Smoking Treatment and Exercise Program for Underserved Populations (STEP UP)

This pilot project proposes to evaluate the feasibility, acceptability, and efficacy of a
mobile intervention to target smoking-cessation and physical activity among low-income
persons. The intervention, named Smoking Treatment and Exercise Program for Underserved
Populations (STEP UP), combines a smartphone-based contingency-management application (app),
which provides monetary reinforcement for smoking abstinence and physical activity, 5 weeks
of telephone-based cognitive-behavioral therapy (CBT) to prevent relapse, nicotine
replacement pharmacotherapy, and text-messaging to support physical-activity goals.
Participants are given a smartphone, a compact carbon-monoxide (CO) monitor, with which
recency of smoking can by determined, and a Garmin Vivosmart wristband step-tracker. Twice a
day at semi-random intervals, participants are prompted by the app to submit a video of
themselves blowing into the CO monitor. Monetary reinforcement is then immediately provided
contingent upon a below-threshold CO reading. The app also continuously syncs with the Garmin
step-tracker, providing supportive messaging and bonus incentives—namely doubled
reinforcement for smoking abstinence among participants who meet personalized daily step
goals. The expected outcome of the project is to provide information to evaluate the efficacy
of an innovative approach in preparation for a subsequent larger clinical trial that builds
upon the capabilities of mHealth technology to reduce the prevalence of smoking among low
income smokers.

Inclusion Criteria:

- current household income less than twice the federal poverty guidelines (Finer &
Henshaw, 2006; for instance, someone from a family of 4 must have a household income
less than $48,500 to be eligible)

- currently smoke >10 cigarettes a day

- smoking for at least the past year

- can speak and write fluent conversational English

- are 18-70 years of age

- are willing to make an attempt to quit smoking and increase physical activity

Exclusion Criteria:

- inability to walk

- expected to have unstable medication regimen during the study

- currently receiving non-study behavioral treatment for smoking

- myocardial infarction in the past 6 months

- contraindication to nicotine replacement therapy (NRT) or bupropion with no medical
clearance

- exclusive use of other forms of nicotine such as cigars, pipes, e-cigarettes, or
chewing tobacco

- current pregnancy

- current imprisonment or psychiatric hospitalization