PROJECT SUMMARY/ABSTRACT
Cigarette smoking remains the leading preventable cause of morbidity and mortality in the United States.
Developing effective cessation interventions remains a public health priority, and mHealth offers the
opportunity to reduce barriers to dissemination and implementation of cessation treatment. This project will test
the emerging technology of augmented reality (AR) to enhance smoking cessation among individuals who
contact the Tobacco Free Florida quitline for treatment services. AR inserts virtual objects into the real-world
environment as viewed on a screen (e.g., smartphone). Cue-exposure treatments have demonstrated efficacy
for decreasing tobacco craving in the laboratory, but these effects do not appear to generalize well beyond the
extinction setting. This post-extinction “renewal effect” has been demonstrated in both animal and human
studies. With the emergence of AR technology, it is now possible to conduct extinction trials across multiple
environments throughout smokers’ own real-world smoking settings. The potential to extend the effects of cue-
exposure to naturalistic settings offers the opportunity for an innovative and scalable cessation treatment that
can be administered remotely. With funding from an R34 treatment development grant, the research team has
already developed an app with the basic AR platform. Importantly, we have tested the app in controlled
experiments and found that the AR stimuli satisfied the key criterion for extinction cues in that they: (a) elicited
substantial cue-reactivity, comparable to in vivo cues and that (b) repeated exposure to the cues reduced
craving (i.e., extinction). The primary goal of the proposed project is to extend this initial work by adapting the
app for clinical use, with the objective of testing the efficacy of AR when combined with quitline treatment, while
also considering key questions relevant to future implementation. Aim 1 will expand the app to be an engaging
and user-friendly treatment tool for smokers, and to coordinate all referral procedures between the study team
and the Tobacco Free Florida quitline. Aim 2 will recruit participants from the Tobacco Free Florida quitline and
randomize individuals either to receive quitline services only or receive quitline services plus the AR app. The
primary outcome is biochemically-confirmed tobacco abstinence at 6 months post-enrollment. Aim 3 will
evaluate treatment implementation questions to guide future quitline adoption. If the AR app proves to be
efficacious, it will be ready for dissemination and implementation through quitlines as well as other smoking
cessation programs (e.g., traditional cessation counseling, text messaging interventions, other mobile
cessation apps). This work has the potential to inform a range of existing treatments not only for tobacco
dependence, but also for other substance use disorders and mental health conditions that are maintained by
principles of conditioning.