Does socioeconomic position moderate the associations between the content and delivery features of digital behaviour change interventions for smoking cessation and intervention effectiveness? A systematic review and meta-analysis.

Prior research indicates that digital smoking cessation interventions can be effective, but little is known about their active ingredients. Therefore, this review aimed to examine the associations of content (behaviour change techniques [BCTs]), delivery features (delivery mode, readability, ease-of-use), and socioeconomic position with effectiveness. Systematic searches and hand searches were conducted from February to June 2023 to identify experimental evaluations of digital smoking cessation interventions published since 2004.

Effectiveness of the Offer of the Smoke Free Smartphone App Compared With No Intervention for Smoking Cessation: Pragmatic Randomized Controlled Trial.

Background: Digital technologies offer the potential for low-cost, scalable delivery of interventions to promote smoking cessation.

Objective: We aimed to evaluate the effectiveness of the offer of Smoke Free-an evidence-informed, widely used app-for smoking cessation versus no support.

Methods: In this 2-arm randomized controlled trial, 3143 motivated adult smokers were recruited online between August 2020 and April 2021 and randomized to receive an offer of the Smoke Free app plus follow-up (intervention arm) versus follow-up only (comparator arm).

The iterative development and refinement of health psychology theories through formal, dynamical systems modelling: a scoping review and initial expert-derived 'best practice' recommendations.

This scoping review aimed to synthesise methodological steps taken by researchers in the development of formal, dynamical systems models of health psychology theories. We searched MEDLINE, PsycINFO, the ACM Digital Library and IEEE Xplore in July 2023. We included studies of any design providing that they reported on the development or refinement of a formal, dynamical systems model unfolding at the within-person level, with no restrictions on population or setting.

Supervised machine learning to predict smoking lapses from Ecological Momentary Assessments and sensor data: Implications for just-in-time adaptive intervention development.

Specific moments of lapse among smokers attempting to quit often lead to full relapse, which highlights a need for interventions that target lapses before they might occur, such as just-in-time adaptive interventions (JITAIs). To inform the decision points and tailoring variables of a lapse prevention JITAI, we trained and tested supervised machine learning algorithms that use Ecological Momentary Assessments (EMAs) and wearable sensor data of potential lapse triggers and lapse incidence. We aimed to identify a best-performing and feasible algorithm to take forwards in a JITAI.

Evaluating the Acceptability of the Drink Less App and the National Health Service Alcohol Advice Web Page: Qualitative Interview Process Evaluation.

Background: The extent to which interventions are perceived as acceptable to users impacts engagement and efficacy.

Objective: In this study, we evaluated the acceptability of (1) the smartphone app Drink Less (intervention) and (2) the National Health Service (NHS) alcohol advice web page (usual digital care and comparator) among adult drinkers in the United Kingdom participating in a randomized controlled trial evaluating the effectiveness of the Drink Less app.

Methods: A subsample of 26 increasing- and higher-risk drinkers (Alcohol Use Disorders Identification Test score≥8) assigned to the intervention group (Drink Less; n=14, 54%; female: n=10, 71%; age: 22-72 years; White: n=9, 64%) or usual digital care group (NHS alcohol advice web page; n=12, 46%; female: n=5, 42%; age: 23-68 years: White: n=9, 75%) took part in semistructured interviews.

Do engagement and behavioural mechanisms underpin the effectiveness of the Drink Less app?

This is a process evaluation of a large UK-based randomised controlled trial (RCT) (n = 5602) evaluating the effectiveness of recommending an alcohol reduction app, Drink Less, compared with usual digital care in reducing alcohol consumption in increasing and higher risk drinkers. The aim was to understand whether participants' engagement ('self-reported adherence') and behavioural characteristics were mechanisms of action underpinning the effectiveness of Drink Less. Self-reported adherence with both digital tools was over 70% (Drink Less: 78.

Developing content for a virtual reality scenario that motivates quit attempts in adult smokers: A focus group study with art-based methods.

Virtual reality (VR) could be used to deliver messages to smokers that encourages them to attempt quitting. For a VR smoking cessation intervention to be effective, the target population must find the content engaging, relevant, inoffensive, and compelling. Informed by health behaviour theory and narrative transportation theory, this study used focus groups combined with art-based methods (participant sketches) to inform the development of VR content that will appropriately address smokers' beliefs about quitting smoking.

Mobile Health Interventions for Substance Use Disorders.

Substance use disorders (SUDs) have an enormous negative impact on individuals, families, and society as a whole. Most individuals with SUDs do not receive treatment because of the limited availability of treatment providers, costs, inflexible work schedules, required treatment-related time commitments, and other hurdles. A paradigm shift in the provision of SUD treatments is currently underway.

Barriers and Enablers to the Adoption of a Healthier Diet Using an App: Qualitative Interview Study With Patients With Type 2 Diabetes Mellitus.

Background: Adopting a healthy diet is one of the cornerstones of type 2 diabetes (T2D) management. Apps are increasingly used in diabetes self-management, but most studies to date have focused on assessing their impact in terms of weight loss or glycemic control, with limited evidence on the behavioral factors that influence app use to change dietary habits.

Objective: The main objectives of this study were to assess the enablers and barriers to adopting a healthier diet using the Gro Health app in 2 patient groups with T2D (patients with recently diagnosed and long-standing T2D) and to identify behavior change techniques (BCTs) to enhance enablers and overcome barriers.

Personality typologies of smokers and excessive drinkers: a cross-sectional survey of respondents in the BBC Lab UK Study.

Background: Several personality traits have been linked to addictive behaviours, including smoking and excessive drinking. We hypothesised that the combination of low conscientiousness, high extraversion and high neuroticism would be synergistically associated with smoking, excessive drinking and both behaviours combined.

Methods: Respondents aged 16+ years ( =363,454) were surveyed between 2009-2013 as part of the BBC Lab UK Study, with no restrictions on geographical location.

User Engagement Clusters of an 8-Week Digital Mental Health Intervention Guided by a Relational Agent (Woebot): Exploratory Study.

Background: With the proliferation of digital mental health interventions (DMHIs) guided by relational agents, little is known about the behavioral, cognitive, and affective engagement components associated with symptom improvement over time. Obtaining a better understanding could lend clues about recommended use for particular subgroups of the population, the potency of different intervention components, and the mechanisms underlying the intervention's success.

Objective: This exploratory study applied clustering techniques to a range of engagement indicators, which were mapped to the intervention's active components and the connect, attend, participate, and enact (CAPE) model, to examine the prevalence and characterization of each identified cluster among users of a relational agent-guided DMHI.

How Notifications Affect Engagement With a Behavior Change App: Results From a Micro-Randomized Trial.

Background: Drink Less is a behavior change app to help higher-risk drinkers in the United Kingdom reduce their alcohol consumption. The app includes a daily notification asking users to "Please complete your drinks and mood diary," yet we did not understand the causal effect of the notification on engagement nor how to improve this component of Drink Less. We developed a new bank of 30 new messages to increase users' reflective motivation to engage with Drink Less.

Classification of Lapses in Smokers Attempting to Stop: A Supervised Machine Learning Approach Using Data From a Popular Smoking Cessation Smartphone App.

Introduction: Smoking lapses after the quit date often lead to full relapse. To inform the development of real time, tailored lapse prevention support, we used observational data from a popular smoking cessation app to develop supervised machine learning algorithms to distinguish lapse from non-lapse reports.

Aims And Methods: We used data from app users with ≥20 unprompted data entries, which included information about craving severity, mood, activity, social context, and lapse incidence.

A pilot randomised trial of a brief virtual reality scenario in smokers unmotivated to quit: Assessing the feasibility of recruitment.

Individual-level interventions for smokers unmotivated to quit remain scarce and have had limited success. Little is known about the potential of virtual reality (VR) for delivering messaging to smokers unmotivated to quit. This pilot trial aimed to assess the feasibility of recruitment and acceptability of a brief, theory-informed VR scenario and estimate proximal quitting outcomes.

Within-person associations between psychological and contextual factors and lapse incidence in smokers attempting to quit: A systematic review and meta-analysis of ecological momentary assessment studies.

Aims: When attempting to stop smoking, discrete smoking events ('lapses') are strongly associated with a return to regular smoking ('relapse'). No study has yet pooled the psychological and contextual antecedents of lapse incidence, captured in ecological momentary assessment (EMA) studies. This systematic review and meta-analysis aimed to synthesize within-person psychological and contextual predictor-lapse associations in smokers attempting to quit.

Estimated Failure to Report Unsuccessful Quit Attempts by Type of Cessation Aid: A Population Survey of Smokers in England.

Introduction: It has been estimated that smokers tend to fail to report unsuccessful quit attempts that lasted a short time and occurred a longer time ago. However, it is unclear whether the failure to report unsuccessful quit attempts varies by the type of cessation aid used.

Methods: A total of 5,892 smokers aged 16+ years who had made 1+ quit attempts in the past year were surveyed between January 2014 and December 2020 as part of the Smoking Toolkit Study.

The Effect of the First UK COVID-19 Lockdown on Users of the Drink Less App: Interrupted Time Series Analysis of Sociodemographic Characteristics, Engagement, and Alcohol Reduction.

Background: The first UK COVID-19 lockdown had a polarizing impact on drinking behavior and may have impacted engagement with digital interventions to reduce alcohol consumption.

Objective: We examined the effect of lockdown on engagement, alcohol reduction, and the sociodemographic characteristics of users of the popular and widely available alcohol reduction app Drink Less.

Methods: This was a natural experiment.

Understanding health behaviours in context: A systematic review and meta-analysis of ecological momentary assessment studies of five key health behaviours.

Ecological Momentary Assessment (EMA) involves repeated, real-time sampling of health behaviours in context. We present the state-of-knowledge in EMA research focused on five key health behaviours (physical activity and sedentary behaviour, dietary behaviour, alcohol consumption, tobacco smoking, sexual health), summarising theoretical (e.g.

Smoking Cessation Smartphone App Use Over Time: Predicting 12-Month Cessation Outcomes in a 2-Arm Randomized Trial.

Background: Little is known about how individuals engage over time with smartphone app interventions and whether this engagement predicts health outcomes.

Objective: In the context of a randomized trial comparing 2 smartphone apps for smoking cessation, this study aimed to determine distinct groups of smartphone app log-in trajectories over a 6-month period, their association with smoking cessation outcomes at 12 months, and baseline user characteristics that predict data-driven trajectory group membership.

Methods: Functional clustering of 182 consecutive days of smoothed log-in data from both arms of a large (N=2415) randomized trial of 2 smartphone apps for smoking cessation (iCanQuit and QuitGuide) was used to identify distinct trajectory groups.

Exploring Users' Experiences With a Quick-Response Chatbot Within a Popular Smoking Cessation Smartphone App: Semistructured Interview Study.

Background: Engagement with smartphone apps for smoking cessation tends to be low. Chatbots (ie, software that enables conversations with users) offer a promising means of increasing engagement.

Objective: We aimed to explore smokers' experiences with a quick-response chatbot (Quit Coach) implemented within a popular smoking cessation app and identify factors that influence users' engagement with Quit Coach.

Associations between smoking to relieve stress, motivation to stop and quit attempts across the social spectrum: A population survey in England.

Smoking prevalence in several high-income countries is steadily declining but remains persistently high in 'lower' socioeconomic position (SEP) groups, contributing to inequities in morbidity and mortality. Smoking to relieve stress is a commonly endorsed motive for continued smoking; however, it remains unclear whether smoking to relieve stress has a negative impact on motivation to stop and future quit attempts and if so, whether associations are moderated by SEP. This was an observational study with cross-sectional and prospective survey data from the nationally representative Smoking Toolkit Study in England.

White Paper: Open Digital Health - accelerating transparent and scalable health promotion and treatment.

In this White Paper, we outline recommendations from the perspective of health psychology and behavioural science, addressing three research gaps: (1) What methods in the health psychology research toolkit can be best used for developing and evaluating digital health tools? (2) What are the most feasible strategies to reuse digital health tools across populations and settings? (3) What are the main advantages and challenges of sharing (openly publishing) data, code, intervention content and design features of digital health tools? We provide actionable suggestions for researchers joining the continuously growing Open Digital Health movement, poised to revolutionise health psychology research and practice in the coming years. This White Paper is positioned in the current context of the COVID-19 pandemic, exploring how digital health tools have rapidly gained popularity in 2020-2022, when world-wide health promotion and treatment efforts rapidly shifted from face-to-face to remote delivery. This statement is written by the Directors of the not-for-profit Open Digital Health initiative (n = 6), Experts attending the European Health Psychology Society Synergy Expert Meeting (n = 17), and the initiative consultant, following a two-day meeting (19-20th August 2021).

Association of smoking status with hospitalisation for COVID-19 compared with other respiratory viruses a year previous: a case-control study at a single UK National Health Service trust.

 It is unclear whether smoking increases the risk of COVID-19 hospitalisation. We first examined the association of smoking status with hospitalisation for COVID-19 compared with hospitalisation for other respiratory viral infections a year previous. Second, we examined the concordance between smoking status recorded on the electronic health record (EHR) and the contemporaneous medical notes.

Changes in Cigarette Smoking and Vaping in Response to the COVID-19 Pandemic in the UK: Findings from Baseline and 12-Month Follow up of HEBECO Study.

This study investigated UK adults' changes in cigarette smoking and vaping during the COVID-19 pandemic and factors associated with any changes. Data were from an online longitudinal study. A self-selected sample (n = 332) of 228 smokers and 155 vapers (51 participants were both smokers and vapers) completed 5 surveys between April 2020 and June 2021.