Controlled smoking as a method of tobacco dependence treatment has been studied since the early 1970s but has required refinement to become an effective tool for achieving abstinence. Applying this technique as a treatment tool has become logistically and commercially feasible with the advent of handheld computer devices.

In this study, LIFETECHniques, Inc., pilot-tested the effectiveness of an alpha version of a computerized device that delivers a scheduled, reduced-smoking regimen for quitting smoking. The aim of the study was to determine whether participants using a feedback-enabled scheduled reduced-smoking device would have significantly higher abstinence rates and report reduced withdrawal symptoms, compared with control subjects.

Description

This pilot study compared a Treatment regimen involving real-time usage feedback vs. a no-treatment Control regimen. The Control group used an identical device to that used by the Treatment group, but with the feedback feature disabled and without a scheduled, reduced-smoking plan.
N = 46 subjects were randomized to the two treatment groups.

Subjects were as follows:

Gender: 28 males, 18 females
Age range: 18 to 70 years old

During one week of baseline measurements, the devices provided no feedback to either the Treatment or the Control groups. After baseline, subjects began using the devices to reduce smoking. Subjects in the Treatment group were prompted when to smoke; Control subjects were advised to reduce their smoking ad lib but were not given a schedule for reduction.

The computerized devices were used by the subjects throughout each day of the study. The devices automatically recorded subjects’ cigarette usage 24 hours each day. Usage data were uploaded at weekly office visits. Duration of the treatment portion of the trial was 5 weeks.

Attrition during the first month occurred after Week 1, with 45% (10 of 22) of Treatment subjects and 33% (8 of 24) of Control subjects no longer participating, and presumed still smoking, by the end of Week 4.

This figure depicts Treatment group subjects’ cigarette use across 35 days of the study.
Note the greater volume on weekends (days 5-6, 12-13, etc.).

The Treatment group experienced a more positive cessation outcome than the Control group (Fisher’s exact test, p < .001, comparing those subjects remaining in the study), with biologically verified seven-day quit rates:

This finding continued as a trend, with subjects remaining in the study providing self-reported abstinence rates at day 29:

The treatment group’s cigarette use declined more sharply than did that of the Control subjects. Average cigarettes per day (cpd) declined across the five weeks of the study as follows:

The Treatment group decreased cigarette consumption more rapidly than the Control group, but with a trend toward less symptomatic discomfort . A larger sample size will be needed for establishing significance of specific abstinence symptoms under Treatment conditions.

Conclusions

The Treatment results in this pilot testing reflect the potential for using this computerized device for treating tobacco dependence treatment. Additionally, the desirability of further enhancing the usability of the device and minimizing abstinence symptoms is evident. These findings also underscore the need to examine individual smoking-reduction patterns and needs.

This project was funded by U.S. National Institutes of Health grant R43 DA12901-01.