There is tremendous need for efficacious and accessible interventions for smoking cessation among American Indians and Alaska Natives. We tested the efficacy of an Acceptance and Commitment Therapy (ACT)-based smartphone application (iCanQuit) vs. US Clinical Practice Guidelines based smartphone application (QuitGuide) for smoking cessation among American Indians and Alaska Natives.
We compared cessation, changes in ACT-based processes, engagement and satisfaction between American Indians and Alaska Natives iCanQuit (n=89) and QuitGuide (n=80) trial participants enrolled in the iCanQuit trial. The primary outcome was self-reported, complete-case, 30-day point-prevalence abstinence (PPA). Follow-up timepoints were 12, 6, and 3-months.
Randomized American Indians and Alaska Natives from 31 US states (70% urban, 30% rural, with 25% of participants residing on tribal land). The outcome data retention rates were 93%, 92%, and 90% at the 12, 6, and 3-month follow-ups, respectively, with no differential retention between arms. The 30-day PPA for iCanQuit vs. QuitGuide was 30% vs. 18% at 12-months (OR=1.96; 95% CI: 0.90, 4.26) 25% vs. 11% at 6-months (OR=2.62; 95% CI: 1.06, 6.45), and 15% vs. 6% at 3-months (OR=2.93; 95% CI: 0.90, 9.59). Increases in acceptance of internal cues to smoke mediated the effect of treatment on smoking cessation at 12-months. iCanQuit arm participants were also significantly more engaged and satisfied with their assigned application.
In a nationwide sample with high data retention and participant engagement, this is the first study to show that a digital intervention may be efficacious for helping American Indians and Alaska Natives quit smoking.
This is the first study to provide evidence of an efficacious, accessible, and engaging treatment for helping American Indians and Alaska Natives quit smoking. Compared to a USCPG-based smartphone application (QuitGuide), an ACT-based smartphone application (iCanQuit) was more efficacious, engaging, and satisfactory among American Indians and Alaska Natives nationwide. Our results will inform the tailoring of the iCanQuit smartphone application for American Indian and Alaska Native tribal communities and organizations with potential for broad dissemination and high impact.