University College London Preliminary evaluation of SF28: a smartphone application to aid smoking cessation Robert West Harveen Kaur University College London

Declaration of interest I receive research funds and undertake consultancy for companies that develop and manufacture smoking cessation medications (Pfizer and J&J) I am co-director of the UK National Centre for Smoking Cessation and Training I am a trustee of the stop-smoking charity, QUIT My salary is funded by the charity, Cancer Research UK

How to stop smoking Get Ready Go Keep going Decide on a ‘quit smoking rule’ Decide on a quit point Lay the ground work Go Apply the quit smoking rule Keep going Do what it takes to stick to the rule

The battle over time between resolve and urge to smoke When the urge is stronger than resolve and cigarettes are available, a lapse will occur Urge to smoke Time Resolve Strength of urge

The role of treatment is to keep these lines as far apart as possible Urge to smoke Time Resolve Strength of urge

SF28

Design principles Maintain complete abstinence for 28 days during which urges to smoke are strongest – launch pad for long-term abstinence Allowed 3 ‘strikes’ Top level framework goal setting, monitoring and feedback tools needed to achieve the goal motivational self-regulatory facilitatory strong emphasis on attractive design

SF28 in practice Clear target and feedback on progress Additional reward: cost calculator Toolbox

Then

Toolbox Lifestyle Inspiration Craving Medication advice on adapting lifestyle to minimise exposure to smoking cues and maximising ego-strength Inspiration motivational messages from smokers video clips of smokers who are at the same stage who went on to succeed Craving Advice on dealing with cravings Distraction game Medication advice on use of stop-smoking medicines

Preliminary evaluation Available free on iTunes Data collected automatically from users Cleaned to remove ‘window shoppers’, people testing the app and repeat log-ins Information collected on Socio-demographic characteristics Smoking characteristics and history Usage Abstinence

Take up of SF28

Aims To assess whether SF28 has sufficient evidence for effectiveness to undertake further development and evaluation in a comparative study To assess the validity of automated data collection of abstinence To assess how far SF28 reaches important target groups: Lower socio-economic status Middle-aged and older adults Both genders Heavy smokers

Approach Effectiveness evaluation Evidence from studies suggests that approximately 15% of smokers trying to quit unaided succeed for at least 4 weeks SF28 should yield success rates significantly higher than this to merit further development Validating automated collection Plausible overall abstinence rate (10%-50%) Show acceptable construct validity (i.e. correlation with variables shown in previous studies to correlate with abstinence using a gold standard measure

Research questions What proportion of SF28 users record smoking abstinence for 28 days or longer? What is the construct validity of abstinence automatically recorded for 28 days in terms of its association with variables known to be associated with success of quit attempts? What is the mean number of logins? What are the characteristics of users of SF28 compared with smokers who made a quit attempt in the past year in a large representative sample of smokers in England?

Inclusion criteria Smokers who: Set a quit date on or after date of registration Were using SF28 for the first time Opened the app on or after the quit date Set a quit date at least 30 days prior to the census date (when the data file was downloaded from the server) Resulted in sample size of 1,170

Overall success rate Percentage 95% confidence interval 18.9 16.7-21.1 Percentage of users who set a quit date, logged in on or after the quit date and recorded at least 28 days’ abstinence with no more than 2 lapses 18.9 16.7-21.1

Predictors of recorded 28-day abstinence Odds ratio p-value Age category 1.66 (1.30-2.13) P<0.001 Non manual occupational group 1.45 (1.08-1.95) P=0.013 Cigarette consumption category 1.16 (0.95-1.43) P=0.152 Intended use of stop-smoking medicine 1.56 (1.16-2.12) P=0.003

Number of log-ins

Characteristics of SF28 users England: 13,706 smokers from Smoking Toolkit Study (www.smokinginengland.info) who tried to stop in the past year All differences between SF28 and England are significant at p<0.05

Characteristics of SF28 users

Conclusions SF28 shows sufficient promise to merit further development and evaluation Automated data collection of the kind used appears to have sufficient validity for screening studies of this kind Engagement with SF28 appears to be good SF28 appeals to heavier smokers, women more than men and to a reasonable proportion of lower SES smokers