Feasibility of a Smartphone App with Mindfulness Training for Adolescent Smoking Cessation: Craving to Quit (C2Q)-Teen
Open accessAbstract
Objectives The use of mobile technology for smoking cessation holds promise for adolescents, who do not typically access traditional treatments, but most are not grounded in theory or mechanism. Operant conditioning theory suggests an addictive smoking loop is formed between nicotine use and affective states, leading to habitual cue-induced craving and automatic behavior; mindfulness training may bring automated smoking behavior into awareness, so smokers may work mindfully with cravings. Mindfulness training delivered via smartphone technology therefore has potential to help adolescent smokers break this addictive loop and quit smoking. This pair-matched cluster-randomized controlled school-based pilot study evaluated program feasibility and preliminary smoking outcomes in relation to intervention engagement.Methods Six high schools were pair matched and randomly assigned to one of three interventions: (1) mindfulness training delivered via mobile smoking cessation application (Craving to Quit, C2Q), (2) NCI's QuitSTART smoking cessation application (NCI), and (3) written cessation materials (Materials). Adolescents (n = 146) smoking 5 or more cigarettes per day were recruited. Interventions were implemented over four weeks and study assessments were collected at baseline and 3- and 6- month follow-up, including self-reported 7-day point prevalence abstinence, program usage, smoking-related measures, and psychosocial factors.Results Overall cotinine-validated abstinence at 6 months was 15.8% and was similar between conditions. Odds of abstinence increased with each quartile increase in app/materials use with no significant differences between conditions (OR=1.60 (C2Q), 1.66 (Materials), and 2.69 (NCI)). Of participants still smoking at 6 months, for each quartile increase in engagement the number of cigarettes smoked in the previous 7 days showed a significantly greater decline in the C2Q condition (-5.71) compared to the Materials (-0.95) and NCI (+7.73) condition (p=0.02 for differences between conditions).Conclusions Cotinine-validated abstinence was similar between intervention conditions and tended to increase with greater engagement in each condition. Greater C2Q app engagement among continuing smokers was associated with a significantly greater decline in number of cigarettes smoked compared to the other conditions. The Craving to Quit (C2Q) mobile smoking cessation application with mindfulness training was feasible to use and has promise in assisting adolescents to quit or decrease cigarette smoking.Clinical trial registration Developing a Smartphone App with Mindfulness Training for Teen Smoking Cessation: ClinicalTrials.gov Identifier: NCT02218281.
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Pooled data from five studies comparing mindfulness training with less intensive smoking cessation treatment showed no evidence of benefit (RR 1.19, 95% CI 0.65 to 2.19; I2 = 60%; 813 participants; very low-certainty evidence).
“Pooled data showed no evidence of a benefit of mindfulness training, with the CI spanning both benefit and harm of mindfulness training interventions in comparison with less intensive smoking cessation treatments (RR 1.19, 95% CI 0.65 to 2.19; I2 = 60%; 813 participants; very low‐certainty evidence; Analysis 1.2).”
From Mindfulness for smoking cessation (2022) · cites this paper as Pbert 2020
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredAdjusting for clustering in Pbert 2020 (assuming an ICC of 0.03) did not substantially change the overall pooled result for mindfulness training versus matched-intensity treatment (RR 1.01, 95% CI 0.68 to 1.50; I2 = 0%).
“this did not substantially change the overall pooled result (RR 1.01, 95% CI 0.68 to 1.50; I2 = 0%; Analysis 7.1).”
From Mindfulness for smoking cessation (2022) · cites this paper as Pbert 2020
Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredPooled data from three studies comparing mindfulness training with an intensity-matched alternative smoking cessation treatment showed no evidence of benefit, with RR 0.99 (95% CI 0.67 to 1.46; I2 = 0%; 542 participants; low-certainty evidence).
“Pooled data showed no evidence of a benefit of mindfulness training, with a point estimate very close to the null (RR 0.99, 95% CI 0.67 to 1.46; I2 = 0%; 542 participants; low‐certainty evidence; Analysis 1.1).”
From Mindfulness for smoking cessation (2022) · cites this paper as Pbert 2020
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measuredThere is emerging evidence for smartphone-based mindfulness training approaches for tobacco use.
“There is emerging evidence for smartphone-based mindfulness training approaches for tobacco use (e.g. Refs. [33,34]).”
From Mindful moms: acceptability and impact of co-designed and digitally delivered video meditations for pregnant and parenting women with opioid use disorder (2025) · cites this paper as [34]
The high acceptability and feasibility of the simple email delivery of the meditation videos reflects the growing recognition of the power of digital platforms for delivery of evidence-based mindfulness interventions.
“The high acceptability and feasibility of the simple email delivery of the meditation videos reflects the growing recognition of the power of digital platforms for delivery of evidence-based mindfulness interventions [14,33,34,45,46].”
From Mindful moms: acceptability and impact of co-designed and digitally delivered video meditations for pregnant and parenting women with opioid use disorder (2025) · cites this paper as [34]
Adjusting for clustering in Pbert 2020 did not substantially change the overall pooled result for mindfulness training versus less intensive treatment (RR 1.22, 95% CI 0.66 to 2.26; I2 = 58%) or the subgroup result for mindfulness training versus self-help materials (RR 0.80, 95% CI 0.24 to 2.67).
“Adjusting for clustering in Pbert 2020 (assuming an ICC of 0.03) did not substantially change the overall pooled result (RR 1.22, 95% CI 0.66 to 2.26; I2 = 58%; Analysis 7.2) or the subgroup result for mindfulness training versus self‐help materials (RR 0.80, 95% CI 0.24 to 2.67).”
From Mindfulness for smoking cessation (2022) · cites this paper as Pbert 2020
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- Authors
- Pbert, L., Druker, S., Crawford, S., Frisard, C., Trivedi, M., Osganian, S. K., & Brewer, J.
- Affiliations
- University of Massachusetts Chan Medical School (US)
- Boston Children's Hospital (US)
- Brown University (US)
- Corresponding author
- Pbert, Lori
- ORCID
- Venue
- Mindfulness
- Published
- 2019-12-20
- Volume
- 11
- Issue
- 3
- Pages
- 720-733
- ISSN
- 1868-8527 (ISSN-L)
- 1868-8535
- PMC
- PMC7747804
- OpenAlex
- W2995860301
- Cited by
- 40
- References
- 57
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 7 · 2023: 9 · 2022: 6 · 2021: 2
- FWCI
- 1.37
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Mindfulness (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- eScholarship@UMassChan (submittedVersion)
- Funders
- National Institute on Drug Abuse (NIH/NIDA R34 DA037886)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- adolescent smoking cessation, mindfulness training, mobile application, mobile health, nicotine craving, operant conditioning, school-based intervention, smoking abstinence, app engagement, feasibility, adolescents, tobacco use prevention, affective states
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