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Health Apps are Falling Short of Their Promise


Mobile health technology seems primed for the task helping patients quit smoking. However, a recent survey of apps for smoking cessation suggests the reality of what patients are using falls short of this promise.

This article published with permission from

Nearly one in five men and women are active smokers. For these individuals, it is estimated that their smoking will take just shy of 15 years off their life expectancy.

In 2005, the last year for which this type of data is available, nearly half a million people died due to smoking.

Unfortunately, as anyone who has tried to work with patients to help them quit knows, once someone picks up the habit it is really hard to kick.

At least in my experience, it’s usually not the chemical addiction that is the hardest part, though — it’s the behavioral dependence.

For that reason, mobile health technology seems primed for the task— ready to deliver the just-in-time intervention when my patient is stressed at work and would normally get up to go have a cigarette.

A Cochrane Review of randomized controlled trials of mobile health interventions for smoking cessation would suggest that they can double a patient’s chances of long-term abstinence. However, a recent survey of apps for smoking cessation suggests the reality of what patients are using falls short of this promise.

The promise

In the review, Whittaker et al. searched for randomized controlled trials (RCTs) or “quasi” RCTs that evaluated a principally mobile phone based intervention for smoking cessation with at least six months of follow up.

Ultimately, they identified five trials for inclusion including:

• Three that used personalized SMS-based interventions

• One that used SMS with a web based quit coach (either separately or in combination)

• One that used a video messaging intervention

In the meta-analysis of the pooled results of these trials, they found improved long term quit rates (RR 1.171, P=0.001) though with significant trial heterogeneity. Individually, only two of the five trials showed a benefit though the authors note that some of those trials face problems like inadequate enrollment.

Of the trials, the largest and most rigorous was a study by Free et al. in 2011 with nearly 6,000 participants from the U.K., which more than doubled biochemically confirmed long-term smoking cessation with an SMS-based intervention (4% to 9% biochemically verified; 12% to 30% self-reported).

The reality

Abroms et al. started by searching for apps, both iOS and Android, using key phrases including quit smoking, stop smoking and smoking cessation. Of the 414 apps they found, the limited themselves to approximately 50 of the most popular for each platform.

In addition to capturing some basic data about the app, two independent coders then assessed the apps based on an Adherence Index based on the U.S. Clinical Practice Guideline for Treating Tobacco Use and Dependence. Overall the best Adherence Score an app could get was 42.

Read more.

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