Effects of Mobile-Based Attentional Bias Modification Training for Young Adult E-Cigarette Users: A Randomized Controlled Trial

In 2018, 3.2% U.S. adults reported current e-cigarette (ENDS) use, and in 2020, 19.6% of high school students and 4.7% of middle school students reported current e-cigarette use, an increasingly pervasive public health concern. This study assesses and redirects attentional bias (AB), or fluctuations in decision-making ability given the presence of personally relevant (salient) ENDS stimuli. Previous psychopathologies show effectiveness in the attentional retraining of participants battling other maladaptive behaviors, specifically modalities of addiction (e.g., alcohol). Our preliminary studies demonstrate the feasibility and acceptability of AB modification programs, from which we developed an innovative mobile-based AB modification training program (mABM) for ENDS users who want to reduce or quit usage. It is an online, mobile-based training program consisting of eight training sessions over 4 weeks and three online assessments (pre-training, post-training, and 1-month follow-up). Since June 2021, we recruited 16 ENDS users with a moderate level of nicotine dependence (≥ 9 on the Penn State Electronic Cigarette Dependence Index [PS-ECDI]) and randomly assigned them to mABM or placebo training control (PLT) groups. Notably, the mABM group showed a 31% reduction at post-training (N=7) and 47% reduction at 1-month follow-up (N=5) in nicotine dependence levels, whereas the PLT group (N=9) had negligible levels of change. The differential training effect was supported by the significant group X time interaction (F[1,14]=6.65, p=.023). Participants reported high acceptability of the training program (\u3e 70 points out of 100 on the Treatment Acceptance Questionnaire adapted from Hunsley, 1992). These results indicate the potential clinical utility of mABM as a sustainable intervention for ENDS users to diminish their dependence on nicotine. Scaling mABM protocol capable of redirecting the attentional allocation of active ENDS users away from potent environmental cues aims to allow users the capacity to disengage from deleterious behaviors and promote desirable population health outcomes