Behavioral Activation mHealth Application for Smoking Cessation: A Randomized Controlled Pilot Trial

Abstract

Abstract Introduction Behavioral activation (BA) is an effective intervention for both depression and substance use disorders. Combining BA with a standard smoking cessation intervention may improve quit rates by addressing depressive symptoms, a key barrier to quitting. This study preliminarily evaluated the acceptability and efficacy of the BA-based Actify! mobile health application (mHealth app) for smoking cessation. Aims and Methods We conducted a pilot randomized controlled trial (n = 242) comparing Actify! with the National Cancer Institute’s (NCI) app for smoking cessation (QuitGuide) on acceptability (user satisfaction, app openings), smoking abstinence, and mechanisms of change (BA and depressive symptoms) at 8 weeks and 6 months postrandomization. Participants were US adults recruited online who smoked daily. Results Treatment satisfaction was uniformly higher in the Actify! arm. Number of app openings was similar across arms (M = 34.3 openings over 8 weeks in both arms). Self-reported 30-day point prevalence abstinence (PPA) at 8 weeks was 12.6% for Actify! versus 7.3% for QuitGuide. Differences in 30-day PPA continued through 6 months (18.5% for Actify! vs. 12.2% for QuitGuide). Changes between baseline and 8 weeks in depressive symptoms and BA favored Actify!. Planned subgroup analyses suggested greater benefit of Actify! among participants with pretreatment mild-to-moderate depression symptom severity compared to those with no depression symptoms. Conclusions Actify! showed considerable promise as a novel mHealth treatment, as evidenced by its high usage and higher user satisfaction and quit rates than QuitGuide at both short- and long-term follow-up. The next step is to evaluate Actify! in a fully powered efficacy trial. Implications Study findings demonstrate the promise of a BA-based mobile health app (Actify!) for smoking cessation as a population-level intervention that can effectively address depressive symptoms as a risk factor for worse smoking treatment outcomes. The Actify! app is the first standalone BA-based app to demonstrate potential for improved acceptability and efficacy relative to a standard care comparison app, with user satisfaction and smoking quit rates descriptively exceeding those of the NCI’s QuitGuide app.