UMMS Affiliation

Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences; Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences; Department of Psychiatry; Graduate School of Biomedical Sciences

Publication Date


Document Type



Behavior and Behavior Mechanisms | Health Communication | Health Psychology | Health Services Administration | Health Services Research | Substance Abuse and Addiction | Telemedicine


BACKGROUND: Smoking continues to be the leading preventable cause of death. Digital Interventions for Smoking Cessation (DISCs) are health communication programs accessible via the internet and smartphones and allow for greater reach and effectiveness of tobacco cessation programs. DISCs have led to increased 6-month cessation rates while also reaching vulnerable populations. Despite this, the impact of DISCs has been limited and new ways to increase access and effectiveness are needed.

OBJECTIVE: We are conducting a hybrid effectiveness-dissemination study. We aim to evaluate the effectiveness of a machine learning-based approach (recommender system) for computer-tailored health communication (CTHC) over a standard CTHC system based on quit rates and risk reduction. In addition, this study will assess the dissemination of providing access to a peer recruitment toolset on recruitment rate and variability of the sample.

METHODS: The Smoker-to-Smoker (S2S) study is a 6-month hybrid effectiveness dissemination trial conducted nationally among English-speaking, current smokers aged > /=18 years. All eligible participants will register for the DISC (Decide2quit) and be randomized to the recommender system CTHC or the standard CTHC, followed by allocation to a peer recruitment toolset group or control group. Primary outcomes will be 7-day point prevalence and risk reduction at the 6-month follow-up. Secondary outcomes include recruitment rate, website engagement, and patient-reported outcomes collected via the 6-month follow-up questionnaire. All primary analyses will be conducted on an intent-to-treat basis.

RESULTS: The project is funded from 2017 to 2020 by the Patient Centered Outcomes Research Institute. Enrollment was completed in early 2019, and 6-month follow-ups will be completed by late 2019. Preliminary data analysis is currently underway.

CONCLUSIONS: Conducting a hybrid study with both effectiveness and dissemination hypotheses raises some unique challenges in the study design and analysis. Our study addresses these challenges to test new innovations and increase the effectiveness and reach of DISCs.



digital Intervention, peer recruitment, smoking cessation, tailored, dissemination

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Copyright ©Jamie M Faro, Elizabeth A Orvek, Amanda C Blok, Catherine S Nagawa, Annalise J McDonald, Greg Seward, Thomas K Houston, Ariana Kamberi, Jeroan J Allison, Sharina D Person, Bridget M Smith, Kathleen Brady, Tina Grosowsky, Lewis L Jacobsen, Jennifer Paine, James M Welch Jr, Rajani S Sadasivam. Originally published in JMIR Research Protocols (, 23.07.2019. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on well as this copyright and license information must be included.

DOI of Published Version



JMIR Res Protoc. 2019 Jul 23;8(7):e14814. doi: 10.2196/14814. Link to article on publisher's site

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JMIR research protocols


Full author list omitted for brevity. For the full list of authors, see article.

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Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.