New research from Fred Hutch shows that an app can dramatically help smokers quit

Jonathan Bricker, professor at the Fred Hutchinson Cancer Research Center. (Fred Hutch Photo)

An app developed by the Fred Hutchinson Cancer Research Center is nearly four times more effective at helping smokers quit than the average success rate for those trying to kick cigarettes.

A clinical trial of 2,415 adult smokers nationwide found that 28% of participants using the Hutch’s iCanQuit app were able to quit after 12 months. The typical rate of smoking cessation in the U.S. is 7.5%, according to federal data from the Centers for Disease Control and Prevention.

The Fred Hutch study is one of the largest, most rigorous randomized trials to test both the performance of a mobile health therapy and evaluate the performance of an intervention approach known Acceptance and Commitment Therapy (ACT), said professor Jonathan Bricker, the study lead.

“We have the evidence of efficacy,” Bricker said. “Now we can look at how we can disseminate this broadly.”

The project, which was funded by a $3.1 million National Cancer Institute grant, was published this week in the peer-reviewed journal JAMA Internal Medicine.

While apps to help smokers quit have been downloaded more than 33 million times, there has been limited research into how well they worked.

 This is a landmark study that fast-forwards the field of digital health.

“This is a landmark study that fast-forwards the field of digital health, including its critical application during the COVID-19 pandemic helping people who smoke quit,” said Dr. Tim McAfee, former director of the CDC’s Office on Smoking and Health, in a statement. McAfee was not involved in the research.

The study compared the performance of the iCanQuit app against that of another app called QuitGuide. The two take fundamentally different approaches to helping people quit smoking. The Fred Hutch app used ACT, which teaches people skills for recognizing the urge smoke and allowing it pass, focusing on what a person values — family, health and community, for example — and how moving past that urge supports those priorities. The National Cancer Institute’s QuitGuide approach instead teaches smokers to avoid their urges and uses reason and logic to motivate people.

Users of the iCanQuit app interacted with the tool more frequently and for longer stretches of time than they did QuitGuide. The study checked in with participants after three, six and 12 months. After a year’s time, 28% of iCanQuit users had given up cigarettes, compared to 21% of those using QuitGuide.

The iCanQuit app from Fred Hutch. (Fred Hutch Image)

That difference is huge in the context of public health, Bricker said. To put it into more relatable numbers, if 100,000 people used iCanQuit, that would mean 28,000 would quit smoking. Compared to QuitGuide, that would be an additional 7,000 people giving up the habit.

“We’re taking about life and death. And if you get more people to quit, this changes families and lives,” said Jo Masterson, CEO of 2Morrow.

2Morrow, a Kirkland, Wash.-based mobile health company, has partnered with the Fred Hutch since 2013 in developing smoking cessation apps. The company sells its own version of an app to help smokers quit, as well as other digital behavioral modification tools based on ACT. Its customers include employers, government agencies, health plans and some providers. The recent study was conducted entirely independently of 2Morrow.

2Morrow is creating its own version of the iCanQuit app. The Fred Hutch app is available for Android and iOS device users. Pass codes for opening the app are available by emailing [email protected]

Bricker previously conducted a pilot study to evaluate the use of an ACT-intervention app on smoking.

ACT can be applied to curbing wide-ranging behaviors including vaping, diet, anxiety, depression, pain management and dealing with grief and loss.

Bricker’s lab has multiple projects underway, including an National Cancer Institute-funded project to test a digital tool that the researchers call a “quitbot,” and describe it as part therapist and part chatbot. The $3.65 million grant for the 5-year study was awarded in April. In July, Bricker received $3.5 million from National Cancer Institute I to test an app targeting cancer patients trying to quit smoking. A third project studies ACT in weight loss and is funded through the National Institutes of Health.

This week Bricker paused, however briefly, to recognize the accomplishment of the JAMA publication and its potential for driving others to pursue this approach to treatment.

“It’s very personally gratifying,” he said. “This is the kind of moment I live for as a scientist.”

The study’s other authors were Noreen Watson, Kristin Mull, Brianna Sullivan and Jaimee Heffner, all affiliated with the Fred Hutch.

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