Feasibility of cue-based treatment intervention to promote cessation among people who smoke lightly (<=10 cigarettes per day) or non-daily - Smoking as little as once every few days significantly increases the risk of all-cause mortality. People who smoke lightly (<10 cigarettes per day (CPD)) and intermittently (PSLI), now represent over 50% of all current smokers. Most interventions for PSLI have applied treatments found to be effective for those who smoke >10 CPD rather than create interventions tailored to the unique challenges faced by PSLI. Existing interventions for those who smoke >10 CPD mostly use pharmacological and behavioral strategies aimed at attenuating symptoms of nicotine withdrawal. These strategies have shown limited success among PSLI, which is not surprising given PSLI typically report low or no nicotine withdrawal. We successfully conducted a small lab-based pilot study to establish feasibility, acceptability, and a signal for efficacy of a cue-based treatment for smoking cessation among PSLI. First, we piloted interactive texting where PSLI sent us pictures of cues from their natural environment. We included these pictures in the lab-based cue-based treatment to help reduce the salience of smoking cues among PSLI. Second, we asked PSLI to text us when they experienced a cue in their natural environment and then texted them a “retrieval cue” that had been linked with not smoking during lab-based cue-based treatment. We paired this cue-based treatment with standard cognitive behavioral treatment (CBT) that included eight weeks of SMS texting support messages and compared our intervention to CBT only. The next step is to adapt this promising intervention into one that is delivered remotely. Thus, an important next step is to adapt the intervention to a telehealth intervention and test it in a larger pilot to firmly establish feasibility, acceptability, and a signal for efficacy. We will work closely will our Community Advisory Board to refine our previously tested intervention and to guide all aspects of the pilot study. The overall aim of this study is to develop a cue-based treatment that can be delivered via telehealth and test whether it outperforms a standard treatment in promoting smoking cessation among PSLI. We propose a two-arm randomized feasibility trial: Arm 1: standard treatment (n=30), and Arm 2: enhanced cue-based treatment (n=30). The primary objective of this trial is to test the feasibility and acceptability of a remotely delivered cue-based treatment intervention to promote cessation in PSLI. Secondary objectives are to assess the preliminary efficacy of the intervention on smoking cessation and to examine the effect of the intervention on cue-reactivity.
