Abstract
Background: Smartphone applications (apps) are popular aids for smoking cessation. Smoke Free is an app that delivers behaviour change techniques used in effective face-to-face behavioural support programmes. The aim of this study was to assess whether the full version of Smoke Free is more effective than the reduced version. Methods: This was a two-arm exploratory randomised controlled trial. Smokers who downloaded Smoke Free were randomly offered the full or reduced version; 28,112 smokers aged 18+ years who set a quit date were included. The full version provided updates on benefits of abstinence, progress (days smoke free), virtual 'badges' and daily 'missions' with push notifications aimed at preventing and managing cravings. The reduced version did not include the missions. At baseline the app recorded users': device type (iPhone or Android), age, sex, daily cigarette consumption, time to first cigarette of the day, and educational level. The primary outcome was self-reported complete abstinence from the quit date in a 3-month follow-up questionnaire delivered via the app. Analyses conducted included logistic regressions of outcome on to app version (full versus reduced) with adjustment for baseline variables using both intention-to-treat/missing-equals smoking (MES) and follow-up-only (FUO) analyses. Results: The 3-month follow-up rate was 8.5% (n=1,213) for the intervention and 6.5% (n=901) for the control. A total of 234 participants reported not smoking in the intervention versus 124 in the control, representing 1.6% versus 0.9% in the MES analysis and 19.3% versus 13.8% in the FUO analysis. Adjusted odds ratios were 1.90, 95%CI=1.53-2.37 (p<0.001) and 1.50, 95%CI=1.18-1.91 (p<0.001) in the MES and FUO analyses respectively. Conclusions: Despite very low follow-up rates using in-app follow up, both intention-to-treat/missing equals smoking and follow-up only analyses showed the full version of the Smoke Free app to result in higher self-reported 3-month continuous smoking abstinence rates than the reduced version.
Highlights
Smartphone applications are used by many smokers to aid cessation but currently little evidence exists on their effectiveness
Participants who received the reduced version of the app were older, smoked more cigarettes per day, started smoking earlier in the day and were more likely to designate a quit date that was after the date of registration, but the differences were small
In the missing-equals smoking (MES) analysis 1.6% (n=234) of the participants in the intervention group and 0.9% (n=124) of the participants in the control group reported as being abstinent from smoking
Summary
Smartphone applications (apps) are used by many smokers to aid cessation but currently little evidence exists on their effectiveness. The Smoke Free app (smokefreeapp.com) is very popular worldwide, with some 4,000 new downloads per day When it first became available, it was the subject of a trial with users finding and downloading the app from the app store being randomly assigned to a full version or a reduced version. The evidence-based BCTs implemented in the full version of the app were: 1) Supporting identity change: supporting app users to think of themselves as non-smokers, 2) Rewarding abstinence: praise, virtual prizes and showing them how much money they are saving each day of not smoking, 3) Changing routines: advising on ways of avoiding smoking cues by changing routines that involve smoking, and 4) Advising on medication use: promoting the use of one of the evidence-based stop-smoking medicines These BCTs are designed to increase resolve and prevent, reduce and counter urges to smoke. A total of 234 participants reported not smoking in the intervention versus 124 in the control, representing 1.6% versus 0.9% in the MES analysis and version 2
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