Who Uses Smoking Cessation Apps? A Feasibility Study Across Three Countries via Smartphones

Mobile Health Initiatives to Improve Outcomes in Primary Prevention of Cardiovascular Disease

OPINION STATEMENT

Cardiovascular disease affects more than a third of American adults and is the leading cause of mortality in the USA. Over the last 40 years, several behavioral and medical risk factors have been recognized as major contributors to cardiovascular disease. Effective management of many of these risk factors, particularly behavioral risk factors, remains challenging. With the growth of mobile health (mHealth) technology, a variety of novel strategies are now available to facilitate the delivery of interventions directed at reducing these risk factors. In this review, we discuss recent clinical studies and technologic innovations leveraging smartphone devices, social media, and wearable health tracking devices to facilitate behavioral interventions directed at three important and highly prevalent behavioral risk factors for cardiovascular disease: smoking, physical inactivity, and sub-optimal nutrition. We believe this technology has significant potential to provide low-cost, scalable, and individualized tools to improve management of these important cardiovascular disease risk factors.

Pilot use of a novel smartphone application to track traveller health behaviour and collect infectious disease data during a mass gathering: Hajj pilgrimage 2014

This study examines the feasibility of using a smartphone application (app) to conduct surveys among travellers during the Hajj pilgrimage, where the use of apps has not been evaluated for infectious disease surveillance. A longitudinal study was conducted among pilgrims at the Hajj 2014 using an iPhone app with separate questionnaires for three study phases covering before, during, and after Hajj. Forty-eight pilgrims from 13 countries downloaded the app. Respondents were aged between 21 and 61 (median 36) years and 58.5% (24/41) were male. Of these, 85% (41/48) completed the first phase, 52% (25/41) completed both the second and third phases, and 25 of these reported meningococcal vaccination, with 36% (9/25) receiving other vaccines. All (25) reported hand hygiene use and 64% (16/25) wore a facemask at some point during the pilgrimage. Four (6%) reported close contact with camels. Respiratory symptoms commenced from the 4th day of Hajj, with sore throat (20%) and cough (12%) being the most common. Three participants (12%) reported respiratory symptoms after returning home. Conducting a prospective survey using a smartphone app to collect data on travel-associated infections and traveller compliance to prevention is feasible at mass gatherings and can provide useful data associated with health-related behaviour.

Predictors of Utilization of a Novel Smoking Cessation Smartphone App

BACKGROUND

Understanding the characteristics of high and low utilizers of smartphone applications (apps) for smoking cessation would inform development of more engaging and effective apps, yet no studies to date have addressed this critical question. Informed by prior research on predictors of cessation Web site utilization, this study examines the degree to which baseline demographic factors (gender, age, and education), smoking-related factors (smoking level and friends' smoking), and psychological factors (depression and anxiety) are predictive of utilization of a smartphone app for smoking cessation called SmartQuit.

MATERIALS AND METHODS

Data came from 98 participants randomized to SmartQuit as part of a pilot trial from March to May 2013. We used negative binomial count regressions to examine the relationship between user characteristics and utilization of the app over an 8-week treatment period.

RESULTS

Lower education (risk ratio [RR]=0.492; p=0.021), heavier smoking (RR=0.613; p=0.033), and depression (RR=0.958; p=0.017) prospectively predicted lower app utilization. Women (RR=0.320; p=0.022), those with lower education (RR=0.491; p=0.013), and heavier smokers (RR=0.418; p=0.039) had lower utilization of app features known to predict smoking cessation.

CONCLUSIONS

Many of the predictors of utilization of smoking cessation apps are the same as those of cessation Web sites. App-delivered smoking cessation treatment effectiveness could be enhanced by focusing on increasing engagement of women, those with lower education, heavy smokers, and those with current depressive symptoms.

There's an App for That: A Guide for Healthcare Practitioners and Researchers on Smartphone Technology

Smartphone technology is nascent compared to other technologies; however, it has shown an unprecedented uptake amongst lay consumers and professionals. This article presents the history, components, and key features of smartphones, as well as their related concepts and how they work, and it also delineates the process of smartphone applications (apps) development and publishing in the app stores. It also describes and discusses smartphone technology utilisation for health consumers, healthcare professionals, and health researchers, as well as the regulations of health-related apps.

A systematic review of quality assessment methods for smartphone health apps

INTRODUCTION

There are large numbers of health-related applications (apps) available in various app stores for many smartphone devices. Consequently, increasing numbers of articles are attempting to evaluate the content and the quality of health-related smartphone apps for specific health conditions. The aim of this article is to describe and summarize the methodologies used to determine the quality of health-related apps targeting health consumers and to propose a set of criteria for evaluating the quality of smartphone health-related apps.

MATERIALS AND METHODS

In 2013, literature searches were performed using Medline and CINAHL, and we included all articles that had the aim of assessing the quality of health-related smartphone apps. The assessment method used in these studies was summarized and scored using a set of quality criteria developed for this study.

RESULTS

From 606 articles generated by the search, only 10 met the inclusion criteria. Based on our quality criteria, the mean score was 5.05 out of 8 (range, 2-7). Eighty percent of the studies did not identify the app store country in which the apps were found. Forty percent of the studies did not clearly mention whether they only had assessed the app description or had downloaded the app content for evaluation. Sixty percent of the studies did not provide a list of the apps they had evaluated. Overall, we identified six evaluation methodologies used to assess the quality of health-related apps described in RESULTS.

CONCLUSIONS

This article provides a summary of currently used methods for assessing the quality of smartphone health-related apps and proposes a set of criteria to enable future studies to consistently review health-related app quality in a standardized manner.

Depression screening via a smartphone app: cross-country user characteristics and feasibility

BACKGROUND AND OBJECTIVE

Smartphone applications (apps) have the potential to be valuable self-help interventions for depression screening. However, information about their feasibility and effectiveness and the characteristics of app users is limited. The aim of this study is to explore the uptake, utilization, and characteristics of voluntary users of an app for depression screening.

METHODS

This was a cross-sectional study of a free depression screening smartphone app that contains the demographics, patient health questionnaire (PHQ-9), brief anxiety test, personalized recommendation based on the participant's results, and links to depression-relevant websites. The free app was released globally via Apple's App Store. Participants aged 18 and older downloaded the study app and were recruited passively between September 2012 and January 2013.

FINDINGS

8241 participants from 66 countries had downloaded the app, with a response rate of 73.9%. While one quarter of the participants had a previous diagnosis of depression, the prevalence of participants with a higher risk of depression was 82.5% and 66.8% at PHQ-9 cut-off 11 and cut-off 15, respectively. Many of the participants had one or more physical comorbid conditions and suicidal ideation. The cut-off 11 (OR: 1.4; 95% CI 1.2 to 1.6), previous depression diagnosis (OR: 1.3; 95% CI1.2 to 1.5), and postgraduate educational level (OR: 1.2; 95% CI 1.0 to 1.5) were associated with completing the PHQ-9 questionnaire more than once.

CONCLUSIONS

Smartphone apps can be used to deliver a screening tool for depression across a large number of countries. Apps have the potential to play a significant role in disease screening, self-management, monitoring, and health education, particularly among younger adults.

Assessing the effect of an interactive decision-aid smartphone smoking cessation application (app) on quit rates: a double-blind automated randomised control trial protocol

INTRODUCTION

In a previous study exploring the feasibility of a smoking cessation application (app), we found that about 77% of the respondents from three countries were ready to quit in the next 30 days without significant differences between countries in terms of age, operating system and number of quitting attempts. However, the efficacy of smartphone apps for smoking cessation has not yet been established. This study tests the efficacy of a smartphone smoking cessation decision-aid app compared with an app that contains only smoking cessation information.

METHODS AND ANALYSIS

This is an automated double-blind, randomised controlled trial of a smoking cessation app that contains the eligibility requirements and baseline questionnaire and will randomise the participants into one of the two subapps (the intervention and the control). Participants will be recruited directly from the Apple app stores in Australia, Singapore, the UK and the USA. Daily smokers aged 18 and above will be randomised into one of the subapps after completing the baseline questionnaire. Abstinence rates will be measured at 10 days, 1 month, 3 months and 6 months, with the 1-month follow-up abstinence rate as the primary outcome. Logistic regression mixed models will be used to analyse the primary outcome.

ETHICS AND DISSEMINATION

This study was approved by the University of Sydney's Human Ethics Committee. The results of the trial will be published in peer-reviewed journals according to the CONSORT statement.

TRIAL REGISTRATION NUMBER

Australian New Zealand ClinicalTrial RegistryACTRN12613000833763.

A mobile app offering distractions and tips to cope with cigarette craving: a qualitative study

Background

Despite considerable effort, most smokers relapse within a few months after quitting due to cigarette craving. The widespread adoption of mobile phones presents new opportunities to provide support during attempts to quit.

Objective

To design and pilot a mobile app "DistractMe" to enable quitters to access and share distractions and tips to cope with cigarette cravings.

Methods

A qualitative study with 14 smokers who used DistractMe on their mobiles during the first weeks of their quit attempt. Based on interviews, diaries, and log data, we examined how the app supported quitting strategies.

Results

Three distinct techniques of coping when using DistractMe were identified: diversion, avoidance, and displacement. We further identified three forms of engagement with tips for coping: preparation, fortification, and confrontation. Overall, strategies to prevent cravings and their effects (avoidance, displacement, preparation, and fortification) were more common than immediate coping strategies (diversion and confrontation). Tips for coping were more commonly used than distractions to cope with cravings, because they helped to fortify the quit attempt and provided opportunities to connect with other users of the application. However, distractions were important to attract new users and to facilitate content sharing.

Conclusions

Based on the qualitative results, we recommend that mobile phone-based interventions focus on tips shared by peers and frequent content updates. Apps also require testing with larger groups of users to assess whether they can be self-sustaining.