Smartphone health apps for tobacco Cessation: A systematic review.

BACKGROUND: Given the low retention and lack of persistent support by traditional tobacco cessation programs, evidence-based smartphone app-supported interventions can be an important tobacco control component. The objective of this systematic review was to identify and evaluate the types of studies that use smartphone apps for interventions in tobacco cessation. METHODS: We conducted a systematic review of PubMed (1946-2019), EMBASE (1974-2019), and PsycINFO (1806-2019) databases with keywords related to smartphone-supported tobacco cessation. Included articles were required to meet 3 baseline screening criteria: 1) be written in English, 2) include an abstract, and 3) be a full, peer-reviewed manuscript. The criteria for the second level of review were: 1) primary outcome of tobacco cessation, 2) intervention study, and 3) smartphone app as primary focus of study. RESULTS: Of 1973 eligible manuscripts, 18 met inclusion criteria. Most studies (n = 17) recruited adult participants (18 + years); one included teens (16 + years). Tobacco cessation was usually self-reported (n = 11), compared to biochemical verification (n = 3) or both (n = 4). There were 11 randomized controlled trials, 4 of which reported statistically significant results, and 7 single-arm trials that reported a mean abstinence rate of 33.9%. DISCUSSION: The majority of studies that use tobacco cessation apps as an intervention delivery modality are mostly at the pilot/feasibility stage. The growing field has resulted in studies that varied in methodologies, study design, and inclusion criteria. More consistency in intervention components and larger randomized controlled trials are needed for tobacco cessation smartphone apps.

Instagram's #JUUL: who's posting what.

Exposure to e-cigarette (e-cig) marketing through traditional and online media can increase the risk of e-cig use among adolescents. Though popular e-cig brand JUUL has scaled back its social media promotions, outside vendors and individual users create posts about JUUL unregulated. Instagram's image-focus offers an opportunity to document promotions that may appeal to adolescents. To assess the visual representation of JUUL on social media, we systematically classified discussion topics and themes of posts to Instagram. Of 25,428 unique Instagram images using the hashtag #JUUL retrieved between June 18 and July 18, 2018, a random subsample of 3,000 images (approximately 12% of the full data set) was drawn for human coding and analyses. Coded categories included relevance to JUUL, type of image, image appeal, and user type. Based on the number of relevant images, percentages of image type and appeal for each user type were calculated. There were 583 images that were coded as relevant. The majority of image types (64%) were classified as product (n =; 374). The most frequently coded type of appeal was flavors, found in 54% of images with appeal (n =; 149), followed by cartoons, found in 21% (n =; 57). Vendors were responsible for posting most of the images (n =; 291), followed by e-cig enthusiasts (n =; 99). Continued surveillance of e-cig products, such as JUUL, remains necessary to provide a foundation for potential regulatory protections against marketing and promotions that may appeal to youth.

Tobacco cessation mobile app intervention (Just Kwit! study): protocol for a pilot randomized controlled pragmatic trial.

BACKGROUND: Adolescence and young adulthood are critical times of initiation and progression to daily use of tobacco. However, it is difficult to recruit young adults to traditional smoking cessation and retention rates are typically low. Smartphone cessation applications (apps) can provide real-time responses to smoking urges and related cues, which are known to be important factors in lapse and relapse. Given the popularity of smartphones among young adults and the considerably higher download rates of commercially developed apps compared to research-based apps, there is a need to design pragmatic studies that evaluate commercial tobacco cessation apps. The aims of this pilot study are to assess the impact on tobacco cessation of using a smartphone app compared with usual care and to generate feasibility data to inform a future fully powered clinical trial. METHODS: We will conduct an open randomized controlled trial with parallel groups. Participants will be selected from hospitalized patients and must be aged 18-30 years, interested in cessation, smoked > 5 cigarettes/day over the past 30 days, and own an Apple or Android smartphone. Participants who are eligible will be randomized to either a smartphone experimental group or patient-initiated follow up (usual care). As this study seeks to assess feasibility, the primary data will include (1) recruitment rates, (2) retention rates, and (3) adherence, measured through user engagement with the app. DISCUSSION: This pilot trial will be the first to evaluate a commercially available smartphone app for tobacco cessation in a hospitalized setting. Data generated by this study can be used for larger fully powered trials such as comparative effectiveness studies against apps developed by academics or health scientists based on behavioral theories, or cost-effectiveness analyses of mobile interventions. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03538678 . Registered on 28 May 2018.