{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T12:29:46Z","timestamp":1793363386285,"version":"4.5.0"},"reference-count":44,"publisher":"American Medical Association (AMA)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Smoking prevalence remains alarmingly high among low-income adults, who face disproportionate barriers to cessation and experience unique smoking lapse triggers.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To compare the efficacy of the Smart-T smartphone intervention, featuring tailored, just-in-time adaptive interventions, with the National Cancer Institute QuitGuide intervention in supporting smoking cessation among adults with low income.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This randomized clinical trial was conducted from August 2019 to November 2023 among US adults with household incomes below 200% of the federal poverty line. Participants were randomized to Smart-T or QuitGuide and followed-up for 27 weeks. Data were analyzed from July 2024 to March 2025.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Both groups received nicotine replacement therapy. The Smart-T intervention provided ecological momentary assessment\u2013driven tailored feedback and prompts to use nicotine replacement therapy, while QuitGuide delivered smoking cessation content based on clinical guidelines.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was biochemically verified 7-day point prevalence abstinence at 26 weeks after quitting, and group differences were evaluated via multivariable logistic regression. Secondary outcomes included 30-day point prevalence abstinence and continuous abstinence. Outcomes were analyzed using logistic regression with intention-to-treat and complete-case approaches.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 454 participants (mean [SD] age, 52.0 [11.2] years; 333 [73.3%] female; mean [SD], 17.7 [9.5] cigarettes\/d) were enrolled, with 225 randomized to Smart-T and 229 randomized to QuitGuide. Biochemically verified 7-day point prevalence abstinence at 26 weeks was higher in the Smart-T group than in the QuitGuide group (37 participants [16.4%] vs 23 participants [10.0%] in intention-to-treat analysis; 37 of 160 participants [23.1%] vs 23 of 161 participants [14.3%] in complete-case analysis). Adjusted odds of abstinence were significantly higher for Smart-T (adjusted odds ratio, 1.81; 95% CI, 1.03-3.18). No significant differences were found for 30-day or continuous abstinence. Smart-T users interacted with the app more often and rated it as more helpful (\n r<\/jats:italic>\n \u2009=\u20090.21;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this randomized clinical trial of 454 adults with low income, the Smart-T intervention led to significantly higher smoking abstinence at 26 weeks compared with QuitGuide. These findings suggest that digital health interventions tailored for low-income populations hold promise for reducing smoking-related health disparities.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT03740490<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.26691","type":"journal-article","created":{"date-parts":[[2025,8,14]],"date-time":"2025-08-14T15:30:55Z","timestamp":1755185455000},"page":"e2526691","source":"Crossref","is-referenced-by-count":17,"title":["Just-in-Time Adaptive Intervention for Smoking Cessation in Low-Income Adults"],"prefix":"10.1001","volume":"8","author":[{"given":"Emily T.","family":"H\u00e9bert","sequence":"first","affiliation":[{"name":"TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City"},{"name":"Department of Family and Preventive Medicine, University of Oklahoma Health Sciences, Oklahoma City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darla E.","family":"Kendzor","sequence":"additional","affiliation":[{"name":"TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City"},{"name":"Department of Family and Preventive Medicine, University of Oklahoma Health Sciences, Oklahoma City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damon J.","family":"Vidrine","sequence":"additional","affiliation":[{"name":"Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida"},{"name":"Department of Oncologic Sciences, Morsani College of Medicine, University of South Florida, Tampa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy S.","family":"Langford","sequence":"additional","affiliation":[{"name":"TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krista M.","family":"Kezbers","sequence":"additional","affiliation":[{"name":"TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Audrey","family":"Montgomery","sequence":"additional","affiliation":[{"name":"TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Summer G.","family":"Frank-Pearce","sequence":"additional","affiliation":[{"name":"TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences, Oklahoma City"},{"name":"Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences, Oklahoma City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara K.","family":"Vesely","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences, Oklahoma City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sixia","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences, Oklahoma City"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zachary C. 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