(PS4-D83) A Pilot Randomized Controlled Trial of a Mobile-based Attention Training Program for E-cigarette Users

In recent years, electronic nicotine delivery systems (ENDS; also known as e-cigarettes), have become the tobacco product consumed the most by young adults (18-24 years). The use of ENDS is linked to a gateway effect to cigarette smoking, underscoring the need to develop effective interventions for ENDS cessation. Attentional bias (AB) is a cognitive factor that contributes to the initiation and maintenance of ENDS use. Our preliminary study utilized a computerized task and eye-tracking paradigm, which revealed that ENDS users exhibit greater attentional fluctuation and sustained attention to ENDS-related stimuli than non-users. Building on this finding, our study aimed to develop and investigate the effects of a novel mobile-based attentional training program on ENDS users' nicotine dependence and urges. Specifically, we aimed to examine the two established attentional bias modification (ABM) mechanisms as potential training regimes for ENDS use: disengaging attention from threat vs. enhancing general attentional control. To this end, we randomized ENDS users to either ABM or attention control condition (ACC).

We recruited 35 ENDS users with a moderate level of nicotine dependence (mean age=21.63 years; White 82.9%; female 74.3%) and randomly assigned them to either the ABM (N=17) or ACC (N=18) group. The attention training program was based on a dot-probe task design. The ABM aimed to help participants disengage their attention from ENDS-related cues, while the ACC aimed to improve participants' general attentional control ability. Participants were required to complete eight training sessions over four weeks, along with three outcome assessments at pre-training, post-training, and 1-month follow-up. A repeated measures ANOVA with a time (pre, post, follow-up) by group (ACC, ABM) design revealed a significant main effect of time on nicotine dependence levels (F [1, 19] =10.07, p=.005, η²=.346), indicating that both groups experienced significant reductions in nicotine dependence over time. There was a significant group by time interaction effect on the urge to use ENDS (F [1, 19] =4.74, p=.042, η² =.200). Specifically, compared to pre-training, the ACC group showed a 31% reduction in nicotine dependence at post-training and a 32% reduction at 1-month follow-up. In contrast, the ABM group displayed a 14% reduction in nicotine dependence at post-training and a 15% reduction at 1-month follow-up.

Overall, the ACC outperformed the ABM in reducing the level of nicotine dependence at post-training, and maintained the therapeutic gain at 1 month follow-up. This line of research indicates that attentional fluctuation is a more central problem in ENDS use, and the ACC designed to improve general attention control is potentially a more effective form of cognitive training for ENDS users. This study is innovative in that it is the first to develop the attention training program for ENDS users while incorporating existing theoretical framework of attention control processes. In addition, this line of work is clinically significant as the mobile-based intervention can improve accessibility for individuals disadvantaged and unable to access treatment resources.