Jonathan Bricker

Understanding the characteristics of high and low utilizers of smartphone applications (apps) for smoking cessation would inform development of more engaging and effective apps, yet no studies to date have addressed this critical question. Informed by prior research on predictors of cessation Web site utilization, this study examines the degree to which baseline demographic factors (gender, age, and education), smoking-related factors (smoking level and friends' smoking), and psychological factors (depression and anxiety) are predictive of utilization of a smartphone app for smoking cessation called SmartQuit. Data came from 98 participants randomized to SmartQuit as part of a pilot trial from March to May 2013. We used negative binomial count regressions to examine the relationship between user characteristics and utilization of the app over an 8-week treatment period. Lower education (risk ratio [RR]=0.492; p=0.021), heavier smoking (RR=0.613; p=0.033), and depression (RR=0.95...

For scientific and public health reasons, it is important to identify the role of family influences on child smoking acquisition. Using a well-followed (>90%) cohort of 3,012 children and their parents, this study prospectively investigated the influence of smoking by 0 vs. 1 vs. 2 parents when the children were young (3rd grade), on whether the children subsequently became daily smokers. It is the only study to investigate the prediction of child/adolescent smoking at the end of the smoking acquisition period (12th grade) by parental smoking at the start of the period (3rd grade). Logistic regression analyses revealed that having one parent who smokes substantially increases the risk that children will become daily smokers, relative to families where neither parent smokes (OR=1.90, p<.01). There is no evidence that the increased risk depends on parent or child gender. These results suggest the need for public health interventions that inform parents of young children that the...

This controlled preliminary trial determined the feasibility and initial effectiveness of a promising behavioral intervention for smoking: Acceptance and Commitment Therapy (ACT). In a quasi-experimental design, the ACT intervention condition used metaphors and experiential exercises focused on personal values to motivate quitting smoking and enhancing the willingness to experience internal cues to smoke (e.g., urges) and abstinence-related internal distress. The comparison condition was cognitive behavioral therapy (CBT)--the current standard in behavioral intervention for smoking cessation. Each treatment was delivered in seven weekly 90-min sessions in a group format to 81 (43 in ACT; 38 in CBT) adult smokers. Results show that the ACT treatment was as feasible as the CBT treatment. They also demonstrate promising evidence of ACT's effectiveness: 30.2% intent-to-treat biochemically-supported 30-day point prevalence at twelve month follow-up, compared with 13.2% in the CBT condition (odds ratio = 5.13; p = .02). Replication in a well-powered, randomized, controlled trial is now needed.

The present study investigated whether parents' antismoking actions mediated the prospective relationship between parental smoking cessation and children's smoking. Smoking status of parents (predictor) was assessed when their children were in 3rd grade, parental antismoking actions (mediators) were assessed when their children were in 11th grade, and children's smoking status (outcome) was assessed when they were in 12th grade. In 20 Washington state school districts, data were collected from 1,600 children (49% female, 91% White) and from their parents. Results showed that children's odds of daily smoking were reduced by 39% (95% CI = 24%-51%) for those whose parents had quit smoking, compared with those whose parents were current smokers. Asking to sit in nonsmoking sections of public establishments was a significant (p<.01) mediator that explained 64% of the association between parental smoking cessation and children's smoking. However, not allowing smoking in the home and asking others not to smoke around them were not significant mediators (p = .10, and p = .06, respectively). In conclusion, asking to sit in a nonsmoking section of a public establishment substantially mediates the relationship between parental smoking cessation and children's smoking.

Quitline smoking cessation counseling results in a mere 12% success rate. Testing of new telephone-delivered cessation counseling approaches is needed. Determine the feasibility of the first telephone-delivered Acceptance and Commitment Therapy (ACT) intervention for smoking cessation. Fourteen adults (57% racial/ethnic minority, 8/14) in a single-arm study. Counselor proactively delivered a 5-session (90-min total) ACT telephone intervention for smoking cessation. Hypothesized ACT processes were self-reported at baseline and posttreatment. Smoking status was self-reported at baseline, 20-day posttreatment (93% retention, 13/14), and 12-month posttreatment (93% retention, 13/14). (a) Delivery length and duration: average of 3.5 calls and 81.9-min intervention duration. (b) Receptivity: 100% (14/14) felt respected by the counselor, 86% (12/14) said that intervention was a good fit, and 93% (13/14) said that intervention helped them quit. (c) ACT processes: (i) acceptance of physical cravings, emotions, and thoughts that cue smoking increased from baseline to posttreatment (p = .001, p = .038, and p = .085, respectively) and (ii) commitment to quitting increased from baseline to posttreatment (p = .01). (4) Intent-to-treat cessation outcomes: (i) at 20-day posttreatment, 43% (6/14) had not smoked the day of the survey and 29% (4/14) had not smoked in past 7 days and (ii) at 12-month posttreatment, 29% (4/14) had not smoked at all in past 12 months. These quit rates are over double the 12% quit rates of current standard telephone counseling. Telephone-delivered ACT shows promise for smoking cessation and warrants future testing in a well-powered randomized trial.

Motivational Interviewing (MI) and Acceptance and Commitment Therapy (ACT) are two emerging therapies that focus on commitment to behavior change. The aim was to provide the first systematic comparison of MI with ACT. A systematic comparison was undertaken of MI and ACT at the conceptual level, with a focus on their philosophical and theoretical bases, and at the clinical level, with a focus on the therapeutic relationship, use of language in therapy, and use of values in therapy. Conceptually, MI and ACT have distinct philosophical bases. MI's theoretical basis focuses on language content, whereas ACT's theoretical basis focuses on language process. Clinically, ACT and MI have distinct approaches to the therapeutic relationship, fundamentally different foci on client language, and different uses of client values to motivate behavior change. ACT, but not MI, directly targets the willingness to experience thoughts, feelings, and sensations. Despite their conceptual and clinical differences, MI and ACT are complementary interventions. Collaborations between MI and ACT researchers may yield fruitful cross-fertilization research on core processes and clinical outcomes.

Although parental smoking is clearly one important influence on children's smoking, it is still unclear what are the many mechanisms by which parents influence their children's smoking. Antismoking actions are one potential mechanism. To determine whether parental antismoking actions including having rules about smoking in one's home, using nonsmoking sections of public establishments, or asking others not to smoke in one's presence are associated with adolescents' adoption of smoking. A cross-sectional survey. Rural and suburban communities in western Washington State. Population-based cohort of 3555 adolescents and their parents. Daily smoking in 12th grade. Adolescents of parents who report having rules about smoking in one's home, using nonsmoking sections of public establishments, or asking others not to smoke in one's presence were significantly less likely to smoke than adolescents of parents who did not engage in antismoking actions. This association of antismoking action and reduced smoking was found for children of both smoking and nonsmoking parents. Parents' antismoking actions may help prevent smoking by their teenaged children.

For scientific and public health reasons, it is important to identify the role of family influences on child smoking acquisition. Using a well-followed (>90%) cohort of 3,012 children and their parents, this study prospectively investigated the influence of smoking by 0 vs. 1 vs. 2 parents when the children were young (3rd grade), on whether the children subsequently became daily smokers. It is the only study to investigate the prediction of child/adolescent smoking at the end of the smoking acquisition period (12th grade) by parental smoking at the start of the period (3rd grade). Logistic regression analyses revealed that having one parent who smokes substantially increases the risk that children will become daily smokers, relative to families where neither parent smokes (OR=1.90, p<.01). There is no evidence that the increased risk depends on parent or child gender. These results suggest the need for public health interventions that inform parents of young children that their own smoking behavior increases their children's risk for future smoking.

This study investigated longitudinally the extent to which childhood friends who smoke influence adolescents' smoking transitions, and compared that influence with that of parents who smoke. In a sample of 4744 children, results showed that the probability, per close friend, that a smoking close friend influenced the adolescent to make the first transition to trying smoking was 38% (95% CI: 28%, 46%); to make the second transition from trying to monthly smoking, 10% (95% CI: 5%, 15%); and to make the third transition from monthly to daily smoking, 11% (95% CI: 5%, 17%). Compared to parents' smoking, close friends' smoking was 12% (p=0.03) more influential for the first transition, no different for the second transition (p=0.53), and 16% (p=0.01) less influential for the third transition. Results provide new evidence suggesting that childhood close friends who smoke influence not only initiation but also escalation of adolescents' smoking. Results also confirmed the important role of parents' smoking. Targeting both childhood close friends' and parents' smoking would be valuable in prevention research.