Smokers and smart phones: real-time data and new treatment options

Researchers at M.D. Anderson Cancer Center are using real-time smart phone data from struggling-to-quit smokers to better understand the quitting process -- and develop improved and individualized treatment options. The team, led by Dr. David Wetter, recently completed a study of more than 400 smokers. Their current effort focuses on Spanish-speakers.

I spoke with Dr. Wetter last week about what the research shows -- and about how it could be used to ease the quitting process for smokers.

Talk about the smart phone data you collect from people trying to quit smoking.

We use smart phones to collect data during critical events that happen when people try to quit. For example, when they have a craving to smoke or when they actually smoke a cigarette, we'll collect data. [We'll find out]: Who else is in the environment with them? What else is going on? Are cigarettes available? Are they drinking? Are they eating? Are they at work, at home, in the car? The smart phone will also beep at random times throughout the day and evening to collect the same kinds of information. We can compare that information across different situations. For example, when someone is craving we may find that they're in situation characterized by negative emotions, like anxiety and stress, much more so than when you beep them at random times.

Why is getting the data via smart phone integral to this research?

There's a voluminous amount of data showing that people can't recall situations accurately. We all have these inherent biases in our recall. With the smart phones, we don't have to ask them to remember anything. We just ask [them to] tell us what's going on right now. A lot of our recall is a reconstruction rather than plucking out truths from memory. If you ask them to recall what was going on when they had a craving, they'll very likely report being stressed. Most of us think that precipitates craving. When you compare those with real time, that is often not the case. The smart phones are integral for insuring we have accurate data. We use [the data] to develop their treatments and optimize them for each specific person.

What trends are appearing in your research?

The volatility of their emotions and the intensity of their craving is predictive of relapse. People who are having really strong cravings, and then not much, and then really strong cravings again will struggle to stay abstinent. We see the same thing when we look at negative emotions. People who are bouncing around [from really stressed to not stressed], this volatility really predicts relapse. Riding the roller coaster is tough. We wouldn't have been able to [learn] that without using smart phones in real time, in the real world. We get a good picture of what their daily experience looks like.

You mentioned that many people assume a moment of stress comes right before a craving. Did you find truth in assumption?

Negative emotions are strongly related to cravings, just not as much as people believe they are. There is a wide variety of other things that precipitate craving as well: having alcohol, habitual situations such as a cigarette after a meal, a coffee break. People have this really strong belief about stress and negative emotions.

How will the data you've collected help you develop specific treatment options for patients?

We will ask them, when they're right in the middle of a craving, "What would work for you right now? What would help you get through this situation without smoking?" We can provide a menu of coping strategies to help them get through that situation. They tell us which ones would work for them. The next time they're in a similar situation, we can suggest they use those strategies. You're really individualizing people's treatment.

When the smart phone collects data [and] sees a lot of volatility, for example, it could fire off an application that makes suggestions on how to deal with craving. It could fire off a text message to a quit line and they could have a counselor call [the patient]. Or the smart phone could directly connect them to the quit line. We could make suggestions on increasing their pharmacotherapy: "We recommend that you chew some nicotine gum or use the nicotine nasal spray."

It sounds like an evidence-based medical smart phone app.

We want to have some app you can download on your iPhone or Android that gives you the boost you need to help you quit smoking.

How could smart phone monitoring be used to study other health issues?

We know a lot about individuals trying to initiate a physical activity program. A lot of them are able to stick with it for awhile, but very quickly everything drops off. We don't really know what specifically, other than people's ideas and recall, causes them to drop off. We think you can use the smart phones to understand what makes some people successful and some not. They're using it for diet now, too. You can provide people with guidance on what a serving size should look like. The technique is being used for a wide variety of risk behaviors.

Image: Dr. David Wetter

This post was originally published on Smartplanet.com