Efficacy of smartphone applications for smoking cessation: A randomized clinical trial

Abstract

T his double-blind, randomized clinical trial was designed to determine the efficacy of smartphone applications for smoking cessation. The trial compared the "iCanQuit" app, an acceptance and commitment therapybased application that teaches acceptance of smoking triggers, versus the "QuitGuide" app, a National Cancer Institute smoking cessation application that teaches avoidance of smoking triggers and is based on the United States Clinical Practice Guideline (USCPG) developed by the U.S. Department of Health and Human Services. 1 Adult participants who were current smokers desiring to quit (in addition to other eligibility criteria) were recruited via Facebook and then screened via encrypted web-based survey technology. Once accepted for the study, participants were stratified based on self-reported smoking frequency, educational level, depression screening, and race/ethnicity before being randomized in a 1:1 manner to the smartphone apps. A total of 2,415 U.S. adult cigarette smokers (mean age at enrollment 38 years old; 70% female; 36% racial/ethnic minorities; all 50 U.S. states represented) were allocated into the iCanQuit (n51,214) or the QuitGuide (n51,201) study arms. Both groups were followed-up at three, six, and 12 months postrandomization, with the primary study outcome being self-reported 30-day point prevalence abstinence (PPA) at 12 months-meaning that the participant reports 30 days without smoking at the 12-month follow-up. The secondary outcomes were 30-day and 7-day PPA at three and six months, respectively, 7-day PPA at 12 months, and prolonged abstinence (defined as 9 months without smoking when asked at the 12-month follow-up). The study participant retention rate at 12 months was 87%. For the primary outcome, iCanQuit participants achieved a greater 30-day PPA at the 12-month follow-up compared with QuitGuide participants (28.2% vs 21.1%; number needed to treat514; odds ratio [OR] 1.49; 95% CI, 1.22-1.83). Secondary outcomes demonstrated similar effect sizes favoring iCan-Quit over QuitGuide with 30-day PPA at 3-month follow-up (OR 2.20; 95% CI, 1.68-2.89), 30-day PPA at 6-month follow-up (OR 2.03; 95% CI, 1.63-2.54), 7-day PPA at 3month follow-up (OR 2.04; 95% CI, 1.64-2.54), seven-day PPA at 6-month follow-up (OR 1.73; 95% CI, 1.42-2.10), and prolonged abstinence at the 12-month follow-up (OR 2.00; 95% CI, 1.45-2.76). The primary study limitation was the self-reporting nature of the design versus a biochemical verification of smoking cessation.