An Evidence-Based App to Prescribe to Patients for Tobacco Cessation

Tobacco use remains the #1 preventable cause of morbidity and mortality in the United States and worldwide. Overall, cigarette smoking among U.S. adults (aged ≥18 years) declined from 20.9 percent in 2005 to 13.7% in 2018. Still, nearly 34 million American adults smoked cigarettes in 2018, according to the Centers for Disease Control and Prevention (CDC). 

Smoking remains the leading cause of cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD). National efforts have included tobacco taxes and smoking bans which have both proven effective. More recently, the prescribing of apps for cessation has been utilized and shown to be effective. 

We previously reviewed and praised the outstanding QuitMedKit from the University of Texas MD Anderson Cancer Center and the also excellent SmokerStop app. QuitMedKit includes almost everything a primary care provider would need for tobacco cessation, while SmokerStop uses personal motivation to help patients quit. Also, the National Cancer Institute (NCI) has its own tobacco cessation app, QuitGuide, that helps patients quit by avoiding their triggers. But is avoidance of trigger the best way to help patients quit? 

According to Jonathan Bricker,PhD, it is not. He has pioneered the use of acceptance and commitment therapy (ACT) to help patients quit smoking. He has performed numerous trials at the Fred Hutch Cancer Research Center utilizing ACT in face-to-face, telephone, and internet-based treatments with great success. Several years ago (we previewed SmartQuit back in 2016), he partnered with 2Morrow Inc in Kirkland, WA, to design an app that brings ACT for tobacco cessation to the smartphone. In full disclosure, I participated in a pilot study of SmartQuit as the Principal Investigator. Our results were promising, but not conclusive. Now Bricker and the Fred Hutch team have published a large RCT comparing the iCANQUIT app to the NCI app–ACT (embracing your triggers) vs. NCI app (avoid your triggers). The study enrolled over 2500 participants and demonstrated a significant improvement in cessation with iCANQUIT over the NCI app. iCANQUIT users had 1.49 times higher odds (OR 1.49) of quitting (self-reported 30-day abstinence). Furthermore, this study followed participants out to 12 months. 

iCANQUIT utilizes a game-like format to guide users to complete a custom quit plan, complete 14 lessons, and accept (rather than avoid) triggers via exercises, reminders, and progress tracking. The app can be used with or without NRT and can send users daily messages/reminders and live coaching. 2MorrowInc has an entire platform based on ACT to help not only with tobacco cessation, but vaping, weight loss, and chronic pain.

Evidence-based medicine

Developed by Dr. Jonathan Bricker at the Fred Hutch Cancer Research Center in conjunction with 2Morrow Inc and numerous NCI grants, iCANQUIT/SmarQuit is an evidence-based tobacco cessation app based on Dr. Bricker’s work using ACT for tobacco cessation. The app has several published studies demonstrating efficacy on various levels, and just published the largest study yet demonstrating efficacy versus. the NCI tobacco cessation app. 

Who would benefit from this app?

Patients/family members, medical students, primary care physicians, mid-levels, hospital medicine physicians, nurses, pharmacists or any provider who counsels patients on tobacco cessation.

Likes

  • Simple interface for creating a customized quit plan
  • ACT-based, game-like platform for lessons, exercises, tools, online/live coaching
  • Available for Android

 

Dislikes

  • Likely still need medical assistance with NRT or other for success
  • Currently not widely available
  • Requires smartphone, not available for some patients

Overall

iCANQUIT by Dr. Jonathan Bricker at the Fred Hutch Cancer Center/2Morrow Inc has become the standard bearer for tobacco cessation apps. Using its novel acceptance and commitment therapy (ACT) proven in F2F and phone based tobacco cessation, the app has successfully adapted ACT to the smartphone using a game-like platform. The app outperforms the NCI app and along with NRT can increase tobacco cessation. Keep on the lookout for this app as it becomes more widely available. Highly recommended. 

Overall Score

o 5.0 stars

User Interface

o 4.5 stars

Easy-to-use efficient interface to set a customized quit plan and track progress.

Multimedia Usage

o 5.0 stars

App contains progressive lessons (over 14), tips/tools/exercises, daily messaging/reminders, live coaching.

Price

o N/A

App available via clinical trials, some employers, some state smoking cessation programs.

Real-World Applicability

o 5.0 stars

iCANQUIT has taken the existing SmartQuit app and improved upon it. Now with the recent publication of the iCANQUIT trial in JAMA Internal Medicine, this app is ready for prime time. iCANQUIT now has the robust evidence base of any tobacco cessation app on the market. Ideally, this app will become available to patients outside of clinical trials/employers. Regardless, we again have strong evidence of medical apps demonstrating improvement in patient outcomes. 

Device Used For Review

o iPhone 11 Pro running iOS 14.01

Available for download for iPhone, iPad, and Android.

Disclaimer: The views expressed are those of the author(s) and do not reflect the official policy of the Department of the Army, the Department of Defense, or the U.S. Government.