An Avatar-Led Intervention Promotes Smoking Cessation in Young Adults: A Pilot Randomized Clinical Trial
Open accessAbstract
Background: Smoking remains a global concern, especially for young adults. There is a dearth of smoking cessation programs for this population, who seldom seek help or are motivated to quit. Purpose: This pilot study assessed the effectiveness of a digital avatar-led Acceptance and Commitment Therapy (ACT) smoking cessation program (Flexiquit) for young adult smokers at all levels of motivation to quit. Methods: Smokers with no particular interest in quitting smoking (65.45% reported being in pre-contemplation or contemplation stages of change) were recruited from three universities (105 smoking ≥ 1 cigarette per day during the past 30 days, 68 females). Those who completed questionnaires online (N = 84; M = 22.44 years, SD = 2.61, range 18–28 years old) were randomized to either a six-session avatar-led intervention (Flexiquit; N = 49) or a wait-list control (N = 35). Primary outcomes included cessation status (7-day point prevalence) and number of cigarettes smoked per day; secondary outcomes were nicotine dependence, intention-to-quit smoking and self-efficacy, assessed at pre- and post-intervention, and only for Flexiquit at 6-month follow-up. Results: In intention-to-treat analysis more participants (OR = 3.10, 95% CI = 0.92–10.41) in the treatment group (28.57%) versus the control group (11.43%) reported quitting smoking; however, the difference was not statistically significant (p = .067). There were statistically significant decreases in average number of cigarettes, nicotine dependence and increases in self-efficacy, and intention-to-quit smoking compared to controls. Treatment gains in the Flexiquit group were maintained through the 6-month follow-up. Conclusions: An avatar-led digitized smoking cessation intervention based on ACT could increase the odds of quitting smoking. Findings suggest that a digitized program designed to engage young adults in smoking cessation may result in quitting smoking and has a high applicability potential especially among the hard-to-reach population of young adults. Question: Can an avatar-led digitized Acceptance and Commitment Therapy (ACT) smoking cessation intervention result in quitting smoking and increasing intention to quit among young smokers at various levels of motivation to quit, compared to a wait-list control group? Findings: In this pilot randomized clinical trial that included 84 smokers, 28.57% in the treatment condition versus 11.43% in the wait-list control group were abstinent at post (intention-to-treat [ITT] analysis). An avatar-led digitized ACT smoking cessation intervention results in high quitting smoking rates and has a high applicability potential especially among the hard-to-reach population of young adult smokers.
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Smartphone apps can be discreetly accessed, potentially reducing stigma often experienced by individuals with mental health disorders.
“Moreover, smartphone apps can be discreetly accessed, potentially reducing stigma often experienced by individuals with mental health disorders [42].”
From Can an Acceptance and Commitment Therapy-Based Smartphone App Help Individuals with Mental Health Disorders Quit Smoking? (2024) · cites this paper as [42]
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- Authors
- Karekla, M., Savvides, S. N., & Gloster, A.
- Affiliations
- University of Cyprus (CY)
- University of Basel (CH)
- Corresponding author
- Karekla, Maria
- Venue
- Annals of Behavioral Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-05-08
- Volume
- 54
- Issue
- 10
- Pages
- 747-760
- ISSN
- 0742-5554 (ISSN-L)
- 0883-6612
- 1532-4796
- OpenAlex
- W3021875383
- Cited by
- 36
- References
- 43
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 4 · 2023: 7 · 2022: 7 · 2021: 4 · 2020: 2
- FWCI
- 3.01
- Type
- journal article
- Language
- en
- Open access
- green
- edoc.unibas.ch
- Licence
- Locations
- Annals of Behavioral Medicine (publishedVersion)
- PubMed (publishedVersion)
- edoc (University of Basel) (acceptedVersion, other-oa)
- edoc (University of Basel)
- Funders
- University of Cyprus
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Keywords
- smoking cessation, young adults, acceptance and commitment therapy, digital health interventions, nicotine dependence, turnover intention, self-efficacy, precontemplation, contemplation, university students, hard-to-reach populations, tobacco use reduction
- MeSH terms
- Internet-Based Intervention, Cyprus, Female, Humans, Male, Motivation, Pilot Projects, Students, Tobacco Use Disorder, Universities, Smoking Cessation, Self Efficacy, Intention, Young Adult, Acceptance and Commitment Therapy
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