International Journal of Behavioral Medicine

, Volume 24, Issue 5, pp 665–672 | Cite as

Development of a Just-in-Time Adaptive Intervention for Smoking Cessation Among Korean American Emerging Adults

  • Christian Jules Cerrada
  • Eldin Dzubur
  • Kacie C. A. Blackman
  • Vickie Mays
  • Steven Shoptaw
  • Jimi Huh



Cigarette smoking is a preventable risk factor that contributes to unnecessary lung cancer burden among Korean Americans and there is limited research on effective smoking cessation strategies for this population. Smartphone-based smoking cessation apps that leverage just-in-time adaptive interventions (JITAIs) hold promise for smokers attempting to quit. However, little is known about how to develop and tailor a smoking cessation JITAI for Korean American emerging adult (KAEA) smokers.


This paper documents the development process of MyQuit USC according to design guidelines for JITAI. Our development process builds on findings from a prior ecological momentary assessment study by using qualitative research methods. Semi-structured interviews and a focus group were conducted to inform which intervention options to offer and the decision rules that dictate their delivery.


Qualitative findings highlighted that (1) smoking episodes are highly context-driven and that (2) KAEA smokers believe they need personalized cessation strategies tailored to different contexts. Thus, MyQuit USC operates via decision rules that guide the delivery of personalized implementation intentions, which are contingent on dynamic factors, to be delivered “just in time” at user-scheduled, high-risk smoking situations.


Through an iterative design process, informed by quantitative and qualitative formative research, we developed a smoking cessation JITAI tailored specifically for KAEA smokers. Further testing is under way to optimize future versions of the app with the most effective intervention strategies and decision rules. MyQuit USC has the potential to provide cessation support in real-world settings, when KAEAs need them the most.


Smoking cessation Just-in-time adaptive intervention Mobile health 



Funding for this research was provided by American Cancer Society: 124758-MRSG-13-155-01-CPPB (Huh, PI) and from National Institutes of Health: NCI T32CA009492-31. Support for the time of Mays and Shoptaw comes from the National Institutes of Health, National Institute for Minority Health and Health disparities (MD006932).

Compliance with Ethical Standards

Research Involving Human Participants and/or Animals

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Disclosure of Potential Conflicts of Interest

The authors Cerrada, Dzubur, Blackman, Mays, Shoptaw, and Huh declare that they have no conflict of interest.


  1. 1.
    Chen MS. Cancer health disparities among Asian Americans. Cancer. 2005;104(S12):2895–902.CrossRefPubMedGoogle Scholar
  2. 2.
    Nguyen AB, Chawla N, Noone A-M, Srinivasan S. Disaggregated data and beyond: future queries in cancer control research. Cancer Epidemiol Biomarkers Prev. 2014;23(11):2266–72.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    An N, Cochran SD, Mays VM, McCarthy WJ. Influence of American acculturation on cigarette smoking behaviors among Asian American subpopulations in California. Nicotine Tob Res. 2008;10(4):579–87.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Maxwell AE, Crespi CM, Alano RE, Sudan M, Bastani R. Health risk behaviors among five Asian American subgroups in California: identifying intervention priorities. J Immigr Minor Health. 2012;14(5):890–4.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Jamal A, Homa DM, O’Connor E, Babb SD, Caraballo RS, Singh T, et al. Current cigarette smoking among adults—United States, 2005–2014. MMWR Morb Mortal Wkly Rep. 2015;64(44):1233–40.CrossRefPubMedGoogle Scholar
  6. 6.
    Huh J, Thing JP, Abramova ZS, Sami M, Unger JB. Place matters in perceived tobacco exposure among Korean American young adults: mixed methods approach. Subst Use Misuse. 2014;49(8):1054–63.CrossRefPubMedGoogle Scholar
  7. 7.
    Kim SS, Son H, Nam KA. The sociocultural context of Korean American men’s smoking behavior. West J Nurs Res. 2005;27(5):604–23.CrossRefPubMedGoogle Scholar
  8. 8.
    Arnett JJ. The developmental context of substance use in emerging adulthood. J Drug Issues. 2005;35:235–254.Google Scholar
  9. 9.
    Arnett JJ. Emerging adulthood. A theory of development from the late teens through the twenties. Am Psychol. 2000;55(5):469–80.CrossRefPubMedGoogle Scholar
  10. 10.
    Huh J, Sami M, Abramova ZS, Spruijt-Metz D, Pentz MA. Cigarettes, culture, and Korean American emerging adults: an exploratory qualitative study. West J Nurs Res. 2013;35(9):1205–21.CrossRefPubMedGoogle Scholar
  11. 11.
    Cerrada CJ, Unger JB, Huh J. Correlates of perceived smoking prevalence among Korean American emerging adults. J Immigr Minor Heal. 2016;18(5):1183–9.CrossRefGoogle Scholar
  12. 12.
    Dierker L, He J, Kalaydjian A, Swendsen J, Degenhardt L, Glantz M, et al. The importance of timing of transitions for risk of regular smoking and nicotine dependence. Ann Behav Med. 2008;36(1):87–92.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    McDonnell DD, Kazinets G, Lee HJ, Moskowitz JM. An internet-based smoking cessation program for Korean Americans: results from a randomized controlled trial. Nicotine Tob Res. 2011;13(5):336–43.CrossRefPubMedGoogle Scholar
  14. 14.
    Fang CY, Ma GX, Miller SM, Tan Y, Su X, Shive S. A brief smoking cessation intervention for Chinese and Korean American smokers. Prev Med. 2006;43(4):321–4.CrossRefPubMedGoogle Scholar
  15. 15.
    Zhu SH, Cummins SE, Wong S, Gamst AC, Tedeschi GJ, Reyes-Nocon J. The effects of a multilingual telephone quitline for Asian smokers: a randomized controlled trial. J Natl Cancer Inst. 2012;104(4):299–310.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Kim SS, Kim SH, Fang H, Kwon S, Shelley D, Ziedonis D. A culturally adapted smoking cessation intervention for Korean Americans: a mediating effect of perceived family norm toward quitting. J Immigr Minor Heal. 2014;17(4):1120–9.CrossRefGoogle Scholar
  17. 17.
    Kim SR, Kim HK, Kim JY, Kim HY, Ko SH, Park M. Smoking cessation failure among Korean adolescents. J Sch Nurs. 2016;32(3):155–63.CrossRefPubMedGoogle Scholar
  18. 18.
    Pew Research Center. Mobile Technology Fact Sheet. 2014. Accessed 11 Dec 2016.
  19. 19.
    Abroms LC, Lee Westmaas J, Bontemps-Jones J, Ramani R, Mellerson J. A content analysis of popular smartphone apps for smoking cessation. Am J Prev Med. 2013;45(6):732–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Fiore MC, Jaén CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ, et al. A clinical practice guideline for treating tobacco use and dependence: 2008 update. Am J Prev Med. 2008;35:158–76.CrossRefGoogle Scholar
  21. 21.
    Free C, Knight R, Robertson S, Whittaker R, Edwards P, Zhou W, et al. Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial. Lancet. 2011;378(9785):49–55.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Nahum-shani I, Smith SN, Witkiewitz K, Collins LM, Spring B, Murphy SA. Just-in-time adaptive interventions (JITAIs): an organizing framework for ongoing health behavior support. 2014. (Technical Report No. 14-126). University Park, PA: The Methodology Center, Penn State.Google Scholar
  23. 23.
    Riley W, Obermayer J, Jean-Mary J. Internet and mobile phone text messaging intervention for college smokers. J Am Coll Heal. 2008;57(2):245–8.CrossRefGoogle Scholar
  24. 24.
    Obermayer JL, Riley WT, Asif O, Jean-Mary J. College smoking-cessation using cell phone text messaging. J Am Coll Health. 2004;53(2):71–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Nahum-Shani I, Qian M, Almirall D, Pelham WE, Gnagy B, Fabiano GA, et al. Experimental design and primary data analysis methods for comparing adaptive interventions. Psychol Methods. 2012;17(4):457–77.CrossRefPubMedGoogle Scholar
  26. 26.
    Cerrada CJ, Ra CK, Shin H-S, Dzubur E, Huh J. Using ecological momentary assessment to identify common smoking situations among Korean American emerging adults. Prev Sci. 2016;17(7):892–902.CrossRefPubMedGoogle Scholar
  27. 27.
    Seidman I. Interviewing as qualitative research: a guide for researchers in education and the social sciences. 3rd ed. Teachers College Press; 2006.Google Scholar
  28. 28.
    Kreuger RA, Casey MA. Focus groups: a practical guide for applied research. 5th ed. Thousand Oaks: Sage; 2009.Google Scholar
  29. 29.
    Moustakas C. Phenomenological research methods. Thousand Oaks: Sage; 1994.CrossRefGoogle Scholar
  30. 30.
    Shiffman S, Gwaltney CJ, Balabanis MH, Liu KS, Paty JA, Kassel JD, et al. Immediate antecedents of cigarette smoking: an analysis from ecological momentary assessment. J Abnorm Psychol. 2002;111(4):531–45.CrossRefPubMedGoogle Scholar
  31. 31.
    Gollwitzer PM, Sheeran P. Implementation intentions and goal achievement: a meta-analysis of effects and processes. Adv Exp Psychol. 2006;38(38):69–119.CrossRefGoogle Scholar
  32. 32.
    Webb TL, Sheeran P, Luszczynska A. Planning to break unwanted habits: habit strength moderates implementation intention effects on behaviour change. Br J Soc Psychol. 2009;48(Pt 3):507–23.CrossRefPubMedGoogle Scholar
  33. 33.
    Armitage CJ. Efficacy of a brief worksite intervention to reduce smoking: the roles of behavioral and implementation intentions. J Occup Health Psychol. 2007;12(4):376–90.CrossRefPubMedGoogle Scholar
  34. 34.
    van Osch L, Lechner L, Reubsaet A, Wigger S, de Vries H. Relapse prevention in a national smoking cessation contest: effects of coping planning. Br J Health Psychol. 2008;13(Pt 3):525–35.CrossRefPubMedGoogle Scholar
  35. 35.
    Nahum-shani I, Hekler EB, Spruijt-metz D. Building health behavior models to guide the development of just-in-time adaptive interventions: a pragmatic framework. Heal Psychol. 2015;34(Supplement):1209–19.CrossRefGoogle Scholar
  36. 36.
    Klasnja P, Hekler EB, Shiffman S, Boruvka A, Almirall D, Tewari A, et al. Microrandomized trials: an experimental design for developing just-in-time adaptive interventions. Heal Psychol. 2015;34(Suppl):1220–8.CrossRefGoogle Scholar

Copyright information

© International Society of Behavioral Medicine 2017

Authors and Affiliations

  • Christian Jules Cerrada
    • 1
  • Eldin Dzubur
    • 1
  • Kacie C. A. Blackman
    • 1
  • Vickie Mays
    • 2
  • Steven Shoptaw
    • 2
  • Jimi Huh
    • 1
  1. 1.Department of Preventive Medicine, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  2. 2.University of CaliforniaLos AngelesUSA

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