Smoking cessation with smartphone applications (SWAPP): study protocol for a randomized controlled trial

Abstract

BackgroundTobacco smoking remains one of the biggest public health threats. Smartphone apps offer new promising opportunities for supporting smoking cessation in real-time. The social context of smokers has, however, been neglected in smartphone apps promoting smoking cessation. This randomized controlled trial investigates the effectiveness of a smartphone app in which smokers quit smoking with the help of a social network member.MethodsThis protocol describes the design of a single-blind, two-arm, parallel-group, intensive longitudinal randomized controlled trial. Participants of this study are adult smokers who smoke at least one cigarette per day and intend to quit smoking at a self-set quit date. Blocking as means of group-balanced randomization is used to allocate participants to intervention or control conditions. Both intervention and control group use a smartphone-compatible device for measuring their daily smoking behavior objectively via exhaled carbon monoxide. In addition, the intervention group is instructed to use the SmokeFree Buddy app, a multicomponent app that also facilitates smoking-cessation specific social support from a buddy over a smartphone application. All participants fill out a baseline diary for three consecutive days and are invited to the lab for a background assessment. They subsequently participate in an end-of-day diary phase from 7 days before and until 20 days after a self-set quit date. Six months after the self-set quit date a follow-up diary for three consecutive days takes place. The primary outcome measures are daily self-reported and objectively-assessed smoking abstinence and secondary outcome measures are daily self-reported number of cigarettes smoked.DiscussionThis is the first study examining the effectiveness of a smoking cessation mobile intervention using the SmokeFree Buddy app compared to a control group in a real-life setting around a self-set quit date using a portable objective measure to assess smoking abstinence. Opportunities and challenges with running studies with smoking participants and certain design-related decisions are discussed.Trial registrationThis trial was prospectively registered on 04/04/2018 at ISRCTNregistry: ISRCTN11154315.

Methods Used in Smoking Cessation and Reduction Attempts: Findings from Help-Seeking Smokers

“…The nudge approach to health behavior change highlights "choice architecture," individual autonomy, and simplicity in behavioral change [41,42]. Studies on smoking cessation applications are constantly evolving, and the use of smart technology such as the possibility of detecting smoking in real time may be an effective tool for increasing success rates [43,44].…”

Effectiveness of mobile applications to quit smoking: Systematic review and meta-analysis

“…As the boom in mobile applications has been very recent, there are very few clinical trials that evaluate their effectiveness against other types of smoking cessation interventions. Even though some studies with protocols of clinical trials have been published to evaluate the effectiveness of mobile applications compared to other alternatives 36 - 39 , the trials are still in progress, and therefore the results have not been included in the meta-analysis. In addition, as the adherence to smoking cessation treatment guidelines is generally low, this may potentially have a negative impact on the effectiveness of apps 46 .…”

“…Second, an analysis of publication bias was performed, detecting that there is, indeed, a risk of publication bias, due to the recent boom of smartphone applications. Accordingly, many ongoing studies will provide results and conclusions within 2-3 years [37][38][39][40] and a new meta-analysis study will be welcome. Third, the sensitivity analysis showed the robustness of the measurement with the available data, with no significant changes in the magnitude of the combined measurement when repeating the meta-analysis by deleting a study each time.…”

Are Machine Learning Methods the Future for Smoking Cessation Apps?

“…As with other health-related apps, the smoking cessation app market has seen growth, but only a few of the apps have been scientifically examined or supported with randomised controlled trials that have assessed their efficacy [ 27 , 28 , 29 ]. An early approach in designing smoking cessation apps was very simple and contained self-reported trackers (e.g., money spent or cigarettes smoked) and smoking advice, which the user could access when logging in to the app.…”