Innovator Spotlight Q&A Series: Bettina B. Hoeppner, PhD, MS
The CIDH Innovator Spotlight is a Q&A series that celebrates innovative ideas, highlights the important work that digital health innovators are doing to advance patient care and outcomes at Mass General Hospital, and shares key learnings about the innovation journey.
We are pleased to feature Bettina B. Hoeppner, Ph.D., MS, Associate Professor of Psychology at Harvard Medical School, Associate Director of Research at the Recovery Research Institute, and Director of Biostatistics at the Center for Addiction Medicine at Mass General Hospital (MGH).
Q: Tell us about your innovation and the challenge(s) you are trying to solve. Who are the people involved?
BH: Great question, thank you. I’ll focus my answers here on my digital research – I also do research in the recovery support services space; check out our initiative on recovery community centers, housed right here at MGH, and the larger network we have formed with our colleagues across the country on recovery support services in general.
In my digital research, I focus on providing smoking cessation support to marginalized and underserved populations. I started by focusing on people who smoke on some days. This pattern of smoking is particularly common in Black and Latinx populations. It is also a pattern on the rise among people with serious mental health issues. Currently, there is no treatment for nondaily smoking. Pharmaceutical options have been tried, but have not succeeded in helping people who smoke nondaily quit smoking. Thus, we (my research team and I) sought to identify novel treatment targets.
We landed on positive affect for many reasons, including:
- addressing well-being was in line with the goals of our target population
- impacting positive affect is entirely feasible, thanks to the burgeoning research in the area of positive psychology
- research findings have shown that positive affect can have substantial and beneficial impacts on processes underlying smoking cessation; for example, positive affect decreases the urge to smoke and increases confidence to abstain from smoking
Our next step was to choose the delivery method for this intervention. Like many of my colleagues, my thinking has been heavily influenced by the RE-AIM framework, which urges us to think about the factors that impact the real-world effectiveness of the interventions we develop. “Reach” was a particularly important issue to me: time and money are critical barriers to engaging in ‘treatment’ – I use that term lightly here, referring to any kind of support to address health issues, such as seeking out smoking cessation support. We knew that, overall, people who smoke nondaily were less likely than people who smoke daily to seek out support, but when it came to mHealth technologies, there was interest. Thus, we developed a smartphone app that provides smoking cessation support via a positive psychology framework.
Q: The innovation process can be long and challenging but also rewarding. What inspired you to begin this journey?
BH: So many things! My interest in leveraging technology to impact health behaviors definitely has its roots in my graduate training at the Cancer Prevention Research Center at the University of Rhode Island. This team pioneered so much in behavioral medicine, including the use of technology to reach large populations.
My interest in positive psychology exists since this term was coined. I vividly remember reading the paper in the American Psychologist in 2020 introducing “positive psychology” as an area of research. I read the paper, and called up my sister, saying, “how fun would it be to do that kind of research?!” And here we are, doing it – she (Dr. Susanne Hoeppner) is my main collaborator on my positive psychology projects.
I was also inspired by one of my postdoctoral mentors, Dr. Christopher Kahler, who pioneered positive psychotherapy for smoking cessation; and the team here at MGH, the Cardiac Psychiatry Research Program, who are trailblazing positive psychology interventions in impressively productive ways. These colleagues really gave me the courage to go forward with my ideas. Doing the work is what sustains my energy – engaging with our research participants, digesting feedback together in our team, generating ideas, and translating all that into the design of our app: the Smiling instead of Smoking (SiS) app (available on iOS and Android).
Q: Where are you in the innovation cycle (i.e. early stage, commercialization)?
BH: Ah, commercialization! I actually hope never to get to that stage. My hope is to be able to partner with community partners to get the app into the hands of people who can benefit from it free of charge. Ask me in 5 years how we are doing on that front!
As to the stage of research: We just finished our first randomized controlled trial (RCT) testing the SiS app. In earlier studies, we showed that the app effectively engaged people who smoke nondaily, both when onboarded in-person and when on-boarded remotely. Participants in both studies also showed the changes over time we hoped to see: increases in confidence to remain abstinent from smoking, and decreases in urges to smoke. In a feature-level analysis, our data also showed that app use was positively linked to subsequent smoking cessation success, both short-term (6 weeks after the quit attempt) and long-term (6 months after the quit attempt). This was particularly true for using the positive psychology content of the SiS app.
Our proof-of-concept RCT was designed to test, in a randomized design, if onboarding study participants to the SiS app would result in better outcomes in terms of conceptual, interim markers of smoking cessation success, compared to onboarding study participants to materials created by Smokefree.gov (i.e., the “QuitGuide” app and the “Clearing the Air” brochure). We are working on the analyses right now, which are looking very promising.
We have also begun adapting the SiS app for people with HIV who smoke. Here, we are partnering with Dr. Conall O’Cleirigh, director of the MGH Behavioral Medicine program, to integrate a treatment he and his team has developed with our app. The goal is to leverage the joined strengths of our approaches to provide effective smoking cessation support for this important population.
“My hope is to be able to partner with community partners to get the app into the hands of people who can benefit from it free of charge.”
Q: What resources within the Mass General Brigham network have been most helpful to you?
BH: Hands-down, ECOR interim support funding! At the time, I was a mom with two young kids coming off a K01 award, seeking R funding for my work, trying to land a grant that combined too many novel things: nondaily smoking, smartphone app technology, and positive psychology. ECOR funding allowed me to create Version 1 of the SiS app, which led to my subsequent funding. This funding was absolutely critical.
Also – though a less tangible resource – it’s my MGH colleagues, who inspired, encouraged, and supported me throughout this work, and equally important, my mentees, undergraduate interns, and clinical research coordinators, whose hands-on contributions, creativity, and enthusiasm make this work fulfilling and joyful.
Q: If you could give one piece of advice to another innovator, what would it be?
BH: Only one piece of advice? Uh, that’s a tough one. I think for me it boils down to this: you got to love it. If you enjoy thinking about every aspect of your product/innovation, you will always find the energy to figure out the next step.
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