Abstract
BackgroundCigarette 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.ObjectiveThis initial evaluation of Pivot aimed to assess participant engagement, changes in attitudes toward quitting, and changes in smoking behavior.MethodsUS 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]).ResultsA 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.ConclusionsThis 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 RegistrationClinicalTrials.gov NCT03295643; https://clinicaltrials.gov/ct2/show/NCT03295643 (Archived by WebCite at http://www.webcitation.org/75TiNe6BE).
Highlights
In the United States, cigarette smoking is responsible for 480,000 deaths annually, and more than 16 million individuals live with a smoking-related illness [1]
Meaningful gains have been made in smoking cessation over the last decade, with the prevalence of cigarette smoking among US adults decreasing from 20.9% in 2005 to 14.8% in 2017 [2,3]
Trying a variety of strategies to reduce or quit and learning about the effects of smoking through daily activities were the second and third most common reasons, respectively. This was the initial study of the Pivot program; a comprehensive, multiphase digital smoking cessation program that includes a mobile carbon monoxide (CO) breath sensor, the Pivot app, and dedicated human coaching
Summary
BackgroundIn the United States, cigarette smoking is responsible for 480,000 deaths annually, and more than 16 million individuals live with a smoking-related illness [1]. Meaningful gains have been made in smoking cessation over the last decade, with the prevalence of cigarette smoking among US adults decreasing from 20.9% in 2005 to 14.8% in 2017 [2,3] Despite this progress, smoking remains the leading cause of preventable morbidity and mortality. Quit rates are low, with less than 1 in 10 quit attempts being successful This is related, in part, to underutilization of proven treatments, which include behavioral counseling and pharmacotherapy [4]. Use of behavioral counseling or cessation medications approximately doubles quit rates with combined use being more effective than either alone [4,5,6]. 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
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