Smartphone App Profiling May Aid Smoking Cessation

TOPLINE:

Smartphone telehealth profiling, combined with nurse-led telephone counseling, increased smoking cessation rates in users unwilling to quit. This intervention showed higher rates of tobacco abstinence and usage of cessation aids than ecological momentary assessment (EMA) alone.

METHODOLOGY:

• This randomized clinical trial was conducted to assess the effectiveness of a novel smoking cessation intervention using a self-developed EMA smartphone app for profiling smoking behaviors, guiding personalized counseling via telephone, and instant messaging for tobacco users.
• Researchers included 459 participants (mean age, 36.7 years; 33.8% women) from Hong Kong who used tobacco with no intention to use cessation aids in the next month and did not use any smoking cessation services and medications in the preceding 7 days.
• All participants completed EMAs daily for 7 days with a gap of 3 hours between each EMA, reporting smoking behaviors and triggers; these were used to assess smoking-related features to guide the design of the intervention.
• Participants were randomly assigned to either the intervention group (n = 231), where they received personalized telephone counseling lasting about 20 minutes to raise awareness of personal smoking behaviors and an instant messaging support with a tapering schedule based on their profiling data, or the control group, where they completed the EMAs alone (n = 228).
• Primary outcomes were biochemically validated tobacco abstinence, defined as no use of any tobacco products in the preceding 7 days, and behavioral progression toward quitting, measured using incremental behavior change toward smoking cessation, both assessed at a 3-month follow-up period.

TAKEAWAY:

• At 3 months, the intervention group had a higher tobacco abstinence rate than the control group (odds ratio [OR], 2.46; P = .04). At 6 months, the intervention group maintained its higher abstinence rate (OR, 2.56; P = .02).
• The intervention group reported significantly higher rates of 7-day abstinence and usage of smoking cessation services and medications at both 3 and 6 months than the control group.
• The nurse-led telephone counseling and instant messaging were perceived as helpful for increasing motivation to quit (9.0% and 6.8%, respectively) and success in quitting (5.8% and 3.7%, respectively).
• A post hoc analysis showed that in the intervention group, higher EMA adherence rates (adjusted OR, 1.04; P = .04) and more responses to instant messaging (adjusted OR, 1.07; P = .001) were associated with increased abstinence at the 3-month follow-up, and more responses to the 10-week instant messages (adjusted β = 0.09; P < .001) were linked to higher incremental behavior change toward smoking cessation scores at the 3-month follow-up.

IN PRACTICE:

“[The study] findings suggest that this intervention can be used to supplement conventional smoking cessation promotion for individuals using tobacco who are unwilling to use smoking cessation aids,” the authors wrote.

SOURCE:

This study was led by Yee Tak Derek Cheung, PhD, and Min Jin Zhang, PhD, of the School of Nursing, Li Ka Shing Faculty of Medicine, at The University of Hong Kong in Hong Kong, China. It was published online on March 14, 2025, in JAMA Network Open.

LIMITATIONS:

This study targeted individuals who used tobacco without intending to use cessation aids, limiting its applicability to those already using such services. The effects of EMAs, telephone counseling, and instant messaging could not be separated due to the study design and insufficient sample size. Response fatigue may have affected EMA data accuracy, and the intervention’s effect on heavy smokers was uncertain because most participants had low to moderate tobacco dependence.

DISCLOSURES:

This study was supported by the Health and Medical Research Fund of the Food and Health Bureau Research Fellowship Scheme, the Hong Kong government. Two authors reported receiving grants from the same organization during the conduct of the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.