Study of a Smartphone-Based Switch Program

The proportion of participants who self-report 7-day point prevalence abstinence (PPA) from cigarettes at 12 weeks and self-report the use of 1 or more smoke-free nicotine products at 12 weeks.

Trial feasibility in study enrollment is assessed via 3 measures, the first being the proportion of unique (non-duplicate) online screening form completers who are eligible for the screening study phone call.

Trial feasibility in study enrollment is assessed via 3 measures, the second being the proportion of unique (non-duplicate) online screening form completers who are eligible for the screening study phone call and complete the screening study phone call.

Trial feasibility in study enrollment is assessed via 3 measures, the third being the proportion of unique (non-duplicate) online screening form completers who complete the screening phone call and enroll in the study. Enrollment is defined as completing the HIPAA authorization form and electronic informed consent form (ICF), the online baseline questionnaire, and registration in the Pivot app.

Trial feasibility in study completion is assessed via one measure:

• The proportion of enrolled participants who complete the study questionnaire at 12 weeks, 26 weeks, and both timepoints.

Collected via back-end app data collection. Engagement is specifically assessed with number of times the Pivot app was opened (number of app openings/sessions).

Collected via back-end app data collection. Engagement is specifically assessed with the number of days over which the app was opened by participants (at least one app session).

Collected via back-end app data collection. Engagement is specifically assessed with the number of weeks over which the app was opened by participants (at least one app session).

Collected via back-end app data collection. Engagement is specifically assessed with the average duration of app sessions completed by participants. Outcome unit of measure = duration in minutes.

Collected via back-end app data collection. Engagement is specifically assessed with the use of app features (practice switches, challenges, logging cigarettes) by participants. Reported as the number of times each app feature was used.

Collected via back-end app data collection. Engagement is specifically assessed with average number of messages sent by coach to participant per week and average number of messages sent by participant to coach per week.

Collected via back-end app data collection. Specifically, the average number of weeks with at least one message sent from participant to coach, and the average number of weeks with at least one message sent from coach to participant.

Specifically regarding likelihood to recommend to a friend, Net Promoter Score (NPS). Participants asked: "How likely are you to recommend the Pivot program to a friend or colleague?". Answered on a range from 1-10; 1 = Not at all likely, and 10 = Very likely. A higher score indicates greater user satisfaction and promotion of the program.

Specifically regarding set-up and getting started with the program. Participants asked: "How easy or difficult was it to set-up and get started in the Pivot program?". Answered on a range from 1-10; 1 = Very difficult, and 10 = Very easy. A higher score indicates greater ease of program set-up and getting started.

Participants are asked: "Which of the following best describes your need for the Pivot program?". Answer choices include the following: "I really need this program", "I somewhat need this program", "I don't need this program", and "I am not at all interested in this program".

Specifically regarding whether the program was useful in helping participants quit vaping. Participants are asked: "Which of the following best describes the Pivot program's ability to help someone switch off smoking to smoke-free nicotine products?". Answer choices include the following: "The program is extremely helpful to switching"; "The program is helpful to switching"; "The program does not affect being able to switch"; and "The program makes switching harder".

Change in Self-Efficacy from baseline assessment. Self-Efficacy is measured through the 6-item Smoking Abstinence Self-efficacy Questionnaire (SASEQ) (Spek V, et al. Int.J. Behav. Med. (2013) 20:444-449).

SASEQ score is on a scale of 0-24. Each of the 6 questions is answered on a 5-point Likert scale (0-4). Greater scores indicate greater self-efficacy toward quitting smoking.

Change in expected difficulty to stay switched from baseline assessment. Participants asked: "How difficult do you think it would be to stay switched?". Participant self-report on scale 1-10 (1=Really hard to stay switched, 10=Really easy to stay switched).

Change in confidence levels towards switching from baseline assessment. Participants asked: "If you were to switch from cigarette smoking to a smoke-free nicotine product right now, how successful would you be?". Participant self-report on scale 1-10 (1=Not at all successful, 10=Completely successful).

Participants are asked: "Would you like to completely switch from cigarette smoking to a smoke-free nicotine product?". Participants answer "Yes" or "No".

Participants are asked: "How interested are you in completely switching from cigarettes to smoke-free nicotine products?". Participants are provided the following answers to choose from: "Extremely", "Somewhat", "Not interested".

Participant self-report of 7-day and 30-day point prevalence abstinence (PPA) from cigarettes + use of 1 or more smoke-free nicotine products.

Participants who report they have achieved at least 7-day point prevalence abstinence (self-reported switch) at 12 weeks will undergo a videoconference visit with study staff in which they provide a witnessed breath sample using a provided personal mobile carbon monoxide breath sensor. Breath sample values less than 10 ppm (parts per million) will be considered consistent with biochemical abstinence.

Defined as self-report of 7-day (or greater) PPA from cigarettes at 12 weeks + self-report of 30-day PPA at 26 weeks + use of at least one smoke-free nicotine product at both timepoints.

Defined as the duration from present date (date of questionnaire completion) to self-reported date of last cigarette, asked at 12 weeks and 26 weeks, in participants reporting current use of smoke-free nicotine products.

Defined as duration from present date (date of questionnaire completion) to self-reported date of last cigarette.

Participant self-report of any nicotine products, other than cigarettes, that they currently use.

Defined as the duration from present date (date of questionnaire completion) to self-reported date of last use of nicotine product, asked at 12 weeks and 26 weeks.

Proportion of participants who reduced their cigarettes per day (CPD) by ≥ 50% compared to baseline.

The average proportion of reduction in cigarettes per day (CPD) at follow-up compared to baseline.

The proportion of participants whose change in cigarettes per day (CPD) decreased, increased, or remained unchanged from baseline to follow-up.

The proportion of participants whose change in nicotine product use decreased, increased, or remained unchanged from baseline to follow-up.

Self-reported number of attempts to switch from cigarettes to smoke-free nicotine products during the study. Participants are asked: "Since you began the study, how many times have you tried to switch from smoking cigarettes to a smoke-free nicotine product where you've gone at least 1 day without smoking a cigarette, even a single puff?".

Self-reported number of attempts to stop using nicotine products other than cigarettes during the study.

Change in average weekly breath carbon monoxide (CO) value and average maximum weekly breath CO value in participants with ≥ 4 samples per week (frequent breath sensor users) for the weeks of 1, 4, 8, and 12.

Change in average Saturday breath carbon monoxide (CO) value over weeks 1-12 in participants with at least one 1 breath sample on the Saturday in question.

Participant health is assessed with the following: "Would you say that in general your health is... Select one" And the following choices: "Excellent", "Very good", "Good", "Fair", and "Poor".

Assessed via self-report. Participants are asked about other smoking cessation tools they have used since the study started. Tools asked about include: cold turkey, apps (other than Pivot), counseling, medications, acupuncture, hypnotherapy, etc. Participants can report other tools not included in the list provided. Outcome reported as the number of participants who have used each other smoking cessation tool.

Assessed via the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) screening questionnaire, 3 items. A score is calculated from a sum of the 3 items. Possible scores on the scale range from 0-12. A score of 0 indicates no alcohol use. Higher scores indicate greater alcohol use behavior, a worse outcome. Scores are compared from baseline to follow-up to determine change in alcohol use behavior.

Assessed via the Center of Epidemiological Studies Depression Scale (CES-D) screening questionnaire, 10 items. A score is calculated from a sum of the 10 items. Possible scores on the scale range from 0-30. Higher scores indicate greater severity of depressive symptoms, a worse outcome. Scores are compared from baseline to follow-up to determine change in presence of depressive symptoms.

Assessed via participant self-report of living with other adults who uses nicotine products other than cigarettes and/or smokes. Participants asked: "Of the adults you live with, how many smoke cigarettes?" and "Of the adults you live with, how many use nicotine products other than cigarettes?". Outcome unit of measure = number of adults.

Assessed via participant self-report of living with a romantic partner who uses nicotine products other than cigarettes and/or smokes. Participants asked: "Do you live with a romantic partner who smokes cigarettes?" (yes/no) and "Do you live with a romantic partner who uses nicotine products other than cigarettes?" (yes/no). Outcomes measure reported as number of participants who live with a romantic partner that smokes, and number that live with a romantic partner that uses nicotine products other than cigarettes (participants that answer yes to these questions).

Assessed via participant self-report of the number of their close friends who use nicotine products other than cigarettes and/or smoke. Participants asked: "How many of your close friends smoke cigarettes?" and "How many of your close friends use nicotine products other than cigarettes?". Outcome unit of measure = number of close friends.