Smoking is the leading cause of preventable and premature death globally. In the digital age there are now more than 500 English language smoking cessation apps on the market, and with them, new concerns about making the most of these sophisticated tools have emerged.
Dr. Jonathan B. Bricker, a professor in the Public Health Sciences Division at Fred Hutchinson Cancer Center, and his team shed light on a critical aspect of this journey: the impact of FDA-approved smoking cessation medication alongside digital tools like the iCanQuit smartphone app. iCanQuit, accessed through its smartphone app, provides training in Acceptance and Commitment Therapy (ACT) techniques for managing smoking urges, maintaining motivation, and preventing relapse. It is a self-paced program with sequentially unlocked content. The app focuses on developing skills to manage smoking-related physical sensations, emotions, and thoughts. The first four levels, which unlock progressively, are geared towards preparing users for their quit day. While the final four levels, unlocked after seven consecutive smoke-free days, help maintain smoke-free status. The levels include 51 exercises in total addressing cravings, withdrawal symptoms, potential relapse, depression, and weight gain issues. In case of a relapse, users are encouraged, but not required, to reset their quit date and revisit the initial levels. While the iCanQuit app's effectiveness in helping smokers quit was already known, its performance in conjunction with FDA-approved smoking cessation medications remained unexplored until this study. Bricker’s research, featured in Addiction, explores whether combining this digital ally with traditional quit-smoking medications like nicotine patches or pills like varenicline or bupropion can make a difference.
The study's methodology involved a secondary analysis of the parent trial, which included 2415 adults from various racial and ethnic backgrounds, representing all 50 US states. The participants were randomly assigned to use either iCanQuit or QuitGuide, a smartphone app based on the US Clinical Practice Guidelines (USCPG) for 12 months. The study's population was defined as two groups: one consisting of 619 participants who reported using an FDA-approved cessation medication within the first 3 months after being randomized into the trial, and the other consisting of 1469 participants who reported not using any cessation medications during that period. This resulted in a total sample size of 2088, representing 86.5% of the parent trial's participants. These participants were provided with exclusive access to their designated app and received unique links to complete online surveys at the 3-, 6-, and 12-month follow-ups.
This approach allowed for a comprehensive evaluation of the interaction between medication use and digital intervention. The findings showed that for participants who reported using any cessation medication, the 12-month quit rates were significantly higher for iCanQuit users (34%) compared to QuitGuide (20%). This outcome was particularly pronounced in participants who used nicotine replacement therapy exclusively, where iCanQuit users demonstrated a 40% quit rate compared to 18% for QuitGuide users. The study found no significant difference in medication use between the iCanQuit and QuitGuide groups, suggesting that the observed differences in quit rates were likely attributable to the apps themselves rather than variances in medication use. The enhanced effectiveness of the iCanQuit app can be partially attributed to its ACT-based approach, which focuses on accepting and dealing with cravings rather than avoiding them.
These findings suggest that digital interventions, particularly those based on ACT, like iCanQuit, can be significantly more effective when combined with pharmacotherapy. This combination offers a potent tool for individuals seeking to quit smoking, providing both behavioral and physiological support. Bricker's research demonstrates the amplified power of combining digital interventions with traditional medications. It opens new doors in the way we approach smoking cessation, emphasizing the synergy between the mind and body in this challenging journey. As the world leans more into digital solutions for health, the combination of easily accessible apps and widely available medications like NRT represents an efficient, scalable approach to help smokers quit.
This study received support through grants from the National Cancer Institute (NCI).
Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium Member Dr. Jonathan Bricker contributed to this study.
Bricker, J. B., Santiago-Torres, M., Mull, K. E., Sullivan, B. M., David, S. P., Schmitz, J., Stotts, A., & Rigotti, N. A. (2023). Do medications increase the efficacy of digital interventions for smoking cessation? Secondary results from the iCanQuit randomized trial. Addiction.