Effectiveness of the e-Tabac Info Service application for smoking cessation: a pragmatic randomised controlled trial

Aurélie Affret, Amandine Luc, Cédric Baumann, Pierre Bergman, Anne-Laurence Le Faou, Anne Pasquereau, Pierre Arwidson, François Alla, Linda Cambon, Aurélie Affret, Amandine Luc, Cédric Baumann, Pierre Bergman, Anne-Laurence Le Faou, Anne Pasquereau, Pierre Arwidson, François Alla, Linda Cambon

Abstract

Objective: To compare the effectiveness of the mobile e-Tabac Info Service (e-TIS) application (app) for helping adult smokers quit smoking with current practices.

Design: Pragmatic randomised controlled trial with a 1-year follow-up (2017-2018).

Setting: France, population-wide level.

Participants: 2806 adult smokers who wished to quit smoking were recruited via the website of the French National Mandatory Health Insurance fund. Of them, 1400 were randomised to the e-TIS app arm and 1406 were randomised to the current practices arm (control).

Intervention: The app involved personalised interactive contacts that included questionnaires, advice, activities and text messages. All contacts were individually tailored and based on each smoker's progress.In the control group, recommended practices for quitting smoking were described on a non-interactive website.

Primary and secondary outcomes measures: The primary outcome was 7-day point prevalence abstinence (PPA) at 6 months. The secondary outcomes included continuous abstinence rates at 6 and 12 months, minimum 24-hour point abstinence at 3 months, minimum 30-day point abstinence at 12 months and number and duration of quit attempts.

Results: There was no difference between the e-TIS and control arms for the primary outcome (12.6% vs 13.7% for 7-day PPA at 6 months, p=0.3949, intention-to-treat analysis). However, e-TIS participants with high levels of exposure to the app, which was defined by the completion of at least eight activities or questionnaires, showed higher rates of smoking cessation than the control participants (17.6% vs 12.9% for 7-day PPA at 6 months, p=0.0169, per-protocol analysis).

Conclusion: Use of the e-TIS app was not associated with a higher rate of smoking cessation. However, high level of exposure to the e-TIS app may have been more effective than current practices.

Trial registration number: NCT02841683.

Keywords: clinical trials; preventive medicine; public health.

Conflict of interest statement

Competing interests: ALL reports a grant and conference honoraria from Pfizer, as well as a conference honorarium from J&J that was outside the scope of the submitted work. The English in this document has been checked by at least two professional editors, both native speakers of English.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Diagram depicting the flow of participants in the study (n=2806). AT, as-treated; e-TIS, e-intervention Tabac Info Service; ITT, intention-to-treat; PP, per-protocol.

References

    1. GBD 2015 Tobacco Collaborators Smoking prevalence and attributable disease burden in 195 countries and territories, 1990-2015: a systematic analysis from the global burden of disease study 2015. Lancet 2017;389:1885–906. 10.1016/S0140-6736(17)30819-X
    1. Whittaker R, McRobbie H, Bullen C, et al. . Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev 2016;4:CD006611. 10.1002/14651858.CD006611.pub4
    1. Haskins BL, Lesperance D, Gibbons P, et al. . A systematic review of smartphone applications for smoking cessation. Transl Behav Med 2017;7:292–9. 10.1007/s13142-017-0492-2
    1. Ubhi HK, Kotz D, Michie S, et al. . Comparative analysis of smoking cessation smartphone applications available in 2012 versus 2014. Addict Behav 2016;58:175–81. 10.1016/j.addbeh.2016.02.026
    1. Aromatario O, Van Hoye A, Vuillemin A, et al. . How do mobile health applications support behaviour changes? A scoping review of mobile health applications relating to physical activity and eating behaviours. Public Health 2019;175:8–18. 10.1016/j.puhe.2019.06.011
    1. Tabac Info Service Webpage for e-TIS intervention downloading. Available: [Accessed 16 Sep 2019].
    1. Civljak M, Stead LF, Hartmann-Boyce J, et al. . Internet-Based interventions for smoking cessation. Cochrane Database Syst Rev 2013;7:CD007078.
    1. Prochaska JO, DiClemente CC. Stages of change in the modification of problem behaviors. Prog Behav Modif 1992;28:183–218.
    1. Bandura A. Human agency in social cognitive theory. Am Psychol 1989;44:1175–84. 10.1037/0003-066X.44.9.1175
    1. Miller WR, Rollnick S. Motivational interviewing: preparing people for change. Guildford Press, 2002: 456 p..
    1. Miller WR, Rose GS. Toward a theory of motivational interviewing. Am Psychol 2009;64:527–37. 10.1037/a0016830
    1. Janis IL, Mann L. Emergency decision making: a theoretical analysis of responses to disaster warnings. J Human Stress 1977;3:35–48. 10.1080/0097840X.1977.9936085
    1. Cambon L, Bergman P, Le Faou A, et al. . Study protocol for a pragmatic randomised controlled trial evaluating efficacy of a smoking cessation e-'Tabac Info service': ee-TIS trial. BMJ Open 2017;7:e013604. 10.1136/bmjopen-2016-013604
    1. Eysenbach G, Group C-E, CONSORT-EHEALTH Group . CONSORT-EHEALTH: improving and standardizing evaluation reports of web-based and mobile health interventions. J Med Internet Res 2011;13:e126. 10.2196/jmir.1923
    1. Haute Autorité de Santé Arrêt de la consommation de tabac: du dépistage individuel au maintien de l’abstinence ne premier recours. Recommandations, 2014. Available: [Accessed 7 Feb 2017].
    1. Marlatt GA, Gordon J. Determinants of relapse: implications for the maintenance of behavior change. in: behavioral medicine: changing health lifestyles. New York: Brunner/Mazel. Davidson PO, Davidson SM, 1980: 410–52.
    1. Hendershot CS, Witkiewitz K, George WH, et al. . Relapse prevention for addictive behaviors. Subst Abuse Treat Prev Policy 2011;6:17. 10.1186/1747-597X-6-17
    1. Beauregard L, Dumont S. La mesure Du soutien social. Serv Soc 1996.
    1. Velicer WF, Prochaska JO, Rossi JS, et al. . Assessing outcome in smoking cessation studies. Psychol Bull 1992;111:23–41. 10.1037/0033-2909.111.1.23
    1. Hughes JR, Keely JP, Niaura RS, et al. . Measures of abstinence in clinical trials: issues and recommendations. Nicotine Tob Res 2003;5:13–26. 10.1080/1462220031000070552
    1. European Medicines Agency Guideline on treatment of smoking, 2009. Available: [Accessed 7 Feb 2018].
    1. Brown J, Michie S, Geraghty AWA, et al. . Internet-Based intervention for smoking cessation (StopAdvisor) in people with low and high socioeconomic status: a randomised controlled trial. Lancet Respir Med 2014;2:997–1006. 10.1016/S2213-2600(14)70195-X
    1. Dupont WD, Plummer WD. Power and sample size calculations. A review and computer program. Control Clin Trials 1990;11:116–28. 10.1016/0197-2456(90)90005-m
    1. West R, Hajek P, Stead L, et al. . Outcome criteria in smoking cessation trials: proposal for a common standard. Addiction 2005;100:299–303. 10.1111/j.1360-0443.2004.00995.x
    1. Troxel AB, Asch DA, Volpp KG. Statistical issues in pragmatic trials of behavioral economic interventions. Clin Trials 2016;13:478–83. 10.1177/1740774516654862
    1. Gordon JS, Armin J, D Hingle M, et al. . Development and evaluation of the see me smoke-free multi-behavioral mHealth APP for women smokers. Transl Behav Med 2017;7:172–84. 10.1007/s13142-017-0463-7
    1. Pellegrini CA, Verba SD, Otto AD, et al. . The comparison of a technology-based system and an in-person behavioral weight loss intervention. Obesity 2012;20:356–63. 10.1038/oby.2011.13
    1. Craig P, Dieppe P, Macintyre S, et al. . Developing and evaluating complex interventions: the new medical Research Council guidance. BMJ 2008;337:a1655. 10.1136/bmj.a1655
    1. Michie S, Wood CE, Johnston M, et al. . Behaviour change techniques: the development and evaluation of a taxonomic method for reporting and describing behaviour change interventions (a suite of five studies involving consensus methods, randomised controlled trials and analysis of qualitative data). Health Technol Assess 2015;19:1–188. 10.3310/hta19990
    1. Michie S, Richardson M, Johnston M, et al. . The behavior change technique taxonomy (V1) of 93 hierarchically clustered techniques: building an international consensus for the reporting of behavior change interventions. Ann Behav Med 2013;46:81–95. 10.1007/s12160-013-9486-6
    1. Guignard R, Richard J, Pasquereau A, et al. . Tentatives d’arrêt du tabac au dernier trimestre 2016 et lien avec Mois sans tabac : premiers résultats observés dans le Baromètre santé. 2017. Bull Epidémiol Hebd 2018:298–303.
    1. Krebs P, Duncan DT. Health APP use among US mobile phone owners: a national survey. JMIR Mhealth Uhealth 2015;3:e101. 10.2196/mhealth.4924
    1. Balmford J, Borland R, Benda P, et al. . Factors associated with use of automated smoking cessation interventions: findings from the eQuit study. Health Educ Res 2013;28:288–99. 10.1093/her/cys104
    1. Abroms LC, Boal AL, Simmens SJ, et al. . A randomized trial of Text2Quit: a text messaging program for smoking cessation. Am J Prev Med 2014;47:242–50. 10.1016/j.amepre.2014.04.010
    1. Bock B, Heron K, Jennings E, et al. . A text message delivered smoking cessation intervention: the initial trial of TXT-2-Quit: randomized controlled trial. JMIR Mhealth Uhealth 2013;1:e17. 10.2196/mhealth.2522
    1. Nguyen Thanh V, Guignard R, Lancrenon S, et al. . Effectiveness of a fully automated Internet-based smoking cessation program: a randomized controlled trial (stamp). Nicotine Tob Res 2019;21:163–72. 10.1093/ntr/nty016
    1. Baskerville NB, Struik LL, Guindon GE, et al. . Effect of a mobile phone intervention on quitting smoking in a young adult population of smokers: randomized controlled trial. JMIR Mhealth Uhealth 2018;6:e10893. 10.2196/10893
    1. Garrison KA, Pal P, O’Malley SS, et al. . Craving to quit: a randomized controlled trial of smartphone app-based mindfulness training for smoking cessation. Nicotine Tob Res Off J Soc Res Nicotine Tob 2018.
    1. BinDhim NF, McGeechan K, Trevena L. Smartphone Smoking Cessation Application (SSC App) trial: a multicountry double-blind automated randomised controlled trial of a smoking cessation decision-aid 'app'. BMJ Open 2018;8:e017105. 10.1136/bmjopen-2017-017105
    1. Cambon L. Health smart devices and applications…towards a new model of prevention? Eur J Public Health 2017;27:390–1. 10.1093/eurpub/ckx019
    1. Petit A, Cambon L. Exploratory study of the implications of research on the use of smart connected devices for prevention: a scoping review. BMC Public Health 2016;16:552. 10.1186/s12889-016-3225-4
    1. Vaghefi I, Tulu B. The continued use of mobile health Apps: insights from a longitudinal study. JMIR Mhealth Uhealth 2019;7:e12983. 10.2196/12983
    1. Brown J, Michie S, Raupach T, et al. . Prevalence and characteristics of smokers interested in Internet-based smoking cessation interventions: cross-sectional findings from a national household survey. J Med Internet Res 2013;15:e50. 10.2196/jmir.2342
    1. Perski O, Blandford A, West R, et al. . Conceptualising engagement with digital behaviour change interventions: a systematic review using principles from critical interpretive synthesis. Transl Behav Med 2017;7:254–67. 10.1007/s13142-016-0453-1

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