Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2020 Nov 1;180(11):1472-1480.
doi: 10.1001/jamainternmed.2020.4055.

Efficacy of Smartphone Applications for Smoking Cessation: A Randomized Clinical Trial

Jonathan B Bricker  1   2 , Noreen L Watson  1 , Kristin E Mull  1 , Brianna M Sullivan  1 , Jaimee L Heffner  1
Affiliations
Randomized Controlled Trial

Efficacy of Smartphone Applications for Smoking Cessation: A Randomized Clinical Trial

Jonathan B Bricker et al. JAMA Intern Med. .

Abstract

Importance: Smoking is a leading cause of premature death globally. Smartphone applications for smoking cessation are ubiquitous and address barriers to accessing traditional treatments, yet there is limited evidence for their efficacy.

Objective: To determine the efficacy of a smartphone application for smoking cessation based on acceptance and commitment therapy (ACT) vs a National Cancer Institute smoking cessation application based on US clinical practice guidelines (USCPG).

Design, setting, and participants: A 2-group, stratified, double-blind, individually randomized clinical trial was conducted from May 27, 2017, to September 28, 2018, among 2415 adult cigarette smokers (n = 1214 for the ACT-based smoking cessation application group and n = 1201 for the USCPG-based smoking cessation application group) with 3-, 6-, and 12-month postrandomization follow-up. The study was prespecified in the trial protocol. Follow-up data collection started on August 26, 2017, and ended at the last randomized participant's 12-month follow-up survey on December 23, 2019. Data were analyzed from February 25 to April 3, 2020. The primary analysis was performed on a complete-case basis, with intent-to-treat missing as smoking and multiple imputation sensitivity analyses.

Interventions: iCanQuit, an ACT-based smoking cessation application, which taught acceptance of smoking triggers, and the National Cancer Institute QuitGuide, a USCPG-based smoking cessation application, which taught avoidance of smoking triggers.

Main outcomes and measures: The primary outcome was self-reported 30-day point prevalence abstinence (PPA) at 12 months after randomization. Secondary outcomes were 7-day PPA at 12 months after randomization, prolonged abstinence, 30-day and 7-day PPA at 3 and 6 months after randomization, missing data imputed with multiple imputation or coded as smoking, and cessation of all tobacco products (including e-cigarettes) at 12 months after randomization.

Results: Participants were 2415 adult cigarette smokers (1700 women [70.4%]; 1666 White individuals [69.0%] and 868 racial/ethnic minorities [35.9%]; mean [SD] age at enrollment, 38.2 [10.9] years) from all 50 US states. The 3-month follow-up data retention rate was 86.7% (2093), the 6-month retention rate was 88.4% (2136), and the 12-month retention rate was 87.2% (2107). For the primary outcome of 30-day PPA at the 12-month follow-up, iCanQuit participants had 1.49 times higher odds of quitting smoking compared with QuitGuide participants (28.2% [293 of 1040] vs 21.1% [225 of 1067]; odds ratio [OR], 1.49; 95% CI, 1.22-1.83; P < .001). Effect sizes were very similar and statistically significant for 7-day PPA at the 12-month follow-up (OR, 1.35; 95% CI, 1.12-1.63; P = .002), prolonged abstinence at the 12-month follow-up (OR, 2.00; 95% CI, 1.45-2.76; P < .001), abstinence from all tobacco products (including e-cigarettes) at the 12-month follow-up (OR, 1.60; 95% CI, 1.28-1.99; P < .001), 30-day PPA at 3-month follow-up (OR, 2.20; 95% CI, 1.68-2.89; P < .001), 30-day PPA at 6-month follow-up (OR, 2.03; 95% CI, 1.63-2.54; P < .001), 7-day PPA at 3-month follow-up (OR, 2.04; 95% CI, 1.64-2.54; P < .001), and 7-day PPA at 6-month follow-up (OR, 1.73; 95% CI, 1.42-2.10; P < .001).

Conclusions and relevance: This trial provides evidence that, compared with a USCPG-based smartphone application, an ACT-based smartphone application was more efficacious for quitting cigarette smoking and thus can be an impactful treatment option.

Trial registration: ClinicalTrials.gov Identifier: NCT02724462.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Bricker reported receiving grants from the National Cancer Institute during the conduct of the study; serving on the scientific advisory board for and receiving personal fees from Chrono Therapeutics outside the submitted work; and reported that the Fred Hutchinson Cancer Research Center has applied for a US patent that pertains to the content of the iCanQuit application. 2Morrow, Inc, a Kirkland, Washington–based software company, has licensed this technology from the Fred Hutchinson Cancer Research Center. Dr Bricker had no personal financial relationships with this patent application, the licensing agreement, or 2Morrow, Inc. Ms Mull reported receiving grants from the National Institutes of Health/National Cancer Institute during the conduct of the study. Dr Heffner reported receiving nonfinancial support from Pfizer outside the submitted work. None of the authors has a financial relationship with the iCanQuit application and thus will not receive any compensation when it becomes publicly available. No other disclosures were reported.

Figures

Figure.
Figure.. CONSORT Diagram for iCanQuit Trial
IP indicates internet protocol; PIN, personal identification number. aTo increase enrollment of racial/ethnic minorities and men, some nonminorities and women who were otherwise eligible for study enrollment were randomly selected to be excluded.
See this image and copyright information in PMC

References

    1. GBD 2015 Risk Factors Collaborators Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1659-1724. doi:10.1016/S0140-6736(16)31679-8 - DOI - PMC - PubMed
    1. GBD 2015 Tobacco Collaborators Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet. 2017;389(10082):1885-1906. doi:10.1016/S0140-6736(17)30819-X - DOI - PMC - PubMed
    1. Husten CG. A call for ACTTION: increasing access to tobacco-use treatment in our nation. Am J Prev Med. 2010;38(3)(suppl):S414-S417. doi:10.1016/j.amepre.2009.12.006 - DOI - PubMed
    1. Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y, Dobson R. Mobile phone text messaging and app-based interventions for smoking cessation. Cochrane Database Syst Rev. 2019;10:CD006611. doi:10.1002/14651858.CD006611.pub5 - DOI - PMC - PubMed
    1. Pew Research Center. Mobile fact sheet. Published June 12, 2019. Accessed August 14, 2020. https://www.pewresearch.org/internet/fact-sheet/mobile/

Publication types

Associated data