For smokers who are trying to quit, what if a smartphone app could predict when they are most likely to relapse and light a cigarette? And what if that app could intervene, sending its users messages that successfully diverted them from smoking?
Such technology has been created at the Oklahoma Tobacco Research Center, a program of the Stephenson Cancer Center at OU Medicine. The researcher who created the app, Michael Businelle, Ph.D., recently received a $2.7 million grant from the National Cancer Institute to conduct a larger study on its effectiveness as compared to other types of cessation tools. In a time when most people have smartphones, almost always within arm’s reach, such technology is proving to be a valuable means of behavior change.
“Statistics show that nearly 80 percent of smokers want to quit, but without help, less than 5 percent are successful,” Businelle said. “People spend a lot of time on their phones, particularly texting and using apps. I see health behavior change services like smoking cessation becoming more and more mobile.”
Businelle has conducted several years’ worth of development and research on his tobacco cessation app, called Smart-T (Smart Treatment). Before he arrived at OU Medicine, he was a faculty member at the University of Texas School of Public Health in Dallas, where his team created the first version of the app. In his original study, he loaned smartphones to participants who were prompted by the app to answer about 25 questions at five different times during the day. The questions asked about things like current urge to smoke, motivation to quit, access to cigarettes, and whether they had consumed alcohol recently. The questions were then narrowed down to the six most relevant, which were used to create a smoking lapse risk estimator that determines whether a person is in danger of relapsing in the next few hours.
“Our research showed that the risk estimator predicted about 80 percent of all smoking lapses within four hours of the lapse,” Businelle said. “Sometimes the risk estimator would know about the potential for relapse before the person was aware of it.”
Businelle’s previous study set the stage for his current funding. In the earlier study, 81 people were randomized into three treatment groups: the Smart-T app; in-person cessation counseling; or an app produced by the National Cancer Institute. Businelle was pleasantly surprised by the results: 22 percent of those who used Smart-T quit smoking, compared to 15 percent for those who received in-person counseling or used the National Cancer Institute app. Although the sample size was small, the results warranted a larger study, for which he received the $2.7 million federal grant. For five years, the study will follow 450 participants who will be randomized into two groups.
When the risk for lapse is high, the Smart-T app delivers a tailored message in real time. If individuals indicate that their current stress level is high, they immediately receive a message about coping with stress. Or if they report their motivation to quit is low, they receive a message that aims to increase motivation. “Smart-T truly tailors treatment content to what is needed in that moment,” he said.
The app has additional features that are crucial to the study. For instance, it has on-demand treatment functions so that users can click a “quit tips” button at any time to read through tips on how to cope with stress and urges to smoke. In the newly funded study, participants will blow into a small device that connects to the phone and measures the level of carbon monoxide in their breath, which determines if they have smoked recently. This reduces the burden on participants because they will not have to return to the clinic to verify if they successfully quit smoking or not.
Businelle’s hypothesis is that Smart-T will help people to stop smoking and remain tobacco-free. The advantage of the app, he said, is its ability to prompt people with questions throughout the day and then automatically deliver tailored messages in real time, a function that other apps don’t have.
Using an app for tobacco cessation may not be for everyone, he said, but it is sure to appeal to many people. Because Oklahoma is such a rural state, many people don’t have the time or resources to drive longer distances to a tobacco cessation clinic. Calling the tobacco quitline has helped many people quit, but those calls may last up to 30 minutes vs. interacting with Smart-T for 30 seconds five times a day, wherever the user may be.
“As a clinical psychologist, my expertise is in helping people change behaviors they want to change,” Businelle said. “Mobile technology holds much potential for helping people who want to quit smoking.”
For more information about Businelle’s Smart-T study, his research team can be reached by calling 405-271-QUIT or by emailing Michael-Businelle@ouhsc.edu. He directs the Mobile Health Technology Shared Resource, which has developed more than 30 apps aimed at helping people change behaviors they want to change. The Oklahoma Tobacco Research Center at the Stephenson Cancer Center is funded by a grant from the Oklahoma Tobacco Settlement Endowment Trust.
