A Behavioral Activation Mobile Health App for Smokers With Depression: Development and Pilot Evaluation in a Single-Arm Trial
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Abstract
Background: The integration of Behavioral Activation Treatment for Depression (BAT-D) into smoking cessation interventions is a promising approach to address depression as a barrier to quitting. However, this approach has only been tested as a face-to-face intervention, which has low reach. Objective: The aims of the study were to develop a BAT-D mobile health app with high potential reach and determine its feasibility, acceptability, and preliminary effects on theory-based behavioral processes of behavioral activation, reduced depressive symptoms, and smoking cessation. Methods: Following a user-centered design process consisting of competitive analysis, focus groups, and prototype testing, we conducted a single-arm pilot trial of Actify!, a BAT-D app for depressed smokers. Participants used SmokefreeTXT along with Actify! to provide cessation content that had not yet been built into the app for this initial phase of pilot testing. Participants in the trial were current, daily smokers with mild to moderate depressive symptoms. We examined use outcomes for all enrolled participants and process and cessation outcomes at 6 weeks postenrollment for study completers (16/17, 94% retention). Results: Regarding acceptability, average number of log-ins per participant was 16.6 (SD 13.7), and 63% (10/16) reported being satisfied overall with the app. Posttreatment interviews identified some usability challenges (eg, high perceived burden of planning and scheduling values-based activities). There was a significant decrease in depressive symptoms from baseline to follow-up (mean change in Patient Health Questionnaire–9 scores was –4.5, 95% CI –7.7 to –1.3; P=.01). Additionally, carbon monoxide (CO)-confirmed, 7-day point prevalence abstinence (PPA) at 6-week follow-up was 31% (5/16), and the 30-day PPA was 19% (3/16). Conclusions: Results demonstrate promising engagement with Actify! and potential for impact on theory-based change processes and cessation outcomes. Preliminary quit rates compare favorably to previous trials of smoking cessation apps for the general population (ie, short-term, self-reported 30-day quit rates in the 8% to 18% range) and a previous trial of face-to-face BAT-D for depressed smokers (ie, CO-confirmed, 7-day PPA rate of 17% at end of treatment).
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Presently, there is limited evidence for the efficacy of smartphone apps delivering behavioral smoking cessation interventions for individuals with mental health disorders; most studies have been limited to small pilot RCTs and single-arm studies.
“Presently, there is limited evidence for the efficacy of smartphone apps delivering behavioral smoking cessation interventions for individuals with mental health disorders. Most studies have been limited to small pilot randomized controlled trials (RCTs) and single-arm studies [43, 44, 45, 46, 47].”
From Can an Acceptance and Commitment Therapy-Based Smartphone App Help Individuals with Mental Health Disorders Quit Smoking? (2024) · cites this paper as [44]
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Cites
The PHQ-9: Validity of a brief depression severity measure
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001) · Journal of General Internal Medicine · doi:10.1046/j.1525-1497.2001.016009606.x · Cited by 44,910 · see citing works
The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire
HEATHERTON, T. F., KOZLOWSKI, L. T., FRECKER, R. C., & FAGERSTROM, K. (1991) · British Journal of Addiction · doi:10.1111/j.1360-0443.1991.tb01879.x · Cited by 10,738 · see citing works
Biochemical verification of tobacco use and cessation
Benowitz, N. L., III, P. J., Ahijevych, K., Jarvis, M. J., Hall, S., LeHouezec, J., Hansson, A., Lichtenstein, E., Henningfield, J., Tsoh, J., et al. (2002) · Nicotine & Tobacco Research · doi:10.1080/14622200210123581 · Cited by 1,800 · see citing works
Tanoue, L. T. (2007) · Yearbook of Medicine · doi:10.1016/s0084-3873(08)70176-7 · Cited by 1,413 · see citing works
Michie, S., Yardley, L., West, R., Patrick, K., & Greaves, F. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7126 · Cited by 865 · see citing works
A stage model of behavioral therapies research: getting started and moving on from stage I.
Rounsaville, B. J., Carroll, K. M., & Onken, L. S. (2001) · Clinical Psychology: Science and Practice · doi:10.1093/clipsy.8.2.133 · Cited by 846 · see citing works
Quitting Smoking Among Adults — United States, 2001–2010
Tanoue, L. T. (2012) · Yearbook of Medicine · doi:10.1016/s0084-3873(12)00225-8 · Cited by 737 · see citing works
Contemporary behavioral activation treatments for depression: Procedures, principles, and progress
Hopko, D. R., Lejuez, C. W., Ruggiero, K. J., & Eifert, G. H. (2003) · Clinical Psychology Review · doi:10.1016/s0272-7358(03)00070-9 · Cited by 634 · see citing works
Lejuez, C. W., Hopko, D. R., Acierno, R. E., Daughters, S. B., & Pagoto, S. (2011) · Behavior Modification · doi:10.1177/0145445510390929 · Cited by 574 · see citing works
Quitting smoking among adults--United States, 2001-2010.
(2011) · PubMed · Cited by 495 · see citing works
Kanter, J. W., Mulick, P. S., Busch, A. M., Berlin, K. S., & Martell, C. R. (2007) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-006-9038-5 · Cited by 493 · see citing works
Reliability and validity of a smoking timeline follow-back interview.
Brown, R. A., Burgess, E. S., Sales, S. D., Whiteley, J. A., Evans, D. M., & Miller, I. W. (1998) · Psychology of Addictive Behaviors · doi:10.1037/0893-164x.12.2.101 · Cited by 491 · see citing works
User profiles and personas in the design and development of consumer health technologies
LeRouge, C., Ma, J., Sneha, S., & Tolle, K. (2013) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2011.03.006 · Cited by 411 · see citing works
Use of Smoking-Cessation Treatments in the United States
Shiffman, S. S., Brockwell, S. E., Pillitteri, J. L., & Gitchell, J. G. (2008) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2007.09.033 · Cited by 393 · see citing works
Titov, N., Dear, B. F., McMillan, D., Anderson, T., Zou, J., & Sunderland, M. (2011) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2010.550059 · Cited by 342 · see citing works
Bricker, J. B., Mull, K. E., Kientz, J. A., Vilardaga, R., Mercer, L. D., Akioka, K. J., & Heffner, J. L. (2014) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2014.07.006 · Cited by 340 · see citing works
Self-citationMacPherson, L., Tull, M. T., Matusiewicz, A. K., Rodman, S., Strong, D. R., Kahler, C. W., Hopko, D. R., Zvolensky, M. J., Brown, R. A., & Lejuez, C. W. (2010) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0017939 · Cited by 293 · see citing works
Self-citationLy, K. H., Trüschel, A., Jarl, L., Magnusson, S., Windahl, T., Johansson, R., Carlbring, P., & Andersson, G. (2014) · BMJ Open · doi:10.1136/bmjopen-2013-003440 · Cited by 269 · see citing works
Buller, D. B., Borland, R., Bettinghaus, E. P., Shane, J. H., & Zimmerman, D. E. (2014) · Telemedicine and e-Health · doi:10.1089/tmj.2013.0169 · Cited by 178 · see citing works
A Mobile App to Aid Smoking Cessation: Preliminary Evaluation of SmokeFree28
Ubhi, H. K., Michie, S., Kotz, D., Wong, W. C., & West, R. (2015) · Journal of Medical Internet Research · doi:10.2196/jmir.3479 · Cited by 149 · see citing works
Cropsey, K. L., Trent, L. R., Clark, C. B., Stevens, E. N., Lahti, A. C., & Hendricks, P. S. (2014) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntu085 · Cited by 145 · see citing works
Businelle, M. S., Ma, P., Kendzor, D. E., Frank-Pearce, S. G., Vidrine, D. J., & Wetter, D. W. (2016) · Journal of Medical Internet Research · doi:10.2196/jmir.6058 · Cited by 140 · see citing works
Clickotine, A Personalized Smartphone App for Smoking Cessation: Initial Evaluation
Iacoviello, B. M., Steinerman, J. R., Klein, D. B., Silver, T. L., Berger, A. G., Luo, S. X., & Schork, N. J. (2017) · JMIR mhealth and uhealth · doi:10.2196/mhealth.7226 · Cited by 115 · see citing works
Feature-level analysis of a novel smartphone application for smoking cessation
Heffner, J. L., Vilardaga, R., Mercer, L. D., Kientz, J. A., & Bricker, J. B. (2015) · The American Journal of Drug and Alcohol Abuse · doi:10.3109/00952990.2014.977486 · Cited by 103 · cited 1× · see citing works
“User stories illustrating how values can be translated into actions were associated with cessation in our prior work [28].”
Self-citationBricker, J. B., Mull, K. E., McClure, J. B., Watson, N. L., & Heffner, J. L. (2018) · Addiction · doi:10.1111/add.14127 · Cited by 91 · see citing works
Self-citationGame On? Smoking Cessation Through the Gamification of mHealth: A Longitudinal Qualitative Study
El-Hilly, A., Iqbal, S., Ahmed, M., Sherwani, Y., Muntasir, M., Siddiqui, S., Al-Fagih, Z., Usmani, O. S., & Eisingerich, A. B. (2016) · JMIR Serious Games · doi:10.2196/games.5678 · Cited by 90 · see citing works
Berlin, I., & Covey, L. S. (2006) · Addiction · doi:10.1111/j.1360-0443.2006.01616.x · Cited by 89 · see citing works
Effects of anhedonia on days to relapse among smokers with a history of depression: A brief report
Cook, J. W., Spring, B. J., McChargue, D. E., & Doran, N. (2010) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntq118 · Cited by 89 · see citing works
Bricker, J. B., Copeland, W. K., Mull, K. E., Zeng, E. Y., Watson, N. L., Akioka, K. J., & Heffner, J. L. (2016) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2016.10.029 · Cited by 84 · see citing works
Self-citationJacobs, E. J., Newton, C. C., Carter, B. D., Feskanich, D., Freedman, N. D., Prentice, R. L., & Flanders, W. D. (2014) · Annals of Epidemiology · doi:10.1016/j.annepidem.2014.11.008 · Cited by 83 · see citing works
Dahne, J., Lejuez, C. W., Diaz, V. A., Player, M. S., Kustanowitz, J., Felton, J. W., & Carpenter, M. J. (2019) · Behavior Therapy · doi:10.1016/j.beth.2018.12.003 · Cited by 78 · cited 1× · see citing works
“With the most advanced evaluation of a BAT-D app to date being pilot RCTs not adequately powered to test efficacy [18,22,23] and the remainder of the published work limited to intervention descriptions or single-arm feasibility studies [19-21], there remains much to be learned about how to effectively translate BAT-D…”
BackgroundDahne, J., Collado, A., Lejuez, C. W., Risco, C. M., Diaz, V. A., Coles, L., Kustanowitz, J., Zvolensky, M. J., & Carpenter, M. J. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.03.009 · Cited by 62 · see citing works
Cole-Lewis, H. J., Augustson, E. M., Sanders, A. E., Schwarz, M., Geng, Y., Coa, K. I., & Hunt, Y. M. (2016) · Tobacco Control · doi:10.1136/tobaccocontrol-2016-052945 · Cited by 58 · see citing works
A comparison of the characteristics of iOS and Android users of a smoking cessation app
Ubhi, H. K., Kotz, D., Michie, S., van Schayck, O. C. P., & West, R. (2017) · Translational Behavioral Medicine · doi:10.1007/s13142-016-0455-z · Cited by 49 · see citing works
Current Major Depression Among Smokers Using a State Quitline
Hebert, K. K., Cummins, S. E., Hernández, S., Tedeschi, G. J., & Zhu, S. (2010) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2010.09.030 · Cited by 47 · see citing works
Development and evaluation of the See Me Smoke-Free multi-behavioral mHealth app for women smokers
Gordon, J. S., Armin, J. S., Hingle, M. D., Giacobbi, P. R., Cunningham, J. K., Johnson, T. M., Abbate, K., Howe, C. L., & Roe, D. J. (2017) · Translational Behavioral Medicine · doi:10.1007/s13142-017-0463-7 · Cited by 35 · see citing works
Busch, A. M., Tooley, E. M., DUNSIGER, S. I., Chattillion, E. A., Srour, J. F., Pagoto, S., Kahler, C. W., & Borrelli, B. (2017) · BMC Public Health · doi:10.1186/s12889-017-4250-7 · Cited by 34 · see citing works
The association between changes in alternative reinforcers and short-term smoking cessation
Goelz, P. M., Audrain-McGovern, J. E., Hitsman, B. L., Leone, F. T., Veluz‐Wilkins, A. K., Jepson, C., Wileyto, E. P., D’Avanzo, P. A., Rivera, J. G., & Schnoll, R. A. (2014) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2014.02.007 · Cited by 31 · see citing works
Dahne, J., Lejuez, C. W., Kustanowitz, J., Felton, J. W., Díaz, V. A., Player, M. S., & Carpenter, M. J. (2017) · The International Journal of Psychiatry in Medicine · doi:10.1177/0091217417720899 · Cited by 31 · see citing works
Heffner, J. L., & Mull, K. E. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7953 · Cited by 28 · see citing works
Self-citationDahne, J., Kustanowitz, J., & Lejuez, C. W. (2017) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2017.05.004 · Cited by 22 · see citing works
Heffner, J. L., Mull, K. E., McClure, J. B., & Bricker, J. B. (2018) · Substance Use & Misuse · doi:10.1080/10826084.2017.1387569 · Cited by 16 · see citing works
Self-citationDahne, J., Collado, A., Lejuez, C. W., Risco, C. M., Díaz, V. A., Kustanowitz, J., Zvolensky, M. J., & Carpenter, M. J. (2018) · Psychological Services · doi:10.1037/ser0000304 · Cited by 10 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [15]The health consequences of smoking—50 years of progress: a report of the Surgeon General 2014 2019-10-02 Atlanta Centers for Disease Control and Prevention https://www.ncbi.nlm.nih.gov/books/n/surgsmoke50/pdf/ 24455788
Cited by
Sorted by citations
Kabir, K. S., Kenfield, S. A., Blarigan, E. L. V., Chan, J. M., & Wiese, J. (2022) · Proceedings of the ACM on Interactive Mobile Wearable and Ubiquitous Technologies · doi:10.1145/3534612 · Cited by 34 · see citing works
Padró‐Arocas, A., Quifer‐Rada, P., Aguilar‐Camprubí, L., & Tudela, D. M. (2020) · Research in Nursing & Health · doi:10.1002/nur.22095 · Cited by 31 · see citing works
Behavioral Activation, Depression, and Promotion of Health Behaviors: A Scoping Review
May, D., Litvin, B., & Allegrante, J. P. (2022) · Health Education & Behavior · doi:10.1177/10901981221090157 · Cited by 22 · see citing works
Chen, J., Chu, J. T. W., Marsh, S., Shi, T., & Bullen, C. (2023) · Psych · doi:10.3390/psych5040072 · Cited by 7 · see citing works
Behavioral Activation mHealth Application for Smoking Cessation: A Randomized Controlled Pilot Trial
Heffner, J. L., Serfozo, E., Baker, K., Gasser, M. L., Watson, N. L., Daughters, S. B., Becoña, E., & McClure, J. B. (2024) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntae137 · Cited by 5 · see citing works
Self-citationHuang, S., Wahlquist, A. E., & Dahne, J. (2024) · Substance Use & Misuse · doi:10.1080/10826084.2024.2369155 · Cited by 4 · see citing works
Santiago-Torres, M., Mull, K. E., Sullivan, B. M., Prochaska, J. J., Zvolensky, M. J., & Bricker, J. B. (2024) · Depression and Anxiety · doi:10.1155/2024/1055801 · Cited by 3 · see citing works
“Most studies have been limited to small pilot randomized controlled trials (RCTs) and single-arm studies [43, 44, 45, 46, 47].”
Self-citationChen, J., Chu, J. T. W., Marsh, S., & Bullen, C. (2021) · Research Square · doi:10.21203/rs.3.rs-401435/v1 · Cited by 2 · see citing works
Stroian, P., David, D. O., Hora, A., Erenler, B., Tuominen, E. W., Vlachantonis, K., & Žagar, T. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100839 · Cited by 1 · see citing works
Arshad, R., Hamid, A., & Shahid, S. (2021) · Behaviour and Information Technology · doi:10.1080/0144929x.2021.2006787
Zamer, F. N. A. M., & Mahamarowi, N. H. (2026) · International Conference on e-Education, e-Business, e-Management and e-Learning · doi:10.1109/ic4e69618.2026.11631406
- Authors
- Heffner, J. L., Watson, N. L., Serfozo, E., Mull, K. E., MacPherson, L., Gasser, M., & Bricker, J. B.
- Affiliations
- Fred Hutch Cancer Center (US)
- University of Washington (US)
- Corresponding author
- Heffner, Jaimee L
- ORCID
- Venue
- JMIR Formative Research
- Publisher
- JMIR Publications Inc.
- Published
- 2019-11-27
- Volume
- 3
- Issue
- 4
- Pages
- e13728
- ISSN
- 2561-326X (ISSN-L)
- PMC
- PMC6913543
- OpenAlex
- W2975960765
- Cited by
- 10
- References
- 44
- Citations by year
- 2026: 1 · 2024: 4 · 2023: 1 · 2022: 2 · 2021: 1 · 2020: 1
- FWCI
- 0.67
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- JMIR Formative Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- Fred Hutchinson Cancer Research Center
- University of Washington
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Keywords
- behavioral activation, depression, smoking cessation, mobile health apps, user-centered design, depressive symptoms
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