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The Institute for International Internet Interventions for Health at Palo Alto University proposes to develop digital tools specifically designed to help low income English-speaking and Spanish-speaking smokers to quit. With support from TRDRP, in 1998 our research group, then based at the University of California, San Francisco, began work on the San Francisco Stop Smoking website (www.stopsmoking.ucsf.edu). We have now had over 347,000 visitors to the site from over 200 countries and territories and 52,268 consented participants in several online smoking cessation trials. Our published quit rates (using the missing = smoking convention, in which participants with missing data are assumed to be smoking) are comparable to those reported by the nicotine patch or smoking cessation groups. Secondary analyses of our results, however, indicate that users from lower-income countries and those with lower social status quit at lower rates than those from high-income countries and those with higher social status.
We therefore requested TRDRP support to launch a project designed to test whether a mobile-based digital intervention designed with systematic input from low-income English- and Spanish-speaking smokers from a public sector health care system can significantly improve its acceptability, utilization, and effectiveness. Using human-centered development methods, we will involve low-income patients of the San Francisco Health Network in the design of a web app/text messaging tool. We will also use their input to improve our recruitment and dissemination strategies. We will join forces with the Center for Behavioral Intervention Technologies (CBITs) at Northwestern University to develop successive versions of the digital interventions informed by our human-centered approach. The project involves three specific aims:
- Specific Aim #1: Human-centered development of an English/Spanish smoking cessation web app. We will develop iterative versions of a digital smoking cessation tool (a web app with text messaging components) that is highly responsive to the needs and preferences of low-income English- and Spanish-speaking smokers. Development will take place with systematic input from patients who are part of the San Francisco Health Network (SFHN). The SFHN serves 70,000 members, most of whom are low-income individuals.
- Specific Aim #2: Improvement of dissemination strategies. Input from SFHN patients will identify effective ways of reaching and encouraging low-income English- and Spanish-speaking smokers to use the digital smoking cessation interventions to be developed. This information will support ongoing dissemination and implementation efforts beyond the grant period.
- Specific Aim #3: Evaluation of resulting smoking cessation web app. We will evaluate the effectiveness of the successive versions of the resulting stop smoking web app by recruiting smokers at two levels: a) within the SFHN, and b) throughout the state of California, culminating with an online randomized controlled trial. Increased effectiveness will be defined as 1) increased utilization of the web app and 2) higher abstinence rates than those obtained by a baseline “usual care” web app.
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