App based on acceptance helps more smokers quit than app based on avoidance

iCanQuit, an acceptance and commitment therapy-based smoking cessation app, helped more smokers quit than the National Cancer Institute’s QuitGuide, a U.S. clinical practice guidelines app based on avoidance of smoking triggers, data show.

“The findings can change clinical practice in two key ways,” Jonathan B. Bricker, PhD, professor and director of the Health and Behavioral Innovations in Technology Lab at the Fred Hutchinson Cancer Research Center, told Healio Primary Care. “First, the findings elevate the overall value of smartphone apps for quitting smoking since up until now, there has been little proof that they actually work. Second, the findings show that the [acceptance and commitment therapy] smartphone-based approach is an efficacious option for patients to quit smoking.”

Bricker and colleagues recruited 2,415 smokers from all 50 states (mean age, 38.2 years; 70.4% women; 69% white). They randomly assigned 1,214 participants to use iCanQuit and the remaining 1,201 smokers to QuitGuide.

“We chose acceptance and commitment therapy because it was an innovative approach showing great promise for advancing the success of quit smoking programs,” Bricker said.

The primary outcome of the study was self-reported 30-day point prevalence abstinence (PPA) — that is, no smoking at all in the past 30 days — at the 12-month follow up. According to the researchers, 2,107 participants had been retained in the study up until that point.

For the primary outcome of 30-day PPA at 12 months, the iCanQuit users had 1.49 times higher odds of quitting smoking vs. QuitGuide users (28.2% vs. 21.1%; OR = 1.49; 95% CI, 1.22–1.83). Based on these data, the researchers determined that for every 100,000 smokers reached with iCanQuit, 28,000 would quit smoking.

The researchers also found that effect sizes were statistically significant for 7-day PPA (OR = 1.35; 95% CI, 1.12–1.63); prolonged abstinence at the 12-month follow-up (OR = 2; 95% CI, 1.45–2.76) and abstinence from all tobacco products, including e-cigarettes (OR = 1.6; 95% CI, 1.28–1.99).

Among the 2,093 smokers were retained in the study at 3 months, results also favored the iCanQuit app for 30-day PPA (OR = 2.2; 95% CI, 1.68–2.89) and 7-day PPA (OR = 2.04; 95% CI, 1.64–2.54). Among the 2,136 smokers retained at 6 months, similar effects were found for 30-day PPA (OR = 2.03; 95% CI, 1.63–2.54) and 7–day PPA (OR = 1.73; 95% CI, 1.42–2.1).

“The best advice for helping patients choose among the behavioral therapies is to inform patients of their efficacy and explain their overall approach,” Bricker said. “Starting with an app will require the least time and cost investment. And if that does not work, step up to more intensive treatment — for example, adding medications and in-person counseling.”