Clinical Question

Does a smartphone application based on acceptance and commitment therapy for smoking cessation increase a smoker's chance for sustained abstinence?

Bottom Line

Use of the iCanQuit smartphone app by smokers, who were recruited through Facebook and other Internet tools, produced higher cessation rates at 12 months (28.2%) than the QuitGuide app (21.1%). This translates into one additional person quitting for every 14 smokers who use the iCanQuit app compared with the QuitGuide app. The app is free and available for Android and Apple smartphones. (Level of Evidence = 1b−)

Synopsis

The investigators recruited patients (via Internet advertisements) who lived in the United States, owned a smart-phone, could read English, and who desired to quit smoking in the next 30 days. The participants were randomly assigned, using concealed allocation, to be given one of two smart-phone-based apps. iCanQuit (2Morrow, Inc.) uses an acceptance and commitment therapy model, which teaches skills for allowing urges to pass without smoking. Users play a game to complete a custom quit plan; complete 14 lessons; and accept, rather than avoid, smoking triggers via exercises, reminders, and progress tracking. The QuitGuide application focuses on avoiding cravings and provides information on the health consequences of smoking. For purposes of masking during the study, both applications were branded as “iCanQuit.” The study researchers did not provide nicotine replacement therapy, but did not prohibit it. More than 87% of patients self-reported their smoking status after 12 months. The participants assigned to the iCanQuit app were significantly more likely to report 30 days of abstinence at 12 months (28.2%) than those assigned to the QuitGuide (21.1%), which translates into a number needed to treat of 14 (95% CI, 8.5 to 28.8). These rates might be slightly inflated, given that they are self-reported rather than biochemically confirmed, although it is unlikely that one group would report more optimistic data than the other. Use of the application was monitored, and the participants who used iCanQuit accessed the app more often, spent more time with it, and used it on more days.

Study design: Randomized controlled trial (double-blinded)

Funding source: Government

Allocation: Concealed

Setting: Outpatient (any)

Reference: Bricker JB, Watson NL, Mull KE, et al. Efficacy of smartphone applications for smoking cessation: a randomized clinical trial. JAMA Intern Med. 2020;180(11):1472–1480.

Editor's Note: Dr. Shaughnessy is an assistant medical editor for AFP.