Feasibility and Acceptability of Version 2 of the “Smiling Instead of Smoking” (SiS) Smartphone App for Nondaily Smokers (Preprint)

BACKGROUND Recent evidence highlights the significant detrimental impact of nondaily smoking on health and its disproportionate prevalence in underserved populations, yet little work has been done to develop treatments specifically geared toward quitting nondaily smoking. OBJECTIVE To test the feasibility, acceptability, and conceptual underpinnings of Version 2 of the “Smiling Instead of Smoking” (SiS2) smartphone app, which was developed specifically for nondaily smokers and uses a positive psychology approach. METHODS Prospective, single-group study of nondaily smokers (n=100) who were prescribed SiS2 app use for seven weeks while undergoing a quit attempt (1 week pre-, 6 weeks post-quit). The app assigned daily positive psychology exercises and behavioral tasks every 2-3 days, which guided smokers through using the smoking cessation tools offered in the app. Participants answered surveys at baseline and 2, 6, 12 and 24 weeks post-quit. Feasibility was evaluated based on app usage and acceptability by survey responses. The underlying conceptual framework was tested by examing if theorized within-person changes occurred from baseline to end-of-treatment on survey scales measuring self-efficacy, desire to smoke, and processing of self-relevant health information (i.e., pros and cons of smoking, importance of pros and cons of quitting, motivation). RESULTS Participants used the SiS2 app on average on 24.7±13.8 days out of the 49 prescribed days. In end-of-treatment surveys, participants indicated that the various functions of the app were “easy” to “very easy” to use. The average score on the System Usability Scale was a 79.8±17.3 (“A” grade; “A+”≥84.1, “B+”<78.8; Sauro, 2011). Most participants indicated that the app helped them in their quit attempt (87%); the app reminded them of why they wanted to quit (92%), helped them prepare for the quit attempt (84%), stay positive while quitting (82%), and deal with risky smoking times (68%). Large effects were found for within-person decreases in desire to smoke (b=-1.5[-1.9,-1.1],p<0.0001,gav=1.01), importance of pros of smoking (b=-20.7[-27.2,-14.3],p<0.0001,gav=0.83), and perceived psychoactive benefits of smoking (b=-0.8[-1.0,-0.5],p<0.0001,gav=0.80). Medium effects were found for increases in self-efficacy for remaining abstinent when encountering internal (b=13.1[7.6,18.7],p<0.0001,gav=0.53) and external (b=11.2[6.1,16.1],p<0.0001,gav=0.49) smoking cues. Smaller effects, and contrary to expectation, were found for decreases in motivation to quit smoking and perceived importance of pros of quitting (ps<0.01). Post-hoc analyses showed that motivation decreased for those who did not succeed in quitting while increasing for those who did (p<0.0001). No such interaction effect existed for the perceived importance of pros of quitting (p=0.94). Self-reported 30-day point prevalence abstinence rates were 40%, 56%, and 56% 6, 12 and 24 weeks after the quit day, respectively. CONCLUSIONS The SiS2 app was feasible and acceptable, showed promising changes on constructs relevant to smoking cessation, and had high self-reported quit rates by nondaily smokers. The SiS2 app warrants testing in a randomized controlled trial. CLINICALTRIAL Trial Registry: Clinicaltrials.gov Registration Number: NCT03951766 URL of Registry: https://clinicaltrials.gov/ct2/show/NCT03951766