Development and feasibility testing of a mobile app to deliver an evidence-based intervention targeting financial stress and smoking - PROJECT SUMMARY Despite the overall declines in smoking in the U.S., tobacco use and tobacco-related illness remain high among the estimated 73 million Americans experiencing financial hardship. Moreover, tobacco use and financial hardship have a reinforcing relationship. Tobacco use exacerbates financial hardship by using money on tobacco that could go towards essentials, while financial hardship can lead people to smoke as a coping mechanism for stress. Financial hardship can also lead people to focus on their immediate needs for survival, leaving little time and attention to work on issues that benefit the future, such as quitting smoking. To intervene on the relationship between financial hardship and smoking, we previously conducted a randomized controlled trial (RCT; N=410) examining an in-person intervention that integrated financial coaching into smoking cessation treatment (called the Financial Freedom from Cigarettes, or FIERCE, intervention). At 6-months, participants randomized to FIERCE were more likely to report 7-day abstinence and lower markers of financial stress than participants randomized to usual care. To expand the reach and scalability of the FIERCE intervention, our long-term goal is to conduct a multi-site RCT estimating the effectiveness of a smartphone app that can enable virtual delivery of the FIERCE intervention. Significantly new data are needed before we can successfully conduct an R01-funded RCT testing a FIERCE smartphone app. Therefore, the Specific Aims of this R34 Planning Grant are to: (1) Develop a FIERCE smartphone app, (2) Evaluate FIERCE app user engagement, user experience, and preliminary efficacy, and (3) Evaluate the feasibility of study protocols needed to conduct a future fully-powered R01-funded RCT estimating the effectiveness of the FIERCE app. To achieve these aims, we will conduct a three-phase study. During Phase I, we will iteratively develop a FIERCE app to meet the needs and preferences of intended end-users (adults with financial hardship who smoke). During Phase 2, we will recruit N=15 adults with financial hardship who smoke for a single-group trial of the app. The trial will gather app engagement data and participants’ quantitative and qualitative feedback during an 8-week trial of the app. We will modify the app based on the Phase 2 trial results. During Phase 3, we will conduct a 12-week, two-arm, parallel-group pilot RCT. We will recruit 50 adults with financial hardship who smoke and randomize them (n=25 per arm) to either: (1) FIERCE app for 12 weeks or (2) QuitGuide (NCI’s publicly available smartphone app) for 12 weeks. We will survey participants at 12 weeks to assess their: (1) experiences with the app, (2) self-reported outcomes of smoking behaviors, financial stress, attention to quitting, and delay discounting, and (3) biochemically verified 7-day abstinence. We will also collect comprehensive RCT process data, including recruitment, retention, and data quality metrics.
