Evidence Based Patient Centric App Review Series
App Reviewed: QuitForever
Goals of app review:
First is to determine if the QuitForever app can be recommended by physicians in a comprehensive program to help smokers quit their habit.
Secondly, to determine if the app follows the recommended AHRQ Guidelines for Treating Tobacco Use and Dependence.
Last Updated: June 14, 2011
Compatibility: iPhone, iPad, iPod Touch
Requires: iOS 3.1 or later
Reviewed on: iPad
Smoking and nicotine use is a major contributor of mortality and morbidity from lung cancer, heart disease, COPD, and stroke. 70% of smokers want to quit, 45% of smokers attempt to quit each year and less than 10% are successful .
An app utilizing evidence-based guidelines for smoking cessation could be a useful tool for physicians and other healthcare providers to boost discontinuance rates.
This app was developed by the University of Tennessee Health Science Center to assist smokers in their quest to stop. It is promoted as a step-by-step program based on research in the study of smoking cessation. Unfortunately, the links to the support site of the University of Tennessee Research Foundation no longer work.
The user begins by inputting how they choose to quit — cold turkey or slowly by weaning.
The user chooses a reason for quitting, number of cigarettes smoked daily, the cost of a pack and a quit date. One can choose “Other” as a reason but cannot input what that reason is.
Once the data is entered the user is directed to read the My Plan section of the app. This area consists of three sections as seen below.
The smoker is supposed to work through all sections of the My Plan area. This includes planning what to do to avoid relapses, defining triggers and writing in what to do about them as well as a discussion of maintenance of the non-smoking state. Areas of input can also be seen in the Workbook area of My Profile.
The My Health area illustrates the impact smoking has on various body systems, pregnancy, secondhand smoke and the benefits of quitting.
The My Support area gives telephone and Online links for further assistance in stopping cigarettes.
Healthcare goals of app:
Smoking is defined as a chronic disease by the US Public Health Department and international experts involved in the study of nicotine dependence. There are evidence based quitting strategies that this app has attempted to use for individuals wishing to quit.
Evidence to support goals:
LC Abroms et al  performed a systematic review of all iPhone apps available for smoking cessation in June of 2009 and ranked the apps based on their adherence to the AHRQ Guidelines for Smoking Cessation .
QuitForever appeared in the app store after this study. By utilizing the table developed by Dr. Abroms and her team this app appeared to better adhere to guidelines than any other smoking cessation app reviewed at the time of the original article.
- $ 1.99
- Uses the 2008 evidence-based smoking cessation guidelines established by the AHRQ
- The app has a strong educational component for the smoker to improve motivation
- Incorporates smoking specific problem solving recommendations
- Provides links to further social supportive and individual supportive sites
- No app support listed in the app and the links on iTunes do not work
- No way to input an individual’s reason for quitting if different from the four reasons cited in the app
- App has not been updated since 2011
- Not a thorough enough discussion and encouragement of medication use (only nicotine replacement and non-generic medications are reviewed in the app)
What providers would benefit from app?
- Primary Care physicians
- Addiction physicians
- Psychologists or other mental health providers working in smoking cessation
What patient would benefit from app?
- This app is specific to smokers and not other nicotine product users
- The app is easy to use, with no technical knowledge necessary
- Given the lack of support, only a physician well-acquainted with the most up-to-date smoking cessation information might consider using this app in clinical practice to supplement his/her own recommendations.
QuitForever follows AHRQ guidelines by determining tobacco use status and assumes willingness to quit by virtue of the smoker’s purchase of the app. It recommends evidence-based treatment by including “counseling” in the app itself, with discussions of the health benefits of smoking cessation, harm of continued smoking, encouragement of garnering support from family and friends, recommended problem-solving skills by the workbook which asked the user to predetermine smoking triggers, causes of relapses and rewards for success. The guidelines specifically recommend the use of medication in all patients in whom it is not contraindicated and the app is very soft in this aspect.
In comparing this app to other apps previously reviewed by Abroms, et al  it appears to have much stronger adherence to the key guidelines in the 2008 AHRQ document.
However, it has not been updated since June 2011 and all links to its developer are broken. For this reason alone, the app cannot be strongly recommended for use with patients, particularly given its $1.99 price tag. This is unfortunate as it appears to be better developed than many of the smoking cessation apps in the App Store.
- Abrams, et al. Boosting Population Quits Through Evidence-Based Cessation Treatment and Policy. URL:http://tobacco-cessation.org/PDFs/March%202010%20Supplement/Boosting-Abrams.pdf. Accessed: 2012-07-18. (Archived by WebCite® at http://www.webcitation.org/69FY7Abd4)
- Abroms, LC et al. iPhone Apps for Smoking Cessation: A Content Analysis. URL:http://preparedpatientforum.org/research/support_020811b.pdf. Accessed: 2012-07-18. (Archived by WebCite® at http://www.webcitation.org/69FapMyVi)
- Agency for Healthcare Research and Quality. Treating Tobacco Use and Dependence: 2008 Update. URL:http://www.ahrq.gov/clinic/tobacco/treating_tobacco_use08.pdf. Accessed: 2012-07-18. (Archived by WebCite® at http://www.webcitation.org/69Fbegyae)
This post does not establish, nor is it intended to establish, a patient physician relationship with anyone. It does not substitute for professional advice, and does not substitute for an in-person evaluation with your healthcare provider. It does not provide the definitive statement on the subject addressed. Before using these apps please consult with your own physician or healthcare provider as to the apps validity and accuracy as this post is not intended to affirm the validity or accuracy of the apps in question. The app(s) mentioned in this post should not be used without discussing the app first with your healthcare provider.