By Samantha Denefrio PhD
Background: Health apps created to promote behavior change are not a new idea in the fields of psychology and nutrition. In particular, smoking is a global health concern that has been the focus of many health-centered mobile applications. Research from 2013 tracked that there are approximately 400 smoking cessation apps available (Abroms et al., 2013).
However, many of these applications have low usage rates and one of the main weaknesses identified was that none of the reviewed apps included the phone number to a quit smoking help hotline. Furthermore, an extensive meta-analysis published in 2017 found that of the most popular commercial apps for smoking cessation, only 4% were scientifically validated in empirical papers making it very difficult for potential users to recognize and choose data-backed apps (Haskins, Lesperance, Gibbons, Boudreaux, 2017).
Technology: Some of the earlier international applications relied on support delivered through text messaging (i.e., Free et al., 2011; Liao et al., 2018). Reviews of the text message approach have shown significant value in smoking cessation, particularly in studies where quitting was biochemically confirmed (Whittaker, McRobbie, Bullen, & Rodgers, 2016).
More recently, gamified mobile applications to modify smoking behaviors have become increasingly popular. Apps are an effective and easy way to make theory-driven games more accessible to targeted populations as well as increase engagement and compliance.
One recent smoking cessation game that has been created in England, Cigbreak, was created by a team of clinicians and game developers who incorporated evidence-based principles of behavior modification into a game (Edwards et al., 2018). Cigarettes dance on the screen out of a pack and the player must break the cigarettes by swiping the screen. Built into the app are opportunities for daily entries about feelings and challenges. Rewards are sent for a reduction in smoking in real life as well as improvements made in the game. There is also an optional social support component via Facebook. Among a focus group of 73 smokers, 84% reported that they would continue to use the app and refer it to a friend.
Conclusions: Although there is a plethora of smoking cessation apps available, more innovation is needed coupled with academically-rigorous review of quality and efficacy.
Keywords: games for smoking cessation; smoking cessation, health apps
Key Learning Points:
Search Methods: Articles were extracted from Google Scholar with results ranging from 2010 to present date and using the following search terms: “smoking cessation app”, smoking cessation smartphone”,” smoking cessation app meta-analysis”.
Abroms, L. C., Westmaas, J. L., Bontemps-Jones, J., Ramani, R., & Mellerson, J. (2013). A content analysis of popular smartphone apps for smoking cessation. American journal of preventive medicine, 45(6), 732-736.
Edwards, E. A., Caton, H., Lumsden, J., Rivas, C., Steed, L., Pirunsarn, Y., … & Smith, J. Q. (2018). Creating a theoretically grounded, gamified health app: lessons from developing the Cigbreak smoking cessation mobile phone game. JMIR serious games, 6(4), e10252.
Free, C., Knight, R., Robertson, S., Whittaker, R., Edwards, P., Zhou, W., … & Roberts, I. (2011). Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial. The Lancet, 378(9785), 49-55.
Haskins, B. L., Lesperance, D., Gibbons, P., & Boudreaux, E. D. (2017). A systematic review of smartphone applications for smoking cessation. Translational behavioral medicine, 7(2), 292-299.
Liao, Y., Wu, Q., Kelly, B. C., Zhang, F., Tang, Y. Y., Wang, Q., … & Tang, J. (2018). Effectiveness of a text-messaging-based smoking cessation intervention (“Happy Quit”) for smoking cessation in China: A randomized controlled trial. PLoS medicine, 15(12), e1002713.
Whittaker, R., McRobbie, H., Bullen, C., Rodgers, A., & Gu, Y. (2016). Mobile phone‐based interventions for smoking cessation. Cochrane Database of Systematic Reviews, (4).