Brief Report
A Content Analysis of Popular Smartphone Apps for Smoking Cessation

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Background

Smartphone applications (apps) are increasingly available for smoking cessation.

Purpose

This study examined the content of popular apps for smoking cessation for both iPhone and Android operating systems in February 2012.

Methods

A total of 252 smoking-cessation apps were identified for the iPhone and 148 for the Android. Across both operating systems, the most popular apps were identified (n=47 for the iPhone and n=51 for the Android) and analyzed for their (1) approach to smoking cessation and (2) adherence to an index based on the U.S. Public Health Service's Clinical Practice Guidelines for Treating Tobacco Use and Dependence. Where available, apps were coded for frequency of downloads. The analysis took place in 2012.

Results

Overall, popular apps have low levels of adherence, with an average score of 12.9 of a possible 42 on the Adherence Index. No apps recommended calling a quitline, and only a handful of apps recommended using approved medications (4.1%). Android apps in the sample were downloaded worldwide between 310,800 and 1,248,000 times per month. For both the iPhone and Android, user ratings were positively associated with scores on the Adherence Index. For the iPhone, display order was also positively associated with scores on the Adherence Index.

Conclusions

Apps could be improved by better integration with the Clinical Practice Guidelines and other evidence-based practices.

Introduction

Based on the prevalence of smartphone ownership1 and smoking2, and an estimated 11 million smokers in the U.S. own a smartphone. The extent to which smoking-cessation apps are being used on smartphones, and to what effect, is unknown. No studies to date in the peer-reviewed literature have reported on the efficacy of smartphone apps for smoking cessation. Moreover, a content analysis of 47 iPhone apps for smoking cessation indicated that apps have low levels of adherence to key evidence-based practices.3

A number of trends have emerged that have made an updated review of apps warranted. Android has overtaken iPhone and its operating system as the leading smartphone operating system.4 Additionally, the number of available smoking-cessation apps on both platforms has increased substantially. Finally, the evidence base to support using mobile phones for smoking cessation, specifically text-messaging programs, has grown,5, 6 with two meta-analyses supporting the use of text-messaging programs.5, 7

This study set out to update the previous study3 by expanding the scope of review to include apps for both the iPhone and Android and by expanding the evaluation criteria to reflect the current evidence base. Of interest is the degree to which popular smoking-cessation apps adhere to established best practices for smoking cessation and the extent to which these apps are being used by the public.

Section snippets

Sample

A list of smartphone apps was collected for both the iPhone and Android, the two leading smartphone operating systems,4 on February 11, 2012, using the search terms quit smoking, stop smoking, and smoking cessation. The list of possible apps for the iPhone was obtained using iTunes (version 10.5.2) and for the Android, using Google Play. A total of 414 quit-smoking apps were identified. Because the volume of apps exceeded available resources, a decision was made to limit the analysis to the top

Results

An overview of the characteristics of smoking-cessation apps (n=98) is presented in Table 1, and details about each app are provided in Appendix A (available online at www.ajpmonline.org) for the iPhone and Appendix B (available online at www.ajpmonline.org) for the Android. The average Adherence Index Score for all apps in the sample was 12.9 (SD=6.8) of a possible 42 points. Calculator apps were the most common category, representing 38.8% of all apps, followed by hypnosis apps (17.3%);

Discussion

Overall, apps were found to have low levels of adherence to items on the Adherence Index. Although apps were found to have some strengths, including being specific to smoking and being interactive, several basic evidence-based practices were missing from the vast majority of apps. Omissions included referrals to a quitline (no apps) and recommending approved medications (4.1% of apps). The presence of these gaps supports earlier findings3 and represents areas for improvements.

Emerging evidence

Acknowledgments

Lorien Abroms/George Washington University has licensed Text2Quit to Voxiva Inc. Text2Quit is a text-messaging program for smoking cessation.

This research was supported by Grant 5K07 CA124579-02 to Dr. Lorien Abroms, from the National Cancer Institute of the NIH. Support also came from an award from a Culminating Experience Award to Rathna Ramani from the Department of Prevention & Community Health at the George Washington University School of Public Health and Health Services.

No other

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