Libre Del Cigarrillo: Development of an mHealth Smoking Cessation App to Extend Reach of a Validated Smoking Cessation Intervention for Spanish-speaking Smokers - Project Summary Racial/ethnic minorities suffer disproportionately from smoking related morbidity and mortality. Four of the five leading causes of death among Hispanic/Latinx (hereafter referred to as Hispanic) individuals are smoking-related; thus, there is a significant public health need to reduce smoking in this population. Despite the Hispanic population being the largest and one of the fastest growing minority populations, there is a dearth of culturally appropriate Spanish-language smoking cessation interventions. Previous work from our research group and others has demonstrated unique barriers faced by Hispanic smokers, such as less access to cessation treatments and overall less utilization of evidence-based cessation treatments. To address the gap in availability of Spanish-language interventions, our team used a multi-step process to develop a printed self- help smoking cessation intervention for Hispanic smokers, “Libre del cigarrillo, por mi familia y por mí: Guía para dejar de fumar” (LDC; “Free from cigarettes, for my family and for me: Guide to quitting smoking”). Findings from our randomized controlled trial (RCT) with a nationwide sample (N=1,417), revealed high efficacy of our intervention through 24 months compared to Usual Care (an NCI-produced Spanish-language self-help booklet). There are, however, key limitations with the print modality, including the inability to access intervention content in real time and limited ability to enhance engagement with the intervention content. Given the increasing popularity of digital interventions and high ownership of smartphones among Hispanics (91%) a smartphone app delivering evidence-based smoking cessation content can overcome these barriers and has additional strengths. The goals of this study are to adapt our validated printed smoking cessation intervention for Spanish-speaking smokers into a smartphone app (Aim 1) and to conduct a three-arm pilot RCT to examine feasibility and acceptability of the smartphone app intervention and feasibility of the future clinical trial (Aim 2). The smartphone app version will be based on our recent formative research, bidirectional stakeholder engagement, and validated content that we have already transcreated and will be enhanced via functionality of the app (Aim 1). After the Libre del Cigarrillo smartphone App is developed (Aim 1), participants (N=120) will be randomly assigned to either the: (1) newly developed Libre del Cigarrillo smartphone app; (2) existing Libre del Cigarrillo booklets; or (3) NCI smokefree TXT (text) program in Spanish (standard-of-care-comparator) (Aim 2). We will evaluate feasibility and acceptability of the smartphone app and future clinical trial feasibility using a priori benchmarks. We will also measure changes in intermediary smoking-related variables (e.g., motivation, self-efficacy) and smoking behavior. This R34 represents the next logical step in a systematic approach to develop scalable, cost-effective, and accessible smoking cessation interventions for Spanish- speaking individuals who smoke. This work has potential to expand dissemination of smoking cessation interventions to an underserved population, and ultimately reduce tobacco-related health disparities.
