Accepted for/Published in: JMIR Formative Research
Date Submitted: Apr 10, 2023
Date Accepted: Sep 28, 2023
Preliminary efficacy of a cognitive behavioral therapy-based smartphone app for smoking cessation in China: a randomized controlled pilot trial
ABSTRACT
Background:
The overall prevalence of cigarette smokers in China is very high, and China’s total cigarette consumption makes up more than 40% of the world’s consumption. In view of the lack of smoking cessation services and social support in China and the effectiveness of mobile phone applications (apps) for quitting smoking in other countries, we carried out a smartphone-app-based smoking cessation trial in China.
Objective:
The purpose of this study was to evaluate the efficacy of a cognitive behavioral therapy (CBT) based smoking cessation smartphone app among smokers seeking treatment in China.
Methods:
We conducted a randomized controlled, virtual pilot clinical trial in China between February 23, 2021, and June 27, 2021. Eligible participants were randomly assigned to the smoking cessation app intervention group or the control group in a ratio of 1:1. The intervention group received the CBT smoking cessation intervention using smartphone app and the control group received a thank-you message. The intervention was 4 weeks, and the patients were followed up for 4 weeks. The primary outcome was self-reported continuous smoking abstinence at week 4 after the quit date. The secondary outcomes included self-reported 7-day point prevalence of smoking abstinence, reduction of the number of cigarettes smoked per day at weeks 1, 2, 3, and 4, and program acceptability.
Results:
973 people were recruited to quit smoking, of whom 262 completed basic information, 56 were excluded, 206 were randomized and included in the final analysis. There were 189 men (91.7 %) and 17 women (8.3%), with an average age of 34.46 ± 7.53 years old, and an average daily smoking rate of 15.93 ± 7.10 cigarettes/day. We found 30/101 participants (29.7%) in the intervention group and 7/105 participants (6.7%) in the control group reported continuous smoking cessation after the quit date at week 4 (OR = 5.92, 95% CI: 3.78-9.26, P ＜0.001). The 7-day point prevalence abstinence rate after 1, 2, 3, and 4 weeks was 42.6% to 46.5% in the intervention group, and 18.1% to 26.7% in the control group. Compared to the control group, continued smokers consumed 1.5-3.0 fewer cigarettes/per day in the intervention group. The overall program got positive user feedback with high satisfaction rate (75.9%) and an average user version Mobile Application Rating Scale (uMARS) score of 3.46.
Conclusions:
Our pilot study provided preliminary evidence that the CBT-based smoking cessation smartphone app led to improved smoking quit rates vs control in Chinese smokers. The study demonstrated the CBT-based smartphone app may be an effective and feasible digital treatment model to help smokers quit, which may improve smoking cessation service quality and accessibility in China. Clinical Trial: NCT04421170
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