Real-World Data for Enhancement of a National Smoking Cessation Intervention

Transcription

1 Real-World Data for Enhancement of a National Smoking Cessation Intervention SmokefreeTXT Erik Augustson, PhD, MPH Director, Smokefree.gov Initiative Tobacco Control Research Branch Behavioral Research Program National Cancer Institute

2 DISCLOSURES This work was supported by the National Cancer Institute. No financial relationships to disclose.

3 SMOKEFREE PROGRAM SmokefreeMOM HealthyYouTXT Smokefree Apps:

4 BACKGROUND Text message-based interventions show promise for smoking cessation Current evidence on text message-based interventions comes from RCTs NCI launched SmokefreeTXT in day intervention, option to start 2 weeks prior to quit date Two-way messaging for quit status, cravings, mood, and slips 35+ behavior change techniques built into the messages RCT showed quit rates of ~20% 5

5 RESEARCH OBJECTIVE Assess engagement and self-reported cessation rates among real-world smokers who subscribe to the SmokefreeTXT program 6

6 METHODS Inclusion Criteria Opted-in to the SmokefreeTXT program September 20, 2011, to May 22, 2014 Had the opportunity to complete the 42-day treatment by May 22, 2014 Exclusion Criteria Failed to set a quit date on or after enrollment date Opted out on or before their quit date 18,080 of 25,283 included in study 7

7 METHODS Subscribers could opt out of the program at any time by texting STOP Cessation status was self-reported as a response to a text message prompt at the following time points: 7 days post-quit End of the program 1-month post-treatment 3-months post-treatment 6-months post-treatment Sensitivity Analyses Logistic Regression 8

8 SAMPLE DEMOGRAPHICS Demographics Mean Age: 34.8 years; Median Age: 32 years 62% Female 88% Daily Smokers 70% had Web-Enabled Phone 9

9 MEASURING CESSATION Point prevalence abstinence Assessment of cessation status at the particular point in time when the question is asked End of treatment- Primary 7-days post-quit 3-months post-treatment 6-months post-treatment 10

10 RESULTS: ABSTINENCE RATES SmokefreeTXT Point-Prevalence Abstinence Rates All Subscribers, Nonresponders & Opt-outs = Smokers Responders Only Response Rate Treatment Completers Response Rate 7 Days Post-Quit 20.3% 64.4% 31.5% 23.7% 34.8% End of Treatment 7.2% 75.1% 9.6% 12.9% 17.0% 3 Months Post-Treatment 4.0% 52.0% 7.7% 7.3% 13.4% 6 Months Post-Treatment 2.0% 45.4% 4.4% 3.7% 7.6% 11

11 MEASURING ENGAGEMENT Time in Program Treatment Initiation Opt out Program Interactions Response rates

12 GUIDING QUESTIONS FOR ANALYSIS To what extent does SmokefreeTXT engage users in a quit attempt? To what extent does SmokefreeTXT keep users engaged? How can SmokefreeTXT more effectively re-engage users who have opted out?

13 POTENTIAL FAIL POINTS 2 weeks Pre- Treatment 6 Week Treatment Initiating the quit attempt Establishing an initial period of abstinence Recovering from a lapse

14 PURPOSE To describe baseline user characteristics associated with SmokefreeTXT user engagement Age Gender Frequency of Smoking Region Emphasis on key fail points Treatment Initiation Opt Out Re-engagement 15

15 METHODS Retrospective records analysis of SmokefreeTXT user data between N=25,283 subscribers Logistic regression to examine differences in baseline characteristics on key engagement metrics

16 TREATMENT INITIATION Treatment Initiation 71.5% % Non-initiator Treament Initiator

17 USER CHARACTERISTICS OF NON-INITIATORS Non-daily smokers were more likely to be non-initiators compared to daily smokers OR: 1.461; 95%CI: 1.313, No other baseline characteristics differed significantly by treatment initiation status

18 Percent of Total Subscribers Remaining Number of Subscribers Who Opt Out FAIL POINT 2 Weeks Pre- Treatment 1 Week Treatment Weeks 2-6 Treatment % % 80.00% % % 50.00% 40.00% 30.00% % 10.00% 0.00% Quit Date Days of Treatment Percent of Total Subscribers Remaining in Treatment Number of Subscribers Who Opt Out End of Treatment 0 19

19 USER CHARACTERISTICS OF TREATMENT ENGAGEMENT Odds of opting out Males OR: 0.866, 95% CI: 0.807, Older OR: 0.987, 95% CI: 0.984, Non-daily smokers OR: 0.866, 95% CI: 0.763, 0,984

20 IN-DEPTH INTERVIEWS From March 14, 2014, to April 4, 2014, the research team conducted IDIs with users of SmokefreeTXT 9 male, 9 female Qualitative data Usability & acceptability User interactions with the program, feasibility

21 OPPORTUNITIES: RESULTS In-depth interviews with program users suggest that opting-out was associated with relapse to smoking

22 CONCLUSIONS Analysis of user data provides insight to guide further research and intervention refinement Many subscribers opt out before program end Some subscribers do not respond SmokefreeTXT supports short-term cessation in a real-world implementation CONSIDERATIONS Low response rates for long-term follow up Does no response/opt-out mean relapse? 23

23 CONCLUSIONS CONTINUED Sub-optimal engagement is a challenge for mhealth interventions Fail points are opportunities for improvement Real world process data is needed to guide the design and implementation of mhealth interventions 24

24 Thank you! Smokefree.gov/SmokefreeTXT 25