March 3, 2016

Our tobacco cessation research is smoking hot


Dr. McClure studies how best to fight the most common preventable cause of death—including the apps for that.

With widespread smoking bans, you might think tobacco is all “been there, done that.” So many people have accomplished the hard work of quitting smoking, and Group Health has played a major role in that success story since the 1980s.

Group Health helped develop the phone and online tools that are now standard care for Alere Wellbeing’s tobacco quitline program, Quit for Life. (Alere is the United States’ leading quitline service provider.) We also helped to prove that combining behavioral coaching with medication—like nicotine patches, bupropion, and varenicline (Chantix)—works best for quitting. And we were the first to demonstrate that tailoring your medication based on your DNA is feasible in a health care setting, helping to pave the way for more personalized treatments in a few years.

But the story is far from over: Although rates of tobacco use fell dramatically for decades, they’ve plateaued in recent years, with only about a three percent decline in the past decade.

“That’s a tragedy, because tobacco claims more lives than does any other cause that can be prevented,” says Jennifer McClure, PhD, a senior investigator at GHRI who has devoted her career to changing this harmful—and addictive—behavior. Now she’s focusing on new developments like mobile applications for quitting smoking, alternative behavioral approaches to help people quit, and vaping e-cigarettes.

Online programs and mobile apps’ active ingredients

“For years, we have been studying how to make stop smoking programs delivered over the Internet more effective. Now we are focusing on mobile apps and the ‘active ingredients’ of these programs,” Dr. McClure says. “We want to know how best to design apps to help people quit smoking. If we can do that, we can greatly increase access to evidence-based care and help a lot more people quit smoking.”

“We already know what drives relapse: cravings, nicotine withdrawal symptoms, and medication side effects,” she says. “Mobile apps give us a chance to intervene with people in the moment, as they experience these things. That means we have the opportunity to provide them the right help at just the right time.”

But not all apps deliver on this promise. “Most Smartphone apps for smoking cessation are not particularly smart,” Dr. McClure says. Most commercially available apps aren’t based on evidence and don’t even take advantage of the technology to tailor help to individuals’ changing needs, she explains.

That’s why Dr. McClure and colleagues at the University of Michigan and University of California (UC) developed My Mobile Advice Program (MyMAP), a comprehensive new mobile app. “It’s a really cool intervention,” she says: the first to combine traditional self-help content with automated, adaptively tailored help plus the ability to get additional assistance from a trained counselor using secure messaging. In a pilot study to be reported soon, it seems feasible and acceptable.

In a recent survey, Smartphone-owning smokers and clinical experts agreed that stop-smoking apps should be free or low cost, keep information private, help to manage nicotine withdrawal symptoms and medication side effects, and let users track their progress. Dr. McClure conducted the survey with Andrea Hartzler, PhD, a GHRI assistant investigator, and Sheryl Catz, PhD, of UC Davis, an affiliate researcher at GHRI. “Most important, and in keeping with our prior findings with online programs,” Dr. McClure says, “smokers and clinical experts told us these programs need to be tailored and adaptable: to match individual needs and interests, and adapt as those interests change.”

She adds: “When people feel the content applies to them and addresses their concerns, it may be more effective—and may even be processed differently by the brain.”

Acceptance and commitment therapy

“Standard cognitive and behavioral therapy (CBT) helps many smokers to quit,” she says. “But it doesn’t work for everyone, so we want to offer them new tools.” One new tool is acceptance and commitment therapy (ACT), which tries to increase psychological flexibility by teaching people acceptance and mindfulness strategies. She and colleagues at the Fred Hutchinson Cancer Research Center are now analyzing a large randomized trial of group-based counseling—the first with enough statistical power to compare the effects of ACT to CBT for quitting smoking.

Vaping e-cigarettes

“Traditionally, people who smoke start in their teens or as young adults,” Dr. McClure said. “But now we’re seeing people of all ages trying e-cigarettes.” More than half of current and former smokers have tried e-cigs, as well as a growing number of adolescents. The risk of these devices is largely unknown, she says.

With Jessica Chubak, PhD, a GHRI associate investigator, Dr. McClure is studying cancer survivors’ use of e-cigarettes. They want to understand how common e-cigs are in this high-risk population and whether their use affects smoking over time.

Teachable moment

Using tobacco is well known for raising the risks for developing lung cancer, heart disease, and stroke. “A lung cancer diagnosis can be a ‘teachable moment’ when people are open to quitting smoking,” Dr. McClure said. Her team previously found that smokers told they had impaired lung function were more likely to stop smoking. In light of new recommendations that heavy and long-term smokers undergo lung cancer screening, she hopes to do research with this population soon.

Smoking also raises the risks for other cancers including mouth and throat cancers, as well as cavities and gum disease. “Dentists’ offices can be good places to intervene for smoking cessation,” Dr. McClure says. “But smokers tend to visit dentists less often than nonsmokers do.”

That’s why a more promising approach may be to integrate oral health coaching into the standard protocol for tobacco quitlines—and that’s just what she and Alere colleagues are studying now. “As people who’ve quit smoking go to the dentist and see their nice white teeth,” she adds, “we’re hoping that they’ll want to keep them that way—and that we’ll see synergistic effects on staying quit and maintaining oral health.”

Learn more

You can learn more about recent GHRI quit-smoking studies. And you can learn more about quitting smoking including making a quit plan, gathering your support team, trying again, and avoiding weight gain.


by Rebecca Hughes