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

2. 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

3. 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

4. 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

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

6. SF28

7. 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

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

11. Then

12. 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

13. 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

14. Take up of SF28

15. 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

16. 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

17. 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?

18. 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

19. 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

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

21. Number of log-ins

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

23. Characteristics of SF28 users

24. 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