Intervention: Pivot
exhaled breath
Pivot is a 12-month digital smoking cessation program based on the USCPG for tobacco cessation. Pivot includes the Pivot Breath Sensor and Pivot app (Pivot Health Technologies Inc).The Pivot Breath Sensor is a portable, personal mobile breath sensor that measures the level of CO in the exhaled breath. The user submits a breath sample by exhaling into the sensor mouthpiece. The sensor displays the exhaled breath CO value in parts per million (ppm) to the user directly on the device. When paired with the user’s smartphone, the user’s CO values also populate the user’s Pivot app. Displayed CO values are color coded and categorized as most consistent with not smoking (green; 0-6 ppm), possibly smoking (orange; 7-9 ppm), or smoking (red; ≥10 ppm).The self-guided Pivot app leverages evidence-based principles and clinical best practices. This includes the USCPG-recommended 5 A’s; tailoring on readiness to quit [The educational journey in the Pivot app comprises 4 tracts—Learn, Reduce, Prepare to Quit, and Maintain My Quit—and is designed to accommodate smokers along the spectrum of readiness to quit. Participants may navigate between tracts as desired to access content most relevant to their goals and needs.Pivot users are assigned a human coach with whom they work one-on-one over the duration of their use of Pivot (up to 1 year). Communication between the coach and Pivot user is via asynchronous in-app SMS text messaging. Pivot coaches are tobacco treatment specialists. The coach reaches out periodically, approximately once per week, during the participant’s active use of Pivot. Participants may reach out to their coach whenever and however often they like.Pivot users may access the moderated web-based discussion community through the Pivot app. The forum is moderated by a tobacco treatment specialist. The web-based community forum is a place to give and receive support and advice from others going through the Pivot program.