Abstract
IntroductionVerifying self-reports of smoking abstinence is challenging in studies that involve remote data collection. Resting heart rate (HR) decreases during smoking abstinence. This study assessed whether a decrease in resting HR measured using freely available smartphone apps could potentially be used to verify smoking abstinence.MethodsThis study involved a repeated measures experimental design, with data collection in natural setting. Participants were 18 adult, daily smokers. They recorded resting HR in beats per minute (bpm) using freely available smartphone apps during five timepoints (two in the morning and three postnoon) on each of 3 days. The outcome measure was the mean of the postnoon HR recordings. The experimental condition for each of the 3 days (counterbalanced order) was as follows: (1) smoking as usual, (2) not smoking without nicotine replacement therapy (NRT), or (3) not smoking but using NRT. Abstinence was verified using expired-air carbon monoxide (CO) concentration.ResultsCompared with the smoking as usual condition, mean HR was 13.4 bpm lower (95% confidence interval [CI] = 5.4 to 21.4, p = .001) in the not smoking without NRT condition and 10.4 bpm lower (95% CI = 3.1 to 17.8, p = 0.004) in the not smoking with NRT condition. There was no statistically significant difference in HR between the two not smoking conditions (p = .39). Abstinence during not smoking days without and with NRT was CO-verified in 18/18 and in 16/18 cases, respectively.ConclusionsSelf-recording of resting HR in natural setting using smartphone apps shows a reliable decrease in response to smoking abstinence and may provide a basis for remote verification in smoking cessation studies.ImplicationsRemote verification of self-reported abstinence in smoking cessation studies remains challenging. Smoking abstinence has been shown to decrease resting HR under laboratory conditions. This study demonstrated that self-recording using freely available smartphone apps shows reliable decreases in resting HR during smoking abstinence and may provide a basis for inexpensive remote verification of smoking abstinence.
Highlights
Verifying self-reports of smoking abstinence is challenging in studies that involve remote data collection
This study demonstrated that self-recording using freely available smartphone apps shows reliable decreases in resting heart rate during smoking abstinence and may provide a basis for inexpensive
The current study provided an initial assessment of r whether a decrease in resting heart rate as measured using smartphones in people’s natural settings sc could provide a sufficiently reliable indicator of abstinence to be used to verify self-reports. nu The two most commonly used methods of verifying smoking abstinence are expired-air carbon a monoxide (CO) concentration and cotinine concentration measured in saliva or urine.[1]
Summary
In studies of smoking cessation it is important to be able to verify self-reports of abstinence.[1]. Resting heart rate decreases by an average of around 5-15 beats per minute within a day of stopping smoking and remains at that level for at least a year and probably indefinitely.[2,3,4,5] This is most likely because of the acute effect of nicotine on the cardiovascular system, an effect that reverses as the concentration of nicotine in body tissues falls to zero.[11,12] The nicotine-induced increase in heart rate is subject to acute tolerance, such that HR increases rapidly on ingestion of nicotine from the first cigarette of the day, but does not increase substantially as tissue nicotine concentrations increase further when subsequent cigarettes are smoked.[13] This effect appears to be reliable and it may occur with all, or almost all smokers.[11,14,15] If that is the case heart rate should decrease substantially on days when smoking has not occurred and should increase again if smoking does occur This makes decrease in heart rate a potentially useful marker for verifying self-reports of smoking abstinence. There was no statistically significant difference in HR between the two not smoking conditions (p=0.39)
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