Using augmented reality to deliver cue exposure treatment for smoking cessation: App usability findings and protocol for a randomized controlled trial

Ranjita Poudel¹, Skye O Dougan¹, Helen Yates¹, Leslie Sawyer², Ursula Martinez³, Karen O Brandon¹, Steven K Sutton⁴, Damon J Vidrine⁵, Lee M Ritterband⁶, Kara P Wiseman⁷, Katrina A Vickerman⁸, Kea Turner⁹, Margaret M Byrne¹, Min-Jeong Yang¹⁰, Marilyn Horta¹, Thomas H Brandon¹¹, Christine Vinci¹²

Affiliations

¹ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
² Department of Psychology, University of South Florida, Tampa, FL, USA.
³ Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA.
⁴ Department of Psychology, University of South Florida, Tampa, FL, USA; Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA; Department of Oncological Sciences, University of South Florida, Tampa, FL, USA.
⁵ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA; Department of Oncological Sciences, University of South Florida, Tampa, FL, USA.
⁶ Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA.
⁷ Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA.
⁸ Center for Wellbeing Research, RVO Health, Fort Mill, SC, USA.
⁹ Division of Health Systems, Policy, and Innovation, University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁰ Institute for Nicotine and Tobacco Studies, Rutgers Biomedical and Health Sciences (Rutgers Health), Rutgers, The State University of New Jersey, New Brunswick, NJ, USA; Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
¹¹ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA; Department of Psychology, University of South Florida, Tampa, FL, USA.
¹² Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA; Department of Psychology, University of South Florida, Tampa, FL, USA; Department of Oncological Sciences, University of South Florida, Tampa, FL, USA. Electronic address: christine.vinci@moffitt.org.

PMID: 39880329
PMCID: PMC12149911 (available on 2026-03-01)
DOI: 10.1016/j.cct.2025.107827

Using augmented reality to deliver cue exposure treatment for smoking cessation: App usability findings and protocol for a randomized controlled trial

Ranjita Poudel et al. Contemp Clin Trials. 2025 Mar.

. 2025 Mar:150:107827.

doi: 10.1016/j.cct.2025.107827. Epub 2025 Jan 27.

Authors

Affiliations

¹ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA.
² Department of Psychology, University of South Florida, Tampa, FL, USA.
³ Department of Family and Preventive Medicine, University of Utah, Salt Lake City, UT, USA.
⁴ Department of Psychology, University of South Florida, Tampa, FL, USA; Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA; Department of Oncological Sciences, University of South Florida, Tampa, FL, USA.
⁵ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA; Department of Oncological Sciences, University of South Florida, Tampa, FL, USA.
⁶ Center for Behavioral Health and Technology, Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, VA, USA.
⁷ Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, VA, USA.
⁸ Center for Wellbeing Research, RVO Health, Fort Mill, SC, USA.
⁹ Division of Health Systems, Policy, and Innovation, University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
¹⁰ Institute for Nicotine and Tobacco Studies, Rutgers Biomedical and Health Sciences (Rutgers Health), Rutgers, The State University of New Jersey, New Brunswick, NJ, USA; Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers, The State University of New Jersey, Piscataway, NJ, USA.
¹¹ Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA; Department of Psychology, University of South Florida, Tampa, FL, USA.
¹² Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA; Department of Psychology, University of South Florida, Tampa, FL, USA; Department of Oncological Sciences, University of South Florida, Tampa, FL, USA. Electronic address: christine.vinci@moffitt.org.

PMID: 39880329
PMCID: PMC12149911 (available on 2026-03-01)
DOI: 10.1016/j.cct.2025.107827

Abstract

Background: Augmented Reality (AR) is a rapidly developing technology with potential utility for treating addictive behaviors, including tobacco smoking. AR inserts digital images into a natural real-time scene as viewed on a smartphone or other video devices. With respect to smoking cessation, AR can place virtual smoking cues (i.e., smoking "triggers") within an individual's natural smoking environment. Repeated exposure to these cues could enhance smoking cessation through Pavlovian extinction processes.

Method: In a usability study (N = 10), we evaluated the acceptability of a smoking cessation AR app to inform modifications to the app prior to an upcoming randomized controlled trial (RCT). For the subsequent RCT, individuals who enroll in a state tobacco quitline will be referred to the study and, if eligible and consented, randomized to use the app with AR features or without AR features (control) for 5 weeks. The efficacy of the AR features to enhance smoking cessation in the context of concurrent quitline treatment will be evaluated with the primary outcome of self-reported 7-day point-prevalence cigarette abstinence at 6 months post-enrollment. Implementation will be evaluated via incremental cost-effectiveness analyses and interviews with participants, quitline staff, and app coaches.

Conclusions: Interventions utilizing emerging mobile technologies such as AR have the potential, compared to traditional therapies, to improve both reach and efficacy by administering therapeutic elements in users' natural environments. Our AR app will target tobacco smoking, but the approach could be used to deliver exposure therapies for other addictive behaviors, as well as anxiety disorders.

Clinical trial registration: NCT06088498.

Keywords: Augmented reality; Cue exposure therapy; Smartphone application; Smoking cessation; mHealth.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

References

1. Reitsma MB, et al. , Spatial, temporal, and demographic patterns in prevalence of smoking tobacco use and attributable disease burden in 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. The Lancet, 2021. 397(10292): p. 2337–2360 DOI: 10.1016/S0140-6736(21)01169-7. - DOI - PMC - PubMed
1. Leventhal AM, Dai H, and Higgins ST, Smoking Cessation Prevalence and Inequalities in the United States: 2014–2019. J Natl Cancer Inst, 2022. 114(3): p. 381–390 DOI: 10.1093/jnci/djab208. - DOI - PMC - PubMed
1. Stumpp S, Knopf T, and Michelis D. User experience design with augmented reality (AR). in Proceedings of the ECIE 2019 14th European conference on innovation and entrepreneurship. 2019.
1. Munzer BW, et al. , Augmented reality in emergency medicine: a scoping review. Journal of medical Internet research, 2019. 21(4): p. e12368 DOI: 10.2196/12368. - DOI - PMC - PubMed
1. Barsom EZ, Graafland M, and Schijven MP, Systematic review on the effectiveness of augmented reality applications in medical training. Surgical endoscopy, 2016. 30: p. 4174–4183 DOI: 10.1007/s00464-016-4800-6. - DOI - PMC - PubMed

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Using augmented reality to deliver cue exposure treatment for smoking cessation: App usability findings and protocol for a randomized controlled trial

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Using augmented reality to deliver cue exposure treatment for smoking cessation: App usability findings and protocol for a randomized controlled trial

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Abstract

Conflict of interest statement

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