The objectives of this project are to develop, implement, and test the feasibility and effectiveness of an artificial intelligence adaptive mobile pregnancy tobacco cessation app-based intervention using deep tailoring and a self-nominated support person, and to build mHealth research capacity in Romania.

Aim 1: Develop and test the feasibility and acceptability of the SFT2.0 app-based mobile smoking cessation intervention with a support person during pregnancy and postpartum in Romania. Through a user-centered and iterative design we will enhance our SFT1.0 app, deepen the tailoring, incorporate reinforcement learning, expand the app for use by any support person, and test the intervention including the app and MI video counseling in a series of usability studies and a 12-week open trial.

Aim 2: Test the SFT2.0 app-based smoking cessation intervention in a hybrid effectiveness and implementation randomized controlled trial. We will randomize 375 pregnant smokers and their support persons to i) a fixed arm, including the SFT2.0 app for both, and fixed pre- and postnatal MI counseling; ii) an reinforcement-learning-adaptive arm, with the app continuously optimizing as-needed MI counseling; or iii) control group.

Aim 3: Develop mHealth research capacity by enhancing individual and institutional research capabilities in Romania and expanding the existing international research network.