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Sue Zbikowski, Ph.D., serves as chief science officer for 2Morrow, whose clinically tested digital health platforms help people change unhealthy behaviors. An experienced health and wellness leader, entrepreneur, psychologist and scientist, Zbikowski has spent more than 25 years studying tobacco use dependence, risk factors, and behavioral and technology supported interventions.
Interact for Health: How did you become involved in smoking cessation research?
Zbikowski: My father died of a heart attack at the age of 48 when I was 10. For most of my adolescence/young adulthood I thought I wanted to be a doctor, but I quickly learned that doctors typically treat illness and disease, and I wanted to prevent it. I figured I could do more good doing research to help physicians prevent disease onset.
While in graduate school at the University of Memphis I had the opportunity to work on smoking cessation research with leading researchers in the field. During one of my assistantships, I served as a cessation group instructor. This is when I learned how to use cognitive behavioral therapy strategies and problem-solving techniques to help smokers overcome challenges they experienced while quitting. Later, I learned about research being done at St. Jude Children’s Research Hospital in Memphis showing high rates of smoking among children who survived cancer. This inspired the topic of my doctoral research—to examine the prevalence of and risk factors for smoking among children with asthma. I was incredibly fortunate to have supportive faculty and unique career development opportunities in graduate school that enabled me to develop skills as a researcher and leader. It was this set of experiences that led me to my career in industry.
Interact for Health: You’ve been studying tobacco dependence for more than two decades. How have cessation programs evolved over that time?
Zbikowski: The core content of cessation programs is, by and large, the same. What has changed is how programs are delivered and the removal of significant barriers to treatment and improved access. When I entered the field, most programs were offered in person via clinic-based and university-run programs. There were no widely available commercial, public or employer-sponsored programs. Through comprehensive public health campaigns and programs, smokers now have greater awareness of the hazards of smoking and the benefits of quitting and employers are aware of benefits of smoke-free policies and paying for cessation resources.
Today, there are more options than ever for smokers to use when trying to quit. That includes free state quitlines, smokefree.gov resources, and employer sponsored programs that include everything ranging from programs delivered digitally via apps, text or online, to those that include one on one coaching and coverage for FDA-approved cessation medications.
Interact for Health: 2Morrow’s cessation and behavior change programs rely on acceptance and commitment therapy to help people change their behaviors and improve their coping skills. How does ACT differ from traditional cognitive behavioral therapy?
Zbikowski: Acceptance and commitment therapy and cognitive behavioral therapy are both empirically based psychological therapies that share a common foundational history. According to CBT, psychological problems are based, in part, on faulty or unhelpful ways of thinking and behaving and treatment focuses on reframing thoughts and learning better ways to cope.
ACT focuses less on changing thoughts and more on encouraging psychological flexibility and living toward your individual values. ACT teaches ways of being aware of and accepting negative or distressing thoughts and persevering with one’s goals despite them. Rather than pushing negative thoughts out, individuals are encouraged to acknowledge one’s thoughts and to let them pass without judgment or forced action. For example, people are taught just because they have an urge or craving, they don’t have to act on it—they can sit with the urge, acknowledge it and choose to persist toward their values. Over time, these thoughts will become less and less intense.
Interact for Health: 2Morrow’s smoking cessation programs are delivered via smartphone apps. What makes smartphones such an effective tool for helping people change their behaviors?
Zbikowski: Access to smartphones has proliferated over the past decade. Today more than 85% of U.S. adults own a smartphone, up from 35% a decade ago. Smartphones are incredible tools for delivering health interventions that include text messages, phone and video calls, and mobile apps with various content, features and tools. Smartphones are portable and accessible and can deliver tailored, personalized programs based on various sources of data. Smartphones have removed many of the barriers to access—they are a pocket size computer that you can carry with you anytime and anywhere. They have shifted what consumers expect from services and service providers.
Interact for Health: How has COVID-19 affected the need for smoking cessation programs?
Zbikowski: COVID-19 has increased stress, anxiety, depression and substance use and resulted in hundreds of thousands of individuals putting their health and well-being priorities on hold. There is a need to help individuals who have put their health priorities on hold and to re-engage them. This may include sparking motivation, reducing shame and encouraging new quit attempts.
Interact for Health: When you look at advancements in the field, what do you find most encouraging?
Zbikowski: I am impressed with the amount of ongoing innovation and research. Researchers and commercial providers haven’t given up on trying to discover new ways to help smokers quit. In some cases this is examining the optimal timing, intensity, duration and tools. In other cases, it is examining how to combine treatments or tailoring content for different populations or offering incentives to promote engagement. The commitment to providing evidence-based solutions that benefit smokers is critical. I hope that service providers will continue to raise the bar for demonstrating effectiveness and reach.
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