Smoking cessation apps can increase smoking cessation rates, especially when combined with medication

Smoking cessation apps can increase smoking cessation rates, especially when combined with medication

A new meta-analysis suggests that well-designed smartphone apps can outperform minimal support and strengthen standard smoking cessation treatments.

Study: Effectiveness of smartphone apps used alone or in conjunction with traditional smoking cessation interventions: a systematic review and meta-analysis. Photo credit: Kaspars Grinvalds/Shutterstock.com

In a recently published systematic review inBMJ Evidence-based medicineResearchers evaluated the effectiveness of smartphone applications as smoking cessation (SC) tools or aids. The review used a meta-analytic approach, analyzing data from 31 randomized controlled trials (RCTs) involving over 12,000 participants.

The results of the review found that the use of SC support apps generally performed better than minimal or no cessation support, which in some studies consisted solely of brief advice. More importantly, the data suggests that smartphone apps may provide additional benefit when used alongside traditional cessation interventions. When smartphone apps were used in addition to traditional interventions, particularly pharmacotherapy and behavioral support, abstinence rates were higher than when traditional methods were used alone, although the certainty of this evidence was low.

While the review highlights the low certainty of some evidence, particularly in cases where participants' data were self-reported, and there was significant heterogeneity and variation in participant engagement across studies, these results suggest that digital tools based on psychological and behavioral theories offer a scalable and accessible way to improve public health efforts to reduce tobacco use.

Traditional weaning methods work

Decades of research and global surveys have shown that tobacco use is the leading preventable cause of death worldwide. Yet the resources available to help people quit smoking are often limited by cost, geography, and health system capacity.

Traditionally, cessation interventions have included face-to-face behavioral counseling and medications such as nicotine replacement therapy, bupropion, or varenicline. Although these interventions have been shown to induce smoking cessation (SC), they reportedly suffer from low utilization rates.

In a modern era of near-universal mobile technology, “digital health” has emerged as a potential solution to bridge this gap. Anecdotal evidence suggests that smartphone apps offer features that traditional therapies do not, such as: B. 24/7 availability, progress tracking and interactive engagement.

Unfortunately, their effectiveness has not yet been clearly demonstrated by previous scientific research, which is often hampered by small sample sizes, short follow-up periods, inconsistent user engagement, or rapid obsolescence of the tested software.

The meta-analysis compares apps, treatments and psychological conditions

The present systematic review aims to address this knowledge gap to inform future consumer (smoker) decisions and public health recommendations by compiling published literature (randomized controlled trials, RCTs) on the topic up to August 15, 2025. The aim of the review was to determine not only whether apps work better than willpower alone, but also whether they improve traditional medical treatments and whether specific psychological approaches within the apps make a difference.

The review used a meta-analytic approach that conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Potential publications were retrieved from several online scientific databases, including PubMed and the Cochrane Library, using a custom keyword search targeting randomized controlled trials in smokers aged 15 years or older who wanted to quit smoking.

The included studies (31 studies, n = 12,802 participants) were divided into three specific comparisons:

1. Apps vs. minimal/no support: Comparing app users to users who receive brief advice or no intervention.

2. Combined interventions: Comparing patients using apps plus traditional methods (counseling or medication) to those using traditional methods only.

3. Psychological framework: Comparison of apps based on psychological behavioral theories (PBT, such as cognitive behavioral therapy, CBT or acceptance and commitment therapy, ACT) with apps that provide behavioral support aligned with clinical guidelines but do not have explicitly defined theoretical frameworks.

The main outcome of interest in the analyzes was six-month continuous abstinence rate, defined as self-reported abstinence with no more than five cigarettes in six months and none in the previous seven days, a commonly used clinical outcome in cessation studies. Secondary endpoints of interest included point prevalence abstinence (PPA), which is whether a person had abstained from smoking at various check-in points in the past seven days.

Additional benefits arise when apps support the treatment

The review analyzes highlight the potential benefits of digital health (SC apps) for smoking cessation support, with all three comparisons indicating improvements in smoking cessation outcomes; However, many estimates were based on a small number of studies, showed high heterogeneity, and reflected large differences in app engagement and adherence.

Smokers who used smartphone apps alone showed a significantly higher success rate than smokers with no or minimal support. The data showed a relative risk (RR) of 2.85 for six months of continuous abstinence. In absolute terms, this meant that for every 1,000 people, an additional 40 people stopped smoking.

When apps were added to standard interventions, abstinence rates increased after six months. However, these results were characterized by significant heterogeneity and low certainty, limiting confidence in the magnitude of the effect. This effect was also observed when apps were combined with pharmacotherapy such as nicotine replacement therapy, bupropion or varenicline, resulting in an RR of 1.77 compared to medication alone.

When comparing different types of apps, those based on psychological behavioral theories showed significant benefits for short-term abstinence outcomes. In particular, PBT-based apps showed a 36% increase in 7-day abstinence after six months, with similar strong effects observed at three months, supported by high-confidence evidence. However, these results do not mean that all commercially available quitting apps are equally effective, as many widely used apps have not been evaluated in randomized trials. The evidence for long-term outcomes with continuous abstinence remained very limited in this comparison.

Digital cessation tools can support public health efforts

The present systematic review and meta-analysis supports the use of mobile apps as potentially useful tools for smoking cessation and highlights their promise as scalable, cost-effective tools that can complement traditional SC interventions, particularly in resource-limited settings.

While the authors note that the overall certainty of evidence for long-term continuous abstinence remains "low" due to inconsistency between studies, high attrition rates, reliance on self-reported data and variability in sustained user engagement, the review highlights that the combination of pharmacotherapy and digital apps requires further investigation in larger, higher quality studies with longer follow-up and biochemical validation as a promising frontier in the search for quitting the cigarette habit.

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