JMIR Publications

ABSTRACT

Background:

Cigarette smoking remains one of the leading causes of preventable death worldwide [1]. A worldwide study by the WHO concluded that more than 8 million people die every year from smoking, tobacco consumption, and second-hand smoke [2]. Meanwhile, the annual economic burden attributable to smoking was found to be more than $600 billion in the U.S. alone in 2018 as reported by the CDC [3]. The most effective tobacco cessation programs require personalized human intervention combined with costly pharmaceutical supplementation, making them unaffordable and/or inaccessible to most tobacco users [3]. Thus, digital interventions, delivered through smartphones, offer a promising alternative to these traditional methods. However, the leading smartphone applications available in the market today have either not been studied in a clinical setting or are unable to match the smoking cessation success rates of their expensive offline counterparts. We would like to understand whether QuitSure, a novel smoking cessation application, is able to bridge this efficacy gap and deliver affordable and effective smoking cessation at scale.

Objective:

Our objective was to do an initial exploration into the engagement, efficacy, and safety of QuitSure based on the self-reported experiences of its users. Outcomes measured were program completion, the effect of program completion on smoking behavior, including self-reported cessation outcomes, and negative health events from using the application.

Methods:

All QuitSure registered users who created their accounts on the QuitSure application between 1 April 2021 and 28 Feb 2022 were sent an anonymised web-based survey. The survey results were added to their engagement data on the app to evaluate the feasibility and efficacy of the app as a smoking cessation intervention. The data was analyzed using descriptive statistics (frequencies and percentages) and chi-square test of independence.

Results:

A total of 13,237 users who had completed the QuitSure program were sent the survey, of which a final 1,299 participated in the study. App engagement and pre-program smoking behavior data between those who filled out the survey versus those who did not were not significantly different. Of the study participants, 1,286 had completed the program more than 30 days ago and 80.87% (1040) of them had maintained continuous smoking abstinence (c.s.a.) 30-days post program completion. 1,002 of the total participants had completed the program more than 6 months ago, of which 72.36% (725) had maintained c.s.a. 6-months post program completion. Only 13.13% of participants who reported abstinence for at least 1 day experienced known severe nicotine withdrawal symptoms. No additional adverse events outside of these known nicotine withdrawal symptoms were reported.

Conclusions:

The nature of the web-based survey and cohort selection allows for extensive unknown biases. However, the efficacy rates of survey respondents who completed the program are high and provide a case for further investigation in the form of randomized controlled trials on the QuitSure tobacco cessation program.