Abstract
BackgroundTobacco 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.ObjectiveThe 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.MethodsUS 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).ResultsParticipants 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.ConclusionsUse 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 RegistrationClinicalTrials.gov NCT04133064; https://clinicaltrials.gov/ct2/show/NCT04133064
Highlights
Cigarette smoking is the largest preventable cause of morbidity and mortality, accounting for approximately 480,000 annual deaths in the United States, including about 30% of cancer deaths and 30% of cardiovascular disease deaths [1,2,3]
At 12 weeks, Cigarettes per day (CPD) decreased by 41.1% from baseline (P
More than 90% (>196/214) indicated the sensor taught them about their carbon monoxide (CO) levels and smoking behavior, and 73.1% (166/227) reported that seeing their CO values made them want to quit smoking
Summary
Cigarette smoking is the largest preventable cause of morbidity and mortality, accounting for approximately 480,000 annual deaths in the United States, including about 30% of cancer deaths and 30% of cardiovascular disease deaths [1,2,3]. Launched by the US government in 2010, the 2020 Healthy People initiative identified several related goals including decreasing the prevalence of smoking to 12% or less (tobacco use objective 1.1, or TU-1.1), increasing the proportion of US adults who attempt to quit smoking cigarettes to 80.0% or more (TU-4.1), and increasing recent smoking cessation success to 8.0% or more (TU-5.1) [5]. Evidence-based interventions proven to increase quit rates include counseling (individual, group, or phone) and FDA-approved pharmacotherapy. 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
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