Introduction
depressive, depression, depressive symptoms
Despite significant declines over the last 50+ years in cigarette smoking prevalence among the general population, smoking rates remain astonishingly high among certain vulnerable subgroups. One such subgroup is the 48 million US adults with depressive symptomatology [Tailored cessation treatments that incorporate depression-specific psychosocial treatment components increase long-term quit rates by up to 50% among those with current depressive symptoms [An ideal depression-specific psychosocial treatment to adapt for digital delivery must be both evidence-based and simple so that the treatment can be easily understood via a self-guided digital platform. Behavioral activation (BA) is an evidence-based depression intervention that focuses on regular self-monitoring to (1) examine already occurring activities and (2) facilitate the incorporation of new activities consistent with individualized values or goals across life areas [Importantly, because medication management is a critical component of any tobacco cessation intervention [To address the lack of effective, scalable smoking cessation approaches for individuals with depressive symptoms, our team developed “Goal2Quit,” a BA-based self-directed mobile app intervention. Goal2Quit was paired with a short duration of mailed nicotine replacement therapy (NRT) with instructions provided in Goal2Quit that users should contact their primary care provider, their state quitline, or visit a local pharmacy to obtain additional NRT or other cessation medications. This nationwide decentralized randomized clinical trial aimed to examine the usability and uptake of Goal2Quit among adult smokers with depressive symptoms as well as its efficacy for improving depression and promoting smoking cessation.