 2.10.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Young adults with serious mental illness are over twice as likely to have tobacco use disorder than those in the general population and are less likely to utilize proven treatment methods during quit attempts. However, little research has evaluated the efficacy of interventions for this group. Smartphone apps may be an underutilized tool for tobacco use disorder among young adults with serious mental illness. Objective: The aim of this study was to explore attitudes toward smoking cessation apps and preferences regarding app design in young adult smokers with serious mental illness. Methods: Five focus groups involving 25- to 35-year-old adults with serious mental illness receiving treatment at a community mental health center were conducted between May 2019 and August 2019. Three researchers independently coded transcripts and identified themes using thematic analysis. Results: Participants (n=22) were individuals who smoke daily: 10 (46%) self-identified as female, 18 (82%) self-identified as White, and 9 (41%) had psychotic disorders. Key themes that emerged included a general interest in using health apps; a desire for apps to provide ongoing motivation during a quit attempt via social support, progress tracking, and rewards; a desire for apps to provide distraction from smoking; concerns about app effectiveness due to a lack of external accountability; and concerns that apps could trigger cravings or smoking behavior by mentioning cigarettes or the act of smoking. Conclusions: Apps have the potential to support smoking cessation or reduction efforts among young adults with serious mental illness. However, they may require tailoring, optimization, and clinical support to effectively promote cessation in this population. %M 33006560 %R 10.2196/19860 %U https://formative.jmir.org/2020/10/e19860 %U https://doi.org/10.2196/19860 %U http://www.ncbi.nlm.nih.gov/pubmed/33006560 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22811 %T Assessment of a Personal Interactive Carbon Monoxide Breath Sensor in People Who Smoke Cigarettes: Single-Arm Cohort Study %A Marler,Jennifer D %A Fujii,Craig A %A Wong,Kristine S %A Galanko,Joseph A %A Balbierz,Daniel J %A Utley,David S %+ Carrot Inc., 1400A Seaport Blvd., Ste. 501, Redwood City, CA, 94063, United States, 1 4157577696, marler@carrot.co %K smoking cessation %K digital health %K smartphone %K digital sensor %K carbon monoxide %K breath sensor %K biofeedback %D 2020 %7 2.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Tobacco use is the leading cause of preventable morbidity and mortality. Existing evidence-based treatments are underutilized and have seen little recent innovation. The success of personal biofeedback interventions in other disease states portends a similar opportunity in smoking cessation. The Pivot Breath Sensor is a personal interactive FDA-cleared (over-the-counter) device that measures carbon monoxide (CO) in exhaled breath, enabling users to link their smoking behavior and CO values, and track their progress in reducing or quitting smoking. Objective: The objective of this study is to assess the Pivot Breath Sensor in people who smoke cigarettes, evaluating changes in attitudes toward quitting smoking, changes in smoking behavior, and use experience. Methods: US adults (18-80 years of age, ≥10 cigarettes per day [CPD]) were recruited online for this remote 12-week study. Participants completed a screening call, informed consent, and baseline questionnaire, and then were mailed their sensor. Participants were asked to submit 4 or more breath samples per day and complete questionnaires at 1-4, 8, and 12 weeks. Outcomes included attitudes toward quitting smoking (Stage of Change, success to quit, and perceived difficulty of quitting), smoking behavior (quit attempts, CPD reduction, and 7-, 30-day point prevalence abstinence [PPA]), and use experience (impact and learning). Results: Participants comprised 234 smokers, mean age 39.9 (SD 11.3) years, 52.6% (123/234) female, mean CPD 20.3 (SD 8.0). The 4- and 12-week questionnaires were completed by 92.3% (216/234) and 91.9% (215/234) of participants, respectively. Concerning attitude outcomes, at baseline, 15.4% (36/234) were seriously thinking of quitting in the next 30 days, increasing to 38.9% (84/216) at 4 weeks and 47.9% (103/215) at 12 weeks (both P<.001). At 12 weeks, motivation to quit was increased in 39.1% (84/215), unchanged in 54.9% (118/215), and decreased in 6.0% (13/215; P<.001). Additional attitudes toward quitting improved from baseline to 12 weeks: success to quit 3.3 versus 5.0 (P<.001) and difficulty of quitting 2.8 versus 4.3 (P<.001). Regarding smoking behavior, at 4 weeks, 28.2% (66/234) had made 1 or more quit attempts (≥1 day of abstinence), increasing to 48.3% (113/234) at 12 weeks. At 4 weeks, 23.1% (54/234) had reduced CPD by 50% or more, increasing to 38.5% (90/234) at 12 weeks. At 12 weeks, CPD decreased by 41.1% from baseline (P<.001), and 7- and 30-day PPA were 12.0% (28/234) and 6.0% (14/234), respectively. Concerning use experience, 75.3% (171/227) reported the sensor increased their motivation to quit. More than 90% (>196/214) indicated the sensor taught them about their CO levels and smoking behavior, and 73.1% (166/227) reported that seeing their CO values made them want to quit smoking. Conclusions: Use of the Pivot Breath Sensor resulted in a significant increase in motivation to quit, a reduction in CPD, and favorable quit attempt rates. These outcomes confer increased likelihood of quitting smoking. Accordingly, the results support a role for biofeedback via personal CO breath sampling in smoking cessation. Trial Registration: ClinicalTrials.gov NCT04133064; https://clinicaltrials.gov/ct2/show/NCT04133064 %M 32894829 %R 10.2196/22811 %U https://www.jmir.org/2020/10/e22811 %U https://doi.org/10.2196/22811 %U http://www.ncbi.nlm.nih.gov/pubmed/32894829 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19378 %T Impact of a Blended Periconception Lifestyle Care Approach on Lifestyle Behaviors: Before-and-After Study %A van der Windt,Melissa %A van der Kleij,Rianne Maria %A Snoek,Katinka Marianne %A Willemsen,Sten Paul %A Dykgraaf,Ramon Henny Maria %A Laven,Joop Stephanus Elisabeth %A Schoenmakers,Sam %A Steegers-Theunissen,Régine Patricia Maria %+ Department of Obstetrics and Gynecology, Erasmus University Medical Center, PO Box 2040, Rotterdam, 3000CA, Netherlands, +31 107038255, r.steegers@erasmusmc.nl %K eHealth %K periconception period %K lifestyle intervention %D 2020 %7 30.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Periconception lifestyle behaviors affect maternal, paternal, offspring, and transgenerational health outcomes. Previous research in other target populations has shown that personalized lifestyle interventions, in which face-to-face counseling and eHealth (“blended care”) are combined, may effectively target these lifestyle behaviors. Objective: We aimed to assess the effectiveness of a periconceptional lifestyle intervention on the improvement of specific lifestyle components. Methods: A blended periconception lifestyle care approach was developed, combining the outpatient lifestyle counseling service “Healthy Pregnancy” with the eHealth platform “Smarter Pregnancy” (www.smarterpregnancy.co.uk) in which lifestyle was coached for 24 weeks. All couples contemplating pregnancy or already pregnant (≤12 weeks of gestation) who visited the outpatient clinics of the Department of Obstetrics and Gynecology at the Erasmus University Medical Center (Erasmus MC), Rotterdam, the Netherlands, between June and December 2018, were invited to participate. We measured changes in lifestyle behaviors at weeks 12 and 24 compared with baseline. Generalized estimating equations were used to analyze the changes in lifestyle behaviors over time. Subgroup analyses were performed for women with obesity (BMI ≥30 kg/m2), women pregnant at the start of the intervention, and those participating as a couple. Results: A total of 539 women were screened for eligibility, and 450 women and 61 men received the blended periconception intervention. Among the participating women, 58.4% (263/450) were included in the preconception period. Moreover, 78.9% (403/511) of the included participants completed the online lifestyle coaching. At baseline, at least one poor lifestyle behavior was present in most women (379/450, 84.2%) and men (58/61, 95.1%). In the total group, median fruit intake increased from 1.8 to 2.2 pieces/day (P<.001) and median vegetable intake increased from 151 to 165 grams/day (P<.001) after 24 weeks of online coaching. The probability of taking folic acid supplementation among women increased from 0.97 to 1 (P<.001), and the probability of consuming alcohol and using tobacco in the total group decreased from 0.25 to 0.19 (P=.002) and from 0.20 to 0.15 (P=.63), respectively. Overall, the program showed the strongest effectiveness for participating couples. Particularly for vegetable and fruit intake, their consumption increased from 158 grams/day and 1.8 pieces/day at baseline to 190 grams/day and 2.7 pieces/day at the end of the intervention, respectively. Conclusions: We succeeded in including most participating women in the preconception period. A high compliance rate was achieved and users demonstrated improvements in several lifestyle components. The blended periconception lifestyle care approach seems to be an effective method to improve lifestyle behaviors. The next step is to further disseminate this approach and to perform a randomized trial to compare the use of blended care with the provision of only eHealth. Additionally, the clinical relevance of these results will need to be substantiated further. %M 32996885 %R 10.2196/19378 %U http://www.jmir.org/2020/9/e19378/ %U https://doi.org/10.2196/19378 %U http://www.ncbi.nlm.nih.gov/pubmed/32996885 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e19157 %T Impact of a Web-Based Clinical Decision Support System to Assist Practitioners in Addressing Physical Activity and/or Healthy Eating for Smoking Cessation Treatment: Protocol for a Hybrid Type I Randomized Controlled Trial %A Minian,Nadia %A Lingam,Mathangee %A Moineddin,Rahim %A Thorpe,Kevin E %A Veldhuizen,Scott %A Dragonetti,Rosa %A Zawertailo,Laurie %A Taylor,Valerie H %A Hahn,Margaret %A deRuiter,Wayne K %A Melamed,Osnat %A Selby,Peter %+ Nicotine Dependence Services, Centre for Addiction and Mental Health, 175 College Street, Toronto, ON, M5T 1P7, Canada, 1 416 535 8501 ext 36859, peter.selby@camh.ca %K smoking cessation %K physical activity %K healthy eating %K clinical decision support system %K hybrid type 1 %D 2020 %7 29.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Modifiable risk factors such as tobacco use, physical inactivity, and poor diet account for a significant proportion of the preventable deaths in Canada. These factors are also known to cluster together, thereby compounding the risks of morbidity and mortality. Given this association, smoking cessation programs appear to be well-suited for integration of health promotion activities for other modifiable risk factors. The Smoking Treatment for Ontario Patients (STOP) program is a province-wide smoking cessation program that currently encourages practitioners to deliver Screening, Brief Intervention, and Referral to treatment for patients who are experiencing depressive symptoms or consume excessive amounts of alcohol via a web-enabled clinical decision support system. However, there is no available clinical decision support system for physical inactivity and poor diet, which are among the leading modifiable risk factors for chronic diseases. Objective: The aim of this study is to assess whether adding a computerized/web-enabled clinical decision support system for physical activity and diet to a smoking cessation program affects smoking cessation outcomes. Methods: This study is designed as a hybrid type 1 effectiveness/implementation randomized controlled trial to evaluate a web-enabled clinical decision support system for supporting practitioners in addressing patients’ physical activity and diet as part of smoking cessation treatment in a primary care setting. This design was chosen as it allows for simultaneous testing of the intervention, its delivery in target settings, and the potential for implementation in real-world situations. Intervention effectiveness will be measured using a two-arm randomized controlled trial. Health care practitioners will be unblinded to their patients’ treatment allocation; however, patients will be blinded to whether their practitioner receives the clinical decision support system for physical activity and/or fruit/vegetable consumption. The evaluation of implementation will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results: Recruitment for the primary outcome of this study is ongoing and will be completed in November 2020. Results will be reported in March 2021. Conclusions: The findings of the study will provide much needed insight into whether adding a computerized/web-enabled clinical decision support system for physical activity and diet to a smoking cessation program affects smoking cessation outcome. Furthermore, the implementation evaluation would provide insight into the feasibility of online-based interventions for physical activity and diet in a smoking cessation program. Addressing these risk factors simultaneously could have significant positive effects on chronic disease and cancer prevention. Trial Registration: ClinicalTrials.gov NCT04223336; https://clinicaltrials.gov/ct2/show/NCT04223336 International Registered Report Identifier (IRRID): DERR1-10.2196/19157 %M 32990250 %R 10.2196/19157 %U http://www.researchprotocols.org/2020/9/e19157/ %U https://doi.org/10.2196/19157 %U http://www.ncbi.nlm.nih.gov/pubmed/32990250 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e17563 %T Implementing Facilitated Access to a Text Messaging, Smoking Cessation Intervention Among Swedish Patients Having Elective Surgery: Qualitative Study of Patients’ and Health Care Professionals’ Perspectives %A Thomas,Kristin %A Bendtsen,Marcus %A Linderoth,Catharina %A Bendtsen,Preben %+ Department of Health, Medicine and Caring Sciences, Linköping University, 58381, Linköping, , Sweden, 46 13282546, kristin.thomas@liu.se %K mHealth %K mobile health %K text messages %K health care %K smoking cessation %K patients with elective surgery %K implementation %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is strong evidence that short-term smoking cessation before surgery can reduce postoperative morbidity. There are, however, several structural problems in health care systems concerning how to implement smoking cessation interventions in routine practice for preoperative patients. Objective: This study aimed to analyze the implementation of a text messaging, smoking cessation intervention targeting patients having elective surgery. Implementation of facilitated access (ie, referral from practitioners) and the perceived usefulness among patients were investigated. Elective surgery is defined as scheduled, nonacute surgery. Methods: A qualitative study was carried out at two medium-sized hospitals in the south of Sweden. The implementation of facilitated access was investigated during a 12-month period from April 2018 to April 2019. Facilitated access was conceptualized as specialists recommending the text messaging intervention to patients having elective surgery. Implementation was explored in terms of perceptions about the intervention and behaviors associated with implementation; that is, how patients used the intervention and how specialists behaved in facilitating usage among patients. Two focus groups with smoking cessation specialists and 10 individual interviews with patients were carried out. Qualitative content analysis was used to analyze the data. Results: Two main categories were identified from the focus group data with smoking cessation specialists: implementation approach and perceptions about the intervention. The first category, implementation approach, referred to how specialists adapted their efforts to situational factors and to the needs and preferences of patients, and how building of trust with patients was prioritized. The second category, perceptions about the intervention, showed that specialists thought the content and structure of the text messaging intervention felt familiar and worked well as a complement to current practice. Two categories were identified from the patient interview data: incorporating new means of support from health care and determinants of use. The first category referred to how patients adopted and incorporated the intervention into their smoking cessation journey. Patients were receptive, shared the text messages with friends and family, humanized the text messages, and used the messages as a complement to other strategies to quit smoking. The second category, determinants of use, referred to aspects that influenced how and when patients used the intervention and included the following: timing of the intervention and text messages, motivation to change, and perceptions of the mobile phone medium. Conclusions: Smoking cessation specialists adopted an active role in implementing the intervention by adapting their approach and fitting the intervention into existing routines. Patients showed strong motivation to change and openness to incorporate the intervention into their behavior change journey; however, the timing of the intervention and messages were important in optimizing the support. A text messaging, smoking cessation intervention can be a valuable and feasible way to reach smoking patients having elective surgery. %M 32945772 %R 10.2196/17563 %U https://mhealth.jmir.org/2020/9/e17563 %U https://doi.org/10.2196/17563 %U http://www.ncbi.nlm.nih.gov/pubmed/32945772 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e18071 %T A Mobile Social Network–Based Smoking Cessation Intervention for Chinese Male Smokers: Protocol for a Pilot Randomized Controlled Trial %A Chen,Jinsong %A Ho,Elsie %A Jiang,Yannan %A Whittaker,Robyn %A Yang,Tingzhong %A Bullen,Christopher %+ The National Institute for Health Innovation, The University of Auckland, 507, University of Auckland, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand, 64 093737599, jinsong.chen@auckland.ac.nz %K mHealth %K mobile phone %K smoking cessation %K public health %D 2020 %7 18.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Approximately 2 million Chinese people die annually from tobacco-related diseases, mostly men; yet, fewer than 8% of Chinese smokers ever receive any smoking cessation advice or support. A social network–based gamified smoking cessation intervention (SCAMPI: Smoking Cessation App for Chinese Male: Pilot Intervention) is designed to help Chinese male smokers to quit smoking. Objective: This paper aims to present the protocol of a study examining the preliminary effectiveness of SCAMPI by comparing the prolonged abstinence rate of a group of users with a comparator group during a 6-week follow-up period. Methods: A two-arm pilot randomized controlled trial was conducted to assess the preliminary effectiveness and acceptability of the SCAMPI program as a smoking cessation intervention. After initial web-based screening, the first 80 eligible individuals who had gone through the required registration process were registered as participants of the trial. Participants were randomly allocated to the intervention group (n=40) and the control group (n=40). Participants in the intervention group used the full version of the SCAMPI program, which is a Chinese smoking cessation program developed based on the Behavior Change Wheel framework and relevant smoking cessation and design guidelines with involvement of target users. The program delivers a range of smoking cessation approaches, including helping users to make quitting plans, calculator to record quitting benefits, calendar to record progress, gamification to facilitate quitting, providing information about smoking harms, motivational messages to help users overcome urges, providing standardized tests to users for assessing their levels of nicotine dependence and lung health, and providing a platform to encourage social support between users. Participants in the control group used the restricted version of the SCAMPI program (placebo app). Results: Recruitment for this project commenced in January 2019 and proceeded until March 2019. Follow-up data collection was commenced and completed by June 2019. The primary outcome measure of the study was the 30-day bio-verified smoking abstinence at the 6-week follow-up (self-reported data verified by the Nicotine Cotinine Saliva Test). The secondary outcome measures of the study included participants’ cigarette consumption reduction (compared baseline daily cigarette consumption with end-of-trial daily cigarette consumption), participants’ 7-day smoking abstinence at 4-week and 6-week follow-up (self-reported), participants’ 30-day smoking abstinence at 6-week follow-up (self-reported data only), and participants’ acceptability and satisfaction levels of using the SCAMPI program (measured by the Mobile App Rating Scale questionnaire). Conclusions: If the SCAMPI program is shown to be preliminary effective, the study will be rolled out to be a future trial with a larger sample size and longer follow-up (6 months) to identify if it is an effective social network–based tool to support Chinese male smokers to quit smoking. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001089224; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375381 International Registered Report Identifier (IRRID): RR1-10.2196/18071 %M 32945261 %R 10.2196/18071 %U http://www.researchprotocols.org/2020/9/e18071/ %U https://doi.org/10.2196/18071 %U http://www.ncbi.nlm.nih.gov/pubmed/32945261 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18621 %T Effectiveness of Individual Real-Time Video Counseling on Smoking, Nutrition, Alcohol, Physical Activity, and Obesity Health Risks: Systematic Review %A Byaruhanga,Judith %A Atorkey,Prince %A McLaughlin,Matthew %A Brown,Alison %A Byrnes,Emma %A Paul,Christine %A Wiggers,John %A Tzelepis,Flora %+ Hunter New England Population Health, Locked Bag 10, Wallsend, , Australia, 61 249246454, judith.byaruhanga@uon.edu.au %K telehealth %K videoconferencing %K smoking cessation %K diet %K alcohol drinking %K physical activity %K obesity %K mobile phone %D 2020 %7 11.9.2020 %9 Review %J J Med Internet Res %G English %X Background: Real-time video communication technology allows virtual face-to-face interactions between the provider and the user, and can be used to modify risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. No systematic reviews have examined the effectiveness of individual real-time video counseling for addressing each of the risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. Objective: This systematic review aims to examine the effectiveness of individually delivered real-time video counseling on risk factors for smoking, nutrition, alcohol consumption, physical activity, and obesity. Methods: The MEDLINE (Medical Literature Analysis and Retrieval System Online), EMBASE (Excerpta Medica Database), PsycINFO, Cochrane Register of Controlled Trials, and Scopus databases were searched for eligible studies published up to November 21, 2019. Eligible studies were randomized or cluster randomized trials that tested the effectiveness of individual real-time video communication interventions on smoking, nutrition, alcohol, physical activity, and obesity in any population or setting; the comparator was a no-intervention control group or any other mode of support (eg, telephone); and an English-language publication. Results: A total of 13 studies were eligible. Four studies targeted smoking, 3 alcohol, 3 physical activity, and 3 obesity. In 2 of the physical activity studies, real-time video counseling was found to significantly increase physical activity when compared with usual care at week 9 and after 5 years. Two obesity studies found a significant change in BMI between a video counseling and a documents group, with significantly greater weight loss in the video counseling group than the in-person as well as the control groups. One study found that those in the video counseling group were significantly more likely than those in the telephone counseling group to achieve smoking cessation. The remaining studies found no significant differences between video counseling and telephone counseling or face-to-face counseling for smoking cessation, video counseling and face-to-face treatment on alcohol consumption, video counseling and no counseling for physical activity, and video counseling and face-to-face treatment on BMI. The global methodological quality rating was moderate in 1 physical activity study, whereas 12 studies had a weak global rating. Conclusions: Video counseling is potentially more effective than a control group or other modes of support in addressing physical inactivity and obesity and is not less effective in modifying smoking and alcohol consumption. Further research is required to determine the relative benefits of video counseling in terms of other policy and practice decision-making factors such as costs and feasibility. %M 32915156 %R 10.2196/18621 %U http://www.jmir.org/2020/9/e18621/ %U https://doi.org/10.2196/18621 %U http://www.ncbi.nlm.nih.gov/pubmed/32915156 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19975 %T Investigating the Attitudes of Adolescents and Young Adults Towards JUUL: Computational Study Using Twitter Data %A Benson,Ryzen %A Hu,Mengke %A Chen,Annie T %A Nag,Subhadeep %A Zhu,Shu-Hong %A Conway,Mike %+ Department of Biomedical Informatics, University of Utah, 421 Wakara Way, #140, Salt Lake City, UT, 84108, United States, 1 (801) 581 4080, ryzen.benson@utah.edu %K JUUL %K electronic cigarettes %K smoking cessation %K natural language processing %K NLP %K Twitter %K underage tobacco use %K tobacco %K e-cig %K ENDS %K electronic nicotine delivery system %K machine learning %K infodemiology %K infoveillance %K social media %K public health %D 2020 %7 2.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Increases in electronic nicotine delivery system (ENDS) use among high school students from 2017 to 2019 appear to be associated with the increasing popularity of the ENDS device JUUL. Objective: We employed a content analysis approach in conjunction with natural language processing methods using Twitter data to understand salient themes regarding JUUL use on Twitter, sentiment towards JUUL, and underage JUUL use. Methods: Between July 2018 and August 2019, 11,556 unique tweets containing a JUUL-related keyword were collected. We manually annotated 4000 tweets for JUUL-related themes of use and sentiment. We used 3 machine learning algorithms to classify positive and negative JUUL sentiments as well as underage JUUL mentions. Results: Of the annotated tweets, 78.80% (3152/4000) contained a specific mention of JUUL. Only 1.43% (45/3152) of tweets mentioned using JUUL as a method of smoking cessation, and only 6.85% (216/3152) of tweets mentioned the potential health effects of JUUL use. Of the machine learning methods used, the random forest classifier was the best performing algorithm among all 3 classification tasks (ie, positive sentiment, negative sentiment, and underage JUUL mentions). Conclusions: Our findings suggest that a vast majority of Twitter users are not using JUUL to aid in smoking cessation nor do they mention the potential health benefits or detriments of JUUL use. Using machine learning algorithms to identify tweets containing underage JUUL mentions can support the timely surveillance of JUUL habits and opinions, further assisting youth-targeted public health intervention strategies. %M 32876579 %R 10.2196/19975 %U https://publichealth.jmir.org/2020/3/e19975 %U https://doi.org/10.2196/19975 %U http://www.ncbi.nlm.nih.gov/pubmed/32876579 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e21784 %T Development of a Mobile Health Intervention with Personal Experiments for Smokers Who Are Ambivalent About Quitting: Formative Design and Testing %A Heffner,Jaimee L %A Catz,Sheryl L %A Klasnja,Predrag %A Tiffany,Brooks %A McClure,Jennifer B %+ Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, United States, 1 206 287 2737, Jennifer.B.McClure@kp.org %K tobacco %K nicotine %K smoking %K cessation %K smartphone %K motivation %K mHealth %K intervention %K formative %K development %D 2020 %7 27.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The majority of cigarette smokers want to quit someday but are not ready to commit to long-term abstinence. However, available smoking cessation treatments are not well-suited to meet the needs of these ambivalent smokers. Low-cost, high-reach mobile health (mHealth) interventions may be a cost-efficient means of offering assistance to ambivalent smokers, yet there are currently no evidence-based options available for this group. Objective: The aim of this study was to develop and preliminarily evaluate the core content for an mHealth program targeting adult smokers who are ambivalent about quitting. The core content consisted of a series of “personal experiments” similar to those tested as part of a counseling intervention in prior work, including brief cognitive or behavioral tasks designed to boost readiness for changing smoking behavior. Methods: We conducted individual user interviews (N=3) to refine program content, and then conducted a one-arm pilot study (N=25) to assess user receptivity and the potential impact of the experiments on motivation and self-efficacy to quit or reduce smoking. Results: In user interviews, participants liked the concept of the personal experiments. Participants in the pilot study found a medium-fidelity prototype to be highly acceptable. After watching a brief orientation video that explained how the program works, most participants (80%, 20/25) indicated that it sounded interesting, primarily because it did not require any commitment to quit. All participants (100%, 25/25) completed all 7 experiments, including a 24-hour quit attempt, although not all were able to refrain from smoking for a full day based on qualitative feedback on the experiment. The mean rating of usefulness of the overall program was 4.12 (SD 1.09) out of 5, and the average rating of the difficulty of the experiments was 2.16 (SD 1.18) out of 5. At the last assessment point, 92% (23/25) of the participants indicated that they were more interested in either quitting or cutting back than when they began the program, and 72% (18/25) said that if the program had included a free trial of nicotine replacement therapy, they would have used it to try to quit smoking. Conclusions: This formative work confirmed that ambivalent smokers are willing to use and will remain engaged with an mHealth intervention that employs the novel concept of personal experiments to enhance their motivation for and ability to quit smoking. The addition of action-oriented treatment (self-help and free nicotine replacement therapy, quitline referral) could further support users’ efforts to stop smoking and remain quit. %M 32852278 %R 10.2196/21784 %U http://formative.jmir.org/2020/8/e21784/ %U https://doi.org/10.2196/21784 %U http://www.ncbi.nlm.nih.gov/pubmed/32852278 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e18583 %T A Mobile Health Intervention for Adolescents Exposed to Secondhand Smoke: Pilot Feasibility and Efficacy Study %A Nardone,Natalie %A Giberson,Jeremy %A Prochaska,Judith J %A Jain,Shonul %A Benowitz,Neal L %+ Clinical Pharmacology Research Program, Division of Cardiology, Department of Medicine, University of California, Building 30, Room 3316, 1001 Potrero Ave, San Francisco, CA, 94110, United States, 1 628 206 8324, neal.benowitz@ucsf.edu %K secondhand smoke %K adolescents %K cotinine %K mHealth %K intervention %D 2020 %7 19.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Secondhand smoke (SHS) exposure in children and adolescents has adverse health effects. For adolescents of lower socioeconomic status (SES), exposure is widespread, evidenced in the measurement of urinary cotinine, a major metabolite of nicotine. Direct intervention with exposed children has been proposed as a novel method, yet there is minimal evidence of its efficacy. Combining this approach with a mobile health (mHealth) intervention may be more time and cost-effective and feasible for adolescent populations. Objective: In this pilot study, we assessed the feasibility and preliminary evidence of efficacy of a 30-day text message–based mHealth intervention targeted at reducing SHS exposure in adolescent populations of low SES. Methods: For the study, 14 nonsmoking and nonvaping participants between the ages of 12-21 years exposed to SHS were enrolled. The intervention consisted of a daily text message sent to the participants over the course of a month. Text message types included facts and information about SHS, behavioral methods for SHS avoidance, or true-or-false questions. Participants were asked to respond to each message within 24 hours as confirmation of receipt. Feasibility outcomes included completion of the 30-day intervention, receiving and responding to text messages, and feedback on the messages. Efficacy outcomes included a reduction in urinary cotinine, accuracy of true-or-false responses, and participants’ perceptions of effectiveness. Results: Of the 14 participants that were enrolled, 13 completed the intervention. Though not required, all participants had their own cell phones with unlimited text messaging plans. Of the total number of text messages sent to the 13 completers, 91% (372/407) of them received on-time responses. Participant feedback was generally positive, with most requesting more informational and true-or-false questions. In terms of efficacy, 54% (6/11) of participants reduced their cotinine levels (however, change for the group overall was not statistically significant (P=.33) and 45% (5/11) of participants increased their cotinine levels. Of the total number of true-or-false questions sent across all completers, 77% (56/73) were answered correctly. Participants’ ratings of message effectiveness averaged 85 on a scale of 100. Conclusions: In this pilot study, the intervention was feasible as the majority of participants had access to a cell phone, completed the study, and engaged by responding to the messages. The efficacy of the study requires further replication, as only half of the participants reduced their cotinine levels. However, participants answered the majority of true-or-false questions accurately and reported that the messages were helpful. %M 32812888 %R 10.2196/18583 %U http://formative.jmir.org/2020/8/e18583/ %U https://doi.org/10.2196/18583 %U http://www.ncbi.nlm.nih.gov/pubmed/32812888 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e18943 %T Tactics for Drawing Youth to Vaping: Content Analysis of Electronic Cigarette Advertisements %A Struik,Laura L %A Dow-Fleisner,Sarah %A Belliveau,Michelle %A Thompson,Desiree %A Janke,Robert %+ School of Nursing, Department of Health and Social Development, University of British Columbia Okanagan, ARTS 140, 1147 Research Road, Kelowna, BC, V1V1V7, Canada, 1 2508077792, laura.struik@ubc.ca %K qualitative research %K electronic nicotine delivery systems %K marketing %K advertisement %K youth %K vaping %D 2020 %7 14.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of electronic cigarettes (e-cigarettes), also known as vaping, has risen exponentially among North American youth in recent years and has become a critical public health concern. The marketing strategies used by e-cigarette companies have been associated with the uptick in use among youth, with video advertisements on television and other electronic platforms being the most pervasive strategy. It is unknown how these advertisements may be tapping into youth needs and preferences. Objective: The aim of this 2-phase study was to examine the marketing strategies that underpin e-cigarette advertisements, specifically in the context of television. Methods: In phase 1, a scoping review was conducted to identify various influences on e-cigarette uptake among youth. Results of this scoping review informed the development of a coding framework. In phase 2, this framework was used to analyze the content of e-cigarette advertisements as seen on 2 popular television channels (Discovery and AMC). Results: In phase 1, a total of 20 articles met the inclusion criteria. The resultant framework consisted of 16 key influences on e-cigarette uptake among youth, which were categorized under 4 headings: personal, relational, environmental, and product-related. In phase 2, 38 e-cigarette advertisements were collected from iSpot.tv and represented 11 popular e-cigarette brands. All of the advertisements tapped into the cited influences of youth e-cigarette uptake, with the most commonly cited influences (product and relational) tapping into the most, at 97% (37/38) and 53% (20/38), respectively. Conclusions: The findings highlight the multidimensional influences on youth uptake of e-cigarettes, which has important implications for developing effective antivaping messages, and assist public health professionals in providing more comprehensive prevention and cessation support as it relates to e-cigarette use. The findings also bring forward tangible strategies employed by e-cigarette companies to recruit youth into vaping. Understanding this is vital to the development of cohesive strategies that combat these provaping messages. %M 32663163 %R 10.2196/18943 %U https://www.jmir.org/2020/8/e18943 %U https://doi.org/10.2196/18943 %U http://www.ncbi.nlm.nih.gov/pubmed/32663163 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19389 %T Comparing Methods of Recruiting Spanish-Preferring Smokers in the United States: Findings from a Randomized Controlled Trial %A Medina-Ramirez,Patricia %A Calixte-Civil,Patricia %A Meltzer,Lauren R %A Brandon,Karen O %A Martinez,Ursula %A Sutton,Steven K %A Meade,Cathy D %A Byrne,Margaret M %A Brandon,Thomas H %A Simmons,Vani N %+ Tobacco Research & Intervention Program, Department of Health Outcomes & Behavior, Moffitt Cancer Center & Research Institute, 4115 E. Fowler Avenue, Tampa, FL, 33617, United States, 1 813 745 4673 ext 4816, vani.simmons@moffitt.org %K Hispanic %K Latino %K smoking cessation intervention %K randomized controlled trial %K tobacco cigarette %K recruitment %K social media %K Facebook %K web banner ad %D 2020 %7 14.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a pressing need to address the unacceptable disparities and underrepresentation of racial and ethnic minority groups, including Hispanics or Latinxs, in smoking cessation trials. Objective: Given the lack of research on recruitment strategies for this population, this study aims to assess effective recruitment methods based on enrollment and cost. Methods: Recruitment and enrollment data were collected from a nationwide randomized controlled trial (RCT) of a Spanish-language smoking cessation intervention (N=1417). The effectiveness of each recruitment strategy was evaluated by computing the cost per participant (CPP), which is the ratio of direct cost over the number enrolled. More effective strategies yielded lower CPPs. Demographic and smoking-related characteristics of participants recruited via the two most effective strategies were also compared (n=1307). Results: Facebook was the most effective method (CPP=US $74.12), followed by TV advertisements (CPP=US $191.31), whereas public bus interior card advertising was the least effective method (CPP=US $642.50). Participants recruited via Facebook had lower average age (P=.008) and had spent fewer years in the United States (P<.001). Among the participants recruited via Facebook, a greater percentage of individuals had at least a high school education (P<.001) and an annual income above US $10,000 (P<.001). In addition, a greater percentage of individuals were employed (P<.001) and foreign born (P=.003). In terms of subethnicity, among the subjects recruited via Facebook, a lower percentage of individuals were of Mexican origin (P<.001) and a greater percentage of individuals were of Central American (P=.02), South American (P=.01), and Cuban (P<.001) origin. Conclusions: Facebook was the most effective method for recruiting Hispanic or Latinx smokers in the United States for this RCT. However, using multiple methods was necessary to recruit a more diverse sample of Spanish-preferring Hispanic or Latinx smokers. %M 32795986 %R 10.2196/19389 %U https://www.jmir.org/2020/8/e19389 %U https://doi.org/10.2196/19389 %U http://www.ncbi.nlm.nih.gov/pubmed/32795986 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17478 %T Machine Learning Classifiers for Twitter Surveillance of Vaping: Comparative Machine Learning Study %A Visweswaran,Shyam %A Colditz,Jason B %A O’Halloran,Patrick %A Han,Na-Rae %A Taneja,Sanya B %A Welling,Joel %A Chu,Kar-Hai %A Sidani,Jaime E %A Primack,Brian A %+ Department of Biomedical Informatics, University of Pittsburgh, The Offices at Baum, 5607 Baum Blvd, Suite 523, Pittsburgh, PA, 15206, United States, 1 (412) 648 7119, shv3@pitt.edu %K vaping %K social media %K infodemiology %K infoveillance %K machine learning %K deep learning %D 2020 %7 12.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Twitter presents a valuable and relevant social media platform to study the prevalence of information and sentiment on vaping that may be useful for public health surveillance. Machine learning classifiers that identify vaping-relevant tweets and characterize sentiments in them can underpin a Twitter-based vaping surveillance system. Compared with traditional machine learning classifiers that are reliant on annotations that are expensive to obtain, deep learning classifiers offer the advantage of requiring fewer annotated tweets by leveraging the large numbers of readily available unannotated tweets. Objective: This study aims to derive and evaluate traditional and deep learning classifiers that can identify tweets relevant to vaping, tweets of a commercial nature, and tweets with provape sentiments. Methods: We continuously collected tweets that matched vaping-related keywords over 2 months from August 2018 to October 2018. From this data set of tweets, a set of 4000 tweets was selected, and each tweet was manually annotated for relevance (vape relevant or not), commercial nature (commercial or not), and sentiment (provape or not). Using the annotated data, we derived traditional classifiers that included logistic regression, random forest, linear support vector machine, and multinomial naive Bayes. In addition, using the annotated data set and a larger unannotated data set of tweets, we derived deep learning classifiers that included a convolutional neural network (CNN), long short-term memory (LSTM) network, LSTM-CNN network, and bidirectional LSTM (BiLSTM) network. The unannotated tweet data were used to derive word vectors that deep learning classifiers can leverage to improve performance. Results: LSTM-CNN performed the best with the highest area under the receiver operating characteristic curve (AUC) of 0.96 (95% CI 0.93-0.98) for relevance, all deep learning classifiers including LSTM-CNN performed better than the traditional classifiers with an AUC of 0.99 (95% CI 0.98-0.99) for distinguishing commercial from noncommercial tweets, and BiLSTM performed the best with an AUC of 0.83 (95% CI 0.78-0.89) for provape sentiment. Overall, LSTM-CNN performed the best across all 3 classification tasks. Conclusions: We derived and evaluated traditional machine learning and deep learning classifiers to identify vaping-related relevant, commercial, and provape tweets. Overall, deep learning classifiers such as LSTM-CNN had superior performance and had the added advantage of requiring no preprocessing. The performance of these classifiers supports the development of a vaping surveillance system. %M 32784184 %R 10.2196/17478 %U https://www.jmir.org/2020/8/e17478 %U https://doi.org/10.2196/17478 %U http://www.ncbi.nlm.nih.gov/pubmed/32784184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17432 %T Review of Evaluation Metrics Used in Digital and Traditional Tobacco Control Campaigns %A Chan,Lilian %A O'Hara,Blythe %A Phongsavan,Philayrath %A Bauman,Adrian %A Freeman,Becky %+ Sydney School of Public Health and Charles Perkins Centre, Prevention Research Collaboration, The University of Sydney, Johns Hopkins Dr, Camperdown, NSW 2006, Australia, 61 2 8627 7554, lilian.chan@sydney.edu.au %K mass media %K internet %K evaluation studies as topic %K smoking cessation %K public health %D 2020 %7 11.8.2020 %9 Review %J J Med Internet Res %G English %X Background: Mass media campaigns for public health are increasingly using digital media platforms, such as web-based advertising and social media; however, there is a lack of evidence on how to best use these digital platforms for public health campaigns. To generate this evidence, appropriate campaign evaluations are needed, but with the proliferation of digital media–related metrics, there is no clear consensus on which evaluation metrics should be used. Public health campaigns are diverse in nature, so to facilitate analysis, this review has selected tobacco control campaigns as the scope of the study. Objective: This literature review aimed to examine how tobacco control campaigns that use traditional and digital media platforms have been evaluated. Methods: Medicine and science databases (Medical Literature Analysis and Retrieval System Online [MEDLINE], EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature [CINAHL], and Scopus), and a marketing case study database (World Advertising Research Center) were searched for articles published between 2013 and 2018. Two authors established the eligibility criteria and reviewed articles for inclusion. Individual campaigns were identified from the articles, and information on campaigns and their evaluations were supplemented with searches on Google, Google Scholar, and social media platforms. Data about campaign evaluations were tabulated and mapped to a conceptual framework. Results: In total, 17 campaigns were included in this review, with evaluations reported on by 51 articles, 17 marketing reports, and 4 grey literature reports. Most campaigns were from English-speaking countries, with behavioral change as the primary objective. In the process evaluations, a wide range of metrics were used to assess the reach of digital campaign activities, making comparison between campaigns difficult. Every campaign in the review, except one, reported some type of engagement impact measure, with website visits being the most commonly reported metric (11 of the 17 campaigns). Other commonly reported evaluation measures identified in this review include engagement on social media, changes in attitudes, and number of people contacting smoking cessation services. Of note, only 7 of the 17 campaigns attempted to measure media platform attribution, for example, by asking participants where they recalled seeing the campaign or using unique website tracking codes for ads on different media platforms. Conclusions: One of the key findings of this review is the numerous and diverse range of measures and metrics used in tobacco control campaign evaluations. To address this issue, we propose principles to guide the selection of digital media–related metrics for campaign evaluations, and also outline a conceptual framework to provide a coherent organization to the diverse range of metrics. Future research is needed to specifically investigate whether engagement metrics are associated with desired campaign outcomes, to determine whether reporting of engagement metrics is meaningful in campaign evaluations. %M 32348272 %R 10.2196/17432 %U https://www.jmir.org/2020/8/e17432 %U https://doi.org/10.2196/17432 %U http://www.ncbi.nlm.nih.gov/pubmed/32348272 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17571 %T Virtual Reality Smartphone-Based Intervention for Smoking Cessation: Pilot Randomized Controlled Trial on Initial Clinical Efficacy and Adherence %A Goldenhersch,Emilio %A Thrul,Johannes %A Ungaretti,Joaquín %A Rosencovich,Nicolas %A Waitman,Cristian %A Ceberio,Marcelo Rodriguez %+ Laboratorio de Investigación en Neurociencia y Ciencias Sociales, Universidad de Flores, Avenida Rivadavia 5741, Ciudad Autónoma de Buenos Aires, CP 1414, Argentina, 1 4808860102, emiliogolden@gmail.com %K smoking cessation %K nicotine dependence %K craving %K virtual reality %K mindfulness %K digital therapy %K mHealth %K mobile phone %D 2020 %7 29.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Obstacles to current tobacco cessation programs include limited access and adherence to effective interventions. Digital interventions offer a great opportunity to overcome these difficulties, yet virtual reality has not been used as a remote and self-administered tool to help increase adherence and effectiveness of digital interventions for tobacco cessation. Objective: This study aimed to evaluate participant adherence and smoking cessation outcomes in a pilot randomized controlled trial of the digital intervention Mindcotine (MindCotine Inc) using a self-administered treatment of virtual reality combined with mindfulness. Methods: A sample of 120 participants was recruited in the city of Buenos Aires, Argentina (mean age 43.20 years, SD 9.50; 57/120, 47.5% female). Participants were randomly assigned to a treatment group (TG), which received a self-assisted 21-day program based on virtual reality mindful exposure therapy (VR-MET) sessions, daily surveys, and online peer-to-peer support moderated by psychologists, or a control group (CG), which received the online version of the smoking cessation manual from the Argentine Ministry of Health. Follow-up assessments were conducted by online surveys at postintervention and 90-day follow-up. The primary outcome was self-reported abstinence at postintervention, with missing data assumed as still smoking. Secondary outcomes included sustained abstinence at 90-day follow-up, adherence to the program, and readiness to quit. Results: Follow-up rates at day 1 were 93% (56/60) for the TG and 100% (60/60) for the CG. At postintervention, the TG reported 23% (14/60) abstinence on that day compared with 5% (3/60) in the CG. This difference was statistically significant (χ21=8.3; P=.004). The TG reported sustained abstinence of 33% (20/60) at 90 days. Since only 20% (12/60) of participants in the CG completed the 90-day follow-up, we did not conduct a statistical comparison between groups at this follow-up time point. Among participants still smoking at postintervention, the TG was significantly more ready to quit compared to the CG (TG: mean 7.71, SD 0.13; CG: mean 7.16, SD 0.13; P=.005). A total of 41% (23/56) of participants completed the treatment in the time frame recommended by the program. Conclusions: Results provide initial support for participant adherence to and efficacy of Mindcotine and warrant testing the intervention in a fully powered randomized trial. However, feasibility of trial follow-up assessment procedures for control group participants needs to be improved. Further research is needed on the impact of VR-MET on long-term outcomes. Trial Registration: ISRCTN Registry ISRCTN50586181; http://www.isrctn.com/ISRCTN50586181 %M 32723722 %R 10.2196/17571 %U http://www.jmir.org/2020/7/e17571/ %U https://doi.org/10.2196/17571 %U http://www.ncbi.nlm.nih.gov/pubmed/32723722 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e19485 %T A Web-Based Intervention to Prevent Multiple Chronic Disease Risk Factors Among Adolescents: Co-Design and User Testing of the Health4Life School-Based Program %A Champion,Katrina Elizabeth %A Gardner,Lauren Anne %A McGowan,Cyanna %A Chapman,Cath %A Thornton,Louise %A Parmenter,Belinda %A McBride,Nyanda %A Lubans,David R %A McCann,Karrah %A Spring,Bonnie %A Teesson,Maree %A , %A Newton,Nicola Clare %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, The Matilda Centre, Level 6, Jane Foss Russell Building (G02), University of Sydney, NSW, Sydney, 2006, Australia, 61 286279006, katrina.champion@sydney.edu.au %K primary prevention %K schools %K eHealth %K chronic disease %K mobile phone %K health promotion %D 2020 %7 28.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic diseases are the leading cause of death worldwide. Addressing key lifestyle risk factors during adolescence is critical for improving physical and mental health outcomes and reducing chronic disease risk. Schools are ideal intervention settings, and electronic health (eHealth) interventions afford several advantages, including increased student engagement, scalability, and sustainability. Although lifestyle risk behaviors tend to co-occur, few school-based eHealth interventions have targeted multiple behaviors concurrently. Objective: This study aims to summarize the co-design and user testing of the Health4Life school-based program, a web-based cartoon intervention developed to concurrently prevent 6 key lifestyle risk factors for chronic disease among secondary school students: alcohol use, smoking, poor diet, physical inactivity, sedentary recreational screen time, and poor sleep (the Big 6). Methods: The development of the Health4Life program was conducted over 18 months in collaboration with students, teachers, and researchers with expertise relevant to the Big 6. The iterative process involved (1) scoping of evidence and systematic literature review; (2) consultation with adolescents (N=815) via a cross-sectional web-based survey to identify knowledge gaps, attitudes, barriers, and facilitators in relation to the Big 6; (3) content and web development; and (4) user testing of the web-based program with students (n=41) and teachers (n=8) to evaluate its acceptability, relevance, and appeal to the target audience. Results: The co-design process resulted in a six-module, evidence-informed program that uses interactive cartoon storylines and web-based delivery to engage students. Student and teacher feedback collected during user testing was positive in terms of acceptability and relevance. Commonly identified areas for improvement concerned the length of modules, age appropriateness of language and alcohol storyline, the need for character backstories and links to syllabus information, and feasibility of implementation. Modifications were made to address these issues. Conclusions: The Health4Life school-based program is the first universal, web-based program to concurrently address 6 important chronic disease risk factors among secondary school students. By adopting a multiple health behavior change approach, it has the potential to efficiently modify the Big 6 risk factors within one program and to equip young people with the skills and knowledge needed to achieve and maintain good physical and mental health throughout adolescence and into adulthood. %M 32720898 %R 10.2196/19485 %U http://formative.jmir.org/2020/7/e19485/ %U https://doi.org/10.2196/19485 %U http://www.ncbi.nlm.nih.gov/pubmed/32720898 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17207 %T Adherence to Blended or Face-to-Face Smoking Cessation Treatment and Predictors of Adherence: Randomized Controlled Trial %A Siemer,Lutz %A Brusse-Keizer,Marjolein G J %A Postel,Marloes G %A Ben Allouch,Somaya %A Sanderman,Robbert %A Pieterse,Marcel E %+ Technology, Health & Care Research Group, Saxion University of Applied Sciences, MH Tromplaan 28, Enschede, 7513 AB, Netherlands, 31 17678025906, l.siemer@utwente.nl %K blended treatment %K smoking cessation %K adherence %K predictors %K tobacco %K prevention %D 2020 %7 23.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Blended face-to-face and web-based treatment is a promising way to deliver smoking cessation treatment. Since adherence has been shown to be an indicator of treatment acceptability and a determinant for effectiveness, we explored and compared adherence and predictors of adherence to blended and face-to-face alone smoking cessation treatments with similar content and intensity. Objective: The objectives of this study were (1) to compare adherence to a blended smoking cessation treatment with adherence to a face-to-face treatment; (2) to compare adherence within the blended treatment to its face-to-face mode and web mode; and (3) to determine baseline predictors of adherence to both treatments as well as (4) the predictors to both modes of the blended treatment. Methods: We calculated the total duration of treatment exposure for patients (N=292) of a Dutch outpatient smoking cessation clinic who were randomly assigned either to the blended smoking cessation treatment (n=130) or to a face-to-face treatment with identical components (n=162). For both treatments (blended and face-to-face) and for the two modes of delivery within the blended treatment (face-to-face vs web mode), adherence levels (ie, treatment time) were compared and the predictors of adherence were identified within 33 demographic, smoking-related, and health-related patient characteristics. Results: We found no significant difference in adherence between the blended and the face-to-face treatments. Participants in the blended treatment group spent an average of 246 minutes in treatment (median 106.7% of intended treatment time, IQR 150%-355%) and participants in the face-to-face group spent 238 minutes (median 103.3% of intended treatment time, IQR 150%-330%). Within the blended group, adherence to the face-to-face mode was twice as high as that to the web mode. Participants in the blended group spent an average of 198 minutes (SD 120) in face-to-face mode (152% of the intended treatment time) and 75 minutes (SD 53) in web mode (75% of the intended treatment time). Higher age was the only characteristic consistently found to uniquely predict higher adherence in both the blended and face-to-face groups. For the face-to-face group, more social support for smoking cessation was also predictive of higher adherence. The variability in adherence explained by these predictors was rather low (blended R2=0.049; face-to-face R2=0.076). Within the blended group, living without children predicted higher adherence to the face-to-face mode (R2=0.034), independent of age. Higher adherence to the web mode of the blended treatment was predicted by a combination of an extrinsic motivation to quit, a less negative attitude toward quitting, and less health complaints (R2=0.164). Conclusions: This study represents one of the first attempts to thoroughly compare adherence and predictors of adherence of a blended smoking cessation treatment to an equivalent face-to-face treatment. Interestingly, although the overall adherence to both treatments appeared to be high, adherence within the blended treatment was much higher for the face-to-face mode than for the web mode. This supports the idea that in blended treatment, one mode of delivery can compensate for the weaknesses of the other. Higher age was found to be a common predictor of adherence to the treatments. The low variance in adherence predicted by the characteristics examined in this study suggests that other variables such as provider-related health system factors and time-varying patient characteristics should be explored in future research. Trial Registration: Netherlands Trial Register NTR5113; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5113 %M 32459643 %R 10.2196/17207 %U http://www.jmir.org/2020/7/e17207/ %U https://doi.org/10.2196/17207 %U http://www.ncbi.nlm.nih.gov/pubmed/32459643 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e12619 %T Effectiveness of Social Media Approaches to Recruiting Young Adult Cigarillo Smokers: Cross-Sectional Study %A Cavallo,David %A Lim,Rock %A Ishler,Karen %A Pagano,Maria %A Perovsek,Rachel %A Albert,Elizabeth %A Koopman Gonzalez,Sarah %A Trapl,Erika %A Flocke,Susan %+ Department of Nutrition, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4954, United States, 1 216 368 6627, david.cavallo@case.edu %K adolescent, young adult %K tobacco products %K social media %K research subject recruitment %D 2020 %7 22.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The prevalence of social media use among youth and young adults suggests it is an appropriate platform for study recruitment from this population. Previous studies have examined the use of social media for recruitment, but few have compared platforms, and none, to our knowledge, have attempted to recruit cigarillo users. Objective: The purpose of this study was to examine the effectiveness of different social media platforms and advertisement images for recruiting cigarillo users aged 14-28 years to complete a cigarillo use survey. Methods: We obtained objective data for advertisement impressions for a 39-week social media recruitment campaign. Advertisements were targeted to users based on their age, geography, and interests. Effectiveness was defined as the percentage of approved surveys per advertising impression. Chi-square tests were performed to compare the effectiveness of different advertisement images and platforms. Results: Valid survey completers (n=1089) were predominately older (25-28 years old, n=839, 77%). Of the 1089 survey completers, 568 (52%) identified as male, 335 (31%) as African American, and 196 (18%) as Hispanic. Advertisements delivered via Facebook/Instagram were more effective than Twitter; 311/1,027,738 (0.03%) vs 661/2,998,715 (0.02%); χ21=21.45, N=4,026,453); P<.001. Across platforms, ads featuring exclusively an image of cigarillos were more effective (397/682,994, 0.06%) than ads with images of individuals smoking (254/1,308,675, 0.02%), individuals not smoking (239/1,393,134, .02%), and groups not smoking (82/641,650, 0.01%); χ23133.73, N=4,026,453; P<.001. Conclusions: The campaign was effective in recruiting a diverse sample representative of relevant racial/ethnic categories. Advertisements on Facebook were more effective than Twitter. Advertisements that featured an image of a cigarillo were consistently the most effective and should be considered by others recruiting cigarillo users via social media. %M 32459629 %R 10.2196/12619 %U https://www.jmir.org/2020/7/e12619 %U https://doi.org/10.2196/12619 %U http://www.ncbi.nlm.nih.gov/pubmed/32459629 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16962 %T Characterizing Social Media Messages Related to Underage JUUL E-Cigarette Buying and Selling: Cross-Sectional Analysis of Reddit Subreddits %A Liu,Hejing %A Li,Qiudan %A Zhan,Yongcheng %A Zhang,Zhu %A Zeng,Daniel D %A Leischow,Scott J %+ The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Rd, Beijing, 100190, China, 86 10 82449802, qiudan.li@ia.ac.cn %K JUUL %K e-cigarette %K Reddit %K cross-sectional analysis %K electronic nicotine delivery system %K underage JUUL use %D 2020 %7 20.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Stopping the epidemic of e-cigarette use among youth has become the common goal of both regulatory authorities and health departments. JUUL is currently the most popular e-cigarette brand on the market. Young people usually obtain and exchange information about JUUL with the help of social media platforms. Along with the rising prevalence of JUUL, posts about underage JUUL buying and selling have appeared on social media platforms such as Reddit, which sharply increase the risk of minors being exposed to JUUL. Objective: This study aims to analyze Reddit messages about JUUL buying and selling among the users of the UnderageJuul subreddit, and to further summarize the characteristics of those messages. The findings and insights can contribute to a better understanding of the patterns of underage JUUL use, and help public health officials provide timely education and guidance to minors who have intentions of accessing JUUL. Methods: We used a novel cross-subreddit method to analyze the Reddit messages on 2 subreddits. From July 9, 2017, to January 7, 2018, we collected data from the UnderageJuul subreddit, which was created for underage JUUL use discussion. The data set included 716 threads, 2935 comments, and 844 Reddit users (ie, Redditors). We collected our second data set, comprising 23,840 threads and 162,106 comments posted between July 9, 2017, and January 8, 2019, from the JUUL subreddit. We conducted analyses including the following: (1) annotation of users with buying/selling intention, (2) posting patterns discovery and topic comparison, and (3) posting activeness observation of discovered Redditors. Term frequency–inverse document frequency and regular expression-enhanced keyword search methods were applied during the content analysis to extract the posting patterns. The public posting records of the discovered users on the JUUL subreddit during the year after the UnderageJuul subreddit was shut down were analyzed to determine whether they were still active and interested in obtaining JUUL. Results: Our study revealed the following: (1) Among the 716 threads on the UnderageJuul subreddit, there were 214 threads related to JUUL sale and 168 threads related to JUUL purchase, which accounted for 53.5% (382/714) of threads. (2) Among the 844 Redditors of the UnderageJuul subreddit, 23.82% (201/844) of users were annotated with buying intention, and 21.10% (178/844) of users were annotated with selling intention. There were 34 users with buying/selling intention that self-reported as being <21 years old. (3) The most common key phrases used in selling threads were “WTS,” “want to sell,” “for sale,” and “selling” (154/214, 72.0%). The most common key phrases used in buying threads were “look for/get JUUL/pods” (58/168, 34.5%) and “WTB” (53/168, 31.5%). (4) The most important concern that UnderageJuul Redditors had in obtaining JUULs was the price (311/1306, 23.81%), followed by the delivery service (68/1306, 5.21%). (5) The most popular flavors among the users with buying/selling intention were mango, cucumber, and mint. The flavor preferences remained consistent on both subreddits. Adverse symptoms related to the mango flavor were reported by 3 users on the JUUL subreddit. (6) In total, 24.4% (49/201) of users wanted to buy JUULs and 46.6% (83/178) of users wanted to sell JUULs, including 11 self-reported underage users, who also participated in the discussions on the JUUL subreddit. (7) Within one year of the UnderageJuul subreddit shutting down, there were 40 users who continued to post 186 threads on the JUUL subreddit, including 10 threads indicating buying/selling willingness that were posted shortly after the UnderageJuul subreddit was closed. Conclusions: There were overlapping users active in the JUUL and UnderageJuul subreddits. The buying/selling-related content appeared in multiple venues with certain posting patterns from July 9, 2017, to January 7, 2018. Such content might lead to a high risk of health problems for minors, such as nicotine addiction. Based on these findings, this study provided some insights and suggestions that might contribute to the decision-making processes of regulators and public health officials. %M 32706661 %R 10.2196/16962 %U http://www.jmir.org/2020/7/e16962/ %U https://doi.org/10.2196/16962 %U http://www.ncbi.nlm.nih.gov/pubmed/32706661 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 7 %P e17160 %T Assessment of the Effectiveness and Cost-Effectiveness of Tailored Web- and Text-Based Smoking Cessation Support in Primary Care (iQuit in Practice II): Protocol for a Randomized Controlled Trial %A Proctor,Joanna %A Naughton,Felix %A Sloan,Melanie %A Hopewell,Sarah %A Brimicombe,James %A Prevost,A Toby %A Wilson,Edward C F %A Coleman,Tim %A Sutton,Stephen %+ University of Cambridge, Cambridge, United Kingdom, 44 1223 330594, srs34@medschl.cam.ac.uk %K text messaging %K smoking cessation %K internet-based intervention %K adults %K smokers %K tobacco %K primary care %D 2020 %7 14.7.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence of smoking is declining; however, it continues to be a major public health burden. In England, primary care is the health setting that provides smoking cessation support to most smokers. However, this setting has one of the lowest success rates. The iQuit in practice intervention (iQuit) is a tailored web-based and text message intervention developed for use in primary care consultations as an adjunct to routine smoking cessation support with the aim of increasing success rates. iQuit has demonstrated feasibility, acceptability, and potential effectiveness. Objective: This definitive trial aims to determine the effectiveness and cost-effectiveness of iQuit when used as an adjunct to the usual support provided to patients who wish to quit smoking, compared with usual care alone. Methods: The iQuit in Practice II trial is a two-arm, parallel-group, randomized controlled trial (RCT) with a 1:1 individual allocation comparing usual care (ie, pharmacotherapy combined with multisession behavioral support)—the control—with usual care plus iQuit—the intervention. Participants were recruited through primary care clinics and talked to a smoking cessation advisor. Participants were randomized during the initial consultation, and those allocated to the intervention group received a tailored advice report and 90 days of text messaging in addition to the standard support provided to all patients. Results: The primary outcome is self-reported prolonged abstinence biochemically verified using saliva cotinine at 6 months after the quit date. A sample size of 1700 participants, with 850 per arm, would yield 90% power to detect a 4.3% difference in validated quit rates between the groups at the two-sided 5% level of significance. The Cambridge East Research Ethics Committee approved the study in February 2016, and funding for the study was granted from May 2016. In total, 1671 participants were recruited between August 2016 and July 2019. Follow-up for all participants was completed in January 2020. Data analysis will begin in the summer of 2020. Conclusions: iQuit in Practice II is a definitive, pragmatic RCT assessing whether a digital intervention can augment the impact of routine smoking cessation support in primary care. Previous research has found good acceptability and feasibility for delivering iQuit among smoking cessation advisors working in primary care. If demonstrated to be cost-effective, iQuit could be delivered across primary care and other settings, such as community pharmacies. The potential benefit would likely be highest where less behavioral support is delivered. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 44559004; http://www.isrctn.com /ISRCTN44559004. International Registered Report Identifier (IRRID): DERR1-10.2196/17160 %M 32673255 %R 10.2196/17160 %U https://www.researchprotocols.org/2020/7/e17160 %U https://doi.org/10.2196/17160 %U http://www.ncbi.nlm.nih.gov/pubmed/32673255 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e16083 %T Changes in Health-Risk Behavior, Body Mass Index, Mental Well-Being, and Risk Status Following Participation in a Stepwise Web-Based and Face-to-Face Intervention for Prevention of Lifestyle-Related Diseases: Nonrandomized Follow-Up Cohort Study %A Thilsing,Trine %A Sonderlund,Anders Larrabee %A Sondergaard,Jens %A Svensson,Nanna Herning %A Christensen,Jeanette Reffstrup %A Thomsen,Janus Laust %A Hvidt,Niels Christian %A Larsen,Lars Bruun %+ Research Unit of General Practice, Department of Public Health, University of Southern Denmark, JB Winsloews Vej 9A, Odense, Denmark, 45 65 50 71 95, tthilsing@health.sdu.dk %K health behavior %K noncommunicable diseases %K lifestyle-related disease %K prevention %K patient web portal %K primary health care %K risk reduction behavior %D 2020 %7 9.7.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Recent evidence suggests the effectiveness of stepwise, targeted approaches for the prevention of lifestyle-related diseases with combinations of web-based and face-to-face interventions showing promising results. Objective: This paper reports on 1-year changes in health-risk behaviors, BMI, self-rated health, mental well-being, and risk of disease at 1-year follow-up after participation in a stepwise intervention that targeted persons at high risk of disease and persons with health-risk behavior. To this end, we distinguish between participants who took up the full intervention (web-based plus face-to-face) and those who received only the web-based intervention. Methods: The Early Detection and Prevention (Danish acronym: TOF) pilot study was conducted as a nonrandomized, 1-year follow-up intervention study in two municipalities in the Region of Southern Denmark. A total of 9400 citizens born between 1957 and 1986 (aged 29 to 60 years) were randomly sampled from participating general practitioner (GP) patient-list systems and were invited to take part in the study. Participants were subsequently stratified into risk groups based on their responses to a questionnaire on health-risk behavior and data from their GP’s electronic patient record (EPR) system. All participants received a digital personal health profile with individualized information on current health-risk behavior and targeted advice on relevant health-risk behavior changes. In addition, patients at high risk of disease, as indicated by their digital health profile, were offered a targeted intervention at their GP. Patients who were not deemed at high risk of disease but who exhibited health-risk behaviors were offered a targeted intervention at their municipal health center (MHC). At 1-year follow-up, health-risk behaviors, self-rated health, BMI, and mental well-being were reassessed by questionnaire, and current information on diagnoses and medical treatment was retrieved from the EPRs. Results: Of 598 patients at high risk of disease or with health-risk behavior, 135 took up the targeted intervention at their GP or MHC and 463 received the personal health profile only. From baseline to 1-year follow-up, the number of patients with unhealthy eating habits decreased, mean mental well-being increased, and smoking prevalence decreased in patients who had received the digital personal health profile alone. Among patients who took up the targeted intervention, unhealthy eating habits and sedentary lifestyles decreased and significant reductions in mean BMI were observed. At 1-year follow up, no health-risk behaviors were detected among 17.4% of patients who at baseline had exhibited health-risk behaviors or high risk of disease. Conclusions: A stepwise targeted preventive approach using web-based and face-to-face elements may lead to favorable lifestyle changes. Specifically, a web-based approach may improve smoking and eating habits and mental well-being, whereas supplementary face-to-face interventions may be necessary to improve exercise habits and BMI. Trial Registration: ClinicalTrials.gov NCT02797392; https://clinicaltrials.gov/ct2/show/NCT02797392 International Registered Report Identifier (IRRID): RR2-10.1186/s12875-018-0820-8 %M 32673269 %R 10.2196/16083 %U https://publichealth.jmir.org/2020/3/e16083 %U https://doi.org/10.2196/16083 %U http://www.ncbi.nlm.nih.gov/pubmed/32673269 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17451 %T The Potential of Smartphone Apps in Informing Protobacco and Antitobacco Messaging Efforts Among Underserved Communities: Longitudinal Observational Study %A Lee,Edmund WJ %A Bekalu,Mesfin Awoke %A McCloud,Rachel %A Vallone,Donna %A Arya,Monisha %A Osgood,Nathaniel %A Li,Xiaoyan %A Minsky,Sara %A Viswanath,Kasisomayajula %+ Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA, 02215, United States, 1 6178587988, Edmund_Lee@dfci.harvard.edu %K mobile health %K mobile phone %K tobacco use %K big data %K spatial analysis %K data science %D 2020 %7 7.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: People from underserved communities such as those from lower socioeconomic positions or racial and ethnic minority groups are often disproportionately targeted by the tobacco industry, through the relatively high levels of tobacco retail outlets (TROs) located in their neighborhood or protobacco marketing and promotional strategies. It is difficult to capture the smoking behaviors of individuals in actual locations as well as the extent of exposure to tobacco promotional efforts. With the high ownership of smartphones in the United States—when used alongside data sources on TRO locations—apps could potentially improve tobacco control efforts. Health apps could be used to assess individual-level exposure to tobacco marketing, particularly in relation to the locations of TROs as well as locations where they were most likely to smoke. To date, it remains unclear how health apps could be used practically by health promotion organizations to better reach underserved communities in their tobacco control efforts. Objective: This study aimed to demonstrate how smartphone apps could augment existing data on locations of TROs within underserved communities in Massachusetts and Texas to help inform tobacco control efforts. Methods: Data for this study were collected from 2 sources: (1) geolocations of TROs from the North American Industry Classification System 2016 and (2) 95 participants (aged 18 to 34 years) from underserved communities who resided in Massachusetts and Texas and took part in an 8-week study using location tracking on their smartphones. We analyzed the data using spatial autocorrelation, optimized hot spot analysis, and fitted power-law distribution to identify the TROs that attracted the most human traffic using mobility data. Results: Participants reported encountering protobacco messages mostly from store signs and displays and antitobacco messages predominantly through television. In Massachusetts, clusters of TROs (Dorchester Center and Jamaica Plain) and reported smoking behaviors (Dorchester Center, Roxbury Crossing, Lawrence) were found in economically disadvantaged neighborhoods. Despite the widespread distribution of TROs throughout the communities, participants overwhelmingly visited a relatively small number of TROs in Roxbury and Methuen. In Texas, clusters of TROs (Spring, Jersey Village, Bunker Hill Village, Sugar Land, and Missouri City) were found primarily in Houston, whereas clusters of reported smoking behaviors were concentrated in West University Place, Aldine, Jersey Village, Spring, and Baytown. Conclusions: Smartphone apps could be used to pair geolocation data with self-reported smoking behavior in order to gain a better understanding of how tobacco product marketing and promotion influence smoking behavior within vulnerable communities. Public health officials could take advantage of smartphone data collection capabilities to implement targeted tobacco control efforts in these strategic locations to reach underserved communities in their built environment. %M 32673252 %R 10.2196/17451 %U https://www.jmir.org/2020/7/e17451 %U https://doi.org/10.2196/17451 %U http://www.ncbi.nlm.nih.gov/pubmed/32673252 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e15951 %T Evaluation of the Tobbstop Mobile App for Smoking Cessation: Cluster Randomized Controlled Clinical Trial %A Pallejà-Millán,Meritxell %A Rey-Reñones,Cristina %A Barrera Uriarte,Maria Luisa %A Granado-Font,Esther %A Basora,Josep %A Flores-Mateo,Gemma %A Duch,Jordi %+ Institut Català de la Salut, Unitat de Suport a la Recerca Camp de Tarragona, C/ Camí de Riudoms, 53, Reus, 43202, Spain, 34 977778515 ext 405, crey.tgn.ics@gencat.cat %K tobacco smoking %K tobacco use cessation %K mobile application %K primary public health %K clinical trial %K mobile phone %D 2020 %7 26.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps provide an accessible way to test new health-related methodologies. Tobacco is still the primary preventable cause of death in industrialized countries, constituting an important public health issue. New technologies provide novel opportunities that are effective in the cessation of smoking tobacco. Objective: This paper aims to evaluate the efficacy and usage of a mobile app for assisting adult smokers to quit smoking. Methods: We conducted a cluster randomized clinical trial. We included smokers older than 18 years who were motivated to stop smoking and used a mobile phone compatible with our mobile app. We carried out follow-up visits at 15, 30, and 45 days, and at 2, 3, 6, and 12 months. Participants of the intervention group had access to the Tobbstop mobile app designed by the research team. The primary outcomes were continuous smoking abstinence at 3 and 12 months. Results: A total of 773 participants were included in the trial, of which 602 (77.9%) began the study on their D-Day. Of participants in the intervention group, 34.15% (97/284) did not use the app. The continuous abstention level was significantly larger in the intervention group participants who used the app than in those who did not use the app at both 3 months (72/187, 38.5% vs 13/97, 13.4%; P<.001) and 12 months (39/187, 20.9% vs 8/97, 8.25%; P=.01). Participants in the intervention group who used the app regularly and correctly had a higher probability of not being smokers at 12 months (OR 7.20, 95% CI 2.14-24.20; P=.001) than the participants of the CG. Conclusions: Regular use of an app for smoking cessation is effective in comparison with standard clinical practice. Trial Registration: Clinicaltrials.gov NCT01734421; https://clinicaltrials.gov/ct2/show/NCT01734421 %M 32589153 %R 10.2196/15951 %U http://mhealth.jmir.org/2020/6/e15951/ %U https://doi.org/10.2196/15951 %U http://www.ncbi.nlm.nih.gov/pubmed/32589153 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e17337 %T Perceptions About Mindfulness and Text Messaging for Smoking Cessation in Vietnam: Results From a Qualitative Study %A Do,Vuong Van %A Spears,Claire Adams %A Van Minh,Hoang %A Huang,Jidong %A Redmon,Pamela Buffington %A Xuan Long,Nguyen %A Eriksen,Michael Paul %+ Center for Population Health Sciences, Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Hanoi, 100000, Vietnam, 1 7702352346, dvv@huph.edu.vn %K mHealth %K mobile health %K text messages %K smoking %K smoking cessation %K mobile phone %D 2020 %7 24.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With 15.6 million smokers, Vietnam is one of the top 10 largest cigarette-consuming countries in the world. Unfortunately, smoking cessation programs are still scarce in Vietnam. Mindfulness-based and text messaging–based interventions have been increasingly used in smoking cessation studies in developed countries, with promising results. Given the exponential growth of mobile phone usage in Vietnam in recent years, mobile health interventions could be a potential strategy to increase smoking cessation in Vietnam. However, substantial cultural adaptations are needed to optimize the effectiveness of these interventions among Vietnamese smokers. Objective: This study aims to involve qualitative research to inform the development of a mindfulness-based text messaging smoking cessation intervention for Vietnamese smokers. Methods: A total of 10 focus groups were conducted with 71 Vietnamese male smokers aged between 18 and 65 years (5-9 participants per focus group). Overall, 5 focus groups were conducted with smokers who had the intention to quit (ie, preparation stage of change in the transtheoretical model), and 5 focus groups were conducted with smokers who did not have the intention to quit (contemplation or precontemplation stage). The focus groups were audio recorded, transcribed verbatim, and analyzed using NVivo 12 software (QSR International). Results: The major themes included smoking triggers, barriers and facilitators for quitting, the perceptions of text messaging and mindfulness approaches for smoking cessation, and suggestions for the development of a text messaging–based smoking cessation program. Common smoking triggers included stress, difficulties concentrating, and fatigue. Frequently encountering other people who were smoking was a common barrier to quitting. However, participants indicated that concerns about the harmful effects of smoking on themselves and their wives and children, and encouragement from family members could motivate them to quit. The participants preferred diverse message content, including information about the consequences of smoking, encouragement to quit, and tips to cope with cravings. They suggested that text messages be clear and concise and use familiar language. Most smokers perceived that mindfulness training could be useful for smoking cessation. However, some suggested that videos or in-person training may also be needed to supplement teaching mindfulness through text messages. Conclusions: This study provides important insights to inform the development of a text messaging–based smoking cessation program that incorporates mindfulness for Vietnamese male smokers. The results could also be useful for informing similar programs in other low- and middle-income countries. %M 32442140 %R 10.2196/17337 %U http://mhealth.jmir.org/2020/6/e17337/ %U https://doi.org/10.2196/17337 %U http://www.ncbi.nlm.nih.gov/pubmed/32442140 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17280 %T User Perceptions of Different Electronic Cigarette Flavors on Social Media: Observational Study %A Lu,Xinyi %A Chen,Long %A Yuan,Jianbo %A Luo,Joyce %A Luo,Jiebo %A Xie,Zidian %A Li,Dongmei %+ University of Rochester Medical Center, 265 Crittenden Boulevard, CU 420708, Rochester, NY, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K e-cigarette %K flavor %K social media %D 2020 %7 24.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of electronic cigarette (e-cigarette) users has been increasing rapidly in recent years, especially among youth and young adults. More e-cigarette products have become available, including e-liquids with various brands and flavors. Various e-liquid flavors have been frequently discussed by e-cigarette users on social media. Objective: This study aimed to examine the longitudinal prevalence of mentions of electronic cigarette liquid (e-liquid) flavors and user perceptions on social media. Methods: We applied a data-driven approach to analyze the trends and macro-level user sentiments of different e-cigarette flavors on social media. With data collected from web-based stores, e-liquid flavors were classified into categories in a flavor hierarchy based on their ingredients. The e-cigarette–related posts were collected from social media platforms, including Reddit and Twitter, using e-cigarette–related keywords. The temporal trend of mentions of e-liquid flavor categories was compiled using Reddit data from January 2013 to April 2019. Twitter data were analyzed using a sentiment analysis from May to August 2019 to explore the opinions of e-cigarette users toward each flavor category. Results: More than 1000 e-liquid flavors were classified into 7 major flavor categories. The fruit and sweets categories were the 2 most frequently discussed e-liquid flavors on Reddit, contributing to approximately 58% and 15%, respectively, of all flavor-related posts. We showed that mentions of the fruit flavor category had a steady overall upward trend compared with other flavor categories that did not show much change over time. Results from the sentiment analysis demonstrated that most e-liquid flavor categories had significant positive sentiments, except for the beverage and tobacco categories. Conclusions: The most updated information about the popular e-liquid flavors mentioned on social media was investigated, which showed that the prevalence of mentions of e-liquid flavors and user perceptions on social media were different. Fruit was the most frequently discussed flavor category on social media. Our study provides valuable information for future regulation of flavored e-cigarettes. %M 32579123 %R 10.2196/17280 %U http://www.jmir.org/2020/6/e17280/ %U https://doi.org/10.2196/17280 %U http://www.ncbi.nlm.nih.gov/pubmed/32579123 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17496 %T A Social Media Study on the Associations of Flavored Electronic Cigarettes With Health Symptoms: Observational Study %A Chen,Long %A Lu,Xinyi %A Yuan,Jianbo %A Luo,Joyce %A Luo,Jiebo %A Xie,Zidian %A Li,Dongmei %+ University of Rochester Medical Center, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K e-cigarette %K social media %K eHealth %D 2020 %7 22.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, flavored electronic cigarettes (e-cigarettes) have become popular among teenagers and young adults. Discussions about e-cigarettes and e-cigarette use (vaping) experiences are prevalent online, making social media an ideal resource for understanding the health risks associated with e-cigarette flavors from the users’ perspective. Objective: This study aimed to investigate the potential associations between electronic cigarette liquid (e-liquid) flavors and the reporting of health symptoms using social media data. Methods: A dataset consisting of 2.8 million e-cigarette–related posts was collected using keyword filtering from Reddit, a social media platform, from January 2013 to April 2019. Temporal analysis for nine major health symptom categories was used to understand the trend of public concerns related to e-cigarettes. Sentiment analysis was conducted to obtain the proportions of positive and negative sentiment scores for all reported health symptom categories. Topic modeling was applied to reveal the topics related to e-cigarettes and health symptoms. Furthermore, generalized estimating equation (GEE) models were used to quantitatively measure potential associations between e-liquid flavors and the reporting of health symptoms. Results: Temporal analysis showed that the Respiratory category was consistently the most discussed health symptom category among all categories related to e-cigarettes on Reddit, followed by the Throat category. Sentiment analysis showed higher proportions of positive sentiment scores for all reported health symptom categories, except for the Cancer category. Topic modeling conducted on all health-related posts showed that 17 of the top 100 topics were flavor related. GEE models showed different associations between the reporting of health symptoms and e-liquid flavor categories, for example, lower association of the Beverage flavors with Respiratory compared with other flavors and higher association of the Fruit flavors with Cardiovascular than other flavors. Conclusions: This study identified different potential associations between e-liquid flavors and the reporting of health symptoms using social media data. The results of this study provide valuable information for further investigation of the health effects associated with different e-liquid flavors. %M 32568093 %R 10.2196/17496 %U http://www.jmir.org/2020/6/e17496/ %U https://doi.org/10.2196/17496 %U http://www.ncbi.nlm.nih.gov/pubmed/32568093 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e19494 %T Influence of the SARS-CoV-2 Outbreak on the Uptake of a Popular Smoking Cessation App in UK Smokers: Interrupted Time Series Analysis %A Perski,Olga %A Herbeć,Aleksandra %A Shahab,Lion %A Brown,Jamie %+ Department of Behavioural Science and Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 020 7679 1258, olga.perski@ucl.ac.uk %K SARS-CoV-2 %K COVID-19 %K smoking cessation %K mobile health %K smartphone app %K time series analysis %K smoking %K public health %K app %D 2020 %7 11.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak may motivate smokers to attempt to stop in greater numbers. However, given the temporary closure of UK stop smoking services and vape shops, smokers attempting to quit may instead seek out mobile health support, such as smartphone apps. Objective: We examined, using an interrupted time series approach, whether the SARS-CoV-2 outbreak has been associated with a step change or increasing trend in UK downloads of an otherwise popular smoking cessation app, Smoke Free. Methods: Data were from daily and nondaily adult smokers in the United Kingdom who had downloaded the Smoke Free app between January 1, 2020, and March 31, 2020 (primary analysis), and January 1, 2019, and March 31, 2020 (secondary analysis). The outcome variable was the number of downloads aggregated at the 12-hourly (primary analysis) or daily level (secondary analysis). The explanatory variable was the start of the SARS-CoV-2 outbreak, operationalized as March 1, 2020 (primary analysis), and January 15, 2020 (secondary analysis). Generalized additive mixed models adjusted for relevant covariates were fitted. Results: Data were collected on 45,105 (primary analysis) and 119,881 (secondary analysis) users. In both analyses, there was no evidence for a step change or increasing trend in downloads attributable to the start of the SARS-CoV-2 outbreak. Calculation of Bayes factors (BFs) indicated that the data for the primary analysis favored the null hypothesis compared with large associations (for level, BF=0.25; for slope, BF=0.26) but were insensitive to the detection of small associations (for level, BF=0.78; for slope, BF=1.35). Conclusions: In the United Kingdom, between January 1, 2020, and March 31, 2020, and between January 1, 2019, and March 31, 2020, there was no evidence that the SARS-CoV-2 outbreak has been associated with a large step change or increasing trend in downloads of a popular smoking cessation app. Findings on the association of the SARS-CoV-2 outbreak with a small step change or increasing trend were inconclusive. %M 32463375 %R 10.2196/19494 %U http://mhealth.jmir.org/2020/6/e19494/ %U https://doi.org/10.2196/19494 %U http://www.ncbi.nlm.nih.gov/pubmed/32463375 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e15160 %T Cigarette Packs With URLs Leading to Tobacco Company Websites: Content Analysis %A Weiger,Caitlin Victoria %A Smith,Katherine %A Hong,Amy Y %A Cohen,Joanna E %+ Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St, 4th Floor, Baltimore, MD, 21205, United States, 1 410 614 5378, cweiger2@jhmi.edu %K advertising %K developing countries %K product packaging %K product labeling %K tobacco industry %D 2020 %7 9.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Tobacco companies include on the packaging of their products URLs directing consumers to websites that contain protobacco messages. Online media tend to be underregulated and provide the industry with an opportunity to present users with protobacco communication. Objective: The objective of our study was to document the content of websites that were advertised on tobacco packs in 14 low- and middle-income countries. Methods: We purchased tobacco packs from 14 low- and middle-income countries in 2013 and examined them for the presence of URLs. We visited unique URLs on multiple occasions between October 1, 2016 and August 9, 2017. We developed a coding checklist and used it to conduct a content analysis of active corporate websites to identify types of protobacco communication. The coding checklist included the presence of regulatory controls and warnings, engagement strategies, marketing appeals (eg, description of product popularity, luxury/quality, taste), corporate social responsibility programs, and image management. We coded brand websites separately and also described social media and other website types. Results: We identified 89 unique URLs, of which 54 were active during the search period. We assessed 26 corporate websites, 21 brand websites, 2 nontobacco websites, and 5 social media pages. We excluded 2 corporate websites and 14 brand websites due to limited accessible content or incomplete content. Corporate social responsibility was discussed on all corporate websites, and marketing appeals were also common. Corporate websites were also more likely to include more nonspecific (12/24, 50%) than specific (7/24, 29%) health warnings. Promotions (6/7, 86%) and sociability appeals (3/7, 43%) were common on brand websites. The small number of social media webpages in our sample used gendered marketing. Conclusions: URLs appearing on tobacco packs direct consumers to websites where users are exposed to marketing that highlights the “positive” contributions of tobacco companies on corporate websites, and extensive promotions and marketing appeals on brand websites and social media pages. It is essential that marketing regulations become more comprehensive and ban all protobacco communication, a policy that is in line with articles 5.3 and 13 of the World Health Organization Framework Convention on Tobacco Control. For countries that already ban internet tobacco advertising, enforcement efforts should be strengthened. Tobacco companies’ use of URLs on packs may also be compelling for plain packaging advocacy, where all branding is removed from the pack and large graphic health warning labels are the only communication on the tobacco packaging. Future research should consider including tobacco websites in marketing surveillance. %M 32459649 %R 10.2196/15160 %U https://www.jmir.org/2020/6/e15160 %U https://doi.org/10.2196/15160 %U http://www.ncbi.nlm.nih.gov/pubmed/32459649 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e7570 %T A Digital Smoking Cessation Program for Heavy Drinkers: Pilot Randomized Controlled Trial %A Kahler,Christopher W %A Cohn,Amy M %A Costantino,Catherine %A Toll,Benjamin A %A Spillane,Nichea S %A Graham,Amanda L %+ Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, United States, 1 4018636651, Christopher_Kahler@brown.edu %K smoking cessation %K alcohol drinking %K internet %K text messaging %K therapy %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Heavy drinking (HD) is far more common among smokers compared with nonsmokers and interferes with successful smoking cessation. Alcohol-focused smoking cessation interventions delivered by counselors have shown promise, but digital versions of these interventions—which could have far greater population reach—have not yet been tested. Objective: This pilot randomized controlled trial aimed to examine the feasibility, acceptability, and effect sizes of an automated digital smoking cessation program that specifically addresses HD using an interactive web-based intervention with an optional text messaging component. Methods: Participants (83/119, 69.7% female; 98/119, 82.4% white; mean age 38.0 years) were daily smokers recruited on the web from a free automated digital smoking cessation program (BecomeAnEX.org, EX) who met the criteria for HD: women drinking 8+ drinks/week or 4+ drinks on any day and men drinking 15+ drinks/week or 5+ drinks on any day. Participants were randomized to receive EX with standard content (EX-S) or an EX with additional content specific to HD (EX-HD). Outcomes were assessed by web-based surveys at 1 and 6 months. Results: Participants reported high satisfaction with the website and the optional text messaging component. Total engagement with both EX-S and EX-HD was modest, with participants visiting the website a median of 2 times, and 52.9% of the participants enrolled to receive text messages. Participants in both the conditions showed substantial, significant reductions in drinking across 6 months of follow-up, with no condition effects observed. Although smoking outcomes tended to favor EX-HD, the condition effects were small and nonsignificant. A significantly smaller proportion of participants in EX-HD reported having a lapse back to smoking when drinking alcohol (7/58, 16%) compared with those in EX-S (18/61, 41%; χ21=6.2; P=.01). Conclusions: This is the first trial to examine a digital smoking cessation program tailored to HD smokers. The results provide some initial evidence that delivering such a program is feasible and may reduce the risk of alcohol-involved smoking lapses. However, increasing engagement in this and other web-based interventions is a crucial challenge to address in future work. Trial Registration: ClinicalTrials.gov NCT03068611; https://clinicaltrials.gov/ct2/show/NCT03068611 %M 32348286 %R 10.2196/formative.7570 %U https://formative.jmir.org/2020/6/e7570 %U https://doi.org/10.2196/formative.7570 %U http://www.ncbi.nlm.nih.gov/pubmed/32348286 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17554 %T Facebook Recruitment Using Zip Codes to Improve Diversity in Health Research: Longitudinal Observational Study %A Pechmann,Cornelia %A Phillips,Connor %A Calder,Douglas %A Prochaska,Judith J %+ Paul Merage School of Business, University of California, Irvine, School of Business I, Irvine, CA, , United States, 1 949 824 4058, cpechman@uci.edu %K smoking %K advertisement %K social media %D 2020 %7 5.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Facebook’s advertising platform reaches most US households and has been used for health-related research recruitment. The platform allows for advertising segmentation by age, gender, and location; however, it does not explicitly allow for targeting by race or ethnicity to facilitate a diverse participant pool. Objective: This study looked at the efficacy of zip code targeting in Facebook advertising to reach blacks/African Americans and Hispanics/Latinos who smoke daily for a quit-smoking web-based social media study. Methods: We ran a general market campaign for 61 weeks using all continental US zip codes as a baseline. Concurrently, we ran 2 campaigns to reach black/African American and Hispanic-/Latino-identified adults, targeting zip codes ranked first by the percentage of households of the racial or ethnic group of interest and then by cigarette expenditure per household. We also ran a Spanish language campaign for 13 weeks, targeting all continental US zip codes but utilizing Facebook’s Spanish language targeting. The advertising images and language were common across campaigns. Costs were compared for advertisement clicks, queries, applications, and participants, and yields were compared for the final three outcomes. We examined outcomes before and after the Cambridge Analytica scandal that broke in March 2018. Finally, we examined 2 promoted Facebook features: lookalike audiences and audience network placement. Results: Zip code targeting campaigns were effective for yielding the racial or ethnic groups of interest. The black-/African American–focused versus general market campaign increased black/African American weekly queries (mean 9.48, SD 5.69 vs general market mean 2.83, SD 2.05; P<.001) and applicants (mean 1.11, SD 1.21 vs general market mean 0.54, SD 0.58; P<.001). The Hispanic-/Latino-focused versus general market campaign increased Hispanic/Latino weekly queries (mean 3.10, SD 2.16 vs general market mean 0.71, SD 0.48; P<.001) and applicants (mean 0.36, SD 0.55 vs general market mean 0.10, SD 0.14; P=.001). Cost metrics did not differ between campaigns at generating participants (overall P=.54). Costs increased post- versus prescandal for the black-/African American–focused campaign for queries (mean US $8.51, SD 3.08 vs US $5.87, SD 1.89; P=.001) and applicants (mean US $59.64, SD 35.63 vs US $38.96, SD 28.31; P=.004) and for the Hispanic-/Latino-focused campaign for queries (mean US $9.24, SD 4.74 vs US $7.04, SD 3.39; P=.005) and applicants (mean US $61.19, SD 40.08 vs US $38.19, SD 21.20; P=.001). Conclusions: Zip code targeting in Facebook advertising is an effective way to recruit diverse populations for health-based interventions. Audience network placement should be avoided. The Facebook lookalike audience may not be necessary for recruitment, with drawbacks including an unknown algorithm and unclear use of Facebook user data, and so public concerns around data privacy should be considered. Trial Registration: ClinicalTrial.gov NCT02823028; https://clinicaltrials.gov/ct2/show/NCT02823028 %M 32501274 %R 10.2196/17554 %U https://www.jmir.org/2020/6/e17554 %U https://doi.org/10.2196/17554 %U http://www.ncbi.nlm.nih.gov/pubmed/32501274 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e14550 %T Patients’ User Experience of a Blended Face-to-Face and Web-Based Smoking Cessation Treatment: Qualitative Study %A Siemer,Lutz %A Ben Allouch,Somaya %A Pieterse,Marcel E %A Brusse-Keizer,Marjolein %A Sanderman,Robbert %A Postel,Marloes G %+ Technology, Health & Care Research Group, Saxion University of Applied Sciences, Postbus 70000, Enschede, 7500 KB, Netherlands, 49 17678025906, l.siemer@utwente.nl %K smoking cessation %K cognitive therapy %K blended treatment %K smoking %K user experience %K tobacco %K patient perspective %D 2020 %7 3.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Blended web-based and face-to-face (F2F) treatment is a promising electronic health service because the strengths of one mode of delivery should compensate for the weaknesses of the other. Objective: The aim of this study was to explore this compensation by examining patients’ user experience (UX) in a blended smoking cessation treatment (BSCT) in routine care. Methods: Data on patients’ UX were collected through in-depth interviews (n=10) at an outpatient smoking cessation clinic in the Netherlands. A content analysis of the semantic domains was used to analyze patients’ UX. To describe the UX, the Hassenzahl UX model was applied, examining 4 of the 5 key elements of UX from a user’s perspective: (1) patients’ standards and expectations, (2) apparent character (pragmatic and hedonic attributes), (3) usage situation, and (4) consequences (appeal, emotions, and behavior). Results: BSCT appeared to be a mostly positively experienced service. Patients had a positive-pragmatic standard and neutral-open expectation toward BSCT at the treatment start. The pragmatic attributes of the F2F sessions were mostly perceived as positive, whereas the pragmatic attributes of the web sessions were perceived as both positive and negative. For the hedonic attributes, there seemed to be a difference between the F2F and web sessions. Specifically, the hedonic attributes of the web sessions were experienced as mostly negative, whereas those of the F2F sessions were experienced as mostly positive. For the usage situation, the physical and social contexts were experienced positively, whereas the task and technical contexts were experienced negatively. Nevertheless, the consequential appeal of BSCT was positive. However, the consequential emotions and behavior varied, ultimately resulting in diverse combinations of consequential appeal, emotions, and behavior (positive, negative, and mixed). Conclusions: This study provided insights into the UX of a blended treatment, and the results support the expectation that in a blended treatment, the strengths of one mode of delivery may compensate for the weaknesses of the other. However, in this certain setting, this is mainly achieved in only one way: F2F sessions compensated for the weaknesses of the web sessions. As a practical conclusion, this may mean that the web sessions, supported by the strengths of the F2F sessions, offer an interesting approach for further improving the blended treatment. Our theoretical findings reflect the relevance of the aspects of hedonism, such as fun, joy, or happiness in the UX, which were not mentioned in relation to the web sessions and were only scarcely mentioned in relation to the F2F sessions. Future research should further investigate the role of hedonistic aspects in a blended treatment and whether increased enjoyment of a blended treatment could increase treatment adherence and, ultimately, effectiveness. %M 32343245 %R 10.2196/14550 %U https://formative.jmir.org/2020/6/e14550 %U https://doi.org/10.2196/14550 %U http://www.ncbi.nlm.nih.gov/pubmed/32343245 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17104 %T Modifications to Electronic Nicotine Delivery Systems: Content Analysis of YouTube Videos %A Massey,Zachary B %A Li,Yachao %A Holli,Jessica %A Churchill,Victoria %A Yang,Bo %A Henderson,Katherine %A Ashley,David L %A Huang,Jidong %A Popova,Lucy %+ School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, United States, 1 4044139338, lpopova1@gsu.edu %K ENDS modifications %K YouTube %K coils %K e-liquid %K vaping %D 2020 %7 2.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: As user modification can alter the addictiveness and toxicity of electronic nicotine delivery systems (ENDS), more research is needed to understand the types, motivations, risks, and information sources that lead to these product alterations. YouTube has been identified as a major platform where ENDS users obtain and share information about ENDS products and modifications. However, a comprehensive study of ENDS modification videos on YouTube is lacking. Objective: This study aimed to analyze the content of YouTube videos depicting modifications of ENDS. Methods: YouTube was searched in March 2019 to identify videos depicting ENDS modifications. Search terms were derived from interviews with ENDS users and current literature. We used 28 search phrases that combined the words vape and vaping with modification-related key terms (eg, custom build, modification, and dripping). The final sample included 168 videos. Results: Videos were 1 to 108 min long (median 9.55). Presenters were largely male (117/168, 69.6%), white (94/168, 56.0%), and older than 25 years (94/168, 56.0%). Most videos gave how to instructions (148/168, 88.1%), but few offered warnings (30/168, 17.9%) or mentioned commercial alternatives to modifications they presented (16/168, 9.5%). The ENDS devices most often featured were drippers (63/168, 37.5%) and refillable tanks (37/168, 22.0%). The most often modified ENDS components were coils (82/168, 48.8%) and e-liquids (34/168, 20.2%), which included adding other substances, such as cannabis, to the e-liquids (6/168, 3.6%). Most videos portrayed ENDS modifications positively (106/168, 63.1% positive; 60/168, 35.7% neutral; and 2/168, 1.2% negative) and were either neutral or positive in their overall portrayal of ENDS devices (78/168, 46.4% positive; 89/168, 53.0% neutral; and 1/168, 0.6% negative). Conclusions: This study identified several concerning trends in popular YouTube videos on ENDS modifications, including lack of warnings, the addition of marijuana derivatives to e-liquids, and the positive portrayal of ENDS devices and modifications. By identifying the types of modifications (coil and e-liquid being the most prevalent), this study sets an agenda for research on the effects of modifications. %M 32348288 %R 10.2196/17104 %U https://www.jmir.org/2020/6/e17104 %U https://doi.org/10.2196/17104 %U http://www.ncbi.nlm.nih.gov/pubmed/32348288 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e17270 %T Efficacy of the Ascure Smoking Cessation Program: Retrospective Study %A Kato,Ayaka %A Tanigawa,Tomoyuki %A Satake,Kohta %A Nomura,Akihiro %+ Innovative Clinical Research Center, Kanazawa University, 13-1 Takara-machi, Kanazawa, Kanazawa, Ishikawa, 920-8641, Japan, 81 76 265 2049, anomura@med.kanazawa-u.ac.jp %K smoking cessation %K nicotine dependence %K telecare %K telemedicine %K mHealth %K digital therapeutics %K mobile phone %K smoking cessation program %K online counseling %D 2020 %7 14.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking cessation helps extend a healthy life span and reduces medical expenses. However, the standard 12-week smoking cessation program in Japan has several notable problems. First, only 30% of participants complete this program. Second, participants may choose not to participate unless they have a strong motivation to quit smoking, such as health problems. Third, the program does not provide enough support during the period between clinical visits and after 12 weeks. Objective: This study examined the efficacy of the 24-week ascure program to address the problems of accessibility and continuous support. The program combines online mentoring, over-the-counter pharmacotherapy, and a smartphone app. Methods: Using a retrospective study design, we investigated data for 177 adult smokers who were enrolled in the ascure smoking cessation program between August 2017 and August 2018. The primary outcomes were continuous abstinence rates (CARs) during weeks 9-12 and weeks 21-24. To confirm smoking status, we performed salivary cotinine testing at weeks 12 and 24. We also evaluated the program adherence rate. Finally, we performed exploratory analysis to determine the factors associated with continuous abstinence at weeks 21-24 to provide insights for assisting with long-term continuous abstinence. Results: The CARs of all participants for weeks 9-12 and weeks 21-24 were 48.6% (95% CI 41.2-56.0) and 47.5% (95% CI 40.0-54.8), respectively. Program adherence rates were relatively high throughout (72% at week 12 and 60% at week 24). In the analysis of the factors related to the CAR at weeks 21-24, the number of entries in the app’s digital diary and number of educational videos watched during the first 12 weeks were significant factors. Conclusions: The ascure program achieved favorable CARs, and participants showed high adherence. Proactive usage of the smartphone app may help contribute to smoking cessation success in the long-term. %M 32406856 %R 10.2196/17270 %U https://mhealth.jmir.org/2020/5/e17270 %U https://doi.org/10.2196/17270 %U http://www.ncbi.nlm.nih.gov/pubmed/32406856 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 5 %P e16342 %T Combining Web-Based Attentional Bias Modification and Approach Bias Modification as a Self-Help Smoking Intervention for Adult Smokers Seeking Online Help: Double-Blind Randomized Controlled Trial %A Wen,Si %A Larsen,Helle %A Boffo,Marilisa %A Grasman,Raoul P P P %A Pronk,Thomas %A van Wijngaarden,Joeri B G %A Wiers,Reinout W %+ Department of Psychology, University of Amsterdam, Nieuwe Achtergracht 129B, Amsterdam, 1001NK, Netherlands, 31 684128489, si-wen@hotmail.com %K cognitive bias modification %K attentional bias modification %K approach bias modification %K Web-based intervention %K smoking addiction %K smoking cessation %K eHealth %K randomized controlled trial %D 2020 %7 8.5.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Automatically activated cognitive motivational processes such as the tendency to attend to or approach smoking-related stimuli (ie, attentional and approach bias) have been related to smoking behaviors. Therefore, these cognitive biases are thought to play a role in maintaining smoking behaviors. Cognitive biases can be modified with cognitive bias modification (CBM), which holds promise as an easy-access and low-cost online intervention. However, little is known about the effectiveness of online interventions combining two varieties of CBM. Targeting multiple cognitive biases may improve treatment outcomes because these biases have been shown to be relatively independent. Objective: This study aimed to test the individual and combined effects of two web-based CBM varieties—attentional bias modification (AtBM) and approach bias modification (ApBM)—in a double-blind randomized controlled trial (RCT) with a 2 (AtBM: active versus sham) × 2 (ApBM: active versus sham) factorial design. Methods: A total of 504 adult smokers seeking online help to quit smoking were randomly assigned to 1 of 4 experimental conditions to receive 11 fully automated CBM training sessions. To increase participants’ intrinsic motivation to change their smoking behaviors, all participants first received brief, automated, tailored feedback. The primary outcome was point prevalence abstinence during the study period. Secondary outcomes included daily cigarette use and attentional and approach bias. All outcomes were repeatedly self-assessed online from baseline to the 3-month follow-up. For the examination of training effects on outcome changes, an intention-to-treat analysis with a multilevel modeling (MLM) approach was adopted. Results: Only 10.7% (54/504) of the participants completed all 11 training sessions, and 8.3% (42/504) of the participants reached the 3-month follow-up assessment. MLM showed that over time, neither AtBM or ApBM nor a combination of both differed from their respective sham training in point prevalence abstinence rates (P=.17, P=.56, and P=.14, respectively), and in changes in daily cigarette use (P=.26, P=.08, and P=.13, respectively), attentional bias (P=.07, P=.81, and P=.15, respectively), and approach bias (P=.57, P=.22, and P=.40, respectively), while daily cigarette use decreased over time across conditions for all participants (P<.001). Conclusions: This RCT provides no support for the effectiveness of combining AtBM and ApBM in a self-help web-based smoking cessation intervention. However, this study had a very high dropout rate and a very low frequency of training usage, indicating an overall low acceptability of the intervention, which precludes any definite conclusion on its efficacy. We discuss how this study can inform future designs and settings of online CBM interventions. Trial Registration: Netherlands Trial Register NTR4678; https://www.trialregister.nl/trial/4678 %M 32383682 %R 10.2196/16342 %U https://mental.jmir.org/2020/5/e16342 %U https://doi.org/10.2196/16342 %U http://www.ncbi.nlm.nih.gov/pubmed/32383682 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e13289 %T Secure Asynchronous Communication Between Smokers and Tobacco Treatment Specialists: Secondary Analysis of a Web-Assisted Tobacco Intervention in the QUIT-PRIMO and National Dental PBRN Networks %A Sadasivam,Rajani Shankar %A Kamberi,Ariana %A DeLaughter,Kathryn %A Phillips,Barrett %A Williams,Jessica H %A Cutrona,Sarah L %A Ray,Midge N %A Gilbert,Gregg H %A Houston,Thomas K %A , %A , %+ University of Massachusetts Medical School, 365 Plantation Street, Worcester, MA, 01605, United States, 1 508 856 8923, rajani.sadasivam@umassmed.edu %K distance counseling %K tobacco cessation %K internet-based intervention %K smoking cessation %D 2020 %7 6.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Within a web-assisted tobacco intervention, we provided a function for smokers to asynchronously communicate with a trained tobacco treatment specialist (TTS). Previous studies have not attempted to isolate the effect of asynchronous counseling on smoking cessation. Objective: This study aimed to conduct a semiquantitative analysis of TTS-smoker communication and evaluate its association with smoking cessation. Methods: We conducted a secondary analysis of data on secure asynchronous communication between trained TTSs and a cohort of smokers during a 6-month period. Smokers were able to select their preferred TTS and message them using a secure web-based form. To evaluate whether the TTS used evidence-based practices, we coded messages using the Motivational Interviewing Self-Evaluation Checklist and Smoking Cessation Counseling (SCC) Scale. We assessed the content of messages initiated by the smokers by creating topical content codes. At 6 months, we assessed the association between smoking cessation and the amount of TTS use and created a multivariable model adjusting for demographic characteristics and smoking characteristics at baseline. Results: Of the 725 smokers offered asynchronous counseling support, 33.8% (245/725) messaged the TTS at least once. A total of 1082 messages (TTSs: 565; smokers 517) were exchanged between the smokers and TTSs. The majority of motivational interviewing codes were those that supported client strengths (280/517, 54.1%) and promoted engagement (280/517, 54.1%). SCC code analysis showed that the TTS provided assistance to smokers if they were willing to quit (247/517, 47.8%) and helped smokers prepare to quit (206/517, 39.8%) and anticipate barriers (197/517, 38.1%). The majority of smokers’ messages discussed motivations to quit (234/565, 41.4%) and current and past treatments (talking about their previous use of nicotine replacement therapy and medications; 201/565, 35.6%). The majority of TTS messages used behavioral strategies (233/517, 45.1%), offered advice on treatments (189/517, 36.5%), and highlighted motivations to quit (171/517, 33.1%). There was no association between the amount of TTS use and cessation. In the multivariable model, after adjusting for gender, age, race, education, readiness at baseline, number of cigarettes smoked per day at baseline, and the selected TTS, smokers messaging the TTS one or two times had a smoking cessation odds ratio (OR) of 0.8 (95% CI 0.4-1.4), and those that messaged the TTS more than two times had a smoking cessation OR of 1.0 (95% CI 0.4-2.3). Conclusions: Our study demonstrated the feasibility of using asynchronous counseling to deliver evidence-based counseling. Low participant engagement or a lack of power could be potential explanations for the nonassociation with smoking cessation. Future trials should explore approaches to increase participant engagement and test asynchronous counseling in combination with other approaches for improving the rates of smoking cessation. %M 32374266 %R 10.2196/13289 %U https://www.jmir.org/2020/5/e13289 %U https://doi.org/10.2196/13289 %U http://www.ncbi.nlm.nih.gov/pubmed/32374266 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e18064 %T Comparison of a Collective Intelligence Tailored Messaging System on Smoking Cessation Between African American and White People Who Smoke: Quasi-Experimental Design %A Faro,Jamie M %A Nagawa,Catherine S %A Allison,Jeroan A %A Lemon,Stephenie C %A Mazor,Kathleen M %A Houston,Thomas K %A Sadasivam,Rajani S %+ Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation St, The Albert Sherman Center, Worcester, MA, United States, 1 774 455 4672, jamie.faro@umassmed.edu %K machine learning %K computer-tailored health communication %K smoking cessation %K health disparities %D 2020 %7 27.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Patient Experience Recommender System for Persuasive Communication Tailoring (PERSPeCT) is a machine learning recommender system with a database of messages to motivate smoking cessation. PERSPeCT uses the collective intelligence of users (ie, preferences and feedback) and demographic and smoking profiles to select motivating messages. PERSPeCT may be more beneficial for tailoring content to minority groups influenced by complex, personally relevant factors. Objective: The objective of this study was to describe and evaluate the use of PERSPeCT in African American people who smoke compared with white people who smoke. Methods: Using a quasi-experimental design, we compared African American people who smoke with a historical cohort of white people who smoke, who both received up to 30 emailed tailored messages over 65 days. People who smoke rated the daily message in terms of perceived influence on quitting smoking for 30 days. Our primary analysis compared daily message ratings between the two groups using a t test. We used a logistic model to compare 30-day cessation between the two groups and adjusted for covariates. Results: The study included 119 people who smoke (African Americans, 55/119; whites, 64/119). At baseline, African American people who smoke were significantly more likely to report allowing smoking in the home (P=.002); all other characteristics were not significantly different between groups. Daily mean ratings were higher for African American than white people who smoke on 26 of the 30 days (P<.001). Odds of quitting as measured by 30-day cessation were significantly higher for African Americans (odds ratio 2.3, 95% CI 1.04-5.53; P=.03) and did not change after adjusting for allowing smoking at home. Conclusions: Our study highlighted the potential of using a recommender system to personalize for African American people who smoke. Trial Registration: ClinicalTrials.gov NCT02200432; https://clinicaltrials.gov/ct2/show/NCT02200432 International Registered Report Identifier (IRRID): RR2-10.2196/jmir.6465 %M 32338619 %R 10.2196/18064 %U http://mhealth.jmir.org/2020/4/e18064/ %U https://doi.org/10.2196/18064 %U http://www.ncbi.nlm.nih.gov/pubmed/32338619 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e17530 %T A Mobile Health Solution Complementing Psychopharmacology-Supported Smoking Cessation: Randomized Controlled Trial %A Carrasco-Hernandez,Laura %A Jódar-Sánchez,Francisco %A Núñez-Benjumea,Francisco %A Moreno Conde,Jesús %A Mesa González,Marco %A Civit-Balcells,Antón %A Hors-Fraile,Santiago %A Parra-Calderón,Carlos Luis %A Bamidis,Panagiotis D %A Ortega-Ruiz,Francisco %+ Research and Innovation Group in Biomedical Informatics, Biomedical Engineering and Health Economy, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital, Spanish National Research Council, University of Seville, Avenida Manuel Siurot S/N, Seville, 41013, Spain, 34 670943651, francisco.jodar@juntadeandalucia.es %K smoking cessation %K behavioral change %K health recommender systems %K mHealth %K randomized controlled trial %D 2020 %7 27.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking cessation is a persistent leading public health challenge. Mobile health (mHealth) solutions are emerging to improve smoking cessation treatments. Previous approaches have proposed supporting cessation with tailored motivational messages. Some managed to provide short-term improvements in smoking cessation. Yet, these approaches were either static in terms of personalization or human-based nonscalable solutions. Additionally, long-term effects were neither presented nor assessed in combination with existing psychopharmacological therapies. Objective: This study aimed to analyze the long-term efficacy of a mobile app supporting psychopharmacological therapy for smoking cessation and complementarily assess the involved innovative technology. Methods: A 12-month, randomized, open-label, parallel-group trial comparing smoking cessation rates was performed at Virgen del Rocío University Hospital in Seville (Spain). Smokers were randomly allocated to a control group (CG) receiving usual care (psychopharmacological treatment, n=120) or an intervention group (IG) receiving psychopharmacological treatment and using a mobile app providing artificial intelligence–generated and tailored smoking cessation support messages (n=120). The secondary objectives were to analyze health-related quality of life and monitor healthy lifestyle and physical exercise habits. Safety was assessed according to the presence of adverse events related to the pharmacological therapy. Per-protocol and intention-to-treat analyses were performed. Incomplete data and multinomial regression analyses were performed to assess the variables influencing participant cessation probability. The technical solution was assessed according to the precision of the tailored motivational smoking cessation messages and user engagement. Cessation and no cessation subgroups were compared using t tests. A voluntary satisfaction questionnaire was administered at the end of the intervention to all participants who completed the trial. Results: In the IG, abstinence was 2.75 times higher (adjusted OR 3.45, P=.01) in the per-protocol analysis and 2.15 times higher (adjusted OR 3.13, P=.002) in the intention-to-treat analysis. Lost data analysis and multinomial logistic models showed different patterns in participants who dropped out. Regarding safety, 14 of 120 (11.7%) IG participants and 13 of 120 (10.8%) CG participants had 19 and 23 adverse events, respectively (P=.84). None of the clinical secondary objective measures showed relevant differences between the groups. The system was able to learn and tailor messages for improved effectiveness in supporting smoking cessation but was unable to reduce the time between a message being sent and opened. In either case, there was no relevant difference between the cessation and no cessation subgroups. However, a significant difference was found in system engagement at 6 months (P=.04) but not in all subsequent months. High system appreciation was reported at the end of the study. Conclusions: The proposed mHealth solution complementing psychopharmacological therapy showed greater efficacy for achieving 1-year tobacco abstinence as compared with psychopharmacological therapy alone. It provides a basis for artificial intelligence–based future approaches. Trial Registration: ClinicalTrials.gov NCT03553173; https://clinicaltrials.gov/ct2/show/NCT03553173 International Registered Report Identifier (IRRID): RR2-10.2196/12464 %M 32338624 %R 10.2196/17530 %U http://mhealth.jmir.org/2020/4/e17530/ %U https://doi.org/10.2196/17530 %U http://www.ncbi.nlm.nih.gov/pubmed/32338624 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e14660 %T Public Reactions to the Cigarette Control Regulation on a Chinese Microblogging Platform: Empirical Analysis %A Wen,Wanting %A Zhang,Zhu %A Li,Ziqiang %A Liang,Jiaqi %A Zhan,Yongcheng %A Zeng,Daniel D %A Leischow,Scott J %+ State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Beijing, 100190, China, 86 13488793849, wanting.wen@ia.ac.cn %K cigarette smoking %K regulations %K social media %K information networks %D 2020 %7 27.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: On January 1, 2019, a new regulation on the control of smoking in public places was officially implemented in Hangzhou, China. On the day of the implementation, a large number of Chinese media reported the contents of the regulation on the microblog platform Weibo, causing a strong response from and heated discussion among netizens. Objective: This study aimed to conduct a content and network analysis to examine topics and patterns in the social media response to the new regulation. Methods: We analyzed all microblogs on Weibo that mentioned and explained the regulation in the first 8 days following the implementation. We conducted a content analysis on these microblogs and used social network visualization and descriptive statistics to identify key users and key microblogs. Results: Of 7924 microblogs, 12.85% (1018/7924) were in support of the smoking control regulation, 84.12% (6666/7924) were neutral, and 1.31% (104/7924) were opposed to the smoking regulation control. For the negative posts, the public had doubts about the intentions of the policy, its implementation, and the regulations on electronic cigarettes. In addition, 1.72% (136/7924) were irrelevant to the smoking regulation control. Among the 1043 users who explicitly expressed their positive or negative attitude toward the policy, a large proportion of users showed supportive attitudes (956/1043, 91.66%). A total of 5 topics and 11 subtopics were identified. Conclusions: This study used a content and network analysis to examine topics and patterns in the social media response to the new smoking regulation. We found that the number of posts with a positive attitude toward the regulation was considerably higher than that of the posts with a negative attitude toward the regulation. Our findings may assist public health policy makers to better understand the policy’s intentions, scope, and potential effects on public interest and support evidence-based public health regulations in the future. %M 32338615 %R 10.2196/14660 %U http://www.jmir.org/2020/4/e14660/ %U https://doi.org/10.2196/14660 %U http://www.ncbi.nlm.nih.gov/pubmed/32338615 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e15960 %T Automated Mobile Delivery of Financial Incentives for Smoking Cessation Among Socioeconomically Disadvantaged Adults: Feasibility Study %A Kendzor,Darla E %A Businelle,Michael S %A Waring,Joseph J C %A Mathews,Ashley J %A Geller,Daryl W %A Barton,Jocelyn M %A Alexander,Adam C %A Hébert,Emily T %A Ra,Chaelin K %A Vidrine,Damon J %+ Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 4052718001 ext 50478, Darla-Kendzor@ouhsc.edu %K socioeconomic status %K smoking cessation %K incentives %K mobile health %K mobile phone %D 2020 %7 15.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Socioeconomic disadvantage is associated with a reduced likelihood of smoking cessation. Smartphone ownership is increasing rapidly, including among low-income adults, and smartphone interventions for smoking cessation may increase access to smoking cessation treatment among socioeconomically disadvantaged adults. Objective: This study aimed to evaluate the feasibility of an automated smartphone-based approach to delivering financial incentives for smoking cessation. Methods: Socioeconomically disadvantaged adults initiating tobacco cessation treatment were followed from 1 week before a scheduled quit attempt through 26 weeks after the quit date. Participants received telephone counseling and nicotine replacement therapy. Smoking cessation was verified 5 times per week via smartphone prompts to self-report smoking status and submit a breath sample via a portable carbon monoxide (CO) monitor that was connected with participants’ smartphones. Identity was verified during smoking status assessments using smartphone-based facial recognition software. When smoking abstinence and identity were verified, an automated credit card payment was triggered. Participants were incentivized for abstinence on the quit date and up to five days per week during the first 4 weeks after the scheduled quit date, with additional incentives offered during postquit weeks 8 and 12. In total, participants had the opportunity to earn up to US $250 in abstinence-contingent incentives over the first 12 weeks of the quit attempt. Results: Participants (N=16) were predominantly female (12/16, 75%) and non-Hispanic white (11/16, 69%), black (4/16, 25%), or Hispanic of any race (1/16, 6%). Most participants (9/16, 56%) reported an annual household income of 0.30 was observed for main effects on any outcome, results suggest that for some outcomes, the combined intervention was stronger than individual factors alone. Conclusions: This factorial experiment demonstrates the effectiveness of text messaging as a strategy to increase engagement with an internet smoking cessation intervention, resulting in greater overall intervention dose and greater exposure to the core components of tobacco dependence treatment that can promote abstinence. Trial Registration: ClinicalTrials.gov NCT02585206; https://clinicaltrials.gov/ct2/show/NCT02585206. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2015-010687 %M 32238338 %R 10.2196/17734 %U https://www.jmir.org/2020/4/e17734 %U https://doi.org/10.2196/17734 %U http://www.ncbi.nlm.nih.gov/pubmed/32238338 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e13031 %T Using Digital Media to Empower Adolescents in Smoking Prevention: Mixed Methods Study %A Park,Eunhee %A Chang,Yu-Ping %+ University at Buffalo, 3435 Main Street, Buffalo, NY, 14214, United States, 1 7168293701, eunheepa@buffalo.edu %K adolescent %K children %K digital media production %K technology %K empowerment %K smoking prevention %D 2020 %7 31.3.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: There is a critical need for effective health education methods for adolescent smoking prevention. The coproduction of antismoking videos shows promising results for adolescent health education. Objective: This study explored the feasibility of a smoking prevention program using the coproduction of antismoking videos in order to empower adolescents in smoking prevention and tobacco control. A smoking prevention program based on coproduction of antismoking videos over eight sessions was implemented in a low-income neighborhood. Methods: A mixed methods design with a concurrent embedded approach was used. In total, 23 adolescents participated in the program. During the prevention program, small groups of participants used video cameras and laptops to produce video clips containing antismoking messages. Quantitative data were analyzed using the Wilcoxon signed-rank test to examine changes in participants’ psychological empowerment levels between pre- and postintervention; qualitative interview data were analyzed using content analysis. Results: Pre- and postcomparison data revealed that participants’ psychological empowerment levels were significantly enhanced for all three domains—intrapersonal, interactional, and behavioral—of psychological empowerment (P<.05). Interviews confirmed that the coproduction of antismoking videos is feasible in empowering participants, by supporting nonsmoking behaviors and providing them with an opportunity to help build a smoke-free community. Conclusions: Both quantitative and qualitative data supported the feasibility of the coproduction of antismoking videos in empowering adolescents in smoking prevention. Coproduction of antismoking videos with adolescents was a beneficial health education method. %M 32229463 %R 10.2196/13031 %U http://pediatrics.jmir.org/2020/1/e13031/ %U https://doi.org/10.2196/13031 %U http://www.ncbi.nlm.nih.gov/pubmed/32229463 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e16907 %T A Mobile Just-in-Time Adaptive Intervention for Smoking Cessation: Pilot Randomized Controlled Trial %A Hébert,Emily T %A Ra,Chaelin K %A Alexander,Adam C %A Helt,Angela %A Moisiuc,Rachel %A Kendzor,Darla E %A Vidrine,Damon J %A Funk-Lawler,Rachel K %A Businelle,Michael S %+ Oklahoma Tobacco Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 4052718001 ext 50558, Emily-Hebert@ouhsc.edu %K smartphones %K mobile phones %K smoking cessation %K just-in-time adaptive intervention %K mHealth %D 2020 %7 9.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone apps for smoking cessation could offer easily accessible, highly tailored, intensive interventions at a fraction of the cost of traditional counseling. Although there are hundreds of publicly available smoking cessation apps, few have been empirically evaluated using a randomized controlled trial (RCT) design. The Smart-Treatment (Smart-T2) app is a just-in-time adaptive intervention that uses ecological momentary assessments (EMAs) to assess the risk for imminent smoking lapse and tailors treatment messages based on the risk of lapse and reported symptoms. Objective: This 3-armed pilot RCT aimed to determine the feasibility and preliminary efficacy of an automated smartphone-based smoking cessation intervention (Smart-T2) relative to standard in-person smoking cessation clinic care and the National Cancer Institute’s free smoking cessation app, QuitGuide. Methods: Adult smokers who attended a clinic-based tobacco cessation program were randomized into groups and followed for 13 weeks (1 week prequitting through 12 weeks postquitting). All study participants received nicotine patches and gum and were asked to complete EMAs five times a day on study-provided smartphones for 5 weeks. Participants in the Smart-T2 group received tailored treatment messages after the completion of each EMA. Both Smart-T2 and QuitGuide apps offer on-demand smoking cessation treatment. Results: Of 81 participants, 41 (50%) were women and 55 (68%) were white. On average, participants were aged 49.6 years and smoked 22.4 cigarettes per day at baseline. A total of 17% (14/81) of participants were biochemically confirmed 7-day point prevalence abstinent at 12 weeks postquitting (Smart-T2: 6/27, 22%, QuitGuide: 4/27, 15%, and usual care: 4/27, 15%), with no significant differences across groups (P>.05). Participants in the Smart-T2 group rated the app positively, with most participants agreeing that they can rely on the app to help them quit smoking, and endorsed the belief that the app would help them stay quit, and these responses were not significantly different from the ratings given by participants in the usual care group. Conclusions: Dynamic smartphone apps that tailor intervention content in real time may increase user engagement and exposure to treatment-related materials. The results of this pilot RCT suggest that smartphone-based smoking cessation treatments may be capable of providing similar outcomes to traditional, in-person counseling. Trial Registration: ClinicalTrials.gov NCT02930200; https://clinicaltrials.gov/show/NCT02930200 %M 32149716 %R 10.2196/16907 %U https://www.jmir.org/2020/3/e16907 %U https://doi.org/10.2196/16907 %U http://www.ncbi.nlm.nih.gov/pubmed/32149716 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 2 %P e16524 %T Brief, Web-Based Interventions to Motivate Smokers With Schizophrenia: Randomized Controlled Trial %A Brunette,Mary F %A Ferron,Joelle C %A McGurk,Susan R %A Williams,Jill M %A Harrington,Amy %A Devitt,Timothy %A Xie,Haiyi %+ Geisel School of Medicine at Dartmouth, Dartmouth-Hitchcock, 2 Pillsbury St, Concord, NH, 03301, United States, 1 603 229 5419, Mary.F.Brunette@Dartmouth.edu %K schizophrenia %K smoking %K tobacco %K technology %K digital %K motivational interviewing %K education %K cognition %D 2020 %7 10.2.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: In-person motivational interventions increase engagement with evidence-based cessation treatments among smokers with schizophrenia, but access to such interventions can be limited because of workforce shortages and competing demands in mental health clinics. The use of digital technology to deliver interventions can increase access, but cognitive impairments in schizophrenia may impede the use of standard digital interventions. We developed an interactive, multimedia, digital motivational decision support system for smokers with schizophrenia (Let’s Talk About Smoking). We also digitalized a standard educational pamphlet from the National Cancer Institute (NCI Education). Both were tailored to reduce cognitive load during use. Objective: We conducted a randomized trial of Let’s Talk About Smoking versus NCI Education to test whether the interactive motivational intervention was more effective and more appealing than the static educational intervention for increasing use of smoking cessation treatment, quit attempts, and abstinence among smokers with schizophrenia, accounting for the level of cognitive functioning. Methods: Adult smokers with schizophrenia (n=162) were enrolled in the study from 2014 to 2015, randomly assigned to an intervention condition, and assessed in person at 3- and 6-month follow-ups. Interventions were delivered on a laptop computer in a single session. All participants had access to standard, community-delivered cessation treatments during follow-up. Multivariate models were used to evaluate outcomes. Results: Treatment initiation outcomes were not different between intervention conditions (27/84 [32%] for Let’s Talk About Smoking vs 36/78 [46%] for NCI Education; odds ratio [OR] 0.71 [95% CI 0.37-1.33]); 38.9% (63/162) of participants initiated treatment. Older age (OR 1.03 [95% CI 1.00-1.07]; P=.05), higher education (OR 1.21 [95% CI 1.04-1.41]; P=.03), and fewer positive symptoms (OR 0.87 [95% CI 0.80-0.96]; P=.01) predicted cessation treatment initiation, whereas level of cognition did not. The mean satisfaction and usability index score was higher for Let’s Talk About Smoking versus NCI Education (8.9 [SD 1.3] vs 8.3 [SD 2.1]; t120.7=2.0; P=.045). Quit attempts (25/84, 30% vs 36/78, 46%; estimate [Est]=−0.093, SE 0.48; P=.85) and abstinence (1/84, 1% vs 6/78, 7%; χ21=3.4; P=.07) were not significantly different between intervention conditions. Cognitive functioning at baseline (Est=1.47, SE 0.47; P=.002) and use of any behavioral or medication cessation treatment (Est=1.43, SE 0.47; P=.003) predicted quit attempts with self-reported abstinence over the 6-month follow-up. Conclusions: The interactive, multimedia intervention was not more effective than the static, text-based intervention among smokers with schizophrenia. Both tailored digital interventions resulted in levels of treatment engagement and quit attempts that were similar to findings from previous studies of in-person interventions, confirming the potential role of digital interventions to educate and motivate smokers with schizophrenia to use cessation treatment and to quit smoking. These findings indicate that additional cessation treatment is needed after brief education or motivational interventions, and that cessation treatment should be adjusted for people with cognitive impairment. Trial Registration: ClinicalTrials.gov NCT02086162; https://clinicaltrials.gov/show/NCT02086162 %R 10.2196/16524 %U https://mental.jmir.org/2020/2/e16524 %U https://doi.org/10.2196/16524 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e14725 %T Online Information on Electronic Cigarettes: Comparative Study of Relevant Websites From Baidu and Google Search Engines %A Chen,Ting %A Gentry,Sarah %A Qiu,Dechao %A Deng,Yan %A Notley,Caitlin %A Cheng,Guangwen %A Song,Fujian %+ Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, United Kingdom, 44 1603 591253, fujian.song@uea.ac.uk %K electronic nicotine delivery system %K electronic cigarette %K online health information %K internet-based information %D 2020 %7 24.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Online information on electronic cigarettes (e-cigarettes) may influence people’s perception and use of e-cigarettes. Websites with information on e-cigarettes in the Chinese language have not been systematically assessed. Objective: The aim of this study was to assess and compare the types and credibility of Web-based information on e-cigarettes identified from Google (in English) and Baidu (in Chinese) search engines. Methods: We used the keywords vaping or e-cigarettes to conduct a search on Google and the equivalent Chinese characters for Baidu. The first 50 unique and relevant websites from each of the two search engines were included in this analysis. The main characteristics of the websites, credibility of the websites, and claims made on the included websites were systematically assessed and compared. Results: Compared with websites on Google, more websites on Baidu were owned by manufacturers or retailers (15/50, 30% vs 33/50, 66%; P<.001). None of the Baidu websites, compared to 24% (12/50) of Google websites, were provided by public or health professional institutions. The Baidu websites were more likely to contain e-cigarette advertising (P<.001) and less likely to provide information on health education (P<.001). The overall credibility of the included Baidu websites was lower than that of the Google websites (P<.001). An age restriction warning was shown on all advertising websites from Google (15/15) but only on 10 of the 33 (30%) advertising websites from Baidu (P<.001). Conflicting or unclear health and social claims were common on the included websites. Conclusions: Although conflicting or unclear claims on e-cigarettes were common on websites from both Baidu and Google search engines, there was a lack of online information from public health authorities in China. Unbiased information and evidence-based recommendations on e-cigarettes should be provided by public health authorities to help the public make informed decisions regarding the use of e-cigarettes. %M 32012069 %R 10.2196/14725 %U http://www.jmir.org/2020/1/e14725/ %U https://doi.org/10.2196/14725 %U http://www.ncbi.nlm.nih.gov/pubmed/32012069 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e16652 %T A Smartphone App Designed to Help Cancer Patients Stop Smoking: Results From a Pilot Randomized Trial on Feasibility, Acceptability, and Effectiveness %A Bricker,Jonathan B %A Watson,Noreen L %A Heffner,Jaimee L %A Sullivan,Brianna %A Mull,Kristin %A Kwon,Diana %A Westmaas,Johann Lee %A Ostroff,Jamie %+ Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N, Seattle, WA, 98109, United States, 1 2066675074, jbricker@fredhutch.org %K smartphone app %K mHealth %K tobacco %K smoking %K cancer patient %D 2020 %7 17.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Persistent smoking after a cancer diagnosis predicts worse treatment outcomes and mortality, but access to effective smoking cessation interventions is limited. Smartphone apps can address this problem by providing a highly accessible, low-cost smoking cessation intervention designed for patients with a recent cancer diagnosis. Objective: This study aimed to summarize our development process and report the trial design, feasibility, participant acceptability, preliminary effectiveness, and impact on processes of change (eg, cancer stigma) of the first-known smoking cessation smartphone app targeted for cancer patients. Methods: We used an agile, user-centered design framework to develop a fully automated smartphone app called Quit2Heal that provided skills training and stories from cancer survivors focusing on coping with internalized shame, cancer stigma, depression, and anxiety as core triggers of smoking. Quit2Heal was compared with the National Cancer Institute’s QuitGuide, a widely used stop smoking app for the general population, in a pilot double-blinded randomized trial with a 2-month follow-up period. Participants were 59 adult smokers diagnosed with cancer within the past 12 months and recruited through 2 cancer center care networks and social media over a 12-month period. The most common types of cancer diagnosed were lung (21/59, 36%) and breast (10/59, 17%) cancers. The 2-month follow-up survey retention rate was 92% (54/59) and did not differ by study arm (P=.15). Results: Compared with QuitGuide participants, Quit2Heal participants were more satisfied with their assigned app (90% [19/21] for Quit2Heal vs 65% [17/26] for QuitGuide; P=.047) and were more likely to report that the app assigned to them was made for someone like them (86% [18/21] for Quit2Heal vs 62% [16/26] for QuitGuide; P=.04). Quit2Heal participants opened their app a greater number of times during the 2-month trial period, although this difference was not statistically significant (mean 10.0, SD 14.40 for Quit2Heal vs mean 6.1, SD 5.3 for QuitGuide; P=.33). Self-reported 30-day point prevalence quit rates at the 2-month follow-up were 20% (5/25) for Quit2Heal versus 7% (2/29) for QuitGuide (odds ratio 5.16, 95% CI 0.71-37.29; P=.10). Quit2Heal participants also showed greater improvement in internalized shame, cancer stigma, depression, and anxiety, although these were not statistically significant (all P>.05). Conclusions: In a pilot randomized trial with a high short-term retention rate, Quit2Heal showed promising acceptability and effectiveness for helping cancer patients stop smoking. Testing in a full-scale randomized controlled trial with a longer follow-up period and a larger sample size is required to test the effectiveness, mediators, and moderators of this promising digital cessation intervention. Trial Registration: ClinicalTrials.gov NCT03600038; https://clinicaltrials.gov/ct2/show/NCT03600038 %M 31951215 %R 10.2196/16652 %U http://formative.jmir.org/2020/1/e16652/ %U https://doi.org/10.2196/16652 %U http://www.ncbi.nlm.nih.gov/pubmed/31951215 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 1 %P e13673 %T Perceptions and Sentiments About Electronic Cigarettes on Social Media Platforms: Systematic Review %A Kwon,Misol %A Park,Eunhee %+ School of Nursing, University at Buffalo, 3435 Main Street, Buffalo, NY, United States, 1 716 829 3701, eunheepa@buffalo.edu %K electronic cigarettes %K electronic nicotine delivery systems %K internet %K social media %K review %D 2020 %7 15.1.2020 %9 Review %J JMIR Public Health Surveill %G English %X Background: Electronic cigarettes (e-cigarettes) have been widely promoted on the internet, and subsequently, social media has been used as an important informative platform by e-cigarette users. Beliefs and knowledge expressed on social media platforms have largely influenced e-cigarette uptake, the decision to switch from conventional smoking to e-cigarette smoking, and positive and negative connotations associated with e-cigarettes. Despite this, there is a gap in our knowledge of people’s perceptions and sentiments on e-cigarettes as depicted on social media platforms. Objective: This study aimed to (1) provide an overview of studies examining the perceptions and sentiments associated with e-cigarettes on social media platforms and online discussion forums, (2) explore people’s perceptions of e-cigarette therein, and (3) examine the methodological limitations and gaps of the included studies. Methods: Searches in major electronic databases, including PubMed, Cumulative Index of Nursing and Allied Health Literature, EMBASE, Web of Science, and Communication and Mass Media Complete, were conducted using the following search terms: “electronic cigarette,” “electronic vaporizer,” “electronic nicotine,” and “electronic nicotine delivery systems” combined with “internet,” “social media,” and “internet use.” The studies were selected if they examined participants’ perceptions and sentiments of e-cigarettes on online forums or social media platforms during the 2007-2017 period. Results: A total of 21 articles were included. A total of 20 different social media platforms and online discussion forums were identified. A real-time snapshot and characteristics of sentiments, personal experience, and perceptions toward e-cigarettes on social media platforms and online forums were identified. Common topics regarding e-cigarettes included positive and negative health effects, testimony by current users, potential risks, benefits, regulations associated with e-cigarettes, and attitude toward them as smoking cessation aids. Conclusions: Although perceptions among social media users were mixed, there were more positive sentiments expressed than negative ones. This study particularly adds to our understanding of current trends in the popularity of and attitude toward e-cigarettes among social media users. In addition, this study identified conflicting perceptions about e-cigarettes among social media users. This suggests that accurate and up-to-date information on the benefits and risks of e-cigarettes needs to be disseminated to current and potential e-cigarette users via social media platforms, which can serve as important educational channels. Future research can explore the efficacy of social media–based interventions that deliver appropriate information (eg, general facts, benefits, and risks) about e-cigarettes. Trial Registration: PROSPERO CRD42019121611; https://tinyurl.com/yfr27uxs %M 31939747 %R 10.2196/13673 %U http://publichealth.jmir.org/2020/1/e13673/ %U https://doi.org/10.2196/13673 %U http://www.ncbi.nlm.nih.gov/pubmed/31939747 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 4 %N 1 %P e14963 %T Using Mobile Health Tools to Assess Physical Activity Guideline Adherence and Smoking Urges: Secondary Analysis of mActive-Smoke %A Shan,Rongzi %A Yanek,Lisa R %A Silverman-Lloyd,Luke G %A Kianoush,Sina %A Blaha,Michael J %A German,Charles A %A Graham,Garth N %A Martin,Seth S %+ Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Carnegie 591, Baltimore, MD, 21287, United States, 1 4105020469, smart100@jhmi.edu %K physical activity %K smoking %K mHealth %K fitness trackers %K short message service %D 2020 %7 6.1.2020 %9 Original Paper %J JMIR Cardio %G English %X Background: Rates of cigarette smoking are decreasing because of public health initiatives, pharmacological aids, and clinician focus on smoking cessation. However, a sedentary lifestyle increases cardiovascular risk, and therefore, inactive smokers have a particularly enhanced risk of cardiovascular disease. Objective: In this secondary analysis of mActive-Smoke, a 12-week observational study, we investigated adherence to guideline-recommended moderate-to-vigorous physical activity (MVPA) in smokers and its association with the urge to smoke. Methods: We enrolled 60 active smokers (≥3 cigarettes per day) and recorded continuous step counts with the Fitbit Charge HR. MVPA was defined as a cadence of greater than or equal to 100 steps per minute. Participants were prompted to report instantaneous smoking urges via text message 3 times a day on a Likert scale from 1 to 9. We used a mixed effects linear model for repeated measures, controlling for demographics and baseline activity level, to investigate the association between MVPA and urge. Results: A total of 53 participants (mean age 40 [SD 12] years, 57% [30/53] women, 49% [26/53] nonwhite, and 38% [20/53] obese) recorded 6 to 12 weeks of data. Data from 3633 person-days were analyzed, with a mean of 69 days per participant. Among all participants, median daily MVPA was 6 min (IQR 2-13), which differed by sex (12 min [IQR 3-20] for men vs 3.5 min [IQR 1-9] for women; P=.004) and BMI (2.5 min [IQR 1-8.3] for obese vs 10 min [IQR 3-15] for nonobese; P=.04). The median total MVPA minutes per week was 80 (IQR 31-162). Only 10% (5/51; 95% CI 4% to 22%) of participants met national guidelines of 150 min per week of MVPA on at least 50% of weeks. Adjusted models showed no association between the number of MVPA minutes per day and mean daily smoking urge (P=.72). Conclusions: The prevalence of MVPA was low in adult smokers who rarely met national guidelines for MVPA. Given the poor physical activity attainment in smokers, more work is required to enhance physical activity in this population. %M 31904575 %R 10.2196/14963 %U https://cardio.jmir.org/2020/1/e14963 %U https://doi.org/10.2196/14963 %U http://www.ncbi.nlm.nih.gov/pubmed/31904575 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e15684 %T Health Effects Associated With Electronic Cigarette Use: Automated Mining of Online Forums %A Hua,My %A Sadah,Shouq %A Hristidis,Vagelis %A Talbot,Prue %+ University of California, Riverside, 2320 Spieth Hall, 900 University Ave, Riverside, CA, 92521, United States, 1 9518273768, talbot@ucr.edu %K electronic cigarettes %K vaping epidemic %K vaping-associated pulmonary illness %K e-cigarettes %K electronic nicotine delivery devices %K health effects %K nicotine %K symptoms %K disorders %K pulmonary disease %K pneumonia %K headaches %K content analysis %K text classification %K e-cigarette, or vaping, product use associated lung injury %D 2020 %7 3.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Our previous infodemiological study was performed by manually mining health-effect data associated with electronic cigarettes (ECs) from online forums. Manual mining is time consuming and limits the number of posts that can be retrieved. Objective: Our goal in this study was to automatically extract and analyze a large number (>41,000) of online forum posts related to the health effects associated with EC use between 2008 and 2015. Methods: Data were annotated with medical concepts from the Unified Medical Language System using a modified version of the MetaMap tool. Of over 1.4 million posts, 41,216 were used to analyze symptoms (undiagnosed conditions) and disorders (physician-diagnosed terminology) associated with EC use. For each post, sentiment (positive, negative, and neutral) was also assigned. Results: Symptom and disorder data were categorized into 12 organ systems or anatomical regions. Most posts on symptoms and disorders contained negative sentiment, and affected systems were similar across all years. Health effects were reported most often in the neurological, mouth and throat, and respiratory systems. The most frequently reported symptoms and disorders were headache (n=939), coughing (n=852), malaise (n=468), asthma (n=916), dehydration (n=803), and pharyngitis (n=565). In addition, users often reported linked symptoms (eg, coughing and headache). Conclusions: Online forums are a valuable repository of data that can be used to identify positive and negative health effects associated with EC use. By automating extraction of online information, we obtained more data than in our prior study, identified new symptoms and disorders associated with EC use, determined which systems are most frequently adversely affected, identified specific symptoms and disorders most commonly reported, and tracked health effects over 7 years. %M 31899452 %R 10.2196/15684 %U https://www.jmir.org/2020/1/e15684 %U https://doi.org/10.2196/15684 %U http://www.ncbi.nlm.nih.gov/pubmed/31899452 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13728 %T A Behavioral Activation Mobile Health App for Smokers With Depression: Development and Pilot Evaluation in a Single-Arm Trial %A Heffner,Jaimee L %A Watson,Noreen L %A Serfozo,Edit %A Mull,Kristin E %A MacPherson,Laura %A Gasser,Melissa %A Bricker,Jonathan B %+ Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, PO Box 19024, Seattle, WA, , United States, 1 206 667 7314, jheffner@fredhutch.org %K tobacco %K nicotine %K smoking cessation %K depression %K smartphone %D 2019 %7 27.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The integration of Behavioral Activation Treatment for Depression (BAT-D) into smoking cessation interventions is a promising approach to address depression as a barrier to quitting. However, this approach has only been tested as a face-to-face intervention, which has low reach. Objective: The aims of the study were to develop a BAT-D mobile health app with high potential reach and determine its feasibility, acceptability, and preliminary effects on theory-based behavioral processes of behavioral activation, reduced depressive symptoms, and smoking cessation. Methods: Following a user-centered design process consisting of competitive analysis, focus groups, and prototype testing, we conducted a single-arm pilot trial of Actify!, a BAT-D app for depressed smokers. Participants used SmokefreeTXT along with Actify! to provide cessation content that had not yet been built into the app for this initial phase of pilot testing. Participants in the trial were current, daily smokers with mild to moderate depressive symptoms. We examined use outcomes for all enrolled participants and process and cessation outcomes at 6 weeks postenrollment for study completers (16/17, 94% retention). Results: Regarding acceptability, average number of log-ins per participant was 16.6 (SD 13.7), and 63% (10/16) reported being satisfied overall with the app. Posttreatment interviews identified some usability challenges (eg, high perceived burden of planning and scheduling values-based activities). There was a significant decrease in depressive symptoms from baseline to follow-up (mean change in Patient Health Questionnaire–9 scores was –4.5, 95% CI –7.7 to –1.3; P=.01). Additionally, carbon monoxide (CO)-confirmed, 7-day point prevalence abstinence (PPA) at 6-week follow-up was 31% (5/16), and the 30-day PPA was 19% (3/16). Conclusions: Results demonstrate promising engagement with Actify! and potential for impact on theory-based change processes and cessation outcomes. Preliminary quit rates compare favorably to previous trials of smoking cessation apps for the general population (ie, short-term, self-reported 30-day quit rates in the 8% to 18% range) and a previous trial of face-to-face BAT-D for depressed smokers (ie, CO-confirmed, 7-day PPA rate of 17% at end of treatment). %M 31774405 %R 10.2196/13728 %U http://formative.jmir.org/2019/4/e13728/ %U https://doi.org/10.2196/13728 %U http://www.ncbi.nlm.nih.gov/pubmed/31774405 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e15441 %T Assessing the Appeal of Instagram Electronic Cigarette Refill Liquid Promotions and Warnings Among Young Adults: Mixed Methods Focus Group Study %A Laestadius,Linnea I %A Penndorf,Kendall E %A Seidl,Melissa %A Cho,Young I %+ Zilber School of Public Health, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI, 53201-0413, United States, 1 414 227 4512, llaestad@uwm.edu %K social media %K vaping %K tobacco %K marketing %D 2019 %7 25.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: While marketing for electronic cigarette refill liquids (e-liquids) is widespread on Instagram, little is known about the post elements that create appeal among young adult Instagram users. Further information is needed to help shape regulatory strategies appropriate for social media. Objective: This study examined young adult Instagram user perceptions of actual e-liquid marketing posts and US Food and Drug Administration (FDA)–mandated nicotine addiction warning statements on Instagram. Methods: A series of 12 focus groups (n=69) were held with non–tobacco users, vapers, smokers, and dual users in Wisconsin between September and December 2018. Participants discussed the elements of posts that they found appealing or unappealing, in addition to completing a survey about each post and e-liquid. Focus group transcripts were analyzed by smoking status using a framework analysis approach. Results: Although willingness to try e-liquids was highest among nicotine users, focus group discussions indicated that Instagram posts promoting e-liquids held appeal for individuals across smoking statuses. The primary elements that created appeal were the perceived trustworthiness of the Instagram account, attractive design and flavor visuals, and promotion of flavors and nicotine levels that met personal preferences. Post appeal was reduced by references to vaping subcultures, indicators that the post creator did not take nicotine addiction seriously, and FDA-mandated nicotine warning statements. Non–tobacco users were particularly drawn to posts featuring nicotine-free e-liquids with attractive visual designs and flavors known from foods. Conclusions: Young adults consider a broad range of elements in assessing the appeal of e-liquid marketing on Instagram, with minor but notable distinctions by smoking status. Non–tobacco users are uniquely drawn to nicotine-free e-liquids and are more deterred by the FDA’s mandated nicotine addiction warning statements than those from other smoking statuses. This suggests that it may be possible to tailor policy interventions in a manner that helps to reduce novel uptake of vaping without significantly diminishing its potential harm-reduction benefits. %M 31763987 %R 10.2196/15441 %U http://www.jmir.org/2019/11/e15441/ %U https://doi.org/10.2196/15441 %U http://www.ncbi.nlm.nih.gov/pubmed/31763987 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 11 %P e15155 %T Social Media Intervention to Promote Smoking Treatment Utilization and Cessation Among Alaska Native People Who Smoke: Protocol for the Connecting Alaska Native People to Quit Smoking (CAN Quit) Pilot Study %A Sinicrope,Pamela S %A Koller,Kathryn R %A Prochaska,Judith J %A Hughes,Christine A %A Bock,Martha J %A Decker,Paul A %A Flanagan,Christie A %A Merritt,Zoe T %A Meade,Crystal D %A Willetto,Abbie L %A Resnicow,Ken %A Thomas,Timothy K %A Patten,Christi A %+ Department of Psychiatry and Psychology and Behavioral Health Research Program, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, United States, 1 507 266 1238, Sinicrope.Pamela@mayo.edu %K smoking %K tobacco cessation %K Alaska %K Alaska Natives %K tobacco smoking %K internet %K social media %K clinical trial randomized %K smoking cessation %K intervention %D 2019 %7 22.11.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the high prevalence of tobacco use among Alaska Native (AN) people, tobacco cessation interventions developed specifically for this group are lacking. Social media hold promise as a scalable intervention strategy to promote smoking treatment utilization and cessation, given the barriers to treatment delivery (ie, geographic remoteness, limited funding, climate, and travel costs) in the state of Alaska (AK). Building on a longstanding tobacco control research partnership with the AK Tribal Health System, in this study, we are developing and pilot-testing a culturally relevant, Facebook (FB)-delivered intervention that incorporates a digital storytelling approach adapted from the effective Centers for Disease Control Tips from Former Smokers campaign. Objective: This study aims to promote evidence-based smoking treatment (eg, state quitline and Tribal cessation programs) uptake and cessation among AN people. Methods: This study fulfills the objectives for stage 1 of the National Institute on Drug Abuse behavioral integrative treatment development program. In stage 1a, we will use a mixed method approach to develop the FB intervention. Cultural variance and surface/deep structure frameworks will address the influence of culture in designing health messages. These developmental activities will include qualitative and quantitative assessments, followed by beta testing of proposed intervention content. In stage 1b, we will conduct a randomized pilot trial enrolling 60 AN adults who smoke. We will evaluate the feasibility, uptake, consumer response, and potential efficacy of the FB intervention compared with a control condition (quitline/treatment referral only). Primary outcome measures include feasibility and biochemically verified smoking abstinence at 1-, 3-, and 6-month follow-ups. Secondary outcomes will include self-reported smoking cessation treatment utilization and abstinence from tobacco/nicotine products. We will also explore interdependence (relationship orientation and collaborative efforts in lifestyle change) as a culturally relevant mediator of intervention efficacy. Results: The study enrolled 40 participants for phase 1, with data saturation being achieved at 30 AN people who smoke and 10 stakeholders. For phase 2, we enrolled 40 participants. Qualitative assessment of proposed intervention content was completed with 30 AN smokers and 10 stakeholders. We are currently analyzing data from the quantitative assessment with 40 participants in preparation for the beta testing, followed by the randomized pilot trial. Conclusions: The project is innovative for its use of social media communication tools that are culturally relevant in a behavioral intervention designed to reach AN people statewide to promote smoking treatment utilization and cessation. The study will further advance tobacco cessation research in an underserved disparity group. If the pilot intervention is successful, we will have a blueprint to conduct a large randomized controlled efficacy trial. Our approach could be considered for other remote AN communities to enhance the reach of evidence-based tobacco cessation treatments. International Registered Report Identifier (IRRID): DERR1-10.2196/15155 %M 31755867 %R 10.2196/15155 %U http://www.researchprotocols.org/2019/11/e15155/ %U https://doi.org/10.2196/15155 %U http://www.ncbi.nlm.nih.gov/pubmed/31755867 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e14143 %T Antismoking Advertisements and Price Promotions and Their Association With the Urge to Smoke and Purchases in a Virtual Convenience Store: Randomized Experiment %A Dutra,Lauren McCarl %A Nonnemaker,James %A Bradfield,Brian %A Taylor,Nathaniel %A Guillory,Jamie %A Feld,Ashley %A Kim,Annice %+ Center for Health Policy Science and Tobacco Research, RTI International, 2150 Shattuck Avenue, Suite 1200, Berkeley, CA, 94704, United States, 1 5106658297, ldutra@rti.org %K cigarette smoking %K advertisement %K craving %K tobacco products %K commerce %K consumer behavior %D 2019 %7 23.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Point of sale (POS) advertising is associated with smoking initiation, current smoking, and relapse among former smokers. Price promotion bans and antismoking advertisements (ads) are 2 possible interventions for combating POS advertising. Objective: The purpose of this analysis was to determine the influence of antismoking ads and promotions on urges to smoke and tobacco purchases. Methods: This analysis examined exposure to graphic (graphic images depicting physical consequences of tobacco use) and supportive (pictures of and supportive messages from former smokers) antismoking ads and promotions in a virtual convenience store as predictors of urge to smoke and buying tobacco products among 1200 current cigarette smokers and 800 recent quitters recruited via a Web-based panel (analytical n=1970). We constructed linear regression models for urge to smoke and logistic regression models for the odds of purchasing tobacco products, stratified by smoking status. Results: The only significant finding was a significant negative relationship between exposure to supportive antismoking ads and urge to smoke among current smokers (beta coefficient=−5.04, 95% CI −9.85 to −0.22; P=.04). There was no significant relationship between graphic antismoking ads and urge to smoke among current smokers (coefficient=−3.77, 95% CI −8.56 to 1.02; P=.12). Neither relationship was significant for recent quitters (graphic: coefficient=−3.42, 95% CI −8.65 to 1.81; P=.15 or supportive: coefficient=−3.82, 95% CI −8.99 to 1.36; P=.20). There were no significant differences in urge to smoke by exposure to promotions for current smokers (coefficient=−1.06, 95% CI −4.53 to 2.41; P=.55) or recent quitters (coefficient=1.76, 95% CI −2.07 to 5.59; P=.37). There were also no differences in tobacco purchases by exposure to graphic (current smokers: coefficient=0.93, 95% CI 0.67 to 1.29; P=.66 and recent quitters: coefficient=0.73, 95% CI 0.44 to 1.19; P=.20) or supportive (current smokers: coefficient=1.05, 95% CI 0.75 to 1.46; P=.78 and recent quitters: coefficient=0.73, 95% CI 0.45 to 1.18; P=.20) antismoking ads or price promotions (current smokers: coefficient=1.09, 95% CI 0.86 to 1.38; P=.49 and recent quitters: coefficient=0.90, 95% CI 0.62 to 1.31; P=.60). Conclusions: The results of this analysis support future research on the ability of supportive antismoking ads to reduce urges to smoke among current cigarette smokers. Research on urges to smoke has important tobacco control implications, given the relationship between urge to smoke and smoking cigarettes, time to next smoke, and amount smoked. %M 31647468 %R 10.2196/14143 %U https://www.jmir.org/2019/10/e14143 %U https://doi.org/10.2196/14143 %U http://www.ncbi.nlm.nih.gov/pubmed/31647468 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 10 %P e12444 %T Health Research Using Facebook to Identify and Recruit Pregnant Women Who Use Electronic Cigarettes: Internet-Based Nonrandomized Pilot Study %A Lee,Harold H %A Hsieh,Yuli Patrick %A Murphy,Joe %A Tidey,Jennifer W %A Savitz,David A %+ Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 428F, 401 Park Dr, Boston, MA, 02215, United States, 1 617 432 1135, hhlee@hsph.harvard.edu %K e-cigarette %K pregnancy %K social media %D 2019 %7 18.10.2019 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Participant recruitment is often a challenge, particularly enrolling individuals with relatively rare characteristics. The wide reach of social media may provide a mechanism to overcome these challenges. Objective: This paper aimed to provide information to researchers who seek to recruit participants from rare populations using social media for studies with demanding protocols. We aimed to describe a pilot study protocol that identified and enrolled pregnant women (second or third trimester) who were exclusive users of electronic cigarettes (e-cigarettes). We have described the recruitment methods, time, and cost; examined advertisement types that were more or less successful; discussed participant retention and relationship management; and described the process of collecting biological data. Methods: In an open-access, nonrandomized pilot study, we placed Facebook advertisements that were selectively targeting women who were likely to be pregnant and interested in e-cigarettes or vaping. The advertisements invited individuals to complete a fully automated eligibility screener based on Qualtrics. Eligible participants were asked to (1) complete a Web-based survey that collected detailed information on the use of e-cigarettes, including the exact type of device and electronic liquid, (2) report the frequency and intensity of e-cigarette use for 3 months before pregnancy and during each trimester, and (3) provide a saliva specimen for a nicotine biomarker assay. We collected a photograph of each participant’s e-cigarette device, 8 weeks after the mother’s due date, to allow corroboration of the self-report and the baby’s birth weight and gestational age from the participant’s physician. Results: Participants were recruited between August 19 and October 26, 2017. We enrolled 20 participants in 2 months at a cost of US $3421.28. Baseline data were collected for all 20 participants. Of the 20 women enrolled, 16 provided a saliva sample, 4 provided a photo of the e-cigarette device, and 10 provided physician contact information. Of the 10 physicians contacted by mail, 6 responded with information on the participants and their babies. Conclusions: Study findings suggest that Facebook’s targeting criteria should focus on e-cigarette users to maximize advertisement exposure of potentially eligible women. In addition, saliva sample collection was feasible among pregnant women (second or third trimester) who were exclusive e-cigarette users, but obtaining photographs and physician reports was problematic and called for further refinement. These lessons are likely useful to others who are seeking to use social media to recruit participants from rare populations into studies with demanding protocols. %M 31628785 %R 10.2196/12444 %U https://www.researchprotocols.org/2019/10/e12444 %U https://doi.org/10.2196/12444 %U http://www.ncbi.nlm.nih.gov/pubmed/31628785 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e12878 %T Prevalence and Characteristics of Twitter Posts About Court-Ordered, Tobacco-Related Corrective Statements: Descriptive Content Analysis %A Kelley,Dannielle E %A Brown,Meredith %A Murray,Alice %A Blake,Kelly D %+ Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Dr, 3E536, Rockville, MD, 20850, United States, 1 240 276 7227, dannielle.kelley@nih.gov %K social media %K Twitter %K tobacco corrective statements %K tobacco industry/legislation and jurisprudence %D 2019 %7 8.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Three major US tobacco companies were recently ordered to publish corrective statements intended to prevent and restrain further fraud about the health effects of smoking. The court-ordered statements began appearing in newspapers and on television (TV) in late 2017. Objective: The objective of this study was to examine the social media dissemination of the tobacco corrective statements during the first 6 months of the implementation of the statements. Methods: We conducted a descriptive content analysis of Twitter posts using an iterative search strategy through Crimson Hexagon and randomly selected 19.74% (456/2309) of original posts occurring between November 1, 2017, and March 27, 2018, for coding and analysis. We assessed post volume over time, source or author, valence, linked content, and reference to the industry (eg, big tobacco, tobacco industry, and Philip Morris) and media outlet (TV or newspaper). Retweeted content was coded for source/author and prevalence. Results: Most posts were published in November 2017, surrounding the initial release of the corrective statements. Content was generally neutral (58.7%, 268/456) or positive (33.3%, 152/456) in valence, included links to additional information about the statements (94.9%, 433/456), referred to the industry (87.7%, 400/456), and did not mention a specific media channel on which the statements were aired or published (15%). The majority of original posts were created by individual users (55.2%, 252/456), whereas the majority of retweeted posts were posted by public health organizations (51%). Differences by source are reported, for example, organization posts are more likely to include a link to additional information compared with individual users (P=.03). Conclusions: Conversations about the court-ordered corrective statements are taking place on Twitter and are generally neutral or positive in nature. Public health organizations may be increasing the prevalence of these conversations through social media engagement. %M 31596243 %R 10.2196/12878 %U https://publichealth.jmir.org/2019/4/e12878 %U https://doi.org/10.2196/12878 %U http://www.ncbi.nlm.nih.gov/pubmed/31596243 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14699 %T Dropout and Abstinence Outcomes in a National Text Messaging Smoking Cessation Intervention for Pregnant Women, SmokefreeMOM: Observational Study %A Kamke,Kristyn %A Grenen,Emily %A Robinson,Cendrine %A El-Toukhy,Sherine %+ Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, 7201 Wisconsin Ave, RM 533M, Bethesda, MD, 20814, United States, 1 301 594 4743, sherine.el-toukhy@nih.gov %K smoking cessation %K pregnancy %K women's health %K mHealth %K text messaging intervention %D 2019 %7 7.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Population-level text messaging smoking cessation interventions may reduce racial and ethnic differences in smoking among pregnant women. Objective: Our objective was to examine racial and ethnic differences in dropout, response, and abstinence rates among users of a US national, publicly available text messaging cessation intervention targeting pregnant women, SmokefreeMOM. Methods: Participants were online subscribers to SmokefreeMOM who set a prospective quit date within the 9 months before their due date. We examined demographics, smoking frequency, number of cigarettes smoked per day, and prequit time (up to 14 days of preparation time before quit date) as correlates of response rate and abstinence at 8 time points: quit date, day 7, day 14, day 21, day 28, day 35, day 42 (intervention end), and day 72 (1-month follow-up). We conducted survival analysis of time from quit date to dropout by race and ethnicity. Results: The mean age of the analytic sample of 1288 users was 29.46 (SD 7.11) years. Of these, 65.81% (848/1288) were white, 16.04% (207/1288) were black, 8.86% (114/1288) were Latina, and 9.29% (120/1288) were multiracial, American Indian/Alaska Native, Native Hawaiian Pacific Islander, or other; 82.68% (1065/1288) had some college education or less. Point-prevalence abstinence was 14.51% (157/1082) on quit day, 3.51% (38/1082) at intervention end, and 1.99% (21/1053) at 1-month follow-up. Black users (hazard ratio 0.68, 95% CI 0.51-0.91) and those with a high school degree or less (hazard ratio 0.66, 95% CI 0.49-0.89) or some college education (hazard ratio 0.75, 95% CI 0.57-0.99) were less likely to drop out than whites or users with a bachelor’s degree or higher. Response and abstinence rates were similar across race, ethnicity, and education. Conclusions: Enrollment was low among racial and ethnic minority women but high among less-educated women. Abstinence at intervention end and 1-month follow-up was lower than that in controlled trials of text messaging cessation interventions for pregnant women (range 7%-20%). Increasing the reach, engagement, and effectiveness of SmokefreeMOM, especially among women with high rates of smoking during pregnancy, must be prioritized. %M 31593542 %R 10.2196/14699 %U https://mhealth.jmir.org/2019/10/e14699 %U https://doi.org/10.2196/14699 %U http://www.ncbi.nlm.nih.gov/pubmed/31593542 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14331 %T Nurse-Driven mHealth Implementation Using the Technology Inpatient Program for Smokers (TIPS): Mixed Methods Study %A Blok,Amanda C %A Sadasivam,Rajani S %A Hogan,Timothy P %A Patterson,Angela %A Day,Nicole %A Houston,Thomas K %+ Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, United States Department of Veterans Affairs, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, , United States, 1 734 845 3502, amanda.blok@va.gov %K implementation strategy %K telemedicine %K mHealth, tobacco use cessation %K care transition %K patient transfer %K smoking cessation %K mobile health %K smoking %K tobacco %D 2019 %7 4.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking is the leading cause of preventable death and disease, yet implementation of smoking cessation in inpatient settings is inconsistent. The Technology Inpatient Program for Smokers (TIPS) is an implementation program designed to reach smokers with a mobile health (mHealth) intervention using stakeholder-supported strategies. Objective: The purpose of this study was to determine the impact of the TIPS implementation strategies on smoker-level engagement of the mHealth intervention during care transition. Methods: We examined varying intensities (passive motivational posters only and posters + active nurse-led facilitation) of TIPS strategies on four hospital units located in two sites. Unit-level and smoker-level adoption was monitored during active implementation (30 weeks) and sustainability follow-up (30 weeks). Process measures reflecting the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework, stakeholder reported adaptations of strategies, and formative evaluation data were collected and analyzed. Results: For our smoker-level reach, 103 smokers signed up for the mHealth intervention in-hospital, with minimal decline during sustainability follow-up. While posters + nurse facilitation did not lead to higher reach than posters alone during active implementation (27 vs 30 signed up), it did lead to higher engagement of smokers (85.2% vs 73.3% completion of the full 2-week intervention). TIPS strategy adoption and fidelity varied by unit, including adoption of motivational posters (range: weeks 1 and 5), fidelity of posters (0.4% to 16.2% of posters missing per unit weekly) and internal facilitation of nurse training sessions (average of 2 vs 7.5 by site). Variable maintenance costs of the program totaled US $6.63 (US $683.28/103) per smoker reached. Reported family-member facilitation of mHealth sign-up was an observation of unintended behavior. Conclusions: TIPS is a feasible and low-cost implementation program that successfully engages smokers in an mHealth intervention and sustains engagement after discharge. Further testing of nurse facilitation and expanding reach to patient family and friends as an implementation strategy is needed. %M 31588908 %R 10.2196/14331 %U https://mhealth.jmir.org/2019/10/e14331 %U https://doi.org/10.2196/14331 %U http://www.ncbi.nlm.nih.gov/pubmed/31588908 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e12200 %T Design and Development of Smoking Cessation Apps Based on Smokers’ and Providers’ Perspectives in China: Survey Study %A Xu,Junfang %A Bricker,Jonathan %A Fu,Xiaoxing %A Su,Chunyan %A Wang,Peicheng %A Qi,Tengfei %A Cheng,Feng %+ Research Center for Public Health, School of Medicine, Tsinghua University, 30 Shuangqing Rd, Beijing, 100084, China, 86 010 6278 4700, fcheng@mail.tsinghua.edu.cn %K smoking cessation apps %K mHealth %K design %K smartphones %K China %D 2019 %7 4.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although there are more than 60 smartphone apps for smoking cessation in China, many of them do not include the content and features that health care professionals and smokers prefer—which may make them impractical, unengaging, and ineffective. Therefore, we investigated both health care providers’ and smokers’ preferences for features of future smoking cessation apps. Objective: This study aimed to investigate Chinese health care providers’ and smokers’ desired features of a smoking cessation app, with the goal of providing design recommendations for app designers and researchers. Methods: Both Chinese smokers who own smartphones (n=357) and Chinese health care providers (n=224) responded to a survey collecting data on their sociodemographic characteristics and opinions on the importance of 20 smoking cessation app design features studied in previous US research. Results: Chinese health care providers expressed strong support of smoking cessation apps on a number of attitude indicators (range 153/224, 68.3% to 204/224, 91.1%). They rated nearly all (18/20) features as very or extremely important (range 52.2%-83.4%) and rated nearly all features (17/20) as more important than the smokers did. More than 60% of smokers rated the following 4 features as very or extremely important: allow sharing the process of smoking cessation with family members and friends (216/319, 67.7%), helping smokers track their progress (such as the amount of smoking per day; 213/319, 66.8%), helping with the side effects of medications and nicotine withdrawal symptoms (201/319, 63.0%), and adapting to ongoing needs and interests of smokers (194/319, 60.8%). Contrary to a similar study of US smokers and health care providers, Chinese smokers and providers rated reputation and ability to communicate with family members and friends as important features, whereas Chinese smokers rated privacy and security as less important. Conclusions: The design of future smoking cessation and health behavior change apps should consider perspectives of both providers and smokers as well as the role of culture. %M 31588914 %R 10.2196/12200 %U https://mhealth.jmir.org/2019/10/e12200 %U https://doi.org/10.2196/12200 %U http://www.ncbi.nlm.nih.gov/pubmed/31588914 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e12137 %T Comparing the Efficacy of an Identical, Tailored Smoking Cessation Intervention Delivered by Mobile Text Messaging Versus Email: Randomized Controlled Trial %A Gram,Inger Torhild %A Larbi,Dillys %A Wangberg,Silje Camilla %+ Norwegian Centre for E-health Research, University Hospital of North Norway, SIVA Innovation Centre Tromsø, Sykehusvn 23, Tromsø, 9038, Norway, 47 92401177, inger.gram@ehealthresearch.no %K eHealth %K electronic mail %K mHealth %K mobile phones %K randomized controlled trial %K smoking cessation %K text-messaging %D 2019 %7 27.9.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is a need to deliver smoking cessation support at a population level, both in developed and developing countries. Studies on internet-based and mobile phone–based smoking cessation interventions have shown that these methods can be as effective as other methods of support, and they can have a wider reach at a lower cost. Objective: This randomized controlled trial (RCT) aimed to compare, on a population level, the efficacy of an identical, tailored smoking cessation intervention delivered by mobile text messaging versus email. Methods: We conducted a nationwide 2-arm, double-blinded, fully automated RCT, close to a real-world setting, in Norway. We did not offer incentives to increase participation and adherence or to decrease loss to follow-up. We recruited users of the website, slutta.no, an open, free, multi-component Norwegian internet-based smoking cessation program, from May 2010 until October 2012. Enrolled smokers were considered as having completed a time point regardless of their response status if it was 1, 3, 6, or 12 months post cessation. We assessed 7315 participants using the following inclusion criteria: knowledge of the Norwegian language, age 16 years or older, ownership of a Norwegian cell phone, having an email account, current cigarette smoker, willingness to set a cessation date within 14 days (mandatory), and completion of a baseline questionnaire for tailoring algorithms. Altogether, 6137 participants were eligible for the study and 4378 participants (71.33%) provided informed consent to participate in the smoking cessation trial. We calculated the response rates for participants at the completed 1, 3, 6, and 12 months post cessation. For each arm, we conducted an intention-to-treat (ITT) analysis for each completed time point. The main outcome was 7-day self-reported point prevalence abstinence (PPA) at the completed 6 months post cessation. We calculated effect size of the 7-day self-reported PPA in the text message arm compared with the email arm as odds ratios (ORs) with 95% CIs for the 4 time points post cessation. Results: At 6 months follow-up, 21.06% (384/1823) of participants in the text message arm and 18.62% (333/1788) in the email arm responded (P=.07) to the surveys. In the ITT analysis, 11.46% (209/1823) of participants in the text message arm compared with 10.96% (196/1788) in the email arm (OR 1.05, 95% CI 0.86-1.30) reported to have achieved 7 days PPA. Conclusions: This nationwide, double-blinded, large, fully automated RCT found that 1 in 9 enrolled smokers reported 7-day PPA in both arms, 6 months post cessation. Our study found that identical smoking cessation interventions delivered by mobile text messaging and email may be equally successful at a population level. Trial Registration: ClinicalTrials.gov NCT01103427; https://clinicaltrials.gov/ct2/show/NCT01103427 %M 31573935 %R 10.2196/12137 %U https://mhealth.jmir.org/2019/9/e12137 %U https://doi.org/10.2196/12137 %U http://www.ncbi.nlm.nih.gov/pubmed/31573935 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 9 %P e13038 %T Underage JUUL Use Patterns: Content Analysis of Reddit Messages %A Zhan,Yongcheng %A Zhang,Zhu %A Okamoto,Janet M %A Zeng,Daniel D %A Leischow,Scott J %+ Department of Management Information Systems, University of Arizona, Tucson, 1130 E Helen St, McClelland Hall 430, Tucson, AZ, 85721-0108, United States, 1 5205763741, yongchengzhan@email.arizona.edu %K electronic nicotine delivery systems %K social media %K minors %D 2019 %7 09.09.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The popularity of JUUL (an e-cigarette brand) among youth has recently been reported in news media and academic papers, which has raised great public health concerns. Little research has been conducted on the age distribution, geographic distribution, approaches to buying JUUL, and flavor preferences pertaining to underage JUUL users. Objective: The aim of this study was to analyze social media data related to demographics, methods of access, product characteristics, and use patterns of underage JUUL use. Methods: We collected publicly available JUUL-related data from Reddit. We extracted and summarized the age, location, and flavor preference of subreddit UnderageJuul users. We also compared common and unique users between subreddit UnderageJuul and subreddit JUUL. The methods of purchasing JUULs were analyzed by manually examining the content of the Reddit threads. Results: A total of 716 threads and 2935 comments were collected from the subreddit UnderageJuul before it was shut down. Most threads did not mention a specific age, but ages ranged from 13 years to greater than 21 years in those that did. Mango, mint, and cucumber were the most popular among the 7 flavors listed on JUUL’s official website, and 336 subreddit UnderageJuul threads mentioned 7 discreet approaches to circumvent relevant legal regulations to get JUUL products, the most common of which was purchasing JUUL from other Reddit users (n=181). Almost half of the UnderageJuul users (389/844, 46.1%) also participated in discussions on the main JUUL subreddit and sought information across multiple Reddit forums. Most (64/74, 86%) posters were from large metropolitan areas. Conclusions: The subreddit UnderageJuul functioned as a forum to explore methods of obtaining JUUL and to discuss and recommend specific flavors before it was shut down. About half of those using UnderageJuul also used the more general JUUL subreddit, so a forum still exists where youths can attempt to share information on how to obtain JUUL and other products. Exploration of such social media data in real time for rapid public health surveillance could provide early warning for significant health risks before they become major public health threats. %M 31502542 %R 10.2196/13038 %U http://www.jmir.org/2019/9/e13038/ %U https://doi.org/10.2196/13038 %U http://www.ncbi.nlm.nih.gov/pubmed/31502542 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 3 %P e14023 %T Tailoring of a Smartphone Smoking Cessation App (Kick.it) for Serious Mental Illness Populations: Qualitative Study %A Klein,Pauline %A Lawn,Sharon %A Tsourtos,George %A van Agteren,Joep %+ College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, 5001, Australia, 61 427 370 673, klei0081@flinders.edu.au %K mental health %K mHealth %K tobacco %K smoking cessation %K public health %K technology %D 2019 %7 03.09.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Smoking rates of Australians with severe mental illness (SMI) are disproportionately higher than the general population. Despite the rapid growth in mobile health (mHealth) apps, limited evidence exists to inform their design for SMI populations. Objective: This study aimed to explore the feasibility, acceptability, and utility of adapting a novel smoking cessation app (Kick.it) to assist smokers with SMI to prevent smoking relapse and quit. Methods: Using co-design, two in-depth interviews with 12 adult smokers and ex-smokers with SMI were conducted in this qualitative study. Stage 1 interviews explored participants’ smoking-related experiences and perceptions of social support for smoking cessation, informed the development of the stage 2 interview schedule, and provided context for participants’ responses to the second interview. Stage 2 interviews explored participants’ perceptions of the feasibility, utility, and acceptability of the app features for SMI populations. Results: People with SMI perceived mHealth interventions to support their quit smoking attempts as feasible, acceptable, and useful. Key emerging themes included personalization of the app to users’ psychosocial needs, a caring app to mediate self-esteem and self-efficacy, an app that normalizes smoking relapse and multiple quit attempts, a strong focus on user experience to improve usability, and a social network to enhance social support for smoking cessation. Conclusions: This study gained an in-depth understanding of the lived experiences of smoking and quitting among people with SMI and their perception of the Kick.it app features to help inform the tailoring of the app. Specific program tailoring is required to assist them in navigating the complex interactions between mental illness and smoking in relation to their psychosocial well-being and capacity to quit. This study describes the adaptations required for the Kick.it app to meet the specific needs and preferences of people with SMI. Results of this study will guide the tailoring of the Kick.it app for SMI populations. The study findings can also inform a co-design process for the future development and design of smoking cessation apps for SMI populations. %M 31482850 %R 10.2196/14023 %U https://humanfactors.jmir.org/2019/3/e14023 %U https://doi.org/10.2196/14023 %U http://www.ncbi.nlm.nih.gov/pubmed/31482850 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e11506 %T Safety of Electronic Cigarette Use During Breastfeeding: Qualitative Study Using Online Forum Discussions %A Johnston,Emily Jade %A Campbell,Katarzyna %A Coleman,Tim %A Lewis,Sarah %A Orton,Sophie %A Cooper,Sue %+ Division of Primary Care, School of Medicine, University of Nottingham, Towers Building, 14th Floor, University Park, Nottingham, NG7 2RD, United Kingdom, 44 1157484622, msxejj@nottingham.ac.uk %K e-cigarette %K online forum %K postpartum relapse %K smoking %K breastfeeding %K forum data %D 2019 %7 12.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic cigarettes (e-cigs) are an increasingly popular alternative to smoking, helping to prevent relapse in those trying to quit and with the potential to reduce harm as they are likely to be safer than standard cigarettes. Many women return to smoking in the postpartum period having stopped during pregnancy, and while this can affect their decisions about breastfeeding, little is known about women’s opinions on using e-cigs during this period. Objective: The aim of this study is to explore online forum users’ current attitudes, motivations, and barriers to postpartum e-cig use, particularly as a breastfeeding mother. Methods: Data were collected via publicly accessible (identified by Google search) online forum discussions, and a priori codes identified. All transcripts were entered into NVivo for analysis, with a template approach to thematic analysis being used to code all transcripts from which themes were derived. Results: Four themes were identified: use, perceived risk, social support and evidence, with a number of subthemes identified within these. Women were using e-cigs to prevent postpartum return to smoking, but opinions on their safety were conflicting. They were concerned about possible transfer of harmful products from e-cigs via breastmilk and secondhand exposure, so they were actively seeking and sharing information on e-cigs from a variety of sources. Although some women were supportive of e-cig use, others provided harsh judgement for mothers who used them. Conclusions: E-cigs have the potential to reduce the number of women who return to smoking in the postpartum period and potentially improve breastfeeding rates, if breastfeeding mothers have access to relevant and reliable information. Health care providers should consider discussing e-cigs with mothers at risk of returning to smoking in the postpartum period. %M 31407672 %R 10.2196/11506 %U https://www.jmir.org/2019/8/e11506/ %U https://doi.org/10.2196/11506 %U http://www.ncbi.nlm.nih.gov/pubmed/31407672 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13712 %T Predictors of Retention in an Adult Text Messaging Smoking Cessation Intervention Program: Cohort Study %A Wiseman,Kara P %A Coa,Kisha I %A Prutzman,Yvonne M %+ Tobacco Control Research Branch, Behavioral Research Program, National Cancer Institute, 9606 Medical Center Drive, MSC 9761, Room 3E208, Bethesda, MD, 20892-9761, United States, 1 2402765873, kara.wiseman@nih.gov %K smoking cessation %K text-messaging %K mHealth %K engagement %D 2019 %7 01.08.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health tools such as text messaging programs can support smoking cessation. However, high rates of disengagement from these tools decrease their effectiveness. Objective: The purpose of this study was to identify user characteristics associated with retention in an adult text messaging smoking cessation intervention. Methods: Adults initiating a quit attempt using the publicly available program SmokefreeTXT between March 6 and June 21, 2016 (n=6215), were included. Data were collected to assess nicotine dependence, frequency of being around other smokers, time of the day for cigarette cravings, extrinsic and intrinsic motivation to quit smoking, confidence in quitting, and long-term intention to be smoke free. Multivariable survival analysis modeling for time to opt out was conducted to identify characteristics associated with opting out over the course of the intervention, adjusting for age, sex, and smoking frequency, reset of the quit date by the user, and the number of days enrolled before initiating the quit attempt. Among those who opted out, multivariable multinomial logistic regression analysis was used to identify predictors of opting out early (within 3 days and between 4 and 7 days into the quit attempt) compared to opting out late (more than 7 days into the quit attempt), adjusting for the same confounders. Results: Survival analyses indicated that younger age, female sex, higher levels of nicotine dependence, lower intention to be smoke free, and enrolling in SmokefreeTXT ≤1 week before initiating the quit attempt were associated with an increased risk of opting out. For example, users who smoked within 5 minutes of waking up were 1.17 times more likely to opt out than those who smoked more than 5 minutes after waking up (95% CI 1.01-1.35). Among users who opted out from SmokefreeTXT, logistic regression modeling indicated that compared to users who were never or rarely around other smokers, those who were sometimes around other smokers had 1.96 times more likely to opt out within the first 3 days of the quit attempt (95% CI 1.18-3.25). In addition, compared to users with high levels of long-term quit intention, users with lower levels of intention had 1.80 times the odds of opting out between 4 and 7 days into the quit attempt (95% CI 1.02-3.18). Users who reset their quit date after initiating a quit attempt were less likely to opt out at either time point compared with those who did not reset their quit date. Conclusions: Several user characteristics are associated with retention in an adult text messaging smoking cessation program. These results provide guidance on potential characteristics that should be addressed in future text messaging smoking cessation programs. Providing additional support to users with these characteristics may increase retention in text messaging programs and ultimately lead to smoking cessation. %M 31373278 %R 10.2196/13712 %U https://mhealth.jmir.org/2019/8/e13712/ %U https://doi.org/10.2196/13712 %U http://www.ncbi.nlm.nih.gov/pubmed/31373278 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 7 %P e14814 %T Dissemination and Effectiveness of the Peer Marketing and Messaging of a Web-Assisted Tobacco Intervention: Protocol for a Hybrid Effectiveness Trial %A Faro,Jamie M %A Orvek,Elizabeth A %A Blok,Amanda C %A Nagawa,Catherine S %A McDonald,Annalise J %A Seward,Gregory %A Houston,Thomas K %A Kamberi,Ariana %A Allison,Jeroan J %A Person,Sharina D %A Smith,Bridget M %A Brady,Kathleen %A Grosowsky,Tina %A Jacobsen,Lewis L %A Paine,Jennifer %A Welch Jr,James M %A Sadasivam,Rajani S %+ Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, The Albert Sherman Center, 368 Plantation Street, Worcester, MA, 01605, United States, 1 (774) 455 3744, Jamie.faro@umassmed.edu %K smoking cessation %K peer recruitment %K digital Intervention %K tailored, dissemination %D 2019 %7 23.07.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking continues to be the leading preventable cause of death. Digital Interventions for Smoking Cessation (DISCs) are health communication programs accessible via the internet and smartphones and allow for greater reach and effectiveness of tobacco cessation programs. DISCs have led to increased 6-month cessation rates while also reaching vulnerable populations. Despite this, the impact of DISCs has been limited and new ways to increase access and effectiveness are needed. Objective: We are conducting a hybrid effectiveness-dissemination study. We aim to evaluate the effectiveness of a machine learning–based approach (recommender system) for computer-tailored health communication (CTHC) over a standard CTHC system based on quit rates and risk reduction. In addition, this study will assess the dissemination of providing access to a peer recruitment toolset on recruitment rate and variability of the sample. Methods: The Smoker-to-Smoker (S2S) study is a 6-month hybrid effectiveness dissemination trial conducted nationally among English-speaking, current smokers aged ≥18 years. All eligible participants will register for the DISC (Decide2quit) and be randomized to the recommender system CTHC or the standard CTHC, followed by allocation to a peer recruitment toolset group or control group. Primary outcomes will be 7-day point prevalence and risk reduction at the 6-month follow-up. Secondary outcomes include recruitment rate, website engagement, and patient-reported outcomes collected via the 6-month follow-up questionnaire. All primary analyses will be conducted on an intent-to-treat basis. Results: The project is funded from 2017 to 2020 by the Patient Centered Outcomes Research Institute. Enrollment was completed in early 2019, and 6-month follow-ups will be completed by late 2019. Preliminary data analysis is currently underway. Conclusions: Conducting a hybrid study with both effectiveness and dissemination hypotheses raises some unique challenges in the study design and analysis. Our study addresses these challenges to test new innovations and increase the effectiveness and reach of DISCs. International Registered Report Identifier (IRRID): DERR1-10.2196/14814 %M 31339104 %R 10.2196/14814 %U http://www.researchprotocols.org/2019/7/e14814/ %U https://doi.org/10.2196/14814 %U http://www.ncbi.nlm.nih.gov/pubmed/31339104 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e14398 %T Characterizing Swisher Little Cigar–Related Posts on Twitter in 2018: Text Analysis %A Allem,Jon-Patrick %A Uppu,Sree Priyanka %A Boley Cruz,Tess %A Unger,Jennifer B %+ Keck School of Medicine of USC, 2001 N Soto Street, Los Angeles, CA,, United States, 1 8586030812, allem@usc.edu %K little cigar %K cigarillo %K Swisher %K social media %K Twitter %K tobacco %D 2019 %7 19.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Little cigars are growing in popularity in the United States, and Swisher is the market leader. The contexts and experiences associated with the use of Swisher-related products is understudied, but such information is available via publicly available posts on Twitter. Objective: This study aimed to analyze Twitter posts to characterize Twitter users’ recent experiences with Swisher-related products. Methods: Twitter posts containing the term “swisher” were analyzed from January 1, 2018, to December 31, 2018. Text classifiers were used to identify topics in posts (n=81,333). Results: The most prevalent topic was Person Tagging (mentioning a Twitter account in a post; 32.77%), followed by Flavors (eg, Grape and Strawberry; 20.96%) and Swisher use (eg, smoke swisher; 17.44%). Additional topics included Cannabis use (eg, blunt, roll, and gut swisher; 6.26%), Appeal (eg, like Swisher; 5.92%), Dislike (eg, posts that showed dissatisfaction with Swisher products; 3.53%), Purchases (eg, buy swisher; 1.90%), and Cigar comparison (eg, mentions of other cigar products including White-owl and Backwoods; 1.64%). Conclusions: This paper describes common contexts and experiences associated with the use of Swisher little cigars from the population posting on Twitter in 2018. These online messages may have offline consequences for tobacco-related behaviors, indicating the need for countering from public health officials. Findings should inform us about targets for surveillance, policy, and interventions addressing Swisher little cigars as well as communication planning and tobacco product counter messaging on Twitter. %M 31325291 %R 10.2196/14398 %U http://www.jmir.org/2019/7/e14398/ %U https://doi.org/10.2196/14398 %U http://www.ncbi.nlm.nih.gov/pubmed/31325291 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e14602 %T A Pilot Randomized Controlled Trial of a Web-Based Growth Mindset Intervention to Enhance the Effectiveness of a Smartphone App for Smoking Cessation %A Sridharan,Vasundhara %A Shoda,Yuichi %A Heffner,Jaimee %A Bricker,Jonathan %+ University of Washington, Guthrie Hall, Seattle, WA, 98195, United States, 1 2067792248, vsri@u.washington.edu %K addictive behavior %K smoking behaviors %K smoking cessation %K health technology %K mobile apps %K psychological theory %D 2019 %7 09.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although smartphone apps have shown promise for smoking cessation, there is a need to enhance their low engagement rates. This study evaluated the application of the growth mindset theory, which has demonstrated the potential to improve persistence in behavior change in other domains, as a means to improve engagement and cessation. Objective: This study aimed to explore the feasibility, utility, and efficacy of a Web-based growth mindset intervention for addiction when used alongside a smoking cessation app. Methods: Daily smokers (N=398) were all recruited on the Web and randomly assigned to receive either a cessation app alone or the app plus a Web-delivered growth mindset intervention. The primary outcome was engagement, that is, the number of log-ins to the smoking cessation app. The secondary outcome was 30-day point prevalence abstinence at 2-month follow-up collected through a Web-based survey. Results: The 2-month outcome data retention rate was 91.5% (364/398). In addition, 77.9% (310/398) of the participants in the experimental arm viewed at least 1 page of their growth mindset intervention, and 21.1% (84/398) of the group viewed all the growth mindset intervention. The intention-to-treat analysis did not show statistically significant differences between the experimental and comparison arms on log-ins to the app (19.46 vs 21.61; P=.38). The experimental arm had cessation rates, which trended higher than the comparison arm (17% vs 13%; P=.10). The modified intent-to-treat analysis, including only participants who used their assigned intervention at least once (n=115 in experimental group and n=151 in the control group), showed that the experimental arm had a similar number of log-ins (32.31 vs 28.48; P=.55) but significantly higher cessation rates (21% vs 13%; P=.03) than the comparison arm. Conclusions: A growth mindset intervention for addiction did not increase engagement rates, although it may increase cessation rates when used alongside a smartphone app for smoking cessation. Future research is required to refine the intervention and assess efficacy with long-term follow-up to evaluate the efficacy of the mindset intervention. Trial Registration: ClinicalTrials.gov NCT03174730; https://clinicaltrials.gov/ct2/show/NCT03174730 %M 31290404 %R 10.2196/14602 %U http://mhealth.jmir.org/2019/7/e14602/ %U https://doi.org/10.2196/14602 %U http://www.ncbi.nlm.nih.gov/pubmed/31290404 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 7 %P e12701 %T Comparing Telemedicine and Face-to-Face Consultation Based on the Standard Smoking Cessation Program for Nicotine Dependence: Protocol for a Randomized Controlled Trial %A Tanigawa,Tomoyuki %A Nomura,Akihiro %A Kuroda,Maki %A Muto,Tomoyasu %A Hida,Eisuke %A Satake,Kohta %+ Department of Cardiology, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, 920-8641, Japan, 81 76 265 2259, anomura@med.kanazawa-u.ac.jp %K tobacco use disorder %K smoking cessation %K telemedicine %K smartphone %K mobile apps %K videoconferencing %K digital therapeutics %K adult %K human %K randomized controlled trials as topic %D 2019 %7 09.07.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking is a major public health concern. In Japan, a 12-week standard smoking cessation support program is available, however, its required face-to-face visits are a key obstacle in completing the program. Telemedicine is a useful way to provide medical treatment at a distance. Although telemedicine for smoking cessation using an internet-based video system has the potential for ensuring better clinical outcomes for patients with nicotine dependence, its efficacy is unclear. Objective: The aim of this study is to determine the efficacy and feasibility of a smoking cessation support program using an internet-based video system compared with a face-to-face program among patients with nicotine dependence. Methods: This study will be a randomized, controlled, open-label, multicenter trial. Participants randomized to the intervention arm will undergo an internet-based smoking cessation program, whereas control participants will undergo a standard face-to-face program. We will use the CureApp Smoking Cessation (CASC) for both arms, which consists of the CASC smartphone app for patients and a Web-based patient information management system for clinicians with a mobile carbon monoxide checking device. The primary endpoint will be the continuous abstinence rate (CAR) from weeks 9 to 12. Secondary endpoints will be: (1) the smoking cessation success rate at 4, 8, 12, and 24 weeks; (2) CAR from weeks 9 to 24; (3) changes in scores on the mood and physical symptoms scale and 12-Item French Version Of The Tobacco Craving Questionnaire; (4) Kano Test for Social Nicotine Dependence scores at 8, 12, and 24 weeks; (5) time to first lapse after the first visit; (6) nicotine dependence and cognition scale scores at 12 and 24 weeks; (7) usage rate of the CASC; (8) qualitative questionnaire about the usability and acceptability of telemedicine; and (9) presence of product problems or adverse events. Results: We will recruit 114 participants who are nicotine-dependent but otherwise healthy adults from March to July 2018 and follow up with them until January 2019 (24 weeks). We expect all study results to be available by the end of March 2019. Conclusions: This will be the first randomized controlled trial to evaluate the efficacy and feasibility of an internet-based (telemedicine) smoking cessation support program relative to a face-to-face program among patients with nicotine dependence. We expect that the efficacy of the telemedicine smoking cessation support program will not be clinically worse than the face-to-face program. If this trial demonstrates that telemedicine does not have clinically worse efficacy and feasibility than a conventional face-to-face program, physicians can begin to offer a more flexible smoking cessation program to patients who may otherwise give up on trying such programs. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry: UMIN000031620; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000035975 International Registered Report Identifier (IRRID): DERR1-10.2196/12701 %M 31290402 %R 10.2196/12701 %U https://www.researchprotocols.org/2019/7/e12701/ %U https://doi.org/10.2196/12701 %U http://www.ncbi.nlm.nih.gov/pubmed/31290402 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e12443 %T Identifying Key Target Audiences for Public Health Campaigns: Leveraging Machine Learning in the Case of Hookah Tobacco Smoking %A Chu,Kar-Hai %A Colditz,Jason %A Malik,Momin %A Yates,Tabitha %A Primack,Brian %+ School of Medicine, University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA, 15213, United States, 1 4126922578, chuk@pitt.edu %K smoking water pipes %K waterpipe tobacco %K tobacco %K smoking %K social media %K public health %K infodemiology %K infoveillance %K machine learning %D 2019 %7 08.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Hookah tobacco smoking (HTS) is a particularly important issue for public health professionals to address owing to its prevalence and deleterious health effects. Social media sites can be a valuable tool for public health officials to conduct informational health campaigns. Current social media platforms provide researchers with opportunities to better identify and target specific audiences and even individuals. However, we are not aware of systematic research attempting to identify audiences with mixed or ambivalent views toward HTS. Objective: The objective of this study was to (1) confirm previous research showing positively skewed HTS sentiment on Twitter using a larger dataset by leveraging machine learning techniques and (2) systematically identify individuals who exhibit mixed opinions about HTS via the Twitter platform and therefore represent key audiences for intervention. Methods: We prospectively collected tweets related to HTS from January to June 2016. We double-coded sentiment for a subset of approximately 5000 randomly sampled tweets for sentiment toward HTS and used these data to train a machine learning classifier to assess the remaining approximately 556,000 HTS-related Twitter posts. Natural language processing software was used to extract linguistic features (ie, language-based covariates). The data were processed by machine learning tools and algorithms using R. Finally, we used the results to identify individuals who, because they had consistently posted both positive and negative content, might be ambivalent toward HTS and represent an ideal audience for intervention. Results: There were 561,960 HTS-related tweets: 373,911 were classified as positive and 183,139 were classified as negative. A set of 12,861 users met a priori criteria indicating that they posted both positive and negative tweets about HTS. Conclusions: Sentiment analysis can allow researchers to identify audience segments on social media that demonstrate ambiguity toward key public health issues, such as HTS, and therefore represent ideal populations for intervention. Using large social media datasets can help public health officials to preemptively identify specific audience segments that would be most receptive to targeted campaigns. %M 31287063 %R 10.2196/12443 %U http://www.jmir.org/2019/7/e12443/ %U https://doi.org/10.2196/12443 %U http://www.ncbi.nlm.nih.gov/pubmed/31287063 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e13436 %T Leveraging Positive Psychology to Support Smoking Cessation in Nondaily Smokers Using a Smartphone App: Feasibility and Acceptability Study %A Hoeppner,Bettina B %A Hoeppner,Susanne S %A Carlon,Hannah A %A Perez,Giselle K %A Helmuth,Eric %A Kahler,Christopher W %A Kelly,John F %+ Recovery Research Institute, Massachusetts General Hospital, Harvard Medical School, 151 Merrimac Street, 6th Floor, Boston, MA, 02114, United States, 1 6176431988, bhoeppner@mgh.harvard.edu %K smartphone %K mHealth %K smoking cessation %K happiness %K cigarettes %D 2019 %7 03.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nondaily smoking is an increasingly prevalent smoking pattern that poses substantial health risks. Objective: We tested the feasibility of using a smartphone app with positive psychology exercises to support smoking cessation in nondaily smokers. Methods: In this prospective, single-group pilot study, nondaily smokers (n=30) used version 1 of the Smiling Instead of Smoking (SiS) app for 3 weeks while undergoing a quit attempt. The app assigned daily happiness exercises, provided smoking cessation tools, and made smoking cessation information available. Participants answered surveys at baseline and 2, 6, 12, and 24 weeks after their chosen quit day and participated in structured user feedback sessions 2 weeks after their chosen quit day. Results: App usage during the prescribed 3 weeks of use was high, with an average 84% (25.2/30) of participants using the app on any given day. App use was largely driven by completing happiness exercises (73%, 22/30) of participants per day), which participants continued to complete even after the end of the prescribed period. At the end of prescribed use, 90% (27/30) of participants reported that the app had helped them during their quit attempt, primarily by reminding them to stay on track (83%, 25/30) and boosting their confidence to quit (80%, 24/30) and belief that quitting was worthwhile (80%, 24/30). Happiness exercises were rated more favorably than user-initiated smoking cessation tools, and 80% (24/30) of participants proactively expressed in interviews that they liked them. App functionality to engage social support was not well received. Functionality to deal with risky times was rated useful but was rarely used. Within-person changes from baseline to the end of prescribed use were observed for several theorized mechanisms of behavior change, all in the expected direction: confidence increased (on a 0-100 scale, internal cues: b=16.7, 95% CI 7.2 to 26.3, P=.001; external cues: b=15.8, 95% CI 5.4 to 26.1, P=.004), urge to smoke decreased (on a 1-7 scale, b=−0.8, 95% CI −1.3 to −0.3, P=.002), and perceptions of smoking became less positive (on a 1-5 scale, psychoactive benefits: b=−0.5, 95% CI −0.9 to −0.2, P=.006; pleasure: b=−0.4, 95% CI −0.7 to −0.01, P=.03; on a 0-100 scale, importance of pros of smoking: b=−11.3, 95% CI −18.9 to −3.8, P=.004). Self-reported abstinence rates were 40% (12/30) and 53% (16/30) of participants 2 and 24 weeks post quit, respectively, with 30% (9/30) biochemically validated as abstinent 2 weeks post quit. Conclusions: A smartphone app using happiness exercises to aid smoking cessation was well received by nondaily smokers. Given the high nonadherence and dropout rates for technology-delivered interventions reported in the literature, the high engagement with positive psychology exercises is noteworthy. Observed within-person changes and abstinence rates are promising and warrant further development of this app. %M 31271147 %R 10.2196/13436 %U https://mhealth.jmir.org/2019/7/e13436/ %U https://doi.org/10.2196/13436 %U http://www.ncbi.nlm.nih.gov/pubmed/31271147 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e14303 %T Mechanisms of Social Media Effects on Attitudes Toward E-Cigarette Use: Motivations, Mediators, and Moderators in a National Survey of Adolescents %A Cho,Hyunyi %A Li,Wenbo %A Shen,Lijiang %A Cannon,Julie %+ School of Communication, The Ohio State University, 154 N Oval Mall, Columbus, OH,, United States, 1 614 292 3400, cho.919@osu.edu %K adolescents %K e-cigarettes %K motivation %K affordances %K agency %K realism %K self-expression %K social comparison %K social learning %K social media %K filter %K uses and gratifications %D 2019 %7 27.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Exposure to risk behavior on social media is associated with risk behavior tendencies among adolescents, but research on the mechanisms underlying the effects of social media exposure is sparse. Objective: This study aimed to investigate the motivations of social media use and the mediating and moderating mechanisms of their effects on attitude toward electronic cigarette (e-cigarette) use among adolescents. Methods: Using data from a national sample survey of adolescents (age=14-17 years, N=594), we developed and validated a social media use motivation scale. We examined the roles of motivations in the effect of social media use on risk exposure and risk attitude. Results: Motivations for social media use included agency, self-expression, realism, social learning, social comparison, and filter. These motivations were associated differentially with the frequency of use of Facebook, Instagram, Snapchat, and YouTube. Frequency of social media use was positively associated with exposure to e-cigarette messages across the four platforms (Ps<.001). Exposure to e-cigarette messages on Instagram (P=.005) and Snapchat (P=.03) was positively associated with attitude toward e-cigarette use. Perceived social media realism moderated the effects of e-cigarette message exposure such that when realism was high, the exposure effect was amplified, but when realism was low, the effect was mitigated (P<.001). A three-way interaction effect (P=.02) among exposure, social learning motivation, and social norm on attitude toward e-cigarette use was found. When perceived social norm was high, the moderating effect of social learning motivation on e-cigarette use attitude was amplified, but when social norm was low, the social learning motivation effect was attenuated. Conclusions: Because perceived social media realism moderates the effect of exposure to e-cigarette messages on attitude toward e-cigarette use, future intervention efforts should address the realism perceptions. The three-way interaction among exposure, social learning motivation, and social norm indicates the importance of addressing both the online and offline social environments of adolescents. The social media use motivation scale, reflecting perceived affordances, is broadly applicable. Understanding social media use motivations is important, as they indirectly influence attitude toward e-cigarette use via frequency of social media use and/or frequency of exposure to e-cigarette messages on social media. %M 31250830 %R 10.2196/14303 %U http://www.jmir.org/2019/6/e14303/ %U https://doi.org/10.2196/14303 %U http://www.ncbi.nlm.nih.gov/pubmed/31250830 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13059 %T Mindfulness-Based Smoking Cessation Enhanced With Mobile Technology (iQuit Mindfully): Pilot Randomized Controlled Trial %A Spears,Claire Adams %A Abroms,Lorien C %A Glass,Carol R %A Hedeker,Donald %A Eriksen,Michael P %A Cottrell-Daniels,Cherell %A Tran,Binh Q %A Wetter,David W %+ Department of Health Policy and Behavioral Sciences, Georgia State University School of Public Health, 140 Decatur St SE, Atlanta, GA, 30303, United States, 1 404 413 9335, cspears@gsu.edu %K text messaging %K smoking cessation %K low-income populations %D 2019 %7 24.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mindfulness training shows promise for improving smoking cessation and lapse recovery, and between-session mobile health messages could enhance treatment engagement and effectiveness. Personalized, in-the-moment text messaging support could be particularly useful for low-income smokers with fewer smoking cessation resources. Objective: This pilot study examined the feasibility of a text messaging program (iQuit Mindfully) as an adjunct to in-person Mindfulness-Based Addiction Treatment (MBAT) for smoking cessation. Methods: A total of 71 participants were randomly assigned to MBAT (n=33) or iQuit Mindfully (n=38; MBAT + between-session text messages); of these, 70% (50/71) were African American, and 61% (43/71) had an annual household income of US $30,000 or less. All participants received 8 weekly therapist-led group counseling sessions, nicotine patches, and self-help materials. Outcomes were feasibility (attrition, engagement, and participants’ ratings), participants’ feedback regarding the text messaging intervention, and smoking cessation (assessed in person). Results: Strong retention was achieved (76% [54/71] at the end of treatment, and 89% [63/71] at 1-month follow-up). In the iQuit Mindfully group, engagement was high (88% [29/33] indicated reading all or most texts, and 89% [34/38] engaged in interactive texting), and participants provided positive ratings (on a 1-10 scale, average rating for recommending the program to others was 8.4 [SD 2.5]). Participants indicated benefiting from the texts (eg, appreciating encouraging reminders, coping strategies, and social support) and suggested improvements (eg, more personalization). Overall, biochemically confirmed smoking cessation rates were 22% (12/55) at the end of treatment and 19% (12/62) at 1-month follow-up, with no differences between conditions. Living below the poverty level predicted worse cessation outcomes at 1-month follow-up among participants receiving in-person only treatment (P=.03) but not among those receiving iQuit Mindfully. Conclusions: Text messaging appears to be a feasible and acceptable modality for supporting mindfulness-based smoking cessation treatment. The availability of 24/7 text messaging might be particularly helpful for low-income smokers who have access to fewer cessation resources and experience significant day-to-day barriers to quitting. Trial Registration: ClinicalTrials.gov NCT03029819; https://clinicaltrials.gov/ct2/show/NCT03029819 %M 31237242 %R 10.2196/13059 %U http://mhealth.jmir.org/2019/6/e13059/ %U https://doi.org/10.2196/13059 %U http://www.ncbi.nlm.nih.gov/pubmed/31237242 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e13500 %T Comparing Treatment Acceptability and 12-Month Cessation Rates in Response to Web-Based Smoking Interventions Among Smokers Who Do and Do Not Screen Positive for Affective Disorders: Secondary Analysis %A Watson,Noreen L %A Heffner,Jaimee L %A Mull,Kristin E %A McClure,Jennifer B %A Bricker,Jonathan B %+ Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, Seattle, WA,, United States, 1 206 667 2942, nlwatson@fredhutch.org %K smoking %K smoking cessation %K affective disorders %K anxiety %K depression %K eHealth %K Web intervention %K co-occurring disorders %D 2019 %7 19.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based cessation programs are now common for intervening with smokers. However, it remains unclear how acceptable or effective these interventions are among people with affective disorders and symptoms (ADS; eg, depression and anxiety). Research examining this is extremely limited, with mixed results on cessation rates. Additional large studies are needed to more fully understand whether Web-based interventions are similarly used and equally effective among people with and without affective disorder symptomology. If not, more targeted Web-based interventions may be required. Objective: The goal of the research was to compare Web-based treatment acceptability (defined by satisfaction and use) and 12-month cessation outcomes between smokers with and without ADS. Methods: Participants (N=2512) were adult smokers enrolled in a randomized, comparative effectiveness trial of two Web-based smoking interventions designed for the general population of smokers. At baseline, participants reported demographic and smoking characteristics and completed measures assessing ADS. Participants were then classified into subgroups based on their self-reported ADS—either into a no ADS group or into six nonmutually exclusive subgroups: depression, posttraumatic stress disorder (PTSD), panic disorder (PD), generalized anxiety disorder (GAD), social anxiety disorder (SAD), and more than one ADS. Surveys at 12 months postrandomization included subjective ratings of treatment acceptability and self-reported smoking cessation. Treatment use (ie, number of log-ins and total duration of exposure) was assessed via automated records. Results: Relative to the no ADS group, all six ADS subgroups reported significantly greater satisfaction with their assigned Web treatment program, but they spent less time logged in than those with no ADS. For number of log-ins, a treatment arm by ADS group interaction was observed across all ADS subgroups except GAD, suggesting that relative to the no ADS group, they logged in less to one website but not the other. At the 12-month follow-up, abstinence rates in the no ADS group (153/520, 29.42%) were significantly higher than for participants who screened positive for depression (306/1267, 24.15%; P=.03), PTSD (294/1215, 24.19%; P=.03), PD (229/1003, 23.83%; P=.009), and two or more ADS (323/1332, 24.25%; P=.03). Post hoc analyses suggest the lower quit rates may be associated with differences in baseline nicotine dependence and levels of commitment to resist smoking in difficult situations. Website use did not explain the differential abstinence rates. Conclusions: Despite reporting higher levels of treatment satisfaction, most smokers with ADS used their assigned intervention less often and had lower quit rates than smokers with no ADS at treatment onset. The results support the need for developing more targeted interventions for smokers with ADS. Trial registration: Clinical Trials.gov NCT01812278; https://clinicaltrials.gov/ct2/show/NCT01812278 (Archived by WebCite at http://www.webcitation.org/78L9cNdG4) %M 31219052 %R 10.2196/13500 %U https://www.jmir.org/2019/6/e13500/ %U https://doi.org/10.2196/13500 %U http://www.ncbi.nlm.nih.gov/pubmed/31219052 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e12709 %T Promotion of Vape Tricks on YouTube: Content Analysis %A Kong,Grace %A LaVallee,Heather %A Rams,Alissa %A Ramamurthi,Divya %A Krishnan-Sarin,Suchitra %+ Yale School of Medicine, 34 Park St, New Haven, CT, 06519, United States, 1 2039747601, grace.kong@yale.edu %K e-cigarettes %K social media %K marketing %D 2019 %7 18.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The ability to perform vape tricks (ie, blowing large vapor clouds or shapes like rings) using e-cigarettes appeals to youth. Vape tricks are promoted on social media, but the promotion of vape tricks on social media is not well understood. Objective: The aim of this study was to examine how vape tricks were promoted on YouTube to youth. Methods: Videos on vape tricks that could be accessed by underage youth were identified. The videos were coded for number of views, likes, dislikes, and content (ie, description of vape tricks, e-cigarette devices used for this purpose, video sponsors [private or industry], brand marketing, and contextual characteristics [eg, model characteristics, music, and profanity]). Results: An analysis of 59 sample videos on vape tricks identified 25 distinct vape tricks. These videos had more likes than dislikes (11 to 1 ratio) and a 32,017 median view count. 48% (28/59) of the videos were posted by industry accounts (27% [16/59] provaping organizations, 15% [9/59] online shops, and 3% [2/59] vape shops) and 53% by private accounts (55% [17/31] private users, 26% [8/31] vape enthusiasts, and 19% [6/31] YouTube influencers); 53% (31/59) of the videos promoted a brand of e-cigarette devices, e-liquids, or online/vape shops, and 99% of the devices used for vape tricks were advanced generation devices. The models in the videos were 80.2% (160/198) male, 51.5% white (102/198), and 61.6% (122/198) aged 18 to 24 years; 85% (50/59) of the videos had electronic dance music and hip hop, and 32% (19/59) had profanity. Conclusions: Vape trick videos on YouTube, about half of which were industry sponsored, were accessible to youth. Restrictions of e-cigarette marketing on social media, such as YouTube, are needed. %M 31215510 %R 10.2196/12709 %U http://www.jmir.org/2019/6/e12709/ %U https://doi.org/10.2196/12709 %U http://www.ncbi.nlm.nih.gov/pubmed/31215510 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 6 %P e12138 %T Biological and Functional Changes in Healthy Adult Smokers Who Are Continuously Abstinent From Smoking for One Year: Protocol for a Prospective, Observational, Multicenter Cohort Study %A Tran,Cam Tuan %A Felber Medlin,Loyse %A Lama,Nicola %A Taranu,Brindusa %A Ng,Weeteck %A Haziza,Christelle %A Picavet,Patrick %A Baker,Gizelle %A Lüdicke,Frank %+ Philip Morris International Science and Innovation, Philip Morris Products SA, Quai Jeanrenaud 5, Neuchâtel, 2000, Switzerland, 41 58 242 1111, CamTuan.Tran@pmi.com %K smoking cessation %K smoking %K tobacco %K harm reduction %K tobacco products %K biomarkers %K metabolic networks %K pathways %D 2019 %7 7.6.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: The harm of smoking results mainly from long-term exposure to harmful and potentially harmful constituents (HPHCs) generated by tobacco combustion. Smoking cessation (SC) engenders favorable changes of clinical signs, pathomechanisms, and metabolic processes that together could reduce the harm of smoking-related diseases to a relative risk level approximating that of never-smokers over time. In most SC studies, the main focus is on the quitting rate of the SC program being tested. As there is limited information in the literature on short to multiple long-term functional or biological changes following SC, more data on short to mid-term favorable impacts of SC are needed. Objective: The overall aim of the study was to assess the reversibility of the harm related to smoking over 1 year of continuous smoking abstinence (SA). This has been verified by assessing a set of biomarkers of exposure to HPHCs and a set of biomarkers of effect indicative of multiple pathophysiological pathways underlying the development of smoking-related diseases. Methods: This multiregional (United States, Japan, and Europe), multicenter (42 sites) cohort study consisting of a 1-year SA period in an ambulatory setting was conducted from May 2015 to May 2017. A total of 1184 male and female adult healthy smokers, willing to quit smoking, were enrolled in the study. Nicotine replacement therapy (NRT) was provided for up to 3 months upon the subject’s request. SC counseling and behavioral support were continuously provided. Biomarkers of exposure to HPHCs and biomarkers of effect were assessed in urine and blood at baseline, Month 3, Month 6, and Month 12. Cardiovascular biomarkers of effect included parameters reflecting inflammation (white blood cell), lipid metabolism (high-density lipoprotein cholesterol), endothelial function (soluble intercellular adhesion molecule-1), platelet function (11-dehydrothromboxane B2), oxidative stress (8-epi-prostaglandin F2 alpha), and carbon monoxide exposure (carboxyhemoglobin). Respiratory biomarkers of effect included lung function parameters and cough symptoms. The biomarkers of effect to evaluate genotoxicity (total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol) and xenobiotic metabolism (cytochrome P450 2A6 activity) were also assessed. Continuous SA was verified at each visit following the actual quit date using self-reporting and chemical verification. Safety assessments included adverse events and serious adverse events, body weight, vital signs, spirometry, electrocardiogram, clinical chemistry, hematology and urine analysis safety panel, physical examination, and concomitant medications. Results: In total, 1184 subjects (50.1% male) were enrolled; 30% of them quit smoking successfully for 1 year. Data analyses of the study results are ongoing and will be published after study completion. Conclusions: This study provides insights into biological and functional changes and health effects, after continuous SA over 1 year. Study results will be instrumental in assessing novel alternative products to cigarettes considered for tobacco harm reduction strategies. Trial Registration: ClinicalTrials.gov NCT02432729; http://clinicaltrials.gov/ct2/show/NCT02432729 (Archived by WebCite at http://www.webcitation.org/78QxovZrr) International Registered Report Identifier (IRRID): DERR1-10.2196/12138 %M 31199335 %R 10.2196/12138 %U https://www.researchprotocols.org/2019/6/e12138/ %U https://doi.org/10.2196/12138 %U http://www.ncbi.nlm.nih.gov/pubmed/31199335 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e13290 %T Outcomes and Device Usage for Fully Automated Internet Interventions Designed for a Smartphone or Personal Computer: The MobileQuit Smoking Cessation Randomized Controlled Trial %A Danaher,Brian G %A Tyler,Milagra S %A Crowley,Ryann C %A Brendryen,Håvar %A Seeley,John R %+ Prevention Science Institute, University of Oregon, 1600 Millrace Dr, Eugene, OR, 97403, United States, 1 5413464490, bdanaher@uoregon.edu %K tobacco %K smoking %K internet %K eHealth %K mHealth %K smartphone %K device %D 2019 %7 06.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Many best practice smoking cessation programs use fully automated internet interventions designed for nonmobile personal computers (desktop computers, laptops, and tablets). A relatively small number of smoking cessation interventions have been designed specifically for mobile devices such as smartphones. Objective: This study examined the efficacy and usage patterns of two internet-based best practices smoking cessation interventions. Methods: Overall, 1271 smokers who wanted to quit were randomly assigned to (1) MobileQuit (designed for—and constrained its use to—mobile devices, included text messaging, and embodied tunnel information architecture) or (2) QuitOnline (designed for nonmobile desktop or tablet computers, did not include text messages, and used a flexible hybrid matrix-hierarchical information architecture). Primary outcomes included self-reported 7-day point-prevalence smoking abstinence at 3- and 6-month follow-up assessments. Program visits were unobtrusively assessed (frequency, duration, and device used for access). Results: Significantly more MobileQuit participants than QuitOnline participants reported quitting smoking. Abstinence rates using intention-to-treat analysis were 20.7% (131/633) vs 11.4% (73/638) at 3 months, 24.6% (156/633) vs 19.3% (123/638) at 6 months, and 15.8% (100/633) vs 8.8% (56/638) for both 3 and 6 months. Using Complete Cases, MobileQuit’s advantage was significant at 3 months (45.6% [131/287] vs 28.4% [73/257]) and the combined 3 and 6 months (40.5% [100/247] vs 25.9% [56/216]) but not at 6 months (43.5% [156/359] vs 34.4% [123/329]). Participants in both conditions reported their program was usable and helpful. MobileQuit participants visited their program 5 times more frequently than did QuitOnline participants. Consistent with the MobileQuit’s built-in constraint, 89.46% (8820/9859) of its visits were made on an intended mobile device, whereas 47.72% (691/1448) of visits to QuitOnline used an intended nonmobile device. Among MobileQuit participants, 76.0% (459/604) used only an intended mobile device, 23.0% (139/604) used both mobile and nonmobile devices, and 0.1% (6/604) used only a nonmobile device. Among QuitOnline participants, 31.3% (137/438) used only the intended nonmobile devices, 16.7% (73/438) used both mobile and nonmobile devices, and 52.1% (228/438) used only mobile devices (primarily smartphones). Conclusions: This study provides evidence for optimizing intervention design for smartphones over a usual care internet approach in which interventions are designed primarily for use on nonmobile devices such as desktop computers, laptops. or tablets. We propose that future internet interventions should be designed for use on all of the devices (multiple screens) that users prefer. We forecast that the approach of designing internet interventions for mobile vs nonmobile devices will be replaced by internet interventions that use a single Web app designed to be responsive (adapt to different screen sizes and operating systems), share user data across devices, embody a pervasive information architecture, and complemented by text message notifications. Trial Registration: ClinicalTrials.gov NCT01952236; https://clinicaltrials.gov/ct2/show/NCT01952236 (Archived by WebCite at http://www.webcitation.org/6zdSxqbf8) %M 31172967 %R 10.2196/13290 %U https://www.jmir.org/2019/6/e13290/ %U https://doi.org/10.2196/13290 %U http://www.ncbi.nlm.nih.gov/pubmed/31172967 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e14067 %T “Where There’s Smoke, There’s Fire”: A Content Analysis of Print and Web-Based News Media Reporting of the Philip Morris–Funded Foundation for a Smoke-Free World %A Watts,Christina %A Freeman,Becky %+ Cancer Council New South Wales, 153 Dowling Street, Woolloomooloo,, Australia, 61 400709347, cmcb8303@uni.sydney.edu.au %K tobacco industry %K mass media %K smoking, nontobacco products %D 2019 %7 06.06.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In September 2017, the Foundation for a Smoke-Free World (FSFW), a not-for-profit organization with a core purpose “to accelerate global efforts to reduce deaths and harm from smoking” was launched. However, the legitimacy of the FSFW’s vision has been questioned by experts in tobacco control because of the organization’s only funding partner, Philip Morris International (PMI). Objective: This study aimed to examine the response to the FSFW in Web-based and print news media to understand how the FSFW and its funding partner, PMI, were framed. Methods: News articles published within a 6-month period after the FSFW was announced were downloaded via Google News and Factiva and coded for topic, framing argument, slant, mention of tobacco control policies, and direct quotes or position statements. Results: A total of 124 news articles were analyzed. The news coverage of the FSFW was framed by 6 key arguments. Over half of the news articles presented a framing argument in opposition to the FSFW (64/124, 51.6%). A further 20.2% (25/124) of articles framed the FSFW positively and 28.2% of articles (35/124) presented a neutral debate with no primary slant. The FSFW was presented as not credible because of the funding link to PMI in 29.0% (36/124) of articles and as a tactic to mislead and undermine effective tobacco control measures in 11.3% of articles (14/124). However, 12.9% of articles (16/124) argued that the FSFW or PMI is part of the solution to reducing the impact of tobacco use. Evidence-based tobacco control policies were mentioned positively in 66.9% (83/124) of news articles and 9.6% (12/124) of articles presented tobacco control policies negatively. Conclusions: The Web-based and print news media reporting of the formation of the FSFW and its mission and vision has primarily been framed by doubt, skepticism, and disapproval. %M 31172959 %R 10.2196/14067 %U http://publichealth.jmir.org/2019/2/e14067/ %U https://doi.org/10.2196/14067 %U http://www.ncbi.nlm.nih.gov/pubmed/31172959 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e13162 %T SmokefreeTXT for Homeless Smokers: Pilot Randomized Controlled Trial %A Baggett,Travis P %A McGlave,Claire %A Kruse,Gina R %A Yaqubi,Awesta %A Chang,Yuchiao %A Rigotti,Nancy A %+ Tobacco Research and Treatment Center, Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge St, 16th Floor, Boston, MA, 02114, United States, 1 617 643 9314, tbaggett@mgh.harvard.edu %K homeless persons %K cigarette smoking %K smoking cessation %K text messaging %D 2019 %7 04.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Homeless smokers want to quit smoking but face numerous barriers to doing so, including pervasive smoking among peers and a lack of social support for quitting. An SMS (short message service) text messaging intervention could address these challenges by providing virtual daily support for homeless smokers who are trying to quit but coping with multiple triggers to smoke. Objective: This study aimed to assess whether a free SMS text messaging program, added to evidence-based pharmacotherapy and counseling, improved smoking abstinence among homeless adult smokers. Methods: From October 2015 to June 2016, we conducted an 8-week pilot randomized controlled trial (RCT) of nicotine patch therapy and weekly in-person counseling with (n=25) or without (n=25) SmokefreeTXT, a free SMS text messaging service administered by the National Cancer Institute (NCI) at Boston Health Care for the Homeless Program. All participants were provided with a mobile phone and a 2-month prepaid voice and text plan at no cost. SmokefreeTXT enrollees were sent 1 to 5 automated SMS text messages daily for up to 8 weeks and could receive on-demand tips for managing cravings, mood symptoms, and smoking lapses. The primary outcome was smoking abstinence, defined as an exhaled carbon monoxide count of <8 parts per million, assessed 14 times over 8 weeks of follow-up, and analyzed using repeated-measures logistic regression with generalized estimating equations. Other outcomes were use of SmokefreeTXT, assessed by data obtained from NCI; perceptions of SmokefreeTXT, assessed by surveys and qualitative interviews; and mobile phone retention, assessed by self-report. Results: Of the SmokefreeTXT arm participants (n=25), 88% (22) enrolled in the program, but only 56% (14) had confirmed enrollment for ≥2 weeks. Among 2-week enrollees, the median response rate to interactive messages from SmokefreeTXT was 2.1% (interquartile range 0-10.5%). Across all time points, smoking abstinence did not differ significantly between SmokefreeTXT and control arm participants (odds ratio 0.92, 95% CI 0.30-2.84). Of SmokefreeTXT enrollees who completed exit surveys (n=15), two-thirds were very or extremely satisfied with the program. However, qualitative interviews (n=14) revealed that many participants preferred in-person intervention formats over phone-based, found the SMS text messages impersonal and robotic, and felt that the messages were too frequent and repetitive. Only 40% (10/25) of SmokefreeTXT arm participants retained their study-supplied mobile phone for the 8-week duration of the trial, with phone theft being common. Storing and charging phones were cited as challenges. Conclusions: SmokefreeTXT, added to nicotine patch therapy and in-person counseling, did not significantly improve smoking abstinence in this 8-week pilot RCT for homeless smokers. SMS text messaging interventions for this population should be better tuned to the unique circumstances of homelessness and coupled with efforts to promote mobile phone retention over time. Trial Registration: ClinicalTrials.gov NCT02565381; https://clinicaltrials.gov/ct2/show/NCT02565381 (Archived by WebCite at http://www.webcitation.org/78PLpDptZ) %M 31165717 %R 10.2196/13162 %U https://mhealth.jmir.org/2019/6/e13162/ %U https://doi.org/10.2196/13162 %U http://www.ncbi.nlm.nih.gov/pubmed/31165717 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e12676 %T Tobacco Use Behaviors, Attitudes, and Demographic Characteristics of Tobacco Opinion Leaders and Their Followers: Twitter Analysis %A Chu,Kar-Hai %A Majmundar,Anuja %A Allem,Jon-Patrick %A Soto,Daniel W %A Cruz,Tess Boley %A Unger,Jennifer B %+ University of Pittsburgh, 230 McKee Place, Suite 600, Pittsburgh, PA,, United States, 1 412 692 2578, chuk@pitt.edu %K tobacco %K social media %K online social networking %K peer influence %K social networking %D 2019 %7 04.06.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Tobacco-related content on social media is generated and propagated by opinion leaders on the Web who disseminate messages to others in their network, including followers, who then continue to spread the information. Opinion leaders can exert powerful influences on their followers’ knowledge, attitudes, and behaviors; yet, little is known about the demographic characteristics and tobacco use behavior of tobacco opinion leaders on the Web and their followers, compared with general Twitter users. Objective: In this study, we hypothesized that opinion leaders use more tobacco products and have higher nicotine dependence than the other 2 groups (eg, followers and general Twitter users) and that followers—those who spread messages by opinion leaders—would more likely be in demographic groups that are vulnerable to tobacco marketing influence (eg, young adults and lower educational attainment). Methods: We constructed the social networks of people who tweet about tobacco and categorized them using a combination of social network and Twitter metrics. To understand the characteristics of tobacco opinion leaders and their followers, we conducted a survey of tobacco opinion leaders, their followers, and general Twitter users. The sample included 347 opinion leaders, 567 followers, and 519 general users. The opinion leaders had a median of 1000 followers, whereas followers and general users had fewer than 600 followers. Results: Opinion leaders were more likely than their followers to report past month use of tobacco products; followers, in turn, were more likely to report past month use of these products than general Twitter users. The followers appeared to be an especially vulnerable group; they tended to be younger (mean age 22.4 years) and have lower education compared with the opinion leaders and general users. Conclusions: Followers of Twitter tobacco opinion leaders are a vulnerable group that might benefit from antitobacco education to counter the protobacco communications they see on social media. %M 31165716 %R 10.2196/12676 %U https://www.jmir.org/2019/6/e12676/ %U https://doi.org/10.2196/12676 %U http://www.ncbi.nlm.nih.gov/pubmed/31165716 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12406 %T Considerations of Privacy and Confidentiality in Developing a Clinical Support Tool for Adolescent Tobacco Prevention: Qualitative Study %A Theis,Ryan P %A Malik,Ali M %A Thompson,Lindsay A %A Shenkman,Elizabeth A %A Pbert,Lori %A Salloum,Ramzi G %+ Institute for Child Health Policy, Department of Health Outcomes and Biomedical Informatics, University of Florida, 2004 Mowry Road, Suite 2252, Gainesville, FL, 32610, United States, 1 352 294 5973, rtheis@ufl.edu %K clinical decision support %K adolescent %K primary care %K tobacco use %K confidentiality %K implementation science %K qualitative research %D 2019 %7 28.4.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic clinical support tools show promise for facilitating tobacco screening and counseling in adolescent well-care. However, the application of support tools in pediatric settings has not been thoroughly studied. Successfully implementing support tools in local settings requires an understanding of barriers and facilitators from the perspective of both patients and providers. Objective: This paper aimed to present the findings of a qualitative study conducted to inform the development and implementation of a support tool for adolescent tobacco screening and counseling in 3 pediatric clinics in North Florida. The primary objective of the study was to test and collect information needed to refine a tablet-based support tool with input from patients and providers in the study clinics. Methods: A tablet prototype was designed to collect information from adolescents on tobacco susceptibility and use before their well-care visit and to present tobacco prevention videos based on their responses. Information collected from adolescents by the support tool would be available to providers during the visit to facilitate and streamline tobacco use assessment and counseling components of well-care. Focus groups with providers and staff from 3 pediatric clinics (n=24) identified barriers and facilitators to implementation of the support tool. In-depth interviews with racially and ethnically diverse adolescent patients who screened as susceptible to tobacco use (n=16) focused on acceptability and usability of the tool. All focus groups and interviews were audio-recorded and transcribed for team-based coding using thematic analysis. Results: Privacy and confidentiality of information was a salient theme. Both groups expressed concerns that the tool’s audio and visual components would impede privacy and that parents may read their child’s responses or exert control over the process. Nearly all adolescents stated they would be comfortable with the option to complete the tool at home via a Web portal. Most adolescents stated they would feel comfortable discussing tobacco with their doctor. Adolescent interviews elicited 3 emergent themes that added context to perspectives on confidentiality and had practical implications for implementation: (1) purity: an expressed lack of concern for confidentiality among adolescents with no reported history of tobacco use; (2) steadfast honesty: a commitment to being honest with parents and providers about tobacco use, regardless of the situation; and (3) indifference: a perceived lack of relevance of confidentiality, based on the premise that others will “find out anyway” if adolescents are using tobacco. Conclusions: This study informed several modifications to the intervention to address confidentiality and introduce efficiency to well-care visits. The support tool was integrated into the electronic health record system used by the study clinics and modified to offer videos to all adolescents regardless of their tobacco use or susceptibility. Future studies will further test the acceptability of the intervention in practice. %M 31066687 %R 10.2196/12406 %U http://formative.jmir.org/2019/2/e12406/ %U https://doi.org/10.2196/12406 %U http://www.ncbi.nlm.nih.gov/pubmed/31066687 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e13520 %T Clinical Efficacy of Telemedicine Compared to Face-to-Face Clinic Visits for Smoking Cessation: Multicenter Open-Label Randomized Controlled Noninferiority Trial %A Nomura,Akihiro %A Tanigawa,Tomoyuki %A Muto,Tomoyasu %A Oga,Takafumi %A Fukushima,Yasushi %A Kiyosue,Arihiro %A Miyazaki,Masaki %A Hida,Eisuke %A Satake,Kohta %+ Innovative Clinical Research Center, Kanazawa University, 13-1 Takaramachi, Kanazawa, 920-8641, Japan, 81 76 265 2049, anomura@med.kanazawa-u.ac.jp %K smoking cessation %K nicotine dependence %K telecare %K telemedicine %K mHealth %K digital therapeutics %K mobile phone %D 2019 %7 26.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Tobacco is a major public health concern. A 12-week standard smoking cessation program is available in Japan; however, it requires face-to-face clinic visits, which has been one of the key obstacles to completing the program, leading to a low smoking cessation success rate. Telemedicine using internet-based video counseling instead of regular clinic visits could address this obstacle. Objective: This study aimed to evaluate the efficacy and feasibility of an internet-based remote smoking cessation support program compared with the standard face-to-face clinical visit program among patients with nicotine dependence. Methods: This study was a randomized, controlled, open-label, multicenter, noninferiority trial. We recruited nicotine-dependent adults from March to June 2018. Participants randomized to the telemedicine arm received internet-based video counseling, whereas control participants received standard face-to-face clinic visits at each time point in the smoking cessation program. Both arms received a CureApp Smoking Cessation smartphone app with a mobile exhaled carbon monoxide checker. The primary outcome was a continuous abstinence rate (CAR) from weeks 9 to 12. Full analysis set was used for data analysis. Results: We randomized 115 participants with nicotine dependence: 58 were allocated to the telemedicine (internet-based video counseling) arm and 57, to the control (standard face-to-face clinical visit) arm. We analyzed all 115 participants for the primary outcome. Both telemedicine and control groups had similar CARs from weeks 9 to 12 (81.0% vs 78.9%; absolute difference, 2.1%; 95% CI –12.8 to 17.0), and the lower limit of the difference between groups (–12.8%) was greater than the prespecified limit (–15%). Conclusions: The application of telemedicine using internet-based video counseling as a smoking cessation program had a similar CAR from weeks 9 to 12 as that of the standard face-to-face clinical visit program. The efficacy of the telemedicine-based smoking cessation program was not inferior to that of the standard visit–based smoking cessation program. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry: UMIN000031620; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000035975. %M 30982776 %R 10.2196/13520 %U http://www.jmir.org/2019/4/e13520/ %U https://doi.org/10.2196/13520 %U http://www.ncbi.nlm.nih.gov/pubmed/30982776 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12482 %T A Mobile Smoking Cessation Intervention for Mexico (Vive sin Tabaco... ¡Decídete!): Single-Arm Pilot Study %A Cupertino,Ana Paula %A Cartujano-Barrera,Francisco %A Ramírez,Mariana %A Rodríguez-Bolaños,Rosibel %A Thrasher,James F %A Pérez-Rubio,Gloria %A Falfán-Valencia,Ramcés %A Ellerbeck,Edward F %A Reynales-Shigematsu,Luz Myriam %+ Department of Tobacco Research, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, Mexico, 52 777 101 2977, lreynales@insp.mx %K smoking %K smoking cessation %K mHealth %K text messages %K global health %D 2019 %7 25.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Of the 14.3 million Mexicans who smoke, only a minority take advantage of evidence-based approaches to smoking cessation. Mobile health interventions have the potential to increase the reach of effective cessation interventions in Mexico. Objective: This study aimed to assess the feasibility and acceptability of an innovative, personalized, and interactive smoking cessation mobile intervention developed for Mexican smokers. Methods: We recruited 40 Mexican smokers to participate in Vive sin Tabaco... ¡Decídete!, a smoking cessation program that uses a tablet-based decision support software to drive a 12-week text messaging smoking cessation program and pharmacotherapy support. Outcome measures included participant text messaging interactivity with the program, participant satisfaction, and 12-week verified abstinence using urinary cotinine testing or exhaled carbon monoxide. Results: Average age of the participants was 36 years (SD 10.7), and they were primarily male (65%, 26/40) with at least an undergraduate degree (62%, 25/40). Most participants (95%, 38/40) smoked daily and were interested in quitting in the next 7 days. As an indicator of participant interactivity, participants sent an average of 21 text messages during the 12-week intervention (SD 17.62). Of the 843 messages that participants sent to the program, only 96 messages (11.3%, 96/843) used keywords. At 12 weeks, 40% (16/40) of participants were biochemically verified (87%, 35/40, follow-up rate). The majority of participants (85%, 30/35) reported being very satisfied or extremely satisfied with the program. Conclusions: The Vive sin Tabaco... ¡Decídete! smoking cessation mobile intervention was accepted by participants, generated high satisfaction and high text messaging interactivity, and resulted in a noteworthy cessation rate at the end of treatment. This intervention is a promising strategy for smoking cessation in Mexico. Additional testing as a formal randomized clinical trial appears warranted. %M 31021326 %R 10.2196/12482 %U http://mhealth.jmir.org/2019/4/e12482/ %U https://doi.org/10.2196/12482 %U http://www.ncbi.nlm.nih.gov/pubmed/31021326 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 4 %P e12304 %T Exposure to Potentially Harmful E-Cigarette Emissions via Vape Tricks: Protocol for a Mixed-Methods Study %A Furberg,Robert %A Ortiz,Alexa M %A McCombs,Michelle %A Cress,Margaret %A Thornburg,Jonathan %A Pepper,Jessica K %A Lee,Youn Ok %+ Digital Health and Clinical Informatics, RTI International, 3040 Cornwallis Rd, Research Triangle Park, NC, 27709, United States, 1 919 316 3726, rfurberg@rti.org %K electronic nicotine delivery systems %K vaping %K human exposure modeling %K digital health %K wearable electronic devices %D 2019 %7 15.04.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: The number of adolescents and adults using e-cigarettes, referred to as vaping, has dramatically increased. E-cigarettes can be used to perform vape tricks by inhaling and exhaling the e-cigarette aerosol in patterns to create visual effects or large clouds. To create these effects, the puffing patterns associated with vape tricks may be different than standard ad-lib e-cigarette usage. The prevalence of vape tricks and the harm associated with exposure to e-cigarette emissions when performing vape tricks is currently unknown. Objective: Our objectives are to characterize duration, heart rate, respiratory rate, tidal volume, minute volume, and physical activity metrics associated with the performance of vape tricks and to characterize the emission of e-cigarettes when performing vape tricks in a manner suitable to inform novel exposure modeling. Methods: The study will recruit e-cigarette users with a history of performing vape tricks. Data collection will occur in two different sessions. In the first session, participants will be asked to puff on their e-cigarette as they normally would for 20 minutes. The second session will be a vape tricks session, where users will be asked to perform a series of up to five different vape tricks with their e-cigarette. Data will be collected through screener surveys, in-person interviews, video recordings, a personal exposure monitor, and a biometric garment. Results: Data analysis is pending and scheduled to take place in the fall of 2019. Conclusions: This study will be used to assess the feasibility of using a biometric garment to complement environmental and observational data. The approach may provide greater insight into the health risks of performing vape tricks compared to typical e-cigarette use. International Registered Report Identifier (IRRID): DERR1-10.2196/12304 %M 30985285 %R 10.2196/12304 %U http://www.researchprotocols.org/2019/4/e12304/ %U https://doi.org/10.2196/12304 %U http://www.ncbi.nlm.nih.gov/pubmed/30985285 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 4 %P e13508 %T Process Evaluation of a Medical Student–Delivered Smoking Prevention Program for Secondary Schools: Protocol for the Education Against Tobacco Cluster Randomized Trial %A Brinker,Titus Josef %A Buslaff,Fabian %A Suhre,Janina Leonie %A Silchmüller,Marc Philipp %A Divizieva,Evgenia %A Wilhelm,Jilada %A Hillebrand,Gabriel %A Penka,Dominik %A Gaim,Benedikt %A Swoboda,Susanne %A Baumermann,Sonja %A Walther,Jörg Werner %A Brieske,Christian Martin %A Jakob,Lena %A Baumert,Hannah Maria %A Anhuef,Ole %A Schmidt,Selina Marisa %A Alfitian,Jonas %A Batra,Anil %A Taha,Lava %A Mons,Ute %A Hofmann,Felix Johannes %A Haney,Ailís Ceara %A Haney,Caelán Max %A Schaible,Samuel %A Tran,Thien-An %A Beißwenger,Hanna %A Stark,Tobias %A Groneberg,David A %A Seeger,Werner %A Srivastava,Aayushi %A Gall,Henning %A Holzapfel,Julia %A Rigotti,Nancy A %A Baudson,Tanja Gabriele %A Enk,Alexander H %A Fröhling,Stefan %A von Kalle,Christof %A Bernardes-Souza,Breno %A Pereira,Rayanna Mara de Oliveira Santos %A Thomas,Roger %+ Department of Translational Oncology, National Center for Tumor Diseases, German Cancer Research Center (DKFZ), University of Heidelberg, , Heidelberg,, Germany, 49 15175084347, titus.brinker@dkfz.de %K schools %K tobacco prevention %K smoking prevention %K medical students %K medical school %D 2019 %7 11.04.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Most smokers start smoking during their early adolescence under the impression that smoking entails positive attributes. Given the addictive nature of cigarettes, however, many of them might end up as long-term smokers and suffering from tobacco-related diseases. To prevent tobacco use among adolescents, the large international medical students’ network Education Against Tobacco (EAT) educates more than 40,000 secondary school students per year in the classroom setting, using evidence-based self-developed apps and strategies. Objective: This study aimed to evaluate the long-term effectiveness of the school-based EAT intervention in reducing smoking prevalence among seventh-grade students in Germany. Additionally, we aimed to improve the intervention by drawing conclusions from our process evaluation. Methods: We conduct a cluster-randomized controlled trial with measurements at baseline and 9, 16, and 24 months postintervention via paper-and-pencil questionnaires administered by teachers. The study groups consist of randomized schools receiving the 2016 EAT curriculum and control schools with comparable baseline data (no intervention). The primary outcome is the difference of change in smoking prevalence between the intervention and control groups at the 24-month follow-up. Secondary outcomes are between-group differences of changes in smoking-related attitudes and the number of new smokers, quitters, and never-smokers. Results: A total of 11,268 students of both sexes, with an average age of 12.32 years, in seventh grade of 144 secondary schools in Germany were included at baseline. The prevalence of cigarette smoking in our sample was 2.6%. The process evaluation surveys were filled out by 324 medical student volunteers, 63 medical student supervisors, 4896 students, and 141 teachers. Conclusions: The EAT cluster randomized trial is the largest school-based tobacco-prevention study in Germany conducted to date. Its results will provide important insights with regards to the effectiveness of medical student–delivered smoking prevention programs at school. International Registered Report Identifier (IRRID): DERR1-10.2196/13508 %M 30973348 %R 10.2196/13508 %U http://www.researchprotocols.org/2019/4/e13508/ %U https://doi.org/10.2196/13508 %U http://www.ncbi.nlm.nih.gov/pubmed/30973348 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e11735 %T Implementation of a Novel Electronic Patient-Directed Smoking Cessation Platform for Cancer Patients: Interrupted Time Series Analysis %A Giuliani,Meredith Elana %A Liu,Geoffrey %A Xu,Wei %A Dirlea,Mihaela %A Selby,Peter %A Papadakos,Janet %A Abdelmutti,Nazek %A Yang,Dongyang %A Eng,Lawson %A Goldstein,David Paul %A Jones,Jennifer Michelle %+ Princess Margaret Cancer Centre, 610 University Ave, Toronto, ON, M5G 2C1, Canada, 1 4167864583, jonesbernard5@gmail.com %K neoplasms %K smoking cessation %K implementation science %K quality improvement %D 2019 %7 09.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Continued smoking in cancer patients undergoing treatment results in significantly higher rates of treatment toxicities and persistent effects, increased risk of recurrence and second malignancy, and increased all-cause mortality. Despite this, routine tobacco use screening and the provision of smoking cessation treatment has yet to be implemented widely in the cancer setting. Objective: The objective of this study was to implement and evaluate the adoption and impact of an innovative Smoking Cessation e-referral System (CEASE) to promote referrals to smoking cessation programs in cancer patients. Methods: A patient-directed electronic smoking cessation platform (CEASE) was developed to promote smoking screening and referral and implemented at 1 of Canada’s largest cancer centers. The implementation and evaluation were guided by the Ottawa Model of Research Use. An interrupted time series design was used to examine the impact of CEASE on screening rates, referrals offered, and referrals accepted compared with a previous paper-based screening program. A subsample of smokers or recent quitters was also assessed and compared pre- and postimplementation to examine the effect of CEASE on subsequent contact with smoking cessation programs and quit attempts. Results: A total of 17,842 new patients attended clinics over the 20-month study period. The CEASE platform was successfully implemented across all disease sites. Screening rates increased from 44.28% (2366/5343) using the paper-based approach to 65.72% (3538/5383) using CEASE (P<.01), and referrals offered to smokers who indicated interest in quitting increased from 18.6% (58/311) to 98.8% (421/426; P<.01). Accepted referrals decreased from 41% (24/58) to 20.4% (86/421), though the overall proportion of referrals generated from total current/recent tobacco users willing to quit increased from 5.8% (24/414) to 20.2% (86/426) due to the increase in referrals offered. At 1-month postscreening, there was no significant difference in the proportion that was currently using tobacco and had not changed use in the past 4 weeks (pre: 28.9% [24/83] and post: 28.8% [83/288]). However, contact with the referral program increased from 0% to 78% in the postCEASE cohort (P<.001). Conclusions: CEASE is an innovative tool to improve smoking screening and can be implemented in both a time- and cost-effective manner which promotes sustainability. CEASE was successfully implemented across all clinics and resulted in improvements in overall screening and referral rates and engagement with referral services. %M 30964445 %R 10.2196/11735 %U https://www.jmir.org/2019/4/e11735/ %U https://doi.org/10.2196/11735 %U http://www.ncbi.nlm.nih.gov/pubmed/30964445 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e12745 %T A Smartphone App to Assist Smoking Cessation Among Aboriginal Australians: Findings From a Pilot Randomized Controlled Trial %A Peiris,David %A Wright,Lachlan %A News,Madeline %A Rogers,Kris %A Redfern,Julie %A Chow,Clara %A Thomas,David %+ The George Institute for Global Health, UNSW Sydney, 1 King St, Newtown,, Australia, 61 280524513, dpeiris@georgeinstitute.org %K smoking cessation %K oceanic ancestry group %K mobile apps %D 2019 %7 02.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps have the potential to increase smoking cessation, but little research has been conducted with Aboriginal communities in Australia. Objective: We conducted a pilot study to assess the feasibility and acceptability and explore the effectiveness of a novel mHealth app to assist Aboriginal people to quit smoking. Methods: A pilot randomized controlled trial (RCT) and process evaluation comprising usage analytics data and in-depth interviews was conducted. Current Aboriginal smokers (>16 years old), who were willing to make a quit attempt in the next month, were recruited from Aboriginal Community Controlled Health Services and a government telephone coaching service. The intervention was a multifaceted Android or iOS app comprising a personalized profile and quit plan, text and in-app motivational messages, and a challenge feature allowing users to compete with others. The comparator was usual cessation support services. Outcome data collection and analysis were conducted blinded to treatment allocation. The primary outcome was self-reported continuous smoking abstinence verified by carbon monoxide breath testing at 6 months. Secondary outcomes included point prevalence of abstinence and use of smoking cessation therapies and services. Results: A total of 49 participants were recruited. Competing service delivery priorities, the lack of resources for research, and lack of support for randomization to a control group were the major recruitment barriers. At baseline, 23/49 (47%) of participants had tried to quit in recent weeks. At 6-month follow-up, only 1 participant (intervention arm) was abstinent. The process evaluation highlighted low to moderate app usage (3-10 new users per month and 4-8 returning users per month), an average of 2.9 sessions per user per month and 6.3 min per session. Key themes from interviews with intervention participants (n=15) included the following: (1) the powerful influence of prevailing social norms around acceptability of smoking; (2) high usage of mobile devices for phone, text, and social media but very low use of other smartphone apps; (3) the role of family and social group support in supporting quit attempts; and (4) low awareness and utilization of smoking cessation support services. Despite the broad acceptability of the app, participants also recommended technical improvements to improve functionality, greater customization of text messages, integration with existing social media platforms, and gamification features. Conclusions: Smoking cessation apps need to be integrated with commonly used functions of mobile phones and draw on social networks to support their use. Although they have the potential to increase utilization of cessation support services and treatments, more research is needed to identify optimal implementation models. Robust evaluation is critical to determine their impact; however, an RCT design may not be feasible in this setting. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12616001550493; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371792 (Archived by WebCite at http://www.webcitation.org/76TiV7HA6). %M 30938691 %R 10.2196/12745 %U https://mhealth.jmir.org/2019/4/e12745/ %U https://doi.org/10.2196/12745 %U http://www.ncbi.nlm.nih.gov/pubmed/30938691 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 2 %P e12139 %T Exploring the Experiences of Individuals Allocated to a Control Setting: Findings From a Mobile Health Smoking Cessation Trial %A Müssener,Ulrika %A Linderoth,Catharina %A Bendtsen,Marcus %+ Department of Medical and Health Sciences, Linköping University, Building 511-001, Entrance 75, Linköping, S-58183, Sweden, 46 732702426, ulrika.mussener@liu.se %K tobacco smoking %K smoking cessation %K students %K text messaging %K mobile phones %K cell phone %K control groups %D 2019 %7 02.04.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Tobacco smoking is the primary cause of preventable premature disease and death worldwide. Evidence of the efficacy of text messaging interventions to reduce smoking behavior is well established, but there is still a need for studies targeting young people, especially because young adult smokers are less likely to seek treatment than older adults. A mobile health intervention, Nicotine Exit (NEXit), targeting smoking among university students was developed to support university students to quit smoking. Short-term effectiveness was measured through a randomized controlled trial, which found that immediately after the 12-week intervention, 26% of smokers in the intervention group had prolonged abstinence compared with 15% in the control group. Objective: The objective of this study was to explore the experience of being allocated to the control group in the NEXit smoking cessation intervention. Methods: We asked students who were allocated to the control group in the main NEXit randomized controlled trial to report their experiences. An email was sent to the participants with an electronic link to a short questionnaire. We assessed the distribution of the responses to the questionnaire by descriptive analysis. We analyzed free-text comments to 4 questions. Results: The response rate for the questionnaire was 33.8% (258/763), and we collected 143 free-text comments. Of the responders, 60.9% (157/258) experienced frustration, disappointment, and irritation about being allocated to the control group; they felt they were being denied support by having to wait for the intervention. Monthly text messages during the waiting period thanking them for taking part in the trial were perceived as negative by 72.3% (189/258), but for some the messages served as a reminder about the decision to quit smoking. Of the responders, 61.2% (158/258) chose to wait to quit smoking until they had access to the intervention, and 29.8% (77/258) decided to try to quit smoking without support. Of the respondents, 77.5% (200/258) claimed they were still smoking and had signed up or were thinking about signing up for the smoking cessation program at the time of the questionnaire. Conclusions: Most of the respondents reported negative feelings about having to wait for the support of the intervention and that they had decided to continue smoking. A similar number decided to wait to quit smoking until they had access to the intervention, and these respondents reported a high interest in the intervention. Free-text comments indicated that some control group participants believed that they had been excluded from the trial, while others were confused when asked to sign up for the intervention again. Trial Registration: ISRCTN Registry ISRCTN75766527; http://www.isrctn.com/ISRCTN75766527 (Archived by WebCite at http://www.webcitation.org/7678sUKbR) %M 30938682 %R 10.2196/12139 %U https://humanfactors.jmir.org/2019/2/e12139/ %U https://doi.org/10.2196/12139 %U http://www.ncbi.nlm.nih.gov/pubmed/30938682 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11300 %T Challenges in the Development of e-Quit worRx: An iPad App for Smoking Cessation Counseling and Shared Decision Making in Primary Care %A Doarn,Charles R %A Vonder Meulen,Mary Beth %A Pallerla,Harini %A Acquavita,Shauna P %A Regan,Saundra %A Elder,Nancy %A Tubb,Matthew R %+ Department of Family and Community Medicine, University of Cincinnati, 231 Albert Sabin Way, ML0582, Cincinnati, OH, 45267, United States, 1 5135586148, charles.doarn@uc.edu %K mobile health %K smoking cessation %K primary care %K decision aid %D 2019 %7 29.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is the leading preventable cause of morbidity and mortality in the United States, killing more than 450,000 Americans. Primary care physicians (PCPs) have a unique opportunity to discuss smoking cessation evidence in a way that enhances patient-initiated change and quit attempts. Patients today are better equipped with technology such as mobile devices than ever before. Objective: The aim of this study was to evaluate the challenges in developing a tablet-based, evidence-based smoking cessation app to optimize interaction for shared decision making between PCPs and their patients who smoke. Methods: A group of interprofessional experts developed content and a graphical user interface for the decision aid and reviewed these with several focus groups to determine acceptability and usability in a small population. Results: Using a storyboard methodology and subject matter experts, a mobile app, e-Quit worRx, was developed through an iterative process. This iterative process helped finalize the content and ergonomics of the app and provided valuable feedback from both patients and provider teams. Once the app was made available, other technical and programmatic challenges arose. Conclusions: Subject matter experts, although generally amenable to one another’s disciplines, are often challenged with effective interactions, including language, scope, clinical understanding, technology awareness, and expectations. The successful development of this app and its evaluation in a clinical setting highlighted those challenges and reinforced the need for effective communications and team building. %M 30924783 %R 10.2196/11300 %U https://formative.jmir.org/2019/1/e11300/ %U https://doi.org/10.2196/11300 %U http://www.ncbi.nlm.nih.gov/pubmed/30924783 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 1 %P e12835 %T Exploring Efficacy of a Serious Game (Tobbstop) for Smoking Cessation During Pregnancy: Randomized Controlled Trial %A Marin-Gomez,Francesc X %A Garcia-Moreno Marchán,Rocio %A Mayos-Fernandez,Anabel %A Flores-Mateo,Gemma %A Granado-Font,Esther %A Barrera Uriarte,Maria Luisa %A Duch,Jordi %A Rey-Reñones,Cristina %+ Servei d'Atenció Primària d'Osona, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Pl Divina Pastora N7, Vic, 08500, Spain, 34 938890222, xavy.marin@gmail.com %K pregnancy %K video games %K smoking cessation %D 2019 %7 27.03.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Tobacco use during pregnancy entails a serious risk to the mother and harmful effects on the development of the child. Europe has the highest tobacco smoking prevalence (19.3%) compared with the 6.8% global mean. Between 20% to 30% of pregnant women used tobacco during pregnancy worldwide. These data emphasize the urgent need for community education and implementation of prevention strategies focused on the risks associated with tobacco use during pregnancy. Objective: The aim of this study was to investigate the efficacy of an intervention that incorporates a serious game (Tobbstop) to help pregnant smokers quit smoking. Methods: A two-arm randomized controlled trial enrolled 42 women who visited 2 primary care centers in Catalonia, Spain, between March 2015 and November 2016. All participants were pregnant smokers, above 18 years old, attending consultation with a midwife during the first trimester of pregnancy, and had expressed their desire to stop smoking. Participants were randomized to the intervention (n=21) or control group (n=21). The intervention group was instructed to install the game on their mobile phone or tablet and use it for 3 months. Until delivery, all the participants were assessed on their stage of smoking cessation during their follow-up midwife consultations. The primary outcome was continuous tobacco abstinence until delivery confirmed by the amount of carbon monoxide at each visit, measured with a carboxymeter. Results: Continuous abstinence until delivery outcome was 57% (12/21) in the intervention group versus 14% (3/21) in the control group (hazard ratio=4.31; 95% CI 1.87-9.97; P=.001). The mean of total days without smoking until delivery was higher in the intervention group (mean 139.75, SD 21.76) compared with the control group (mean 33.28, SD 13.27; P<.001). In addition, a Kapplan-Meier survival analysis showed that intervention group has a higher abstinence rate compared with the control group (log-rank test, χ21=13.91; P<.001). Conclusions: Serious game use is associated with an increased likelihood to maintain abstinence during the intervention period if compared with those not using the game. Pregnancy is an ideal opportunity to intervene and control tobacco use among future mothers. On the other hand, serious games are an emerging technology, growing in importance, which are shown to be a good tool to help quitting smoking during pregnancy and also to maintain this abstinent behavior. However, because of the study design limitations, these outcomes should be interpreted with caution. More research, using larger samples and longer follow-up periods, is needed to replicate the findings of this study. Trial Registration: ClinicalTrials.gov NCT01734421; https://clinicaltrials.gov/ct2/show/NCT01734421 (Archived by WebCite at http://www.webcitation.org/75ISc59pB) %M 30916655 %R 10.2196/12835 %U http://games.jmir.org/2019/1/e12835/ %U https://doi.org/10.2196/12835 %U http://www.ncbi.nlm.nih.gov/pubmed/30916655 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11498 %T Combining Real-Time Ratings With Qualitative Interviews to Develop a Smoking Cessation Text Messaging Program for Primary Care Patients %A Kruse,Gina %A Park,Elyse R %A Shahid,Naysha N %A Abroms,Lorien %A Haberer,Jessica E %A Rigotti,Nancy A %+ Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street 16th Fl, Boston, MA, 02114, United States, 1 617 724 3157, gkruse@mgh.harvard.edu %K text messaging %K smoking cessation %K primary care %D 2019 %7 26.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Text messaging (short message service, SMS) interventions show promise as a way to help cigarette smokers quit. Few studies have examined the effectiveness of text messaging (SMS) programs targeting smokers associated with primary care or hospital settings. Objective: This study aimed to develop a text messaging (SMS) program targeting primary care smokers. Methods: Adult smokers in primary care were recruited from February 2017 to April 2017. We sent patients 10 to 11 draft text messages (SMS) over 2 days and asked them to rate each message in real time. Patients were interviewed daily by telephone to discuss ratings, message preferences, and previous experiences with nicotine replacement therapy (NRT). Content analysis of interviews was directed by a step-wise text messaging (SMS) intervention development process and the Information-Motivation-Behavioral Skills model of medication adherence. Results: We sent 149 text messages (SMS) to 15 patients. They replied with ratings for 93% (139/149) of the messages: 134 (96%, 134/139) were rated as clear or useful and 5 (4%, 5/139) as unclear or not useful. Patients’ preferences included the addition of graphics, electronic cigarette (e-cigarette) content, and use of first names. Regarding NRT, patients identified informational gaps around safety and effectiveness, preferred positively framed motivational messages, and needed behavioral skills to dose and dispose of NRT. Conclusions: Patients recommended text message (SMS) personalization, inclusion of e-cigarette information and graphics, and identified barriers to NRT use. Combining real-time ratings with telephone interviews is a feasible method for incorporating primary care patients’ preferences into a behavioral text messaging (SMS) program. %M 30912755 %R 10.2196/11498 %U http://mhealth.jmir.org/2019/3/e11498/ %U https://doi.org/10.2196/11498 %U http://www.ncbi.nlm.nih.gov/pubmed/30912755 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 3 %P e12511 %T Mobile Phone–Based Smoking-Cessation Intervention for Patients Undergoing Elective Surgery: Protocol for a Randomized Controlled Trial %A Bendtsen,Marcus %A Linderoth,Catharina %A Bendtsen,Preben %+ Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, 58183, Sweden, 46 13 28 10 00, marcus.bendtsen@liu.se %K smoking cessation %K mobile phone–based interventions %K SMS %K mHealth interventions %D 2019 %7 26.03.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Several large studies have shown that the risk of cardiovascular, respiratory, and wound-healing complications (including death) within 30 days of surgery is greater for smokers than for nonsmokers. However, there is evidence that even short-term perioperative smoking cessation may reduce postoperative morbidity. Over the past few years, it has become more evident that short message service (SMS)–based interventions can help individuals quit smoking. Objective: The overall aim of this project is to fill the knowledge gap on whether an SMS-based smoking-cessation intervention can be effective in helping patients stop smoking perioperatively. The aim of this trial is to evaluate the effectiveness of an SMS-based intervention on smoking behavior of patients undergoing elective surgery. Methods: A two-arm parallel-group randomized controlled trial will be conducted at 20 surgical departments in southeast Sweden. Smokers undergoing elective surgery who own a mobile phone will be included. Power calculations indicate that it will be necessary to randomize 434 participants. One group will be given access to a novel 12-week SMS program, which includes daily SMS messages with behavior change–enforcing text content and hyperlinks to interactive modules, while the other group will not be given access to the intervention. Both groups will have access to the surgical departments’ current routine for smoking cessation prior to surgery. Primary outcome measures, prolonged abstinence, and point prevalence of smoking cessation will be measured through questionnaires at 3, 6, and 12 months after randomization. Logistic regression models adjusted using baseline characteristics will be explored to identify potential effects of the intervention. Results: Recruitment started in late October 2018 and is expected to last for a maximum of 30 months. The first results are expected to be available approximately 3 months after the final date of recruitment. Conclusions: Owing to the structural problems and scarcity of time and resources, patients at most Swedish surgical departments are simply instructed to quit smoking, and perhaps, referred to a primary health care clinic. An SMS-based smoking-cessation aid can be effective in helping individuals quit smoking and is a very simple and time-efficient tool for surgical departments to use. Trial Registration: ISRCTN Registry ISRCTN33869008; http://www.isrctn.com/ISRCTN33869008 International Registered Report Identifier (IRRID): PRR1-10.2196/12511 %M 30912757 %R 10.2196/12511 %U http://www.researchprotocols.org/2019/3/e12511/ %U https://doi.org/10.2196/12511 %U http://www.ncbi.nlm.nih.gov/pubmed/30912757 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e10750 %T Comparison of Developers’ and End-Users’ Perspectives About Smoking Cessation Support Through the Crush the Crave App %A Struik,Laura Louise %A Bottorff,Joan L %A Baskerville,N Bruce %A Oliffe,John %A Crichton,Susan %+ Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4520, laurastruik134@hotmail.com %K mobile app %K smoking cessation %K tobacco control %K young adult %K qualitative research %D 2019 %7 07.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: High smoking rates among end-users, combined with their high rates of app use, render this age group as a particularly captive audience for quit smoking apps. There is emerging evidence that apps are an effective way to support smoking cessation among end-users. How the expectations behind the design of apps align with the needs and preferences of end-users, and if this differs by gender, is poorly understood, limiting the ability to evaluate and scale these interventions. Objective: The objective of this qualitative case study was to detail how the overall design approach of Crush the Crave (CTC), a quit smoking app that targets end-users, compares with young adult women’s and men’s perspectives and experiences, with consideration for the influence of gender. Methods: Semistructured interviews were conducted with 15 developers involved in the development of CTC and 31 young adult CTC users. Data were analyzed inductively to derive thematic findings of the perceived pros and cons of CTC by both developers and end-users. Findings were grouped under 4 categories (1) technology and platforms utilized for the app, (2) foundation of app content, (3) underlying focus of the app, and (4) look, feel and functionality of the app. Results: Under the category, technology and platforms utilized for the app, it was found that both developers and end-users agreed that apps aligned with the needs and preferences of young adult smokers. Major limitations with the technology identified by end-users were the frequent “glitches” and requirement for internet or data. For the category, foundation of app content,developers agreed that the strength of CTC was in its strong evidence-base. What mattered to end-users, however, was that the content was packaged positively, focusing on the benefits of quitting versus the consequences of smoking. It was found under the category, underlying focus of the app, that the individually-led focus of the app resonated with both developers and end-users, especially young men. Under the final category, look, feel and functionality of the app, it was found that developers were very positive about the app's aesthetics but end-users thought that the aesthetics incited a negative effect. Also, while end-users found it easy to use, they did not find the app intuitive. Finally, end-users thought that, because the app functions were largely based on a user’s quit date versus their ongoing efforts, this often lent to unmeaningful data. Conclusions: The current study findings highlight the importance of understanding multiple perspectives of stakeholders involved in a mobile-based intervention. By gathering the viewpoints of developers and end-users, both problematic and effective approaches that underlie development goals were revealed as a means of informing the development, implementation, and evaluation of future electronic health (eHealth) interventions. %M 30843864 %R 10.2196/10750 %U https://mhealth.jmir.org/2019/3/e10750/ %U https://doi.org/10.2196/10750 %U http://www.ncbi.nlm.nih.gov/pubmed/30843864 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e13000 %T Digital Education for Health Professions on Smoking Cessation Management: Systematic Review by the Digital Health Education Collaboration %A Semwal,Monika %A Whiting,Penny %A Bajpai,Ram %A Bajpai,Shweta %A Kyaw,Bhone Myint %A Tudor Car,Lorainne %+ Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore, 308232, Singapore, 65 6904 1258, lorainne.tudor.car@ntu.edu.sg %K evidence-based practice %K health personnel %K learning %K systematic review %K smoking cessation %D 2019 %7 04.03.2019 %9 Review %J J Med Internet Res %G English %X Background: Tobacco smoking, one of the leading causes of preventable death and disease, is associated with 7 million deaths every year. This is estimated to rise to more than 8 million deaths per year by 2030, with 80% occurring in low- and middle-income countries. Digital education, teaching, and learning using digital technologies have the potential to increase educational opportunities, supplement teaching activities, and decrease distance barriers in health professions education. Objective: The primary objective of this systematic review was to evaluate the effectiveness of digital education compared with various controls in improving learners’ knowledge, skills, attitudes, and satisfaction to deliver smoking cessation therapy. The secondary objectives were to assess patient-related outcomes, change in health professionals’ practice or behavior, self-efficacy or self-rated competence of health professionals in delivering smoking cessation therapy, and cost-effectiveness of the interventions. Methods: We searched 7 electronic databases and 2 trial registers for randomized controlled trials published between January 1990 and August 2017. We used gold standard Cochrane methods to select and extract data and appraise eligible studies. Results: A total of 11 studies (number of participants, n=2684) were included in the review. All studies found that digital education was at least as effective as traditional or usual learning. There was some suggestion that blended education results in similar or greater improvements in knowledge (standardized mean difference, SMD=0.19, 95% CI −0.35 to 0.72), skill (SMD=0.58, 95% CI 0.08-1.08), and satisfaction (SMD=0.62, 95% CI 0.12-1.12) compared with digital education or usual learning alone. There was also some evidence for improved attitude (SMD=0.45, 95% CI 0.18-0.72) following digital education compared with usual learning. Only 1 study reported patient outcomes and the setup cost of blended education but did not compare outcomes among groups. There were insufficient data to investigate what components of the digital education interventions were associated with the greatest improvements in learning outcomes. Conclusions: The evidence suggests that digital education is at least as effective as usual learning in improving health professionals’ knowledge and skill for delivering smoking cessation therapy. However, limitations in the evidence base mean that these conclusions should be interpreted with some caution. Trial Registration: PROSPERO CRD42016046815; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=46815 %M 30829576 %R 10.2196/13000 %U http://www.jmir.org/2019/3/e13000/ %U https://doi.org/10.2196/13000 %U http://www.ncbi.nlm.nih.gov/pubmed/30829576 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e12854 %T A Smoking Prevention Program Delivered by Medical Students to Secondary Schools in Brazil Called “Education Against Tobacco”: Randomized Controlled Trial %A Lisboa,Oscar Campos %A Bernardes-Souza,Breno %A Xavier,Luiz Eduardo De Freitas %A Almeida,Matheus Rocha %A Corrêa,Paulo César Rodrigues Pinto %A Brinker,Titus Josef %+ National Center for Tumor Diseases, German Cancer Research Center, University of Heidelberg, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany, 49 62213219304, titus.brinker@nct-heidelberg.de %K smoking %K tobacco %K prevention %K medical students %K schools %D 2019 %7 21.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Smoking is the largest preventable cause of mortality in Brazil. Education Against Tobacco (EAT) is a network of more than 3500 medical students and physicians across 14 countries who volunteer for school-based smoking prevention programs. EAT educates 50,000 adolescents per year in the classroom setting. A recent quasi-experimental study conducted in Germany showed that EAT had significant short-term smoking cessation effects among adolescents aged 11 to 15 years. Objective: The aim is to measure the long-term effectiveness of the most recent version of the EAT curriculum in Brazil. Methods: A randomized controlled trial was conducted among 2348 adolescents aged 12 to 21 years (grades 7-11) at public secondary schools in Brazil. The prospective experimental design included measurements at baseline and at 6 and 12 months postintervention. The study groups comprised randomized classes receiving the standardized EAT intervention (90 minutes of mentoring in a classroom setting) and control classes in the same schools (no intervention). Data were collected on smoking status, gender, social aspects, and predictors of smoking. The primary endpoint was the difference in the change in smoking prevalence between the intervention group and the control group at 12-month follow-up. Results: From baseline to 12 months, the smoking prevalence increased from 11.0% to 20.9% in the control group and from 14.1% to 15.6% in the intervention group. This difference was statistically significant (P<.01). The effects were smaller for females (control 12.4% to 18.8% vs intervention 13.1% to 14.6%) than for males (control 9.1% to 23.6% vs intervention 15.3% to 16.8%). Increased quitting rates and prevented onset were responsible for the intervention effects. The differences in change in smoking prevalence from baseline to 12 months between the intervention and control groups were increased in students with low school performance. Conclusions: To our knowledge, this is the first randomized trial on school-based tobacco prevention in Brazil that shows significant long-term favorable effects. The EAT program encourages quitting and prevents smoking onset, especially among males and students with low educational background. Trial Registration: ClinicalTrials.gov NCT02725021; https://clinicaltrials.gov/ct2/show/NCT02725021 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.7134 %M 30789347 %R 10.2196/12854 %U http://www.jmir.org/2019/2/e12854/ %U https://doi.org/10.2196/12854 %U http://www.ncbi.nlm.nih.gov/pubmed/30789347 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e12694 %T Impact of a Novel Smartphone App (CureApp Smoking Cessation) on Nicotine Dependence: Prospective Single-Arm Interventional Pilot Study %A Masaki,Katsunori %A Tateno,Hiroki %A Kameyama,Naofumi %A Morino,Eriko %A Watanabe,Riri %A Sekine,Kazuma %A Ono,Tomohiro %A Satake,Kohta %A Suzuki,Shin %A Nomura,Akihiro %A Betsuyaku,Tomoko %A Fukunaga,Koichi %+ Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan, 81 3 3353 1211, km-fuku@cpnet.med.keio.ac.jp %K digital therapeutics %K nicotine dependence %K smoking cessation %K smartphone application %K telemedicine %D 2019 %7 19.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps have been considered to provide active and continuous support for smoking cessation. However, it is yet to be known whether a smoking cessation smartphone app improves long-term abstinence rates in nicotine-dependent patients. Objective: This study aimed to evaluate the long-term abstinence effect of a novel smartphone app, CureApp Smoking Cessation (CASC), in patients with nicotine dependence. Methods: In this prospective, interventional, multicenter, single-arm study, we provided the CASC app to all the participants, who used it daily for 24 weeks. The CASC app includes features to maximize the therapeutic effect of pharmacological therapies and counseling at outpatient clinics for smoking cessation. The primary endpoint was a continuous abstinence rate (CAR) from weeks 9 to 24, whereas secondary endpoints were CARs from weeks 9 to 12 and 9 to 52. Results: Of the 56 adult smokers recruited, 1 did not download the app; therefore, 55 participants constituted the full analysis sample. The CAR from weeks 9 to 24 was 64% (35/55, 95% CI 51%-76%), whereas the CARs from weeks 9 to 12 and 9 to 52 were 76% (42/55, 95% CI 65%-88%) and 58% (32/55, 95% CI 46%-71%), respectively. These CARs were better than the results of the national survey on outpatient clinics with regard to smoking cessation under the National Health Insurance Program and that of the varenicline phase 3 trial in Japan and the United States. There was only 1 participant who dropped out during the 12 weeks of the treatment period. This treatment decreased the scores related to withdrawal and craving symptoms. Conclusions: The addition of CASC to usual smoking cessation therapies resulted in high CARs, high patient retention rates, and improvement of cessation-related symptoms. The smartphone app CASC is a feasible and useful tool to help long-term continuous abstinence that can be combined with a standard smoking cessation treatment program. %M 30777848 %R 10.2196/12694 %U http://mhealth.jmir.org/2019/2/e12694/ %U https://doi.org/10.2196/12694 %U http://www.ncbi.nlm.nih.gov/pubmed/30777848 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 2 %P e12252 %T A Novel Smoking Cessation Smartphone App Integrated With a Mobile Carbon Monoxide Checker for Smoking Cessation Treatment: Protocol for a Randomized Controlled Trial %A Nomura,Akihiro %A Tateno,Hiroki %A Masaki,Katsunori %A Muto,Tomoyasu %A Suzuki,Shin %A Satake,Kohta %A Hida,Eisuke %A Fukunaga,Koichi %+ Department of Internal Medicine, Saitama City Hospital, 2460 Mimuro, Midori-ward, Saitama, 3368522, Japan, 81 48 873 4111, hrk12tateno@me.com %K continuous abstinence rate %K nicotine dependence %K telemedicine %K randomized controlled trial %K smoking cessation %K tobacco use disorder %D 2019 %7 11.02.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking cessation treatment programs have been widely available for patients with nicotine dependence. Despite intensive programs, the continuous abstinence rate (CAR) from weeks 9-12 is still about 50%. Recently, a smartphone app emerged as a novel tool for therapeutic interventions, including nicotine dependence. In this study, we developed “CureApp Smoking Cessation” (CASC), which consists of a smartphone app for patients and a Web-based patient management software for doctors with a mobile carbon monoxide (CO) checking device to improve the efficacy of the smoking cessation treatment. Objective: This study aims to evaluate whether the CASC app is effective for individuals with nicotine dependence in addition to standard smoking cessation programs. Methods: This will be a randomized, sham-controlled, open-label, multicenter trial. We will recruit participants with nicotine dependence, but are otherwise healthy adults. We will randomize and allocate participants 1:1 to the CASC treatment group or a control app group. Both groups will receive a 12-week standard smoking cessation program with pharmacotherapy and counseling. In addition, participants in the treatment group will have the CASC app installed on their smartphone, which will provide video tutorials, advice from an artificial intelligence nurse, a digital diary, and measure daily exhaled CO concentration. In contrast, the control group will have the control app installed on their smartphone, where all the functions that can potentially effect smoking cessation are removed. The primary outcome will be the biochemically validated CAR from weeks 9-24. The success of smoking cessation will be defined as self-reported continuous abstinence from weeks 9-24 and exhaled CO concentration ≤10 ppm both at weeks 12 and 24. The main secondary outcomes will be the CAR from weeks 9-12, weeks 9-52, and 7-day point prevalence abstinence at weeks 4, 8, 12, 24, and 52. Results: We will recruit 580 participants with nicotine dependence from October 2017 to September 2018 or until the recruitment process is complete. The final 52-week follow-up will be completed in October 2019. We expect all trial results to be available by the end of 2019. The trial is funded by CureApp, Inc. Conclusions: This is the first randomized controlled trial to evaluate the efficacy of CASC. We expect that CASC, in addition to standard smoking cessation programs, has a significantly higher CAR during weeks 9-24 than the control app. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000031589; https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000033555 International Registered Report Identifier (IRRID): DERR1-10.2196/12252 %M 30741641 %R 10.2196/12252 %U http://www.researchprotocols.org/2019/2/e12252/ %U https://doi.org/10.2196/12252 %U http://www.ncbi.nlm.nih.gov/pubmed/30741641 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11953 %T The Messages Presented in Electronic Cigarette–Related Social Media Promotions and Discussion: Scoping Review %A McCausland,Kahlia %A Maycock,Bruce %A Leaver,Tama %A Jancey,Jonine %+ Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, 6102, Australia, 61 92667382 ext 7382, kahlia.mccausland@curtin.edu.au %K electronic nicotine delivery systems %K social media %K public health %K review %D 2019 %7 05.02.2019 %9 Review %J J Med Internet Res %G English %X Background: There has been a rapid rise in the popularity of electronic cigarettes (e-cigarettes) over the last decade, with growth predicted to continue. The uptake of these devices has escalated despite inconclusive evidence of their efficacy as a smoking cessation device and unknown long-term health consequences. As smoking rates continue to drop or plateau in many well-developed countries, transnational tobacco companies have transitioned into the vaping industry and are now using social media to promote their products. Evidence indicates e-cigarettes are being marketed on social media as a harm reduction alternative, with retailers and manufacturers utilizing marketing techniques historically used by the tobacco industry. Objective: This study aimed to identify and describe the messages presented in e-cigarette–related social media (Twitter, YouTube, Instagram, and Pinterest) promotions and discussions and identify future directions for research, surveillance, and regulation. Methods: Data sources included MEDLINE, Scopus, ProQuest, Informit, the Journal of Medical Internet Research, and Google Scholar. Included studies were published in English between 2007 and 2017, analyzed content captured from e-cigarette–related social media promotions or discussions, and reported results for e-cigarettes separately from other forms of tobacco and nicotine delivery. Database search ceased in October 2017. Initial searches identified 536 studies. Two reviewers screened studies by title and abstract. One reviewer examined 71 full-text articles to determine eligibility and identified 25 studies for inclusion. This process was undertaken with the assistance of the Web-based screening and data extraction tool—Covidence. The review was registered with the Joanna Briggs Institute (JBI) Systematic Reviews database and followed the methodology for JBI Scoping Reviews. Results: Several key messages are being used to promote e-cigarettes including as a safer alternative to cigarettes, efficacy as a smoking cessation aid, and for use where smoking is prohibited. Other major marketing efforts aimed at capturing a larger market involve promotion of innovative flavoring and highlighting the public performance of vaping. Discussion and promotion of these devices appear to be predominantly occurring among the general public and those with vested interests such as retailers and manufacturers. There is a noticeable silence from the public health and government sector in these discussions on social media. Conclusions: The social media landscape is dominated by pro-vaping messages disseminated by the vaping industry and vaping proponents. The uncertainty surrounding e-cigarette regulation expressed within the public health field appears not to be reflected in ongoing social media dialogues and highlights the need for public health professionals to interact with the public to actively influence social media conversations and create a more balanced discussion. With the vaping industry changing so rapidly, real-time monitoring and surveillance of how these devices are discussed, promoted, and used on social media is necessary in conjunction with evidence published in academic journals. %M 30720440 %R 10.2196/11953 %U https://www.jmir.org/2019/2/e11953/ %U https://doi.org/10.2196/11953 %U http://www.ncbi.nlm.nih.gov/pubmed/30720440 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 2 %P e12609 %T Initial Assessment of a Comprehensive Digital Smoking Cessation Program That Incorporates a Mobile App, Breath Sensor, and Coaching: Cohort Study %A Marler,Jennifer D %A Fujii,Craig A %A Utley,David S %A Tesfamariam,Lydia J %A Galanko,Joseph A %A Patrick,Heather %+ Carrot Inc, 1600 Seaport Blvd, Suite 150, Redwood City, CA, 94063, United States, 1 4157577696, marler@carrot.co %K smoking cessation %K mobile applications %K health promotion %K cell phone %D 2019 %7 04.02.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cigarette smoking is the leading cause of preventable morbidity and mortality, excess health care expenditure, and lost work productivity. Otherwise effective evidence-based treatments have had limited success owing to challenges with access, engagement, and scale. Pivot is a comprehensive digital smoking cessation program that incorporates a Food and Drug Administration–cleared carbon monoxide breath sensor, smartphone app, and text-based human coaching. Objective: This initial evaluation of Pivot aimed to assess participant engagement, changes in attitudes toward quitting, and changes in smoking behavior. Methods: US cigarette smokers aged 18 to 65 years who smoked ≥5 cigarettes per day (CPD) were recruited online. Participants completed a screening call, electronic informed consent, registration, and onboarding before beginning Pivot. Pivot includes 5 sequential stages (Explore, Build, Mobilize, Quit, and Secure), taking 14.5 to 18.5 weeks to complete. Data were collected via app and online questionnaires. Outcomes included engagement and retention (ie, weeks of active engagement and Pivot stage progression); attitudes toward quitting (ie, quit readiness, quit confidence, and expected difficulty maintaining quit); and smoking behavior (ie, quit attempts, cigarette reduction, and abstinence (7- and 30-day point prevalence abstinence [PPA]). Results: A total of 319 participants completed onboarding (intention-to-treat [ITT] sample); 272/319 participants (85.3%) completed the end-of-Pivot questionnaire (study completer sample). Most (212/319, 66.5%) were not ready to quit in the next 30 days at baseline. On average, participants actively engaged in the program for a mean 12.4 (SD 7.1) weeks. Pivot stage completion rates were Explore: 88.7% (283/319), Build: 57.4% (183/319), Mobilize: 43.6% (139/319), Quit: 41.1% (131/319), and Secure: 39.5% (126/319). Repeated measures linear mixed model analyses demonstrated positive changes in attitudes from baseline to Mobilize (pre-Quit): increased confidence to quit (4.2 to 7.4, P<.001) and decreased expected difficulty maintaining quit (3.1 to 6.8, P<.001). The quit attempt rate (ie, those making ≥1 quit attempt lasting ≥1 day) was 79.4% (216/272, completer). At the end of Pivot, 7-day PPA rates were 32.0% (102/319, ITT) and 37.5% (102/272, completer); 30-day PPA rates were 27.6% (88/319, ITT) and 32.4% (88/272, completer). Moreover, 30-day PPA rates were comparable among those ready and not ready to quit in the next 30 days at baseline. Of those not achieving abstinence, 25.9% (44/170, completer) achieved ≥50% reduction in CPD by study end. Conclusions: This study evaluated Pivot’s initial performance with comparable quit rates among those ready and not ready to quit in the next 30 days at entry. The present data, considered with the program’s accessibility, innovation, evidence-based foundation, and design for all smokers, suggest Pivot has the potential to address limitations of reach and scale and thereby advance smoking cessation efforts. Trial Registration: ClinicalTrials.gov NCT03295643; https://clinicaltrials.gov/ct2/show/NCT03295643 (Archived by WebCite at http://www.webcitation.org/75TiNe6BE). %M 30670372 %R 10.2196/12609 %U http://mhealth.jmir.org/2019/2/e12609/ %U https://doi.org/10.2196/12609 %U http://www.ncbi.nlm.nih.gov/pubmed/30670372 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11954 %T Exploring Community Smokers’ Perspectives for Developing a Chat-Based Smoking Cessation Intervention Delivered Through Mobile Instant Messaging: Qualitative Study %A Luk,Tzu Tsun %A Wong,Sze Wing %A Lee,Jung Jae %A Chan,Sophia Siu-Chee %A Lam,Tai Hing %A Wang,Man Ping %+ School of Nursing, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong,, China (Hong Kong), 852 39176636, mpwang@hku.hk %K chat intervention %K instant messaging %K mHealth %K mobile phone %K social media %K smoking cessation %K tobacco dependence %K WhatsApp %D 2019 %7 31.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advances in mobile communication technologies provide a promising avenue for the delivery of tobacco dependence treatment. Although mobile instant messaging (IM) apps (eg, WhatsApp, Facebook messenger, and WeChat) are an inexpensive and widely used communication tool, evidence on its use for promoting health behavior, including smoking cessation, is scarce. Objective: This study aims to explore the perception of using mobile IM as a modality to deliver a proposed chat intervention for smoking cessation in community smokers in Hong Kong, where the proportion of smartphone use is among the highest in the world. Methods: We conducted 5 focus group, semistructured qualitative interviews on a purposive sample of 15 male and 6 female current cigarette smokers (age 23-68 years) recruited from the community in Hong Kong. All interviews were audiotaped and transcribed. Two investigators independently analyzed the transcripts using thematic analyses. Results: Participants considered mobile IM as a feasible and acceptable platform for the delivery of a supportive smoking cessation intervention. The ability to provide more personalized and adaptive behavioral support was regarded as the most valued utility of the IM–based intervention. Other perceived utilities included improved perceived psychosocial support and identification of motivator to quit. In addition, participants provided suggestions on the content and design of the intervention, which may improve the acceptability and usability of the IM–based intervention. These include avoiding health warning information, positive messaging, using former smokers as counselors, and adjusting the language style (spoken vs written) according to the recipients’ preference. Conclusions: This qualitative study provides the first evidence that mobile IM may be an alternative mobile health platform for the delivery of a smoking cessation intervention. Furthermore, the findings inform the development of a chat-based, IM smoking cessation program being evaluated in a community trial. %M 30702431 %R 10.2196/11954 %U https://mhealth.jmir.org/2019/1/e11954/ %U https://doi.org/10.2196/11954 %U http://www.ncbi.nlm.nih.gov/pubmed/30702431 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 1 %P e12414 %T Data Analysis and Visualization of Newspaper Articles on Thirdhand Smoke: A Topic Modeling Approach %A Liu,Qian %A Chen,Qiuyi %A Shen,Jiayi %A Wu,Huailiang %A Sun,Yimeng %A Ming,Wai-Kit %+ Department of Obstetrics & Gynaecology, The First Affiliated Hospital, Sun Yat-sen University, 58 Zhongshan 2nd Rd, Guangzhou,, China, 86 14715485116, wkming@connect.hku.hk %K media concerns %K topic modeling %K third-hand smoke %K tobacco %K indoor air quality %D 2019 %7 29.01.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: Thirdhand smoke has been a growing topic for years in China. Thirdhand smoke (THS) consists of residual tobacco smoke pollutants that remain on surfaces and in dust. These pollutants are re-emitted as a gas or react with oxidants and other compounds in the environment to yield secondary pollutants. Objective: Collecting media reports on THS from major media outlets and analyzing this subject using topic modeling can facilitate a better understanding of the role that the media plays in communicating this health issue to the public. Methods: The data were retrieved from the Wiser and Factiva news databases. A preliminary investigation focused on articles dated between January 1, 2013, and December 31, 2017. Use of Latent Dirichlet Allocation yielded the top 10 topics about THS. The use of the modified LDAvis tool enabled an overall view of the topic model, which visualizes different topics as circles. Multidimensional scaling was used to represent the intertopic distances on a two-dimensional plane. Results: We found 745 articles dated between January 1, 2013, and December 31, 2017. The United States ranked first in terms of publications (152 articles on THS from 2013-2017). We found 279 news reports about THS from the Chinese media over the same period and 363 news reports from the United States. Given our analysis of the percentage of news related to THS in China, Topic 1 (Cancer) was the most popular among the topics and was mentioned in 31.9% of all news stories. Topic 2 (Control of quitting smoking) was related to roughly 15% of news items on THS. Conclusions: Data analysis and the visualization of news articles can generate useful information. Our study shows that topic modeling can offer insights into understanding news reports related to THS. This analysis of media trends indicated that related diseases, air and particulate matter (PM2.5), and control and restrictions are the major concerns of the Chinese media reporting on THS. The Chinese press still needs to consider fuller reports on THS based on scientific evidence and with less focus on sensational headlines. We recommend that additional studies be conducted related to sentiment analysis of news data to verify and measure the influence of THS-related topics. %M 30694199 %R 10.2196/12414 %U http://medinform.jmir.org/2019/1/e12414/ %U https://doi.org/10.2196/12414 %U http://www.ncbi.nlm.nih.gov/pubmed/30694199 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e10071 %T The QuitIT Coping Skills Game for Promoting Tobacco Cessation Among Smokers Diagnosed With Cancer: Pilot Randomized Controlled Trial %A Krebs,Paul %A Burkhalter,Jack %A Fiske,Jeffrey %A Snow,Herbert %A Schofield,Elizabeth %A Iocolano,Michelle %A Borderud,Sarah %A Ostroff,Jamie S %+ Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, United States, 1 6465012637, Paul.Krebs@nyumc.org %K tobacco %K cancer %K mHealth %K app %K mobile phone %D 2019 %7 10.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although smoking cessation apps have become popular, few have been tested in randomized clinical trials or undergone formative evaluation with target users. Objective: We developed a cessation app targeting tobacco-dependent cancer patients. Game design and behavioral rehearsal principles were incorporated to help smokers identify, model, and practice coping strategies to avoid relapse to smoking. In this randomized pilot trial, we examined feasibility (recruitment and retention rates), acceptability (patient satisfaction), quitting self-confidence, and other cessation-related indices to guide the development of a larger trial. Methods: We randomized 42 English-speaking cancer patients scheduled for surgical treatment to either the Standard Care (SC; telecounseling and cessation pharmacotherapies) or the experimental QuitIT study arm (SC and QuitIT game). Gameplay parameters were captured in-game; satisfaction with the game was assessed at 1-month follow-up. We report study screening, exclusion, and refusal reasons; compare refusal and attrition by key demographic and clinical variables; and report tobacco-related outcomes. Results: Follow-up data were collected from 65% (13/20) patients in the QuitIT and 61% (11/18) in SC arms. Study enrollees were 71% (27/38) females, 92% (35/38) white people, and 95% (36/38) non-Hispanic people. Most had either lung (12/38, 32%) or gastrointestinal (9/38, 24%) cancer. Those dropping out were less likely than completers to have used a tablet (P<.01) and have played the game at all (P=.02) and more likely to be older (P=.05). Of 20 patients in the QuitIT arm, 40% (8/20) played the game (system data). There were no differences between those who played and did not play by demographic, clinical, technology use, and tobacco-related variables. Users completed an average of 2.5 (SD 4.0) episodes out of 10. A nonsignificant trend was found for increased confidence to quit in the QuitIT arm (d=0.25, 95% CI −0.56 to 1.06), and more participants were abstinent in the QuitIT group than in the SC arm (4/13, 30%, vs 2/11, 18%). Satisfaction with gameplay was largely positive, with most respondents enjoying use, relating to the characters, and endorsing that gameplay helped them cope with actual smoking urges. Conclusions: Recruitment and retention difficulties suggest that the perihospitalization period may be a less than ideal time for delivering a smoking cessation app intervention. Framing of the app as a “game” may have decreased receptivity as participants may have been preoccupied with hospitalization demands and illness concerns. Less tablet experience and older age were associated with participant dropout. Although satisfaction with the gameplay was high, 60% (12/20) of QuitIT participants did not play the game. Paying more attention to patient engagement, changing the intervention delivery period, providing additional reward and support for use, and improving cessation app training may bolster feasibility for a larger trial. Trial Registration: ClinicalTrials.gov NCT01915836; https://clinicaltrials.gov/ct2/show/NCT01915836 (Archived by WebCite at http://www.webcitation.org/73vGsjG0Y) %M 30632971 %R 10.2196/10071 %U http://mhealth.jmir.org/2019/1/e10071/ %U https://doi.org/10.2196/10071 %U http://www.ncbi.nlm.nih.gov/pubmed/30632971 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11246 %T Text Messaging to Enhance Mindfulness-Based Smoking Cessation Treatment: Program Development Through Qualitative Research %A Spears,Claire A %A Bell,Sharrill A %A Scarlett,Charlayne A %A Anderson,Natalie K %A Cottrell-Daniels,Cherell %A Lotfalian,Sadaf %A Bandlamudi,Maitreyi %A Grant,Amanda %A Sigurdardottir,Anna %A Carter,Brittani P %A Abroms,Lorien C %A Wetter,David W %+ Division of Health Promotion and Behavior, Georgia State University School of Public Health, 140 Decatur Street SE, Suite 612, Atlanta, GA, United States, 1 404 413 9335, cspears@gsu.edu %K mobile phone %K low socioeconomic status %K qualitative %K short message service text messaging %K smoking cessation %D 2019 %7 07.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mindfulness-based programs show promise for promoting smoking cessation in diverse populations. Mobile health strategies could increase treatment engagement and in-the-moment support, thus enhancing the effects of mindfulness-based smoking cessation interventions. However, most mobile health programs have been developed without sufficient input from the target population. Objective: By eliciting input from the target population, predominantly low socioeconomic status (SES) African American adult smokers, throughout the development of an SMS (short message service) text messaging program that teaches mindfulness for smoking cessation, we aimed for the resulting program to be optimally effective and consistent with participants’ needs and preferences. Methods: Two qualitative studies (N=25) were conducted with predominantly low SES, African American adult smokers. In Study 1 (initial qualitative input; n=15), participants engaged in focus groups to provide suggestions for program development. In Study 2 (abbreviated trial; n=10), participants received a 1-week version of the SMS text messaging program and provided feedback through in-depth interviews. Results: In Study 1, participants suggested that the SMS text messaging program should be personalized and interactive (ie, involve two-way messaging); provide strategies for coping with cravings and recovering from smoking lapses; involve relatively short, to-the-point messages; and include pictures. In Study 2, participants were highly engaged with the texts, indicated that the program was useful, and provided additional suggestions for improvement. Conclusions: Eliciting feedback from the target population throughout the intervention development process allowed for iterative revisions to increase feasibility, acceptability, and effectiveness. Overall, SMS text messaging appears to be a feasible, appealing way to provide in-the-moment personalized support and encourage mindfulness among low-income African American smokers. %M 30617043 %R 10.2196/11246 %U https://mhealth.jmir.org/2019/1/e11246/ %U https://doi.org/10.2196/11246 %U http://www.ncbi.nlm.nih.gov/pubmed/30617043 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e203 %T Comparison of mHealth and Face-to-Face Interventions for Smoking Cessation Among People Living With HIV: Meta-Analysis %A Uthman,Olalekan A %A Nduka,Chidozie U %A Abba,Mustapha %A Enriquez,Rocio %A Nordenstedt,Helena %A Nalugoda,Fred %A Kengne,Andre P %A Ekström,Anna M %+ Warwick-Centre for Applied Health Research and Delivery, Division of Health Sciences, University Warwick, Gibbet Hill campus, Coventry, CV4 7AL, United Kingdom, 44 2476573163, olalekan.uthman@warwick.ac.uk %K HIV %K mHealth %K smoking cessation %D 2019 %7 07.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The prevalence of smoking among people living with HIV (PLHIV) is higher than that reported in the general population, and it is a significant risk factor for noncommunicable diseases in this group. Mobile phone interventions to promote healthier behaviors (mobile health, mHealth) have the potential to reach a large number of people at a low cost. It has been hypothesized that mHealth interventions may not be as effective as face-to-face strategies in achieving smoking cessation, but there is no systematic evidence to support this, especially among PLHIV. Objective: This study aimed to compare two modes of intervention delivery (mHealth vs face-to-face) for smoking cessation among PLHIV. Methods: Literature on randomized controlled trials (RCTs) investigating effects of mHealth or face-to-face intervention strategies on short-term (4 weeks to <6 months) and long-term (≥6 months) smoking abstinence among PLHIV was sought. We systematically reviewed relevant RCTs and conducted pairwise meta-analyses to estimate relative treatment effects of mHealth and face-to-face interventions using standard care as comparison. Given the absence of head-to-head trials comparing mHealth with face-to-face interventions, we performed adjusted indirect comparison meta-analyses to compare these interventions. Results: A total of 10 studies involving 1772 PLHIV met the inclusion criteria. The average age of the study population was 45 years, and women comprised about 37%. In the short term, mHealth-delivered interventions were significantly more efficacious in increasing smoking cessation than no intervention control (risk ratio, RR, 2.81, 95% CI 1.44-5.49; n=726) and face-to-face interventions (RR 2.31, 95% CI 1.13-4.72; n=726). In the short term, face-to-face interventions were no more effective than no intervention in increasing smoking cessation (RR 1.22, 95% CI 0.94-1.58; n=1144). In terms of achieving long-term results among PLHIV, there was no significant difference in the rates of smoking cessation between those who received mHealth-delivered interventions, face-to-face interventions, or no intervention. Trial sequential analysis showed that only 15.16% (726/1304) and 5.56% (632/11,364) of the required information sizes were accrued to accept or reject a 25% relative risk reduction for short- and long-term smoking cessation treatment effects. In addition, sequential monitoring boundaries were not crossed, indicating that the cumulative evidence may be unreliable and inconclusive. Conclusions: Compared with face-to-face interventions, mHealth-delivered interventions can better increase smoking cessation rate in the short term. The evidence that mHealth increases smoking cessation rate in the short term is encouraging but not sufficient to allow a definitive conclusion presently. Future research should focus on strategies for sustaining smoking cessation treatment effects among PLHIV in the long term. %M 30617044 %R 10.2196/mhealth.9329 %U https://mhealth.jmir.org/2019/1/e203/ %U https://doi.org/10.2196/mhealth.9329 %U http://www.ncbi.nlm.nih.gov/pubmed/30617044 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11071 %T Coping Strategies and Social Support in a Mobile Phone Chat App Designed to Support Smoking Cessation: Qualitative Analysis %A Granado-Font,Esther %A Ferré-Grau,Carme %A Rey-Reñones,Cristina %A Pons-Vigués,Mariona %A Pujol Ribera,Enriqueta %A Berenguera,Anna %A Barrera-Uriarte,Maria Luisa %A Basora,Josep %A Valverde-Trillo,Araceli %A Duch,Jordi %A Flores-Mateo,Gemma %+ Institut Català de la Salut, Unitat de Suport a la Recerca Tarragona-Reus, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Camí de Riudoms, 53-55, Reus, 43202, Spain, 34 977778515, crey.tgn.ics@gencat.cat %K primary health care %K qualitative research %K mobile apps %K smoking cessation %K social support %K psychological adaptation %D 2018 %7 20.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking is one of the most significant factors contributing to low life expectancy, health inequalities, and illness at the worldwide scale. Smoking cessation attempts benefit from social support. Mobile phones have changed the way we communicate through the use of freely available message-oriented apps. Mobile app–based interventions for smoking cessation programs can provide interactive, supportive, and individually tailored interventions. Objective: This study aimed to identify emotions, coping strategies, beliefs, values, and cognitive evaluations of smokers who are in the process of quitting, and to analyze online social support provided through the analysis of messages posted to a chat function integrated into a mobile app. Methods: In this descriptive qualitative study, informants were smokers who participated in the chat of Tobbstop. The technique to generate information was documentary through messages collected from September 2014 through June 2016, specifically designed to support a smoking cessation intervention. A thematic content analysis of the messages applied 2 conceptual models: the Lazarus and Folkman model to assess participant’s experiences and perceptions and the Cutrona model to evaluate online social support. Results: During the study period, 11,788 text messages were posted to the chat by 101 users. The most frequent messages offered information and emotional support, and all the basic emotions were reported in the chat. The 3 most frequent coping strategies identified were physical activity, different types of treatment such as nicotine replacement, and humor. Beliefs about quitting smoking included the inevitability of weight gain and the notion that not using any type of medications is better for smoking cessation. Health and family were the values more frequently described, followed by freedom. A smoke-free environment was perceived as important to successful smoking cessation. The social support group that was developed with the app offered mainly emotional and informational support. Conclusions: Our analysis suggests that a chat integrated into a mobile app focused on supporting smoking cessation provides a useful tool for smokers who are in the process of quitting, by offering social support and a space to share concerns, information, or strategies. %M 30573445 %R 10.2196/11071 %U http://mhealth.jmir.org/2018/12/e11071/ %U https://doi.org/10.2196/11071 %U http://www.ncbi.nlm.nih.gov/pubmed/30573445 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 12 %P e11708 %T A Comprehensive Digital Program for Smoking Cessation: Assessing Feasibility in a Single-Group Cohort Study %A Patrick,Heather %A Fujii,Craig A %A Glaser,Debra B %A Utley,David S %A Marler,Jennifer D %+ Carrot Inc, 1600 Seaport Boulevard, Suite 150, Redwood City, CA, 94063, United States, 1 650 216 9689, heather@carrot.co %K smoking cessation %K cell phone %K health promotion %K carbon monoxide %D 2018 %7 18.12.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cigarette smoking remains the leading cause of preventable death and disease worldwide. Evidence-based approaches are available, but few people access them. Although digital solutions offer great promise for population reach, few multicomponent programs exist. Pivot is a comprehensive digital solution combining a Food and Drug Administration–cleared carbon monoxide (CO) breath sensor; cigarette logging; a 6-phase, app-delivered smoking cessation program based on the US Clinical Practice Guidelines; and dedicated human coaching via text-based chat. Objective: The purpose of this study was to assess program engagement, changes in attitudes toward smoking, self-reported changes in smoking behavior, and program acceptability for the initial phase of Pivot: Explore. Methods: A total of 48 participants enrolled, and 41 completed the study. About half the participants (54%, 22/41) were men, and the mean age was 43 years. Most (85%, 35/41) were daily smokers and smoked an average of 12 cigarettes per day. Explore includes CO breath sensing, logging cigarettes in-app, learning via in-app activities, and dedicated human coaching through a text messaging interface. Participants completed surveys at baseline and exit assessing attitudes toward quitting including readiness, perceived difficulty, and confidence in quit success. At exit, participants also completed a survey of changes in smoking behavior and ratings of program acceptability. Results: More than 80% of participants (34-39 of 41) took ≥1 CO breath sample each day, and more than 55% (23-27 of 41) took ≥5 samples each day. More than 65% of participants (27-34 of 41) logged ≥1 cigarette using the in-app logging feature each day. All 9 in-app activities had completion rates ≥80% (33-40 of 41). Response to coach-initiated outreach was also high, with all contacts receiving ≥73% (30-39 of 41) response. In matched pair analyses, significant positive changes in mean attitudes toward quitting (scale 1-10) were evident from baseline (T1) to study exit (T2), including increased readiness to quit (T1 mean=6.1, T2 mean=7.4, P=.005), lower perceived difficulty (T1 mean=3.7, T2 mean=5.6, P=.001), and greater expectations of success (T1 mean=4.5, T2 mean=6.5, P<.001). At exit, 78% (32/41) of participants reported decreasing the number of cigarettes smoked per day during the study. Participants rated program quality and satisfaction very high (mean ≥8 for all items). Conclusions: These results support the feasibility and acceptability of the initial 9-day phase of Pivot: Explore. Participants had high levels of engagement with sensing, logging, learning, and coaching. Attitudes toward quitting improved significantly, and the majority of users indicated decreasing smoking behavior. Explore was designed to raise smoker awareness and motivation. Additional research is underway to assess how users progress through the full Pivot smoking cessation program and determine the program’s effectiveness for achieving sustained cessation. %M 30563807 %R 10.2196/11708 %U https://mhealth.jmir.org/2018/12/e11708/ %U https://doi.org/10.2196/11708 %U http://www.ncbi.nlm.nih.gov/pubmed/30563807 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 12 %P e12464 %T Using the Social-Local-Mobile App for Smoking Cessation in the SmokeFreeBrain Project: Protocol for a Randomized Controlled Trial %A Jódar-Sánchez,Francisco %A Carrasco Hernández,Laura %A Núñez-Benjumea,Francisco J %A Mesa González,Marco Antonio %A Moreno Conde,Jesús %A Parra Calderón,Carlos Luis %A Fernandez-Luque,Luis %A Hors-Fraile,Santiago %A Civit,Anton %A Bamidis,Panagiotis %A Ortega-Ruiz,Francisco %+ Research and Innovation Group in Biomedical Informatics, Biomedical Engineering and Health Economy, Institute of Biomedicine of Seville, Virgen del Rocío University Hospital / Spanish National Research Council / University of Seville, Avenida Manuel Siurot, s/n, Centro de Documentación Clínica Avanzada, Virgen del Rocío University Hospital, Seville, 41013, Spain, 34 955013616, francisco.nunez.exts@juntadeandalucia.es %K smoking cessation %K mobile applications %K randomized controlled trial %K economic evaluation %D 2018 %7 06.12.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking is considered the main cause of preventable illness and early deaths worldwide. The treatment usually prescribed to people who wish to quit smoking is a multidisciplinary intervention, combining both psychological advice and pharmacological therapy, since the application of both strategies significantly increases the chance of success in a quit attempt. Objective: We present a study protocol of a 12-month randomized open-label parallel-group trial whose primary objective is to analyze the efficacy and efficiency of usual psychopharmacological therapy plus the Social-Local-Mobile app (intervention group) applied to the smoking cessation process compared with usual psychopharmacological therapy alone (control group). Methods: The target population consists of adult smokers (both male and female) attending the Smoking Cessation Unit at Virgen del Rocío University Hospital, Seville, Spain. Social-Local-Mobile is an innovative intervention based on mobile technologies and their capacity to trigger behavioral changes. The app is a complement to pharmacological therapies to quit smoking by providing personalized motivational messages, physical activity monitoring, lifestyle advice, and distractions (minigames) to help overcome cravings. Usual pharmacological therapy consists of bupropion (Zyntabac 150 mg) or varenicline (Champix 0.5 mg or 1 mg). The main outcomes will be (1) the smoking abstinence rate at 1 year measured by means of exhaled carbon monoxide and urinary cotinine tests, and (2) the result of the cost-effectiveness analysis, which will be expressed in terms of an incremental cost-effectiveness ratio. Secondary outcome measures will be (1) analysis of the safety of pharmacological therapy, (2) analysis of the health-related quality of life of patients, and (3) monitoring of healthy lifestyle and physical exercise habits. Results: Of 548 patients identified using the hospital’s electronic records system, we excluded 308 patients: 188 declined to participate and 120 did not meet the inclusion criteria. A total of 240 patients were enrolled: the control group (n=120) will receive usual psychopharmacological therapy, while the intervention group (n=120) will receive usual psychopharmacological therapy plus the So-Lo-Mo app. The project was approved for funding in June 2015. Enrollment started in October 2016 and was completed in October 2017. Data gathering was completed in November 2018, and data analysis is under way. The first results are expected to be submitted for publication in early 2019. Conclusions: Social networks and mobile technologies influence our daily lives and, therefore, may influence our smoking habits as well. As part of the SmokeFreeBrain H2020 European Commission project, this study aims at elucidating the potential role of these technologies when used as an extra aid to quit smoking. Trial Registration: ClinicalTrials.gov NCT03553173; https://clinicaltrials.gov/ct2/show/record/NCT03553173 (Archived by WebCite at http://www.webcitation.org/74DuHypOW). International Registered Report Identifier (IRRID): PRR1-10.2196/12464 %M 30522992 %R 10.2196/12464 %U http://www.researchprotocols.org/2018/12/e12464/ %U https://doi.org/10.2196/12464 %U http://www.ncbi.nlm.nih.gov/pubmed/30522992 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 4 %P e10252 %T Creating a Theoretically Grounded, Gamified Health App: Lessons From Developing the Cigbreak Smoking Cessation Mobile Phone Game %A Edwards,Elizabeth A %A Caton,Hope %A Lumsden,Jim %A Rivas,Carol %A Steed,Liz %A Pirunsarn,Yutthana %A Jumbe,Sandra %A Newby,Chris %A Shenvi,Aditi %A Mazumdar,Samaresh %A Smith,Jim Q %A Greenhill,Darrel %A Griffiths,Chris J %A Walton,Robert T %+ Centre for Primary Care and Public Health, Blizard Institute, Bart’s and The London School of Medicine and Dentistry, Queen Mary University of London, 58 Turner Street, London, E1 2AB, United Kingdom, 44 020 7882 2498, dr.elizabeth.ann.edwards@gmail.com %K smoking cessation %K health behaviors %K behavioral medicine %K games for health %K mHealth %K eHealth %D 2018 %7 29.11.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Gaming techniques are increasingly recognized as effective methods for changing behavior and increasing user engagement with mobile phone apps. The rapid uptake of mobile phone games provides an unprecedented opportunity to reach large numbers of people and to influence a wide range of health-related behaviors. However, digital interventions are still nascent in the field of health care, and optimum gamified methods of achieving health behavior change are still being investigated. There is currently a lack of worked methodologies that app developers and health care professionals can follow to facilitate theoretically informed design of gamified health apps. Objective: This study aimed to present a series of steps undertaken during the development of Cigbreak, a gamified smoking cessation health app. Methods: A systematic and iterative approach was adopted by (1) forming an expert multidisciplinary design team, (2) defining the problem and establishing user preferences, (3) incorporating the evidence base, (4) integrating gamification, (5) adding behavior change techniques, (6) forming a logic model, and (7) user testing. A total of 10 focus groups were conducted with 73 smokers. Results: Users found the app an engaging and motivating way to gain smoking cessation advice and a helpful distraction from smoking; 84% (62/73) of smokers said they would play again and recommend it to a friend. Conclusions: A dedicated gamified app to promote smoking cessation has the potential to modify smoking behavior and to deliver effective smoking cessation advice. Iterative, collaborative development using evidence-based behavior change techniques and gamification may help to make the game engaging and potentially effective. Gamified health apps developed in this way may have the potential to provide effective and low-cost health interventions in a wide range of clinical settings. %M 30497994 %R 10.2196/10252 %U http://games.jmir.org/2018/4/e10252/ %U https://doi.org/10.2196/10252 %U http://www.ncbi.nlm.nih.gov/pubmed/30497994 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 11 %P e10513 %T Automated Identification of Hookahs (Waterpipes) on Instagram: An Application in Feature Extraction Using Convolutional Neural Network and Support Vector Machine Classification %A Zhang,Youshan %A Allem,Jon-Patrick %A Unger,Jennifer Beth %A Boley Cruz,Tess %+ Keck School of Medicine of USC, 2001 N Soto Street, 3rd Floor Mail, Los Angeles, CA, 90032, United States, 1 8586030812, allem@usc.edu %K convolutional neural network %K feature extraction %K image classification %K Instagram %K social media %K support vector machine %D 2018 %7 21.11.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Instagram, with millions of posts per day, can be used to inform public health surveillance targets and policies. However, current research relying on image-based data often relies on hand coding of images, which is time-consuming and costly, ultimately limiting the scope of the study. Current best practices in automated image classification (eg, support vector machine (SVM), backpropagation neural network, and artificial neural network) are limited in their capacity to accurately distinguish between objects within images. Objective: This study aimed to demonstrate how a convolutional neural network (CNN) can be used to extract unique features within an image and how SVM can then be used to classify the image. Methods: Images of waterpipes or hookah (an emerging tobacco product possessing similar harms to that of cigarettes) were collected from Instagram and used in the analyses (N=840). A CNN was used to extract unique features from images identified to contain waterpipes. An SVM classifier was built to distinguish between images with and without waterpipes. Methods for image classification were then compared to show how a CNN+SVM classifier could improve accuracy. Results: As the number of validated training images increased, the total number of extracted features increased. In addition, as the number of features learned by the SVM classifier increased, the average level of accuracy increased. Overall, 99.5% (418/420) of images classified were correctly identified as either hookah or nonhookah images. This level of accuracy was an improvement over earlier methods that used SVM, CNN, or bag-of-features alone. Conclusions: A CNN extracts more features of images, allowing an SVM classifier to be better informed, resulting in higher accuracy compared with methods that extract fewer features. Future research can use this method to grow the scope of image-based studies. The methods presented here might help detect increases in the popularity of certain tobacco products over time on social media. By taking images of waterpipes from Instagram, we place our methods in a context that can be utilized to inform health researchers analyzing social media to understand user experience with emerging tobacco products and inform public health surveillance targets and policies. %M 30452385 %R 10.2196/10513 %U http://www.jmir.org/2018/11/e10513/ %U https://doi.org/10.2196/10513 %U http://www.ncbi.nlm.nih.gov/pubmed/30452385 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 11 %P e11669 %T Hookah-Related Posts to Twitter From 2017 to 2018: Thematic Analysis %A Allem,Jon-Patrick %A Dharmapuri,Likhit %A Leventhal,Adam M %A Unger,Jennifer B %A Boley Cruz,Tess %+ Keck School of Medicine of University of Southern California, 2001 North Soto Street, Los Angeles, CA, 90032, United States, 1 8586030812, allem@usc.edu %K hookah %K waterpipe %K Twitter %K social media %K nicotine %K flavors %K social smoking %K infodemiology %D 2018 %7 19.11.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Hookah (or tobacco waterpipe) use has recently become prevalent in the United States. The contexts and experiences associated with hookah use are unclear, yet such information is abundant via publicly available hookah users’ social media postings. Objective: In this study, we utilized Twitter data to characterize Twitter users’ recent experiences with hookah. Methods: Twitter posts containing the term “hookah” were obtained from April 1, 2017 to 29 March, 2018. Text classifiers were used to identify clusters of topics that tended to co-occur in posts (n=176,706). Results: The most prevalent topic cluster was Person Tagging (use of @username to tag another Twitter account in a post) at 21.58% (38,137/176,706) followed by Promotional or Social Events (eg, mentions of ladies’ nights, parties, etc) at 20.20% (35,701/176,706) and Appeal or Abuse Liability (eg, craving, enjoying hookah) at 18.12% (32,013/176,706). Additional topics included Hookah Use Behavior (eg, mentions of taking a “hit” of hookah) at 11.67% (20,603/176,706), Polysubstance Use (eg, hookah use along with other substances) at 10.95% (19,353/176,706), Buying or Selling (eg, buy, order, purchase, sell) at 9.37% (16,552/176,706), and Flavors (eg, mint, cinnamon, watermelon) at 1.66% (2927/176,706). The topic Dislike of Hookah (eg, hate, quit, dislike) was rare at 0.59% (1043/176,706). Conclusions: Social events, appeal or abuse liability, flavors, and polysubstance use were the common contexts and experiences associated with Twitter discussions about hookah in 2017-2018. Considered in concert with traditional data sources about hookah, these results suggest that social events, appeal or abuse liability, flavors, and polysubstance use warrant consideration as targets in future surveillance, policy making, and interventions addressing hookah. %M 30455162 %R 10.2196/11669 %U http://www.jmir.org/2018/11/e11669/ %U https://doi.org/10.2196/11669 %U http://www.ncbi.nlm.nih.gov/pubmed/30455162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e11668 %T Geographic Representativeness of a Web-Based Smoking Cessation Intervention: Reach Equity Analysis %A Amato,Michael S %A Graham,Amanda L %+ Schroeder Institute, Truth Initiative, 900 G Street NW, Fourth Floor, Washington, DC, 20001, United States, 1 202 454 5767, mamato@truthinitiative.org %K smoking cessation %K health behavior %K internet %K population health %K rural health %K urban health %K health equity %K telemedicine %D 2018 %7 24.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Cigarette smoking is the leading cause of preventable death and disease in the United States. Smoking prevalence is higher in rural areas than in metropolitan areas, due partly to differences in access to cessation treatment. With internet use at 89% of all US adults, digital approaches could increase use of cessation treatment and reduce smoking. Objective: We investigated the extent to which smokers from rural areas use a digital cessation resource. We compared the geographic distribution of registered users of a free Web-based smoking cessation program with the geographic distribution of US smokers. Methods: We mapped user-provided ZIP codes to Rural-Urban Continuum Codes. A total of 59,050 of 118,574 users (49.80%) provided valid ZIP codes from 2013 to 2017. We used US National Survey of Drug Use and Health data from 2013 to 2017 to compare the geographic distribution of our sample of Web-based cessation users with the geographic distribution of US smokers. Reach ratios and 95% confidence intervals quantified the extent to which rural smokers’ representation in the sample was proportionate to their representation in the national smoking population. Reach ratios less than 1 indicate underrepresentation. Results: Smokers from rural areas were significantly underrepresented in 2013 (reach ratio 0.89, 95% CI 0.87-0.91) and 2014 (reach ratio 0.89, 95% CI 0.86-0.92), proportionally represented in 2015 (reach ratio 1.08, 95% CI 1.02-1.14) and 2016 (reach ratio 1.03, 95% CI 0.94-1.14), and proportionally overrepresented in 2017 (reach ratio 1.16, 95% CI 1.12-1.21). Smokers from Large Metro areas were proportionally represented in 2013 and 2014 but underrepresented in 2015 (reach ratio 0.97, 95% CI 0.94-1.00), 2016 (reach ratio 0.89, 95% CI 0.85-0.94), and 2017 (reach ratio 0.89, 95% CI 0.86-0.91). Conclusions: Results suggest that smokers from rural areas are more than proportionally reached by a long-standing digital cessation intervention. The underrepresentation of smokers from Large Metro areas warrants further study. %M 30355557 %R 10.2196/11668 %U http://www.jmir.org/2018/10/e11668/ %U https://doi.org/10.2196/11668 %U http://www.ncbi.nlm.nih.gov/pubmed/30355557 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e10893 %T Effect of a Mobile Phone Intervention on Quitting Smoking in a Young Adult Population of Smokers: Randomized Controlled Trial %A Baskerville,Neill Bruce %A Struik,Laura Louise %A Guindon,Godefroy Emmanuel %A Norman,Cameron D %A Whittaker,Robyn %A Burns,Catherine %A Hammond,David %A Dash,Darly %A Brown,K Stephen %+ Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L3G1, Canada, 1 518 888 4567 ext 35236, neill.baskerville@gmail.com %K health behavior %K smoking cessation %K young adult %K mobile phone %K mHealth %K randomized controlled trial %D 2018 %7 23.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital mobile technology presents a promising medium for reaching young adults with smoking cessation interventions because they are the heaviest users of this technology. Objective: The aim of this study was to determine the efficacy of an evidence-informed smartphone app for smoking cessation, Crush the Crave (CTC), on reducing smoking prevalence among young adult smokers in comparison with an evidence-informed self-help guide, On the Road to Quitting (OnRQ). Methods: A parallel, double-blind, randomized controlled trial with 2 arms was conducted in Canada to evaluate CTC. In total, 1599 young adult smokers (aged 19 to 29 years) intending to quit smoking in the next 30 days were recruited online and randomized to receive CTC or the control condition OnRQ for a period of 6 months. The primary outcome measure was self-reported continuous abstinence at the 6-month follow-up. Results: Overall follow-up rates were 57.41% (918/1599) and 60.48% (967/1599) at 3 and 6 months, respectively. Moreover, 45.34% (725/1599) of participants completed baseline, 3-, and 6-month follow-up. Intention-to-treat analysis (last observation carried forward) showed that continuous abstinence (N=1599) at 6 months was not significantly different at 7.8% (64/820) for CTC versus 9.2% (72/779) for OnRQ (odds ratio; OR 0.83, 95% CI 0.59-1.18). Similarly, 30-day point prevalence abstinence at 6 months was not significantly different at 14.4% (118/820) and 16.9% (132/779) for CTC and OnRQ, respectively (OR 0.82, 95% CI 0.63-1.08). However, these rates of abstinence were favorable compared with unassisted 30-day quit rates of 11.5% among young adults. Secondary measures of quit attempts and the number of cigarettes smoked per day at 6-month follow-up did not reveal any significant differences between groups. For those who completed the 6-month follow-up, 85.1% (359/422) of young adult smokers downloaded CTC as compared with 81.8% (346/423) of OnRQ, χ21(N=845)=1.6, P=.23. Furthermore, OnRQ participants reported significantly higher levels of overall satisfaction (mean 3.3 [SD 1.1] vs mean 2.6 [SD 1.3]; t644=6.87, P<.001), perceived helpfulness (mean 5.8 [SD 2.4] vs mean 4.3 [SD 2.6], t657=8.0, P<.001), and frequency of use (mean 3.6 [SD 1.2] vs mean 3.2 [SD 1.1], t683=5.7, P<.001) compared with CTC participants. Conclusions: CTC was feasible for delivering cessation support but was not superior to a self-help guide in helping motivated young adults to quit smoking. CTC will benefit from further formative research to address satisfaction and usage. As smartphone apps may not serve as useful alternatives to printed self-help guides, there is a need to conduct further research to understand how digital mobile technology smoking cessation interventions for smoking cessation can be improved. Trial Registration: ClinicalTrials.gov NCT01983150; http://clinicaltrials.gov/ct2/show/NCT01983150 (Archived by WebCite at http://www.webcitation.org/6VGyc0W0i) %M 30355563 %R 10.2196/10893 %U http://mhealth.jmir.org/2018/10/e10893/ %U https://doi.org/10.2196/10893 %U http://www.ncbi.nlm.nih.gov/pubmed/30355563 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 10 %P e10977 %T Mobile Phone Text Messaging for Tobacco Risk Communication Among Young Adult Community College Students: Protocol and Baseline Overview for a Randomized Controlled Trial %A Prokhorov,Alexander V %A Khalil,Georges Elias %A Calabro,Karen Sue %A Machado,Tamara Costello %A Russell,Sophia %A Czerniak,Katarzyna W %A Botello,Gabrielle C %A Chen,Minxing %A Perez,Adriana %A Vidrine,Damon J %A Perry,Cheryl L %+ Department of Behavioral Science, MD Anderson Cancer Center, The University of Texas, 1155 Pressler Street, Unit 1330, Houston, TX,, United States, 1 713 563 2605, aprokhor@mdanderson.org %K tobacco use %K risk %K perception %K text messaging %K young adult %D 2018 %7 15.10.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Community-college students are at high risk for tobacco use. Because the use of mobile phone text messaging is nearly ubiquitous today, short message service (SMS) may be an effective strategy for tobacco risk communication in this population. Little is known, however, concerning the message structure significantly influencing perceived tobacco risk. Objective: We aim to outline the rationale and design of Project Debunk, a randomized trial comparing the effects of different SMS text message structures. Methods: We conducted a 6-month randomized trial comparing 8 arms, based on the combination of the 3 message structures delivered to young adults in a 2×2×2 study design: framing (gain-framed or loss-framed), depth (simple or complex), and appeal (emotional or rational). Participants were invited to participate from 3 community colleges in Houston from September 2016 to July 2017. Participants were randomized to 1 arm and received text messages in 2 separate campaigns. Each campaign consisted of 2 text messages per day for 30 days. Perceived tobacco risk was assessed at baseline, 2 months after the first campaign, and 2 months after the second campaign. We assessed the perceived risk of using conventional products (eg, combustible cigarettes) and new and emerging products (eg, electronic cigarettes). The validity of message structures was assessed weekly for each campaign. A 1-week follow-up assessment was also conducted to understand immediate reactions from participants. Results: We completed data collection for the baseline survey on a rolling basis during this time and assessed the validity of the message structure after 1 week of SMS text messages. For the entire sample (N=636), the average age was 20.92 years (SD 2.52), about two-thirds were male (430/636, 67.6%), and most were black or African American (259/636, 40.7%) or white (236/636, 37.1%). After 1 week of receiving text messages, the following was noted: (a) loss-framed messages were more likely to be perceived as presenting a loss than gain-framed messages (F7,522=13.13, P<.001), (b) complex messages were perceived to be more complex than simple messages (F7,520=2.04, P=.05), and (c) emotional messages were perceived to be more emotionally involving than rational messages (F7,520=6.46, P<.001). Conclusions: This study confirms that the recruitment, randomization, and message composition have been successfully implemented. Further analyses will identify specific types of messages that are more effective than others in increasing the perceived risk of tobacco use. If our results suggest that any of the 8 specific message structures are more effective for helping young adults understand tobacco risk, this would provide evidence to include such messages as part of a larger technology-based campaign such as mobile phone apps, entertainment-based campaigns, and social media. Trial Registration: ClinicalTrials.gov NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480 (Archived by WebCite at http://www.webcitation.org/6ykd4IIap) Registered Report Identifier: RR1-10.2196/10977 %M 30322833 %R 10.2196/10977 %U http://www.researchprotocols.org/2018/10/e10977/ %U https://doi.org/10.2196/10977 %U http://www.ncbi.nlm.nih.gov/pubmed/30322833 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e11138 %T Conversation Within a Facebook Smoking Cessation Intervention Trial For Young Adults (Tobacco Status Project): Qualitative Analysis %A McKelvey,Karma %A Ramo,Danielle %+ Weill Institute for Neurosciences, Department of Psychiatry, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, United States, 1 4154767695, danielle.ramo@ucsf.edu %K Facebook %K intervention %K qualitative analysis %K smoking cessation %K social media %K young adults %D 2018 %7 04.09.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Smoking cessation interventions delivered through social media have the potential to engage young people in behavior change. Objective: The aim of this study was to describe participant-posted messages in a Facebook smoking cessation intervention for young adults to discern support for behavior change. Methods: We qualitatively analyzed data from the treatment arm of a randomized trial testing the efficacy of the Tobacco Status Project Facebook intervention. Young adults (N=138) aged 18-25 years (female: 81/138, 58.7%; white: 101/138, 73.2%; mean age 21 years) were recruited using Facebook and placed into one of the 15 secret Facebook groups based on readiness-to-quit smoking. Messages posted to groups for 90 consecutive days were tailored to readiness-to-quit: Not Ready (46/138, 33.3%), Thinking (66/138, 47.8%), and Getting Ready (26/138, 18.8%). Groups were randomized to receive up to US $90 for posting or no incentive. Two independent coders conducted open coding of user posts. We considered content by readiness-to-quit group and incentive condition. Results: There were 4 dominant themes across all groups: coping skills, friends and family, motivation to quit, and benefits of quitting. The dominant themes in Not Ready groups were friends and family (incentive) and motivation to quit (no incentive), whereas coping skills was the dominant theme in Thinking and Getting Ready groups. The expression of themes varied by readiness-to-quit group but not by incentive condition. Conclusions: Intervention messages tailored to readiness-to-quit appear useful in eliciting the desired responses from young adult smokers, with limited influence by monetary incentive. Trial Registration: ClinicalTrials.gov NCT02207036; https://clinicaltrials.gov/ct2/show/NCT02207036 (Archived by WebCite at http://www.webcitation.org/722XAEAAz) %M 30684432 %R 10.2196/11138 %U http://formative.jmir.org/2018/2/e11138/ %U https://doi.org/10.2196/11138 %U http://www.ncbi.nlm.nih.gov/pubmed/30684432 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e173 %T Assessing the Cross-Cultural Adaptation and Translation of a Text-Based Mobile Smoking Cessation Program in Samoa (TXTTaofiTapaa): Pilot Study %A McCool,Judith %A Tanielu,Helen %A Umali,Elaine %A Whittaker,Robyn %+ Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1141, New Zealand, 64 09 373 7599 ext 82372, j.mccool@auckland.ac.nz %K mHealth %K mobile phone %K Pacific %K Samoa %K tobacco cessation %K text messages %D 2018 %7 31.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Samoa faces a persistently high prevalence of adult tobacco use and few existing cessation support services. Mobile phones are ubiquitous and generally affordable. Objective: This study aimed to adopt a text message (short message service, SMS) smoking cessation program designed in New Zealand (stop smoking with mobile phones, STOMP) for use in Samoa to assist national objectives in reducing the tobacco use. Methods: Using focus groups with smokers and ex-smokers, we explored the context for tobacco use and preferences for SMS text messages. Postintervention focus groups were held after participants received SMS text messages for 1 week. Frequent face-to-face meetings with the primary partner (Ministry of Health Samoa) and key stakeholders contributed to the adaptation process. Participatory feedback and collaboration from stakeholders became an integral part of the cultural adaptation and translation of the program. Furthermore, detailed document analyses were included as part of the formal evaluation of the initiative to explore the core determinants of success in adapting the program to the Samoan cultural context. Results: The SMS text messages evolved remarkably following an iterative process of consultation, in situ testing, revision, and retesting to arrive at an acceptable country-specific version of the mobile smoking cessation program. The SMS text messages retained in the final set were consistent with the theory of behavioral change but reflected both linguistic and cultural nuances appropriate for Samoa. Adapting messages required simultaneous multilevel processes, including complex high-level engagement, between the team and the stakeholders, along with crafting the precise content for (character limited) messages. Conclusions: Receiving cessation support messages through a mobile phone is promising and appears to be an acceptable and accessible mode of delivery for tobacco cessation, particularly in the absence of alternative support. Adapting a text-based program in Samoa requires fastidious attention to the nuances of culture, language, and sociopolitical structures in the country. %M 30170994 %R 10.2196/mhealth.9033 %U http://mhealth.jmir.org/2018/8/e173/ %U https://doi.org/10.2196/mhealth.9033 %U http://www.ncbi.nlm.nih.gov/pubmed/30170994 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 8 %P e10351 %T Participant Recruitment and Retention in Remote eHealth Intervention Trials: Methods and Lessons Learned From a Large Randomized Controlled Trial of Two Web-Based Smoking Interventions %A Watson,Noreen L %A Mull,Kristin E %A Heffner,Jaimee L %A McClure,Jennifer B %A Bricker,Jonathan B %+ Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, M3-B232, Seattle, WA, 98109, United States, 1 2066672942, nlwatson@fredhutch.org %K recruitment %K retention %K randomized controlled trial %K RCT %K smoking cessation %K web intervention %D 2018 %7 24.08.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite having many advantages, online eHealth trials are not without challenges—notably, participant recruitment, and outcome data retention. Moreover, publications from these trials rarely provide detailed information on the methods used for recruitment and retention or discuss implications of the methods for future studies. Objective: To address this need for empirical guidance regarding recruitment and outcome data retention planning, we aim to describe the methods and lessons learned from the recruitment and retention procedures used in a large randomized trial of 2 Web-based smoking cessation interventions. Methods: To ensure a demographically and geographically diverse participant sample, we used the recruitment strategies (1) traditional, (2) Web-based, and (3) online survey panel methods and adaptively modified each in response to recruitment success. At baseline, participants indicated how they heard about the study and answered demographic questions. To maximize trial retention at each of the 3-, 6-, and 12-month assessment points, 4 survey modalities (first Web, followed by phone, mail, and postcard) were sequentially timed over a 30-day period. Participants received US $25 for submitting their responses, regardless of modality, and received an additional US $10 bonus for completing the Web survey within 24h of electronic notification. Results: We randomized 2637 smokers in 16 months and achieved 88% retention at 12-months. Participants (79.26% female, 72.60% Caucasian) were recruited from all 50 states. The majority of participants were recruited through Facebook (49.43%), followed by the survey panel (20.85%), free internet sources (14.54%), traditional media (11.34%), and Google ads (3.84%). Descriptively, participant demographics varied by recruitment source. Of the completed follow-up surveys, most were completed by Web (92%). Retention rates did not vary by recruitment source. Conclusions: Continuous monitoring and refinement of multiple recruitment methods, particularly of online advertising campaigns, allowed us to maximize the effectiveness of recruitment strategies in recruiting a large, diverse sample of smokers. Likewise, offering multiple follow-up survey modalities in sequential order along with time-dependent bonus incentives enabled us to obtain outcome data from a very high level of enrolled participants for the duration of the trial protocol. These strategies may be similarly useful in other trials. Trial Registration: ClinicalTrials.gov NCT01812278; https://clinicaltrials.gov/ct2/show/NCT01812278 (Archived by WebCite at http://www.webcitation.org/71gy5GLvO) %M 30143479 %R 10.2196/10351 %U http://www.jmir.org/2018/8/e10351/ %U https://doi.org/10.2196/10351 %U http://www.ncbi.nlm.nih.gov/pubmed/30143479 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 8 %P e11294 %T Evaluation of Biological and Functional Changes in Healthy Smokers Switching to the Tobacco Heating System 2.2 Versus Continued Tobacco Smoking: Protocol for a Randomized, Controlled, Multicenter Study %A Ansari,S Michael %A Lama,Nicola %A Blanc,Nicolas %A Bosilkovska,Marija %A Donelli,Andrea %A Picavet,Patrick %A Baker,Gizelle %A Haziza,Christelle %A Lüdicke,Frank %+ Philip Morris International Research & Development, Quai Jeanrenaud 5, 2000 Neuchâtel,, Switzerland, 41 58 242 2842, christelle.haziza@pmi.com %K smoking %K tobacco %K harm reduction %K tobacco products %K risk %K heated tobacco %K smoking cessation %K biomarkers %K metabolic networks %K pathways %D 2018 %7 24.08.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco harm reduction, substituting less harmful tobacco products for combustible cigarettes, is a complementary approach for smokers who would otherwise continue to smoke. The Philip Morris International (PMI) Tobacco Heating System (THS) 2.2 is a novel tobacco product with the potential to reduce the risk of harm in smokers compared to continued smoking of combustible cigarettes. It heats tobacco electrically in a controlled manner, never allowing the temperature to exceed 350°C, thereby preventing the combustion process from taking place and producing substantially lower levels of toxicants while providing nicotine, taste, ritual, and a sensory experience that closely parallels combustible cigarettes. Previous clinical studies have demonstrated reduced exposure to the toxicants (approaching the levels observed after quitting) for smokers who switched to THS 2.2, for three months. For adult smokers who would otherwise continue smoking combustible cigarettes, switching to THS 2.2 may represent an alternative way to reduce the risk of tobacco-related diseases. Objective: This study aimed to further substantiate the harm reduction potential of THS 2.2 by demonstrating favorable changes in a set of 8 coprimary endpoints, representative of pathomechanistic pathways (ie, inflammation, oxidative stress, lipid metabolism, respiratory function, and genotoxicity), linked to smoking-related diseases, in smokers switching from combustible cigarettes to THS 2.2. Methods: This study was a randomized, controlled, two-arm parallel group, multicenter ambulatory US study conducted in healthy adult smokers switching from combustible cigarettes to THS 2.2 compared with smokers continuing to smoke combustible cigarettes for six months. Subjects had a smoking history of at least ten years and did not intend to quit within the next six months. Results: Enrollment started in March 2015 and the trial was completed in September 2016. In total, 984 subjects were randomized (combustible cigarettes, n=483; THS 2.2, n=477), and 803 completed the study. The results are expected to be available in a subsequent publication in 2019. Conclusions: In this paper, we describe the rationale and design for this clinical study that focused on the evaluation of THS 2.2’s potential to reduce the risk of smoking-related diseases compared with that of combustible cigarettes. This study will provide insights regarding favorable changes in biological and functional endpoints informed by effects known to be seen upon smoking cessation. Trial Registration: ClinicalTrials.gov NCT02396381; http://clinicaltrials.gov/ct2/show/NCT02396381 (Archived by WebCite at http://www.webcitation.org/71PCRdagP) Registered Report Identifier: RR1-10.2196/11294 %M 30143474 %R 10.2196/11294 %U http://www.researchprotocols.org/2018/8/e11294/ %U https://doi.org/10.2196/11294 %U http://www.ncbi.nlm.nih.gov/pubmed/30143474 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 8 %P e10976 %T A Face-Aging App for Smoking Cessation in a Waiting Room Setting: Pilot Study in an HIV Outpatient Clinic %A Brinker,Titus Josef %A Brieske,Christian Martin %A Esser,Stefan %A Klode,Joachim %A Mons,Ute %A Batra,Anil %A Rüther,Tobias %A Seeger,Werner %A Enk,Alexander H %A von Kalle,Christof %A Berking,Carola %A Heppt,Markus V %A Gatzka,Martina V %A Bernardes-Souza,Breno %A Schlenk,Richard F %A Schadendorf,Dirk %+ National Center for Tumor Diseases, Department of Translational Oncology, German Cancer Research Center, Im Neuenheimer Feld 460, Heidelberg, 69120, Germany, 49 15175084347, titus.brinker@nct-heidelberg.de %K face aging %K smoking cessation %K HIV %K mobile apps %K HIV patients %K HIV seropositivity %K smoking %K cessation %K tobacco smoking %K morphing %D 2018 %7 15.08.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: There is strong evidence for the effectiveness of addressing tobacco use in health care settings. However, few smokers receive cessation advice when visiting a hospital. Implementing smoking cessation technology in outpatient waiting rooms could be an effective strategy for change, with the potential to expose almost all patients visiting a health care provider without preluding physician action needed. Objective: The objective of this study was to develop an intervention for smoking cessation that would make use of the time patients spend in a waiting room by passively exposing them to a face-aging, public morphing, tablet-based app, to pilot the intervention in a waiting room of an HIV outpatient clinic, and to measure the perceptions of this intervention among smoking and nonsmoking HIV patients. Methods: We developed a kiosk version of our 3-dimensional face-aging app Smokerface, which shows the user how their face would look with or without cigarette smoking 1 to 15 years in the future. We placed a tablet with the app running on a table in the middle of the waiting room of our HIV outpatient clinic, connected to a large monitor attached to the opposite wall. A researcher noted all the patients who were using the waiting room. If a patient did not initiate app use within 30 seconds of waiting time, the researcher encouraged him or her to do so. Those using the app were asked to complete a questionnaire. Results: During a 19-day period, 464 patients visited the waiting room, of whom 187 (40.3%) tried the app and 179 (38.6%) completed the questionnaire. Of those who completed the questionnaire, 139 of 176 (79.0%) were men and 84 of 179 (46.9%) were smokers. Of the smokers, 55 of 81 (68%) said the intervention motivated them to quit (men: 45, 68%; women: 10, 67%); 41 (51%) said that it motivated them to discuss quitting with their doctor (men: 32, 49%; women: 9, 60%); and 72 (91%) perceived the intervention as fun (men: 57, 90%; women: 15, 94%). Of the nonsmokers, 92 (98%) said that it motivated them never to take up smoking (men: 72, 99%; women: 20, 95%). Among all patients, 102 (22.0%) watched another patient try the app without trying it themselves; thus, a total of 289 (62.3%) of the 464 patients were exposed to the intervention (average waiting time 21 minutes). Conclusions: A face-aging app implemented in a waiting room provides a novel opportunity to motivate patients visiting a health care provider to quit smoking, to address quitting at their subsequent appointment and thereby encourage physician-delivered smoking cessation, or not to take up smoking. %M 30111525 %R 10.2196/10976 %U http://www.jmir.org/2018/8/e10976/ %U https://doi.org/10.2196/10976 %U http://www.ncbi.nlm.nih.gov/pubmed/30111525 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 8 %P e252 %T Understanding Users’ Vaping Experiences from Social Media: Initial Study Using Sentiment Opinion Summarization Techniques %A Li,Qiudan %A Wang,Can %A Liu,Ruoran %A Wang,Lei %A Zeng,Daniel Dajun %A Leischow,Scott James %+ Department of Management Information Systems, Eller College of Management, The University of Arizona, McClelland Hall 430, 1130 E Helen Street, Tucson, AZ, 85721, United States, 1 520 621 4614, zeng@eller.arizona.edu %K electronic nicotine delivery systems %K e-cigarette %K e-liquid %K JuiceDB %K sentiment opinion summarization %K social media %K vaping %K infodemiology %D 2018 %7 15.08.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: E-liquid is one of the main components in electronic nicotine delivery systems (ENDS). ENDS review comments could serve as an early warning on use patterns and even function to serve as an indicator of problems or adverse events pertaining to the use of specific e-liquids—much like types of responses tracked by the Food and Drug Administration (FDA) regarding medications. Objective: This study aimed to understand users’ “vaping” experience using sentiment opinion summarization techniques, which can help characterize how consumers think about specific e-liquids and their characteristics (eg, flavor, throat hit, and vapor production). Methods: We collected e-liquid reviews on JuiceDB from June 27, 2013 to December 31, 2017 using its public application programming interface. The dataset contains 27,070 reviews for 8058 e-liquid products. Each review is accompanied by an overall rating and a set of 4 aspect ratings of an e-liquid, each on a scale of 1-5: flavor accuracy, throat hit, value, and cloud production. An iterative dichotomiser 3 (ID3)-based influential aspect analysis model was adopted to learn the key elements that impact e-liquid use. Then, fine-grained sentiment analysis was employed to mine opinions on various aspects of vaping experience related to e-liquids. Results: We found that flavor accuracy and value were the two most important aspects that affected users’ sentiments toward e-liquids. Of reviews in JuiceDB, 67.83% (18,362/27,070) were positive, while 12.67% (3430/27,070) were negative. This indicates that users generally hold positive attitudes toward e-liquids. Among the 9 flavors, fruity and sweet were the two most popular. Great and sweet tastes, reasonable value, and strong throat hit made users satisfied with fruity and sweet flavors, whereas “strange” tastes made users dislike those flavors. Meanwhile, users complained about some e-liquids’ steep or expensive prices, bad quality, and harsh throat hit. There were 2342 fruity e-liquids and 2049 sweet e-liquids. There were 55.81% (1307/2342) and 59.83% (1226/2049) positive sentiments and 13.62% (319/2342) and 12.88% (264/2049) negative sentiments toward fruity e-liquids and sweet e-liquids, respectively. Great flavors and good vapors contributed to positive reviews of fruity and sweet products. However, bad tastes such as “sour” or “bitter” resulted in negative reviews. These findings can help businesses and policy makers to further improve product quality and formulate effective policy. Conclusions: This study provides an effective mechanism for analyzing users’ ENDS vaping experience based on sentiment opinion summarization techniques. Sentiment opinions on aspect and products can be found using our method, which is of great importance to monitor e-liquid products and improve work efficiency. %M 30111530 %R 10.2196/jmir.9373 %U http://www.jmir.org/2018/8/e252/ %U https://doi.org/10.2196/jmir.9373 %U http://www.ncbi.nlm.nih.gov/pubmed/30111530 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 8 %P e246 %T Blended Smoking Cessation Treatment: Exploring Measurement, Levels, and Predictors of Adherence %A Siemer,Lutz %A Brusse-Keizer,Marjolein GJ %A Postel,Marloes G %A Ben Allouch,Somaya %A Patrinopoulos Bougioukas,Angelos %A Sanderman,Robbert %A Pieterse,Marcel E %+ Research Group Technology, Health & Care, Saxion University of Applied Sciences, MH Tromplaan 28, Enschede, 7513 AB, Netherlands, 31 17678025906, l.siemer@saxion.nl %K blended treatment %K smoking %K adherence %K predictors %K tobacco %K prevention %K cognitive behavioral therapy %D 2018 %7 01.08.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Blended face-to-face and Web-based treatment is a promising way to deliver cognitive behavioral therapy. Since adherence has been shown to be a measure for treatment’s acceptability and a determinant for treatment’s effectiveness, in this study, we explored adherence to a new blended smoking cessation treatment (BSCT). Objective: The objective of our study was to (1) develop an adequate method to measure adherence to BSCT; (2) define an adequate degree of adherence to be used as a threshold for being adherent; (3) estimate adherence to BSCT; and (4) explore the possible predictors of adherence to BSCT. Methods: The data of patients (N=75) were analyzed to trace adherence to BSCT delivered at an outpatient smoking cessation clinic. In total, 18 patient activities (eg, using a Web-based smoking diary tool or responding to counselors’ messages) were selected to measure adherence; the degree of adherence per patient was compared with quitting success. The minimum degree of adherence of patients who reported abstinence was examined to define a threshold for the detection of adherent patients. The number of adherent patients was calculated for each of the 18 selected activities; the degree of adherence over the course of the treatment was displayed; and the number of patients who were adherent was analyzed. The relationship between adherence and 33 person-, smoking-, and health-related characteristics was examined. Results: The method for measuring adherence was found to be adequate as adherence to BSCT correlated with self-reported abstinence (P=.03). Patients reporting abstinence adhered to at least 61% of BSCT. Adherence declined over the course of the treatment; the percentage of adherent patients per treatment activity ranged from 82% at the start of the treatment to 11%-19% at the final-third of BSCT; applying a 61% threshold, 18% of the patients were classified as adherent. Marital status and social modeling were the best independent predictors of adherence. Patients having a partner had 11-times higher odds of being adherent (OR [odds ratio]=11.3; CI: 1.33-98.99; P=.03). For social modeling, graded from 0 (=partner and friends are not smoking) to 8 (=both partner and nearly all friends are smoking), each unit increase was associated with 28% lower odds of being adherent (OR=0.72; CI: 0.55-0.94; P=.02). Conclusions: The current study is the first to explore adherence to a blended face-to-face and Web-based treatment (BSCT) based on a substantial group of patients. It revealed a rather low adherence rate to BSCT. The method for measuring adherence to BSCT could be considered adequate because the expected dose-response relationship between adherence and quitting could be verified. Furthermore, this study revealed that marital status and social modeling were independent predictors of adherence. Trial Registration: Netherlands Trial Registry NTR5113; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5113 (Archived by WebCite at http://www.webcitation.org/71BAPwER8). %M 30068503 %R 10.2196/jmir.9969 %U http://www.jmir.org/2018/8/e246/ %U https://doi.org/10.2196/jmir.9969 %U http://www.ncbi.nlm.nih.gov/pubmed/30068503 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 10 %N 3 %P e9 %T Content-Sensitive Characterization of Peer Interactions of Highly Engaged Users in an Online Community for Smoking Cessation: Mixed-Methods Approach for Modeling User Engagement in Health Promotion Interventions %A Myneni,Sahiti %A Sridharan,Vishnupriya %A Cobb,Nathan %A Cohen,Trevor %+ School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin Street, Suite 165, Houston, TX,, United States, 1 713 486 0115, Sahiti.Myneni@uth.tmc.edu %K user engagement %K smoking cessation %K text analysis %D 2018 %7 24.07.2018 %9 Original Paper %J J Participat Med %G English %X Background: Online communities provide affordable venues for behavior change. However, active user engagement holds the key to the success of these platforms. In order to enhance user engagement and in turn, health outcomes, it is essential to offer targeted interventional and informational support. Objective: In this paper, we describe a content plus frequency framework to enable the characterization of highly engaged users in online communities and study theoretical techniques employed by these users through analysis of exchanged communication. Methods: We applied the proposed methodology for analysis of peer interactions within QuitNet, an online community for smoking cessation. Firstly, we identified 144 highly engaged users based on communication frequency within QuitNet over a period of 16 years. Secondly, we used the taxonomy of behavior change techniques, text analysis methods from distributional semantics, machine learning, and sentiment analysis to assign theory-driven labels to content. Finally, we extracted content-specific insights from peer interactions (n=159,483 messages) among highly engaged QuitNet users. Results: Studying user engagement using our proposed framework led to the definition of 3 user categories—conversation initiators, conversation attractors, and frequent posters. Specific behavior change techniques employed by top tier users (threshold set at top 3) within these 3 user groups were found to be goal setting, social support, rewards and threat, and comparison of outcomes. Engagement-specific trends within sentiment manifestations were also identified. Conclusions: Use of content-inclusive analytics has offered deep insight into specific behavior change techniques employed by highly engaged users within QuitNet. Implications for personalization and active user engagement are discussed. %R 10.2196/jopm.9745 %U http://jopm.jmir.org/2018/3/e9/ %U https://doi.org/10.2196/jopm.9745 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 3 %P e10234 %T Facial-Aging Mobile Apps for Smoking Prevention in Secondary Schools in Brazil: Appearance-Focused Interventional Study %A Bernardes-Souza,Breno %A Patruz Ananias De Assis Pires,Francisco %A Madeira,Gustavo Moreira %A Felício Da Cunha Rodrigues,Túlio %A Gatzka,Martina %A Heppt,Markus V %A Omlor,Albert J %A Enk,Alexander H %A Groneberg,David A %A Seeger,Werner %A von Kalle,Christof %A Berking,Carola %A Corrêa,Paulo César Rodrigues Pinto %A Suhre,Janina Leonie %A Alfitian,Jonas %A Assis,Aisllan %A Brinker,Titus Josef %+ National Center for Tumor Diseases (NCT), Department of Translational Oncology, German Cancer Research Center, Im Neuenheimer Feld 440, Heidelberg, 69120, Germany, 49 +4915175084347, titus.brinker@nct-heidelberg.de %K dermatology %K smoking %K apps %K photoaging %K face %K skin %K tobacco %K tobacco cessation %K tobacco prevention %D 2018 %7 17.07.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Most smokers start smoking during their early adolescence, often with the idea that smoking is glamorous. Interventions that harness the broad availability of mobile phones as well as adolescents' interest in their appearance may be a novel way to improve school-based prevention. A recent study conducted in Germany showed promising results. However, the transfer to other cultural contexts, effects on different genders, and implementability remains unknown. Objective: In this observational study, we aimed to test the perception and implementability of facial-aging apps to prevent smoking in secondary schools in Brazil in accordance with the theory of planned behavior and with respect to different genders. Methods: We used a free facial-aging mobile phone app (“Smokerface”) in three Brazilian secondary schools via a novel method called mirroring. The students’ altered three-dimensional selfies on mobile phones or tablets and images were “mirrored” via a projector in front of their whole grade. Using an anonymous questionnaire, we then measured on a 5-point Likert scale the perceptions of the intervention among 306 Brazilian secondary school students of both genders in the seventh grade (average age 12.97 years). A second questionnaire captured perceptions of medical students who conducted the intervention and its conduction per protocol. Results: The majority of students perceived the intervention as fun (304/306, 99.3%), claimed the intervention motivated them not to smoke (289/306, 94.4%), and stated that they learned new benefits of not smoking (300/306, 98.0%). Only a minority of students disagreed or fully disagreed that they learned new benefits of nonsmoking (4/306, 1.3%) or that they themselves were motivated not to smoke (5/306, 1.6%). All of the protocol was delivered by volunteer medical students. Conclusions: Our data indicate the potential for facial-aging interventions to reduce smoking prevalence in Brazilian secondary schools in accordance with the theory of planned behavior. Volunteer medical students enjoyed the intervention and are capable of complete implementation per protocol. %M 30021713 %R 10.2196/10234 %U http://publichealth.jmir.org/2018/3/e10234/ %U https://doi.org/10.2196/10234 %U http://www.ncbi.nlm.nih.gov/pubmed/30021713 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e229 %T Misleading Claims About Tobacco Products in YouTube Videos: Experimental Effects of Misinformation on Unhealthy Attitudes %A Albarracin,Dolores %A Romer,Daniel %A Jones,Christopher %A Hall Jamieson,Kathleen %A Jamieson,Patrick %+ University of Illinois at Urbana Champaign, 603 E Daniel Street, Champaign, IL, 61822, United States, 1 2178402383, dalbarra@illinois.edu %K health communication %K tobacco %D 2018 %7 29.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Recent content analyses of YouTube postings reveal a proliferation of user generated videos with misleading statements about the health consequences of various types of nontraditional tobacco use (eg, electronic cigarettes; e-cigarettes). Objective: This research was aimed at obtaining evidence about the potential effects of YouTube postings about tobacco products on viewers' attitudes toward these products. Methods: A sample of young adults recruited online (N=350) viewed one of four highly viewed YouTube videos containing misleading health statements about chewing tobacco, e-cigarettes, hookahs, and pipe smoking, as well as a control YouTube video unrelated to tobacco products. Results: The videos about e-cigarettes and hookahs led to more positive attitudes toward the featured products than did control videos. However, these effects did not fully translate into attitudes toward combustive cigarette smoking, although the pipe video led to more positive attitudes toward combustive smoking than did the chewing and the hookah videos, and the e-cigarette video led to more positive attitudes toward combustive cigarette smoking than did the chewing video. Conclusions: This research revealed young people’s reactions to misleading claims about tobacco products featured in popular YouTube videos. Policy implications are discussed. %M 29959113 %R 10.2196/jmir.9959 %U http://www.jmir.org/2018/6/e229/ %U https://doi.org/10.2196/jmir.9959 %U http://www.ncbi.nlm.nih.gov/pubmed/29959113 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e213 %T The Effectiveness of Web-Based Tailored Smoking Cessation Interventions on the Quitting Process (Project Quit): Secondary Analysis of a Randomized Controlled Trial %A Chakraborty,Bibhas %A Maiti,Raju %A Strecher,Victor J %+ Centre for Quantitative Medicine, Duke-NUS Medical School, Academia, Level 6, 20 College Road, Singapore, 169856, Singapore, 65 6576 7377, bibhas.chakraborty@duke-nus.edu.sg %K smoking cessation %K number of quit attempts %K tailored intervention %K treatment regimen %K Web-based intervention %D 2018 %7 20.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Project Quit was a randomized Web-based smoking cessation trial designed and conducted by researchers from the University of Michigan, where its primary outcome was the 7-day point prevalence. One drawback of such an outcome is that it only focuses on smoking behavior over a very short duration, rather than the quitting process over the entire study period. Objective: The aim of this study was to consider the number of quit attempts during the 6-month study period as an alternative outcome, which would better reflect the quitting process. We aimed to find out whether tailored interventions (high vs low) are better in reducing the number of quit attempts for specific subgroups of smokers. Methods: To identify interactions between intervention components of smoking cessation and individual smoker characteristics, we employed Poisson regression to analyze the number of quit attempts. This approach allowed us to construct data-driven, personalized interventions. Results: A negative effect of the number of cigarettes smoked per day (P=.03) and a positive effect of education (P=.03) on the number of quit attempts were detected from the baseline covariates (n=792). Thus, for every 10 extra cigarettes smoked per day, there was a 5.84% decrease in the expected number of quit attempts. Highly educated participants had a 15.49% increase in their expected number of quit attempts compared with their low-educated counterparts. A negative interaction between intervention component story and smoker’s education was also detected (P=.03), suggesting that a high-tailored story given to highly educated people results in 13.50% decrease in the number of quit attempts compared with a low-tailored story. Conclusions: A highly individually tailored story is significantly more effective for smokers with a low level of education. This is consistent with prior findings from Project Quit based on the 7-day point prevalence. %M 29925494 %R 10.2196/jmir.9555 %U http://www.jmir.org/2018/6/e213/ %U https://doi.org/10.2196/jmir.9555 %U http://www.ncbi.nlm.nih.gov/pubmed/29925494 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e197 %T Recruiting Hard-to-Reach Populations for Survey Research: Using Facebook and Instagram Advertisements and In-Person Intercept in LGBT Bars and Nightclubs to Recruit LGBT Young Adults %A Guillory,Jamie %A Wiant,Kristine F %A Farrelly,Matthew %A Fiacco,Leah %A Alam,Ishrat %A Hoffman,Leah %A Crankshaw,Erik %A Delahanty,Janine %A Alexander,Tesfa N %+ RTI International, 3040 E Cornwallis rd, P.O. Box 12194, Research Triangle Park, NC, 27709, United States, 1 9193163725, jguillory@rti.org %K sexual minorities %K social media %K public health %K tobacco %K survey methods %K transgender persons %D 2018 %7 18.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Tobacco public education campaigns focus increasingly on hard-to-reach populations at higher risk for smoking, prompting campaign creators and evaluators to develop strategies to reach hard-to-reach populations in virtual and physical spaces where they spend time. Objective: The aim of this study was to describe two novel recruitment strategies (in-person intercept interviews in lesbian, gay, bisexual, and transgender [LGBT] social venues and targeted social media ads) and compares characteristics of participants recruited via these strategies for the US Food and Drug Administration’s This Free Life campaign evaluation targeting LGBT young adults who smoke cigarettes occasionally. Methods: We recruited LGBT adults aged 18-24 years in the United States via Facebook and Instagram ads (N=1709, mean age 20.94, SD 1.94) or intercept in LGBT social venues (N=2348, mean age 21.98, SD 1.69) for the baseline evaluation survey. Covariates related to recruitment strategy were age; race or ethnicity; LGBT identity; education; pride event attendance; and alcohol, cigarette, and social media use. Results: Lesbian or gay women (adjusted odds ratio, AOR 1.88, 95% CI 1.54-2.29, P<.001), bisexual men and women (AOR 1.46, 95% CI 1.17-1.82, P=.001), gender minorities (AOR 1.68, 95% CI 1.26-2.25, P<.001), and other sexual minorities (AOR 2.48, 95% CI 1.62-3.80, P<.001) were more likely than gay men to be recruited via social media (than intercept). Hispanic (AOR 0.73, 95% CI 0.61-0.89, P=.001) and other or multiracial, non-Hispanic participants (AOR 0.70, 95% CI 0.54-0.90, P=.006) were less likely than white, non-Hispanic participants to be recruited via social media. As age increased, odds of recruitment via social media decreased (AOR 0.76, 95% CI 0.72-0.80, P<.001). Participants with some college education (AOR 1.27, 95% CI 1.03-1.56, P=.03) were more likely than those with a college degree to be recruited via social media. Participants reporting past 30-day alcohol use were less likely to be recruited via social media (AOR 0.33, 95% CI 0.24-0.44, P<.001). Participants who reported past-year pride event attendance were more likely to be recruited via social media (AOR 1.31, 95% CI 1.06-1.64, P=.02), as well as those who used Facebook at least once daily (AOR 1.43, 95% CI 1.14-1.80, P=.002). Participants who reported using Instagram at least once daily were less likely to be recruited via social media (AOR 0.73, 95% CI 0.62-0.86, P<.001). Social media recruitment was faster (incidence rate ratio, IRR=3.31, 95% CI 3.11-3.52, P<.001) and less expensive (2.2% of combined social media and intercept recruitment cost) but had greater data quality issues—a larger percentage of social media respondents were lost because of duplicate and low-quality responses (374/4446, 8.41%) compared with intercept respondents lost to interviewer misrepresentation (15/4446, 0.34%; P<.001). Conclusions: Social media combined with intercept provided access to important LGBT subpopulations (eg, gender and other sexual minorities) and a more diverse sample. Social media methods have more data quality issues but are faster and less expensive than intercept. Recruiting hard-to-reach populations via audience-tailored strategies enabled recruitment of one of the largest LGBT young adult samples, suggesting these methods’ promise for accessing hard-to-reach populations. %M 29914861 %R 10.2196/jmir.9461 %U http://www.jmir.org/2018/6/e197/ %U https://doi.org/10.2196/jmir.9461 %U http://www.ncbi.nlm.nih.gov/pubmed/29914861 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e10024 %T Effective Behavioral Changes through a Digital mHealth App: Exploring the Impact of Hedonic Well-Being, Psychological Empowerment and Inspiration %A Lin,Yuting %A Tudor-Sfetea,Carina %A Siddiqui,Sarim %A Sherwani,Yusuf %A Ahmed,Maroof %A Eisingerich,Andreas B %+ Imperial College Business School, Imperial College London, South Kensington Campus, London, SW7 2AZ, United Kingdom, 44 207 594 7850, y.lin14@imperial.ac.uk %K mHealth %K gamification %K cognitive behavioral therapy %K empowerment %K well-being %K inspiration %K mobile app %K behavior change and prevention %K digital %D 2018 %7 15.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: New mobile health (mHealth) software apps are emerging and are providing the foundation to radically transform the practice and reach of medical research and care. For this study we collaborated with Quit Genius, a cognitive behavioral therapy (CBT) based mHealth app that helps users quit smoking, to explore the effective design of a digital mHealth app; one that delivers important benefits to its users and helps them change their behaviors for a healthier lifestyle. Objective: The specific aims of this study were to (1) explore the key role of CBT program progress, (2) examine the gamification design app elements that deliver significant benefits (ie, empowerment, well-being, inspiration) to users, (3) explore the effectiveness of these app elements to help users quit smoking or reduce the number of cigarettes smoked, and (4) identify and describe any potential drivers and hindrances arising from the app design elements. Methods: We developed an online survey and sent an email invitation to 4144 individuals, who had previously or were at the time using the Quit Genius mHealth app, to encourage participation in the study. We matched the online survey data with objective app usage data of the study participants. Results: A dataset of 190 completed responses was used. At the time of the survey, respondents had completed an average of 60% of the CBT program in the Quit Genius mHealth app. Of the respondents, 36.3% (69/190) noted to have quit smoking successfully after using the Quit Genius app. As for those who remained smokers after using the app (N=121), the number of cigarettes smoked per day was significantly reduced by 59.6%. The ability of the app to enhance users’ hedonic well-being and psychologically empower them in their daily lives was identified as being key in helping users quit smoking. Specifically, the results show that users whose well-being was enhanced through the app were 1.72 times more likely to quit smoking successfully. Moreover, a one-unit increase on a 7-point Likert scale in the app’s ability to empower smokers in their daily lives led to a reduction of cigarettes smoked per day of 53%. The app’s inspiration to users, however, was negatively associated with quitting success and the reduction in cigarette smoked per day. Conclusions: The findings offer important insights for the effective design of digital mHealth apps. Specifically, we find that perceived psychological empowerment and enhanced hedonic well-being from the mobile solution may be a more impactful way to support the effectiveness of mobile cognitive behavioral therapy for smoking cessation than eliciting strong inspiration. %M 29907557 %R 10.2196/10024 %U http://mhealth.jmir.org/2018/6/e10024/ %U https://doi.org/10.2196/10024 %U http://www.ncbi.nlm.nih.gov/pubmed/29907557 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e142 %T Tobacco-Smoking, Alcohol-Drinking, and Betel-Quid-Chewing Behaviors: Development and Use of a Web-Based Survey System %A Hsu,Kuo-Yao %A Tsai,Yun-Fang %A Huang,Chu-Ching %A Yeh,Wen-Ling %A Chang,Kai-Ping %A Lin,Chen-Chun %A Chen,Ching-Yen %A Lee,Hsiu-Lan %+ School of Nursing, College of Medicine, Chang Gung University, 259, Wen-Hwa 1st Road, Tao-Yuan, 333, Taiwan, 886 32118800 ext 3204, yftsai@mail.cgu.edu.tw %K tobacco smoking %K alcohol drinking %K betel-quid chewing %K Web-based survey system %D 2018 %7 11.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking tobacco, drinking alcohol, and chewing betel quid are health-risk behaviors for several diseases, such as cancer, cardiovascular disease, and diabetes, with severe impacts on health. However, health care providers often have limited time to assess clients’ behaviors regarding smoking tobacco, drinking alcohol, and chewing betel quid and intervene, if needed. Objective: The objective of this study was to develop a Web-based survey system; determine the rates of tobacco-smoking, alcohol-drinking, and betel-quid-chewing behaviors; and estimate the efficiency of the system (time to complete the survey). Methods: Patients and their family members or friends were recruited from gastrointestinal medical–surgical, otolaryngology, orthopedics, and rehabilitation clinics or wards at a medical center in northern Taiwan. Data for this descriptive, cross-sectional study were extracted from a large series of research studies. A Web-based survey system was developed using a Linux, Apache, MySQL, PHP stack solution. The Web survey was set up to include four questionnaires: the Chinese-version Fagerstrom Tolerance Questionnaire, the Chinese-version Alcohol Use Disorders Identification Test, the Betel Nut Dependency Scale, and a sociodemographic form with several chronic diseases. After the participants completed the survey, the system automatically calculated their score, categorized their risk level for each behavior, and immediately presented and explained their results. The system also recorded the time each participant took to complete the survey. Results: Of 782 patient participants, 29.6% were addicted to nicotine, 13.3% were hazardous, harmful, or dependent alcohol drinkers, and 1.5% were dependent on chewing betel quid. Of 425 family or friend participants, 19.8% were addicted to nicotine, 5.6% were hazardous, harmful, or dependent alcohol drinkers, and 0.9% were dependent on chewing betel quid. Regarding the mean time to complete the survey, patients took 7.9 minutes (SD 3.0; range 3-20) and family members or friends took 7.7 minutes (SD 2.8; range 3-18). Most of the participants completed the survey within 5-10 minutes. Conclusions: The Web-based survey was easy to self-administer. Health care providers can use this Web-based survey system to save time in assessing these risk behaviors in clinical settings. All smokers had mild-to-severe nicotine addiction, and 5.6%-12.3% of patients and their family members or friends were at risk of alcohol dependence. Considering that these three behaviors, particularly in combination, dramatically increase the risk of esophageal cancer, appropriate and convenient interventions are necessary for preserving public health in Taiwan. %M 29891467 %R 10.2196/mhealth.9783 %U http://mhealth.jmir.org/2018/6/e142/ %U https://doi.org/10.2196/mhealth.9783 %U http://www.ncbi.nlm.nih.gov/pubmed/29891467 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e134 %T The Crush the Crave Quit Smoking App and Young Adult Smokers: Qualitative Case Study of Affordances %A Struik,Laura L %A Bottorff,Joan L %A Baskerville,Neill Bruce %A Oliffe,John L %+ Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 2508647879, laura.struik@uwaterloo.ca %K smartphone %K smoking cessation %K young adult %K qualitative research %K social theory %D 2018 %7 08.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone apps have emerged as a promising way to reach young adult smokers, given their high mobile phone ownership rates and openness to receiving cessation support via digital technologies. Although emerging evidence indicates that quit smoking apps are an effective way to reduce smoking among young adults, lacking is formative evaluative research that captures the perspectives of end-users. Objective: The objective of this study was to contribute insights toward understanding how young adults interact with the Crush the Crave (CTC) app, and how this interaction shapes young adults’ smoking cessation experiences and practices, with consideration of the influence of gender. Methods: Semistructured interviews were conducted with 31 young adult CTC end-users. Guided by sociomateriality theory and an affordances approach, data were inductively analyzed to derive thematic findings in relation to the impacts of CTC on quit efforts, and to expose the underlying affordances (mechanisms) that lend to these outcomes. Findings were grouped according to the 4 design components of CTC: credibility, social support, task support, and dialogue support. Results: The credibility component of CTC played an important role in harnessing the trust of young adults because it afforded them promise in relation to its potential effectiveness in assisting them with quitting smoking. The social support component lent to various end-user practices and experiences that rendered this aspect as the weakest component in supporting quit efforts. Although most functions situated in the task and dialogue support components were found to be helpful, there were a few affordances in CTC that resulted in negative experiences, notably weaning from smoking. Gender-related influences were also evident. For example, young men preferred to control and self-manage their quitting and, therefore, did not engage with functions that afforded journaling or reminding to stay on track. Women, in contrast, were more likely to benefit from these affordances. Conclusions: An affordances approach is productive for gaining an in-depth understanding of how mobile apps interact with end-users to lend to particular outcomes. The study findings have implications for developing and improving apps for helping young adults quit smoking, as well as apps that target other health behaviors. Productive affordances may also serve as a framework for leveraging apps for smoking cessation. %M 29884602 %R 10.2196/mhealth.9489 %U http://mhealth.jmir.org/2018/6/e134/ %U https://doi.org/10.2196/mhealth.9489 %U http://www.ncbi.nlm.nih.gov/pubmed/29884602 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 2 %P e11 %T A Mobile Game to Support Smoking Cessation: Prototype Assessment %A Raiff,Bethany R %A Fortugno,Nicholas %A Scherlis,Daniel R %A Rapoza,Darion %+ Health and Behavioral Integrated Treatments Research Unit, Department of Psychology, Rowan University, 201 Mullica Hill Road, Glassboro, NJ, 08028, United States, 1 856 256 4500 ext 53782, raiff@rowan.edu %K smoking %K smoking cessation %K contingency management %K mobile apps %K virtual rewards %K health games %K video games %K digital games %K carbon monoxide %K incentives %D 2018 %7 07.06.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Cigarette smoking results in an estimated seven million deaths annually. Almost half of all smokers attempt to quit each year, yet only approximately 6% are successful. Although there are multiple effective interventions that can increase these odds, substantial room remains for improvement. One effective approach to helping smokers quit is contingency management, where quitting is incentivized with the delivery of monetary rewards in exchange for objective evidence (eg, exhaled carbon monoxide levels) of abstinence. Objective: We assessed the feasibility and promise of Inspired, a contingency management mobile app for smoking cessation that uses game-based rewards to incentivize abstinence from smoking instead of the monetary (or material) rewards typically used. We sought participant feedback and limited objective data on: the features and design of Inspired, interest in using Inspired when it becomes available, the likelihood of Inspired being an effective cessation aid, and the rank order preference of Inspired relative to other familiar smoking cessation aids. Methods: Twenty-eight treatment-seeking smokers participated in this study. Participants attended a single one-hour session in which they received an overview of the goals of the Inspired mobile game, practiced submitting breath carbon monoxide (CO) samples, and played representative levels of the game. Participants were then told that they could play an extra level, or they could stop, complete an outcome survey, receive payment, and be dismissed. A sign-up sheet requesting personal contact information was available for those who wished to be notified when the full version of Inspired becomes available. Results: Using binary criteria for endorsement, participants indicated that, assuming it was currently available and fully developed, they would be more likely to use Inspired than: any other smoking cessation aid (21/28, 75%), the nicotine patch (23/28, 82%), a drug designed to reduce smoking cravings (23/28, 82%), or a program involving attendance in training sessions or support group meetings (27/28, 96%). In the questionnaire, participants indicated that both the Inspired program (26/28, 93%) and the Inspired game would be “Fun” (28/28, 100%), and 71% (20/28) reported that the program would help them personally quit smoking. Fifty-eight percent of participants (15/26) chose to continue playing the game rather than immediately collecting payment for participation and leaving. Eighty-two percent of participants (23/28) signed up to be notified when the full version of Inspired becomes available. Conclusions: This was the first study to evaluate a game-based contingency management app that uses game-based virtual goods as rewards for smoking abstinence. The outcomes suggest that the completed app has potential to be an effective smoking cessation aid that would be widely adopted by smokers wishing to quit. %R 10.2196/games.9599 %U http://games.jmir.org/2018/2/e11/ %U https://doi.org/10.2196/games.9599 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e11 %T Feasibility of a Proactive Text Messaging Intervention for Smokers in Community Health Centers: Pilot Study %A Kruse,Gina %A Kelley,Jennifer HK %A Chase,Karen %A Rigotti,Nancy A %+ Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, United States, 1 6177243157, gkruse@partners.org %K smoking cessation %K primary health care %K text messaging %D 2018 %7 31.05.2018 %9 Short Paper %J JMIR Formativ Res %G English %X Background: Few smokers receive evidence-based cessation services during primary care visits. Objective: We aimed to assess the feasibility of a proactive text messaging program for primary care patients who smoke. Methods: We used electronic health records to identify smokers who had a mobile phone number listed from two community health centers in Massachusetts. Between March 2014 and June 2015, patients were screened by their primary care physician and then sent a proactive text message inviting them to enroll by texting back. Patients who opted in were asked about their readiness to quit. The text message program included messages from the QuitNowTXT library and novel content for smokers who were not ready to quit. Results: Among 949 eligible smokers, 88 (9.3%) enrolled after receiving a single proactive text message. Compared with those who did not enroll, enrollees were more often female (54/88, 61% vs 413/861, 48.0%, P=.02), but otherwise did not differ in age, race, insurance status, or comorbidities. In all, 28% (19/67) of enrollees reported they were not ready to quit in the next 30 days, 61% (41/67) were ready to quit, and 11% (7/67) already quit. The median time in the program was 9 days (interquartile range 2-32 days). Of current smokers, 25% (15/60) sent one or more keyword requests to the server. These did not differ by readiness to quit. Conclusions: A proactively delivered text messaging program targeting primary care patients who smoke was feasible and engaged both smokers ready to quit and those not ready to quit. This method shows promise as part of a population health model for addressing tobacco use outside of the primary care office. %R 10.2196/formative.9608 %U http://formative.jmir.org/2018/1/e11/ %U https://doi.org/10.2196/formative.9608 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e55 %T New Tobacco and Tobacco-Related Products: Early Detection of Product Development, Marketing Strategies, and Consumer Interest %A Staal,Yvonne CM %A van de Nobelen,Suzanne %A Havermans,Anne %A Talhout,Reinskje %+ RIVM, Centre for Health Protection, Antonie van Leeuwenhoeklaan 9, Bilthoven,, Netherlands, 31 30 274 4505, Reinskje.Talhout@rivm.nl %K noncigarette tobacco products %K electronic nicotine delivery systems %K public opinion %K retrospective studies %D 2018 %7 28.05.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: A wide variety of new tobacco and tobacco-related products have emerged on the market in recent years. Objective: To understand their potential implications for public health and to guide tobacco control efforts, we have used an infoveillance approach to identify new tobacco and tobacco-related products. Methods: Our search for tobacco(-related) products consists of several tailored search profiles using combinations of keywords such as “e-cigarette” and “new” to extract information from almost 9000 preselected sources such as websites of online shops, tobacco manufacturers, and news sites. Results: Developments in e-cigarette design characteristics show a trend toward customization by possibilities to adjust temperature and airflow, and by the large variety of flavors of e-liquids. Additionally, more e-cigarettes are equipped with personalized accessories, such as mobile phones, applications, and Bluetooth. Waterpipe products follow the trend toward electronic vaping. Various heat-not-burn products were reintroduced to the market. Conclusions: Our search for tobacco(-related) products was specific and timely, though advances in product development require ongoing optimization of the search strategy. Our results show a trend toward products resembling tobacco cigarettes vaporizers that can be adapted to the consumers’ needs. Our search for tobacco(-related) products could aid in the assessment of the likelihood of new products to gain market share, as a possible health risk or as an indicator for the need on independent and reliable information of the product to the general public. %R 10.2196/publichealth.7359 %U http://publichealth.jmir.org/2018/2/e55/ %U https://doi.org/10.2196/publichealth.7359 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e10 %T A Multimedia Support Skills Intervention for Female Partners of Male Smokeless Tobacco Users: Use and Perceived Acceptability %A Akers,Laura %A Andrews,Judy A %A Gordon,Judith S %+ Oregon Research Institute, 1776 Millrace Drive, Eugene, OR, 97403, United States, 1 541 484 2123, lauraa@ori.org %K tobacco cessation %K social support %K multimedia %K website design %K website development %K website use assessment %K usability testing %D 2018 %7 28.05.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: UCare is a new multimedia (website+booklet) intervention for women who want their male partner to quit their use of smokeless tobacco. The intervention is based on research showing that perceived partner responsiveness to social support is highest when the supporter conveys respect, understanding, and caring in their actions. The website included both didactic and interactive features, with optional video components, and special activities to help women develop empathy for nicotine addiction. The booklet reinforced the website content, encouraged women to use the website, and served both as a physical reminder of the intervention and a convenient way to share the information with her partner. Objective: The objective of this study was to describe the utilization and acceptability of a multimedia intervention among women seeking to support their partner in quitting smokeless tobacco. Lessons learned with respect to design considerations for online interventions are also summarized. Methods: We present the evaluation of the intervention components’ use and usefulness in a randomized trial. Results: In the randomized clinical trial, more than 250,000 visits were made to the website in a 2-year period, with the vast majority from mobile devices. Of the 552 women randomized to receive the intervention, 96.9% (535/552) visited the website at least once, and 30.8% (170/552) completed the core website component, “The Basics.” About half of the women (287/552) used the interactive “Take Notes” feature, and 37% (204/552) used the checklists. Few women used the post-Basics features. At 6 weeks, 40.7% (116/285) reported reading the printed and mailed booklet. Website and booklet use were uncorrelated. User ratings for the website and booklet were positive overall. Conclusions: Intervention website designers should consider that many users will access the program only once or twice, and many will not complete it. It is also important to distinguish between core and supplemental features and to consider whether the primary purpose is training or support. Furthermore, printed materials still have value. Trial Registration: ClinicalTrials.gov NCT01885221; https://clinicaltrials.gov/ct2/show/NCT01885221 (Archived by WebCite at http://www.webcitation.org/6zdIgGGtx) %R 10.2196/formative.9948 %U http://formative.jmir.org/2018/1/e10/ %U https://doi.org/10.2196/formative.9948 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e10034 %T Attention and Cognitive Bias Modification Apps: Review of the Literature and of Commercially Available Apps %A Zhang,Melvyn %A Ying,JiangBo %A Song,Guo %A Fung,Daniel SS %A Smith,Helen %+ National Addictions Management Service, Institute of Mental Health, 10 Buangkok Green Medical Park, Singapore, 539747, Singapore, 65 63892504, melvynzhangweibin@gmail.com %K attention bias %K cognitive bias %K smartphone %K mHealth %K psychiatry %K telemedicine %K mobile applications %D 2018 %7 24.05.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Automatic processes, such as attentional biases or interpretative biases, have been purported to be responsible for several psychiatric disorders. Recent reviews have highlighted that cognitive biases may be modifiable. Advances in eHealth and mHealth have been harnessed for the delivery of cognitive bias modification. While several studies have evaluated mHealth-based bias modification intervention, no review, to our knowledge, has synthesized the evidence for it. In addition, no review has looked at commercial apps and their functionalities and methods of bias modification. A review is essential in determining whether scientifically validated apps are available commercially and the proportion of commercial apps that have been evaluated scientifically. Objective: The objective of this review was primarily to determine the proportion of attention or cognitive bias modification apps that have been evaluated scientifically and secondarily to determine whether the scientifically evaluated apps were commercially available. We also sought to identify commercially available bias modification apps and determine the functionalities of these apps, the methods used for attention or cognitive bias modification, and whether these apps had been evaluated scientifically. Methods: To identify apps in the published literature, we searched PubMed, MEDLINE, PsycINFO, and Scopus for studies published from 2000 to April 17, 2018. The search terms used were “attention bias” OR “cognitive bias” AND “smartphone” OR “smartphone application” OR “smartphone app” OR “mobile phones” OR “mobile application” OR mobile app” OR “personal digital assistant.” To identify commercial apps, we conducted a manual cross-sectional search between September 15 and 25, 2017 in the Apple iTunes and Google Play app stores. The search terms used to identify the apps were “attention bias” and “cognitive bias.” We also conducted a manual search on the apps with published evaluations. Results: The effectiveness of bias modification was reported in 7 of 8 trials that we identified in the published literature. Only 1 of the 8 previously evaluated apps was commercially available. The 17 commercial apps we identified tended to use either an attention visual search or gamified task. Only 1 commercial app had been evaluated in the published literature. Conclusions: This is perhaps the first review to synthesize the evidence for published mHealth attention bias apps. Our review demonstrated that evidence for mHealth attention bias apps is inconclusive, and quite a few commercial apps have not been validated scientifically. %M 29793899 %R 10.2196/10034 %U http://mhealth.jmir.org/2018/5/e10034/ %U https://doi.org/10.2196/10034 %U http://www.ncbi.nlm.nih.gov/pubmed/29793899 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e193 %T The Effectiveness of a Computer-Tailored E-Learning Program for Practice Nurses to Improve Their Adherence to Smoking Cessation Counseling Guidelines: Randomized Controlled Trial %A de Ruijter,Dennis %A Candel,Math %A Smit,Eline Suzanne %A de Vries,Hein %A Hoving,Ciska %+ Care and Public Health Research Institute, Department of Health Promotion, Maastricht University, , Maastricht,, Netherlands, 31 43 388 24 06, d.deruijter@maastrichtuniversity.nl %K online learning %K guideline adherence %K advanced practice nursing %K randomized controlled trial %K smoking cessation %D 2018 %7 22.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Improving practice nurses’ (PN) adherence to smoking cessation counseling guidelines will benefit the quality of smoking cessation care and will potentially lead to higher smoking abstinence rates. However, support programs to aid PNs in improving their guideline uptake and adherence do not exist yet. Objective: The aim of this study was to assess the effects of a novel computer-tailored electronic learning (e-learning) program on PNs’ smoking cessation guideline adherence. Methods: A Web-based randomized controlled trial (RCT) was conducted in which an intervention group (N=147) with full access to the e-learning program for 6 months was compared with a control group (N=122) without access. Data collection was fully automated at baseline and 6-month follow-up via online questionnaires, assessing PNs’ demographics, work-related factors, potential behavioral predictors based on the I-Change model, and guideline adherence. PNs also completed counseling checklists to retrieve self-reported counseling activities for each consultation with a smoker (N=1175). To assess the program’s effectiveness in improving PNs’ guideline adherence (ie, overall adherence and adherence to individual counseling guideline steps), mixed linear and logistic regression analyses were conducted, thus accommodating for the smokers being nested within PNs. Potential effect moderation by work-related factors and behavioral predictors was also examined. Results: After 6 months, 121 PNs in the intervention group (82.3%, 121/147) and 103 in the control group (84.4%, 103/122) completed the follow-up questionnaire. Mixed linear regression analysis revealed that counseling experience moderated the program’s effect on PNs’ overall guideline adherence (beta=.589; 95% CI 0.111-1.068; PHolm-Bonferroni =.048), indicating a positive program effect on adherence for PNs with a more than average level of counseling experience. Mixed logistic regression analyses regarding adherence to individual guideline steps revealed a trend toward moderating effects of baseline levels of behavioral predictors and counseling experience. More specifically, for PNs with less favorable scores on behavioral predictors (eg, low baseline self-efficacy) and high levels of counseling experience, the program significantly increased adherence. Conclusions: Results from our RCT showed that among PNs with more than average counseling experience, the e-learning program resulted in significantly better smoking cessation guideline adherence. Experienced PNs might have been better able to translate the content of our e-learning program into practically applicable counseling strategies compared with less experienced colleagues. Less favorable baseline levels of behavioral predictors among PNs possibly contributed to this effect, as there was more room for improvement by consulting the tailored content of the e-learning program. To further substantiate the effectiveness of e-learning programs on guideline adherence by health care professionals (HCPs), it is important to assess how to support a wider range of HCPs. Trial Registration: Netherlands Trial Register NTR4436; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4436 (Archived by WebCite at http://www.webcitation.org/6zJQuSRq0) %M 29789278 %R 10.2196/jmir.9276 %U http://www.jmir.org/2018/5/e193/ %U https://doi.org/10.2196/jmir.9276 %U http://www.ncbi.nlm.nih.gov/pubmed/29789278 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e121 %T mActive-Smoke: A Prospective Observational Study Using Mobile Health Tools to Assess the Association of Physical Activity With Smoking Urges %A Silverman-Lloyd,Luke G %A Kianoush,Sina %A Blaha,Michael J %A Sabina,Alyse B %A Graham,Garth N %A Martin,Seth S %+ Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Johns Hopkins Hospital, Carnegie 591, 600 North Wolfe Street, Baltimore, MD, 21287, United States, 1 410 502 0469, smart100@jhmi.edu %K activity trackers %K cigarette smoking %K exercise %K fitness trackers %K mobile health %K mHealth %K physical activity %K smartphone %K smoking %K text messaging %K texting %D 2018 %7 11.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Evidence that physical activity can curb smoking urges is limited in scope to acute effects and largely reliant on retrospective self-reported measures. Mobile health technologies offer novel mechanisms for capturing real-time data of behaviors in the natural environment. Objective: This study aimed to explore this in a real-world longitudinal setting by leveraging mobile health tools to assess the association between objectively measured physical activity and concurrent smoking urges in a 12-week prospective observational study. Methods: We enrolled 60 active smokers (≥3 cigarettes per day) and recorded baseline demographics, physical activity, and smoking behaviors using a Web-based questionnaire. Step counts were measured continuously using the Fitbit Charge HR. Participants reported instantaneous smoking urges via text message using a Likert scale ranging from 1 to 9. On study completion, participants reported follow-up smoking behaviors in an online exit survey. Results: A total of 53 participants (aged 40 [SD 12] years, 57% [30/53] women, 49% [26/53] nonwhite) recorded at least 6 weeks of data and were thus included in the analysis. We recorded 15,365 urge messages throughout the study, with a mean of 290 (SD 62) messages per participant. Mean urge over the course of the study was positively associated with daily cigarette consumption at follow-up (Pearson r=.33; P=.02). No association existed between daily steps and mean daily urge (beta=−6.95×10−3 per 1000 steps; P=.30). Regression models of acute effects, however, did reveal modest inverse associations between steps within 30-, 60-, and 120-min time windows of a reported urge (beta=−.0191 per 100 steps, P<.001). Moreover, 6 individuals (approximately 10% of the study population) exhibited a stronger and consistent inverse association between steps and urge at both the day level (mean individualized beta=−.153 per 1000 steps) and 30-min level (mean individualized beta=−1.66 per 1000 steps). Conclusions: Although there was no association between objectively measured daily physical activity and concurrently self-reported smoking urges, there was a modest inverse relationship between recent step counts (30-120 min) and urge. Approximately 10% of the individuals appeared to have a stronger and consistent inverse association between physical activity and urge, a provocative finding warranting further study. %M 29752250 %R 10.2196/mhealth.9292 %U http://mhealth.jmir.org/2018/5/e121/ %U https://doi.org/10.2196/mhealth.9292 %U http://www.ncbi.nlm.nih.gov/pubmed/29752250 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e10143 %T Trajectories of 12-Month Usage Patterns for Two Smoking Cessation Websites: Exploring How Users Engage Over Time %A Bricker,Jonathan B %A Sridharan,Vasundhara %A Zhu,Yifan %A Mull,Kristin E %A Heffner,Jaimee L %A Watson,Noreen L %A McClure,Jennifer B %A Di,Chongzhi %+ Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA, 98109, United States, 1 2066675074, jbricker@fredhutch.org %K engagement %K trajectories %K eHealth %K websites %K tobacco %K smoking %K acceptance and commitment therapy %K smokefree.gov %K patient participation %K telemedicine %K tobacco use cessation %K smoking cessation %D 2018 %7 20.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Little is known about how individuals engage with electronic health (eHealth) interventions over time and whether this engagement predicts health outcomes. Objective: The objectives of this study, by using the example of a specific type of eHealth intervention (ie, websites for smoking cessation), were to determine (1) distinct groups of log-in trajectories over a 12-month period, (2) their association with smoking cessation, and (3) baseline user characteristics that predict trajectory group membership. Methods: We conducted a functional clustering analysis of 365 consecutive days of log-in data from both arms of a large (N=2637) randomized trial of 2 website interventions for smoking cessation (WebQuit and Smokefree), with a primary outcome of 30-day point prevalence smoking abstinence at 12 months. We conducted analyses for each website separately. Results: A total of 3 distinct trajectory groups emerged for each website. For WebQuit, participants were clustered into 3 groups: 1-week users (682/1240, 55.00% of the sample), 5-week users (399/1240, 32.18%), and 52-week users (159/1240, 12.82%). Compared with the 1-week users, the 5- and 52-week users had 57% higher odds (odds ratio [OR] 1.57, 95% CI 1.13-2.17; P=.007) and 124% higher odds (OR 2.24, 95% CI 1.45-3.43; P<.001), respectively, of being abstinent at 12 months. Smokefree users were clustered into 3 groups: 1-week users (645/1309, 49.27% of the sample), 4-week users (395/1309, 30.18%), and 5-week users (269/1309, 20.55%). Compared with the 1-week users, 5-week users (but not 4-week users; P=.99) had 48% higher odds (OR 1.48, 95% CI 1.05-2.07; P=.02) of being abstinent at 12 months. In general, the WebQuit intervention had a greater number of weekly log-ins within each of the 3 trajectory groups as compared with those of the Smokefree intervention. Baseline characteristics associated with trajectory group membership varied between websites. Conclusions: Patterns of 1-, 4-, and 5-week usage of websites may be common for how people engage in eHealth interventions. The 5-week usage of either website, and 52-week usage only of WebQuit, predicted a higher odds of quitting smoking. Strategies to increase eHealth intervention engagement for 4 more weeks (ie, from 1 week to 5 weeks) could be highly cost effective. Trial Registration: ClinicalTrials.gov NCT01812278; https://www.clinicaltrials.gov/ct2/show/NCT01812278 (Archived by WebCite at http://www.webcitation.org/6yPO2OIKR) %M 29678799 %R 10.2196/10143 %U http://www.jmir.org/2018/4/e10143/ %U https://doi.org/10.2196/10143 %U http://www.ncbi.nlm.nih.gov/pubmed/29678799 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e146 %T Uptake of Tailored Text Message Smoking Cessation Support in Pregnancy When Advertised on the Internet (MiQuit): Observational Study %A Emery,Joanne L %A Coleman,Tim %A Sutton,Stephen %A Cooper,Sue %A Leonardi-Bee,Jo %A Jones,Matthew %A Naughton,Felix %+ Behavioral Science Group, Institute of Public Health, University of Cambridge, Forvie Site, Cambridge Biomedical Campus, Cambridge, CB2 0SR, United Kingdom, 44 0 1223 330355, jle40@medschl.cam.ac.uk %K smoking cessation %K pregnancy %K internet %K telemedicine %K public health %K social media %D 2018 %7 19.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Smoking in pregnancy is a major public health concern. Pregnant smokers are particularly difficult to reach, with low uptake of support options and few effective interventions. Text message–based self-help is a promising, low-cost intervention for this population, but its real-world uptake is largely unknown. Objective: The objective of this study was to explore the uptake and cost-effectiveness of a tailored, theory-guided, text message intervention for pregnant smokers (“MiQuit”) when advertised on the internet. Methods: Links to a website providing MiQuit initiation information (texting a short code) were advertised on a cost-per-click basis on 2 websites (Google Search and Facebook; £1000 budget each) and free of charge within smoking-in-pregnancy webpages on 2 noncommercial websites (National Childbirth Trust and NHS Choices). Daily budgets were capped to allow the Google and Facebook adverts to run for 1 and 3 months, respectively. We recorded the number of times adverts were shown and clicked on, the number of MiQuit initiations, the characteristics of those initiating MiQuit, and whether support was discontinued prematurely. For the commercial adverts, we calculated the cost per initiation and, using quit rates obtained from an earlier clinical trial, estimated the cost per additional quitter. Results: With equal capped budgets, there were 812 and 1889 advert clicks to the MiQuit website from Google (search-based) and Facebook (banner) adverts, respectively. MiQuit was initiated by 5.2% (42/812) of those clicking via Google (95% CI 3.9%-6.9%) and 2.22% (42/1889) of those clicking via Facebook (95% CI 1.65%-2.99%). Adverts on noncommercial webpages generated 53 clicks over 6 months, with 9 initiations (9/53, 17%; 95% CI 9%-30%). For the commercial websites combined, mean cost per initiation was £24.73; estimated cost per additional quitter, including text delivery costs, was £735.86 (95% CI £227.66-£5223.93). Those initiating MiQuit via Google were typically very early in pregnancy (median gestation 5 weeks, interquartile range 10 weeks); those initiating via Facebook were distributed more evenly across pregnancy (median gestation 16 weeks, interquartile range 14 weeks). Conclusions: Commercial online adverts are a feasible, likely cost-effective method for engaging pregnant smokers in digital cessation support and may generate uptake at a faster rate than noncommercial websites. As a strategy for implementing MiQuit, online advertising has large reach potential and can offer support to a hard-to-reach population of smokers. %M 29674308 %R 10.2196/jmir.8525 %U http://www.jmir.org/2018/4/e146/ %U https://doi.org/10.2196/jmir.8525 %U http://www.ncbi.nlm.nih.gov/pubmed/29674308 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e98 %T Evaluation of Two Mobile Health Apps in the Context of Smoking Cessation: Qualitative Study of Cognitive Behavioral Therapy (CBT) Versus Non-CBT-Based Digital Solutions %A Tudor-Sfetea,Carina %A Rabee,Riham %A Najim,Muhammad %A Amin,Nima %A Chadha,Mehak %A Jain,Minal %A Karia,Kishan %A Kothari,Varun %A Patel,Tejus %A Suseeharan,Melanie %A Ahmed,Maroof %A Sherwani,Yusuf %A Siddiqui,Sarim %A Lin,Yuting %A Eisingerich,Andreas B %+ Imperial College Business School, Imperial College London, South Kensington Campus, Ayrton Rd, Kensington, London, SW7 2AZ, United Kingdom, 44 020 7589 5111, a.eisingerich@imperial.ac.uk %K smoking cessation %K mHealth %K mobile health %K health behavior change %K cognitive behavioral therapy %K public health %K health policy %D 2018 %7 18.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) apps can offer users numerous benefits, representing a feasible and acceptable means of administering health interventions such as cognitive behavioral therapy (CBT). CBT is commonly used in the treatment of mental health conditions, where it has a strong evidence base, suggesting that it represents an effective method to elicit health behavior change. More importantly, CBT has proved to be effective in smoking cessation, in the context of smoking-related costs to the National Health Service (NHS) having been estimated to be as high as £2.6bn in 2015. Although the evidence base for computerized CBT in mental health is strong, there is limited literature on its use in smoking cessation. This, combined with the cost-effectiveness of mHealth interventions, advocates a need for research into the effectiveness of CBT-based smoking cessation apps. Objective: The objective of this study was, first, to explore participants’ perceptions of 2 mHealth apps, a CBT-based app, Quit Genius, and a non-CBT-based app, NHS Smokefree, over a variety of themes. Second, the study aimed to investigate the perceptions and health behavior of users of each app with respect to smoking cessation. Methods: A qualitative short-term longitudinal study was conducted, using a sample of 29 smokers allocated to one of the 2 apps, Quit Genius or Smokefree. Each user underwent 2 one-to-one semistructured interviews, 1 week apart. Thematic analysis was carried out, and important themes were identified. Descriptive statistics regarding participants’ perceptions and health behavior in relation to smoking cessation are also provided. Results: The thematic analysis resulted in five higher themes and several subthemes. Participants were generally more positive about Quit Genius’s features, as well as about its design and information engagement and quality. Quit Genius users reported increased motivation to quit smoking, as well as greater willingness to continue using their allocated app after 1 week. Moreover, these participants demonstrated preliminary changes in their smoking behavior, although this was in the context of our limited sample, not yet allowing for the finding to be generalizable. Conclusions: Our findings underscore the use of CBT in the context of mHealth apps as a feasible and potentially effective smoking cessation tool. mHealth apps must be well developed, preferably with an underlying behavioral change mechanism, to promote positive health behavior change. Digital CBT has the potential to become a powerful tool in overcoming current health care challenges. The present results should be replicated in a wider sample using the apps for a longer period so as to allow for generalizability. Further research is also needed to focus on the effect of greater personalization on behavioral change and on understanding the psychological barriers to the adoption of new mHealth solutions. %M 29669708 %R 10.2196/mhealth.9405 %U http://mhealth.jmir.org/2018/4/e98/ %U https://doi.org/10.2196/mhealth.9405 %U http://www.ncbi.nlm.nih.gov/pubmed/29669708 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e97 %T Mobile App Usage Patterns of Patients Prescribed a Smoking Cessation Medicine: Prospective Observational Study %A Bruno,Marianna %A Wright,Marcia %A Baker,Christine L %A Emir,Birol %A Carda,Eric %A Clausen,Michelle %A Sigler,Catherine %A Patel,Aanal %+ Pfizer, 1002 Waverly Ave, Nashville, TN,, United States, 1 913 481 6562, Marcia.Wright@Pfizer.com %K smartphone %K mobile apps %K technology %K patient engagement %K patient satisfaction %K patient adherence %K surveys %K smoking cessation %D 2018 %7 17.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Cigarette smoking is the leading preventable cause of death and is responsible for more than 480,000 deaths per year in the United States. Smoking cessation is challenging for many patients. Regardless of available treatment options, most quit attempts are unaided, and it takes multiple attempts before a patient is successful. With the ever-increasing use of smartphones, mobile apps hold promise in supporting cessation efforts. This study evaluates the ease of use and user satisfaction with the Pfizer Meds app to support smoking cessation among patients prescribed varenicline (Chantix). Objective: Study participants included varenicline users who downloaded and used the app on their personal smartphone. The main objectives were to report mobile app download frequency and usage details and to describe the participant-reported satisfaction with and usefulness of the app over the 14-week follow-up study period. Methods: Adults aged 18 years or older who had been prescribed varenicline were identified from the Express Scripts Incorporated pharmacy claims database. After meeting privacy restrictions, subjects were sent an invitation letter and second reminder letter with instructions on how to download the Pfizer Meds mobile app. Participants received a push notification to complete a smartphone-enabled survey regarding the utility of the app 12 weeks after downloading the app. Descriptive statistics summarized sociodemographics, use of varenicline, and details of use and satisfaction with the mobile app. Results: Of the 38,129 varenicline users who were sent invitation letters, 1281 participants (3.35%) downloaded the Pfizer Meds app. Of the 1032 users with demographic and other data, 585 (56.68%) were females, and 446 (43.22%) were males; mean age was 46.4 years (SD 10.8). The mean number of app sessions per participant was 4.0 (SD 6.8). The end-of-study survey was completed by 131 survey respondents (10.23%, 131/1281); a large number of participants (117/131, 89.3%) reported being extremely, very, or moderately satisfied with the app. A total of 97 survey respondents (97/131, 74.0%) reported setting up a quit date in the app. Of those, 74 (74/97, 76%) reported quitting on their quit date. Conclusions: Positive patient engagement was observed in this study based on app download and usage. This study quantified how the Pfizer Meds app performed in an observational real-world data setting. The findings demonstrate the willingness of participants to set a quit date and use the app for support in medication adherence, refill reminders, and information regarding how to take the medication. This study provides real-world evidence of the contribution apps can make to the continued encouragement of smokers to improve their health by smoking cessation. %M 29666043 %R 10.2196/mhealth.9115 %U http://mhealth.jmir.org/2018/4/e97/ %U https://doi.org/10.2196/mhealth.9115 %U http://www.ncbi.nlm.nih.gov/pubmed/29666043 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 2 %P e7 %T Virtual Reality Cue Refusal Video Game for Alcohol and Cigarette Recovery Support: Summative Study %A Metcalf,Mary %A Rossie,Karen %A Stokes,Katie %A Tallman,Christina %A Tanner,Bradley %+ Clinical Tools, Inc, 101 Market Street, Suite A, Chapel Hill, NC,, United States, 1 919 960 8118, metcalf@clinicaltools.com %K addiction treatment %K Kinect %K serious games %K motion control games %K virtual reality %D 2018 %7 16.04.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: New technologies such as virtual reality, augmented reality, and video games hold promise to support and enhance individuals in addiction treatment and recovery. Quitting or decreasing cigarette or alcohol use can lead to significant health improvements for individuals, decreasing heart disease risk and cancer risks (for both nicotine and alcohol use), among others. However, remaining in recovery from use is a significant challenge for most individuals. Objective: We developed and assessed the Take Control game, a partially immersive Kinect for Windows platform game that allows users to counter substance cues through active movements (hitting, kicking, etc). Methods: Formative analysis during phase I and phase II guided development. We conducted a small wait-list control trial using a quasi-random sampling technique (systematic) with 61 participants in recovery from addiction to alcohol or tobacco. Participants used the game 3 times and reported on substance use, cravings, satisfaction with the game experience, self-efficacy related to recovery, and side effects from exposure to a virtual reality intervention and substance cues. Results: Participants found the game engaging and fun and felt playing the game would support recovery efforts. On average, reported substance use decreased for participants during the intervention period. Participants in recovery for alcohol use saw more benefit than those in recovery for tobacco use, with a statistically significant increase in self-efficacy, attitude, and behavior during the intervention. Side effects from the use of a virtual reality intervention were minor and decreased over time; cravings and side effects also decreased during the study. Conclusions: The preliminary results suggest the intervention holds promise as an adjunct to standard treatment for those in recovery, particularly from alcohol use. %M 29661748 %R 10.2196/games.9231 %U http://games.jmir.org/2018/2/e7/ %U https://doi.org/10.2196/games.9231 %U http://www.ncbi.nlm.nih.gov/pubmed/29661748 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e118 %T Identification of Users for a Smoking Cessation Mobile App: Quantitative Study %A Chevalking,SK Leon %A Ben Allouch,Somaya %A Brusse-Keizer,Marjolein %A Postel,Marloes G %A Pieterse,Marcel E %+ Research Group Technology, Health & Care, Saxion University of Applied Sciences, MH Tromplaan 28, 7513 AB, Enschede, 70.000 PO Box, Netherlands, 31 612292901, s.benallouch@saxion.nl %K mobile applications %K telemedicine %K mHealth %K eHealth %K tobacco %K smoking cessation %K health informatics %D 2018 %7 09.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of mobile apps that support smoking cessation is growing, indicating the potential of the mobile phone as a means to support cessation. Knowledge about the potential end users for cessation apps results in suggestions to target potential user groups in a dissemination strategy, leading to a possible increase in the satisfaction and adherence of cessation apps. Objective: This study aimed to characterize potential end users for a specific mobile health (mHealth) smoking cessation app. Methods: A quantitative study was conducted among 955 Dutch smokers and ex-smokers. The respondents were primarily recruited from addiction care facilities and hospitals through Web-based media via websites and forums. The respondents were surveyed on their demographics, smoking behavior, and personal innovativeness. The intention to use and the attitude toward a cessation app were determined on a 5-point Likert scale. To study the association between the characteristics and intention to use and attitude, univariate and multivariate ordinal logistic regression analyses were performed. Results: The multivariate ordinal logistic regression showed that the number of previous quit attempts (odds ratio [OR] 4.1, 95% CI 2.4-7.0, and OR 3.5, 95% CI 2.0-5.9) and the score on the Fagerstrom Test of Nicotine Dependence (OR 0.8, 95% CI 0.8-0.9, and OR 0.8, 95% CI 0.8-0.9) positively correlates with the intention to use a cessation app and the attitude toward cessation apps, respectively. Personal innovativeness also positively correlates with the intention to use (OR 0.3, 95% CI 0.2-0.4) and the attitude towards (OR 0.2, 95% CI 0.1-0.4) a cessation app. No associations between demographics and the intention to use or the attitude toward using a cessation app were observed. Conclusions: This study is among the first to show that demographic characteristics such as age and level of education are not associated with the intention to use and the attitude toward using a cessation app when characteristics related specifically to the app, such as nicotine dependency and the number of quit attempts, are present in a multivariate regression model. This study shows that the use of mHealth apps depends on characteristics related to the content of the app rather than general user characteristics. %M 29631988 %R 10.2196/jmir.7606 %U http://www.jmir.org/2018/4/e118/ %U https://doi.org/10.2196/jmir.7606 %U http://www.ncbi.nlm.nih.gov/pubmed/29631988 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e27 %T Influence of Flavors on the Propagation of E-Cigarette–Related Information: Social Media Study %A Zhou,Jiaqi %A Zhang,Qingpeng %A Zeng,Daniel Dajun %A Tsui,Kwok Leung %+ Department of Systems Engineering and Engineering Management, City University of Hong Kong, P6606, 6/F, Academic 1, City University of Hong Kong, 83 Tat Chee Avenue, Kowloon Tong, 00001, China (Hong Kong), 852 34424727, qingpeng.zhang@cityu.edu.hk %K e-cigarettes %K flavors %K social media %K information propagation %K social networks %K electronic nicotine delivery systems %K flavoring agents %K information dissemination %K social networking %D 2018 %7 23.03.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Modeling the influence of e-cigarette flavors on information propagation could provide quantitative policy decision support concerning smoking initiation and contagion, as well as e-cigarette regulations. Objective: The objective of this study was to characterize the influence of flavors on e-cigarette–related information propagation on social media. Methods: We collected a comprehensive dataset of e-cigarette–related discussions from public Pages on Facebook. We identified 11 categories of flavors based on commonly used categorizations. Each post’s frequency of being shared served as a proxy measure of information propagation. We evaluated a set of regression models and chose the hurdle negative binomial model to characterize the influence of different flavors and nonflavor control variables on e-cigarette–related information propagation. Results: We found that 5 flavors (sweet, dessert & bakery, fruits, herbs & spices, and tobacco) had significantly negative influences on e-cigarette–related information propagation, indicating the users’ tendency not to share posts related to these flavors. We did not find a positive significance of any flavors, which is contradictory to previous research. In addition, we found that a set of nonflavor–related factors were associated with information propagation. Conclusions: Mentions of flavors in posts did not enhance the popularity of e-cigarette–related information. Certain flavors could even have reduced the popularity of information, indicating users’ lack of interest in flavors. Promoting e-cigarette–related information with mention of flavors is not an effective marketing approach. This study implies the potential concern of users about flavorings and suggests a need to regulate the use of flavorings in e-cigarettes. %M 29572202 %R 10.2196/publichealth.7998 %U http://publichealth.jmir.org/2018/1/e27/ %U https://doi.org/10.2196/publichealth.7998 %U http://www.ncbi.nlm.nih.gov/pubmed/29572202 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e80 %T Evolution of Electronic Cigarette Brands From 2013-2014 to 2016-2017: Analysis of Brand Websites %A Hsu,Greta %A Sun,Jessica Y %A Zhu,Shu-Hong %+ Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Drive, MC 0905, La Jolla, CA, 92093, United States, 1 8583001056, szhu@ucsd.edu %K electronic cigarettes %K vaping %K nicotine %K longitudinal studies %K internet %K market research %D 2018 %7 12.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The electronic cigarette (e-cigarette) industry has grown in size and organizational complexity in recent years, most notably with the entry of major tobacco companies in 2012 and the proliferation of vape shops. Many brands maintain retail websites that present e-cigarette marketing claims and sell directly to consumers. Understanding of the evolving composition of different types of e-cigarette brand websites is currently underdeveloped. Objective: This paper presents how e-cigarette brand websites surveyed in 2013-2014 evolved by 2016-2017, and how the websites run by different types of e-cigarette producers currently differ. Methods: In 2016-2017, we revisited 466 e-cigarette brand websites surveyed in 2013-2014, 288 of which were extant, and identified 145 new English-language websites. We compared product designs, marketing claims, and age-based warnings presented by types of e-cigarette producers: major tobacco companies, independent vape shops, and independent internet-only companies. Results: Among the 433 websites examined in 2016-2017, 12 were owned by major tobacco companies, 162 operated a physical vape shop, and 259 were internet-only operations. Closed-system product designs were sold by 83% (10/12) of tobacco-owned brands. In comparison, 29.0% (47/162, P<.001) of vape shop and 55.2% (143/259, P=.06) of internet-only brands sold closed-system designs. Compared with vape shop and internet-only brands, tobacco-owned brands offered a smaller set of product models (P values <.001) and a narrower range of flavors (P values <.01), with greater emphasis on the traditional combustible cigarette flavors of tobacco and menthol (P values <.001). Tobacco-owned brands also offered a narrower range of nicotine options than the vape shops (P=.002) and were less likely to offer nicotine-free e-liquid compared with internet-only and vape shop brands (P values <.001). Finally, 83% (10/12) of tobacco-owned brand websites featured age verification pop-up windows. In comparison, only 50.2% (130/259) of internet-only brands (P=.01) and 60.5% (98/162) of vape shop brands (P=.06) featured age verification windows. Websites surveyed in both 2013-2014 and 2016-2017 became more likely to sell open-system mods (P<.001) and sold an increased number of product models (P<.001), flavors (P<.001), and nicotine options (P<.001). Prevalence of several types of claims decreased significantly, including indirect claims regarding smoking cessation (P<.001), claims regarding e-cigarettes as healthier (P<.001), less expensive (P<.001), and usable in more places (P<.001) compared with combustible cigarettes. Conclusions: The number of e-cigarette brands has not appeared to increase since 2014, even as website messaging evolved, with brands owned by tobacco companies and vape shops pulling in opposite directions. Brands owned by tobacco companies offered a limited range of e-cigarette products, whereas brands owned by vape shops emphasized a panoply of flavor and nicotine options. Furthermore, the Food and Drug Administration’s regulatory action may influence the types of e-cigarette products offered and the market shares of various companies. %M 29530840 %R 10.2196/jmir.8550 %U http://www.jmir.org/2018/3/e80/ %U https://doi.org/10.2196/jmir.8550 %U http://www.ncbi.nlm.nih.gov/pubmed/29530840 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e18 %T Targeted Secure Messages to Facilitate Access to Tobacco Treatment Counseling for Veterans: Feasibility Study %A Shahani,Shaun %A Korenblit,Pearl %A Thomas,Pauline %A Passannante,Marian R %A Carr,Richard %A Davis,Lynn %+ Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ, 07103, United States, 1 732 445 4636, shaun.shahani@tu.edu %K secure messaging %K tobacco use %K smoking cessation %D 2018 %7 05.03.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Studies show that combining nicotine replacement therapy (NRT) with tobacco treatment counseling is most effective for smoking cessation. However, tobacco treatment counseling has been underutilized across the nation. A secure email message sent to patients already taking NRT was hypothesized to increase the utilization of tobacco treatment counseling among Veterans in New Jersey. Secure messaging for communication between patients and providers was implemented through a web-based password-protected, secure messaging account, where Veterans get notified through their personal email when they have a message awaiting them. Objective: The main objective of this project was to determine if there was a significant increase in adoption of tobacco treatment counseling among Veterans who received a secure message describing the options for tobacco treatment counseling available to them. Secondary objectives were to demographically characterize Veterans who were and were not enrolled in secure messaging, as well as those who opened or did not open a message. Finally, because the language and content of the messages were changed across project phases, this project also sought to determine (by analysis of response rates) the type of language that was most effective at eliciting a response. Methods: Over two phases, messages were sent to two samples of Veterans prescribed NRT within the prior 90 days of each phase. In phase 1, one message was sent in December 2015 (message 1). In phase 2, one message was sent in July 2016 (message 2) and the same message (message 3) was resent in August 2016 to persons who did not open message 2. Messages 2 and 3 were more directive than message 1. Response rates to message 1 versus message 2 were compared. A logistic regression analysis determined effect of age and gender on enrollment in secure messaging across both phases. The effectiveness of each phase at increasing tobacco treatment counseling was analyzed using a McNemar test. Results: Message 2, sent to 423 Veterans, had a significantly higher response rate than message 1, sent to 348 Veterans (18%, 17/93 vs 8%, 6/78, P=.04). Phase 2 (ie, messages 2 and 3) significantly increased utilization of tobacco treatment counseling (net increase of six tobacco treatment counseling adopters, P=.04), whereas phase 1 (ie, message 1) did not (net increase of two tobacco treatment counseling adopters, P=.48). Women (odds ratio [OR] 1.6, 95% CI 1.1-2.3) and those aged 30 to 49 years (compared to other age groups) were more likely to be enrolled in secure messaging. Gender and age were not significant predictors of opening or replying to either message. Conclusions: Although the effect was small, secure messaging was a useful modality to increase tobacco treatment counseling. Directive content with a follow-up message appeared useful. Female Veterans and/or Veterans aged between 30 and 49 years are more likely to use secure messaging. %M 29506969 %R 10.2196/mental.7957 %U http://mental.jmir.org/2018/1/e18/ %U https://doi.org/10.2196/mental.7957 %U http://www.ncbi.nlm.nih.gov/pubmed/29506969 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e52 %T Crush the Crave: Development and Formative Evaluation of a Smartphone App for Smoking Cessation %A Baskerville,Neill B %A Struik,Laura L %A Dash,Darly %+ Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, ON, N2M 3G1, Canada, 1 519 888 4567 ext 35236, nbbaskerville@uwaterloo.ca %K mobile app %K smoking cessation %K young adult %K software design %K formative feedback %D 2018 %7 02.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Emerging evidence supports the use of smartphone apps for smoking cessation, especially in young adults given their high smoking rates and high smartphone ownership rates. Although evaluative evidence is encouraging for supporting smoking cessation, there remains a paucity of research describing the design and development processes of mobile health (mHealth) interventions. Objective: The aim of this paper was to describe the process of developing Crush the Crave (CTC), an evidence-informed app to support smoking cessation in young adults, and the results of a formative evaluation of app usage behavior, as part of a broader program of research that seeks to establish the effectiveness of the CTC app. Methods: The Spiral Technology Action Research (STAR) 5-cycle model (listen, plan, do, act, and study) was employed to guide the development, implementation, and dissemination of CTC. The approach to development and formative evaluation included focus groups with young adult smokers (n=78) across 2 phases, analysis of the content of existing apps, 2 sessions with content experts, and Google Analytics to assess user behavior during a 12-month pilot. Results: LISTEN—focus groups revealed young adult smoker preferences of (1) positive reinforcement, (2) personalization, (3) social support, (4) quit support, (5) tracking the behavior, and (6) tracking quit benefits. PLAN—informed by evidence for smoking cessation, young adult preferences and an assessment of popular cessation apps, content experts produced a mind map and a storyboard describing app content and structure. DO—focus groups with young adult smokers provided feedback on the first version of the app with opinions on content and suggestions for improvement such as providing alerts and distractions from craving. ACT—refinements were made, and app content was organized using the 4 key design components informed by principles of persuasive technology for behavior change: credibility, task support, dialogue support, and social support. CTC was launched in April 2013 and piloted from the period July 2013 to June 2014 where 1987 Android users had 18,567 sessions, resulting in 59,384 page views and 89.58% (1780/1987) of users returning within the same day to use CTC. STUDY—a pragmatic randomized controlled trial of CTC was launched in August 2014 to demonstrate that including mHealth technology as a population-based intervention can help young adult smokers to quit. The results of this phase will be presented in a subsequent publication. Conclusions: CTC is one of the first smoking cessation apps designed to meet the needs of young adult smokers. The development was informed by the inclusion of young adults in the design and the systematic application of multiple stakeholder input, scientific evidence, and theory. The STAR model approach was followed from the beginning of intervention development, which should facilitate optimization of mHealth interventions in the future. Trial Registration: ClinicalTrials.gov NCT01983150; http://clinicaltrials.gov/ct2/show/NCT01983150 (Archived by WebCite at http://www.webcitation.org/6VGyc0W0i) %M 29500157 %R 10.2196/mhealth.9011 %U http://mhealth.jmir.org/2018/3/e52/ %U https://doi.org/10.2196/mhealth.9011 %U http://www.ncbi.nlm.nih.gov/pubmed/29500157 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e8 %T Trust in Health Information Sources: Survey Analysis of Variation by Sociodemographic and Tobacco Use Status in Oklahoma %A Brown-Johnson,Cati G %A Boeckman,Lindsay M %A White,Ashley H %A Burbank,Andrea D %A Paulson,Sjonna %A Beebe,Laura A %+ Evaluation Sciences Unit, Division of Primary Care and Population Health, Stanford School of Medicine, Medical School Office Building, x216, 1265 Welch Rd, Mail Code 5475, Stanford, CA, 94305, United States, 1 6507363394, catibj@stanford.edu %K tobacco use cessation %K health communication %K trust %K social media %K health care providers %K electronic cigarettes %K mass media %K radio %K television %K Oklahoma %D 2018 %7 12.02.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Modern technology (ie, websites and social media) has significantly changed social mores in health information access and delivery. Although mass media campaigns for health intervention have proven effective and cost-effective in changing health behavior at a population scale, this is best studied in traditional media sources (ie, radio and television). Digital health interventions are options that use short message service/text messaging, social media, and internet technology. Although exposure to these products is becoming ubiquitous, electronic health information is novel, incompletely disseminated, and frequently inaccurate, which decreases public trust. Previous research has shown that audience trust in health care providers significantly moderates health outcomes, demographics significantly influence audience trust in electronic media, and preexisting health behaviors such as smoking status significantly moderate audience receptivity to traditional mass media. Therefore, modern health educators must assess audience trust in all sources, both media (traditional and digital) and interpersonal, to balance pros and cons before structuring multicomponent community health interventions. Objective: We aimed to explore current trust and moderators of trust in health information sources given recent changes in digital health information access and delivery to inform design of future health interventions in Oklahoma. Methods: We conducted phone surveys of a cross-sectional sample of 1001 Oklahoma adults (age 18-65 years) in spring 2015 to assess trust in seven media sources: traditional (television and radio), electronic (online and social media), and interpersonal (providers, insurers, and family/friends). We also gathered information on known moderators of trust (sociodemographics and tobacco use status). We modeled log odds of a participant rating a source as “trustworthy” (SAS PROC SURVEYLOGISTIC), with subanalysis for confounders (sociodemographics and tobacco use). Results: Oklahomans showed the highest trust in interpersonal sources: 81% (808/994) reported providers were trustworthy, 55% (550/999) for friends and family, and 48% (485/998) for health insurers. For media sources, 24% of participants (232/989) rated the internet as trustworthy, followed by 21% of participants for television (225/998), 18% for radio (199/988), and only 11% for social media (110/991). Despite this low self-reported trust in social media, 40% (406/991) of participants reported using social media for tobacco-related health information. Trust in health providers did not vary by subpopulation, but sociodemographic variables (gender, income, and education) and tobacco use status significantly moderated trust in other sources. Women were on the whole more trusting than men, trust in media decreased with income, and trust in friends and family decreased with education. Conclusions: Health education interventions should incorporate digital media, particularly when targeting low-income populations. Utilizing health care providers in social media settings could leverage high-trust and low-cost features of providers and social media, respectively. %M 29434015 %R 10.2196/publichealth.6260 %U http://publichealth.jmir.org/2018/1/e8/ %U https://doi.org/10.2196/publichealth.6260 %U http://www.ncbi.nlm.nih.gov/pubmed/29434015 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e23 %T The Impact of mHealth Interventions: Systematic Review of Systematic Reviews %A Marcolino,Milena Soriano %A Oliveira,João Antonio Queiroz %A D'Agostino,Marcelo %A Ribeiro,Antonio Luiz %A Alkmim,Maria Beatriz Moreira %A Novillo-Ortiz,David %+ Pan American Health Organization, 525 23rd St NW, Washington, DC, 20037, United States, 1 2028124726, novillod@paho.org %K telemedicine %K medical informatics %K mobile phones %D 2018 %7 17.01.2018 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone usage has been rapidly increasing worldwide. mHealth could efficiently deliver high-quality health care, but the evidence supporting its current effectiveness is still mixed. Objective: We performed a systematic review of systematic reviews to assess the impact or effectiveness of mobile health (mHealth) interventions in different health conditions and in the processes of health care service delivery. Methods: We used a common search strategy of five major scientific databases, restricting the search by publication date, language, and parameters in methodology and content. Methodological quality was evaluated using the Measurement Tool to Assess Systematic Reviews (AMSTAR) checklist. Results: The searches resulted in a total of 10,689 articles. Of these, 23 systematic reviews (371 studies; more than 79,665 patients) were included. Seventeen reviews included studies performed in low- and middle-income countries. The studies used diverse mHealth interventions, most frequently text messaging (short message service, SMS) applied to different purposes (reminder, alert, education, motivation, prevention). Ten reviews were rated as low quality (AMSTAR score 0-4), seven were rated as moderate quality (AMSTAR score 5-8), and six were categorized as high quality (AMSTAR score 9-11). A beneficial impact of mHealth was observed in chronic disease management, showing improvement in symptoms and peak flow variability in asthma patients, reducing hospitalizations and improving forced expiratory volume in 1 second; improving chronic pulmonary diseases symptoms; improving heart failure symptoms, reducing deaths and hospitalization; improving glycemic control in diabetes patients; improving blood pressure in hypertensive patients; and reducing weight in overweight and obese patients. Studies also showed a positive impact of SMS reminders in improving attendance rates, with a similar impact to phone call reminders at reduced cost, and improved adherence to tuberculosis and human immunodeficiency virus therapy in some scenarios, with evidence of decrease of viral load. Conclusions: Although mHealth is growing in popularity, the evidence for efficacy is still limited. In general, the methodological quality of the studies included in the systematic reviews is low. For some fields, its impact is not evident, the results are mixed, or no long-term studies exist. Exceptions include the moderate quality evidence of improvement in asthma patients, attendance rates, and increased smoking abstinence rates. Most studies were performed in high-income countries, implying that mHealth is still at an early stage of development in low-income countries. %M 29343463 %R 10.2196/mhealth.8873 %U http://mhealth.jmir.org/2018/1/e23/ %U https://doi.org/10.2196/mhealth.8873 %U http://www.ncbi.nlm.nih.gov/pubmed/29343463 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 1 %P e2 %T User-Centered Design of Learn to Quit, a Smoking Cessation Smartphone App for People With Serious Mental Illness %A Vilardaga,Roger %A Rizo,Javier %A Zeng,Emily %A Kientz,Julie A %A Ries,Richard %A Otis,Chad %A Hernandez,Kayla %+ Center for Addiction Science and Technology, Psychiatry and Behavioral Sciences, Duke University, 2812 Erwin Road, Suite 403 Box 13, Durham, NC, 27705, United States, 1 9196813441, roger.vilardaga@duke.edu %K smoking cessation %K mHealth %K serious mental illness %K user-centered design %K gamification %K acceptance and commitment therapy %D 2018 %7 16.01.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Smoking rates in the United States have been reduced in the past decades to 15% of the general population. However, up to 88% of people with psychiatric symptoms still smoke, leading to high rates of disease and mortality. Therefore, there is a great need to develop smoking cessation interventions that have adequate levels of usability and can reach this population. Objective: The objective of this study was to report the rationale, ideation, design, user research, and final specifications of a novel smoking cessation app for people with serious mental illness (SMI) that will be tested in a feasibility trial. Methods: We used a variety of user-centered design methods and materials to develop the tailored smoking cessation app. This included expert panel guidance, a set of design principles and theory-based smoking cessation content, development of personas and paper prototyping, usability testing of the app prototype, establishment of app’s core vision and design specification, and collaboration with a software development company. Results: We developed Learn to Quit, a smoking cessation app designed and tailored to individuals with SMI that incorporates the following: (1) evidence-based smoking cessation content from Acceptance and Commitment Therapy and US Clinical Practice Guidelines for smoking cessation aimed at providing skills for quitting while addressing mental health symptoms, (2) a set of behavioral principles to increase retention and comprehension of smoking cessation content, (3) a gamification component to encourage and sustain app engagement during a 14-day period, (4) an app structure and layout designed to minimize usability errors in people with SMI, and (5) a set of stories and visuals that communicate smoking cessation concepts and skills in simple terms. Conclusions: Despite its increasing importance, the design and development of mHealth technology is typically underreported, hampering scientific innovation. This report describes the systematic development of the first smoking cessation app tailored to people with SMI, a population with very high rates of nicotine addiction, and offers new design strategies to engage this population. mHealth developers in smoking cessation and related fields could benefit from a design strategy that capitalizes on the role visual engagement, storytelling, and the systematic application of behavior analytic principles to deliver evidence-based content. %M 29339346 %R 10.2196/games.8881 %U http://games.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/games.8881 %U http://www.ncbi.nlm.nih.gov/pubmed/29339346 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 4 %P e98 %T E-Cigarette Surveillance With Social Media Data: Social Bots, Emerging Topics, and Trends %A Allem,Jon-Patrick %A Ferrara,Emilio %A Uppu,Sree Priyanka %A Cruz,Tess Boley %A Unger,Jennifer B %+ Keck School of Medicine, University of Southern California, 2001 N. Soto Street, Los Angeles, CA,, United States, 1 858 603 0812, allem@usc.edu %K electronic cigarettes %K vaping %K Twitter %K social media %K social bots %K electronic nicotine delivery system %K infoveillance %D 2017 %7 20.12.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As e-cigarette use rapidly increases in popularity, data from online social systems (Twitter, Instagram, Google Web Search) can be used to capture and describe the social and environmental context in which individuals use, perceive, and are marketed this tobacco product. Social media data may serve as a massive focus group where people organically discuss e-cigarettes unprimed by a researcher, without instrument bias, captured in near real time and at low costs. Objective: This study documents e-cigarette–related discussions on Twitter, describing themes of conversations and locations where Twitter users often discuss e-cigarettes, to identify priority areas for e-cigarette education campaigns. Additionally, this study demonstrates the importance of distinguishing between social bots and human users when attempting to understand public health–related behaviors and attitudes. Methods: E-cigarette–related posts on Twitter (N=6,185,153) were collected from December 24, 2016, to April 21, 2017. Techniques drawn from network science were used to determine discussions of e-cigarettes by describing which hashtags co-occur (concept clusters) in a Twitter network. Posts and metadata were used to describe where geographically e-cigarette–related discussions in the United States occurred. Machine learning models were used to distinguish between Twitter posts reflecting attitudes and behaviors of genuine human users from those of social bots. Odds ratios were computed from 2x2 contingency tables to detect if hashtags varied by source (social bot vs human user) using the Fisher exact test to determine statistical significance. Results: Clusters found in the corpus of hashtags from human users included behaviors (eg, #vaping), vaping identity (eg, #vapelife), and vaping community (eg, #vapenation). Additional clusters included products (eg, #eliquids), dual tobacco use (eg, #hookah), and polysubstance use (eg, #marijuana). Clusters found in the corpus of hashtags from social bots included health (eg, #health), smoking cessation (eg, #quitsmoking), and new products (eg, #ismog). Social bots were significantly more likely to post hashtags that referenced smoking cessation and new products compared to human users. The volume of tweets was highest in the Mid-Atlantic (eg, Pennsylvania, New Jersey, Maryland, and New York), followed by the West Coast and Southwest (eg, California, Arizona and Nevada). Conclusions: Social media data may be used to complement and extend the surveillance of health behaviors including tobacco product use. Public health researchers could harness these data and methods to identify new products or devices. Furthermore, findings from this study demonstrate the importance of distinguishing between Twitter posts from social bots and humans when attempting to understand attitudes and behaviors. Social bots may be used to perpetuate the idea that e-cigarettes are helpful in cessation and to promote new products as they enter the marketplace. %M 29263018 %R 10.2196/publichealth.8641 %U http://publichealth.jmir.org/2017/4/e98/ %U https://doi.org/10.2196/publichealth.8641 %U http://www.ncbi.nlm.nih.gov/pubmed/29263018 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 12 %P e189 %T Detecting Smoking Events Using Accelerometer Data Collected Via Smartwatch Technology: Validation Study %A Cole,Casey A %A Anshari,Dien %A Lambert,Victoria %A Thrasher,James F %A Valafar,Homayoun %+ Computational Biology Research Group, Department of Computer Science, University of South Carolina, 315 Main St., Columbia, SC, 29208, United States, 1 8036298785, homayoun@cse.sc.edu %K machine learning %K neural networks %K automated pattern recognition %K smoking cessation %K ecological momentary assessment %K digital signal processing %K data mining %D 2017 %7 13.12.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking is the leading cause of preventable death in the world today. Ecological research on smoking in context currently relies on self-reported smoking behavior. Emerging smartwatch technology may more objectively measure smoking behavior by automatically detecting smoking sessions using robust machine learning models. Objective: This study aimed to examine the feasibility of detecting smoking behavior using smartwatches. The second aim of this study was to compare the success of observing smoking behavior with smartwatches to that of conventional self-reporting. Methods: A convenience sample of smokers was recruited for this study. Participants (N=10) recorded 12 hours of accelerometer data using a mobile phone and smartwatch. During these 12 hours, they engaged in various daily activities, including smoking, for which they logged the beginning and end of each smoking session. Raw data were classified as either smoking or nonsmoking using a machine learning model for pattern recognition. The accuracy of the model was evaluated by comparing the output with a detailed description of a modeled smoking session. Results: In total, 120 hours of data were collected from participants and analyzed. The accuracy of self-reported smoking was approximately 78% (96/123). Our model was successful in detecting 100 of 123 (81%) smoking sessions recorded by participants. After eliminating sessions from the participants that did not adhere to study protocols, the true positive detection rate of the smartwatch based-detection increased to more than 90%. During the 120 hours of combined observation time, only 22 false positive smoking sessions were detected resulting in a 2.8% false positive rate. Conclusions: Smartwatch technology can provide an accurate, nonintrusive means of monitoring smoking behavior in natural contexts. The use of machine learning algorithms for passively detecting smoking sessions may enrich ecological momentary assessment protocols and cessation intervention studies that often rely on self-reported behaviors and may not allow for targeted data collection and communications around smoking events. %M 29237580 %R 10.2196/mhealth.9035 %U http://mhealth.jmir.org/2017/12/e189/ %U https://doi.org/10.2196/mhealth.9035 %U http://www.ncbi.nlm.nih.gov/pubmed/29237580 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 11 %P e219 %T Recruiting Women to a Mobile Health Smoking Cessation Trial: Low- and No-Cost Strategies %A Abbate,Kristopher J %A Hingle,Melanie D %A Armin,Julie %A Giacobbi Jr,Peter %A Gordon,Judith S %+ College of Medicine, University of Arizona, 1450 N. Cherry, Tucson, AZ, 85719, United States, 1 5206261152, kjabbate@email.arizona.edu %K smoking cessation %K mobile applications %K social media %K women %K mHealth %D 2017 %7 03.11.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Successful recruitment of participants to mobile health (mHealth) studies presents unique challenges over in-person studies. It is important to identify recruitment strategies that maximize the limited recruitment resources available to researchers. Objective: The objective of this study was to describe a case study of a unique recruitment process used in a recent mHealth software app designed to increase smoking cessation among weight-concerned women smokers. The See Me Smoke-Free app was deployed to the Google Play Store (Alphabet, Inc., Google, LLC), where potential participants could download the app and enroll in the study. Users were invited in-app to participate in the study, with no in-person contact. The recruitment activities relied primarily on earned (free) and social media. Methods: To determine the relationship between recruitment activities and participant enrollment, the researchers explored trends in earned and social media activity in relation to app installations, examined social media messaging in relation to reach or impressions, and described app users’ self-reported referral source. The researchers collected and descriptively analyzed data regarding recruitment activities, social media audience, and app use during the 18-week recruitment period (March 30, 2015-July 31, 2015). Data were collected and aggregated from internal staff activity tracking documents and from Web-based data analytics software such as SumAll, Facebook Insights (Facebook, Inc.), and Google Analytics (Alphabet, Inc., Google, LLC). Results: Media coverage was documented across 75 publications and radio or television broadcasts, 35 of which were local, 39 national, and 1 international. The research team made 30 Facebook posts and 49 tweets, yielding 1821 reaches and 6336 impressions, respectively. From March 30, 2015 to July 31, 2015, 289 unique users downloaded the app, and 151 participants enrolled in the study. Conclusions: Research identifying effective online recruitment methods for mHealth studies remains minimal, and findings are inconsistent. We demonstrated how earned media can be leveraged to recruit women to an mHealth smoking cessation trial at low cost. Using earned media and leveraging social media allowed us to enroll 3 times the number of participants that we anticipated enrolling. The cost of earned media resides in the staff time required to manage it, particularly the regular interaction with social media. We recommend communication and cooperation with university public affairs and social media offices, as well as affiliate programs in journalism and communications, so that earned media can be used as a recruitment strategy for mHealth behavior change interventions. However, press releases are not always picked up by the media and should not be considered as a stand-alone method of recruitment. Careful consideration of an intervention’s broad appeal and how that translates into potential media interest is needed when including earned media as part of a comprehensive recruitment plan for mHealth research. %M 29101091 %R 10.2196/resprot.7356 %U http://www.researchprotocols.org/2017/11/e219/ %U https://doi.org/10.2196/resprot.7356 %U http://www.ncbi.nlm.nih.gov/pubmed/29101091 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e356 %T Engagement Within a Mobile Phone–Based Smoking Cessation Intervention for Adolescents and its Association With Participant Characteristics and Outcomes %A Paz Castro,Raquel %A Haug,Severin %A Filler,Andreas %A Kowatsch,Tobias %A Schaub,Michael P %+ Swiss Research Institute for Public Health and Addiction, Zurich University, Konradstrasse 32, Zurich, 8031, Switzerland, 41 444481180, raquel.paz@isgf.uzh.ch %K tobacco %K alcohol drinking %K adolescent %K mobile phones %K treatment outcome %D 2017 %7 01.11.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Although mobile phone–delivered smoking cessation programs are a promising way to promote smoking cessation among adolescents, little is known about how adolescents might actually use them. Objective: The aim of this study was to determine adolescents’ trajectories of engagement with a mobile phone–delivered smoking cessation program over time and the associations these trajectories have with baseline characteristics and treatment outcomes. Methods: We performed secondary data analysis on a dataset from a study that compared a mobile phone–delivered integrated smoking cessation and alcohol intervention with a smoking cessation only intervention for adolescents recruited in vocational and upper secondary school classes (N=1418). Throughout the 3-month intervention, participants in both intervention groups received one text message prompt per week that either assessed smoking-related target behaviors or encouraged participation in a quiz or a message contest. Sequence analyses were performed to identify engagement trajectories. Analyses were conducted to identify predictors of engagement trajectory and associations between engagement trajectories and treatment outcomes. Results: Three engagement trajectories emerged: (1) stable engagement (646/1418, 45.56%), (2) decreasing engagement (501/1418, 35.33%), and (3) stable nonengagement (271/1418, 19.11%). Adolescents who were younger, had no immigrant background, perceived more benefits of quitting smoking, and reported binge drinking preceding the baseline assessment were more likely to exhibit stable engagement. Due to different reach of more engaged and less engaged participants at follow-up, three statistical models (complete-cases, last-observation-carried-forward, and multiple imputation) for the associations of engagement trajectory and smoking outcome were tested. For 7-point smoking abstinence, no association was revealed to be statistically significant over all three models. However, decreasing engagement with the program was associated over all three models, with greater reductions in daily tobacco use than nonengagement. Conclusions: The majority of tobacco-smoking adolescents engaged extensively with a mobile phone–based smoking cessation program. However, not only stable engagement but also decreasing engagement with a program might be an indicator of behavioral change. Measures to avoid nonengagement among adolescents appear especially necessary for older smokers with an immigrant background who do not drink excessively. In addition, future studies should not only examine the use of specific program components but also users’ engagement trajectories to better understand the mechanisms behind behavioral change. %M 29092811 %R 10.2196/jmir.7928 %U http://www.jmir.org/2017/11/e356/ %U https://doi.org/10.2196/jmir.7928 %U http://www.ncbi.nlm.nih.gov/pubmed/29092811 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 10 %P e209 %T Financial Incentives Alone Versus Incentivized Partner Support for Promoting Smoking Cessation During Pregnancy and Postpartum: Protocol for a Non-Randomized Single-Blinded Study %A Frandsen,Mai %A Thow,Megan %A Ferguson,Stuart G %+ School of Health Science, Faculty of Health, University of Tasmania, Locked Bag 1377, Launceston, 7250, Australia, 61 367778167, Mai.Frandsen@utas.edu.au %K smoking %K pregnancy %K financial incentives %K contingency management %K partner support %D 2017 %7 31.10.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking tobacco remains the most significant modifiable cause of adverse pregnancy outcomes and contributor to ongoing maternal and infant ill-health. Pregnancy for many is a time of heightened health focus, with the primary motivation being the well-being of the unborn child. Yet, many women continue to smoke throughout their pregnancy. Despite this heightened motivation and known health risks, interventions to date have not effectively curbed the rate of smoking during pregnancy and they remain as high as rates among the general population. One promising strategy has been to incentivize these women to quit. However, incentives-based studies have not shown or reported long-term efficacy. Here, we present the protocol of a trial exploring the effect of incentivized partner support on pre- and postpartum smoking cessation. Objective: The aim of this study is to determine whether providing incentives to both the expectant mother and her support person in promoting short- and long-term smoking cessation during pregnancy is more effective than incentives to the expectant mother alone. Methods: This protocol is designed as a non-randomized, single-blinded trial to determine the efficacy of incentivized partner support, compared to participant incentive only, in promoting smoking cessation during pregnancy and postpartum. All eligible pregnant women receiving antenatal care via the Tasmanian Health Service (Australia) will be invited to participate. Participants will be eligible for monthly quit-contingent shopping vouchers if they verify, via carbon monoxide breath sample, as being abstinent from smoking. Participating women will be eligible for vouchers until 6-months postpartum and will be followed up at 12-months postpartum. Results: The recruitment phase of this study has concluded. Results are expected to be published by the end of 2018. Conclusions: This study protocol extends the current literature on incentivized smoking cessation interventions for pregnant women by assessing the influence of incentivizing a support partner on short- and long-term abstinence. Key ethical considerations are discussed including potential for receipt (or not) of quit-contingent vouchers impacting negatively on the participant’s relationship with their partner. The findings of the study may have important implications for the role support partners are assigned in smoking cessation programs targeting pregnant women. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN): 12615001158550; https://www.anzctr.org.au/ Trial/Registration/TrialReview.aspx?id=367981 (Archived by WebCite at http://www.webcitation.org/6tGKO28uh) %M 29089293 %R 10.2196/resprot.7907 %U http://www.researchprotocols.org/2017/10/e209/ %U https://doi.org/10.2196/resprot.7907 %U http://www.ncbi.nlm.nih.gov/pubmed/29089293 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e349 %T Web-Based Information on the Treatment of Tobacco Dependence for Oral Health Professionals: Analysis of English-Written Websites %A Diniz-Freitas,Márcio %A Insua,Angel %A Keat,Ross %A Fricain,Jean Christophe %A Catros,Sylvain %A Monteiro,Luis %A Silva,Luis %A Lodi,Giovanni %A Pispero,Alberto %A Albuquerque,Rui %+ School of Medicine and Dentistry, University of Santiago de Compostela, Calle Entrrríos /n, Santiago de Compostela, 15782, Spain, 34 981563100 ext 12344, marcio.diniz@usc.es %K tobacco use cessation %K Internet %K general practice %K dentistry %K education, continuing %D 2017 %7 20.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Studies have been conducted on the content and quality of Web-based information for patients who are interested in smoking cessation advice and for health care practitioners regarding the content of e-learning programs about tobacco cessation. However, to the best of our knowledge, there is no such information about the quality of Web-based learning resources regarding smoking cessation dedicated to oral health professionals. Objective: The aim of this study was to identify and evaluate the quality of the content of webpages providing information about smoking cessation for oral health care professionals. Methods: Websites were identified using Google and Health on Net (HON) search engines using the terms: smoking cessation OR quit smoking OR stop smoking OR 3As OR 5As OR tobacco counselling AND dentistry OR dental clinic OR dentist OR dental hygienist OR oral health professionals. The first 100 consecutive results of the 2 search engines were considered for the study. Quality assessment was rated using the DISCERN questionnaire, the Journal of the American Medical Association (JAMA) benchmarks, and the HON seal. In addition, smoking cessation content on each site was assessed using an abbreviated version of the Smoke Treatment Scale (STS-C) and the Smoking Treatment Scale-Rating (STS-R). To assess legibility of the selected websites, the Flesch Reading Ease (FRES) and the Flesch-Kinkaid Reading Grade Level (FKRGL) were used. Websites were also classified into multimedia and nonmultimedia and friendly and nonfriendly usability. Results: Of the first 200 sites selected (100 of Google and 100 of HON), only 11 met the inclusion criteria and mainly belonged to governmental institutions (n=8), with the others being prepared by Professional Associations (n=2) and nonprofit organizations (n=1). Only 3 were exclusively dedicated to smoking cessation. The average score obtained with the DISCERN was 3.0, and the average score in the FKRGL and FRES was 13.31 (standard deviation, SD 3.34) and 40.73 (SD 15.46), respectively. Of the 11 websites evaluated, none achieved all the four JAMA benchmarks. The mean score of STS-R among all the websites was 2.81 (SD 0.95) out of 5. A significant strong positive correlation was obtained between the DISCERN mean values and the STS-R (R=.89, P=.01). Conclusions: The mean quality of webpages with information for oral health care professionals about smoking cessation is low and displayed a high heterogeneity. These webpages are also difficult to read and often lack multimedia resources, which further limits their usefulness. %M 29054831 %R 10.2196/jmir.8174 %U http://www.jmir.org/2017/10/e349/ %U https://doi.org/10.2196/jmir.8174 %U http://www.ncbi.nlm.nih.gov/pubmed/29054831 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 3 %N 2 %P e19 %T Evaluation of Web-Based Continuing Professional Development Courses: Aggregate Mixed-Methods Model %A Ebn Ahmady,Arezoo %A Barker,Megan %A Fahim,Myra %A Dragonetti,Rosa %A Selby,Peter %+ Centre for Addiction and Mental Health, Nicotine Dependence Service, 175 College Street, 2nd Floor, Toronto, ON, M5T1P7, Canada, 1 416 535 8501 ext 36859, peter.selby@camh.ca %K learning %K Internet %K evaluation studies %K tobacco use %D 2017 %7 20.10.2017 %9 Original Paper %J JMIR Med Educ %G English %X Background: Many continuing professional development (CPD) Web-based programs are not explicit about underlying theory and fail to demonstrate impact. Objective: The aim of this study was to develop and apply an aggregate mixed-methods evaluation model to describe the paradigm, theoretical framework, and methodological approaches used to evaluate a CPD course in tobacco dependence treatment, the Training Enhancement in Applied Cessation Counseling and Health (TEACH) project. Methods: We evaluated the effectiveness of the 5-week TEACH Web-based Core Course in October 2015. The model of evaluation was derived using a critical realist lens to incorporate a dimension of utilitarian to intuitionist approaches. In addition, we mapped our findings to models described by Fitzpatrick et al, Moore et al, and Kirkpatrick. We used inductive and deductive approaches for thematic analysis of qualitative feedback and dependent samples t tests for quantitative analysis. Results: A total of 59 participants registered for the course, and 48/59 participants (81%) completed all course requirements. Quantitative analysis indicated that TEACH participants reported (1) high ratings (4.55/5, where 5=best/excellent) for instructional content and overall satisfaction of the course (expertise and consumer-oriented approach), (2) a significant increase (P ˂.001) in knowledge and skills (objective-oriented approach), and (3) high motivation (78.90% of participants) to change and sustain practice change (management-oriented approach). Through the intuitionist lens, inductive and deductive qualitative thematic analysis highlighted three central themes focused on (1) knowledge acquisition, (2) recommendations to enhance learning for future participants, and (3) plans for practice change in the formative assessment, and five major themes emerged from the summative assessment: (1) learning objectives, (2) interprofessional collaboration, (3) future topics of relevance, (4) overall modification, and (5) overall satisfaction. Conclusions: In the current aggregate model to evaluate CPD Web-based training, evaluators have been influenced by different paradigms, theoretical lenses, methodological approaches, and data collection methods to address and respond to different needs of stakeholders impacted by the training outcomes. %M 29054834 %R 10.2196/mededu.7480 %U http://mededu.jmir.org/2017/2/e19/ %U https://doi.org/10.2196/mededu.7480 %U http://www.ncbi.nlm.nih.gov/pubmed/29054834 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 4 %P e74 %T Identifying Sentiment of Hookah-Related Posts on Twitter %A Allem,Jon-Patrick %A Ramanujam,Jagannathan %A Lerman,Kristina %A Chu,Kar-Hai %A Boley Cruz,Tess %A Unger,Jennifer B %+ Keck School of Medicine of USC, 2001 N. Soto Street, Los Angeles, CA, 90032, United States, 1 8586030812, allem@usc.edu %K hookah %K waterpipe %K Twitter %K social media %K bots %K big data %K sentiment %D 2017 %7 18.10.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The increasing popularity of hookah (or waterpipe) use in the United States and elsewhere has consequences for public health because it has similar health risks to that of combustible cigarettes. While hookah use rapidly increases in popularity, social media data (Twitter, Instagram) can be used to capture and describe the social and environmental contexts in which individuals use, perceive, discuss, and are marketed this tobacco product. These data may allow people to organically report on their sentiment toward tobacco products like hookah unprimed by a researcher, without instrument bias, and at low costs. Objective: This study describes the sentiment of hookah-related posts on Twitter and describes the importance of debiasing Twitter data when attempting to understand attitudes. Methods: Hookah-related posts on Twitter (N=986,320) were collected from March 24, 2015, to December 2, 2016. Machine learning models were used to describe sentiment on 20 different emotions and to debias the data so that Twitter posts reflected sentiment of legitimate human users and not of social bots or marketing-oriented accounts that would possibly provide overly positive or overly negative sentiment of hookah. Results: From the analytical sample, 352,116 tweets (59.50%) were classified as positive while 177,537 (30.00%) were classified as negative, and 62,139 (10.50%) neutral. Among all positive tweets, 218,312 (62.00%) were classified as highly positive emotions (eg, active, alert, excited, elated, happy, and pleasant), while 133,804 (38.00%) positive tweets were classified as passive positive emotions (eg, contented, serene, calm, relaxed, and subdued). Among all negative tweets, 95,870 (54.00%) were classified as subdued negative emotions (eg, sad, unhappy, depressed, and bored) while the remaining 81,667 (46.00%) negative tweets were classified as highly negative emotions (eg, tense, nervous, stressed, upset, and unpleasant). Sentiment changed drastically when comparing a corpus of tweets with social bots to one without. For example, the probability of any one tweet reflecting joy was 61.30% from the debiased (or bot free) corpus of tweets. In contrast, the probability of any one tweet reflecting joy was 16.40% from the biased corpus. Conclusions: Social media data provide researchers the ability to understand public sentiment and attitudes by listening to what people are saying in their own words. Tobacco control programmers in charge of risk communication may consider targeting individuals posting positive messages about hookah on Twitter or designing messages that amplify the negative sentiments. Posts on Twitter communicating positive sentiment toward hookah could add to the normalization of hookah use and is an area of future research. Findings from this study demonstrated the importance of debiasing data when attempting to understand attitudes from Twitter data. %M 29046267 %R 10.2196/publichealth.8133 %U http://publichealth.jmir.org/2017/4/e74/ %U https://doi.org/10.2196/publichealth.8133 %U http://www.ncbi.nlm.nih.gov/pubmed/29046267 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 4 %P e73 %T Implications of Attrition in a Longitudinal Web-Based Survey: An Examination of College Students Participating in a Tobacco Use Study %A McDonald,Bennett %A Haardoerfer,Regine %A Windle,Michael %A Goodman,Michael %A Berg,Carla %+ Emory University, 1518 Clifton Road, Atlanta, GA,, United States, 1 404 558 5395, cjberg@emory.edu %K young adults %K risk factors %K tobacco use %K methods %K surveys and questionnaires %D 2017 %7 16.10.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Web-based survey research has several benefits, including low cost and burden, as well as high use of the Internet, particularly among young adults. In the context of longitudinal studies, attrition raises concerns regarding the validity of data, given the potential associations with individual and institutional characteristics, or the focal area of study (eg, cigarette use). Objectives: The objective of this study was to compare baseline characteristics of nonresponders versus responders in a sample of young adult college students in a Web-based longitudinal study regarding tobacco use. Methods: We conducted a secondary data analysis of 3189 college students from seven Georgia colleges and universities in a 2-year longitudinal study. We examined baseline tobacco use, as well as individual- and institutional-level factors, as predictors of attrition between wave 1 (October and November 2014) and wave 2 (February and March 2015) using multilevel modeling. Results: A total 13.14% (419/3189) participants were lost to follow-up at wave 2. Predictors of nonresponse were similar in the models examining individual-level factors and institutional-level factors only and included being black versus white (odds ratio [OR] 1.74, CI 1.23-2.46); being male versus female (OR 1.41, CI 1.10-1.79); seeking a bachelor’s degree versus advanced degree (OR 1.41, CI 1.09-1.83); not residing on campus (OR 0.62, CI 0.46-0.84); past 30-day tobacco use (OR 1.41, CI 1.10-1.78); attending a nonprivate college (OR 0.48, CI 0.33-0.71); and attending a college with ≤10,000 students (OR 0.56, CI 0.43-0.73). Conclusions: Future longitudinal studies should assess predictors of attrition to examine how survey topic and other individual and institutional factors might influence the response to allow for correction of selection bias. %M 29038092 %R 10.2196/publichealth.7424 %U http://publichealth.jmir.org/2017/4/e73/ %U https://doi.org/10.2196/publichealth.7424 %U http://www.ncbi.nlm.nih.gov/pubmed/29038092 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 10 %P e142 %T User Participation and Engagement With the See Me Smoke-Free mHealth App: Prospective Feasibility Trial %A Schmidt,Chris A %A Romine,James K %A Bell,Melanie L %A Armin,Julie %A Gordon,Judith S %+ College of Nursing, University of Arizona, 1305 N. Martin Avenue, Tucson, AZ, 85721, United States, 1 520 626 4970, judithg@email.arizona.edu %K mHealth %K mobile health %K intervention %K smoking %K diet %K physical activity %D 2017 %7 09.10.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The See Me Smoke-Free (SMSF) mobile health (mHealth) app was developed to help women quit smoking by targeting concerns about body weight, body image, and self-efficacy through cognitive behavioral techniques and guided imagery audio files addressing smoking, diet, and physical activity. A feasibility trial found associations between SMSF usage and positive treatment outcomes. This paper reports a detailed exploration of program use among eligible individuals consenting to study participation and completing the baseline survey (participants) and ineligible or nonconsenting app installers (nonparticipants), as well as the relationship between program use and treatment outcomes. Objective: The aim of this study was to determine whether (1) participants were more likely to set quit dates, be current smokers, and report higher levels of smoking at baseline than nonparticipants; (2) participants opened the app and listened to audio files more frequently than nonparticipants; and (3) participants with more app usage had a higher likelihood of self-reported smoking abstinence at follow up. Methods: The SMSF feasibility trial was a single arm, within-subjects, prospective cohort study with assessments at baseline and 30 and 90 days post enrollment. The SMSF app was deployed on the Google Play Store for download, and basic profile characteristics were obtained for all app installers. Additional variables were assessed for study participants. Participants were prompted to use the app daily during study participation. Crude differences in baseline characteristics between trial participants and nonparticipants were evaluated using t tests (continuous variables) and Fisher exact tests (categorical variables). Exact Poisson tests were used to assess group-level differences in mean usage rates over the full study period using aggregate Google Analytics data on participation and usage. Negative binomial regression models were used to estimate associations of app usage with participant baseline characteristics after adjustment for putative confounders. Associations between app usage and self-reported smoking abstinence were assessed using separate logistic regression models for each outcome measure. Results: Participants (n=151) were more likely than nonparticipants (n=96) to report female gender (P<.02) and smoking in the 30 days before enrollment (P<.001). Participants and nonparticipants opened the app and updated quit dates at the same average rate (rate ratio [RR] 0.98; 95% CI 0.92-1.04; P=.43), but participants started audio files (RR 1.07; 95% CI 1.00-1.13; P<.04) and completed audio files (RR 1.11; 95% CI 1.03-1.18; P<.003) at significantly higher rates than nonparticipants. Higher app usage among participants was positively associated with some smoking cessation outcomes. Conclusions: This study suggests potential efficacy of the SMSF app, as increased usage was generally associated with higher self-reported smoking abstinence. A planned randomized controlled trial will assess the SMSF app’s efficacy as an intervention tool to help women quit smoking. %M 28993302 %R 10.2196/mhealth.7900 %U https://mhealth.jmir.org/2017/10/e142/ %U https://doi.org/10.2196/mhealth.7900 %U http://www.ncbi.nlm.nih.gov/pubmed/28993302 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e333 %T Assessing the National Cancer Institute’s SmokefreeMOM Text-Messaging Program for Pregnant Smokers: Pilot Randomized Trial %A Abroms,Lorien C %A Chiang,Shawn %A Macherelli,Laura %A Leavitt,Leah %A Montgomery,Margaret %+ Milken Insitute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Washington, DC,, United States, 1 202 994 3518, lorien@gwu.edu %K mHealth %K text messaging %K SMS %K mobile phone %K pregnant %K smoking %K quit %D 2017 %7 03.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Automated text messages on mobile phones have been found to be effective for smoking cessation in adult smokers. Objective: This study aims to test the acceptability and feasibility of SmokefreeMOM, a national smoking cessation text-messaging program for pregnant smokers. Methods: Participants were recruited from prenatal care and randomized to receive SmokefreeMOM (n=55), an automated smoking cessation text-messaging program, or a control text message quitline referral (n=44). Participants were surveyed by phone at baseline and at 1 month and 3 months after enrollment. Results: Results indicate that the SmokefreeMOM program was highly rated overall and rated more favorably than the control condition in its helpfulness at 3-month follow-up (P<.01) and in its frequency of messaging at both 1-month and 3-month follow-ups (P<.001, P<.01, respectively). Despite the presence of technical problems, the vast majority of intervention participants read all program messages, and few participants unsubscribed from the program. There were no significant differences between groups on the use of extra treatment resources or on smoking-related outcomes. However, at the 3-month follow-up, some outcomes favored the intervention group. Conclusions: SmokefreeMOM is acceptable for pregnant smokers. It is recommended that SmokefreeMOM be further refined and evaluated. Trial Registration: Clinicaltrials.gov NCT02412956; https://clinicaltrials.gov/ct2/show/NCT02412956 (Archived by WebCite at http://www.webcitation.org/6tcmeRnbC) %M 28974483 %R 10.2196/jmir.8411 %U http://www.jmir.org/2017/10/e333/ %U https://doi.org/10.2196/jmir.8411 %U http://www.ncbi.nlm.nih.gov/pubmed/28974483 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 3 %P e63 %T Classification of Twitter Users Who Tweet About E-Cigarettes %A Kim,Annice %A Miano,Thomas %A Chew,Robert %A Eggers,Matthew %A Nonnemaker,James %+ Center for Health Policy Science and Tobacco Research, RTI International, 2150 Shattuck Ave, 8th Fl, Berkeley, CA, 94704, United States, 1 510 665 8237, akim@rti.org %K electronic cigarettes %K social media %K machine learning %D 2017 %7 26.09.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite concerns about their health risks, e‑cigarettes have gained popularity in recent years. Concurrent with the recent increase in e‑cigarette use, social media sites such as Twitter have become a common platform for sharing information about e-cigarettes and to promote marketing of e‑cigarettes. Monitoring the trends in e‑cigarette–related social media activity requires timely assessment of the content of posts and the types of users generating the content. However, little is known about the diversity of the types of users responsible for generating e‑cigarette–related content on Twitter. Objective: The aim of this study was to demonstrate a novel methodology for automatically classifying Twitter users who tweet about e‑cigarette–related topics into distinct categories. Methods: We collected approximately 11.5 million e‑cigarette–related tweets posted between November 2014 and October 2016 and obtained a random sample of Twitter users who tweeted about e‑cigarettes. Trained human coders examined the handles’ profiles and manually categorized each as one of the following user types: individual (n=2168), vaper enthusiast (n=334), informed agency (n=622), marketer (n=752), and spammer (n=1021). Next, the Twitter metadata as well as a sample of tweets for each labeled user were gathered, and features that reflect users’ metadata and tweeting behavior were analyzed. Finally, multiple machine learning algorithms were tested to identify a model with the best performance in classifying user types. Results: Using a classification model that included metadata and features associated with tweeting behavior, we were able to predict with relatively high accuracy five different types of Twitter users that tweet about e‑cigarettes (average F1 score=83.3%). Accuracy varied by user type, with F1 scores of individuals, informed agencies, marketers, spammers, and vaper enthusiasts being 91.1%, 84.4%, 81.2%, 79.5%, and 47.1%, respectively. Vaper enthusiasts were the most challenging user type to predict accurately and were commonly misclassified as marketers. The inclusion of additional tweet-derived features that capture tweeting behavior was found to significantly improve the model performance—an overall F1 score gain of 10.6%—beyond metadata features alone. Conclusions: This study provides a method for classifying five different types of users who tweet about e‑cigarettes. Our model achieved high levels of classification performance for most groups, and examining the tweeting behavior was critical in improving the model performance. Results can help identify groups engaged in conversations about e‑cigarettes online to help inform public health surveillance, education, and regulatory efforts. %M 28951381 %R 10.2196/publichealth.8060 %U http://publichealth.jmir.org/2017/3/e63/ %U https://doi.org/10.2196/publichealth.8060 %U http://www.ncbi.nlm.nih.gov/pubmed/28951381 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 9 %P e326 %T A Dermatologist's Ammunition in the War Against Smoking: A Photoaging App %A Brinker,Titus Josef %A Enk,Alexander %A Gatzka,Martina %A Nakamura,Yasuhiro %A Sondermann,Wiebke %A Omlor,Albert Joachim %A Petri,Maximilian Philip %A Karoglan,Ante %A Seeger,Werner %A Klode,Joachim %A von Kalle,Christof %A Schadendorf,Dirk %+ Department of Dermatology and National Center for Tumor Diseases (NCT), University of Heidelberg, Im Neuenheimer Feld 440/460, Heidelberg,, Germany, 49 151 7508 4347, titus.brinker@gmail.com %K dermatology %K smoking %K apps %K photoaging %K face %K skin %K tobacco %K tobacco cessation %K tobacco prevention %D 2017 %7 21.09.2017 %9 Viewpoint %J J Med Internet Res %G English %X This viewpoint reviews the perspectives for dermatology as a specialty to go beyond the substantial impact of smoking on skin disease and leverage the impact of skin changes on a person's self-concept and behavior in the design of effective interventions for smoking prevention and cessation. %M 28935619 %R 10.2196/jmir.8743 %U http://www.jmir.org/2017/9/e326/ %U https://doi.org/10.2196/jmir.8743 %U http://www.ncbi.nlm.nih.gov/pubmed/28935619 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e305 %T Smartphone Ownership Among US Adult Cigarette Smokers: 2014 Health Information National Trends Survey (HINTS) Data %A Heffner,Jaimee L %A Mull,Kristin E %+ Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Ave N, Mail Stop M3-B232, PO Box 19024, Seattle, WA, 98109, United States, 1 2066677314, jheffner@fredhutch.org %K mHealth %K mobile health %K tobacco %K smoking %K nicotine use disorder %D 2017 %7 31.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite increasing interest in smartphone apps as a platform for delivery of tobacco cessation interventions, no previous studies have evaluated the prevalence and characteristics of smokers who can access smartphone-delivered interventions. Objective: To guide treatment development in this new platform and to evaluate disparities in access to smartphone-delivered interventions, we examined associations of smartphone ownership with demographics, tobacco use and thoughts about quitting, other health behaviors, physical and mental health, health care access, and Internet and technology utilization using a nationally representative sample of US adult smokers. Methods: Data were from the National Cancer Institute’s 2014 Health Information National Trends Survey 4 (HINTS 4), Cycle 4. This mailed survey targeted noninstitutionalized individuals aged 18 years or older using two-stage stratified random sampling. For this analysis, we restricted the sample to current smokers with complete data on smartphone ownership (n=479). Results: Nearly two-thirds (weighted percent=63.8%, 248/479) of smokers reported owning a smartphone. Those who were younger (P<.001), employed (P=.002), never married (P=.002), and had higher education (P=.002) and income (P<.001) had the highest rates of ownership. Smartphone owners did not differ from nonowners on frequency of smoking, recent quit attempts, or future plans to quit smoking, although they reported greater belief in the benefits of quitting (P=.04). Despite being equally likely to be overweight or obese, smartphone owners reported greater fruit and vegetable consumption (P=.03) and were more likely to report past-year efforts to increase exercise (P=.001) and to lose weight (P=.02). No differences in health care access and utilization were found. Smartphone owners reported better physical and mental health in several domains and higher access to and utilization of technology and the Internet, including for health reasons. Conclusions: Smartphone ownership among smokers mirrors many trends in the general population, including the overall rate of ownership and the association with younger age and higher socioeconomic status. Apps for smoking cessation could potentially capitalize on smartphone owners’ efforts at multiple health behavior changes and interest in communicating with health care providers via technology. These data also highlight the importance of accessible treatment options for smokers without smartphones in order to reach smokers with the highest physical and mental health burden and prevent worsening of tobacco-related health disparities as interventions move to digital platforms. %M 28860108 %R 10.2196/jmir.7953 %U https://www.jmir.org/2017/8/e305/ %U https://doi.org/10.2196/jmir.7953 %U http://www.ncbi.nlm.nih.gov/pubmed/28860108 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e295 %T The Use of Mobile Apps and SMS Messaging as Physical and Mental Health Interventions: Systematic Review %A Rathbone,Amy Leigh %A Prescott,Julie %+ School of Education and Psychology, University of Bolton, Deane Road, Bolton, BL3 5AB, United Kingdom, 44 01204903676, alr3wss@bolton.ac.uk %K mHealth %K smartphone %K health %K review %K systematic %K short message service %K treatment efficacy %K portable electronic applications %K intervention study %D 2017 %7 24.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The initial introduction of the World Wide Web in 1990 brought around the biggest change in information acquisition. Due to the abundance of devices and ease of access they subsequently allow, the utility of mobile health (mHealth) has never been more endemic. A substantial amount of interactive and psychoeducational apps are readily available to download concerning a wide range of health issues. mHealth has the potential to reduce waiting times for appointments; eradicate the need to meet in person with a clinician, successively diminishing the workload of mental health professionals; be more cost effective to practices; and encourage self-care tactics. Previous research has given valid evidence with empirical studies proving the effectiveness of physical and mental health interventions using mobile apps. Alongside apps, there is evidence to show that receiving short message service (SMS) messages, which entail psychoeducation, medication reminders, and links to useful informative Web pages can also be advantageous to a patient’s mental and physical well-being. Available mHealth apps and SMS services and their ever improving quality necessitates a systematic review in the area in reference to reduction of symptomology, adherence to intervention, and usability. Objective: The aim of this review was to study the efficacy, usability, and feasibility of mobile apps and SMS messages as mHealth interventions for self-guided care. Methods: A systematic literature search was carried out in JMIR, PubMed, PsychINFO, PsychARTICLES, Google Scholar, MEDLINE, and SAGE. The search spanned from January 2008 to January 2017. The primary outcome measures consisted of weight management, (pregnancy) smoking cessation, medication adherence, depression, anxiety and stress. Where possible, adherence, feasibility, and usability outcomes of the apps or SMS services were evaluated. Between-group and within-group effect sizes (Cohen d) for the mHealth intervention method group were determined. Results: A total of 27 studies, inclusive of 4658 participants were reviewed. The papers included randomized controlled trials (RCTs) (n=19), within-group studies (n=7), and 1 within-group study with qualitative aspect. Studies show improvement in physical health and significant reductions of anxiety, stress, and depression. Within-group and between-group effect sizes ranged from 0.05-3.37 (immediately posttest), 0.05-3.25 (1-month follow-up), 0.08-3.08 (2-month follow-up), 0.00-3.10 (3-month follow-up), and 0.02-0.27 (6-month follow-up). Usability and feasibility of mHealth interventions, where reported, also gave promising, significant results. Conclusions: The review shows the promising and emerging efficacy of using mobile apps and SMS text messaging as mHealth interventions. %M 28838887 %R 10.2196/jmir.7740 %U http://www.jmir.org/2017/8/e295/ %U https://doi.org/10.2196/jmir.7740 %U http://www.ncbi.nlm.nih.gov/pubmed/28838887 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 3 %P e52 %T Point-of-Sale Tobacco Advertising and Display Bans: Policy Evaluation Study in Five Russian Cities %A Kennedy,Ryan David %A Grant,Ashley %A Spires,Mark %A Cohen,Joanna E %+ Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, 4th floor, Baltimore, MD, 21205, United States, 1 4109553435, rdkennedy@jhu.edu %K tobacco %K marketing %K public health %K public policy %K evaluation %K Russia %D 2017 %7 15.08.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The tobacco industry uses point-of-sale (POS) advertising, promotion, and product display to increase consumption of its products among current users, to attract new consumers, and to encourage former customers to resume tobacco use. As part of a comprehensive tobacco control effort, Russia—having one of the highest tobacco use prevalence rates in the world—enacted legislation that banned tobacco POS advertising, effective November 15, 2013, and banned the display of tobacco and the sale of cigarettes in kiosks, effective June 1, 2014. Objective: The objective of the study was to evaluate the implementation of the national law by assessing the state of POS advertising, promotion, and product display, and sales in kiosks across Russia. Methods: Two waves of observations were conducted to measure compliance with the POS restrictions: wave 1 took place in April-May 2014 after the advertising ban was in effect and again in August-September 2014 after the display ban and elimination of tobacco sales in kiosks came into effect. Observations were conducted by local trained staff that traveled to 5 populous cities in different regions of Russia (Moscow, St. Petersburg, Kazan, Ekaterinburg, and Novosibirsk). Staff followed a published POS evaluation protocol and used mobile phones to collect data. Observations were conducted in a roughly equal number of supermarket chains, convenience stores, and kiosks. Observed items included advertising at POS, product displays, and cigarette sales in kiosks. Results: Observations were made in 780 venues in wave 1 and in 779 revisited venues in wave 2. In wave 1, approximately a third of supermarkets and convenience stores (34.2%, 184/538) were advertising cigarettes using light boxes, and over half of observed venues (54.3%, 292/538) had signage such as banners or shelf liners that used colors or images related to cigarette brands. Product displays were common in wave 1. In wave 2, compliance with advertising restrictions was very good: there were virtually no light boxes (1.0%, 5/489); banners or shelf liners were observed in 30.5% (149/489) of supermarkets/convenience stores; approximately 7.4% (36/489) of venues were still displaying products in a powerwall. In wave 2, 41.3% (100/242) of kiosks continued to sell tobacco. Conclusions: Russia’s compliance with POS bans was excellent. Remaining compliance issues are largely with the use of cigarette brand colors or images used in banners or shelf liners; this type of infraction is more difficult to enforce as inspectors need to be deeply familiar with tobacco industry products and marketing practices. A sizable proportion of kiosks continue to sell tobacco post restrictions. %M 28811269 %R 10.2196/publichealth.6069 %U http://publichealth.jmir.org/2017/3/e52/ %U https://doi.org/10.2196/publichealth.6069 %U http://www.ncbi.nlm.nih.gov/pubmed/28811269 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e116 %T Feasibility and Acceptability of a Text Message-Based Smoking Cessation Program for Young Adults in Lima, Peru: Pilot Study %A Blitchtein-Winicki,Dora %A Zevallos,Karine %A Samolski,M Reuven %A Requena,David %A Velarde,Chaska %A Briceño,Patricia %A Piazza,Marina %A Ybarra,Michele L %+ Executive Office of Research, Peruvian National Institute of Health, Cápac Yupanqui 1400, Jesus María, Lima, CP 11, Peru, 51 999 090917, dblit2007@gmail.com %K Pilot Projects, Text Messaging, Smoking Cessation, Young Adult, Cognitive Therapy, Feasibility Studies, Latinos %D 2017 %7 04.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In Peru’s urban communities, tobacco smoking generally starts during adolescence and smoking prevalence is highest among young adults. Each year, many attempt to quit, but access to smoking cessation programs is limited. Evidence-based text messaging smoking cessation programs are an alternative that has been successfully implemented in high-income countries, but not yet in middle- and low-income countries with limited tobacco control policies. Objective: The objective was to assess the feasibility and acceptability of an short message service (SMS) text message-based cognitive behavioral smoking cessation program for young adults in Lima, Peru. Methods: Recruitment included using flyers and social media ads to direct young adults interested in quitting smoking to a website where interested participants completed a Google Drive survey. Inclusion criteria were being between ages 18 and 25 years, smoking at least four cigarettes per day at least 6 days per week, willing to quit in the next 30 days, owning a mobile phone, using SMS text messaging at least once in past year, and residing in Lima. Participants joined one of three phases: (1) focus groups and in-depth interviews whose feedback was used to develop the SMS text messages, (2) validating the SMS text messages, and (3) a pilot of the SMS text message-based smoking cessation program to test its feasibility and acceptability among young adults in Lima. The outcome measures included adherence to the SMS text message-based program, acceptability of content, and smoking abstinence self-report on days 2, 7, and 30 after quitting. Results: Of 639 participants who completed initial online surveys, 42 met the inclusion criteria and 35 agreed to participate (focus groups and interviews: n=12; validate SMS text messages: n=8; program pilot: n=15). Common quit practices and beliefs emerged from participants in the focus groups and interviews informed the content, tone, and delivery schedule of the messages used in the SMS text message smoking cessation program. A small randomized controlled pilot trial was performed to test the program’s feasibility and acceptability; nine smokers were assigned to the SMS text message smoking cessation program and six to a SMS text message nutrition program. Participant retention was high: 93% (14/15) remained until day 30 after quit day. In all, 56% of participants (5/9) in the SMS text message smoking cessation program reported remaining smoke-free until day 30 after quit day and 17% of participants (1/6) in the SMS text message nutrition program reported remaining smoke-free during the entire program. The 14 participants who completed the pilot reported that they received valuable health information and approved the delivery schedule of the SMS text messages. Conclusions: This study provides initial evidence that a SMS text message smoking cessation program is feasible and acceptable for young adults residing in Lima. %M 28778850 %R 10.2196/mhealth.7532 %U http://mhealth.jmir.org/2017/8/e116/ %U https://doi.org/10.2196/mhealth.7532 %U http://www.ncbi.nlm.nih.gov/pubmed/28778850 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 3 %P e46 %T Effect of Viewing Smoking Scenes in Motion Pictures on Subsequent Smoking Desire in Audiences in South Korea %A Sohn,Minsung %A Jung,Minsoo %+ Department of Health Science, Dongduk Women's University, Ye-Ji Building, Room 403, 23-1 Wolgok-dong, Seongbuk-gu, Seoul, 02748, Republic Of Korea, 82 2 940 4483, mins.jung@gmail.com %K film %K smoking %K craving %K South Korea %D 2017 %7 17.07.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In the modern era of heightened awareness of public health, smoking scenes in movies remain relatively free from public monitoring. The effect of smoking scenes in movies on the promotion of viewers’ smoking desire remains unknown. Objective: The study aimed to explore whether exposure of adolescent smokers to images of smoking in fılms could stimulate smoking behavior. Methods: Data were derived from a national Web-based sample survey of 748 Korean high-school students. Participants aged 16-18 years were randomly assigned to watch three short video clips with or without smoking scenes. After adjusting covariates using propensity score matching, paired sample t test and logistic regression analyses compared the difference in smoking desire before and after exposure of participants to smoking scenes. Results: For male adolescents, cigarette craving was significantly higher in those who watched movies with smoking scenes than in the control group who did not view smoking scenes (t307.96=2.066, P<.05). In the experimental group, too, cigarette cravings of adolescents after viewing smoking scenes were significantly higher than they were before watching smoking scenes (t161.00=2.867, P<.01). After adjusting for covariates, more impulsive adolescents, particularly males, had significantly higher cigarette cravings: adjusted odds ratio (aOR) 3.40 (95% CI 1.40-8.23). However, those who actively sought health information had considerably lower cigarette cravings than those who did not engage in information-seeking: aOR 0.08 (95% CI 0.01-0.88). Conclusions: Smoking scenes in motion pictures may increase male adolescent smoking desire. Establishing a standard that restricts the frequency of smoking scenes in films and assigning a smoking-related screening grade to films is warranted. %M 28716768 %R 10.2196/publichealth.7093 %U http://publichealth.jmir.org/2017/3/e46/ %U https://doi.org/10.2196/publichealth.7093 %U http://www.ncbi.nlm.nih.gov/pubmed/28716768 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e255 %T Images of Little Cigars and Cigarillos on Instagram Identified by the Hashtag #swisher: Thematic Analysis %A Allem,Jon-Patrick %A Escobedo,Patricia %A Chu,Kar-Hai %A Boley Cruz,Tess %A Unger,Jennifer B %+ Keck School of Medicine, University of Southern California, 2001 N Soto Street, 3rd Floor Mail, Los Angeles, CA,, United States, 1 858 603 0812, allem@usc.edu %K Instagram %K Swisher %K little cgars %K cigarillos %K social media %K blunts %K health behavior %K tobacco use %D 2017 %7 14.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Little cigar and cigarillo use is becoming more prevalent in the United States and elsewhere, with implications for public health. As little cigar and cigarillo use grows in popularity, big social media data (eg, Instagram, Google Web Search, Twitter) can be used to capture and document the context in which individuals use, and are marketed, these tobacco products. Big social media data may allow people to organically demonstrate how and why they use little cigars and cigarillos, unprimed by a researcher, without instrument bias and at low costs. Objective: This study characterized Swisher (the most popular brand of cigars in the United States, controlling over 75% of the market share) little cigar- and cigarillo-related posts on Instagram to inform the design of tobacco education campaigns and the development of future tobacco control efforts, and to demonstrate the utility in using big social media data in understanding health behaviors. Methods: We collected images from Instagram, an image-based social media app allowing users to capture, customize, and post photos on the Internet with over 400 million active users. Inclusion criteria for this study consisted of an Instagram post with the hashtag “#swisher”. We established rules for coding themes of images. Results: Of 1967 images collected, 486 (24.71%) were marijuana related, 348 (17.69%) were of tobacco products or promotional material, 324 (16.47%) showed individuals smoking, 225 (11.44%) were memes, and 584 (29.69%) were classified as other (eg, selfies, food, sexually explicit images). Of the marijuana-related images, 157/486 (32.3%) contained a Swisher wrapper, indicating that a Swisher product was used in blunt making, which involves hollowing out a cigar and refilling it with marijuana. Conclusions: Images from Instagram may be used to complement and extend the study of health behaviors including tobacco use. Images may be as valuable as, or more valuable than, words from other social media platforms alone. Posts on Instagram showing Swisher products, including blunt making, could add to the normalization of little cigar and cigarillo use and is an area of future research. Tobacco control researchers should design social media campaigns to combat smoking imagery found on popular sites such as Instagram. %M 28710057 %R 10.2196/jmir.7634 %U http://www.jmir.org/2017/7/e255/ %U https://doi.org/10.2196/jmir.7634 %U http://www.ncbi.nlm.nih.gov/pubmed/28710057 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 7 %P e93 %T Content Analysis of Smartphone Apps for Smoking Cessation in China: Empirical Study %A Cheng,Feng %A Xu,Junfang %A Su,Chunyan %A Fu,Xiaoxing %A Bricker,Jonathan %+ Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue North, Seattle, WA,, United States, 1 206 667 5074, jbricker@fredhutch.org %K smoking cessation %K smartphone apps %K China %D 2017 %7 11.07.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With 360 million smokers, China consumes more cigarettes than any other country in the world. Given that 620 million Chinese own smartphones, smartphone apps for smoking cessation are increasingly used in China to help smokers quit. Objective: This study analyzed and evaluated the contents of all smoking cessation apps (iOS and Android) available in China, applying the China Clinical Smoking Cessation Guideline (CCSCG; identical to the US Clinical Practice Guideline for Treating Tobacco Use and Dependence) as a framework for analysis. Methods: We conducted a content analysis of Chinese Android and iOS smoking cessation apps (N=64) designed to assist users in quitting smoking. Each app was independently coded by two raters for its approach to smoking cessation and adherence to the CCSCG. We also recorded the features of smoking cessation apps (eg, release date, size, frequency of downloads, user ratings, type, quality scores by raters, and designers). Linear regression was used to test predictors of popularity and user-rated quality. Results: Chinese smoking cessation apps have low levels of adherence to guidelines, with an average score of 11.1 for Android and 14.6 for iOS apps on a scale of 0 to 46. There was no significant association between popularity, user rating, and the characteristics of apps. However, there was a positive relationship between popularity, user rating, and adherence score. Conclusions: Chinese apps for smoking cessation have low levels of adherence to standard clinical practice guidelines. New apps need be developed and existing apps be revised following evidence-based principles in China. %M 28698170 %R 10.2196/mhealth.7462 %U http://mhealth.jmir.org/2017/7/e93/ %U https://doi.org/10.2196/mhealth.7462 %U http://www.ncbi.nlm.nih.gov/pubmed/28698170 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e230 %T A Review of the Theoretical Basis, Effects, and Cost Effectiveness of Online Smoking Cessation Interventions in the Netherlands: A Mixed-Methods Approach %A Cheung,Kei Long %A Wijnen,Ben %A de Vries,Hein %+ Department of Health Services Research, Maastricht University, Duboisdomein 30, Maastricht,, Netherlands, 31 43 38 82294, kl.cheung@maastrichtuniversity.nl %K Smoking cessation %K telemedicine %K review %K online intervention %K Internet-based intervention %K behavioral change techniques %K Netherlands %D 2017 %7 23.06.2017 %9 Review %J J Med Internet Res %G English %X Background: Tobacco smoking is a worldwide public health problem. In 2015, 26.3% of the Dutch population aged 18 years and older smoked, 74.4% of them daily. More and more people have access to the Internet worldwide; approximately 94% of the Dutch population have online access. Internet-based smoking cessation interventions (online cessation interventions) provide an opportunity to tackle the scourge of tobacco. Objective: The goal of this paper was to provide an overview of online cessation interventions in the Netherlands, while exploring their effectivity, cost effectiveness, and theoretical basis. Methods: A mixed-methods approach was used to identify Dutch online cessation interventions, using (1) a scientific literature search, (2) a grey literature search, and (3) expert input. For the scientific literature, the Cochrane review was used and updated by two independent researchers (n=651 identified studies), screening titles, abstracts, and then full-text studies between 2013 and 2016 (CENTRAL, MEDLINE, and EMBASE). For the grey literature, the researchers conducted a Google search (n=100 websites), screening for titles and first pages. Including expert input, this resulted in six interventions identified in the scientific literature and 39 interventions via the grey literature. Extracted data included effectiveness, cost effectiveness, theoretical factors, and behavior change techniques used. Results: Overall, many interventions (45 identified) were offered. Of the 45 that we identified, only six that were included in trials provided data on effectiveness. Four of these were shown to be effective and cost effective. In the scientific literature, 83% (5/6) of these interventions included changing attitudes, providing social support, increasing self-efficacy, motivating smokers to make concrete action plans to prepare their attempts to quit and to cope with challenges, supporting identity change and advising on changing routines, coping, and medication use. In all, 50% (3/6) of the interventions included a reward for abstinence. Interventions identified in the grey literature were less consistent, with inclusion of each theoretical factor ranging from 31% to 67% and of each behavior change technique ranging from 28% to 54%. Conclusions: Although the Internet may provide the opportunity to offer various smoking cessation programs, the user is left bewildered as far as efficacy is concerned, as most of these data are not available nor offered to the smokers. Clear regulations about the effectiveness of these interventions need to be devised to avoid disappointment and failed quitting attempts. Thus, there is a need for policy regulations to regulate the proliferation of these interventions and to foster their quality in the Netherlands. %M 28645889 %R 10.2196/jmir.7209 %U http://www.jmir.org/2017/6/e230/ %U https://doi.org/10.2196/jmir.7209 %U http://www.ncbi.nlm.nih.gov/pubmed/28645889 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e199 %T A Medical Student-Delivered Smoking Prevention Program, Education Against Tobacco, for Secondary Schools in Germany: Randomized Controlled Trial %A Brinker,Titus Josef %A Owczarek,Andreas Dawid %A Seeger,Werner %A Groneberg,David Alexander %A Brieske,Christian Martin %A Jansen,Philipp %A Klode,Joachim %A Stoffels,Ingo %A Schadendorf,Dirk %A Izar,Benjamin %A Fries,Fabian Norbert %A Hofmann,Felix Johannes %+ Universities of Giessen and Marburg Lung Center; Member of the German Center for Lung Research (DZL), Department of Internal Medicine, Justus-Liebig-University of Giessen, Klinikstr. 33, Giessen, 35392, Germany, 49 15175084347, titus.brinker@gmail.com %K medical students %K tobacco prevention %K secondary schools %K smoking cessation %K adolescents %K school-based prevention %D 2017 %7 06.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: More than 8.5 million Germans suffer from chronic diseases attributable to smoking. Education Against Tobacco (EAT) is a multinational network of medical students who volunteer for school-based prevention in the classroom setting, amongst other activities. EAT has been implemented in 28 medical schools in Germany and is present in 13 additional countries around the globe. A recent quasi-experimental study showed significant short-term smoking cessation effects on 11-to-15-year-old adolescents. Objective: The aim of this study was to provide the first randomized long-term evaluation of the optimized 2014 EAT curriculum involving a photoaging software for its effectiveness in reducing the smoking prevalence among 11-to-15-year-old pupils in German secondary schools. Methods: A randomized controlled trial was undertaken with 1504 adolescents from 9 German secondary schools, aged 11-15 years in grades 6-8, of which 718 (47.74%) were identifiable for the prospective sample at the 12-month follow-up. The experimental study design included measurements at baseline (t1), 6 months (t2), and 12 months postintervention (t3), via questionnaire. The study groups consisted of 40 randomized classes that received the standardized EAT intervention (two medical student-led interactive modules taking 120 minutes total) and 34 control classes within the same schools (no intervention). The primary endpoint was the difference in smoking prevalence from t1 to t3 in the control group versus the difference from t1 to t3 in the intervention group. The differences in smoking behavior (smoking onset, quitting) between the two groups, as well as gender-specific effects, were studied as secondary outcomes. Results: None of the effects were significant due to a high loss-to-follow-up effect (52.26%, 786/1504). From baseline to the two follow-up time points, the prevalence of smoking increased from 3.1% to 5.2% to 7.2% in the control group and from 3.0% to 5.4% to 5.8% in the intervention group (number needed to treat [NNT]=68). Notable differences were observed between the groups for the female gender (4.2% to 9.5% for control vs 4.0% to 5.2% for intervention; NNT=24 for females vs NNT=207 for males), low educational background (7.3% to 12% for control vs 6.1% to 8.7% for intervention; NNT=30), and migrational background (students who claimed that at least one parent was not born in Germany) at the 12-month follow-up. The intervention appears to prevent smoking onset (NNT=63) but does not appear to initiate quitting. Conclusions: The intervention appears to prevent smoking, especially in females and students with a low educational background. %M 28588007 %R 10.2196/jmir.7906 %U http://www.jmir.org/2017/6/e199/ %U https://doi.org/10.2196/jmir.7906 %U http://www.ncbi.nlm.nih.gov/pubmed/28588007 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e18 %T Who is More Likely to Use the Internet for Health Behavior Change? A Cross-Sectional Survey of Internet Use Among Smokers and Nonsmokers Who Are Orthopedic Trauma Patients %A McCrabb,Sam %A Baker,Amanda L %A Attia,John %A Balogh,Zsolt J %A Lott,Natalie %A Palazzi,Kerrin %A Naylor,Justine %A Harris,Ian A %A Doran,Christopher %A George,Johnson %A Wolfenden,Luke %A Skelton,Eliza %A Bonevski,Billie %+ School of Medicine and Public Health, University of Newcastle, 1 University Drive, Callaghan, 2308, Australia, 61 240335713, sam.mccrabb@newcastle.edu.au %K Internet %K health %K eHealth %K health care %K smoking %K orthopedic trauma %D 2017 %7 30.05.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: eHealth presents opportunities to provide population groups with accessible health interventions, although knowledge about Internet access, peoples’ interest in using the Internet for health, and users’ characteristics are required prior to eHealth program development. Objective: This study surveyed hospital patients to examine rates of Internet use, interest in using the Internet for health, and respondent characteristics related to Internet use and interest in using the Internet for health. For patients who smoke, preferences for types of smoking cessation programs for use at home and while in hospital were also examined. Methods: An online cross-sectional survey was used to survey 819 orthopedic trauma patients (response rate: 72.61%, 819/1128) from two public hospitals in New South Wales, Australia. Logistic regressions were used to examine associations between variables. Results: A total of 72.7% (574/790) of respondents had at least weekly Internet access and more than half (56.6%, 357/631) reported interest in using the Internet for health. Odds of at least weekly Internet usage were higher if the individual was born overseas (OR 2.21, 95% CI 1.27-3.82, P=.005), had a tertiary education (OR 3.75, 95% CI 2.41-5.84, P<.001), or was a nonsmoker (OR 3.75, 95% CI 2.41-5.84, P<.001). Interest in using the Internet for health increased with high school (OR 1.85, 95% CI 1.09-3.15, P=.02) or tertiary education (OR 2.48, 95% CI 1.66-3.70, P<.001), and if household incomes were more than AUS $100,000 (OR 2.5, 95% CI 1.25-4.97, P=.009). Older individuals were less interested in using the Internet for health (OR 0.98, 95% CI 0.97-0.99, P<.001). Conclusions: Online interventions may be a potential tool for health care in this hospitalized population. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614001147673; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366829&isReview=true (Archived by WebCite at http://www.webcitation.org/6qg26u3En) %M 28559228 %R 10.2196/mental.7435 %U http://mental.jmir.org/2017/2/e18/ %U https://doi.org/10.2196/mental.7435 %U http://www.ncbi.nlm.nih.gov/pubmed/28559228 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e84 %T Comparison of Ecological Momentary Assessment Versus Direct Measurement of E-Cigarette Use With a Bluetooth-Enabled E-Cigarette: A Pilot Study %A Pearson,Jennifer L %A Elmasry,Hoda %A Das,Babita %A Smiley,Sabrina L %A Rubin,Leslie F %A DeAtley,Teresa %A Harvey,Emily %A Zhou,Yitong %A Niaura,Raymond %A Abrams,David B %+ Truth Initiative, Schroeder Institute for Tobacco Research and Policy Studies, 900 G St NW, Fourth Floor, Washington, DC,, United States, 1 202 454 5768, jpearson@truthinitiative.org %K smoking %K humans %K tobacco products/utilization %K electronic cigarettes %K observational study %K United States %D 2017 %7 29.05.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Assessing the frequency and intensity of e-cigarette use presents special challenges beyond those posed by cigarette use. Accurate measurement of e-cigarette consumption, puff duration, and the stability of these measures over time will be informative for estimating the behavioral and health effects of e-cigarette use. Objective: The purpose of this pilot study was to compare the accuracy of self-reported e-cigarette puff counts collected via ecological momentary assessment (EMA) to objective puff count data collected by a Bluetooth-enabled e-cigarette device and to examine the feasibility and acceptability of using a second-generation e-cigarette among adult smokers. Methods: A total of 5 adult smokers were enrolled in a longitudinal parent study assessing how e-cigarette use affects cigarette use among e-cigarette–naïve smokers. Using a text message–based EMA system, participants reported e-cigarette puffs for 2 weeks. Participants were also given a Bluetooth-enabled e-cigarette (Smokio) that passively collected puff counts and puff duration. Comparisons between mean reports of Smokio (device-report) and EMA (self-report) use were evaluated using paired t tests. Correlation and agreement between device- and self-reports were evaluated using Pearson correlation and the concordance correlation coefficient (CCC), respectively. A linear mixed effect model was used to determine the fixed effect of timing and Smokio-reported daily puffs on report accuracy. We examined the relationship between time of day and reporting accuracy using Tukey's test for multiple pairwise comparisons. Results: A total of 5 African American participants, 4 men and 1 woman, who ranged in age from 24 to 59 years completed the study, resulting in 5180 observations (device-report) of e-cigarette use. At baseline, participants reported smoking for 5 to 25 years and consumed a mean of 7 to 13 cigarettes per day (CPD); 4 smoked within 30 minutes of waking. At the 30-day follow-up, CPD range decreased to 1 to 3 cigarettes; 4 participants reported past 7-day e-cigarette use, and 1 participant reported no cigarette smoking in the past 7 days. Over 2 weeks of e-cigarette use, participants took an average of 1074 e-cigarette (SD 779.0) puffs per person as captured by the device reports. Each participant took a mean of 75.0 (SD 58.8) puffs per day, with each puff lasting an average of 3.6 (SD 2.4) seconds. Device reports captured an average of 33.3 (SD 47.8) more puffs per person per day than the self-reported e-cigarette puffs. In 87% of days, participants underestimated the number of puffs they had taken on the Smokio. There was significant moderate correlation (r=.47, P<.001) but poor agreement (pc=0.31, 95% CI 0.15-0.46) between the device- and self-reported data. Reporting accuracy was affected by amount and timing of e-cigarette use. Conclusions: Compared to self-reported e-cigarette use, the Bluetooth-enabled device captured significantly more e-cigarette use and allowed for examination of puff duration in addition to puff counts. A Bluetooth-enabled e-cigarette is a powerful and feasible tool for objective collection of e-cigarette use behavior in the real world. %M 28554877 %R 10.2196/resprot.6501 %U http://www.researchprotocols.org/2017/5/e84/ %U https://doi.org/10.2196/resprot.6501 %U http://www.ncbi.nlm.nih.gov/pubmed/28554877 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e74 %T An mHealth App for Supporting Quitters to Manage Cigarette Cravings With Short Bouts of Physical Activity: A Randomized Pilot Feasibility and Acceptability Study %A Hassandra,Mary %A Lintunen,Taru %A Hagger,Martin S %A Heikkinen,Risto %A Vanhala,Mauno %A Kettunen,Tarja %+ Faculty of Sport and Health Sciences, University of Jyvaskyla, PO Box 35 University of Jyvaskyla, Jyvaskyla, 40014, Finland, 358 0408053979, maria.m.chasandra@jyu.fi %K behavior change %K mHealth app %K physical activity %K randomized controlled trial %K relapse prevention %K smoking %D 2017 %7 26.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: While gains in reducing smoking rates in Finland have been made, prevalence rates are still substantial. Relapse rates among smokers engaged in quit-smoking programs are high. Physical activity has been proposed as one means to help smokers manage cravings. Software and apps on mobile phone and handheld devices offer an opportunity to communicate messages on how to use physical activity to manage cravings as part of quit-smoking programs. Objective: We aimed to test the feasibility, acceptability, usability, and preliminary efficacy of an mHealth mobile phone app, Physical activity over Smoking (PhoS), to assist smokers in quitting smoking in a randomized controlled trial. The app was designed to prompt smokers to engage in physical activities to manage their smoking cravings. Methods: Regular smokers (n=44) attended a group-based behavioral counselling program aimed at promoting physical activity as an additional aid to quit. After quit day, participants were randomly allocated to an intervention (n=25) or to a comparison (n=19) group. Participants in the intervention group were provided with the PhoS app and training on how to use it to assist with relapse prevention. Participants in the comparison condition were provided with generalized relapse prevention training. Results: Some participants reported that the PhoS app was useful in assisting them to successfully manage their cigarette cravings, although compliance across the sample was modest and participants reported low levels of usability. Participants receiving the PhoS app did not report greater abstinence than those who did not receive the app. However, participants receiving the app were more likely to report greater abstinence if they did not use pharmacological support, while those who did not receive the app reported greater abstinence when using pharmacological support. Participants receiving the app reported greater levels of physical activity than those who did not. Results revealed that the app resulted in better retention. Conclusions: The PhoS app showed some potential to reduce abstinence among participants not using pharmacological therapy and to increase physical activity. However, problems with usability and lack of effects on abstinence raise questions over the app’s long-term effectiveness. Future research should prioritize further development of the app to maximize usability and test effects of the intervention independent of quit-smoking programs. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 55259451; http://www.controlled-trials.com/ISRCTN55259451 (Archived by WebCite at http://www.webcitation.org/6cKF2mzEI) %M 28550004 %R 10.2196/mhealth.6252 %U http://mhealth.jmir.org/2017/5/e74/ %U https://doi.org/10.2196/mhealth.6252 %U http://www.ncbi.nlm.nih.gov/pubmed/28550004 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e168 %T Harnessing Facebook for Smoking Reduction and Cessation Interventions: Facebook User Engagement and Social Support Predict Smoking Reduction %A Kim,Sunny Jung %A Marsch,Lisa A %A Brunette,Mary F %A Dallery,Jesse %+ Center for Technology and Behavioral Health, Department of Biomedical Data Science, Department of Psychiatry, Geisel School of Medicine at Dartmouth, Dartmouth College, 46 Centerra Parkway Suite 301, Lebanon, NH, 03766, United States, 1 603 646 7041, sunny.j.kim@dartmouth.edu %K social media %K social support %K behavior and behavior mechanisms %K smoking cessation %K persuasive communication %K social networking %K technology %K health promotion %D 2017 %7 23.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media technologies offer a novel opportunity for scalable health interventions that can facilitate user engagement and social support, which in turn may reinforce positive processes for behavior change. Objective: By using principles from health communication and social support literature, we implemented a Facebook group–based intervention that targeted smoking reduction and cessation. This study hypothesized that participants’ engagement with and perceived social support from our Facebook group intervention would predict smoking reduction. Methods: We recruited 16 regular smokers who live in the United States and who were motivated in quitting smoking at screening. We promoted message exposure as well as engagement and social support systems throughout the intervention. For message exposure, we posted prevalidated, antismoking messages (such as national antismoking campaigns) on our smoking reduction and cessation Facebook group. For engagement and social support systems, we delivered a high degree of engagement and social support systems during the second and third week of the intervention and a low degree of engagement and social support systems during the first and fourth week. A total of six surveys were conducted via Amazon Mechanical Turk (MTurk) at baseline on a weekly basis and at a 2-week follow-up. Results: Of the total 16 participants, most were female (n=13, 81%), white (n=15, 94%), and between 25 and 50 years of age (mean 34.75, SD 8.15). There was no study attrition throughout the 6-time-point baseline, weekly, and follow-up surveys. We generated Facebook engagement and social support composite scores (mean 19.19, SD 24.35) by combining the number of likes each participant received and the number of comments or wall posts each participant posted on our smoking reduction and cessation Facebook group during the intervention period. The primary outcome was smoking reduction in the past 7 days measured at baseline and at the two-week follow-up. Compared with the baseline, participants reported smoking an average of 60.56 fewer cigarettes per week (SD 38.83) at the follow-up, and 4 participants out of 16 (25%) reported 7-day point prevalence smoking abstinence at the follow-up. Adjusted linear regression models revealed that a one-unit increase in the Facebook engagement and social support composite scores predicted a 0.56-unit decrease in cigarettes smoked per week (standard error =.24, P=.04, 95% CI 0.024-1.09) when baseline readiness to quit, gender, and baseline smoking status were controlled (F4, 11=8.85, P=.002). Conclusions: This study is the first Facebook group–based intervention that systemically implemented health communication strategies and engagement and social support systems to promote smoking reduction and cessation. Our findings imply that receiving one like or posting on the Facebook-based intervention platform predicted smoking approximately one less cigarette in the past 7 days, and that interventions should facilitate user interactions to foster user engagement and social support. %M 28536096 %R 10.2196/jmir.6681 %U http://www.jmir.org/2017/5/e168/ %U https://doi.org/10.2196/jmir.6681 %U http://www.ncbi.nlm.nih.gov/pubmed/28536096 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 9 %N 1 %P e7653 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2017 %7 ..2017 %9 %J Online J Public Health Inform %G English %X ObjectiveTo examine community engagement as a means to strengthentobacco-related policies and programs use in marginalizedpopulations.IntroductionAlthough significant progress has been made in tobacco control inthe United States (US) over the past 50 years, more than 15% of thepopulation currently use tobacco products.1Tobacco use continuesto be the leading cause of preventable death, contributing to over480,000 deaths and about $300 billion in economic costs each year.To achieve theHealthy People 2020(HP2020) objective of 12%national adult smoking rate by 2020, it is important to focus ourtobacco control efforts on surveillance and addressing disparitiesin tobacco use prevalence and tobacco-induced diseases acrossdifferent subpopulations and geographic areas.2Utah reportedthe lowest prevalence rate (9.7% in 2014), while rates as high as28% were identified in central Appalachia. Modern epidemiologyis limited in its ability to explain patterns of tobacco use andtobacco-related interventions and policies in these highly prevalent,marginalized environments. Therefore, a combination of quantitativeand community-based participatory research (CBPR), as proposedin Public Health 3.0, will expand the scope and reach to addressall factors of tobacco use, including cross-sector collaboration andmulti-level actions.3This study aimed to comprehensively investigatecounties in the Northeast Tennessee region where tobacco useprevalence is disproportionately highest, and to identify regionaland culturally specific evidence-based practices for tobacco control.Additionally, the study examined how these practices can be scaledup to address similar high tobacco use and disadvantaged populationselsewhere in the US and worldwide.MethodsGrounded by the CBPR framework, a mixed-methods approachtriangulated multiple sources of data using a three-prong assemblageofProtection,Prevention, andCessation, to develop tobaccocontrol recommendations and goals as part of a Population HealthImprovement Plan for Tennessee. Information gained from healthcouncil discussions, focus groups, interviews, and stakeholdermeetings were combined with quantitative analyses of secondarydata from Tennessee Department of Health, school-based surveys,and qualitative analyses conducted for descriptive and inferentialstatistics. All discussions and interviews involving 222 individualsfrom 91 organizations were recorded and organized using NVivo10, thematically coded using grounded theory, and analyzed usingdescriptive statistics. The results utilized aggregated themes generatedfrom the data.ResultsTobacco use in the Northeast Tennessee region comprises cigarettesmoking and smokeless tobacco, with increasing uptake of electroniccigarettes across all age groups. Among others, culture of tobaccouse and cultivation was identified as the most salient factor fortobacco use. Reducing tobacco use requires a foundation built oninformatics, community engagement, and a model for sustainablefunding to support infrastructure and program interventions. Whilestate and national policies and programs have received less attentionin this region, several effective community-based policies andprograms to prevent tobacco use were identified, including incentiveprograms such as Baby and Me, voluntary smoke-free campuspolicies by businesses and colleges, 100% screening programs byhospitals, and nicotine-free employee population. Overall, a total of25 recommendations were identified, with 14 aimed at protection,four at prevention, and seven at cessation. These recommendationsculminated into five overarching goals:Protectthe population fromtobacco and secondhand smoke exposure through policy enforcementand implementation and counter-marketing;Preventinitiation oftobacco use with comprehensive youth-focused programs that increaseknowledge and awareness;Expandaccess to cessation resources andtreatment, especially in high risk populations;Fostercollaborationand partnership; andMonitordata for evaluation and validity.ConclusionsThis is one of the few comprehensive attempts to address the socialdynamics of tobacco use and identify population and geographicpolicies and programs in highly prevalent communities. Amongthe myriad issues identified, the expansion of surveillance data toinform tobacco policy and culturally-tailored tobacco policies andprograms are essential to reduce tobacco use in population subgroups.Combining CBPR with actionable data can spur innovations inlocal efforts, highlight social determinants of health, and contributeto evidence-based policy. While the results of this study primarilyprovide in-depth descriptions of central Appalachia’s tobacco-relatedrisks and their perceptions of and reactions to tobacco preventionintervention, the policies and programs identified through the processmay be more readily adopted and scaled-up to address the disparitiesin tobacco use and tobacco-induced diseases, particularly pertainingto low-income, disadvantaged, and hard-to-reach populations. %R 10.5210/ojphi.v9i1.7653 %U %U https://doi.org/10.5210/ojphi.v9i1.7653 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e56 %T Clickotine, A Personalized Smartphone App for Smoking Cessation: Initial Evaluation %A Iacoviello,Brian M %A Steinerman,Joshua R %A Klein,David B %A Silver,Theodore L %A Berger,Adam G %A Luo,Sean X %A Schork,Nicholas J %+ Click Therapeutics, Inc., 101 Avenue of the Americas, 8th Floor, New York, NY, 10013, United States, 1 646 844 2158, brian@clicktherapeutics.com %K smoking cessation %K cigarette smoking %K tobacco %K therapeutics %K smartphone %D 2017 %7 25.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Tobacco smoking is the leading cause of preventable death in the United States, and the annual economic burden attributable to smoking exceeds US $300 billion. Obstacles to smoking cessation include limited access and adherence to effective cessation interventions. Technology can help overcome these obstacles; many smartphone apps have been developed to aid smoking cessation, but few that conform to the US clinical practice guideline (USCPG) have been rigorously tested and reported in the literature. Clickotine is a novel smartphone app for smoking cessation, designed to deliver the essential features of the USCPG and engineered to engage smokers by personalizing intervention components. Objective: Our objective was to assess the engagement, efficacy, and safety of Clickotine in an initial, single-arm study. Outcomes measured were indicators of engagement with the smartphone app (number of app opens, number of interactions with the Clickotine program, and weeks active with Clickotine), cessation outcomes of 7- and 30-day self-reported abstinence from smoking, and negative health events. Methods: We recruited US residents between 18 and 65 years of age who owned an iPhone and smoked 5 or more cigarettes daily for the study via online advertising. Respondents were prescreened for eligibility by telephone and, if appropriate, directed to a Web portal to provide informed consent, confirm eligibility, and download the Clickotine app. Participants completed study assessments via the online portal at baseline and after 8 weeks. Data were collected in Amazon S3 with no manual data entry, and access to all data was maximally restrictive, logged, and auditable. Results: A total of 416 participants downloaded the app and constituted the intention-to-treat (ITT) sample. On average, participants opened the Clickotine app 100.6 times during the 8-week study (median 69), logged 214.4 interactions with the Clickotine program (median 178), and remained engaged with Clickotine for 5.3 weeks (median 5). Among the ITT sample, 45.2% (188/416) reported 7-day abstinence and 26.2% (109/416) reported 30-day abstinence from smoking after 8 weeks. Completer analysis focused on 365 (87.7%) of the 416 enrolled participants who completed the 8-week questionnaire revealed that 51.5% (188/365) of completers reported 7-day abstinence and 29.9% (109/365) reported 30-day abstinence. Few adverse events, mostly consistent with nicotine withdrawal symptoms, were reported and overall no safety signal was detected. Conclusions: In this initial single-arm trial, Clickotine users appeared to demonstrate encouraging indicators of engagement in terms of the number of app opens, number of program interactions, and continued engagement over time. Clickotine users reported encouraging quit rates while reporting few adverse events. Future research is warranted to assess Clickotine’s efficacy in a randomized controlled trial. Trial Registration: Clinicaltrials.gov NCT02656745; https://clinicaltrials.gov/ct2/show/NCT02656745 (Archived by WebCite at http://www.webcitation.org/6peTT4x60) %M 28442453 %R 10.2196/mhealth.7226 %U http://mhealth.jmir.org/2017/4/e56/ %U https://doi.org/10.2196/mhealth.7226 %U http://www.ncbi.nlm.nih.gov/pubmed/28442453 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e91 %T Methods for Coding Tobacco-Related Twitter Data: A Systematic Review %A Lienemann,Brianna A %A Unger,Jennifer B %A Cruz,Tess Boley %A Chu,Kar-Hai %+ Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 N Soto St, Los Angeles, CA, 90032, United States, 1 3109241711, blienema@usc.edu %K tobacco %K Internet %K social marketing %K review %D 2017 %7 31.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: As Twitter has grown in popularity to 313 million monthly active users, researchers have increasingly been using it as a data source for tobacco-related research. Objective: The objective of this systematic review was to assess the methodological approaches of categorically coded tobacco Twitter data and make recommendations for future studies. Methods: Data sources included PsycINFO, Web of Science, PubMed, ABI/INFORM, Communication Source, and Tobacco Regulatory Science. Searches were limited to peer-reviewed journals and conference proceedings in English from January 2006 to July 2016. The initial search identified 274 articles using a Twitter keyword and a tobacco keyword. One coder reviewed all abstracts and identified 27 articles that met the following inclusion criteria: (1) original research, (2) focused on tobacco or a tobacco product, (3) analyzed Twitter data, and (4) coded Twitter data categorically. One coder extracted data collection and coding methods. Results: E-cigarettes were the most common type of Twitter data analyzed, followed by specific tobacco campaigns. The most prevalent data sources were Gnip and Twitter’s Streaming application programming interface (API). The primary methods of coding were hand-coding and machine learning. The studies predominantly coded for relevance, sentiment, theme, user or account, and location of user. Conclusions: Standards for data collection and coding should be developed to be able to more easily compare and replicate tobacco-related Twitter results. Additional recommendations include the following: sample Twitter’s databases multiple times, make a distinction between message attitude and emotional tone for sentiment, code images and URLs, and analyze user profiles. Being relatively novel and widely used among adolescents and black and Hispanic individuals, Twitter could provide a rich source of tobacco surveillance data among vulnerable populations. %M 28363883 %R 10.2196/jmir.7022 %U http://www.jmir.org/2017/3/e91/ %U https://doi.org/10.2196/jmir.7022 %U http://www.ncbi.nlm.nih.gov/pubmed/28363883 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e60 %T Website Use and Effects of Online Information About Tobacco Additives Among the Dutch General Population: A Randomized Controlled Trial %A Reinwand,Dominique A %A Crutzen,Rik %A Kienhuis,Anne S %A Talhout,Reinskje %A de Vries,Hein %+ Rehabilitative Gerontology, Faculty of Human Science, University of Cologne, Herbert Lewin Str 2, Cologne, 50931, Germany, 49 2214701529, d.reinwand@uni-koeln.de %K tobacco additives %K information dissemination %K website use %K website evaluation %K RCT %D 2017 %7 14.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: As a legal obligation, the Dutch government publishes online information about tobacco additives to make sure that it is publicly available. Little is known about the influence this website (”tabakinfo”) has on visitors and how the website is evaluated by them. Objective: This study assesses how visitors use the website and its effect on their knowledge, risk perception, attitude, and smoking behavior. The study will also assess how the website is evaluated by visitors using a sample of the Dutch general population, including smokers and nonsmokers. Methods: A randomized controlled trial was conducted, recruiting participants from an online panel. At baseline, participants (N=672) were asked to fill out an online questionnaire about tobacco additives. Next, participants were randomly allocated to either one of two experimental groups and invited to visit the website providing information about tobacco additives (either with or without a database containing product-specific information) or to a control group that had no access to the website. After 3 months, follow-up measurements took place. Results: At follow-up (n=492), no statistically significant differences were found for knowledge, risk perception, attitude, or smoking behavior between the intervention and control groups. Website visits were positively related to younger participants (B=–0.07, 95% CI –0.12 to –0.01; t11=–2.43, P=.02) and having a low risk perception toward tobacco additives (B=–0.32, 95% CI –0.63 to –0.02; t11=–2.07, P=.04). In comparison, having a lower education (B=–0.67, 95% CI –1.14 to –0.17; t11=–2.65, P=.01) was a significant predictor for making less use of the website. Furthermore, the website was evaluated less positively by smokers compared to nonsmokers (t324=–3.55, P<.001), and males compared to females (t324=–2.21, P=.02). Conclusions: The website did not change perceptions of tobacco additives or smoking behavior. Further research is necessary to find out how online information can be used to effectively communication about the risks of tobacco additives. Trial Registration: Nederlands Trial Register NTR4620; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4620 (Archived by WebCite at http://www.webcitation.org/6oW7w4Gnj) %M 28292739 %R 10.2196/jmir.6785 %U http://www.jmir.org/2017/3/e60/ %U https://doi.org/10.2196/jmir.6785 %U http://www.ncbi.nlm.nih.gov/pubmed/28292739 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 1 %P e7 %T Mobile Phone Apps for Smoking Cessation: Quality and Usability Among Smokers With Psychosis %A Ferron,Joelle C %A Brunette,Mary F %A Geiger,Pamela %A Marsch,Lisa A %A Adachi-Mejia,Anna M %A Bartels,Stephen J %+ Health Promotion Research Center at Dartmouth, Department of Psychiatry, Dartmouth Hitchcock Medical Center, 105 Pleasant Street, Hugh Gallon Office Park, Main Bldg, Concord, NH, 03301, United States, 1 603 271 5044, joelle.ferron@dartmouth.edu %K mHealth %K mobile apps %K smoking cessation %K schizophrenia %K psychotic disorders %D 2017 %7 03.03.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Smoking is one of the top preventable causes of mortality in people with psychotic disorders such as schizophrenia. Cessation treatment improves abstinence outcomes, but access is a barrier. Mobile phone apps are one way to increase access to cessation treatment; however, whether they are usable by people with psychotic disorders, who often have special learning needs, is not known. Objective: Researchers reviewed 100 randomly selected apps for smoking cessation to rate them based on US guidelines for nicotine addiction treatment and to categorize them based on app functions. We aimed to test the usability and usefulness of the top-rated apps in 21 smokers with psychotic disorders. Methods: We identified 766 smoking cessation apps and randomly selected 100 for review. Two independent reviewers rated each app with the Adherence Index to US Clinical Practice Guideline for Treating Tobacco Use and Dependence. Then, smokers with psychotic disorders evaluated the top 9 apps within a usability testing protocol. We analyzed quantitative results using descriptive statistics and t tests. Qualitative data were open-coded and analyzed for themes. Results: Regarding adherence to practice guidelines, most of the randomly sampled smoking cessation apps scored poorly—66% rated lower than 10 out of 100 on the Adherence Index (Mean 11.47, SD 11.8). Regarding usability, three common usability problems emerged: text-dense content, abstract symbols on the homepage, and subtle directions to edit features. Conclusions: In order for apps to be effective and usable for this population, developers should utilize a balance of text and simple design that facilitate ease of navigation and content comprehension that will help people learn quit smoking skills. %M 28258047 %R 10.2196/humanfactors.5933 %U http://humanfactors.jmir.org/2017/1/e7/ %U https://doi.org/10.2196/humanfactors.5933 %U http://www.ncbi.nlm.nih.gov/pubmed/28258047 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 2 %P e44 %T From the Experience of Interactivity and Entertainment to Lower Intention to Smoke: A Randomized Controlled Trial and Path Analysis of a Web-Based Smoking Prevention Program for Adolescents %A Khalil,Georges Elias %A Wang,Hua %A Calabro,Karen Sue %A Mitra,Natasha %A Shegog,Ross %A Prokhorov,Alexander V %+ MD Anderson Cancer Center, Department of Behavioral Sciences, University of Texas, 1155 Pressler St. Unit 1330, Houston, TX, 77030, United States, 1 7137452382, aprokhor@mdanderson.org %K smoking prevention %K intention to smoke %K adolescent %K Web-based intervention %K interactivity %K entertainment %K emotions %K presence %K experience %D 2017 %7 16.02.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based programs for smoking prevention are being increasingly used with some success among adolescents. However, little is known about the mechanisms that link the experience of such programs to intended nicotine or tobacco control outcomes. Objective: Based on the experiential learning theory and extended elaboration likelihood model, this study aimed to evaluate the impact of a Web-based intervention, A Smoking Prevention Interactive Experience (ASPIRE), on adolescents’ intention to smoke, while considering the experience of interactivity and entertainment as predictors of reduced intention to smoke, under a transitional user experience model. Methods: A total of 101 adolescents were recruited from after-school programs, provided consent, screened, and randomized in a single-blinded format to 1 of 2 conditions: the full ASPIRE program as the experimental condition (n=50) or an online , text-based version of ASPIRE as the control condition (n=51). Data were collected at baseline and immediate follow-up. Repeated-measures mixed-effects models and path analyses were conducted. Results: A total of 82 participants completed the study and were included in the analysis. Participants in the experimental condition were more likely to show a decrease in their intention to smoke than those in the control condition (beta=−0.18, P=.008). Perceived interactivity (beta=−0.27, P=.004) and entertainment (beta=−0.20, P=.04) were each associated with a decrease in intention to smoke independently. Results of path analyses indicated that perceived interactivity and perceived entertainment mediated the relationship between ASPIRE use and emotional involvement. Furthermore, perceived presence mediated the relationship between perceived interactivity and emotional involvement. There was a direct relationship between perceived entertainment and emotional involvement. Emotional involvement predicted a decrease in intention to smoke (beta=−0.16, P=.04). Conclusions: Adolescents’ experience of interactivity and entertainment contributed to the expected outcome of lower intention to smoke. Also, emphasis needs to be placed on the emotional experience during Web-based interventions in order to maximize reductions in smoking intentions. Going beyond mere evaluation of the effectiveness of a Web-based smoking prevention program, this study contributes to the understanding of adolescents’ psychological experience and its effect on their intention to smoke. With the results of this study, researchers can work to (1) enhance the experience of interactivity and entertainment and (2) amplify concepts of media effects (eg, presence and emotional involvement) in order to better reach health behavior outcomes. Trial Registration: Clinicaltrials.gov NCT02469779; https://clinicaltrials.gov/ct2/show/NCT02469779 (Archived by WebCite at http://www.webcitation.org/6nxyZVOf0) %M 28209560 %R 10.2196/jmir.7174 %U http://www.jmir.org/2017/2/e44/ %U https://doi.org/10.2196/jmir.7174 %U http://www.ncbi.nlm.nih.gov/pubmed/28209560 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 2 %P e12 %T Latino Adults’ Perspectives on Treating Tobacco Use Via Social Media %A Anguiano,Beatriz %A Brown-Johnson,Cati %A Rosas,Lisa G. %A Pechmann,Cornelia %A Prochaska,Judith J. %+ Stanford Prevention Research Center, Department of Medicine, Stanford University, 1265 Welch Rd, Stanford, CA, 94305, United States, 1 650 724 3608, jpro@stanford.edu %K smoking cessation %K tobacco %K Latino %K Hispanic %K social media %K focus group %D 2017 %7 08.02.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Latinos are the largest minority group in the United States, and in California they outnumber non-Hispanic whites. Smoking cessation programs tailored for Latino culture, and this population’s specific smoking patterns, are needed. Online social networks for smoking cessation have high potential for Latinos, but have not been tested to date. Objective: Building a research program on social media apps for cancer prevention in diverse populations, this qualitative study assessed acceptability of tobacco treatment that was distributed via social media for Latino smokers. Methods: We conducted three focus groups with Latino adults who were former and current smokers recruited from Santa Clara County, California in 2015 (N=32). We assessed participants’ smoking histories, attempts to quit, social media exposure, and receptivity to a social media-based smoking cessation intervention. Audio transcripts were translated and coded for themes. Results: Participants reported factors driving their tobacco use and motivations to quit, and emphasized the importance of community and family in influencing their smoking initiation, cravings and triggers, attempts to quit, and abstinence. Participants valued the communal aspect of social media and suggested strategically tailoring groups based on key features (eg, age, gender, language preference). Participants reported preferring visual, educational, and motivational messages that were connected with existing services. Conclusions: Participants generally voiced acceptability of a social media-delivered intervention to help them quit smoking, viewed the intervention as well-equipped for catering to the strong community orientation of Latinos, and suggested that the platform was able to address variation within the population through strategic group creation. As a group member reflected, “Podemos hacerlo juntos” (We can do it together). %M 28179217 %R 10.2196/mhealth.6684 %U http://mhealth.jmir.org/2017/2/e12/ %U https://doi.org/10.2196/mhealth.6684 %U http://www.ncbi.nlm.nih.gov/pubmed/28179217 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 1 %P e16 %T A Medical Student–Delivered Smoking Prevention Program, Education Against Tobacco, for Secondary Schools in Brazil: Study Protocol for a Randomized Trial %A Xavier,Luiz Eduardo De Freitas %A Bernardes-Souza,Breno %A Lisboa,Oscar Campos %A Seeger,Werner %A Groneberg,David Alexander %A Tran,Thien-An %A Fries,Fabian Norbert %A Corrêa,Paulo César Rodrigues Pinto %A Brinker,Titus Josef %+ Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Department of Internal Medicine, University of Giessen, Klinikstrasse 33, Giessen,, Germany, 49 151 7508 4347, titus.brinker@gmail.com %K photoaging %K schools %K tobacco prevention %K adolescents %K medical students %D 2017 %7 30.01.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking is the largest preventable cause of morbidity and mortality in Brazil. Education Against Tobacco (EAT) is a large network of medical students in 13 countries who volunteer for school-based prevention in the classroom setting. A recent quasi-experimental EAT study conducted in Germany showed significant short-term smoking cessation effects on 11- to 15-year-old adolescents. Objective: The aim of this study is both to describe and to provide the first randomized long-term evaluation of the EAT intervention involving a photoaging app for its effectiveness to reduce the smoking prevalence among 12- to 17-year-old pupils in Brazilian public schools. Methods: A randomized controlled trial will be conducted among approximately 1500 adolescents aged 12 to 17 years in grades 7-11 of public secondary schools in Brazil. The prospective experimental study design includes measurements at baseline and at 6 and 12 months postintervention. The study groups will consist of randomized classes receiving the standardized EAT intervention (90 minutes of mentoring in a classroom setting) and control classes within the same schools (no intervention). The questionnaire measures smoking status, gender, social, and cultural aspects as well as predictors of smoking. Biochemical validation of smoking status is conducted via random carbon monoxide measurements. The primary end point is the difference of the change in smoking prevalence in the intervention group versus the difference in the control group at 12 months of follow-up. The differences in smoking behavior (smoking onset, quitting) between the 2 groups as well as effects on the different genders will be studied as secondary outcomes. Results: The recruitment of schools, participating adolescents, and medical students was conducted from August 2016 until January 2017. The planned period of data collection is February 2017 until June 2018. Data analysis will follow in July 2018 and data presentation/publication will follow shortly thereafter. Conclusions: This is the first evaluative study of a medical student–delivered tobacco prevention program in Brazil and the first randomized trial on the long-term effectiveness of a school-based medical student–delivered tobacco prevention program in general. ClinicalTrial: ClinicalTrials.gov NCT02725021; https://clinicaltrials.gov/ct2/show/NCT02725021 (archived by WebCite at http://www.webcitation.org/6njy3nNml) International Registered Report Identifier (IRRID): DERR1-10.2196/resprot.7134 %M 28137703 %R 10.2196/resprot.7134 %U http://www.researchprotocols.org/2017/1/e16/ %U https://doi.org/10.2196/resprot.7134 %U http://www.ncbi.nlm.nih.gov/pubmed/28137703 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 1 %P e7 %T Adaptation, Implementation Plan, and Evaluation of an Online Tobacco Cessation Training Program for Health Care Professionals in Three Spanish-Speaking Latin American Countries: Protocol of the Fruitful Study %A Martínez,Cristina %A Company,Assumpta %A Guillen,Olga %A Margalef,Mercè %A Arrien,Martha Alicia %A Sánchez,Claudia %A Cáceres de León,Paula %A Fernández,Esteve %A , %+ Institut Català d’Oncologia-ICO, Tobacco Control Unit, Cancer Control and Prevention Programme, Av Granvia 199-203, L'Hospitalet del Llobregat, 08098, Spain, 34 932607357, cmartinez@iconcologia.net %K tobacco cessation %K online %K training %K low- and middle-income countries %K policies %D 2017 %7 27.01.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tobacco cessation training programs to treat tobacco dependence have measureable effects on patients’ smoking. Tobacco consumption in low- and middle-income countries (LMICs) is high and slowly decreasing, but these countries usually lack measures to face the epidemic, including tobacco cessation training programs for health professionals and organizations. Based on a previous online smoking cessation training program for hospital workers in Spain, the Fruitful Study aims to increase smoking cessation knowledge, attitudes, self-confidence, and performance interventions among health care professionals of three Spanish-speaking low- and middle-income Latin American and Caribbean (LAC) countries. Objective: The purpose of this paper is to describe the methodology and evaluation strategy of the Fruitful Study intended to adapt, implement, and test the effectiveness of an online, evidence-based tobacco cessation training program addressed to health professionals from Bolivia, Guatemala, and Paraguay. Methods: This study will use a mixed-methods design with a pre-post evaluation (quantitative approach) and in-depth interviews and focus groups (qualitative approach). The main outcomes will be (1) participants’ attitudes, knowledge, and behaviors before and after the training; and (2) the level of implementation of tobacco control policies within the hospitals before and after the training. Results: To date, adaptation of the materials, study enrollment, and training activities have been completed. During the adaptation, the main mismatches were language background and content adaptation. Several aids were developed to enable students’ training enrollment, including access to computers, support from technicians, and reminders to correctly complete the course. Follow-up data collection is in progress. We have enrolled 281 hospital workers. Results are expected at the beginning of 2017 and will be reported in two follow-up papers: one about the formative evaluation and the other about the summative evaluation. Conclusions: There is a need to learn more about the cultural and content elements that should be modified when an online tobacco cessation training program is adapted to new contexts. Special attention should be given to the personal and material resources that could make the implementation possible. Results from the Fruitful Study may offer a new approach to adapting programs to LMICs in order to offer education solutions with the use of emerging and growing communication technologies. ClinicalTrial: Clinicaltrials.gov NCT02718872; https://clinicaltrials.gov/ct2/show/NCT02718872 (Archived by WebCite at http://www.webcitation.org/6mjihsgE2) %M 28128731 %R 10.2196/resprot.6487 %U http://www.researchprotocols.org/2017/1/e7/ %U https://doi.org/10.2196/resprot.6487 %U http://www.ncbi.nlm.nih.gov/pubmed/28128731 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e24 %T Identifying Topics for E-Cigarette User-Generated Contents: A Case Study From Multiple Social Media Platforms %A Zhan,Yongcheng %A Liu,Ruoran %A Li,Qiudan %A Leischow,Scott James %A Zeng,Daniel Dajun %+ Department of Management Information Systems, Eller College of Management, The University of Arizona, McClelland Hall 430, 1130 E Helen St, Tucson, AZ, 85721, United States, 1 520 621 4614, zeng@eller.arizona.edu %K electronic cigarettes %K topic modeling %K Latent Dirichlet Allocation %K social media %K infodemiology %D 2017 %7 20.01.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic cigarette (e-cigarette) is an emerging product with a rapid-growth market in recent years. Social media has become an important platform for information seeking and sharing. We aim to mine hidden topics from e-cigarette datasets collected from different social media platforms. Objective: This paper aims to gain a systematic understanding of the characteristics of various types of social media, which will provide deep insights into how consumers and policy makers effectively use social media to track e-cigarette-related content and adjust their decisions and policies. Methods: We collected data from Reddit (27,638 e-cigarette flavor-related posts from January 1, 2011, to June 30, 2015), JuiceDB (14,433 e-juice reviews from June 26, 2013 to November 12, 2015), and Twitter (13,356 “e-cig ban”-related tweets from January, 1, 2010 to June 30, 2015). Latent Dirichlet Allocation, a generative model for topic modeling, was used to analyze the topics from these data. Results: We found four types of topics across the platforms: (1) promotions, (2) flavor discussions, (3) experience sharing, and (4) regulation debates. Promotions included sales from vendors to users, as well as trades among users. A total of 10.72% (2,962/27,638) of the posts from Reddit were related to trading. Promotion links were found between social media platforms. Most of the links (87.30%) in JuiceDB were related to Reddit posts. JuiceDB and Reddit identified consistent flavor categories. E-cigarette vaping methods and features such as steeping, throat hit, and vapor production were broadly discussed both on Reddit and on JuiceDB. Reddit provided space for policy discussions and majority of the posts (60.7%) holding a negative attitude toward regulations, whereas Twitter was used to launch campaigns using certain hashtags. Our findings are based on data across different platforms. The topic distribution between Reddit and JuiceDB was significantly different (P<.001), which indicated that the user discussions focused on different perspectives across the platforms. Conclusions: This study examined Reddit, JuiceDB, and Twitter as social media data sources for e-cigarette research. These mined findings could be further used by other researchers and policy makers. By utilizing the automatic topic-modeling method, the proposed unified feedback model could be a useful tool for policy makers to comprehensively consider how to collect valuable feedback from social media. %M 28108428 %R 10.2196/jmir.5780 %U http://www.jmir.org/2017/1/e24/ %U https://doi.org/10.2196/jmir.5780 %U http://www.ncbi.nlm.nih.gov/pubmed/28108428 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 1 %P e1 %T The Readability of Electronic Cigarette Health Information and Advice: A Quantitative Analysis of Web-Based Information %A Park,Albert %A Zhu,Shu-Hong %A Conway,Mike %+ Department of Biomedical Informatics, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108, United States, 1 206 743 7843, alpark1216@gmail.com %K electronic cigarettes %K tobacco use cessation products %K health services %K consumer health information %K health education %D 2017 %7 06.01.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The popularity and use of electronic cigarettes (e-cigarettes) has increased across all demographic groups in recent years. However, little is currently known about the readability of health information and advice aimed at the general public regarding the use of e-cigarettes. Objective: The objective of our study was to examine the readability of publicly available health information as well as advice on e-cigarettes. We compared information and advice available from US government agencies, nongovernment organizations, English speaking government agencies outside the United States, and for-profit entities. Methods: A systematic search for health information and advice on e-cigarettes was conducted using search engines. We manually verified search results and converted to plain text for analysis. We then assessed readability of the collected documents using 4 readability metrics followed by pairwise comparisons of groups with adjustment for multiple comparisons. Results: A total of 54 documents were collected for this study. All 4 readability metrics indicate that all information and advice on e-cigarette use is written at a level higher than that recommended for the general public by National Institutes of Health (NIH) communication guidelines. However, health information and advice written by for-profit entities, many of which were promoting e-cigarettes, were significantly easier to read. Conclusions: A substantial proportion of potential and current e-cigarette users are likely to have difficulty in fully comprehending Web-based health information regarding e-cigarettes, potentially hindering effective health-seeking behaviors. To comply with NIH communication guidelines, government entities and nongovernment organizations would benefit from improving the readability of e-cigarettes information and advice. %M 28062390 %R 10.2196/publichealth.6687 %U http://publichealth.jmir.org/2017/1/e1/ %U https://doi.org/10.2196/publichealth.6687 %U http://www.ncbi.nlm.nih.gov/pubmed/28062390 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e171 %T E-Cigarette Social Media Messages: A Text Mining Analysis of Marketing and Consumer Conversations on Twitter %A Lazard,Allison J %A Saffer,Adam J %A Wilcox,Gary B %A Chung,Arnold DongWoo %A Mackert,Michael S %A Bernhardt,Jay M %+ Center for Health Communication, Moody College of Communication, The University of Texas at Austin, CMB 3.120, Austin, TX, United States, 1 317 331 7807, lazard@unc.edu %K e-cigarettes %K social media %K tweet %K Internet %D 2016 %7 12.12.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As the use of electronic cigarettes (e-cigarettes) rises, social media likely influences public awareness and perception of this emerging tobacco product. Objective: This study examined the public conversation on Twitter to determine overarching themes and insights for trending topics from commercial and consumer users. Methods: Text mining uncovered key patterns and important topics for e-cigarettes on Twitter. SAS Text Miner 12.1 software (SAS Institute Inc) was used for descriptive text mining to reveal the primary topics from tweets collected from March 24, 2015, to July 3, 2015, using a Python script in conjunction with Twitter’s streaming application programming interface. A total of 18 keywords related to e-cigarettes were used and resulted in a total of 872,544 tweets that were sorted into overarching themes through a text topic node for tweets (126,127) and retweets (114,451) that represented more than 1% of the conversation. Results: While some of the final themes were marketing-focused, many topics represented diverse proponent and user conversations that included discussion of policies, personal experiences, and the differentiation of e-cigarettes from traditional tobacco, often by pointing to the lack of evidence for the harm or risks of e-cigarettes or taking the position that e-cigarettes should be promoted as smoking cessation devices. Conclusions: These findings reveal that unique, large-scale public conversations are occurring on Twitter alongside e-cigarette advertising and promotion. Proponents and users are turning to social media to share knowledge, experience, and questions about e-cigarette use. Future research should focus on these unique conversations to understand how they influence attitudes towards and use of e-cigarettes. %M 27956376 %R 10.2196/publichealth.6551 %U http://publichealth.jmir.org/2016/2/e171/ %U https://doi.org/10.2196/publichealth.6551 %U http://www.ncbi.nlm.nih.gov/pubmed/27956376 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 12 %P e321 %T An Ecological Momentary Intervention for Smoking Cessation: Evaluation of Feasibility and Effectiveness %A Businelle,Michael S %A Ma,Ping %A Kendzor,Darla E %A Frank,Summer G %A Vidrine,Damon J %A Wetter,David W %+ Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 405 271 8001 ext 50460, michael-businelle@ouhsc.edu %K smartphone %K mobile applications %K smoking cessation %K low income population %D 2016 %7 12.12.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite substantial public health progress in reducing the prevalence of smoking in the United States overall, smoking among socioeconomically disadvantaged adults remains high. Objective: To determine the feasibility and preliminary effectiveness of a novel smartphone-based smoking cessation app designed for socioeconomically disadvantaged smokers. Methods: Participants were recruited from a safety-net hospital smoking cessation clinic in Dallas, Texas, and were followed for 13 weeks. All participants received standard smoking cessation clinic care (ie, group counseling and cessation pharmacotherapy) and a smartphone with a novel smoking cessation app (ie, Smart-T). The Smart-T app prompted 5 daily ecological momentary assessments (EMAs) for 3 weeks (ie, 1 week before cessation and 2 weeks after cessation). During the precessation period, EMAs were followed by messages that focused on planning and preparing for the quit attempt. During the postcessation period, participant responses to EMAs drove an algorithm that tailored messages to the current level of smoking lapse risk and currently present lapse triggers (eg, urge to smoke, stress). Smart-T offered additional intervention features on demand (eg, one-click access to the tobacco cessation quitline; “Quit Tips” on coping with urges to smoke, mood, and stress). Results: Participants (N=59) were 52.0 (SD 7.0) years old, 54% (32/59) female, and 53% (31/59) African American, and 70% (40/57) had annual household income less than US $16,000. Participants smoked 20.3 (SD 11.6) cigarettes per day and had been smoking for 31.6 (SD 10.9) years. Twelve weeks after the scheduled quit date, 20% (12/59) of all participants were biochemically confirmed abstinent. Participants responded to 87% of all prompted EMAs and received approximately 102 treatment messages over the 3-week EMA period. Most participants (83%, 49/59) used the on-demand app features. Individuals with greater nicotine dependence and minority race used the Quit Tips feature more than their counterparts. Greater use of the Quit Tips feature was linked to nonabstinence at the 2 (P=.02), 4 (P<.01), and 12 (P=.03) week follow-up visits. Most participants reported that they actually used or implemented the tailored app-generated messages and suggestions (83%, 49/59); the app-generated messages were helpful (97%, 57/59); they would like to use the app in the future if they were to lapse (97%, 57/59); and they would like to refer friends who smoke to use the Smart-T app (85%, 50/59). A minority of participants (15%, 9/59) reported that the number of daily assessments (ie, 5) was “too high.” Conclusions: This novel just-in-time adaptive intervention delivered an intensive intervention (ie, 102 messages over a 3-week period), was well-liked, and was perceived as helpful and useful by socioeconomically disadvantaged adults who were seeking smoking cessation treatment. Smartphone apps may be used to increase treatment exposure and may ultimately reduce tobacco-related health disparities among socioeconomically disadvantaged adults. %M 27956375 %R 10.2196/jmir.6058 %U http://www.jmir.org/2016/12/e321/ %U https://doi.org/10.2196/jmir.6058 %U http://www.ncbi.nlm.nih.gov/pubmed/27956375 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 4 %N 2 %P e19 %T Quittr: The Design of a Video Game to Support Smoking Cessation %A Bindoff,Ivan %A de Salas,Kristy %A Peterson,Gregory %A Ling,Tristan %A Lewis,Ian %A Wells,Lindsay %A Gee,Peter %A Ferguson,Stuart G %+ University of Tasmania, Private Bag 87, Hobart, 7001, Australia, 61 3 62266220, Kristy.deSalas@utas.edu.au %K smoking cessation %K video games %K mobile phone %K motivation %D 2016 %7 01.12.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: Smoking is recognized as the largest, single, preventable cause of death and disease in the developed world. While the majority of smokers report wanting to quit, and many try each year, smokers find it difficult to maintain long-term abstinence. Behavioral support, such as education, advice, goal-setting, and encouragement, is known to be beneficial in improving the likelihood of succeeding in a quit attempt, but it remains difficult to effectively deliver this behavioral support and keep the patient engaged with the process for a sufficient duration. In an attempt to solve this, there have been numerous mobile apps developed, yet engagement and retention have remained key challenges that limit the potential effectiveness of these interventions. Video games have been clearly linked with the effective delivery of health interventions, due to their capacity to increase motivation and engagement of players. Objective: The objective of this study is to describe the design and development of a smartphone app that is theory-driven, and which incorporates gaming characteristics in order to promote engagement with content, and thereby help smokers to quit. Methods: Game design and development was informed by a taxonomy of motivational affordances for meaningful gamified and persuasive technologies. This taxonomy describes a set of design components that is grounded in well-established psychological theories on motivation. Results: This paper reports on the design and development process of Quittr, a mobile app, describing how game design principles, game mechanics, and game elements can be used to embed education and support content, such that the app actually requires the user to access and engage with relevant educational content. The next stage of this research is to conduct a randomized controlled trial to determine whether the additional incentivization game features offer any value in terms of the key metrics of engagement–how much content users are consuming, how many days users are persisting with using the app, and what proportion of users successfully abstain from smoking for 28 days, based on user-reported data and verified against a biochemical baseline using cotinine tests. Conclusions: We describe a novel, and theoretically-informed mobile app design approach that has a broad range of potential applications. By using the virtual currency approach, we remove the need for the game to comprehensively integrate the healthy activity as part of its actual play mechanics. This opens up the potential for a wide variety of health problems to be tackled through games where no obvious play mechanic presents itself. The implications of this app are that similar approaches may be of benefit in areas such as managing chronic conditions (diabetes, heart disease, etc), treating substance abuse (alcohol, illicit drugs, etc), diet and exercise, eating disorders (anorexia, bulimia, and binge eating), and various phobias. %M 27908844 %R 10.2196/games.6258 %U http://games.jmir.org/2016/2/e19/ %U https://doi.org/10.2196/games.6258 %U http://www.ncbi.nlm.nih.gov/pubmed/27908844 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e306 %T Web-Based Antismoking Advertising to Promote Smoking Cessation: A Randomized Controlled Trial %A Yom-Tov,Elad %A Muennig,Peter %A El-Sayed,Abdulrahman M %+ Microsoft Research, 13 Shenkar St, Herzeliya, 46875, Israel, 972 747111359, eladyt@microsoft.com %K smoking cessation %K online advertising %K computational advertising %D 2016 %7 21.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Although hundreds of millions of dollars are spent each year on public health advertising, the advertisement content, design, and placement are usually developed by intuition rather than research. Objective: The objective of our study was to develop a methodology for testing Web-based advertisements to promote smoking cessation. Methods: We developed 10 advertisements that varied by their content (those that empower viewers to quit, help viewers to quit, or discuss the effects of smoking). We then conducted a series of Web-based randomized controlled trials that explored the effects of exposing users of Microsoft’s Bing search engine to antismoking advertisements that differed by content, placement, or other characteristics. Finally, we followed users to explore whether they conducted subsequent searches for smoking cessation products or services. Results: The advertisements were shown 710,106 times and clicked on 1167 times. In general, empowering advertisements had the greatest impact (hazard ratio [HR] 2.6, standard error [SE] 0.09 relative to nonempowering advertisements), but we observed significant variations by gender. For instance, we found that men exposed to smoking cessation advertisements were less likely than women to subsequently conduct smoking cessation searches (HR 0.2, SE 0.07), but that this likelihood increased 3.5 times in men exposed to advertisements containing empowering content. Women were more influenced by advertisements that emphasized the health effects of smoking. We also found that appearing at the top right of the page (HR 2.1, SE 0.07) or at the bottom rather than the top of a list (HR 1.1, SE 0.02) can improve smoking cessation advertisements’ effectiveness in prompting future searches related to smoking cessation. Conclusions: Advertising should be targeted to different demographic groups in ways that are not always intuitive. Our study provides a method for testing the effectiveness of Web-based antismoking advertisements and demonstrates the importance of advertisements that are tailored according to specific demographics. %M 27872032 %R 10.2196/jmir.6563 %U http://www.jmir.org/2016/11/e306/ %U https://doi.org/10.2196/jmir.6563 %U http://www.ncbi.nlm.nih.gov/pubmed/27872032 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e165 %T Perceptions Toward a Smoking Cessation App Targeting LGBTQ+ Youth and Young Adults: A Qualitative Framework Analysis of Focus Groups %A Baskerville,N Bruce %A Dash,Darly %A Wong,Katy %A Shuh,Alanna %A Abramowicz,Aneta %+ Propel Centre for Population Health Impact, Applied Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada, 1-519-888-4567 ext. 35236, nbbaskerville@uwaterloo.ca %K qualitative research %K focus groups %K mobile applications %K telemedicine %K sexuality %K smoking cessation %K smartphone %D 2016 %7 18.11.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The prevalence of smoking among lesbian, gay, bisexual, trans, queer, and other sexual minority (LGBTQ+) youth and young adults (YYA) is significantly higher compared with that among non-LGBTQ+ persons. However, in the past, interventions were primarily group cessation classes that targeted LGBTQ+ persons of all ages. mHealth interventions offer an alternate and modern intervention platform for this subpopulation and may be of particular interest for young LGBTQ+ persons. Objective: This study explored LGBTQ+ YYA (the potential users’) perceptions of a culturally tailored mobile app for smoking cessation. Specifically, we sought to understand what LGBTQ+ YYA like and dislike about this potential cessation tool, along with how such interventions could be improved. Methods: We conducted 24 focus groups with 204 LGBTQ+ YYA (aged 16-29 years) in Toronto and Ottawa, Canada. Participants reflected on how an app might support LGBTQ+ persons with smoking cessation. Participants indicated their feelings, likes and dislikes, concerns, and additional ideas for culturally tailored smoking cessation apps. Framework analysis was used to code transcripts and identify the overarching themes. Results: Study findings suggested that LGBTQ+ YYA were eager about using culturally tailored mobile apps for smoking cessation. Accessibility, monitoring and tracking, connecting with community members, tailoring, connecting with social networks, and personalization were key reasons that were valued for a mobile app cessation program. However, concerns were raised about individual privacy and that not all individuals had access to a mobile phone, users might lose interest quickly, an app would need to be marketed effectively, and app users might cheat and lie about progress to themselves. Participants highlighted that the addition of distractions, rewards, notifications, and Web-based and print versions of the app would be extremely useful to mitigate some of their concerns. Conclusions: This study provided insight into the perspectives of LGBTQ+ YYA on a smoking cessation intervention delivered through a mobile app. The findings suggested a number of components of a mobile app that were valued and those that were concerning, as well as suggestions on how to make a mobile app cessation program successful. App development for this subpopulation should take into consideration the opinions of the intended users and involve them in the development and evaluation of mobile-based smoking cessation programs. %M 27864164 %R 10.2196/publichealth.6188 %U http://publichealth.jmir.org/2016/2/e165/ %U https://doi.org/10.2196/publichealth.6188 %U http://www.ncbi.nlm.nih.gov/pubmed/27864164 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e288 %T Comparing Twitter and Online Panels for Survey Recruitment of E-Cigarette Users and Smokers %A Guillory,Jamie %A Kim,Annice %A Murphy,Joe %A Bradfield,Brian %A Nonnemaker,James %A Hsieh,Yuli %+ RTI International, 3040 E Cornwallis Rd, Research Triangle Park, NC, 27709, United States, 1 919 316 3725, jguillory@rti.org %K social media %K electronic cigarettes %K tobacco %K Twitter %D 2016 %7 15.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: E-cigarettes have rapidly increased in popularity in recent years, driven, at least in part, by marketing and word-of-mouth discussion on Twitter. Given the rapid proliferation of e-cigarettes, researchers need timely quantitative data from e-cigarette users and smokers who may see e-cigarettes as a cessation tool. Twitter provides an ideal platform for recruiting e-cigarette users and smokers who use Twitter. Online panels offer a second method of accessing this population, but they have been criticized for recruiting too few young adults, among whom e-cigarette use rates are highest. Objective: This study compares effectiveness of recruiting Twitter users who are e-cigarette users and smokers who have never used e-cigarettes via Twitter to online panelists provided by Qualtrics and explores how users recruited differ by demographics, e-cigarette use, and social media use. Methods: Participants were adults who had ever used e-cigarettes (n=278; male: 57.6%, 160/278; age: mean 34.26, SD 14.16 years) and smokers (n=102; male: 38.2%, 39/102; age: mean 42.80, SD 14.16 years) with public Twitter profiles. Participants were recruited via online panel (n=190) or promoted tweets using keyword targeting for e-cigarette users (n=190). Predictor variables were demographics (age, gender, education, race/ethnicity), e-cigarette use (eg, past 30-day e-cigarette use, e-cigarette puffs per day), social media use behaviors (eg, Twitter use frequency), and days to final survey completion from survey launch for Twitter versus panel. Recruitment method (Twitter, panel) was the dependent variable. Results: Across the total sample, participants were recruited more quickly via Twitter (incidence rate ratio=1.30, P=.02) than panel. Compared with young adult e-cigarette users (age 18-24 years), e-cigarette users aged 25 to 34 years (OR 0.01, 95% CI 0.00-0.60, P=.03) and 35 to 44 years (OR 0.01, 95% CI 0.00-0.51, P=.02) were more likely to be recruited via Twitter than panel. Smokers aged 35 to 44 years were less likely than those aged 18 to 24 years to be recruited via Twitter than panel (35-44: OR 0.03, 95% CI 0.00-0.49, P=.01). E-cigarette users who reported a greater number of e-cigarette puffs per day were more likely to be recruited via Twitter than panel compared to those who reported fewer puffs per day (OR 1.12, 95% CI 1.05-1.20, P=.001). With each one-unit increase in Twitter usage, e-cigarette users were 9.55 times (95% CI 2.28-40.00, P=.002) and smokers were 4.91 times (95% CI 1.90-12.74, P=.001) as likely to be recruited via Twitter than panel. Conclusions: Twitter ads were more time efficient than an online panel in recruiting e-cigarette users and smokers. In addition, Twitter provided access to younger adults, who were heavier users of e-cigarettes and Twitter. Recruiting via social media and online panel in combination offered access to a more diverse population of participants. %M 27847353 %R 10.2196/jmir.6326 %U http://www.jmir.org/2016/11/e288/ %U https://doi.org/10.2196/jmir.6326 %U http://www.ncbi.nlm.nih.gov/pubmed/27847353 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e285 %T Impact of a Collective Intelligence Tailored Messaging System on Smoking Cessation: The Perspect Randomized Experiment %A Sadasivam,Rajani Shankar %A Borglund,Erin M %A Adams,Roy %A Marlin,Benjamin M %A Houston,Thomas K %+ Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical Scool, Albert Sherman Center, 368 Plantation Street, Worcester, MA, 01605, United States, 1 508 856 8924, rajani.sadasivam@umassmed.edu %K recommender system %K health communication %K computer tailoring %K smoking cessation %D 2016 %7 08.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Outside health care, content tailoring is driven algorithmically using machine learning compared to the rule-based approach used in current implementations of computer-tailored health communication (CTHC) systems. A special class of machine learning systems (“recommender systems”) are used to select messages by combining the collective intelligence of their users (ie, the observed and inferred preferences of users as they interact with the system) and their user profiles. However, this approach has not been adequately tested for CTHC. Objective: Our aim was to compare, in a randomized experiment, a standard, evidence-based, rule-based CTHC (standard CTHC) to a novel machine learning CTHC: Patient Experience Recommender System for Persuasive Communication Tailoring (PERSPeCT). We hypothesized that PERSPeCT will select messages of higher influence than our standard CTHC system. This standard CTHC was proven effective in motivating smoking cessation in a prior randomized trial of 900 smokers (OR 1.70, 95% CI 1.03-2.81). Methods: PERSPeCT is an innovative hybrid machine learning recommender system that selects and sends motivational messages using algorithms that learn from message ratings from 846 previous participants (explicit feedback), and the prior explicit ratings of each individual participant. Current smokers (N=120) aged 18 years or older, English speaking, with Internet access were eligible to participate. These smokers were randomized to receive either PERSPeCT (intervention, n=74) or standard CTHC tailored messages (n=46). The study was conducted between October 2014 and January 2015. By randomization, we compared daily message ratings (mean of smoker ratings each day). At 30 days, we assessed the intervention’s perceived influence, 30-day cessation, and changes in readiness to quit from baseline. Results: The proportion of days when smokers agreed/strongly agreed (daily rating ≥4) that the messages influenced them to quit was significantly higher for PERSPeCT (73%, 23/30) than standard CTHC (44%, 14/30, P=.02). Among less educated smokers (n=49), this difference was even more pronounced for days strongly agree (intervention: 77%, 23/30; comparison: 23%, 7/30, P<.001). There was no significant difference in the frequency which PERSPeCT randomized smokers agreed or strongly agreed that the intervention influenced them to quit smoking (P=.07) and use nicotine replacement therapy (P=.09). Among those who completed follow-up, 36% (20/55) of PERSPeCT smokers and 32% (11/34) of the standard CTHC group stopped smoking for one day or longer (P=.70). Conclusions: Compared to standard CTHC with proven effectiveness, PERSPeCT outperformed in terms of influence ratings and resulted in similar cessation rates. ClinicalTrial: Clinicaltrials.gov NCT02200432; https://clinicaltrials.gov/ct2/show/NCT02200432 (Archived by WebCite at http://www.webcitation.org/6lEJY1KEd) %M 27826134 %R 10.2196/jmir.6465 %U http://www.jmir.org/2016/11/e285/ %U https://doi.org/10.2196/jmir.6465 %U http://www.ncbi.nlm.nih.gov/pubmed/27826134 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 4 %N 2 %P e18 %T Game On? Smoking Cessation Through the Gamification of mHealth: A Longitudinal Qualitative Study %A El-Hilly,Abdulrahman Abdulla %A Iqbal,Sheeraz Syed %A Ahmed,Maroof %A Sherwani,Yusuf %A Muntasir,Mohammed %A Siddiqui,Sarim %A Al-Fagih,Zaid %A Usmani,Omar %A Eisingerich,Andreas B %+ Airway Disease, National Heart and Lung Institute, Imperial College London & Royal Brompton Hospital, Dovehouse Street, London, SW3 6LY, United Kingdom, 44 (0)20 7351 8051, o.usmani@imperial.ac.uk %K gamification %K mhealth %K mobile health %K smoking cessation %K health behavior %K health policy %K public health %K behavioral support %D 2016 %7 24.10.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: Finding ways to increase and sustain engagement with mHealth interventions has become a challenge during application development. While gamification shows promise and has proven effective in many fields, critical questions remain concerning how to use gamification to modify health behavior. Objective: The objective of this study is to investigate how the gamification of mHealth interventions leads to a change in health behavior, specifically with respect to smoking cessation. Methods: We conducted a qualitative longitudinal study using a sample of 16 smokers divided into 2 cohorts (one used a gamified intervention and the other used a nongamified intervention). Each participant underwent 4 semistructured interviews over a period of 5 weeks. Semistructured interviews were also conducted with 4 experts in gamification, mHealth, and smoking cessation. Interviews were transcribed verbatim and thematic analysis undertaken. Results: Results indicated perceived behavioral control and intrinsic motivation acted as positive drivers to game engagement and consequently positive health behavior. Importantly, external social influences exerted a negative effect. We identified 3 critical factors, whose presence was necessary for game engagement: purpose (explicit purpose known by the user), user alignment (congruency of game and user objectives), and functional utility (a well-designed game). We summarize these findings in a framework to guide the future development of gamified mHealth interventions. Conclusions: Gamification holds the potential for a low-cost, highly effective mHealth solution that may replace or supplement the behavioral support component found in current smoking cessation programs. The framework reported here has been built on evidence specific to smoking cessation, however it can be adapted to health interventions in other disease categories. Future research is required to evaluate the generalizability and effectiveness of the framework, directly against current behavioral support therapy interventions in smoking cessation and beyond. %M 27777216 %R 10.2196/games.5678 %U http://games.jmir.org/2016/2/e18/ %U https://doi.org/10.2196/games.5678 %U http://www.ncbi.nlm.nih.gov/pubmed/27777216 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 10 %P e275 %T Using Intensive Longitudinal Data Collected via Mobile Phone to Detect Imminent Lapse in Smokers Undergoing a Scheduled Quit Attempt %A Businelle,Michael S %A Ma,Ping %A Kendzor,Darla E %A Frank,Summer G %A Wetter,David W %A Vidrine,Damon J %+ Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, United States, 1 4052718001 ext 50460, michael-businelle@ouhsc.edu %K smartphone %K mobile app %K mhealth %K ecological momentary assessment %K smoking cessation %K socioeconomic disadvantage, risk estimation %D 2016 %7 17.10.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile phone‒based real-time ecological momentary assessments (EMAs) have been used to record health risk behaviors, and antecedents to those behaviors, as they occur in near real time. Objective: The objective of this study was to determine if intensive longitudinal data, collected via mobile phone, could be used to identify imminent risk for smoking lapse among socioeconomically disadvantaged smokers seeking smoking cessation treatment. Methods: Participants were recruited into a randomized controlled smoking cessation trial at an urban safety-net hospital tobacco cessation clinic. All participants completed in-person EMAs on mobile phones provided by the study. The presence of six commonly cited lapse risk variables (ie, urge to smoke, stress, recent alcohol consumption, interaction with someone smoking, cessation motivation, and cigarette availability) collected during 2152 prompted or self-initiated postcessation EMAs was examined to determine whether the number of lapse risk factors was greater when lapse was imminent (ie, within 4 hours) than when lapse was not imminent. Various strategies were used to weight variables in efforts to improve the predictive utility of the lapse risk estimator. Results: Participants (N=92) were mostly female (52/92, 57%), minority (65/92, 71%), 51.9 (SD 7.4) years old, and smoked 18.0 (SD 8.5) cigarettes per day. EMA data indicated significantly higher urges (P=.01), stress (P=.002), alcohol consumption (P<.001), interaction with someone smoking (P<.001), and lower cessation motivation (P=.03) within 4 hours of the first lapse compared with EMAs collected when lapse was not imminent. Further, the total number of lapse risk factors present within 4 hours of lapse (mean 2.43, SD 1.37) was significantly higher than the number of lapse risk factors present during periods when lapse was not imminent (mean 1.35, SD 1.04), P<.001. Overall, 62% (32/52) of all participants who lapsed completed at least one EMA wherein they reported ≥3 lapse risk factors within 4 hours of their first lapse. Differentially weighting lapse risk variables resulted in an improved risk estimator (weighted area=0.76 vs unweighted area=0.72, P<.004). Specifically, 80% (42/52) of all participants who lapsed had at least one EMA with a lapse risk score above the cut-off within 4 hours of their first lapse. Conclusions: Real-time estimation of smoking lapse risk is feasible and may pave the way for development of mobile phone‒based smoking cessation treatments that automatically tailor treatment content in real time based on presence of specific lapse triggers. Interventions that identify risk for lapse and automatically deliver tailored messages or other treatment components in real time could offer effective, low cost, and highly disseminable treatments to individuals who do not have access to other more standard cessation treatments. %M 27751985 %R 10.2196/jmir.6307 %U http://www.jmir.org/2016/10/e275/ %U https://doi.org/10.2196/jmir.6307 %U http://www.ncbi.nlm.nih.gov/pubmed/27751985 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 4 %P e115 %T Using Knowledge Translation to Craft “Sticky” Social Media Health Messages That Provoke Interest, Raise Awareness, Impart Knowledge, and Inspire Change %A Shibasaki,Sanchia %A Gardner,Karen %A Sibthorpe,Beverly %+ ThinkThrough Consultancy Services, P O Box 7083, Holland Park, 4121, Australia, 61 0447040224, sanchia.shibasaki@gmail.com %K knowledge translation %K social media %K Indigenous health %K health promotion %D 2016 %7 05.10.2016 %9 Short Paper %J JMIR Mhealth Uhealth %G English %X Background: In Australia, there is growing use of technology supported knowledge translation (KT) strategies such as social media and mobile apps in health promotion and in Indigenous health. However, little is known about how individuals use technologies and the evidence base for the impact of these health interventions on health behavior change is meager. Objective: The objective of our study was to examine how Facebook is used to promote health messages to Indigenous people and discuss how KT can support planning and implementing health messages to ensure chosen strategies are fit for the purpose and achieve impact. Methods: A desktop audit of health promotion campaigns on smoking prevention and cessation for Australian Indigenous people using Facebook was conducted. Results: Our audit identified 13 out of 21 eligible campaigns that used Facebook. Facebook pages with the highest number of likes (more than 5000) were linked to a website and to other social media applications and demonstrated stickiness characteristics by posting frequently (triggers and unexpected), recruiting sporting or public personalities to promote campaigns (social currency and public), recruiting Indigenous people from the local region (stories and emotion), and sharing stories and experiences based on real-life events (credible and practical value). Conclusions: KT planning may support campaigns to identify and select KT strategies that are best suited and well-aligned to the campaign’s goals, messages, and target audiences. KT planning can also help mitigate unforeseen and expected risks, reduce unwarranted costs and expenses, achieve goals, and limit the peer pressure of using strategies that may not be fit for purpose. One of the main challenges in using KT systems and processes involves coming to an adequate conceptualization of the KT process itself. %M 27707685 %R 10.2196/mhealth.5987 %U http://mhealth.jmir.org/2016/4/e115/ %U https://doi.org/10.2196/mhealth.5987 %U http://www.ncbi.nlm.nih.gov/pubmed/27707685 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e106 %T A Context-Sensing Mobile Phone App (Q Sense) for Smoking Cessation: A Mixed-Methods Study %A Naughton,Felix %A Hopewell,Sarah %A Lathia,Neal %A Schalbroeck,Rik %A Brown,Chloë %A Mascolo,Cecilia %A McEwen,Andy %A Sutton,Stephen %+ Behavioural Science Group, Department of Public Health and Primary Care, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge, CB2 0SR, United Kingdom, 44 1223769302, fmen2@medschl.cam.ac.uk %K mobile phone app %K smoking cessation %K context sensing %K tailoring %K geofence %K just-in-time adaptive intervention %K JITAI %K ecological momentary intervention %K craving %D 2016 %7 16.09.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: A major cause of lapse and relapse to smoking during a quit attempt is craving triggered by cues from a smoker's immediate environment. To help smokers address these cue-induced cravings when attempting to quit, we have developed a context-aware smoking cessation app, Q Sense, which uses a smoking episode-reporting system combined with location sensing and geofencing to tailor support content and trigger support delivery in real time. Objective: We sought to (1) assess smokers’ compliance with reporting their smoking in real time and identify reasons for noncompliance, (2) assess the app's accuracy in identifying user-specific high-risk locations for smoking, (3) explore the feasibility and user perspective of geofence-triggered support, and (4) identify any technological issues or privacy concerns. Methods: An explanatory sequential mixed-methods design was used, where data collected by the app informed semistructured interviews. Participants were smokers who owned an Android mobile phone and were willing to set a quit date within one month (N=15). App data included smoking reports with context information and geolocation, end-of-day (EoD) surveys of smoking beliefs and behavior, support message ratings, and app interaction data. Interviews were undertaken and analyzed thematically (N=13). Quantitative and qualitative data were analyzed separately and findings presented sequentially. Results: Out of 15 participants, 3 (20%) discontinued use of the app prematurely. Pre-quit date, the mean number of smoking reports received was 37.8 (SD 21.2) per participant, or 2.0 (SD 2.2) per day per participant. EoD surveys indicated that participants underreported smoking on at least 56.2% of days. Geolocation was collected in 97.0% of smoking reports with a mean accuracy of 31.6 (SD 16.8) meters. A total of 5 out of 9 (56%) eligible participants received geofence-triggered support. Interaction data indicated that 50.0% (137/274) of geofence-triggered message notifications were tapped within 30 minutes of being generated, resulting in delivery of a support message, and 78.2% (158/202) of delivered messages were rated by participants. Qualitative findings identified multiple reasons for noncompliance in reporting smoking, most notably due to environmental constraints and forgetting. Participants verified the app’s identification of their smoking locations, were largely positive about the value of geofence-triggered support, and had no privacy concerns about the data collected by the app. Conclusions: User-initiated self-report is feasible for training a cessation app about an individual’s smoking behavior, although underreporting is likely. Geofencing was a reliable and accurate method of identifying smoking locations, and geofence-triggered support was regarded positively by participants. %M 27637405 %R 10.2196/mhealth.5787 %U http://mhealth.jmir.org/2016/3/e106/ %U https://doi.org/10.2196/mhealth.5787 %U http://www.ncbi.nlm.nih.gov/pubmed/27637405 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 3 %P e188 %T A Cluster-Randomized Controlled Trial Evaluating the Effectiveness and Cost-Effectiveness of Tobacco Cessation on Prescription in Swedish Primary Health Care: A Protocol of the Motivation 2 Quit (M2Q) Study %A Leppänen,Anne %A Lindgren,Peter %A Sundberg,Carl Johan %A Petzold,Max %A Tomson,Tanja %+ Karolinska Institutet, Department of Learning, Informatics, Management and Ethics, Tomtebodavägen 18A, Stockholm, 17177, Sweden, 46 8 524 836 12, anne.leppanen@ki.se %K tobacco use cessation %K primary health care %K vulnerable populations %K randomized controlled trial %K pragmatic clinical trial %K cost-effectiveness analysis %K Sweden %D 2016 %7 16.09.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Sweden, the prevalence of tobacco use is disproportionately high among socioeconomically disadvantaged groups. Previous research and clinical experience suggest that prescribed lifestyle interventions in the primary health care (PHC) setting such as Physical Activity on Prescription are effective in changing behavior. However, there is a lack of evidence for if and how such a prescription approach could be effectively transferred into the tobacco cessation context. Objective: The aim of this trial is to evaluate the effectiveness and cost-effectiveness of Tobacco Cessation on Prescription (TCP) compared to current practice for tobacco cessation targeting socioeconomically disadvantaged groups in the PHC setting in Sweden. Methods: The design is a pragmatic cluster-randomized controlled trial. The sample will consist of 928 daily tobacco users with Swedish social security numbers and permanent resident permits, recruited from 14-20 PHC centers located in socioeconomically disadvantaged areas in Stockholm County. The primary outcome will be measured in self-reported 7-day abstinence at 6 and 12 months after the intervention. The secondary outcomes will be measured in daily tobacco consumption, number of quit attempts, and health-related quality of life at 6 and 12 months after the intervention. Data will be collected through questionnaires and review of electronic medical records. Cost-effectiveness will be estimated through decision analytic modeling and measured by the incremental cost per quality-adjusted life year. Results: In the first set of PHC centers participating in the study, eight centers have been included. Recruitment of individual study participants is currently ongoing. Inclusion of a second set of PHC centers is ongoing with expected study start in September 2016. Conclusions: If TCP is found effective and cost-effective compared to standard treatment, the method could be implemented to facilitate tobacco cessation for socioeconomically disadvantaged groups in the PHC setting in Sweden. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 11498135; http://www.isrctn.com/ISRCTN11498135 (Archived by WebCite at http://www.webcitation.org/6kTu6giYQ) %M 27637517 %R 10.2196/resprot.6180 %U http://www.researchprotocols.org/2016/3/e188/ %U https://doi.org/10.2196/resprot.6180 %U http://www.ncbi.nlm.nih.gov/pubmed/27637517 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 9 %P e235 %T Does Digital Video Advertising Increase Population-Level Reach of Multimedia Campaigns? Evidence From the 2013 Tips From Former Smokers Campaign %A Davis,Kevin C %A Shafer,Paul R %A Rodes,Robert %A Kim,Annice %A Hansen,Heather %A Patel,Deesha %A Coln,Caryn %A Beistle,Diane %+ Center for Health Policy Science and Tobacco Research, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, United States, 1 919 541 5801, kcdavis@rti.org %K social marketing %K smoking %K health campaigns %K digital advertising %K television advertising %D 2016 %7 14.09.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Federal and state public health agencies in the United States are increasingly using digital advertising and social media to promote messages from broader multimedia campaigns. However, little evidence exists on population-level campaign awareness and relative cost efficiencies of digital advertising in the context of a comprehensive public health education campaign. Objective: Our objective was to compare the impact of increased doses of digital video and television advertising from the 2013 Tips From Former Smokers (Tips) campaign on overall campaign awareness at the population level. We also compared the relative cost efficiencies across these media platforms. Methods: We used data from a large national online survey of approximately 15,000 US smokers conducted in 2013 immediately after the conclusion of the 2013 Tips campaign. These data were used to compare the effects of variation in media dose of digital video and television advertising on population-level awareness of the Tips campaign. We implemented higher doses of digital video among selected media markets and randomly selected other markets to receive similar higher doses of television ads. Multivariate logistic regressions estimated the odds of overall campaign awareness via digital or television format as a function of higher-dose media in each market area. All statistical tests used the .05 threshold for statistical significance and the .10 level for marginal nonsignificance. We used adjusted advertising costs for the additional doses of digital and television advertising to compare the cost efficiencies of digital and television advertising on the basis of costs per percentage point of population awareness generated. Results: Higher-dose digital video advertising was associated with 94% increased odds of awareness of any ad online relative to standard-dose markets (P<.001). Higher-dose digital advertising was associated with a marginally nonsignificant increase (46%) in overall campaign awareness regardless of media format (P=.09). Higher-dose television advertising was associated with 81% increased odds of overall ad awareness regardless of media format (P<.001). Increased doses of television advertising were also associated with significantly higher odds of awareness of any ad on television (P<.001) and online (P=.04). The adjusted cost of each additional percentage point of population-level reach generated by higher doses of advertising was approximately US $440,000 for digital advertising and US $1 million for television advertising. Conclusions: Television advertising generated relatively higher levels of overall campaign awareness. However, digital video was relatively more cost efficient for generating awareness. These results suggest that digital video may be used as a cost-efficient complement to traditional advertising modes (eg, television), but digital video should not replace television given the relatively smaller audience size of digital video viewers. %M 27627853 %R 10.2196/jmir.5683 %U http://www.jmir.org/2016/9/e235/ %U https://doi.org/10.2196/jmir.5683 %U http://www.ncbi.nlm.nih.gov/pubmed/27627853 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 3 %P e120 %T The Development and Piloting of a Mobile Data Collection Protocol to Assess Compliance With a National Tobacco Advertising, Promotion, and Product Display Ban at Retail Venues in the Russian Federation %A Grant,Ashley S %A Kennedy,Ryan D %A Spires,Mark H %A Cohen,Joanna E %+ Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 4th Floor, 2213 McElderry Street, Baltimore, MA, 21205, United States, 1 955 3435, rdkennedy@jhu.edu %K tobacco %K tobacco marketing %K retail environments %K compliance assessment %K policy implementation %K point-of-sale %K Russia %K mobile data collection %K mobile devices %D 2016 %7 31.08.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Tobacco control policies that lead to a significant reduction in tobacco industry marketing can improve public health by reducing consumption of tobacco and preventing initiation of tobacco use. Laws that ban or restrict advertising and promotion in point-of-sale (POS) environments, in the moment when consumers decide whether or not to purchase a tobacco product, must be correctly implemented to achieve the desired public health benefits. POS policy compliance assessments can support implementation; however, there are challenges to conducting evaluations that are rigorous, cost-effective, and timely. Data collection must be discreet, accurate, and systematic, and ideally collected both before and after policies take effect. The use of mobile phones and other mobile technology provide opportunities to efficiently collect data and support effective tobacco control policies. The Russian Federation (Russia) passed a comprehensive national tobacco control law that included a ban on most forms of tobacco advertising and promotion, effective November 15, 2013. The legislation further prohibited the display of tobacco products at retail trade sites and eliminated kiosks as a legal trade site, effective June 1, 2014. Objective: The objective of the study was to develop and test a mobile data collection protocol including: (1) retailer sampling, (2) adaptation of survey instruments for mobile phones, and (3) data management protocols. Methods: Two waves of observations were conducted; wave 1 took place during April-May 2014, after the advertising and promotion bans were effective, and again in August-September 2014, after the product display ban and elimination of tobacco sales in kiosks came into effect. Sampling took place in 5 Russian cities: Moscow, St. Petersburg, Novosibirsk, Yekaterinburg, and Kazan. Lack of access to a comprehensive list of licensed tobacco retailers necessitated a sampling approach that included the development of a walking protocol to identify tobacco retailers to observe. Observation instruments were optimized for use on mobile devices and included the collection of images/photos and the geographic location of retailers. Data were uploaded in real-time to a remote (“cloud-based”) server accessible via Internet and verified with the use of a data management protocol that included submission of daily field notes from the research team for review by project managers. Results: The walking protocol was a practical means of identifying 780 relevant retail venues in Russia, in the absence of reliable sampling resources. Mobile phones were convenient tools for completing observation checklists discretely and accurately. Daily field notes and meticulous oversight of collected data were critical to ensuring data quality. Conclusions: Mobile technology can support timely and accurate data collection and also help monitor data quality through the use of real-time uploads. These protocols can be adapted to assess compliance with other types of public health policies. %M 27580800 %R 10.2196/resprot.5302 %U http://www.researchprotocols.org/2016/3/e120/ %U https://doi.org/10.2196/resprot.5302 %U http://www.ncbi.nlm.nih.gov/pubmed/27580800 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e233 %T A Multirelational Social Network Analysis of an Online Health Community for Smoking Cessation %A Zhao,Kang %A Wang,Xi %A Cha,Sarah %A Cohn,Amy M %A Papandonatos,George D %A Amato,Michael S %A Pearson,Jennifer L %A Graham,Amanda L %+ Department of Management Sciences, Tippie College of Business, The University of Iowa, S224 PBB, Iowa City, IA, 52242, United States, 1 3193353831, kang-zhao@uiowa.edu %K social networks %K smoking cessation %K community networks %D 2016 %7 25.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Online health communities (OHCs) provide a convenient and commonly used way for people to connect around shared health experiences, exchange information, and receive social support. Users often interact with peers via multiple communication methods, forming a multirelational social network. Use of OHCs is common among smokers, but to date, there have been no studies on users’ online interactions via different means of online communications and how such interactions are related to smoking cessation. Such information can be retrieved in multirelational social networks and could be useful in the design and management of OHCs. Objective: To examine the social network structure of an OHC for smoking cessation using a multirelational approach, and to explore links between subnetwork position (ie, centrality) and smoking abstinence. Methods: We used NetworkX to construct 4 subnetworks based on users’ interactions via blogs, group discussions, message boards, and private messages. We illustrated topological properties of each subnetwork, including its degree distribution, density, and connectedness, and compared similarities among these subnetworks by correlating node centrality and measuring edge overlap. We also investigated coevolution dynamics of this multirelational network by analyzing tie formation sequences across subnetworks. In a subset of users who participated in a randomized, smoking cessation treatment trial, we conducted user profiling based on users’ centralities in the 4 subnetworks and identified user groups using clustering techniques. We further examined 30-day smoking abstinence at 3 months postenrollment in relation to users’ centralities in the 4 subnetworks. Results: The 4 subnetworks have different topological characteristics, with message board having the most nodes (36,536) and group discussion having the highest network density (4.35×10−3). Blog and message board subnetworks had the most similar structures with an in-degree correlation of .45, out-degree correlation of .55, and Jaccard coefficient of .23 for edge overlap. A new tie in the group discussion subnetwork had the lowest probability of triggering subsequent ties among the same two users in other subnetworks: 6.33% (54,142/855,893) for 2-tie sequences and 2.13% (18,207/855,893) for 3-tie sequences. Users’ centralities varied across the 4 subnetworks. Among a subset of users enrolled in a randomized trial, those with higher centralities across subnetworks generally had higher abstinence rates, although high centrality in the group discussion subnetwork was not associated with higher abstinence rates. Conclusions: A multirelational approach revealed insights that could not be obtained by analyzing the aggregated network alone, such as the ineffectiveness of group discussions in triggering social ties of other types, the advantage of blogs, message boards, and private messages in leading to subsequent social ties of other types, and the weak connection between one’s centrality in the group discussion subnetwork and smoking abstinence. These insights have implications for the design and management of online social networks for smoking cessation. %M 27562640 %R 10.2196/jmir.5985 %U http://www.jmir.org/2016/8/e233/ %U https://doi.org/10.2196/jmir.5985 %U http://www.ncbi.nlm.nih.gov/pubmed/27562640 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e221 %T Effectiveness of Web-Delivered Acceptance and Commitment Therapy in Relation to Mental Health and Well-Being: A Systematic Review and Meta-Analysis %A Brown,Menna %A Glendenning,Alexander %A Hoon,Alice E %A John,Ann %+ Swansea University, Medical School, ILS2, Swansea, SA2 8PP, United Kingdom, 44 179260 ext 6213, menna.brown@swansea.ac.uk %K acceptance and commitment therapy %K systematic review %K meta-analysis %K depression %K anxiety %K quality of life %K Internet-based %K mobile-based %D 2016 %7 24.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The need for effective interventions to improve mental health and emotional well-being at a population level are gaining prominence both in the United Kingdom and globally. Advances in technology and widespread adoption of Internet capable devices have facilitated rapid development of Web-delivered psychological therapies. Interventions designed to manage a range of affective disorders by applying diverse therapeutic approaches are widely available. Objective: The main aim of this review was to evaluate the evidence base of acceptance and commitment therapy (ACT) in a Web-based delivery format. Method: A systematic review of the literature and meta-analysis was conducted. Two electronic databases were searched for Web-delivered interventions utilizing ACT for the management of affective disorders or well-being. Only Randomized Controlled Trials (RCTs) were included. Results: The search strategy identified 59 articles. Of these, 10 articles met the inclusion criteria specified. The range of conditions and outcome measures that were identified limited the ability to draw firm conclusions about the efficacy of Web-delivered ACT-based intervention for anxiety or well-being. Conclusions: ACT in a Web-based delivery format was found to be effective in the management of depression. Rates of adherence to study protocols and completion were high overall suggesting that this therapeutic approach is highly acceptable for patients and the general public. %M 27558740 %R 10.2196/jmir.6200 %U http://www.jmir.org/2016/8/e221/ %U https://doi.org/10.2196/jmir.6200 %U http://www.ncbi.nlm.nih.gov/pubmed/27558740 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e229 %T Use and Appreciation of a Tailored Self-Management eHealth Intervention for Early Cancer Survivors: Process Evaluation of a Randomized Controlled Trial %A Kanera,Iris Maria %A Willems,Roy A %A Bolman,Catherine A W %A Mesters,Ilse %A Zambon,Victor %A Gijsen,Brigitte CM %A Lechner,Lilian %+ Faculty of Psychology and Educational Sciences, Open University of the Netherlands, Valkenburgerweg 177, Heerlen, 6401 DL, Netherlands, 31 455762448, iris.kanera@ou.nl %K eHealth %K web-based intervention %K computer tailoring %K cancer survivorship %K intervention usage %K appreciation %K multiple behavior intervention %K process evaluation %K self-management %D 2016 %7 23.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: A fully automated computer-tailored Web-based self-management intervention, Kanker Nazorg Wijzer (KNW [Cancer Aftercare Guide]), was developed to support early cancer survivors to adequately cope with psychosocial complaints and to promote a healthy lifestyle. The KNW self-management training modules target the following topics: return to work, fatigue, anxiety and depression, relationships, physical activity, diet, and smoking cessation. Participants were guided to relevant modules by personalized module referral advice that was based on participants’ current complaints and identified needs. Objective: The aim of this study was to evaluate the adherence to the module referral advice, examine the KNW module use and its predictors, and describe the appreciation of the KNW and its predictors. Additionally, we explored predictors of personal relevance. Methods: This process evaluation was conducted as part of a randomized controlled trial. Early cancer survivors with various types of cancer were recruited from 21 Dutch hospitals. Data from online self-report questionnaires and logging data were analyzed from participants allocated to the intervention condition. Chi-square tests were applied to assess the adherence to the module referral advice, negative binominal regression analysis was used to identify predictors of module use, multiple linear regression analysis was applied to identify predictors of the appreciation, and ordered logistic regression analysis was conducted to explore possible predictors of perceived personal relevance. Results: From the respondents (N=231; mean age 55.6, SD 11.5; 79.2% female [183/231]), 98.3% (227/231) were referred to one or more KNW modules (mean 2.9, SD 1.5), and 85.7% (198/231) of participants visited at least one module (mean 2.1, SD 1.6). Significant positive associations were found between the referral to specific modules (range 1-7) and the use of corresponding modules. The likelihoods of visiting modules were higher when respondents were referred to those modules by the module referral advice. Predictors of visiting a higher number of modules were a higher number of referrals by the module referral advice (β=.136, P=.009), and having a partner was significantly related with a lower number of modules used (β=-.256, P=.044). Overall appreciation was high (mean 7.5, SD 1.2; scale 1-10) and was significantly predicted by a higher perceived personal relevance (β=.623, P=.000). None of the demographic and cancer-related characteristics significantly predicted the perceived personal relevance. Conclusions: The KNW in general and more specifically the KNW modules were well used and highly appreciated by early cancer survivors. Indications were found that the module referral advice might be a meaningful intervention component to guide the users in following a preferred selection of modules. These results indicate that the fully automated Web-based KNW provides personal relevant and valuable information and support for early cancer survivors. Therefore, this intervention can complement usual cancer aftercare and may serve as a first step in a stepped-care approach. Trial Registration: Nederlands Trial Register: NTR3375; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3375 (Archived by WebCite at http://www.webcitation.org/6jo4jO7kb) %M 27554525 %R 10.2196/jmir.5975 %U http://www.jmir.org/2016/8/e229/ %U https://doi.org/10.2196/jmir.5975 %U http://www.ncbi.nlm.nih.gov/pubmed/27554525 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e219 %T The Importance of Debiasing Social Media Data to Better Understand E-Cigarette-Related Attitudes and Behaviors %A Allem,Jon-Patrick %A Ferrara,Emilio %+ Keck School of Medicine, Department of Preventive Medicine, University of Southern California, 2001 N. Soto Street, 3rd Floor Mail, Los Angeles, CA, 90032, United States, 1 8586030812, allem@usc.edu %K Internet %K surveillance %K electronic cigarettes %K Twitter %K social media %D 2016 %7 09.08.2016 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 27507563 %R 10.2196/jmir.6185 %U http://www.jmir.org/2016/8/e219/ %U https://doi.org/10.2196/jmir.6185 %U http://www.ncbi.nlm.nih.gov/pubmed/27507563 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e95 %T Prioritizing the mHealth Design Space: A Mixed-Methods Analysis of Smokers’ Perspectives %A Hartzler,Andrea Lisabeth %A BlueSpruce,June %A Catz,Sheryl L %A McClure,Jennifer B %+ Group Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA, 98101, United States, 1 206 287 2030, hartzler.a@ghc.org %K mobile health %K human-centered design %K human-computer interaction %K smartphone %K smoking cessation %K telemedicine %K software design %D 2016 %7 05.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking remains the leading cause of preventable disease and death in the United States. Therefore, researchers are constantly exploring new ways to promote smoking cessation. Mobile health (mHealth) technologies could be effective cessation tools. Despite the availability of commercial quit-smoking apps, little research to date has examined smokers’ preferred treatment intervention components (ie, design features). Honoring these preferences is important for designing programs that are appealing to smokers and may be more likely to be adopted and used. Objective: The aim of this study was to understand smokers’ preferred design features of mHealth quit-smoking tools. Methods: We used a mixed-methods approach consisting of focus groups and written surveys to understand the design preferences of adult smokers who were interested in quitting smoking (N=40). Focus groups were stratified by age to allow differing perspectives to emerge between older (>40 years) and younger (<40 years) participants. Focus group discussion included a “blue-sky” brainstorming exercise followed by participant reactions to contrasting design options for communicating with smokers, providing social support, and incentivizing program use. Participants rated the importance of preselected design features on an exit survey. Qualitative analyses examined emergent discussion themes and quantitative analyses compared feature ratings to determine which were perceived as most important. Results: Participants preferred a highly personalized and adaptive mHealth experience. Their ideal mHealth quit-smoking tool would allow personalized tracking of their progress, adaptively tailored feedback, and real-time peer support to help manage smoking cravings. Based on qualitative analysis of focus group discussion, participants preferred pull messages (ie, delivered upon request) over push messages (ie, sent automatically) and preferred interaction with other smokers through closed social networks. Preferences for entertaining games or other rewarding incentives to encourage program use differed by age group. Based on quantitative analysis of surveys, participants rated the importance of select design features significantly differently (P<.001). Design features rated as most important included personalized content, the ability to track one’s progress, and features designed to help manage nicotine withdrawal and medication side effects. Design features rated least important were quit-smoking videos and posting on social media. Communicating with stop-smoking experts was rated more important than communicating with family and friends about quitting (P=.03). Perceived importance of various design features varied by age, experience with technology, and frequency of smoking. Conclusions: Future mHealth cessation aids should be designed with an understanding of smokers’ needs and preferences for these tools. Doing so does not guarantee treatment effectiveness, but balancing user preferences with best-practice treatment considerations could enhance program adoption and improve treatment outcomes. Grounded in the perspectives of smokers, we identify several design considerations, which should be prioritized when designing future mHealth cessation tools and which warrant additional empirical validation. %M 27496593 %R 10.2196/mhealth.5742 %U http://mhealth.jmir.org/2016/3/e95/ %U https://doi.org/10.2196/mhealth.5742 %U http://www.ncbi.nlm.nih.gov/pubmed/27496593 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e94 %T Evaluating an Adaptive and Interactive mHealth Smoking Cessation and Medication Adherence Program: A Randomized Pilot Feasibility Study %A McClure,Jennifer B %A Anderson,Melissa L %A Bradley,Katharine %A An,Lawrence C %A Catz,Sheryl L %+ Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA,, United States, 1 206 287 2737, McClure.J@ghc.org %K tobacco use cessation %K smoking %K mobile health %K mHealth %K eHealth %K secure messaging %K varenicline %D 2016 %7 03.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) interventions hold great promise for helping smokers quit since these programs can have wide reach and facilitate access to comprehensive, interactive, and adaptive treatment content. However, the feasibility, acceptability, and effectiveness of these programs remain largely untested. Objective: To assess feasibility and acceptability of the My Mobile Advice Program (MyMAP) smoking cessation program and estimate its effects on smoking cessation and medication adherence to inform future research planning. Methods: Sixty-six smokers ready to quit were recruited from a large regional health care system and randomized to one of two mHealth programs: (1) standard self-help including psychoeducational materials and guidance how to quit smoking or (2) an adaptive and interactive program consisting of the same standard mHealth self-help content as controls received plus a) real-time, adaptively tailored advice for managing nicotine withdrawal symptoms and medication side-effects and b) asynchronous secure messaging with a cessation counselor. Participants in both arms were also prescribed a 12-week course of varenicline. Follow-up assessments were conducted at 2 weeks post-target quit date (TQD), 3 months post-TQD, and 5 months post-TQD. Indices of program feasibility and acceptability included acceptability ratings, utilization metrics including use of each MyMAP program component (self-help content, secure messaging, and adaptively tailored advice), and open-ended feedback from participants. Smoking abstinence and medication adherence were also assessed to estimate effects on these treatment outcomes. Results: Utilization data indicated the MyMAP program was actively used, with higher mean program log-ins by experimental than control participants (10.6 vs 2.7, P<.001). The majority of experimental respondents thought the MyMAP program could help other people quit smoking (22/24, 92%) and consistently take their stop-smoking medication (17/22, 97%) and would recommend the program to others (20/23, 87%). They also rated the program as convenient, responsive to their needs, and easy to use. Abstinence rates at 5-month follow-up were 36% in the experimental arm versus 24% among controls (odds ratio 1.79 [0.61-5.19], P=.42). Experimental participants used their varenicline an average of 46 days versus 39 among controls (P=.49). More than two-thirds (22/33, 67%) of experimental participants and three-quarters (25/33, 76%) of controls prematurely discontinued their varenicline use (P=.29). Conclusions: The MyMAP intervention was found to be feasible and acceptable. Since the study was not powered for statistical significance, no conclusions can be drawn about the program’s effects on smoking abstinence or medication adherence, but the overall study results suggest further evaluation in a larger randomized trial is warranted. ClinicalTrial: ClinicalTrials.gov NCT02136498; https://clinicaltrials.gov/ct2/show/NCT02136498 (Archived by WebCite at http://www.webcitation.org/6jT3UMFLj) %M 27489247 %R 10.2196/mhealth.6002 %U http://mhealth.jmir.org/2016/3/e94/ %U https://doi.org/10.2196/mhealth.6002 %U http://www.ncbi.nlm.nih.gov/pubmed/27489247 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e205 %T Social Network Behavior and Engagement Within a Smoking Cessation Facebook Page %A Cole-Lewis,Heather %A Perotte,Adler %A Galica,Kasia %A Dreyer,Lindy %A Griffith,Christopher %A Schwarz,Mary %A Yun,Christopher %A Patrick,Heather %A Coa,Kisha %A Augustson,Erik %+ Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, United States, 1 240 276 6774, augustse@mail.nih.gov %K social network analysis %K smoking cessation %K Facebook %K social support %K Web-based communities %K social media %K communication %D 2016 %7 02.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media platforms are increasingly being used to support individuals in behavior change attempts, including smoking cessation. Examining the interactions of participants in health-related social media groups can help inform our understanding of how these groups can best be leveraged to facilitate behavior change. Objective: The aim of this study was to analyze patterns of participation, self-reported smoking cessation length, and interactions within the National Cancer Institutes’ Facebook community for smoking cessation support. Methods: Our sample consisted of approximately 4243 individuals who interacted (eg, posted, commented) on the public Smokefree Women Facebook page during the time of data collection. In Phase 1, social network visualizations and centrality measures were used to evaluate network structure and engagement. In Phase 2, an inductive, thematic qualitative content analysis was conducted with a subsample of 500 individuals, and correlational analysis was used to determine how participant engagement was associated with self-reported session length. Results: Between February 2013 and March 2014, there were 875 posts and 4088 comments from approximately 4243 participants. Social network visualizations revealed the moderator’s role in keeping the community together and distributing the most active participants. Correlation analyses suggest that engagement in the network was significantly inversely associated with cessation status (Spearman correlation coefficient = −0.14, P=.03, N=243). The content analysis of 1698 posts from 500 randomly selected participants identified the most frequent interactions in the community as providing support (43%, n=721) and announcing number of days smoke free (41%, n=689). Conclusions: These findings highlight the importance of the moderator for network engagement and provide helpful insights into the patterns and types of interactions participants are engaging in. This study adds knowledge of how the social network of a smoking cessation community behaves within the confines of a Facebook group. %M 27485315 %R 10.2196/jmir.5574 %U http://www.jmir.org/2016/8/e205/ %U https://doi.org/10.2196/jmir.5574 %U http://www.ncbi.nlm.nih.gov/pubmed/27485315 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 3 %P e142 %T Young Adult Utilization of a Smoking Cessation Website: An Observational Study Comparing Young and Older Adult Patterns of Use %A Cantrell,Jennifer %A Ilakkuvan,Vinu %A Graham,Amanda L %A Richardson,Amanda %A Xiao,Haijun %A Mermelstein,Robin J %A Curry,Susan J %A Sporer,Amy K %A Vallone,Donna M %+ Evaluation Science and Research, Truth Initiative, 900 G Street, Fourth Floor, Washington, DC,, United States, 1 202 454 5798, jcantrell@truthinitiative.org %K young adults, smoking cessation, Internet, utilization %D 2016 %7 11.07.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: There is little research on how young adults or young adult subgroups utilize and engage with Web-based cessation interventions when trying to quit smoking. Addressing this knowledge gap is important to identify opportunities to optimize the effectiveness of online cessation programs across diverse young adult users. Objective: This study examines utilization of the BecomeAnEX.org smoking cessation website among young adults and young adult subgroups compared with older adults to identify patterns of use by age, gender, and race/ethnicity. Methods: Study participants were 5983 new registered users on a free smoking cessation website who were aged 18 to 70 years. Website utilization was tracked for 6 months; metrics of use included website visits, pages per visit, length of visit, and interaction with specific website features. Differences in website use by age were examined via bivariate analyses and multivariate logistic regression adjusted for age, gender, and race/ethnicity. Interactions were examined to determine differences by gender and race/ethnicity within young (18- to 24-year-olds and 25- to 34-year-olds) and older (35 years and older) adult segments. Results: A greater percentage of young adults aged 18 to 34 years visited the site only once compared with older adults aged 35 years and older (72.05% vs 56.59%, respectively; P<.001). Young adults also spent less time on the site and viewed fewer pages than older adults. In adjusted analyses, young adults were significantly less likely than older adults to visit the site more than once (18-24 years: adjusted odds ratio [AOR] 0.58, 95% CI 0.49-0.68, P<.001; 25-34 years: AOR 0.56, 95% CI 0.50-0.64, P<.001), spend more than 3 minutes on the site (18-24 years: AOR 0.67, 95% CI 0.57-0.79, P<.001; 25-34 years: AOR 0.56, 95% CI 0.49-0.64, P<.001), view 12 or more pages (18-24 years: AOR 0.72, 95% CI 0.61-0.83; P<.001; 25-34 years: AOR 0.67, 95% CI 0.59-0.76, P<.001), utilize the BecomeAnEX.org community (18-24 years: AOR 0.61, 95% CI 0.48-0.79, P<.001; 25-34 years: AOR 0.73, 95% CI 0.60-0.88, P<.001), or utilize Separation Exercises (18-24 years: AOR 0.68, 95% CI 0.51-0.89, P<.01; 25-34 years: AOR 0.77, 95% CI 0.63-0.94, P<.01). Gender differences in utilization were more pronounced among young adults compared with older adults, with lower levels of utilization among young men than young women. For all age groups, utilization was higher among whites and African Americans than among Hispanics and other racial minorities, with one exception—BecomeAnEX.org community utilization was significantly higher among Hispanic young adults compared with white and African American young adults. Conclusions: Results point to important areas of inquiry for future research and development efforts. Research should focus on enhancing demand and increasing engagement among younger adults and men, examining strategies for capitalizing on young adult developmental needs, and increasing utilization of effective site features among diverse young adult users. %M 27401019 %R 10.2196/resprot.4881 %U http://www.researchprotocols.org/2016/3/e142/ %U https://doi.org/10.2196/resprot.4881 %U http://www.ncbi.nlm.nih.gov/pubmed/27401019 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e183 %T Photoaging Mobile Apps in School-Based Tobacco Prevention: The Mirroring Approach %A Brinker,Titus Josef %A Seeger,Werner %A Buslaff,Fabian %+ Universities of Giessen and Marburg Lung Center, Member of the German Center for Lung Research, Justus-Liebig-University of Giessen, Klinikstr. 33, Giessen, 35392, Germany, 49 15175084347, titus.brinker@gmail.com %K tobacco %K smoking %K adolescents %K photoaging %K apps %K secondary schools %K adolescent smoking %K tobacco prevention %K smoking prevention %K smoking cessation %D 2016 %7 28.06.2016 %9 Short Paper %J J Med Internet Res %G English %X Background: Most smokers start smoking during their early adolescence, often with the idea that smoking is glamorous. Adolescent smoking can best be prevented through health education at schools. Interventions that take advantage of the broad availability of mobile phones as well as adolescents’ interest in their appearance may be a novel way to improve prevention. Objective: In this first pilot study, we aimed to use mobile phone technology in accordance with the theory of planned behavior to improve school-based tobacco prevention. Methods: We used a free photoaging mobile phone app (“Smokerface”) in three German secondary schools via a novel method called mirroring. The students’ altered three-dimensional selfies on mobile phones or tablets were “mirrored” via a projector in front of their whole grade. Using an anonymous questionnaire, we then measured on a 5-point Likert scale the perceptions of the intervention among 125 students of both genders (average age 12.75 years). Results: A majority of the students perceived the intervention as fun (77/125, 61.6%), claimed that the intervention motivated them not to smoke (79/125, 63.2%), and stated that they learned new benefits of non-smoking (81/125, 64.8%). Only a minority of students disagreed or fully disagreed that they learned new benefits of non-smoking (16/125, 12.8%) or that they were themselves motivated not to smoke (18/125, 14.4%). Conclusions: We have presented a novel method to integrate photoaging in school-based tobacco prevention that affects student peer groups and considers the predictors of smoking in accordance with the theory of planned behavior. %M 27352819 %R 10.2196/jmir.6016 %U http://www.jmir.org/2016/6/e183/ %U https://doi.org/10.2196/jmir.6016 %U http://www.ncbi.nlm.nih.gov/pubmed/27352819 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e176 %T How a Fully Automated eHealth Program Simulates Three Therapeutic Processes: A Case Study %A Holter,Marianne T. S %A Johansen,Ayna %A Brendryen,Håvar %+ The Norwegian Centre for Addiction Research, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postboks 1039 Blindern, Oslo, 0315, Norway, 47 93 62 30 61, m.t.s.holter@medisin.uio.no %K Internet %K eHealth %K telemedicine %K behavior therapy %K motivational interviewing %K working alliance %K intervention mapping %K smoking cessation %K cell phones %K text messaging %D 2016 %7 28.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth programs may be better understood by breaking down the components of one particular program and discussing its potential for interactivity and tailoring in regard to concepts from face-to-face counseling. In the search for the efficacious elements within eHealth programs, it is important to understand how a program using lapse management may simultaneously support working alliance, internalization of motivation, and behavior maintenance. These processes have been applied to fully automated eHealth programs individually. However, given their significance in face-to-face counseling, it may be important to simulate the processes simultaneously in interactive, tailored programs. Objective: We propose a theoretical model for how fully automated behavior change eHealth programs may be more effective by simulating a therapist’s support of a working alliance, internalization of motivation, and managing lapses. Methods: We show how the model is derived from theory and its application to Endre, a fully automated smoking cessation program that engages the user in several “counseling sessions” about quitting. A descriptive case study based on tools from the intervention mapping protocol shows how each therapeutic process is simulated. Results: The program supports the user’s working alliance through alliance factors, the nonembodied relational agent Endre and computerized motivational interviewing. Computerized motivational interviewing also supports internalized motivation to quit, whereas a lapse management component responds to lapses. The description operationalizes working alliance, internalization of motivation, and managing lapses, in terms of eHealth support of smoking cessation. Conclusions: A program may simulate working alliance, internalization of motivation, and lapse management through interactivity and individual tailoring, potentially making fully automated eHealth behavior change programs more effective. %M 27354373 %R 10.2196/jmir.5415 %U http://www.jmir.org/2016/6/e176/ %U https://doi.org/10.2196/jmir.5415 %U http://www.ncbi.nlm.nih.gov/pubmed/27354373 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 6 %P e104 %T Exposure to Internet-Based Tobacco Advertising and Branding: Results From Population Surveys of Australian Youth 2010-2013 %A Dunlop,Sally %A Freeman,Becky %A Perez,Donna %+ Division of Cancer Screening and Prevention, Cancer Institute New South Wales, Level 9, 8 Central Ave,, Australian Technology Park, Sydney, 2015, Australia, 61 (02) 8374 3665, sally.dunlop@cancerinstitute.org.au %K youth %K tobacco %K social media %K advertising %D 2016 %7 23.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Since legislation prohibiting tobacco advertising in traditional media, online communication platforms and social media have become one of the few avenues for the tobacco industry to promote its products to Australians. Little is currently known about the exposure of young people to these new media promotions. Objective: To measure exposure to Internet-based tobacco advertising and branding among Australian youth, identify common formats of branding encountered, and examine the association between exposure and smoking susceptibility. Methods: The Tobacco Promotion Impact Study is a repeat cross-sectional telephone survey of young people (12-24 years) in 2 Australian states, conducted yearly from 2010 to 2013 (total n=8820). The survey included questions about past-month exposure to Internet-based tobacco advertising and tobacco company branding. Changes in levels of exposure, characteristics of exposed youth, and the association between exposure and smoking susceptibility were explored. Results: Past-month exposure to Internet-based tobacco advertising and branding among young people increased over the years of the survey (advertising: 21% in 2010 to 29% in 2013; branding: 20% in 2010 to 26% in 2013). The participants who were younger, female, from lower socioeconomic status, and never-smokers were more likely to report exposure. Facebook was the most commonly cited platform for encountering tobacco branding in 2013 (22% of all branding). Compared with young people interviewed in 2013, participants in 2010 were significantly less likely to report exposure to tobacco branding on social media (odds ratio [OR] 0.26, 95% CI 0.20-0.33, P<.001) or 2011 (OR 0.46, 95% CI 0.37-0.57, P<.001). Among never-smokers aged 12-17 years, exposure to online advertising and branding (OR 1.32, 95% CI 1.11-1.57, P=.002) or branding alone (OR 1.39, 95% CI 1.10-1.77, P=.007) were significant predictors of smoking susceptibility. Conclusions: Ensuring tobacco advertising bans are inclusive of Internet-based media is essential. Given the global nature of Internet-based content, cooperation among signatory nations to the World Health Organization Framework Convention Alliance on Tobacco Control will be necessary. %M 27338761 %R 10.2196/jmir.5595 %U http://www.jmir.org/2016/6/e104/ %U https://doi.org/10.2196/jmir.5595 %U http://www.ncbi.nlm.nih.gov/pubmed/27338761 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 6 %P e117 %T Beyond Traditional Newspaper Advertisement: Leveraging Facebook-Targeted Advertisement to Recruit Long-Term Smokers for Research %A Carter-Harris,Lisa %A Bartlett Ellis,Rebecca %A Warrick,Adam %A Rawl,Susan %+ Indiana University, School of Nursing, 600 Barnhill Drive, W427, Indianapolis, IN, 46202, United States, 1 317 274 2043, lcharris@iu.edu %K facebook %K recruitment methods %K smokers %K older %D 2016 %7 15.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Smokers are a stigmatized population, but an important population to reach for the purpose of research. Therefore, innovative recruitment methods are needed that are both cost-effective and efficacious in recruiting this population. Objective: The aim of the present article was to evaluate the feasibility of Facebook-targeted advertisement to recruit long-term smokers eligible for lung cancer screening for a descriptive, cross-sectional survey. Methods: A social media recruitment campaign was launched using Facebook-targeted advertisement to target age and keywords related to tobacco smoking in the Facebook users profile, interests, and likes. A 3-day newspaper advertisement recruitment campaign was used as a comparison. The study that used both recruitment methods aimed to test the psychometric properties of 4 newly developed lung cancer screening health belief scales. Data were collected via cross-sectional survey methodology using an Web-based survey platform. Results: The Facebook-targeted advertisements were viewed 56,621 times over an 18-day campaign in 2015 in the United States. The advertisement campaign yielded 1121 unique clicks to the Web-based survey platform at a cost of $1.51 per completed survey. Of those who clicked through to the study survey platform, 423 (37.7%) consented to participate; 92 (8.2%) dropped out during completion of the survey yielding a final study pool of 331 completed surveys. Recruitment by newspaper advertisement yielded a total of 30 participants in response to a 3-day advertisement campaign; recruitment efficacy resulted in 10 participants/day at $40.80 per completed survey. Participants represented current (n=182; 51%) and former smokers (n=178; 49%) with a mean age of 63.4 years (SD 6.0). Cost of the advertisement campaign was $500 total for the 18-day campaign. Conclusions: Recruitment by Facebook was more efficacious and cost-effective compared with newspaper advertisement. Facebook offers a new venue for recruitment into research studies that offer the potential for wider reach at a lower cost while providing privacy and flexibility for potential study participants. The study’s findings extend recent work of other researchers who have demonstrated Facebook’s utility with younger smokers, and Facebook is an effective tool to recruit older smokers. Furthermore, Facebook is a cost-effective alternative to traditional newspaper advertisement offering a new, affordable venue to recruit large numbers of older smokers efficiently. %M 27306780 %R 10.2196/jmir.5502 %U http://www.jmir.org/2016/6/e117/ %U https://doi.org/10.2196/jmir.5502 %U http://www.ncbi.nlm.nih.gov/pubmed/27306780 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 2 %P e127 %T Using Behavioral Intervention Technologies to Help Low-Income and Latino Smokers Quit: Protocol of a Randomized Controlled Trial %A Muñoz,Ricardo F %A Bunge,Eduardo L %A Barrera,Alinne Z %A Wickham,Robert E %A Lee,Jessica %+ Palo Alto University, 1791 Arastradero, Palo Alto, CA,, United States, 1 800 818 6136, rmunoz@paloaltou.edu %K smoking cessation %K Web app %K human-centered design %K recruitment %K dissemination %D 2016 %7 14.06.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: The Institute for International Internet Interventions for Health at Palo Alto University proposes to develop digital tools specifically to help low-income English- and Spanish-speaking smokers to quit. Individuals from lower-income countries and those with lower social status quit at lower rates than those from high-income countries and those with higher social status. Objective: We plan to launch a project designed to test whether a mobile-based digital intervention designed with systematic input from low-income English- and Spanish-speaking smokers from a public-sector health care system can significantly improve its acceptability, utilization, and effectiveness. Methods: Using human-centered development methods, we will involve low-income patients in the design of a Web app/text messaging tool. We will also use their input to improve our recruitment and dissemination strategies. We will iteratively develop versions of the digital interventions informed by our human-centered approach. The project involves three specific aims: (1) human-centered development of an English/Spanish smoking cessation web app, (2) improvement of dissemination strategies, and (3) evaluation of resulting smoking cessation web app. We will develop iterative versions of a digital smoking cessation tool that is highly responsive to the needs and preferences of the users. Input from participants will identify effective ways of reaching and encouraging low-income English- and Spanish-speaking smokers to use the digital smoking cessation interventions to be developed. This information will support ongoing dissemination and implementation efforts beyond the grant period. We will evaluate the effectiveness of the successive versions of the resulting stop smoking Web app by an online randomized controlled trial. Increased effectiveness will be defined as increased utilization of the Web app and higher abstinence rates than those obtained by a baseline usual care Web app. Results: Recruitment will begin January 2016, the study is intended to be completed by summer 2018, and the results should be available by fall 2019. Conclusions: This study will provide useful knowledge in developing, testing, and disseminating mobile-based interventions for low-income smokers. ClinicalTrial: ClinicalTrials.gov NCT02666482; https://clinicaltrials.gov/ct2/show/NCT02666482 (Archived by WebCite at http://www.webcitation.org/6gtcwaT28) %M 27302623 %R 10.2196/resprot.5355 %U http://www.researchprotocols.org/2016/3/e189/ %U https://doi.org/10.2196/resprot.5355 %U http://www.ncbi.nlm.nih.gov/pubmed/27302623 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e71 %T A Pilot Test of Self-Affirmations to Promote Smoking Cessation in a National Smoking Cessation Text Messaging Program %A Taber,Jennifer M %A Klein,William M.P %A Ferrer,Rebecca A %A Augustson,Erik %A Patrick,Heather %+ Kent State University, Department of Psychological Sciences, 309 Kent Hall Annex, Kent, OH, 44242, United States, 1 1 330 672 8783, jtaber1@kent.edu %K self-affirmation %K smoking cessation %K mHealth %K text messaging %K theoretical study %K self concept %K motivation %D 2016 %7 08.06.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although effective smoking cessation treatments, including mHealth interventions, have been empirically validated and are widely available, smoking relapse is likely. Self-affirmation, a process through which individuals focus on their strengths and behaviors, has been shown to reduce negative effects of self-threats and to promote engagement in healthier behavior. Objective: To assess the feasibility of incorporating self-affirmations into an existing text messaging-based smoking cessation program (Smokefree TXT) and to determine whether self-affirmation led to greater engagement and higher cessation rates than the standard intervention. Methods: Data were collected from smokers (n=1261) who subscribed to a free smoking cessation program and met eligibility criteria. The intervention lasted 42 days. The original design was a 2 (Baseline affirmation: 5-item questionnaire present vs absent) × 2 (Integrated affirmation: texts present vs absent) factorial design. Only 17 eligible users completed all baseline affirmation questions and these conditions did not influence any outcomes, so we collapsed across baseline affirmation conditions in analysis. In the integrated affirmation conditions, affirmations replaced approximately 20% of texts delivering motivational content. Results: In all, 687 users remained enrolled throughout the 42-day intervention and 81 reported smoking status at day 42. Among initiators (n=1261), self-affirmation did not significantly improve (1) intervention completion, (2) days enrolled, (3) 1-week smoking status, or (4) 6-week smoking status (all Ps>.10); and among the 687 completers, there were no significant effects of affirmation on cessation (Ps>.25). However, among the 81 responders, those who received affirmations were more likely to report cessation at 6 weeks (97.5%; 39 of 40) than those not given affirmations (78.1%; 32 of 41; χ2(1)=7.08, P=.008). Conclusion: This proof-of-concept study provides preliminary evidence that self-affirmation can be integrated into existing text-based cessation programs, as the affirmations did not lead to any adverse effects (ie, less engagement or lower rates of cessation). Among those who reported smoking status at the end of the intervention period (6.4% of eligible respondents), affirmations facilitated cessation. This study provides a “proof-of-concept” that brief, low-touch interventions may be integrated into a text messaging program with potential benefits, minimal disruption to the program or users, and little cost. Many questions remain regarding how self-affirmation and similar approaches can promote engagement in population interventions. %M 27278108 %R 10.2196/mhealth.5635 %U http://mhealth.jmir.org/2016/2/e71/ %U https://doi.org/10.2196/mhealth.5635 %U http://www.ncbi.nlm.nih.gov/pubmed/27278108 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 2 %P e69 %T Mobile Phone Apps for Preventing Cancer Through Educational and Behavioral Interventions: State of the Art and Remaining Challenges %A Coughlin,Steven %A Thind,Herpreet %A Liu,Benyuan %A Champagne,Nicole %A Jacobs,Molly %A Massey,Rachael I %+ University of Massachusetts Lowell, Department of Community Health and Sustainability, One University Avenue, Kitson Hall 313A, Lowell, MA, 01854, United States, 1 404 983 2524, stevecatlanta@aol.com %K mobile phone apps %K cancer %K early detection of cancer %K diet %K environmental carcinogens %K health literacy %K nutrition %K obesity %K prevention %K randomized controlled trials %K screening %K smoking %K sun safety %K weight loss %D 2016 %7 30.05.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Rapid developments in technology have encouraged the use of mobile phones in smoking cessation, promoting healthy diet, nutrition, and physical activity, sun safety, and cancer screening. Although many apps relating to the prevention of cancer and other chronic diseases are available from major mobile phone platforms, relatively few have been tested in research studies to determine their efficacy. Objective: In this paper, we discuss issues related to the development and testing of new apps for preventing cancer through smoking cessation, sun safety, and other healthy behaviors, including key methodologic issues and outstanding challenges. Methods: An exploratory literature review was conducted using bibliographic searches in PubMed and CINAHL with relevant search terms (eg, smartphones, smoking cessation, cancer prevention, cancer screening, and carcinogens) to identify papers published in English through October 2015. Results: Only 4 randomized controlled trials of the use of mobile phone apps for smoking cessation and 2 trials of apps for sun safety were identified, indicating that it is premature to conduct a systematic search and meta-analysis of the published literature on this topic. Conclusions: Future studies should utilize randomized controlled trial research designs, larger sample sizes, and longer study periods to better establish the cancer prevention and control capabilities of mobile phone apps. In developing new and refined apps for cancer prevention and control, both health literacy and eHealth literacy should be taken into account. There is a need for culturally appropriate, tailored health messages to increase knowledge and awareness of health behaviors such as smoking cessation, cancer screening, and sun safety. Mobile phone apps are likely to be a useful and low-cost intervention for preventing cancer through behavioral changes. %M 27242162 %R 10.2196/mhealth.5361 %U http://mhealth.jmir.org/2016/2/e69/ %U https://doi.org/10.2196/mhealth.5361 %U http://www.ncbi.nlm.nih.gov/pubmed/27242162 %0 Journal Article %@ 2291-9279 %I JMIR Publications Inc. %V 4 %N 1 %P e3 %T Crave-Out: A Distraction/Motivation Mobile Game to Assist in Smoking Cessation %A DeLaughter,Kathryn L %A Sadasivam,Rajani S %A Kamberi,Ariana %A English,Thomas M %A Seward,Greg L %A Chan,S Wayne %A Volkman,Julie E %A Amante,Daniel J %A Houston,Thomas K %+ CHOIR ENRM VAMC, 200 Springs Rd., Bedford, MA,, United States, 1 781 687 2559, kathryn.delaughter@va.gov %K smoking cessation %K Internet %K secondary prevention %K health behavior %D 2016 %7 26.05.2016 %9 Original Paper %J JMIR Serious Games %G English %X Background: Smoking is still the number one preventable cause of death. Cravings—an intense desire or longing for a cigarette—are a major contributor to quit attempt failure. New tools to help smokers’ manage their cravings are needed. Objective: To present a case study of the development process and testing of a distraction/motivation game (Crave-Out) to help manage cravings. Methods: We used a phased approach: in Phase 1 (alpha testing), we tested and refined the game concept, using a Web-based prototype. In Phase 2 (beta testing), we evaluated the distraction/motivation potential of the mobile game prototype, using a prepost design. After varying duration of abstinence, smokers completed the Questionnaire of Smoking Urge-Brief (QSU-Brief) measurement before and after playing Crave-Out. Paired t tests were used to compare pregame and postgame QSU-Brief levels. To test dissemination potential, we released the game on the Apple iTunes App Store and tracked downloads between December 22, 2011, and May 5, 2014. Results: Our concept refinement resulted in a multilevel, pattern memory challenge game, with each level increasing in difficulty. Smokers could play the game as long as they wanted. At the end of each level, smokers were provided clear goals for the next level and rewards (positive reinforcement using motivational tokens that represented a benefit of quitting smoking). Negative reinforcement was removed in alpha testing as smokers felt it reminded them of smoking. Measurement of QSU-Brief (N=30) resulted in a pregame mean of 3.24 (SD 1.65) and postgame mean of 2.99 (SD 1.40) with an overall decrease of 0.25 in cravings (not statistically significant). In a subset analysis, the QSU-Brief decrease was significant for smokers abstinent for more than 48 hours (N=5) with a pregame mean of 2.84 (SD 1.16) and a postgame mean of 2.0 (SD 0.94; change=0.84; P =.03). Between December 22, 2011, and May 29, 2014, the game was downloaded 3372 times from the App-Store, with 1526 smokers visiting the online resource www.decide2quit.org linked to the game. Conclusions: Overall, playing the game resulted in small, but nonsignificant decreases in cravings, with changes greater for those had already quit for more than 48 hours. Lessons learned can inform further development. Future research could incorporate mHealth games in multicomponent cessation interventions. Trial Registration: Clinicaltrials.gov NCT00797628; https://clinicaltrials.gov/ct2/show/NCT00797628 (Archived by WebCite at http://www.webcitation.org/6hbJr6LWG) %M 27229772 %R 10.2196/games.4566 %U http://games.jmir.org/2016/1/e3/ %U https://doi.org/10.2196/games.4566 %U http://www.ncbi.nlm.nih.gov/pubmed/27229772 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e49 %T Text Messaging-Based Interventions for Smoking Cessation: A Systematic Review and Meta-Analysis %A Scott-Sheldon,Lori A. J %A Lantini,Ryan %A Jennings,Ernestine G %A Thind,Herpreet %A Rosen,Rochelle K %A Salmoirago-Blotcher,Elena %A Bock,Beth C %+ Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO Building, Suite 309, 164 Summit Avenue, Providence, RI, 02906, United States, 1 401 793 8714, lori_scott-sheldon@brown.edu %K text messaging %K smoking cessation %K intervention %K cigarette smoking %K meta-analysis %D 2016 %7 20.05.2016 %9 Review %J JMIR mHealth uHealth %G English %X Background: Tobacco use is one of the leading preventable global health problems producing nearly 6 million smoking-related deaths per year. Interventions delivered via text messaging (short message service, SMS) may increase access to educational and support services that promote smoking cessation across diverse populations. Objective: The purpose of this meta-analysis is to (1) evaluate the efficacy of text messaging interventions on smoking outcomes, (2) determine the robustness of the evidence, and (3) identify moderators of intervention efficacy. Methods: Electronic bibliographic databases were searched for records with relevant key terms. Studies were included if they used a randomized controlled trial (RCT) to examine a text messaging intervention focusing on smoking cessation. Raters coded sample and design characteristics, and intervention content. Summary effect sizes, using random-effects models, were calculated and potential moderators were examined. Results: The meta-analysis included 20 manuscripts with 22 interventions (N=15,593; 8128 (54%) women; mean age=29) from 10 countries. Smokers who received a text messaging intervention were more likely to abstain from smoking relative to controls across a number of measures of smoking abstinence including 7-day point prevalence (odds ratio (OR)=1.38, 95% confidence interval (CI)=1.22, 1.55, k=16) and continuous abstinence (OR=1.63, 95% CI=1.19, 2.24, k=7). Text messaging interventions were also more successful in reducing cigarette consumption relative to controls (d+=0.14, 95% CI=0.05, 0.23, k=9). The effect size estimates were biased when participants who were lost to follow-up were excluded from the analyses. Cumulative meta-analysis using the 18 studies (k=19) measuring abstinence revealed that the benefits of using text message interventions were established only after only five RCTs (k=5) involving 8383 smokers (OR=1.39, 95% CI=1.15, 1.67, P<.001). The inclusion of the subsequent 13 RCTs (k=14) with 6870 smokers did not change the established efficacy of text message interventions for smoking abstinence (OR=1.37, 95% CI=1.25, 1.51, P<.001). Smoking abstinence rates were stronger when text messaging interventions (1) were conducted in Asia, North America, or Europe, (2) sampled fewer women, and (3) recruited participants via the Internet. Conclusions: The evidence for the efficacy of text messaging interventions to reduce smoking behavior is well-established. Using text messaging to support quitting behavior, and ultimately long-term smoking abstinence, should be a public health priority. %M 27207211 %R 10.2196/mhealth.5436 %U http://mhealth.jmir.org/2016/2/e49/ %U https://doi.org/10.2196/mhealth.5436 %U http://www.ncbi.nlm.nih.gov/pubmed/27207211 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 5 %P e107 %T Exploring the Utility of Web-Based Social Media Advertising to Recruit Adult Heavy-Drinking Smokers for Treatment %A Bold,Krysten W %A Hanrahan,Tess H %A O'Malley,Stephanie S %A Fucito,Lisa M %+ Yale School of Medicine, Department of Psychiatry, Connecticut Mental Health Center, 34 Park Street, New Haven, CT, 06519, United States, 1 2039747603, krysten.bold@yale.edu %K smoking %K alcohol drinking %K social media %K research subject recruitment %D 2016 %7 18.05.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Identifying novel ways to recruit smokers for treatment studies is important. In particular, certain subgroups of adult smokers, such as heavy-drinking smokers, are at increased risk for serious medical problems and are less likely to try quitting smoking, so drawing this hard-to-reach population into treatment is important for improving health outcomes. Objective: This study examined the utility of Facebook advertisements to recruit smokers and heavy-drinking smokers for treatment research and evaluated smoking and alcohol use and current treatment goals among those who responded to the Web-based survey. Methods: Using Facebook’s advertising program, 3 separate advertisements ran for 2 months targeting smokers who were thinking about quitting. Advertisements were shown to adult (at least 18 years of age), English-speaking Facebook users in the greater New Haven, Connecticut, area. Participants were invited to complete a Web-based survey to determine initial eligibility for a smoking cessation research study. Results: Advertisements generated 1781 clicks and 272 valid, completed surveys in 2 months, with one advertisement generating the most interest. Facebook advertising was highly cost-effective, averaging $0.27 per click, $1.76 per completed survey, and $4.37 per participant meeting initial screening eligibility. On average, those who completed the Web-based survey were 36.8 (SD 10.4) years old, and 65.8% (179/272) were female. Advertisements were successful in reaching smokers; all respondents reported daily smoking (mean 16.2 [SD 7.0] cigarettes per day). The majority of smokers (254/272, 93.4%) were interested in changing their smoking behavior immediately. Many smokers (161/272, 59.2%) also reported heavy alcohol consumption at least once a month. Among smokers interested in reducing their alcohol use, more were heavy drinkers (45/56, 80.4%) compared to non-heavy drinkers (11/56, 19.6%; χ2[1,N=272]=13.0, P<.001). Of those who met initial screening eligibility from the Web-based survey, 12.7% (14/110) attended an in-person follow-up appointment. Conclusions: Social media advertisements designed to target smokers were cost-effective and successful for reaching adult smokers interested in treatment. Additionally, recruiting for smokers reached those who also drink alcohol heavily, many of whom were interested in changing this behavior as well. However, additional social media strategies may be needed to engage individuals into treatment after completion of Web-based screening surveys. %M 27194456 %R 10.2196/jmir.5360 %U http://www.jmir.org/2016/5/e107/ %U https://doi.org/10.2196/jmir.5360 %U http://www.ncbi.nlm.nih.gov/pubmed/27194456 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 1 %P e16 %T Leveraging Big Data to Improve Health Awareness Campaigns: A Novel Evaluation of the Great American Smokeout %A Ayers,John W %A Westmaas,J Lee %A Leas,Eric C %A Benton,Adrian %A Chen,Yunqi %A Dredze,Mark %A Althouse,Benjamin M %+ Graduate School of Public Health, San Diego State University, 2967 Four Corners St, Chula Vista, CA, 91914-5210, United States, 1 6193711846, ayers.john.w@gmail.com %K big data %K evaluation %K health communication %K mass media %K social media %K tobacco control %K infodemiology %K infoveillence %K twitter %K smoking cessation %D 2016 %7 31.03.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Awareness campaigns are ubiquitous, but little is known about their potential effectiveness because traditional evaluations are often unfeasible. For 40 years, the “Great American Smokeout” (GASO) has encouraged media coverage and popular engagement with smoking cessation on the third Thursday of November as the nation’s longest running awareness campaign. Objective: We proposed a novel evaluation framework for assessing awareness campaigns using the GASO as a case study by observing cessation-related news reports and Twitter postings, and cessation-related help seeking via Google, Wikipedia, and government-sponsored quitlines. Methods: Time trends (2009-2014) were analyzed using a quasi-experimental design to isolate spikes during the GASO by comparing observed outcomes on the GASO day with the simulated counterfactual had the GASO not occurred. Results: Cessation-related news typically increased by 61% (95% CI 35-87) and tweets by 13% (95% CI −21 to 48) during the GASO compared with what was expected had the GASO not occurred. Cessation-related Google searches increased by 25% (95% CI 10-40), Wikipedia page visits by 22% (95% CI −26 to 67), and quitline calls by 42% (95% CI 19-64). Cessation-related news media positively coincided with cessation tweets, Internet searches, and Wikipedia visits; for example, a 50% increase in news for any year predicted a 28% (95% CI −2 to 59) increase in tweets for the same year. Increases on the day of the GASO rivaled about two-thirds of a typical New Year’s Day—the day that is assumed to see the greatest increases in cessation-related activity. In practical terms, there were about 61,000 more instances of help seeking on Google, Wikipedia, or quitlines on GASO each year than would normally be expected. Conclusions: These findings provide actionable intelligence to improve the GASO and model how to rapidly, cost-effectively, and efficiently evaluate hundreds of awareness campaigns, nearly all for the first time. %M 27227151 %R 10.2196/publichealth.5304 %U http://publichealth.jmir.org/2016/1/e16/ %U https://doi.org/10.2196/publichealth.5304 %U http://www.ncbi.nlm.nih.gov/pubmed/27227151 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e67 %T 100 Million Views of Electronic Cigarette YouTube Videos and Counting: Quantification, Content Evaluation, and Engagement Levels of Videos %A Huang,Jidong %A Kornfield,Rachel %A Emery,Sherry L %+ Health Media Collaboratory, Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, United States, 1 312 355 0195, jhuang12@uic.edu %K electronic cigarettes %K electronic nicotine delivery systems %K ENDS %K tobacco products %K YouTube %K social media %D 2016 %7 18.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The video-sharing website, YouTube, has become an important avenue for product marketing, including tobacco products. It may also serve as an important medium for promoting electronic cigarettes, which have rapidly increased in popularity and are heavily marketed online. While a few studies have examined a limited subset of tobacco-related videos on YouTube, none has explored e-cigarette videos’ overall presence on the platform. Objective: To quantify e-cigarette-related videos on YouTube, assess their content, and characterize levels of engagement with those videos. Understanding promotion and discussion of e-cigarettes on YouTube may help clarify the platform’s impact on consumer attitudes and behaviors and inform regulations. Methods: Using an automated crawling procedure and keyword rules, e-cigarette-related videos posted on YouTube and their associated metadata were collected between July 1, 2012, and June 30, 2013. Metadata were analyzed to describe posting and viewing time trends, number of views, comments, and ratings. Metadata were content coded for mentions of health, safety, smoking cessation, promotional offers, Web addresses, product types, top-selling brands, or names of celebrity endorsers. Results: As of June 30, 2013, approximately 28,000 videos related to e-cigarettes were captured. Videos were posted by approximately 10,000 unique YouTube accounts, viewed more than 100 million times, rated over 380,000 times, and commented on more than 280,000 times. More than 2200 new videos were being uploaded every month by June 2013. The top 1% of most-viewed videos accounted for 44% of total views. Text fields for the majority of videos mentioned websites (70.11%); many referenced health (13.63%), safety (10.12%), smoking cessation (9.22%), or top e-cigarette brands (33.39%). The number of e-cigarette-related YouTube videos was projected to exceed 65,000 by the end of 2014, with approximately 190 million views. Conclusions: YouTube is a major information-sharing platform for electronic cigarettes. YouTube appears to be used unevenly for promotional purposes by e-cigarette brands, and our analyses indicated a high level of user engagement with a small subset of content. There is evidence that YouTube videos promote e-cigarettes as cigarette smoking cessation tools. Presence and reach of e-cigarette videos on YouTube warrants attention from public health professionals and policymakers. %M 26993213 %R 10.2196/jmir.4265 %U http://www.jmir.org/2016/3/e67/ %U https://doi.org/10.2196/jmir.4265 %U http://www.ncbi.nlm.nih.gov/pubmed/26993213 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 2 %P e39 %T Association Between Media Dose, Ad Tagging, and Changes in Web Traffic for a National Tobacco Education Campaign: A Market-Level Longitudinal Study %A Shafer,Paul R %A Davis,Kevin C %A Patel,Deesha %A Rodes,Robert %A Beistle,Diane %+ Center for Health Policy Science and Tobacco Research, RTI International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, United States, 1 919 260 2711, pshafer@rti.org %K Internet %K advertising %K health communication %K smoking cessation %K public health %K tobacco control %D 2016 %7 17.02.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: In 2012, the US Centers for Disease Control and Prevention (CDC) launched Tips From Former Smokers (Tips), the first federally funded national tobacco education campaign. In 2013, a follow-up Tips campaign aired on national cable television networks, radio, and other channels, with supporting digital advertising to drive traffic to the Tips campaign website. Objective: The objective of this study was to use geographic and temporal variability in 2013 Tips campaign television media doses and ad tagging to evaluate changes in traffic to the campaign website in response to specific doses of campaign media. Methods: Linear regression models were used to estimate the dose-response relationship between weekly market-level television gross rating points (GRPs) and weekly Web traffic to the Tips campaign website. This relationship was measured using unique visitors, total visits, and page views as outcomes. Ad GRP effects were estimated separately for ads tagged with the Tips campaign website URL and 1-800-QUIT-NOW. Results: In the average media market, an increase of 100 television GRPs per week for ads tagged with the Tips campaign website URL was associated with an increase of 650 unique visitors (P<.001), 769 total visits (P<.001), and 1255 total page views (P<.001) per week. The associations between GRPs for ads tagged with 1-800-QUIT-NOW and each Web traffic measure were also statistically significant (P<.001), but smaller in magnitude. Conclusions: Based on these findings, we estimate that the 16-week 2013 Tips television campaign generated approximately 660,000 unique visitors, 900,000 total visits, and 1,390,000 page views for the Tips campaign website. These findings can help campaign planners forecast the likely impact of targeted advertising efforts on consumers’ use of campaign-specific websites. %M 26887959 %R 10.2196/jmir.5343 %U http://www.jmir.org/2016/2/e39/ %U https://doi.org/10.2196/jmir.5343 %U http://www.ncbi.nlm.nih.gov/pubmed/26887959 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e17 %T Design Considerations for Smoking Cessation Apps: Feedback From Nicotine Dependence Treatment Providers and Smokers %A McClure,Jennifer B %A Hartzler,Andrea L %A Catz,Sheryl L %+ Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, , United States, 1 206 287 2737, McClure.J@ghc.org %K tobacco use cessation %K smoking %K mobile health %K smartphone %D 2016 %7 12.02.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Hundreds of smoking cessation apps are commercially available, but most are not theory-based or designed to take advantage of mobile technology in ways that could make them more engaging and possibly more effective. Considering input from both clinical experts (who understand best practice nicotine dependence treatment requirements) to inform appropriate content and from smokers (the end users) to express their preferences is important in designing these programs in the future. Objective: To assess and compare the opinions of nicotine dependence treatment providers and smokers regarding the design of future smoking cessation apps. Methods: We surveyed providers (n=264) and smokers who own smartphones (n=40) to assess their opinions on the importance of 21 app design features. Features represented 5 domains: cost, reputation, privacy and security, content and user experience, and communication. Domains were chosen to reflect best practice treatment, leverage mobile technology to support smoking cessation, and elicit important user preferences. Data were collected between June and July 2015. Results: Most providers agreed that mHealth apps hold promise for helping people quit smoking (203/264, 76.9%) and would recommend them to their clients/patients (201/264, 76.1%), especially if the app were empirically validated (236/264, 89.4%). Few providers believe effective cessation apps currently exist (112/264, 42.4%). Few smokers (5/40, 13%) had ever downloaded a smoking cessation app; of the ones who had not, most said they would consider doing so (29/35, 83%). Both respondent groups indicated the following features were very to extremely important to include in cessation apps: free or low cost, keeps information private, matches individual needs and interests, adapts as one’s needs and interests change, helps to manage nicotine withdrawal symptoms and medication side effects, and allows users to track their progress. Providers and smokers also indicated gaming and social media connectivity were less important than other features. Despite these similarities, the groups had significantly different opinions about the relative importance of various features. In particular, providers rated privacy as the most important feature, whereas smokers rated low cost and the ability to adaptively tailor content as the most important features. Conclusions: Smoking cessation apps hold great promise as intervention tools but only if they engage users and appropriately treat nicotine dependence. Intervention development should take into consideration the perspectives of both treatment experts and smokers. This paper highlights important perspectives from each of these groups to be considered when designing future app-based smoking cessation programs. %M 26872940 %R 10.2196/mhealth.5181 %U http://mhealth.jmir.org/2016/1/e17/ %U https://doi.org/10.2196/mhealth.5181 %U http://www.ncbi.nlm.nih.gov/pubmed/26872940 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e15 %T Interrater Reliability of mHealth App Rating Measures: Analysis of Top Depression and Smoking Cessation Apps %A Powell,Adam C %A Torous,John %A Chan,Steven %A Raynor,Geoffrey Stephen %A Shwarts,Erik %A Shanahan,Meghan %A Landman,Adam B %+ Payer+Provider Syndicate, 8 Garrison St Ste 101, Boston, MA, MA, United States, 1 6179399168, powell@payerprovider.com %K mobile applications %K mental health %K evaluation studies %K health apps %K ratings %D 2016 %7 10.02.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: There are over 165,000 mHealth apps currently available to patients, but few have undergone an external quality review. Furthermore, no standardized review method exists, and little has been done to examine the consistency of the evaluation systems themselves. Objective: We sought to determine which measures for evaluating the quality of mHealth apps have the greatest interrater reliability. Methods: We identified 22 measures for evaluating the quality of apps from the literature. A panel of 6 reviewers reviewed the top 10 depression apps and 10 smoking cessation apps from the Apple iTunes App Store on these measures. Krippendorff’s alpha was calculated for each of the measures and reported by app category and in aggregate. Results: The measure for interactiveness and feedback was found to have the greatest overall interrater reliability (alpha=.69). Presence of password protection (alpha=.65), whether the app was uploaded by a health care agency (alpha=.63), the number of consumer ratings (alpha=.59), and several other measures had moderate interrater reliability (alphas>.5). There was the least agreement over whether apps had errors or performance issues (alpha=.15), stated advertising policies (alpha=.16), and were easy to use (alpha=.18). There were substantial differences in the interrater reliabilities of a number of measures when they were applied to depression versus smoking apps. Conclusions: We found wide variation in the interrater reliability of measures used to evaluate apps, and some measures are more robust across categories of apps than others. The measures with the highest degree of interrater reliability tended to be those that involved the least rater discretion. Clinical quality measures such as effectiveness, ease of use, and performance had relatively poor interrater reliability. Subsequent research is needed to determine consistent means for evaluating the performance of apps. Patients and clinicians should consider conducting their own assessments of apps, in conjunction with evaluating information from reviews. %M 26863986 %R 10.2196/mhealth.5176 %U http://mhealth.jmir.org/2016/1/e15/ %U https://doi.org/10.2196/mhealth.5176 %U http://www.ncbi.nlm.nih.gov/pubmed/26863986 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e21 %T Benefits of E-Cigarettes Among Heavy Smokers Undergoing a Lung Cancer Screening Program: Randomized Controlled Trial Protocol %A Lucchiari,Claudio %A Masiero,Marianna %A Veronesi,Giulia %A Maisonneuve,Patrick %A Spina,Stefania %A Jemos,Costantino %A Omodeo Salè,Emanuela %A Pravettoni,Gabriella %+ Università Degli Studi di Milano, Department of Philosophy, Via Festa del Perdono 7, Milano, 20122, Italy, 39 0250312240, claudio.lucchiari@unimi.it %K tobacco cessation %K electronic cigarettes %K lung cancer screening %K smoking related diseases. %D 2016 %7 03.02.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smoking is a global public health problem. For this reason, experts have called smoking dependence a global epidemic. Over the past 5 years, sales of electronic cigarettes, or e-cigarettes, have been growing strongly in many countries. Yet there is only partial evidence that e-cigarettes are beneficial for smoking cessation. In particular, although it has been proven that nicotine replacement devices may help individuals stop smoking and tolerate withdrawal symptoms, e-cigarettes’ power to increase the quitting success rate is still limited, ranging from 5% to 20% dependent on smokers’ baseline conditions as shown by a recent Cochrane review. Consequently, it is urgent to know if e-cigarettes may have a higher success rate than other nicotine replacement methods and under what conditions. Furthermore, the effects of the therapeutic setting and the relationship between individual characteristics and the success rate have not been tested. This protocol is particularly innovative, because it aims to test the effectiveness of electronic devices in a screening program (the COSMOS II lung cancer prevention program at the European Institute of Oncology), where tobacco reduction is needed to lower individuals’ lung cancer risks. Objective: This protocol was designed with the primary aim of investigating the role of tobacco-free cigarettes in helping smokers improve lung health and either quit smoking or reduce their tobacco consumption. In particular, we aim to investigate the impact of a 3-month e-cigarettes program to reduce smoking-related respiratory symptoms (eg, dry cough, shortness of breath, mouth irritation, and phlegm) through reduced consumption of tobacco cigarettes. Furthermore, we evaluate the behavioral and psychological (eg, well-being, mood, and quality of life) effects of the treatment. Methods: This is a prospective, randomized, placebo-controlled, double-blind, three-parallel group study. The study is organized as a nested randomized controlled study with 3 branches: a nicotine e-cigarettes group, a nicotine-free e-cigarettes group, and a control group. The study is nested in a screening program for early lung cancer detection in heavy smokers. Results: The study is open and is still recruiting. Conclusions: Stopping or reducing tobacco consumption should be a main goal of any health organization. However, traditional antismoking programs are expensive and not always effective. Therefore, favoring a partial or complete shift to e-cigarettes in heavy smokers (eg, persons at high risk for a number of diseases) could be considered a moral imperative. However, before following this path, sound and reliable data on large samples and in a variety of contexts are required. Trial Registration: Clinicaltrials.gov NCT02422914; https://clinicaltrials.gov/ct2/show/NCT02422914 (Archived by WebCite at http://www.webcitation.org/6etwz1bPL) %M 26842790 %R 10.2196/resprot.4805 %U http://www.researchprotocols.org/2016/1/e21/ %U https://doi.org/10.2196/resprot.4805 %U http://www.ncbi.nlm.nih.gov/pubmed/26842790 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 2 %P e28 %T In Pursuit of Theoretical Ground in Behavior Change Support Systems: Analysis of Peer-to-Peer Communication in a Health-Related Online Community %A Myneni,Sahiti %A Cobb,Nathan %A Cohen,Trevor %+ School of Biomedical Informatics, University of Texas Health Science Center at Houston, 7000 Fannin, Suite 165, Houston, TX, 77030, United States, 1 713 486 0115, sahiti.myneni@uth.tmc.edu %K behavior change %K online social media %K web interventions %K smoking cessation %D 2016 %7 02.02.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Research studies involving health-related online communities have focused on examining network structure to understand mechanisms underlying behavior change. Content analysis of the messages exchanged in these communities has been limited to the “social support” perspective. However, existing behavior change theories suggest that message content plays a prominent role reflecting several sociocognitive factors that affect an individual’s efforts to make a lifestyle change. An understanding of these factors is imperative to identify and harness the mechanisms of behavior change in the Health 2.0 era. Objective: The objective of this work is two-fold: (1) to harness digital communication data to capture essential meaning of communication and factors affecting a desired behavior change, and (2) to understand the applicability of existing behavior change theories to characterize peer-to-peer communication in online platforms. Methods: In this paper, we describe grounded theory–based qualitative analysis of digital communication in QuitNet, an online community promoting smoking cessation. A database of 16,492 de-identified public messages from 1456 users from March 1-April 30, 2007, was used in our study. We analyzed 795 messages using grounded theory techniques to ensure thematic saturation. This analysis enabled identification of key concepts contained in the messages exchanged by QuitNet members, allowing us to understand the sociobehavioral intricacies underlying an individual’s efforts to cease smoking in a group setting. We further ascertained the relevance of the identified themes to theoretical constructs in existing behavior change theories (eg, Health Belief Model) and theoretically linked techniques of behavior change taxonomy. Results: We identified 43 different concepts, which were then grouped under 12 themes based on analysis of 795 messages. Examples of concepts include “sleepiness,” “pledge,” “patch,” “spouse,” and “slip.” Examples of themes include “traditions,” “social support,” “obstacles,” “relapse,” and “cravings.” Results indicate that themes consisting of member-generated strategies such as “virtual bonfires” and “pledges” were related to the highest number of theoretical constructs from the existing behavior change theories. In addition, results indicate that the member-generated communication content supports sociocognitive constructs from more than one behavior change model, unlike the majority of the existing theory-driven interventions. Conclusions: With the onset of mobile phones and ubiquitous Internet connectivity, online social network data reflect the intricacies of human health behavior as experienced by health consumers in real time. This study offers methodological insights for qualitative investigations that examine the various kinds of behavioral constructs prevalent in the messages exchanged among users of online communities. Theoretically, this study establishes the manifestation of existing behavior change theories in QuitNet-like online health communities. Pragmatically, it sets the stage for real-time, data-driven sociobehavioral interventions promoting healthy lifestyle modifications by allowing us to understand the emergent user needs to sustain a desired behavior change. %M 26839162 %R 10.2196/jmir.4671 %U http://www.jmir.org/2016/2/e28/ %U https://doi.org/10.2196/jmir.4671 %U http://www.ncbi.nlm.nih.gov/pubmed/26839162 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e2 %T Developing an Internet- and Mobile-Based System to Measure Cigarette Use Among Pacific Islanders: An Ecological Momentary Assessment Study %A Pike,James Russell %A Xie,Bin %A Tan,Nasya %A Sabado-Liwag,Melanie Dee %A Orne,Annette %A Toilolo,Tupou %A Cen,Steven %A May,Vanessa %A Lee,Cevadne %A Pang,Victor Kaiwi %A Rainer,Michelle A %A Vaivao,Dorothy Etimani S %A Lepule,Jonathan Tana %A Tanjasiri,Sora Park %A Palmer,Paula Healani %+ School of Community and Global Health, Claremont Graduate University, 675 West Foothill Boulevard, Suite 310, Claremont, CA, 91711-3475, United States, 1 818 406 0286, James.Pike@cgu.edu %K Pacific Islander %K tobacco use %K cigarette use %K mobile phone %K text message %K ecological momentary assessment %D 2016 %7 07.01.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Recent prevalence data indicates that Pacific Islanders living in the United States have disproportionately high smoking rates when compared to the general populace. However, little is known about the factors contributing to tobacco use in this at-risk population. Moreover, few studies have attempted to determine these factors utilizing technology-based assessment techniques. Objective: The objective was to develop a customized Internet-based Ecological Momentary Assessment (EMA) system capable of measuring cigarette use among Pacific Islanders in Southern California. This system integrated the ubiquity of text messaging, the ease of use associated with mobile phone apps, the enhanced functionality offered by Internet-based Cell phone-optimized Assessment Techniques (ICAT), and the high survey completion rates exhibited by EMA studies that used electronic diaries. These features were tested in a feasibility study designed to assess whether Pacific Islanders would respond to this method of measurement and whether the data gathered would lead to novel insights regarding the intrapersonal, social, and ecological factors associated with cigarette use. Methods: 20 young adult smokers in Southern California who self-identified as Pacific Islanders were recruited by 5 community-based organizations to take part in a 7-day EMA study. Participants selected six consecutive two-hour time blocks per day during which they would be willing to receive a text message linking them to an online survey formatted for Web-enabled mobile phones. Both automated reminders and community coaches were used to facilitate survey completion. Results: 720 surveys were completed from 840 survey time blocks, representing a completion rate of 86%. After adjusting for gender, age, and nicotine dependence, feeling happy (P=<.001) or wanting a cigarette while drinking alcohol (P=<.001) were positively associated with cigarette use. Being at home (P=.02) or being around people who are not smoking (P=.01) were negatively associated with cigarette use. Conclusions: The results of the feasibility study indicate that customized systems can be used to conduct technology-based assessments of tobacco use among Pacific Islanders. Such systems can foster high levels of survey completion and may lead to novel insights for future research and interventions. %M 26743132 %R 10.2196/mhealth.4437 %U http://mhealth.jmir.org/2016/1/e2/ %U https://doi.org/10.2196/mhealth.4437 %U http://www.ncbi.nlm.nih.gov/pubmed/26743132 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 1 %P e2 %T Online Tobacco Cessation Training and Competency Assessment for Complementary and Alternative Medicine (CAM) Practitioners: Protocol for the CAM Reach Web Study %A Muramoto,Myra L %A Howerter,Amy %A Eaves,Emery R %A Hall,John R %A Buller,David B %A Gordon,Judith S %+ University of Arizona, Department of Family & Community Medicine, 1450 N Cherry Ave, Tucson, AZ, 85719, United States, 1 520 626 1090, myram@email.arizona.edu %K tobacco cessation %K brief intervention %K online training %K communication %K acupuncture %K chiropractic %K massage therapy %D 2016 %7 06.01.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Complementary and alternative medicine (CAM) practitioners, such as chiropractors, acupuncturists, and massage therapists, are a growing presence in the US health care landscape and already provide health and wellness care to significant numbers of patients who use tobacco. For decades, conventional biomedical practitioners have received training to provide evidence-based tobacco cessation brief interventions (BIs) and referrals to cessation services as part of routine clinical care, whereas CAM practitioners have been largely overlooked for BI training. Web-based training has clear potential to meet large-scale training dissemination needs. However, despite the exploding use of Web-based training for health professionals, Web-based evaluation of clinical skills competency remains underdeveloped. Objective: In pursuit of a long-term goal of helping CAM practitioners integrate evidence-based practices from US Public Health Service Tobacco Dependence Treatment Guideline into routine clinical care, this pilot protocol aims to develop and test a Web-based tobacco cessation training program tailored for CAM practitioners. Methods: In preparation for a larger trial to examine the effect of training on CAM practitioner clinical practice behaviors around tobacco cessation, this developmental study will (1) adapt an existing in-person tobacco cessation BI training program that is specifically tailored for CAM therapists for delivery via the Internet; (2) develop a novel, Web-based tool to assess CAM practitioner competence in tobacco cessation BI skills, and conduct a pilot validation study comparing the competency assessment tool to live video role plays with a standardized patient; (3) pilot test the Web-based training with 120 CAM practitioners (40 acupuncturists, 40 chiropractors, 40 massage therapists) for usability, accessibility, acceptability, and effects on practitioner knowledge, self-efficacy, and competency with tobacco cessation; and (4) conduct qualitative and quantitative formative research on factors influencing practitioner tobacco cessation clinical behaviors (eg, practice environment, peer social influence, and insurance reimbursement). Results: Web-training and competency assessment tool development and study enrollment and training activities are complete (N=203 practitioners enrolled). Training completion rates were lower than expected (36.9%, 75/203), necessitating over enrollment to ensure a sufficient number of training completers. Follow-up data collection is in progress. Data analysis will begin immediately after data collection is complete. Conclusions: To realize CAM practitioners’ potential to promote tobacco cessation and use of evidence-based treatments, there is a need to know more about the facilitative and inhibitory factors influencing CAM practitioner tobacco intervention behaviors (eg, social influence and insurance reimbursement). Given marked differences between conventional and CAM practitioners, extant knowledge about factors influencing conventional practitioner adoption of tobacco cessation behaviors cannot be confidently extrapolated to CAM practitioners. The potential impact of this study is to expand tobacco cessation and health promotion infrastructure in a new group of health practitioners who can help combat the continuing epidemic of tobacco use. %M 26740468 %R 10.2196/resprot.5061 %U http://www.researchprotocols.org/2016/1/e2/ %U https://doi.org/10.2196/resprot.5061 %U http://www.ncbi.nlm.nih.gov/pubmed/26740468 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 12 %P e291 %T Feasibility and Quit Rates of the Tobacco Status Project: A Facebook Smoking Cessation Intervention for Young Adults %A Ramo,Danielle E %A Thrul,Johannes %A Chavez,Kathryn %A Delucchi,Kevin L %A Prochaska,Judith J %+ Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, Box TRC 0984, San Francisco, CA, 94143, United States, 1 4154767695, danielle.ramo@ucsf.edu %K smoking cessation %K Facebook %K social media %K young adults %D 2015 %7 31.12.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Young adult smokers are a challenging group to engage in smoking cessation interventions. With wide reach and engagement among users, Facebook offers opportunity to engage young people in socially supportive communities for quitting smoking and sustaining abstinence. Objective: We developed and tested initial efficacy, engagement, and acceptability of the Tobacco Status Project, a smoking cessation intervention for young adults delivered within Facebook. Methods: The intervention was based on the US Public Health Service Clinical Practice Guidelines and the Transtheoretical Model and enrolled participants into study-run 3-month secret Facebook groups matched on readiness to quit smoking. Cigarette smokers (N=79) aged 18-25, who used Facebook on most days, were recruited via Facebook. All participants received the intervention and were randomized to one of three monetary incentive groups tied to engagement (commenting in groups). Assessments were completed at baseline, 3-, 6-, and 12-months follow-up. Analyses examined retention, smoking outcomes over 12 months (7-day point prevalence abstinence, ≥50% reduction in cigarettes smoked, quit attempts and strategies used, readiness to quit), engagement, and satisfaction with the intervention. Results: Retention was 82% (65/79) at 6 months and 72% (57/79) at 12 months. From baseline to 12-months follow-up, there was a significant increase in the proportion prepared to quit (10/79, 13%; 36/79, 46%, P<.001). Over a third (28/79, 35%) reduced their cigarette consumption by 50% or greater, and 66% (52/79) made at least one 24-hour quit attempt during the study. In an intent-to-treat analysis, 13% (10/79) self-reported 7-day abstinence (6/79, 8% verified biochemically) at 12-months follow-up. In their quit attempts, 11% (9/79) used a nicotine replacement therapy approved by the Food and Drug Administration, while 18% (14/79) used an electronic nicotine delivery system to quit (eg, electronic cigarette). A majority (48/79, 61%) commented on at least one Facebook post, with more commenting among those with biochemically verified abstinence at 3 months (P=.036) and those randomized to receive a personal monetary incentive (P=.015). Over a third of participants (28/79, 35%) reported reading most or all of the Facebook posts. Highest acceptability ratings of the intervention were for post ease (57/79, 72%) and thinking about what they read (52/79, 66%); 71% (56/79) recommended the program to others. Only 5 participants attended the optional cognitive-behavioral counseling sessions, though their attendance was high (6/7 sessions overall) and the sessions were rated as easy to understand, useful, and helpful (all 90-100% agreed). Conclusions: A Facebook quit smoking intervention is attractive and feasible to deliver, and early efficacy data are encouraging. However, the 1.5-fold greater use of electronic cigarettes over nicotine replacement products for quitting is concerning. %M 26721211 %R 10.2196/jmir.5209 %U http://www.jmir.org/2015/12/e291/ %U https://doi.org/10.2196/jmir.5209 %U http://www.ncbi.nlm.nih.gov/pubmed/26721211 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 1 %N 2 %P e20 %T Implementation of a Multimodal Mobile System for Point-of-Sale Surveillance: Lessons Learned From Case Studies in Washington, DC, and New York City %A Cantrell,Jennifer %A Ganz,Ollie %A Ilakkuvan,Vinu %A Tacelosky,Michael %A Kreslake,Jennifer %A Moon-Howard,Joyce %A Aidala,Angela %A Vallone,Donna %A Anesetti-Rothermel,Andrew %A Kirchner,Thomas R %+ Truth Initiative, Evaluation Science and Research, 900 G Street, NW, Fourth Floor, Washington, DC, 20001, United States, 1 202 436 2118, jcantrell@truthinitiative.org %K mobile technology %K public health surveillance %K tobacco %K point-of-sale %K implementation %K tobacco industry advertising %K marketing %D 2015 %7 26.11.2015 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In tobacco control and other fields, point-of-sale surveillance of the retail environment is critical for understanding industry marketing of products and informing public health practice. Innovations in mobile technology can improve existing, paper-based surveillance methods, yet few studies describe in detail how to operationalize the use of technology in public health surveillance. Objective: The aims of this paper are to share implementation strategies and lessons learned from 2 tobacco, point-of-sale surveillance projects to inform and prepare public health researchers and practitioners to implement new mobile technologies in retail point-of-sale surveillance systems. Methods: From 2011 to 2013, 2 point-of-sale surveillance pilot projects were conducted in Washington, DC, and New York, New York, to capture information about the tobacco retail environment and test the feasibility of a multimodal mobile data collection system, which included capabilities for audio or video recording data, electronic photographs, electronic location data, and a centralized back-end server and dashboard. We established a preimplementation field testing process for both projects, which involved a series of rapid and iterative tests to inform decisions and establish protocols around key components of the project. Results: Important components of field testing included choosing a mobile phone that met project criteria, establishing an efficient workflow and accessible user interfaces for each component of the system, training and providing technical support to fieldworkers, and developing processes to integrate data from multiple sources into back-end systems that can be utilized in real-time. Conclusions: A well-planned implementation process is critical for successful use and performance of multimodal mobile surveillance systems. Guidelines for implementation include (1) the need to establish and allow time for an iterative testing framework for resolving technical and logistical challenges; (2) developing a streamlined workflow and user-friendly interfaces for data collection; (3) allowing for ongoing communication, feedback, and technology-related skill-building among all staff; and (4) supporting infrastructure for back-end data systems. Although mobile technologies are evolving rapidly, lessons learned from these case studies are essential for ensuring that the many benefits of new mobile systems for rapid point-of-sale surveillance are fully realized. %M 27227138 %R 10.2196/publichealth.4191 %U http://publichealth.jmir.org/2015/2/e20/ %U https://doi.org/10.2196/publichealth.4191 %U http://www.ncbi.nlm.nih.gov/pubmed/27227138 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 1 %N 2 %P e19 %T Tracking Hookah Bars in New York: Utilizing Yelp as a Powerful Public Health Tool %A Cawkwell,Philip B %A Lee,Lily %A Weitzman,Michael %A Sherman,Scott E %+ Department of Pediatrics, New York University School of Medicine, 550 1st Avenue, New York, NY 10016, United States, 1 212 263 7300, Philip.Cawkwell@med.nyu.edu %K hookah %K hookah bar %K Internet %K public health %K Yelp %D 2015 %7 20.11.2015 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: While cigarette use has seen a steady decline in recent years, hookah (water pipe) use has rapidly increased in popularity. While anecdotal reports have noted a rise in hookah bars, methodological difficulties have prevented researchers from drawing definitive conclusions about the number of hookah bars in any given location. There is no publicly available database that has been shown to reliably provide this information. It is now possible to analyze Internet trends as a measure of population behavior and health-related phenomena. Objective: The objective of the study was to investigate whether Yelp can be used to accurately identify the number of hookah bars in New York State, assess the distribution and characteristics of hookah bars, and monitor temporal trends in their presence. Methods: Data were obtained from Yelp that captures a variety of parameters for every business listed in their database as of October 28, 2014, that was tagged as a “hookah bar” and operating in New York State. Two algebraic models were created: one estimated the date of opening of a hookah bar based on the first Yelp review received and the other estimated whether the bar was open or closed based on the date of the most recent Yelp review. These findings were then compared with empirical data obtained by Internet searches. Results: From 2014 onward, the date of the first Yelp review predicts the opening date of new hookah bars to within 1 month. Yelp data allow the estimate of such venues and demonstrate that new bars are not randomly distributed, but instead are clustered near colleges and in specific racial/ethnic neighborhoods. New York has seen substantially more new hookah bars in 2012-2014 compared with the number that existed prior to 2009. Conclusions: Yelp is a powerful public health tool that allows for the investigation of various trends and characteristics of hookah bars. New York is experiencing tremendous growth in hookah bars, a worrying phenomenon that necessitates further investigation. %M 27227137 %R 10.2196/publichealth.4809 %U http://publichealth.jmir.org/2015/2/e19/ %U https://doi.org/10.2196/publichealth.4809 %U http://www.ncbi.nlm.nih.gov/pubmed/27227137 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e244 %T Smoking Cessation Intervention on Facebook: Which Content Generates the Best Engagement? %A Thrul,Johannes %A Klein,Alexandra B %A Ramo,Danielle E %+ Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, CA, 94143-1390, United States, 1 415 514 9340, Johannes.Thrul@ucsf.edu %K young adults %K smoking cessation %K Facebook %K engagement %K Transtheoretical Model %D 2015 %7 11.11.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media offer a great opportunity to deliver smoking cessation treatment to young adults, but previous online and social media interventions targeting health behavior change have struggled with low participant engagement. We examined engagement generated by content based on the Transtheoretical Model of Behavior Change (TTM) in a motivationally tailored smoking cessation intervention on Facebook. Objective: This study aimed to identify which intervention content based on the TTM (Decisional Balance and 10 processes of change) generated the highest engagement among participants in pre-action stages of change (Precontemplation, Contemplation, and Preparation). Methods: Participants (N=79, 20% female, mean age 20.8) were assessed for readiness to quit smoking and assigned to one of 7 secret Facebook groups tailored to their stage of change. Daily postings to the groups based on TTM Decisional Balance and the 10 processes of change were made by research staff over 3 months. Engagement was operationalized as the number of participant comments to each post. TTM content-based predictors of number of comments were analyzed and stratified by baseline stage of change, using negative binomial regression analyses with and without zero inflation. Results: A total of 512 TTM-based posts generated 630 individual comments. In Precontemplation and Contemplation groups, Decisional Balance posts generated above average engagement (P=.01 and P<.001). In Contemplation groups, posts based on the TTM processes Dramatic Relief and Self-Liberation resulted in below average engagement (P=.01 and P=.005). In Preparation groups, posts based on Consciousness Raising generated above average engagement (P=.009). Participant engagement decreased over time and differed between groups within Precontemplation and Contemplation stages, but was independent of day of the week and time of day the content was posted to the groups. No participant baseline characteristics significantly predicted engagement. Conclusions: Participants not ready to quit in the next 30 days (in Precontemplation or Contemplation) engaged most when prompted to think about the pros and cons of behavior change, while those in the Preparation stage engaged most when posts increased awareness about smoking and smoking cessation. Findings support tailoring intervention content to readiness to quit and suggest intervention components that may be most effective in generating high participant engagement on social media. %M 26561529 %R 10.2196/jmir.4575 %U http://www.jmir.org/2015/11/e244/ %U https://doi.org/10.2196/jmir.4575 %U http://www.ncbi.nlm.nih.gov/pubmed/26561529 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 11 %P e251 %T Using Twitter Data to Gain Insights into E-cigarette Marketing and Locations of Use: An Infoveillance Study %A Kim,Annice E %A Hopper,Timothy %A Simpson,Sean %A Nonnemaker,James %A Lieberman,Alicea J %A Hansen,Heather %A Guillory,Jamie %A Porter,Lauren %+ RTI International, 3040 E Cornwallis Road, Research Triangle Park, NC 27709, United States, 1 91931 63725, jguillory@rti.org %K electronic cigarettes %K social media %K tobacco %K marketing %K natural language processing %D 2015 %7 06.11.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Marketing and use of electronic cigarettes (e-cigarettes) and other electronic nicotine delivery devices have increased exponentially in recent years fueled, in part, by marketing and word-of-mouth communications via social media platforms, such as Twitter. Objective: This study examines Twitter posts about e-cigarettes between 2008 and 2013 to gain insights into (1) marketing trends for selling and promoting e-cigarettes and (2) locations where people use e-cigarettes. Methods: We used keywords to gather tweets about e-cigarettes between July 1, 2008 and February 28, 2013. A randomly selected subset of tweets was manually coded as advertising (eg, marketing, advertising, sales, promotion) or nonadvertising (eg, individual users, consumers), and classification algorithms were trained to code the remaining data into these 2 categories. A combination of manual coding and natural language processing methods was used to indicate locations where people used e-cigarettes. Additional metadata were used to generate insights about users who tweeted most frequently about e-cigarettes. Results: We identified approximately 1.7 million tweets about e-cigarettes between 2008 and 2013, with the majority of these tweets being advertising (93.43%, 1,559,508/1,669,123). Tweets about e-cigarettes increased more than tenfold between 2009 and 2010, suggesting a rapid increase in the popularity of e-cigarettes and marketing efforts. The Twitter handles tweeting most frequently about e-cigarettes were a mixture of e-cigarette brands, affiliate marketers, and resellers of e-cigarette products. Of the 471 e-cigarette tweets mentioning a specific place, most mentioned e-cigarette use in class (39.1%, 184/471) followed by home/room/bed (12.5%, 59/471), school (12.1%, 57/471), in public (8.7%, 41/471), the bathroom (5.7%, 27/471), and at work (4.5%, 21/471). Conclusions: Twitter is being used to promote e-cigarettes by different types of entities and the online marketplace is more diverse than offline product offerings and advertising strategies. E-cigarettes are also being used in public places, such as schools, underscoring the need for education and enforcement of policies banning e-cigarette use in public places. Twitter data can provide new insights on e-cigarettes to help inform future research, regulations, surveillance, and enforcement efforts. %M 26545927 %R 10.2196/jmir.4466 %U http://www.jmir.org/2015/11/e251/ %U https://doi.org/10.2196/jmir.4466 %U http://www.ncbi.nlm.nih.gov/pubmed/26545927 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 10 %P e243 %T Social Listening: A Content Analysis of E-Cigarette Discussions on Twitter %A Cole-Lewis,Heather %A Pugatch,Jillian %A Sanders,Amy %A Varghese,Arun %A Posada,Susana %A Yun,Christopher %A Schwarz,Mary %A Augustson,Erik %+ National Cancer Institute, Tobacco Control Research Branch, 9609 Medical Center Drive, MSC 9761, Bethesda, MD, 20892, United States, 1 240 276 6774, augustse@mail.nih.gov %K social media %K Twitter %K e-cigarettes %K content analysis %D 2015 %7 27.10.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic cigarette (e-cigarette) use has increased in the United States, leading to active debate in the public health sphere regarding e-cigarette use and regulation. To better understand trends in e-cigarette attitudes and behaviors, public health and communication professionals can turn to the dialogue taking place on popular social media platforms such as Twitter. Objective: The objective of this study was to conduct a content analysis to identify key conversation trends and patterns over time using historical Twitter data. Methods: A 5-category content analysis was conducted on a random sample of tweets chosen from all publicly available tweets sent between May 1, 2013, and April 30, 2014, that matched strategic keywords related to e-cigarettes. Relevant tweets were isolated from the random sample of approximately 10,000 tweets and classified according to sentiment, user description, genre, and theme. Descriptive analyses including univariate and bivariate associations, as well as correlation analyses were performed on all categories in order to identify patterns and trends. Results: The analysis revealed an increase in e-cigarette–related tweets from May 2013 through April 2014, with tweets generally being positive; 71% of the sample tweets were classified as having a positive sentiment. The top two user categories were everyday people (65%) and individuals who are part of the e-cigarette community movement (16%). These two user groups were responsible for a majority of informational (79%) and news tweets (75%), compared to reputable news sources and foundations or organizations, which combined provided 5% of informational tweets and 12% of news tweets. Personal opinion (28%), marketing (21%), and first person e-cigarette use or intent (20%) were the three most common genres of tweets, which tended to have a positive sentiment. Marketing was the most common theme (26%), and policy and government was the second most common theme (20%), with 86% of these tweets coming from everyday people and the e-cigarette community movement combined, compared to 5% of policy and government tweets coming from government, reputable news sources, and foundations or organizations combined. Conclusions: Everyday people and the e-cigarette community are dominant forces across several genres and themes, warranting continued monitoring to understand trends and their implications regarding public opinion, e-cigarette use, and smoking cessation. Analyzing social media trends is a meaningful way to inform public health practitioners of current sentiments regarding e-cigarettes, and this study contributes a replicable methodology. %M 26508089 %R 10.2196/jmir.4969 %U http://www.jmir.org/2015/10/e243/ %U https://doi.org/10.2196/jmir.4969 %U http://www.ncbi.nlm.nih.gov/pubmed/26508089 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 4 %P e125 %T Effectiveness of a Mobile Phone App for Adults That Uses Physical Activity as a Tool to Manage Cigarette Craving After Smoking Cessation: A Study Protocol for a Randomized Controlled Trial %A Hassandra,Mary %A Lintunen,Taru %A Kettunen,Tarja %A Vanhala,Mauno %A Toivonen,Hanna-Mari %A Kinnunen,Kimmo %A Heikkinen,Risto %+ Department of Sport Sciences, University of Jyväskylä, PO Box 35, Jyväskylä, 40014, Finland, 358 408053979, maria.m.chasandra@jyu.fi %K behavior change %K mHealth app %K physical activity %K randomized controlled trial %K relapse prevention %K smoking %D 2015 %7 22.10.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Results from studies on the effects of exercise on smoking-related variables have provided strong evidence that physical activity acutely reduces cigarette cravings. Mobile technology may provide some valuable tools to move from explanatory randomized controlled trials to pragmatic randomized controlled trials by testing the acute effectiveness of exercise on quitters under real-life conditions. An mHealth app was developed to be used as a support tool for quitters to manage their cigarette cravings. Objective: The primary aim of this paper is to present the protocol of a study examining the effectiveness of the Physical over smoking app (Ph.o.S) by comparing the point prevalence abstinence rate of a group of users to a comparator group during a 6-month follow-up period. Methods: After initial Web-based screening, eligible participants are recruited to attend a smoking cessation program for 3 weeks to set a quit smoking date. Fifty participants who succeed in quitting will be randomly allocated to the comparator and experimental groups. Both groups will separately have 1 more counseling session on how to manage cravings. In this fourth session, the only difference in treatment between the groups is that the experimental group will have an extra 10-15 minutes of guidance on how to use the fully automated Ph.o.S app to manage cravings during the follow-up period. Data will be collected at baseline, as well as before and after the quit day, and follow-up Web-based measures will be collected for a period of 6 months. The primary efficacy outcome is the 7-day point prevalence abstinence rate, and secondary efficacy outcomes are number of relapses and cravings, self-efficacy of being aware of craving experience, self-efficacy in managing cravings, and power of control in managing cravings. Results: Recruitment for this project commenced in December 2014, and proceeded until May 2015. Follow-up data collection has commenced and will be completed by the end of December 2015. Conclusions: If the Ph.o.S app is shown to be effective, the study will provide evidence for the use of the app as a support tool for people who are trying to manage cravings during smoking cessation programs. It is anticipated that the results of the study will provide knowledge of how physical activity affects cigarette craving in real-life situations and inform the development and delivery of relapse prevention in smoking cessation treatment. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN55259451; http://www.controlled-trials.com/ISRCTN55259451 (Archived by WebCite at http://www.webcitation.org/6cKF2mzEI) %M 26494256 %R 10.2196/resprot.4600 %U http://www.researchprotocols.org/2015/4/e125/ %U https://doi.org/10.2196/resprot.4600 %U http://www.ncbi.nlm.nih.gov/pubmed/26494256 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 10 %P e238 %T Using WhatsApp and Facebook Online Social Groups for Smoking Relapse Prevention for Recent Quitters: A Pilot Pragmatic Cluster Randomized Controlled Trial %A Cheung,Yee Tak Derek %A Chan,Ching Han Helen %A Lai,Chi-Keung Jonah %A Chan,Wai Fung Vivian %A Wang,Man Ping %A Li,Ho Cheung William %A Chan,Sophia Siu Chee %A Lam,Tai-Hing %+ School of Public Health, The University of Hong Kong, 5/F William MW Mong Block, 21 Sassoon Road, Hong Kong, Hong Kong, China (Hong Kong), 852 39176652, derekcheung@hku.hk %K social networking %K social media %K smoking cessation %K relapse prevention %D 2015 %7 22.10.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Quit attempters often have episodes of smoking relapse before they eventually quit. Interactive text messaging through mobile phones has been shown to increase abstinence. This service can be potentially applied on the platform of a social networking service to help quitters maintain abstinence. Objective: Our aim was to determine if the group discussion and reminders via the WhatsApp or Facebook social group were effective to prevent smoking relapse in quitters who had stopped smoking recently. Methods: This was a single-blinded, parallel, 3-arm pilot cluster randomized controlled trial allocating recent quitters, who had completed an 8-week treatment and reported abstinence for at least 7 days, to WhatsApp (n=42), Facebook (n=40), and a control group (n=54). The 2 intervention groups participated in a 2-month online group discussion with either WhatsApp or Facebook moderated by a trained smoking cessation counselor and received a self-help booklet on smoking cessation. The control group only received the booklet. The primary outcome was the 2- and 6-month relapse rates, defined as the proportion of participants who smoked at least 5 cigarettes in 3 consecutive days. Results: Fewer participants in the WhatsApp group (17%, 7/42) reported relapse than the control group (42.6%, 23/54) at 2-month (OR 0.27, 95% CI 0.10-0.71) and 6-month (40.5%, 17/42 vs 61.1%, 33/54; OR 0.43, 95% CI 0.19-0.99) follow-ups. The Facebook group (30.0%, 12/40) had an insignificantly lower relapse rate than the control group (42.6%, 23/54) at 2-month (OR 0.58, 95% CI 0.24-1.37) and 6-month (52.5%, 13/40 vs 61.1%, 33/54; OR 0.70, 95% CI 0.31-1.61) follow-ups. The WhatsApp social groups had more moderators’ posts (median 60, IQR 25 vs median 32, IQR 7; P=.05) and participants’ posts (median 35, IQR 50 vs median 6, IQR 9; P=.07) than their Facebook counterparts, but the difference was insignificant. Conclusions: The intervention via the WhatsApp social group was effective in reducing relapse probably because of enhanced discussion and social support. Inactive discussion in the Facebook social group might have attributed to the lower effectiveness. ClinicalTrial: Clinicaltrials.gov NCT02007369; https://clinicaltrials.gov/show/NCT02007369 (Archived by WebCite® at http://www.webcitation.org/6c3RbltQG) %M 26494159 %R 10.2196/jmir.4829 %U http://www.jmir.org/2015/10/e238/ %U https://doi.org/10.2196/jmir.4829 %U http://www.ncbi.nlm.nih.gov/pubmed/26494159 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 9 %P e220 %T What Online Communities Can Tell Us About Electronic Cigarettes and Hookah Use: A Study Using Text Mining and Visualization Techniques %A Chen,Annie T %A Zhu,Shu-Hong %A Conway,Mike %+ School of Information and Library Science, University of North Carolina at Chapel Hill, 216 Lenoir Drive/CB #3360, 100 Manning Hall, Chapel Hill, NC, 27514, United States, 1 919 962 8366, atchen@email.unc.edu %K electronic cigarettes %K hookah smoking %K cigarettes %K tobacco products %K social media %K text mining %D 2015 %7 29.09.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The rise in popularity of electronic cigarettes (e-cigarettes) and hookah over recent years has been accompanied by some confusion and uncertainty regarding the development of an appropriate regulatory response towards these emerging products. Mining online discussion content can lead to insights into people’s experiences, which can in turn further our knowledge of how to address potential health implications. In this work, we take a novel approach to understanding the use and appeal of these emerging products by applying text mining techniques to compare consumer experiences across discussion forums. Objective: This study examined content from the websites Vapor Talk, Hookah Forum, and Reddit to understand people’s experiences with different tobacco products. Our investigation involves three parts. First, we identified contextual factors that inform our understanding of tobacco use behaviors, such as setting, time, social relationships, and sensory experience, and compared the forums to identify the ones where content on these factors is most common. Second, we compared how the tobacco use experience differs with combustible cigarettes and e-cigarettes. Third, we investigated differences between e-cigarette and hookah use. Methods: In the first part of our study, we employed a lexicon-based extraction approach to estimate prevalence of contextual factors, and then we generated a heat map based on these estimates to compare the forums. In the second and third parts of the study, we employed a text mining technique called topic modeling to identify important topics and then developed a visualization, Topic Bars, to compare topic coverage across forums. Results: In the first part of the study, we identified two forums, Vapor Talk Health & Safety and the Stopsmoking subreddit, where discussion concerning contextual factors was particularly common. The second part showed that the discussion in Vapor Talk Health & Safety focused on symptoms and comparisons of combustible cigarettes and e-cigarettes, and the Stopsmoking subreddit focused on psychological aspects of quitting. Last, we examined the discussion content on Vapor Talk and Hookah Forum. Prominent topics included equipment, technique, experiential elements of use, and the buying and selling of equipment. Conclusions: This study has three main contributions. Discussion forums differ in the extent to which their content may help us understand behaviors with potential health implications. Identifying dimensions of interest and using a heat map visualization to compare across forums can be helpful for identifying forums with the greatest density of health information. Additionally, our work has shown that the quitting experience can potentially be very different depending on whether or not e-cigarettes are used. Finally, e-cigarette and hookah forums are similar in that members represent a “hobbyist culture” that actively engages in information exchange. These differences have important implications for both tobacco regulation and smoking cessation intervention design. %M 26420469 %R 10.2196/jmir.4517 %U http://www.jmir.org/2015/9/e220/ %U https://doi.org/10.2196/jmir.4517 %U http://www.ncbi.nlm.nih.gov/pubmed/26420469 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 1 %N 2 %P e11 %T Electronic Cigarette Marketing Online: a Multi-Site, Multi-Product Comparison %A Chu,Kar-Hai %A Sidhu,Anupreet K %A Valente,Thomas W %+ University of Southern California, Department of Preventive Medicine, 2001 North Soto Street, 3rd Floor, Los Angeles, CA, 90032, United States, 1 323 442 7244, karhaich@usc.edu %K electronic cigarettes %K content analysis %K social networking sites %K marketing %D 2015 %7 11.09.2015 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Electronic cigarette awareness and use has been increasing rapidly. E-cigarette brands have utilized social networking sites to promote their products, as the growth of the e-cigarette industry has paralleled that of Web 2.0. These online platforms are cost-effective and have unique technological features and user demographics that can be attractive for selective marketing. The popularity of multiple sites also poses a risk of exposure to social networks where e-cigarette brands might not have a presence. Objective: To examine the marketing strategies of leading e-cigarette brands on multiple social networking sites, and to identify how affordances of the digital media are used to their advantage. Secondary analyses include determining if any brands are benefitting from site demographics, and exploring cross-site diffusion of marketing content through multi-site users. Methods: We collected data from two e-cigarette brands from four social networking sites over approximately 2.5 years. Content analysis is used to search for themes, population targeting, marketing strategies, and cross-site spread of messages. Results: Twitter appeared to be the most frequently used social networking site for interacting directly with product users. Facebook supported informational broadcasts, such as announcements regarding political legislation. E-cigarette brands also differed in their approaches to their users, from informal conversations to direct product marketing. Conclusions: E-cigarette makers use different strategies to market their product and engage their users. There was no evidence of direct targeting of vulnerable populations, but the affordances of the different sites are exploited to best broadcast context-specific messages. We developed a viable method to study cross-site diffusion, although additional refinement is needed to account for how different types of digital media are used. %M 27227129 %R 10.2196/publichealth.4777 %U http://publichealth.jmir.org/2015/2/e11/ %U https://doi.org/10.2196/publichealth.4777 %U http://www.ncbi.nlm.nih.gov/pubmed/27227129 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e81 %T Cannabis Mobile Apps: A Content Analysis %A Ramo,Danielle E %A Popova,Lucy %A Grana,Rachel %A Zhao,Shirley %A Chavez,Kathryn %+ Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, Box TRC 0984, San Francisco, CA, 94143, United States, 1 415 476 7695, danielle.ramo@ucsf.edu %K cell phones %K mobile apps %K cannabis %D 2015 %7 12.08.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile technology is pervasive and widely used to obtain information about drugs such as cannabis, especially in a climate of rapidly changing cannabis policy; yet the content of available cannabis apps is largely unknown. Understanding the resources available to those searching for cannabis apps will clarify how this technology is being used to reflect and influence cannabis use behavior. Objective: We investigated the content of 59 cannabis-related mobile apps for Apple and Android devices as of November 26, 2014. Methods: The Apple and Google Play app stores were searched using the terms “cannabis” and “marijuana.” Three trained coders classified the top 20 apps for each term and each store, using a coding guide. Apps were examined for the presence of 20 content codes derived by the researchers. Results: Total apps available for each search term were 124 for cannabis and 218 for marijuana in the Apple App Store, and 250 each for cannabis and marijuana on Google Play. The top 20 apps in each category in each store were coded for 59 independent apps (30 Apple, 29 Google Play). The three most common content areas were cannabis strain classification (33.9%), facts about cannabis (20.3%), and games (20.3%). In the Apple App Store, most apps were free (77%), all were rated “17+” years, and the average user rating was 3.9/5 stars. The most popular apps provided cannabis strain classifications (50%), dispensary information (27%), or general facts about cannabis (27%). Only one app (3%) provided information or resources related to cannabis abuse, addiction, or treatment. On Google Play, most apps were free (93%), rated “high maturity” (79%), and the average user rating was 4.1/5. The most popular app types offered games (28%), phone utilities (eg, wallpaper, clock; 21%) and cannabis food recipes (21%); no apps addressed abuse, addiction, or treatment. Conclusions: Cannabis apps are generally free and highly rated. Apps were most often informational (facts, strain classification), or recreational (games), likely reflecting and influencing the growing acceptance of cannabis for medical and recreational purposes. Apps addressing addiction or cessation were underrepresented in the most popular cannabis mobile apps. Differences among apps for Apple and Android platforms likely reflect differences in the population of users, developer choice, and platform regulations. %M 26268634 %R 10.2196/mhealth.4405 %U http://mhealth.jmir.org/2015/3/e81/ %U https://doi.org/10.2196/mhealth.4405 %U http://www.ncbi.nlm.nih.gov/pubmed/26268634 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 1 %N 2 %P e8 %T The Tobacco Pack Surveillance System: A Protocol for Assessing Health Warning Compliance, Design Features, and Appeals of Tobacco Packs Sold in Low- and Middle-Income Countries %A Smith,Katherine %A Washington,Carmen %A Brown,Jennifer %A Vadnais,Alison %A Kroart,Laura %A Ferguson,Jacqueline %A Cohen,Joanna %+ Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Rm 726, 624 N. Broadway, Baltimore, MD, 21215, United States, 1 4105020025, katecsmith@jhu.edu %K tobacco products %K cigarettes %K public health surveillance %K health communication %K national health policy %K marketing %K developing countries %D 2015 %7 12.08.2015 %9 Protocol %J JMIR Public Health Surveill %G English %X Background: Tobacco remains the world’s leading preventable cause of death, with the majority of tobacco-caused deaths occurring in low- and middle-income countries. The first global health treaty, the Framework Convention on Tobacco Control (FCTC), outlines a set of policy initiatives that have been demonstrated as effective in reducing tobacco use. Article 11 of the FCTC focuses on using the tobacco package to communicate tobacco-caused harms; it also seeks to restrict the delivery of misleading information about the product on the pack. Objective: The objective of this study was to establish a surveillance system for tobacco packs in the 14 low- and middle-income countries with the greatest number of smokers. The Tobacco Pack Surveillance System (TPackSS) monitors whether required health warnings on tobacco packages are being implemented as intended, and identifies pack designs and appeals that might violate or detract from the communication of harm-related information and undermine the impact of a country’s tobacco packaging laws. The protocol outlined is intended to be applicable or adaptable for surveillance efforts in other countries. Methods: Tobacco packs were collected in 14 countries during 2013. The intention was, to the extent possible, to construct a census of “unique” pack presentations available for purchase in each country. The TPackSS team partnered with in-country field staff to implement a standardized protocol for acquiring packs from 36 diverse neighborhoods across three cities in each country. At the time of purchase, data on price and place of acquisition of each pack was recorded. The field staff, according to a standardized protocol, then photographed packs before they were shipped to the United States for coding and archiving. Results: Each pack was coded for compliance with the country-specific health warning label laws, as well as for key design features of the pack and appeals of the branding elements. The coding protocols were developed based upon prior research, expert opinion, and communication theories. Each pack was coded by two independent coders, with consistency of personnel across the project. We routinely measured intercoder reliability, and only retained variables for which a good level of reliability was achieved. Variables where reliability was too low were not included in final analyses, and any inconsistencies in coding were resolved on a daily basis. Conclusions: Across the 14 countries, the TPackSS team collected 3307 tobacco packs. We have established a publicly accessible, Internet archive of these packs that is intended for use by the tobacco control policy advocacy and research community. %M 27227142 %R 10.2196/publichealth.4616 %U http://publichealth.jmir.org/2015/2/e8/ %U https://doi.org/10.2196/publichealth.4616 %U http://www.ncbi.nlm.nih.gov/pubmed/27227142 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 8 %P e190 %T “If I Were Nick”: Men’s Responses to an Interactive Video Drama Series to Support Smoking Cessation %A Bottorff,Joan L %A Sarbit,Gayl %A Oliffe,John L %A Kelly,Mary T %A Lohan,Maria %A Stolp,Sean %A Sharp,Paul %+ School of Nursing, Faculty of Health and Social Development, University of British Columbia, 1147 University Road, Art 223, Kelowna, BC, V1V 1V7, Canada, 1 2508078627, joan.bottorff@ubc.ca %K smoking cessation %K tobacco use %K technology %K interactive video drama %K self-efficacy %D 2015 %7 10.08.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Men continue to smoke in greater numbers than women; however, few interventions have been developed and tested to support men’s cessation. Men tend to rely on quitting strategies associated with stereotypical manliness, such as willpower, stoicism, and independence, but they may lack the self-efficacy skills required to sustain a quit. In this paper, we describe the development of and reception to an interactive video drama (IVD) series, composed of 7 brief scenarios, to support and strengthen men’s smoking cessation efforts. The value of IVD in health promotion is predicated on the evidence that viewers engage with the material when they are presented characters with whom they can personally identify. The video dramatizes the challenges unfolding in the life of the main character, Nick, on the first day of his quit and models the skills necessary to embark upon a sustainable quit. Objective: The objective was to describe men’s responses to the If I were Nick IVD series as part of a study of QuitNow Men, an innovative smoking cessation website designed for men. Specific objectives were to explore the resonance of the main character of the IVD series with end-users and explore men’s perceptions of the effectiveness of the IVD series for supporting their quit self-management. Methods: Seven brief IVD scenarios were developed, filmed with a professional actor, and uploaded to a new online smoking cessation website, QuitNow Men. A sample of 117 men who smoked were recruited into the study and provided baseline data prior to access to the QuitNow Men website for a 6-month period. During this time, 47 men chose to view the IVDs. Their responses to questions about the IVDs were collected in online surveys at 3-month and 6-month time points and analyzed using descriptive statistics. Results: The majority of participants indicated they related to the main character, Nick. Participants who “strongly agreed” they could relate to Nick perceived significantly higher levels of support from the IVDs than the “neutral” and “disagree” groups (P<.001, d=2.0, P<.001, d=3.1). The “agree” and “neutral” groups were significantly higher on rated support from the videos than the “disagree” (P<.001, d=2.2, P=.01, d=1.5). Participants’ perception of the main character was independent of participant age, education attainment, or previous quit attempts. Conclusions: The findings suggest that IVD interventions may be an important addition to men’s smoking cessation programs. Given that the use of IVD scenarios in health promotion is in its infancy, the positive outcomes from this study signal the potential for IVD and warrant ongoing evaluation in smoking cessation and, more generally, men’s health promotion. %M 26265410 %R 10.2196/jmir.4491 %U http://www.jmir.org/2015/8/e190/ %U https://doi.org/10.2196/jmir.4491 %U http://www.ncbi.nlm.nih.gov/pubmed/26265410 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 7 %P e186 %T Photoaging Mobile Apps: A Novel Opportunity for Smoking Cessation? %A Brinker,Titus J %A Seeger,Werner %+ Universities of Giessen and Marburg Lung Center (UGMLC), Member of the German Center for Lung Research (DZL), Justus-Liebig-University Giessen, Klinkstr. 32, Giessen, 35392, Germany, 49 15175084347, titus.brinker@gmail.com %K tobacco prevention, tobacco cessation, photoaging, mobile phone apps, apps, app, smartphones %D 2015 %7 27.07.2015 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 26215210 %R 10.2196/jmir.4792 %U http://www.jmir.org/2015/7/e186/ %U https://doi.org/10.2196/jmir.4792 %U http://www.ncbi.nlm.nih.gov/pubmed/26215210 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 7 %P e179 %T Impact of Baseline Assessment Modality on Enrollment and Retention in a Facebook Smoking Cessation Study %A Villanti,Andrea C %A Jacobs,Megan A %A Zawistowski,Grace %A Brookover,Jody %A Stanton,Cassandra A %A Graham,Amanda L %+ The Schroeder Institute for Tobacco Research and Policy Studies, Legacy, 1724 Massachusetts Ave NW, Washington, DC, 20036, United States, 1 202 454 5751, avillanti@legacyforhealth.org %K research subject recruitment %K smoking cessation %K Internet %K social networking %K adult %D 2015 %7 16.07.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Few studies have addressed enrollment and retention methods in online smoking cessation interventions. Fully automated Web-based trials can yield large numbers of participants rapidly but suffer from high rates of attrition. Personal contact with participants can increase recruitment of smokers into cessation trials and improve participant retention. Objective: To compare the impact of Web-based (WEB) and phone (PH) baseline assessments on enrollment and retention metrics in the context of a Facebook smoking cessation study. Methods: Participants were recruited via Facebook and Google ads which were randomly displayed to adult smokers in the United States over 27 days from August to September 2013. On each platform, two identical ads were randomly displayed to users who fit the advertising parameters. Clicking on one of the ads resulted in randomization to WEB, and clicking on the other ad resulted in randomization to PH. Following online eligibility screening and informed consent, participants in the WEB arm completed the baseline survey online whereas PH participants completed the baseline survey by phone with a research assistant. All participants were contacted at 30 days to complete a follow-up survey that assessed use of the cessation intervention and smoking outcomes. Participants were paid $15 for follow-up survey completion. Results: A total of 4445 people clicked on the WEB ad and 4001 clicked on the PH ad: 12.04% (n=535) of WEB participants and 8.30% (n=332) of PH participants accepted the online study invitation (P<.001). Among the 726 participants who completed online eligibility screening, an equivalent proportion in both arms was eligible and an equivalent proportion of the eligible participants in both arms provided informed consent. There was significant drop-off between consent and completion of the baseline survey in the PH arm, resulting in enrollment rates of 32.7% (35/107) for the PH arm and 67.9% (114/168) for the WEB arm (P<.001). The overall enrollment rate among everyone who clicked on a study ad was 2%. There were no between group differences in the proportion that installed the Facebook app (66/114, 57.9% WEB vs 17/35, 49% PH) or that completed the 30-day follow-up survey (49/114, 43.0% WEB vs 16/35, 46% PH). A total of $6074 was spent on ads, generating 3,834,289 impressions and resulting in 8446 clicks (average cost $0.72 per click). Per participant enrollment costs for advertising alone were $27 WEB and $87 PH. Conclusions: A more intensive phone baseline assessment protocol yielded a lower rate of enrollment, equivalent follow-up rates, and higher enrollment costs compared to a Web-based assessment protocol. Future research should focus on honing mixed-mode assessment protocols to further optimize enrollment and retention. %M 26183789 %R 10.2196/jmir.4341 %U http://www.jmir.org/2015/7/e179/ %U https://doi.org/10.2196/jmir.4341 %U http://www.ncbi.nlm.nih.gov/pubmed/26183789 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 7 %P e164 %T Prevalence and Frequency of mHealth and eHealth Use Among US and UK Smokers and Differences by Motivation to Quit %A Borrelli,Belinda %A Bartlett,Yvonne Kiera %A Tooley,Erin %A Armitage,Christopher J %A Wearden,Alison %+ Boston University, Henry M Goldman School of Dental Medicine, 560 Harrison Ave, 3rd floor, Boston, MA, 02118, United States, 1 617 414 1116, belindab@bu.edu %K smoking cessation %K eHealth %K mHealth %K health behavior %K motivation %K text messaging %D 2015 %7 4.7.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Both mHealth and eHealth interventions for smoking cessation are rapidly being developed and tested. There are no data on use of mHealth and eHealth technologies by smokers in general or by smokers who are not motivated to quit smoking. Objective: The aims of our study were to (1) assess technology use (eg, texting, social media, Internet) among smokers in the United States and United Kingdom, (2) examine whether technology use differs between smokers who are motivated to quit and smokers who are not motivated to quit, (3) examine previous use of technology to assist with smoking cessation, and (4) examine future intentions to use technology to assist with smoking cessation. Methods: Participants were 1000 adult smokers (54.90%, 549/1000 female; mean age 43.9, SD 15.5 years; US: n=500, UK: n=500) who were recruited via online representative sampling strategies. Data were collected online and included demographics, smoking history, and frequency and patterns of technology use. Results: Among smokers in general, there was a high prevalence of mobile and smartphone ownership, sending and receiving texts, downloading and using apps, using Facebook, and visiting health-related websites. Smokers who were unmotivated to quit were significantly less likely to own a smartphone or handheld device that connects to the Internet than smokers motivated to quit. There was a significantly lower prevalence of sending text messages among US smokers unmotivated to quit (78.2%, 179/229) versus smokers motivated to quit (95.0%, 229/241), but no significant differences between the UK groups (motivated: 96.4%, 239/248; unmotivated: 94.9%, 223/235). Smokers unmotivated to quit in both countries were significantly less likely to use a handheld device to read email, play games, browse the Web, or visit health-related websites versus smokers motivated to quit. US smokers had a high prevalence of app downloads regardless of motivation to quit, but UK smokers who were motivated to quit had greater prevalence of app downloads than smokers unmotivated to quit. US smokers were significantly more likely to have a Facebook account (87.0%, 435/500) than UK smokers (76.4%, 382/500), but smokers unmotivated to quit in both countries used Facebook less frequently than smokers motivated to quit. Smokers who were unmotivated to quit were less likely to have used eHealth or mHealth platforms to help them quit smoking in the past and less likely to say that they would use them for smoking cessation in the future. Conclusions: Although smokers unmotivated to quit make less use of technology than smokers motivated to quit, there is sufficient prevalence to make it worthwhile to develop eHealth and mHealth interventions to encourage cessation. Short and low-effort communications, such as text messaging, might be better for smokers who are less motivated to quit. Multiple channels may be required to reach unmotivated smokers. %M 26149323 %R 10.2196/jmir.4420 %U http://www.jmir.org/2015/7/e164/ %U https://doi.org/10.2196/jmir.4420 %U http://www.ncbi.nlm.nih.gov/pubmed/26149323 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 2 %P e76 %T Using Ecological Momentary Assessment to Study Tobacco Behavior in Urban India: There’s an App for That %A Soong,Andrea %A Chen,Julia Cen %A Borzekowski,Dina LG %+ Institute for Global Tobacco Control, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry St, 4th Floor, Baltimore, MD, 21205, United States, 1 410 502 2482, asoong@jhu.edu %K ecological momentary assessment %K tobacco control %K cell phones %K mobile phones %K mHealth %K telemedicine %K smoking %D 2015 %7 24.06.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Ecological momentary assessment (EMA) uses real-time data collection to assess participants’ behaviors and environments. This paper explores the strengths and limitations of using EMA to examine social and environmental exposure to tobacco in urban India among older adolescents and adults. Objective: Objectives of this study were (1) to describe the methods used in an EMA study of tobacco use in urban India using a mobile phone app for data collection, (2) to determine the feasibility of using EMA in the chosen setting by drawing on participant completion and compliance rates with the study protocol, and (3) to provide recommendations on implementing mobile phone EMA research in India and other low- and middle-income countries. Methods: Via mobile phones and the Internet, this study used two EMA surveys: (1) a momentary survey, sent multiple times per day at random to participants, which asked about their real-time tobacco use (smoked and smokeless) and exposure to pro- and antitobacco messaging in their location, and 2) an end-of-day survey sent at the end of each study day. Trained participants, from Hyderabad and Kolkata, India, reported on their social and environmental exposure to tobacco over 10 consecutive days. This feasibility study examined participant compliance, exploring factors related to the successful completion of surveys and the validity of EMA data. Results: The sample included 205 participants, the majority of whom were male (135/205, 65.9%). Almost half smoked less than daily (56/205, 27.3%) or daily (43/205, 21.0%), and 4.4% (9/205) used smokeless tobacco products. Participants completed and returned 46.87% and 73.02% of momentary and end-of-day surveys, respectively. Significant predictors of momentary survey completion included employment and completion of end-of-day surveys. End-of-day survey completion was only significantly predicted by momentary survey completion. Conclusions: This first study of EMA in India offers promising results, although more research is needed on how to increase compliance. End-of-day survey completion, which has a lower research burden, may be the more appropriate approach to understanding behaviors such as tobacco use within vulnerable populations in challenging locations. Compliance may also be improved by increasing the number of study visits, compliance checks, or opportunities for retraining participants before and during data collection. %M 26109369 %R 10.2196/resprot.4408 %U http://www.researchprotocols.org/2015/2/e76/ %U https://doi.org/10.2196/resprot.4408 %U http://www.ncbi.nlm.nih.gov/pubmed/26109369 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 2 %P e54 %T Men’s Responses to Online Smoking Cessation Resources for New Fathers: The Influence of Masculinities %A Bottorff,Joan L %A Oliffe,John L %A Sarbit,Gayl %A Kelly,Mary Theresa %A Cloherty,Alexandra %+ Institute for Healthy Living and Chronic Disease Prevention, University of British Columbia, 1147 Research Road ART, Kelowna, BC, V1V 1V7, Canada, 1 250 807 8627, joan.bottorff@ubc.ca %K Cancer prevention %K smoking cessation %K gender %K men’s health promotion %K fathers %K oncology %D 2015 %7 13.05.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Smoking cessation is the single most important step to preventing cancer. Drawing on previous research, Web-based resources were developed to complement a program to support expectant and new fathers to quit smoking. Objective: The objectives of this research were to: (1) describe the responses of expectant and new fathers who smoke or had recently quit smoking to the website resources, and (2) explore how masculinities shape men’s responses to and experiences with online smoking cessation resources. Methods: Using semi-structured, individual face-to-face interviews, the Dads in Gear Web-based resources were reviewed and evaluated by 20 new fathers who smoked or had recently quit smoking. The data were transcribed and analyzed using NVivo 8 qualitative data analysis software. Results: We describe the fathers’ reactions to various components of the website, making connections between masculinities and fathering within 5 themes: (1) Fathering counts: gender-specific parenting resources; (2) Measuring up: bolstering masculine identities as fathers; (3) Money matters: triggering masculine virtues related to family finances; (4) Masculine ideals: father role models as cessation aids; and (5) Manly moves: physical activity for the male body. Conclusions: A focus on fathering was an effective draw for men to the smoking cessation resources. The findings provide direction for considering how best to do virtual cessation programs as well as other types of online cancer prevention programs for men. %M 25971202 %R 10.2196/resprot.4079 %U http://www.researchprotocols.org/2015/2/e54/ %U https://doi.org/10.2196/resprot.4079 %U http://www.ncbi.nlm.nih.gov/pubmed/25971202 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 5 %P e113 %T Comparative and Cost Effectiveness of Telemedicine Versus Telephone Counseling for Smoking Cessation %A Richter,Kimber P %A Shireman,Theresa I %A Ellerbeck,Edward F %A Cupertino,A Paula %A Catley,Delwyn %A Cox,Lisa Sanderson %A Preacher,Kristopher J %A Spaulding,Ryan %A Mussulman,Laura M %A Nazir,Niaman %A Hunt,Jamie J %A Lambart,Leah %+ University of Kansas Medical Center, Department of Preventive Medicine and Public Health, 3901 Rainbow Boulevard, Kansas City, KS, 66160, United States, 1 9135882718, krichter@kumc.edu %K telemedicine %K Internet %K rural %K smoking cessation, RCT %K primary care %D 2015 %7 08.05.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: In rural America, cigarette smoking is prevalent and health care providers lack the time and resources to help smokers quit. Telephone quitlines are important avenues for cessation services in rural areas, but they are poorly integrated with local health care resources. Objective: The intent of the study was to assess the comparative effectiveness and cost effectiveness of two models for delivering expert tobacco treatment at a distance: telemedicine counseling that was integrated into smokers’ primary care clinics (Integrated Telemedicine—ITM) versus telephone counseling, similar to telephone quitline counseling, delivered to smokers in their homes (Phone). Methods: Smokers (n=566) were recruited offline from 20 primary care and safety net clinics across Kansas. They were randomly assigned to receive 4 sessions of ITM or 4 sessions of Phone counseling. Patients in ITM received real-time video counseling, similar to Skype, delivered by computer/webcams in clinic exam rooms. Three full-time equivalent trained counselors delivered the counseling. The counseling duration and content was the same in both groups and was available in Spanish or English. Both groups also received identical materials and assistance in selecting and obtaining cessation medications. The primary outcome was verified 7-day point prevalence smoking abstinence at month 12, using an intent-to-treat analysis. Results: There were no significant baseline differences between groups, and the trial achieved 88% follow-up at 12 months. Verified abstinence at 12 months did not significantly differ between ITM or Phone (9.8%, 27/280 vs 12%, 34/286; P=.406). Phone participants completed somewhat more counseling sessions than ITM (mean 2.6, SD 1.5 vs mean 2.4, SD 1.5; P=.0837); however, participants in ITM were significantly more likely to use cessation medications than participants in Phone (55.9%, 128/280 vs 46.1%, 107/286; P=.03). Compared to Phone participants, ITM participants were significantly more likely to recommend the program to a family member or friend (P=.0075). From the combined provider plus participant (societal) perspective, Phone was significantly less costly than ITM. Participants in ITM had to incur time and mileage costs to travel to clinics for ITM sessions. From the provider perspective, counseling costs were similar between ITM (US $45.46, SD 31.50) and Phone (US $49.58, SD 33.35); however, total provider costs varied widely depending on how the clinic space for delivering ITM was valued. Conclusions: Findings did not support the superiority of ITM over telephone counseling for helping rural patients quit smoking. ITM increased utilization of cessation pharmacotherapy and produced higher participant satisfaction, but Phone counseling was significantly less expensive. Future interventions could combine elements of both approaches to optimize pharmacotherapy utilization, counseling adherence, and satisfaction. Such an approach could commence with a telemedicine-delivered clinic office visit for pharmacotherapy guidance, and continue with telephone or real-time video counseling delivered via mobile phones to flexibly deliver behavioral support to patients where they most need it—in their homes and communities. Trial Registration: Clinicaltrials.gov NCT00843505; http://clinicaltrials.gov/ct2/show/NCT00843505 (Archived by WebCite at http://www.webcitation.org/6YKSinVZ9). %R 10.2196/jmir.3975 %U http://www.jmir.org/2015/5/e113/ %U https://doi.org/10.2196/jmir.3975 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e59 %T A Web-Based, Computer-Tailored Smoking Prevention Program to Prevent Children From Starting to Smoke After Transferring to Secondary School: Randomized Controlled Trial %A Cremers,Henricus-Paul %A Mercken,Liesbeth %A Candel,Math %A de Vries,Hein %A Oenema,Anke %+ Maastricht University, Department of Health Promotion, School for Public Health and Primary Care (CAPHRI), PO Box 616, Maastricht, 6200 MD Maastricht, Netherlands, 31 (0)43 388 2379, p.cremers@maastrichtuniversity.nl %K Web-based intervention %K primary school children %K smoking prevention %K prompts %K computer-tailoring %D 2015 %7 09.03.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Smoking prevalence rates among Dutch children increase rapidly after they transit to secondary school, in particular among children with a low socioeconomic status (SES). Web-based, computer-tailored programs supplemented with prompt messages may be able to empower children to prevent them from starting to smoke when they transit to secondary school. Objective: The main aim of this study is to evaluate whether computer-tailored feedback messages, with and without prompt messages, are effective in decreasing children’s smoking intentions and smoking behavior after 12 and 25 months of follow-up. Methods: Data were gathered at baseline (T0), and after 12 months (T1) and 25 months (T2) of follow-up of a smoking prevention intervention program called Fun without Smokes. A total of 162 schools were randomly allocated to a no-intervention control group, an intervention prompt group, or an intervention no-prompt group. A total of 3213 children aged 10 to 12 years old participated in the study and completed a Web-based questionnaire assessing their smoking intention, smoking behavior, and sociocognitive factors, such as attitude, social influence, and self-efficacy, related to smoking. After completion, children in the intervention groups received computer-tailored feedback messages in their own email inbox and those messages could be accessed on the intervention website. Children in the prompt group received prompt messages, via email and short message service (SMS) text messaging, to stimulate them to reuse the intervention website with nonsmoking content. Multilevel logistic regression analyses were performed using multiple imputations to assess the program effects on smoking intention and smoking behavior at T1 and T2. Results: A total of 3213 children participated in the Fun without Smokes study at T0. Between T0 and T1 a total of 1067 children out of the original 3213 (33.21%) dropped out of the study. Between T0 and T2 the number of children that did not participate in the final measurement was 1730 out of the original 3213 (53.84%). No significant program effects were observed for any of the intervention groups compared to the control group at T1 for the intention to engage in smoking—prompt, OR 0.67 (95% CI 0.30-1.50), no-prompt, OR 0.76 (95% CI 0.34-1.67)—or for smoking behavior—prompt, OR 1.13 (95% CI 0.13-9.98), no-prompt, OR 0.50 (95% CI 0.04-5.59). Similar nonsignificant program effects were found at T2 for the intention to start smoking—prompt, OR 0.78 (95% CI 0.26-2.32), no-prompt, OR 1.31 (95% CI 0.45-3.82)—and smoking behavior—prompt, OR 0.53 (95% CI 0.12-2.47), no-prompt, OR 1.01 (95% CI 0.24-4.21). Conclusions: This study showed that the Web-based, computer-tailored feedback messages with and without prompt messages were not effective in modifying children’s smoking intentions and smoking behavior as compared to no information. Future smoking prevention interventions are recommended to start closer to the age of actual smoking uptake. Furthermore, future studies on Web-based, computer-tailored smoking prevention programs should focus on assessing and controlling exposure to the educational content and the response to the prompt messages. Trial Registration: Netherlands Trial Register NTR3116; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3116 (Archived by WebCite at http://www.webcitation.org/6O0wQYuPI). %M 25759248 %R 10.2196/jmir.3794 %U http://www.jmir.org/2015/3/e59/ %U https://doi.org/10.2196/jmir.3794 %U http://www.ncbi.nlm.nih.gov/pubmed/25759248 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 2 %P e50 %T Development of a Twitter-Based Intervention for Smoking Cessation that Encourages High-Quality Social Media Interactions via Automessages %A Pechmann,Cornelia %A Pan,Li %A Delucchi,Kevin %A Lakon,Cynthia M %A Prochaska,Judith J %+ University of California Irvine, The Paul Merage School of Business, Building 2, Room 331, Irvine, CA, 90266, United States, 1 949 824 4058, cpechman@uci.edu %K smoking cessation %K social media %K text messaging %D 2015 %7 23.02.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The medical field seeks to use social media to deliver health interventions, for example, to provide low-cost, self-directed, online self-help groups. However, engagement in online groups is often low and the informational content may be poor. Objective: The specific study aims were to explore if sending automessages to online self-help groups encouraged engagement and to see if overall or specific types of engagement related to abstinence. Methods: We conducted a Stage I Early Therapy Development Trial of a novel social media intervention for smoking cessation called Tweet2Quit that was delivered online over closed, 20-person quit-smoking groups on Twitter in 100 days. Social media such as Twitter traditionally involves non-directed peer-to-peer exchanges, but our hybrid social media intervention sought to increase and direct such exchanges by sending out two types of autocommunications daily: (1) an “automessage” that encouraged group discussion on an evidence-based cessation-related or community-building topic, and (2) individualized “autofeedback” to each participant on their past 24-hour tweeting. The intervention was purposefully designed without an expert group facilitator and with full automation to ensure low cost, easy implementation, and broad scalability. This purely Web-based trial examined two online quit-smoking groups with 20 members each. Participants were adult smokers who were interested in quitting and were recruited using Google AdWords. Participants’ tweets were counted and content coded, distinguishing between responses to the intervention’s automessages and spontaneous tweets. In addition, smoking abstinence was assessed at 7 days, 30 days, and 60 days post quit date. Statistical models assessed how tweeting related to abstinence. Results: Combining the two groups, 78% (31/40) of the members sent at least one tweet; and on average, each member sent 72 tweets during the 100-day period. The automessage-suggested discussion topics and participants’ responses to those daily automessages were related in terms of their content (r=.75, P=.012). Responses to automessages contributed 22.78% (653/2867) of the total tweets; 77.22% (2214/2867) were spontaneous. Overall tweeting related only marginally to abstinence (OR 1.03, P=.086). However, specific tweet content related to abstinence including tweets about setting of a quit date or use of nicotine patches (OR 1.52, P=.024), countering of roadblocks to quitting (OR 1.76, P=.008) and expressions of confidence about quitting (OR 1.71, SE 0.42, P=.032). Questionable, that is, non-evidence-based, information about quitting did not relate to abstinence (OR 1.12, P=.278). Conclusions: A hybrid social media intervention that combines traditional online social support with daily automessages appears to hold promise for smoking cessation. This hybrid approach capitalizes on social media’s spontaneous real-time peer-to-peer exchanges but supplements this with daily automessages that group members respond to, bolstering and sustaining the social network and directing the information content. Highly engaging, this approach should be studied further. Trial Registration: Clinicaltrials.gov NCT01602536; https://clinicaltrials.gov/ct2/show/NCT01602536 (Archived by WebCite at http://www.webcitation.org/6WGbt0o1K) %M 25707037 %R 10.2196/jmir.3772 %U http://www.jmir.org/2015/2/e50/ %U https://doi.org/10.2196/jmir.3772 %U http://www.ncbi.nlm.nih.gov/pubmed/25707037 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 2 %P e39 %T A Web-Based Program to Increase Knowledge and Reduce Cigarette and Nargila Smoking Among Arab University Students in Israel: Mixed-Methods Study to Test Acceptability %A Essa-Hadad,Jumanah %A Linn,Shai %A Rafaeli,Sheizaf %+ Bar Ilan University, Faculty of Medicine in the Galilee, Henrietta Szold, 8, POB 1589, Safed, 1311502, Israel, 972 502700022, jamanh.essa-hadad@mail.biu.ac.il %K Web-based intervention %K smoking cessation %K nargila smoking %K Arabs in Israel %K university students %K tailored feedback %D 2015 %7 20.02.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Among Arab citizens in Israel, cigarette and nargila (hookah, waterpipe) smoking is a serious public health problem, particularly among the young adult population. With the dramatic increase of Internet and computer use among Arab college and university students, a Web-based program may provide an easy, accessible tool to reduce smoking rates without heavy resource demands required by traditional methods. Objective: The purpose of this research was to examine the acceptability and feasibility of a pilot Web-based program that provides tailored feedback to increase smoking knowledge and reduce cigarette and nargila smoking behaviors among Arab college/university students in Israel. Methods: A pilot Web-based program was developed, consisting of a self-administered questionnaire and feedback system on cigarette and nargila smoking. Arab university students were recruited to participate in a mixed-methods study, using both quantitative (pre-/posttest study design) and qualitative tools. A posttest was implemented at 1 month following participation in the intervention to assess any changes in smoking knowledge and behaviors. Focus group sessions were implemented to assess acceptability and preferences related to the Web-based program. Results: A total of 225 participants—response rate of 63.2% (225/356)—completed the intervention at baseline and at 1-month poststudy, and were used for the comparative analysis. Statistically significant reductions in nargila smoking among participants (P=.001) were found. The intervention did not result in reductions in cigarette smoking. However, the tailored Web intervention resulted in statistically significant increases in the intention to quit smoking (P=.021). No statistically significant increases in knowledge were seen at 1-month poststudy. Participants expressed high satisfaction with the intervention and 93.8% (211/225) of those who completed the intervention at both time intervals reported that they would recommend the program to their friends, indicating excellent acceptability and feasibility of the intervention. This was further emphasized in the focus group sessions. Conclusions: A tailored Web-based program may be a promising tool to reduce nargila smoking among Arab university students in Israel. The tailored Web intervention was not successful at significantly reducing cigarette smoking or increasing knowledge. However, the intervention did increase participants’ intention to quit smoking. Participants considered the Web-based tool to be an interesting, feasible, and highly acceptable strategy. Trial Registration: Trial Registration: ISRCTN registry ISRCTN59207794; http://www.isrctn.com/ISRCTN59207794 (Archived by WebCite at http://www.webcitation.org/6VkYOBNOJ). %M 25707034 %R 10.2196/jmir.2988 %U http://www.jmir.org/2015/2/e39/ %U https://doi.org/10.2196/jmir.2988 %U http://www.ncbi.nlm.nih.gov/pubmed/25707034 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 2 %P e36 %T Utilization of a Web-Based vs Integrated Phone/Web Cessation Program Among 140,000 Tobacco Users: An Evaluation Across 10 Free State Quitlines %A Nash,Chelsea M %A Vickerman,Katrina A %A Kellogg,Elizabeth S %A Zbikowski,Susan M %+ Alere Wellbeing, Research, Training and Evaluation Services, 999 Third Avenue, Suite 2000, Seattle, WA, 98104, United States, 1 206 876 2328, chelsea.nash@alere.com %K Internet-based intervention %K tobacco cessation %K smoking cessation %K Internet %K telephone %K behavior %K evaluation studies %K online support %D 2015 %7 04.02.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Phone-based tobacco cessation program effectiveness has been established and randomized controlled trials have provided some support for Web-based services. Relatively little is known about who selects different treatment modalities and how they engage with treatments in a real-world setting. Objective: This paper describes the characteristics, Web utilization patterns, and return rates of tobacco users who self-selected into a Web-based (Web-Only) versus integrated phone/Web (Phone/Web) cessation program. Methods: We examined the demographics, baseline tobacco use, Web utilization patterns, and return rates of 141,429 adult tobacco users who self-selected into a Web-Only or integrated Phone/Web cessation program through 1 of 10 state quitlines from August 2012 through July 2013. For each state, registrants were only included from the timeframe in which both programs were offered to all enrollees. Utilization data were limited to site interactions occurring within 6 months after registration. Results: Most participants selected the Phone/Web program (113,019/141,429, 79.91%). After enrollment in Web services, Web-Only were more likely to log in compared to Phone/Web (21,832/28,410, 76.85% vs 23,920/56,892, 42.04%; P<.001), but less likely to return after their initial log-in (8766/21,832, 40.15% vs 13,966/23,920, 58.39%; P<.001). In bivariate and multivariable analyses, those who chose Web-Only were younger, healthier, more highly educated, more likely to be uninsured or commercially insured, more likely to be white non-Hispanic and less likely to be black non-Hispanic, less likely to be highly nicotine-addicted, and more likely to have started their program enrollment online (all P<.001). Among both program populations, participants were more likely to return to Web services if they were women, older, more highly educated, or were sent nicotine replacement therapy (NRT) through their quitline (all P<.001). Phone/Web were also more likely to return if they had completed a coaching call, identified as white non-Hispanic or “other” race, or were commercially insured (all P<.001). Web-Only were less likely to return if they started their enrollment online versus via phone. The interactive Tobacco Tracker, Cost Savings Calculator, and Quitting Plan were the most widely used features overall. Web-Only were more likely than Phone/Web to use most key features (all P<.001), most notably the 5 Quitting Plan behaviors. Among quitlines that offered NRT to both Phone/Web and Web-Only, Web-Only were less likely to have received quitline NRT. Conclusions: This paper adds to our understanding of who selects different cessation treatment modalities and how they engage with the program in a real-world setting. Web-Only were younger, healthier smokers of higher socioeconomic status who interacted more intensely with services in a single session, but were less likely to re-engage or access NRT benefits. Further research should examine the efficacy of different engagement techniques and services with different subpopulations of tobacco users. %M 25673013 %R 10.2196/jmir.3658 %U http://www.jmir.org/2015/2/e36/ %U https://doi.org/10.2196/jmir.3658 %U http://www.ncbi.nlm.nih.gov/pubmed/25673013 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 1 %P e27 %T Picture Me Smokefree: A Qualitative Study Using Social Media and Digital Photography to Engage Young Adults in Tobacco Reduction and Cessation %A Haines-Saah,Rebecca J %A Kelly,Mary T %A Oliffe,John L %A Bottorff,Joan L %+ Institute for Healthy Living and Chronic Disease Prevention, Faculty of Health and Social Development, University of British Columbia Okanagan, ART223, 3333 University Way, Kelowna, BC, V1V 1V7, Canada, 1 250 807 8072, rebecca.haines-saah@nursing.ubc.ca %K smoking cessation %K tobacco use %K young adults %K Facebook %K participatory visual methods %D 2015 %7 26.01.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Young adults have high rates of tobacco use compared to other subpopulations, yet there are relatively few tobacco interventions specifically targeted to this group. Picture Me Smokefree is an online tobacco reduction and cessation intervention for young adults that uses digital photography and social networking. Objective: The main goal of the project was to determine the feasibility of engaging young adults in participating in user-driven, online forums intended to provide peer support and motivate critical reflection about tobacco use and cessation among this high-use, hard-to-reach population. A related aim was to explore the influence of gender-related factors on participation, in order to determine the need for online interventions to be tailored to the specific gender preferences reflecting young men and women’s participation styles. Methods: A total of 60 young adults ages 19-24 years who self-identified as current cigarette smokers or who had quit within the last year were recruited from across British Columbia, Canada, and participated in an online photo group on Facebook over a period of 12 consecutive weeks. A variety of data collection methods were used including tracking online activity, a brief online follow-up survey, and qualitative interviews with study participants. Data analysis involved descriptive statistics on recruitment, retention, and participation and qualitative (eg, narrative analysis, synthesis of feedback) feedback about participant engagement. Results: Findings from this study suggest good potential for Facebook as an accessible, low-cost platform for engaging young adults to reflect on the reasons for their tobacco use, the benefits of quitting or reducing, and the best strategies for tobacco reduction. Young adults’ frequent use of mobile phones and other mobile devices to access social networking permitted ease of access and facilitated real-time peer-to-peer support across a diverse group of participants. However, our experience of conducting the study suggests that working with young tobacco users can be accompanied by considerable recruitment, participation, and retention challenges. Our findings also pointed to differences in how young women and men engaged the photo-group intervention that should be considered, bearing in mind that in follow-up interviews participants indicated their preference for a mixed gender and “gender neutral” group format. Conclusions: Tobacco interventions for youth and young adults should be embedded within the existing social networking platforms they access most frequently, rather than designing a stand-alone online prevention or intervention resource. This subpopulation would likely benefit from tobacco reduction interventions that are gender-sensitive rather than gender-specific. %M 25624064 %R 10.2196/jmir.4061 %U http://www.jmir.org/2015/1/e27/ %U https://doi.org/10.2196/jmir.4061 %U http://www.ncbi.nlm.nih.gov/pubmed/25624064 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e10 %T Quit4baby: Results From a Pilot Test of a Mobile Smoking Cessation Program for Pregnant Women %A Abroms,Lorien C %A Johnson,Pamela R %A Heminger,Christina L %A Van Alstyne,Judith M %A Leavitt,Leah E %A Schindler-Ruwisch,Jennifer M %A Bushar,Jessica A %+ Milken Institute School of Public Health, Prevention & Community Health, The George Washington University, 950 New Hampshire Avenue NW, 3rd floor, Washington, DC, 20052, United States, 1 202 994 3518, lorien@gwu.edu %K mobile health %K tobacco cessation %K pregnancy %K text messaging %D 2015 %7 23.01.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Text messaging (short message service, SMS) programs have been shown to be effective in helping adult smokers quit smoking. This study describes the results of a pilot test of Quit4baby, a smoking cessation text messaging program for pregnant smokers that was adapted from Text2quit. Objective: The study aimed to demonstrate the feasibility and acceptability of Quit4baby for women currently enrolled in Text4baby, a perinatal health text messaging program. Methods: Pregnant women enrolled in Text4baby and who were current smokers or had quit within the last 4 weeks (n=20) were enrolled in Quit4baby. Those under the age of 18, not pregnant, not current smokers, those using nicotine replacement therapy, and those not interested in participating were ineligible. Participants were surveyed at baseline and at 2 and 4 weeks postenrollment. Results: Most participants responded to the program favorably. Highly rated aspects included the content of the program, skills taught within the program, and encouragement and social support provided by the program. Participants reported that the program was helpful in quitting, that the program gave good ideas on quitting, and that they would recommend the program to a friend. Suggestions for improvement included increasing the message dose and making the quitpal more interactive. Conclusions: This pilot test provides support for the feasibility and acceptability of Quit4baby. Future studies are needed to assess whether Quit4baby is effective for smoking cessation during pregnancy. %M 25650765 %R 10.2196/mhealth.3846 %U http://mhealth.jmir.org/2015/1/e10/ %U https://doi.org/10.2196/mhealth.3846 %U http://www.ncbi.nlm.nih.gov/pubmed/25650765 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 1 %P e17 %T A Mobile App to Aid Smoking Cessation: Preliminary Evaluation of SmokeFree28 %A Ubhi,Harveen Kaur %A Michie,Susan %A Kotz,Daniel %A Wong,Wai Chi %A West,Robert %+ Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, United Kingdom, 44 789 134 0056, harveenk26@gmail.com %K smoking cessation intervention %K mobile %K smartphone %K apps %K PRIME theory %D 2015 %7 16.01.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Little is known about the effectiveness of mobile apps in aiding smoking cessation or their validity for automated collection of data on smoking cessation outcomes. Objective: We conducted a preliminary evaluation of SF28 (SF28 is the name of the app, short for SmokeFree28)—an app aimed at helping smokers to be smoke-free for 28 days. Methods: Data on sociodemographic characteristics, smoking history, number of logins, and abstinence at each login were uploaded to a server from SF28 between August 2012 and August 2013. Users were included if they were aged 16 years or over, smoked cigarettes at the time of registration, had set a quit date, and used the app at least once on or after their quit date. Their characteristics were compared with data from a representative sample of smokers trying to stop smoking in England. The percentage of users recording 28 days of abstinence was compared with a value of 15% estimated for unaided quitting. Correlations were assessed between recorded abstinence for 28 days and well-established abstinence predictors. Results: A total of 1170 users met the inclusion criteria. Compared with smokers trying to quit in England, they had higher consumption, and were younger, more likely to be female, and had a non-manual rather than manual occupation. In total, 18.9% (95% CI 16.7-21.1) were recorded as being abstinent from smoking for 28 days or longer. The mean number of logins was 8.5 (SD 9.0). The proportion recording abstinence for 28 days or longer was higher in users who were older, in a non-manual occupation, and in those using a smoking cessation medication. Conclusions: The recorded 28-day abstinence rates from the mobile app, SF28, suggest that it may help some smokers to stop smoking. Further evaluation by means of a randomized trial appears to be warranted. %M 25596170 %R 10.2196/jmir.3479 %U http://www.jmir.org/2015/1/e17/ %U https://doi.org/10.2196/jmir.3479 %U http://www.ncbi.nlm.nih.gov/pubmed/25596170 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 1 %P e18 %T An Observational Study of Social and Emotional Support in Smoking Cessation Twitter Accounts: Content Analysis of Tweets %A Rocheleau,Mary %A Sadasivam,Rajani Shankar %A Baquis,Kate %A Stahl,Hannah %A Kinney,Rebecca L %A Pagoto,Sherry L %A Houston,Thomas K %+ Division of Health Informatics and Implementation Science, Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Albert Sherman Center, Worcester, MA, 01605, United States, 1 5088568923, rajani.sadasivam@umassmed.edu %K smoking cessation %K Twitter %K Internet %K social network %D 2015 %7 14.01.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Smoking continues to be the number one preventable cause of premature death in the United States. While evidence for the effectiveness of smoking cessation interventions has increased rapidly, questions remain on how to effectively disseminate these findings. Twitter, the second largest online social network, provides a natural way of disseminating information. Health communicators can use Twitter to inform smokers, provide social support, and attract them to other interventions. A key challenge for health researchers is how to frame their communications to maximize the engagement of smokers. Objective: Our aim was to examine current Twitter activity for smoking cessation. Methods: Active smoking cessation related Twitter accounts (N=18) were identified. Their 50 most recent tweets were content coded using a schema adapted from the Roter Interaction Analysis System (RIAS), a theory-based, validated coding method. Using negative binomial regression, the association of number of followers and frequency of individual tweet content at baseline was assessed. The difference in followership at 6 months (compared to baseline) to the frequency of tweet content was compared using linear regression. Both analyses were adjusted by account type (organizational or not organizational). Results: The 18 accounts had 60,609 followers at baseline and 68,167 at 6 months. A total of 24% of tweets were socioemotional support (mean 11.8, SD 9.8), 14% (mean 7, SD 8.4) were encouraging/engagement, and 62% (mean 31.2, SD 15.2) were informational. At baseline, higher frequency of socioemotional support and encouraging/engaging tweets was significantly associated with higher number of followers (socioemotional: incident rate ratio [IRR] 1.09, 95% CI 1.02-1.20; encouraging/engaging: IRR 1.06, 95% CI 1.00-1.12). Conversely, higher frequency of informational tweets was significantly associated with lower number of followers (IRR 0.95, 95% CI 0.92-0.98). At 6 months, for every increase by 1 in socioemotional tweets, the change in followership significantly increased by 43.94 (P=.027); the association was slightly attenuated after adjusting by account type and was not significant (P=.064). Conclusions: Smoking cessation activity does exist on Twitter. Preliminary findings suggest that certain content strategies can be used to encourage followership, and this needs to be further investigated. %M 25589009 %R 10.2196/jmir.3768 %U http://www.jmir.org/2015/1/e18/ %U https://doi.org/10.2196/jmir.3768 %U http://www.ncbi.nlm.nih.gov/pubmed/25589009 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 1 %P e4 %T Who Uses Smoking Cessation Apps? A Feasibility Study Across Three Countries via Smartphones %A BinDhim,Nasser F %A McGeechan,Kevin %A Trevena,Lyndal %+ Sydney Medical School, Department of Public Health, University of Sydney, Rm 125, Lvl 1, Edward Ford Building A27, Sydney, 2006, Australia, 61 434556298, nbin6641@uni.sydney.edu.au %K smartphone %K handheld computers %K health promotion %K tobacco and smoking %K global health %K prevention %K apps %K health Informatics %K public health %D 2014 %7 06.02.2014 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone use is growing worldwide. While hundreds of smoking cessation apps are currently available in the app stores, there is no information about who uses them. Smartphones also offer potential as a research tool, but this has not previously been explored. Objective: This study aims to measure and compare the uptake of a smoking cessation app over one year in Australia, the United Kingdom, and the United States. It also assesses the feasibility of conducting research via an app, describing respondents’ characteristics (demographics, smoking status, and other health related app use), and examining differences across countries. Methods: This is a cross-sectional exploratory study of adults 18 years and older, passively recruited over one year in 2012, who downloaded this study app (Quit Advisor) via the two largest app stores (Apple and Android). Results: The total number of app downloads after one year was 1751, 72.98% (1278/1751) of them were Apple operation system users. Of these 1751 participants, 47.68% (835/1751) were from the United States, 29.18% (511/1751) were from the United Kingdom, and 16.68% (292/1751) were from Australia. There were 602 participants, 36.75% (602/1638) that completed a questionnaire within the app. Of these 602 participants, 58.8% (354/602) were female and the mean age was 32 years. There were no significant differences between countries in terms of age, operation system used, number of quitting attempts, and language spoken at home. However, there were significant differences between countries in terms of gender and stage of change. There were 77.2% (465/602) of the respondents that were ready to quit in the next 30 days and the majority of these had never sought professional help (eg, “Quitline”). More than half had downloaded smoking cessation apps in the past and of these, three-quarters had made quitting attempts (lasted at least 24 hours) using an app before. Respondents who had attempted to quit three times or more in the previous year were more likely to have tried smoking cessation apps (OR 3.3, 95% CI 2.1-5.2). There were 50.2% (302/602) of the respondents that had used other health related apps before. Of these, 89.4% (270/302) were using health related apps at least once a week, but 77.5% (234/302) never checked the credibility of the health app publishers before downloading. Conclusions: A smartphone app was able to reach smokers across three countries that were not seeking professional help, but were ready to quit within the next 30 days. Respondents were relatively young and almost demographically similar across all three countries. They also frequently used other health related apps, mostly without checking the credibility of their publishers. %M 25098439 %R 10.2196/mhealth.2841 %U http://mhealth.jmir.org/2014/1/e4/ %U https://doi.org/10.2196/mhealth.2841 %U http://www.ncbi.nlm.nih.gov/pubmed/25098439 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 4 %N 2 %P e4190 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2012 %7 ..2012 %9 %J Online J Public Health Inform %G English %X INTRODUCTION: Portable handheld computers and electronic data management systems have been used for national surveys in many high-income countries, however their use in developing countries has been challenging due to varying geographical, economic, climatic, political and cultural environments. In order to monitor and measure global adult tobacco use, the World Health Organization and the US Centers for Disease Control and Prevention initiated the Global Adult Tobacco Survey, a nationally representative household survey of adults, 15 years of age or older, using a standard core questionnaire, sample design, and data collection and management procedures. The Survey has been conducted in 14 low- and middle-income countries, using an electronic data collection and management system. This paper describes implementation of the electronic data collection system and associated findings.METHODS: The Survey was based on a comprehensive data management protocol, to enable standardized, globally comparable high quality data collection and management. It included adaptation to specific country needs, selection of appropriate handheld hardware devices, use of open source software, and building country capacity and provide technical support.RESULTS: In its first phase, the Global Adult Tobacco Survey was successfully conducted between 2008 and 2010, using an electronic data collection and management system for interviews in 302,800 households in 14 countries. More than 2,644 handheld computers were fielded and over 2,634 fieldworkers, supervisors and monitors were trained to use them. Questionnaires were developed and programmed in 38 languages and scripts. The global hardware failure rate was < 1% and data loss was almost 0%.CONCLUSION: Electronic data collection and management systems can be used effectively for conducting nationally representative surveys, particularly in low- and middle-income countries, irrespective of geographical, climatic, political and cultural environments, and capacity-building at the country level is an important vehicle for Health System Strengthening. %M 23569638 %R 10.5210/ojphi.v4i2.4190 %U %U https://doi.org/10.5210/ojphi.v4i2.4190 %U http://www.ncbi.nlm.nih.gov/pubmed/23569638 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e119 %T Online Social Networks and Smoking Cessation: A Scientific Research Agenda %A Cobb,Nathan K %A Graham,Amanda L %A Byron,M. Justin %A Niaura,Raymond S %A Abrams,David B %A , %+ The Schroeder Institute for Tobacco Research and Policy Studies, American Legacy Foundation, 1724 Massachusetts Ave NW, Washington, DC, 20036, United States, 1 202 454 5745, ncobb@legacyforhealth.org %K Smoking cessation %K social support %K social networks %K addiction %K treatment %K tobacco %D 2011 %7 19.12.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: Smoking remains one of the most pressing public health problems in the United States and internationally. The concurrent evolution of the Internet, social network science, and online communities offers a potential target for high-yield interventions capable of shifting population-level smoking rates and substantially improving public health. Objective: Our objective was to convene leading practitioners in relevant disciplines to develop the core of a strategic research agenda on online social networks and their use for smoking cessation, with implications for other health behaviors. Methods: We conducted a 100-person, 2-day, multidisciplinary workshop in Washington, DC, USA. Participants worked in small groups to formulate research questions that could move the field forward. Discussions and resulting questions were synthesized by the workshop planning committee. Results: We considered 34 questions in four categories (advancing theory, understanding fundamental mechanisms, intervention approaches, and evaluation) to be the most pressing. Conclusions: Online social networks might facilitate smoking cessation in several ways. Identifying new theories, translating these into functional interventions, and evaluating the results will require a concerted transdisciplinary effort. This report presents a series of research questions to assist researchers, developers, and funders in the process of efficiently moving this field forward. %M 22182518 %R 10.2196/jmir.1911 %U http://www.jmir.org/2011/4/e119/ %U https://doi.org/10.2196/jmir.1911 %U http://www.ncbi.nlm.nih.gov/pubmed/22182518