Relative Efficacy of an Acceptance and Commitment Therapy-Based Smartphone App with a Standard US Clinical Practice Guidelines-Based App for Smoking Cessation in Dual Users of Combustible and Electronic Cigarettes: Secondary Findings from a Randomized Trial
Open accessAbstract
Background While smartphone apps for smoking cessation have shown promise for combustible cigarette smoking cessation, their efficacy in helping dual users of combustible and electronic cigarettes (e-cigarettes) to quit cigarettes remains unknown. This study utilized data from a randomized trial to determine if an Acceptance and Commitment Therapy (ACT)-based app (iCanQuit) was more efficacious than a US Clinical Practice Guidelines-based app (QuitGuide) for combustible cigarette smoking cessation among 575 dual users.Methods The primary cessation outcome was self-reported, complete-case 30-day abstinence from combustible cigarettes at 12 months. Logistic regression assessed the interaction between dual use and treatment arm on the primary outcome in the full trial sample (N = 2,415). We then compared the primary outcome between arms among dual users (iCanQuit: n = 297; QuitGuide: n = 178). Mediation analyses were conducted to explore mechanisms of action of the intervention: acceptance of cues to smoke and app engagement. Results: There was an interaction between dual use of combustible and e-cigarettes and treatment arm on the primary outcome (p = 0.001). Among dual users, 12-month abstinence from cigarettes did not differ between arms (23% for iCanQuit vs. 27% for QuitGuide, p = 0.40). Mediation analysis revealed a significant positive indirect effect of the iCanQuit app on 12-month abstinence from cigarettes through acceptance of emotions that cue smoking (p = 0.004).Conclusions Findings from this study of dual users of combustible and e-cigarettes showed no evidence of a difference in quit rates between arms. Acceptance of emotions that cue smoking is a potential mechanism contributing to cigarette smoking abstinence among dual users.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
R: A Language and Environment for Statistical Computing
R Core Team (2000) · doi:10.32614/r.manuals · Cited by 355,706 · see citing works
The CES-D Scale: A Self-Report Depression Scale for Research in the General Population
Radloff, L. S. (1977) · Applied Psychological Measurement · doi:10.1177/014662167700100306 · Cited by 53,267 · see citing works
(2013) · Cited by 44,563 · see citing works
Preacher, K. J., & Hayes, A. F. (2008) · Behavior Research Methods · doi:10.3758/brm.40.3.879 · Cited by 34,117 · see citing works
Multiple Imputation for Nonresponse in Surveys
Rubin, D. B. (1987) · Wiley Series in Probability and Statistics · doi:10.1002/9780470316696 · Cited by 20,701 · see citing works
Modern Applied Statistics with S
Venables, W., & Ripley, B. (2010) · Statisctics and computing/Statistics and computing · doi:10.1007/978-0-387-21706-2 · Cited by 16,188 · see citing works
<b>mice</b>: Multivariate Imputation by Chained Equations in<i>R</i>
Buuren, S. V., & Groothuis-Oudshoorn, K. (2011) · Journal of Statistical Software · doi:10.18637/jss.v045.i03 · Cited by 13,870 · see citing works
Reconsidering Baron and Kenny: myths and truths about mediation analysis
Zhao, X., Lynch, J. G., & Chen, Q. (2010) · Journal of Consumer Research · doi:10.1086/651257 · Cited by 12,583 · see citing works
The Fagerstrom Test for Nicotine Dependence: a revision of the Fagerstrom Tolerance Questionnaire
HEATHERTON, T. F., KOZLOWSKI, L. T., FRECKER, R. C., & FAGERSTROM, K. (1991) · British Journal of Addiction · doi:10.1111/j.1360-0443.1991.tb01879.x · Cited by 10,738 · see citing works
Beyond Baron and Kenny: Statistical Mediation Analysis in the New Millennium
Hayes, A. F. (2009) · Communication Monographs · doi:10.1080/03637750903310360 · Cited by 9,757 · see citing works
Mediation Analysis in Social Psychology: Current Practices and New Recommendations
Rucker, D. D., Preacher, K. J., Tormala, Z. L., & Petty, R. E. (2011) · Social and Personality Psychology Compass · doi:10.1111/j.1751-9004.2011.00355.x · Cited by 2,430 · see citing works
Reitsma, M. B., Fullman, N., Ng, M., Salama, J. S., Abajobir, A., Abate, K. H., Abbafati, C., Abera, S. F., Abraham, B., Abyu, G. Y., et al. (2017) · The Lancet · doi:10.1016/s0140-6736(17)30819-x · Cited by 2,028 · see citing works
The validity of self-reported smoking: a review and meta-analysis.
Patrick, D. L., Cheadle, A. D., Thompson, D. C., Diehr, P. H., Koepsell, T. D., & Kinne, S. (1994) · American Journal of Public Health · doi:10.2105/ajph.84.7.1086 · Cited by 1,737 · see citing works
A Clinical Practice Guideline for Treating Tobacco Use and Dependence: 2008 Update
(2008) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2008.04.009 · Cited by 1,410 · see citing works
Subgroup analysis and other (mis)uses of baseline data in clinical trials
Assmann, S. F., Pocock, S. J., Enos, L. E., & Kasten, L. E. (2000) · The Lancet · doi:10.1016/s0140-6736(00)02039-0 · Cited by 1,167 · see citing works
Hayes, S. C., Levin, M. E., Plumb-Vilardaga, J., Villatte, J. L., & Pistorello, J. (2013) · Behavior Therapy · doi:10.1016/j.beth.2009.08.002 · Cited by 1,120 · cited 1× · see citing works
“ACT offers a unique approach by targeting these physical cravings, emotions, and thoughts related to nicotine dependence (Hayes et al., 2013).”
BackgroundPocock, S. J., Assmann, S. E., Enos, L. E., & Kasten, L. E. (2002) · Statistics in Medicine · doi:10.1002/sim.1296 · Cited by 1,077 · see citing works
Change in mental health after smoking cessation: systematic review and meta-analysis
Taylor, G., McNeill, A., Girling, A., Farley, A., Lindson-Hawley, N., & Aveyard, P. (2014) · BMJ · doi:10.1136/bmj.g1151 · Cited by 1,039 · cited 1× · see citing works
“Hence, it is conceivable that having any of these mental health conditions could have negatively influenced their attempts to quit, as it has been shown for individuals with depression who smoke (Hitsman et al., 2013; Taylor et al., 2014; Wiernik et al., 2019; Wu et al., 2023).”
BackgroundTobacco product use among adults—United States, 2019.
Cornelius, M. E., Wang, T. W., Jamal, A., Loretan, C. G., & Neff, L. J. (2020) · MMWR. Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6946a4 · Cited by 975 · see citing works
Stratified Randomization for Clinical Trials
Kernan, W. N., Viscoli, C. M., Makuch, R. W., Brass, L. M., & Horwitz, R. I. (1999) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(98)00138-3 · Cited by 627 · see citing works
Electronic cigarettes for smoking cessation and reduction
McRobbie, H. J., Bullen, C., Hartmann‐Boyce, J., & Hájek, P. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010216.pub2 · Cited by 553 · see citing works
Acceptance-based treatment for smoking cessation
Gifford, E. V., Kohlenberg, B. S., Hayes, S. C., Antonuccio, D. O., Piasecki, M. M., Rasmussen-Hall, M. L., & Palm, K. M. (2004) · Behavior Therapy · doi:10.1016/s0005-7894(04)80015-7 · Cited by 499 · see citing works
Assessment of validity of self-reported smoking status.
Wong, S. L., Shields, M. E., Leatherdale, S. T., Malaison, E., & Hammond, D. G. (2012) · PubMed · Cited by 392 · see citing works
Abbreviated PTSD Checklist (PCL) as a guide to clinical response
Lang, A. J., Wilkins, K., Roy-Byrne, P. P., Golinelli, D., Chavira, D., Sherbourne, C., Rose, R. D., Bystritsky, A., Sullivan, G., Craske, M. G., et al. (2012) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2012.02.003 · Cited by 280 · see citing works
Efficacy of Smartphone Applications for Smoking Cessation: A Randomized Clinical Trial
Bricker, J. B., Watson, N. L., Mull, K. E., Sullivan, B. M., & Heffner, J. L. (2020) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2020.4055 · Cited by 207 · see citing works
Self-citationQuit Methods Used by US Adult Cigarette Smokers, 2014–2016
Caraballo, R. S., Shafer, P. R., Patel, D., Davis, K. C., & McAfee, T. A. (2017) · Preventing Chronic Disease · doi:10.5888/pcd14.160600 · Cited by 177 · see citing works
Cigarette Smoking Reduction and Health Risks: A Systematic Review and Meta-analysis
Chang, J. T., Anic, G. M., Rostron, B. L., Tanwar, M., & Chang, C. M. (2021) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntaa156 · Cited by 167 · see citing works
Past major depression and smoking cessation outcome: A systematic review and meta-analysis update
Hitsman, B., Papandonatos, G. D., McChargue, D. E., DeMott, A., Herrera, M. J., Spring, B., Borrelli, B., & Niaura, R. (2013) · Addiction · doi:10.1111/add.12009 · Cited by 162 · see citing works
Is there a health benefit of reduced tobacco consumption? A systematic review
Pisinger, C. H., & Godtfredsen, N. S. (2007) · Nicotine & Tobacco Research · doi:10.1080/14622200701365327 · Cited by 144 · see citing works
Martínez, Ú., Loredo, V. M., Simmons, V. N., Meltzer, L. R., Drobes, D. J., Brandon, K. O., Palmer, A. M., Eissenberg, T., Bullen, C., Harrell, P. T., et al. (2019) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntz043 · Cited by 109 · see citing works
Rass, O., Pacek, L. R., Johnson, P. S., & Johnson, M. W. (2015) · Experimental and Clinical Psychopharmacology · doi:10.1037/pha0000050 · Cited by 101 · see citing works
Dual Use of Combustible Cigarettes and E-cigarettes: a Narrative Review of Current Evidence
Coleman, S. R. M., Piper, M. E., Byron, M., & Bold, K. W. (2022) · Current Addiction Reports · doi:10.1007/s40429-022-00448-1 · Cited by 101 · see citing works
Development of a brief diagnostic screen for panic disorder in primary care
Stein, M. B., Roy-Byrne, P. P., McQuaid, J. R., Laffaye, C., Russo, J., McCahill, M. E., Katon, W., Craske, M., Bystritsky, A., & Sherbourne, C. D. (1999) · Psychosomatic Medicine · doi:10.1097/00006842-199905000-00016 · Cited by 92 · see citing works
Roy, M., Dum, M., Sobell, L. C., Sobell, M. B., Simco, E. R., Manor, H. L., & Palmerio, R. (2008) · Substance Use & Misuse · doi:10.1080/10826080802347586 · Cited by 85 · see citing works
Wu, A. D., Gao, M., Aveyard, P., & Taylor, G. M. J. (2023) · JAMA Network Open · doi:10.1001/jamanetworkopen.2023.16111 · Cited by 68 · see citing works
Prochaska, J. J. (2018) · Addiction · doi:10.1111/add.14478 · Cited by 61 · see citing works
Persoskie, A., O'Brien, E. K., & Poonai, K. (2019) · Addiction · doi:10.1111/add.14730 · Cited by 54 · see citing works
Martínez, Ú., Simmons, V. N., Sutton, S. K., Drobes, D. J., Meltzer, L. R., Brandon, K. O., Byrne, M. M., Harrell, P. T., Eissenberg, T., Bullen, C., et al. (2021) · The Lancet Public Health · doi:10.1016/s2468-2667(20)30307-8 · Cited by 53 · see citing works
Piñeiro, B., Vidrine, D. J., Wetter, D. W., Hoover, D. S., Frank-Pearce, S. G., Nguyen, N., Zbikowski, S. M., & Vidrine, J. I. (2018) · Translational Behavioral Medicine · doi:10.1093/tbm/iby108 · Cited by 51 · see citing works
Wiernik, E., Airagnes, G., Lequy, É., Gomajee, R., Melchior, M., Faou, A.-L. L., Limosin, F., Goldberg, M., Zins, M., & Lemogne, C. (2018) · Addictive Behaviors · doi:10.1016/j.addbeh.2018.10.021 · Cited by 50 · see citing works
Pierce, J. P., Chen, R., Kealey, S., Leas, E. C., White, M. M., Stone, M. D., McMenamin, S. B., Trinidad, D. R., Strong, D. R., Benmarhnia, T., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.28810 · Cited by 44 · see citing works
Acceptance and commitment therapy (ACT) for smoking cessation: a synthesis
McCallion, E. A., & Zvolensky, M. J. (2015) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2015.02.005 · Cited by 43 · see citing works
Validation of the Avoidance and Inflexibility Scale (AIS) among treatment-seeking smokers.
Farris, S. G., Zvolensky, M. J., DiBello, A. M., & Schmidt, N. B. (2015) · Psychological Assessment · doi:10.1037/pas0000059 · Cited by 43 · see citing works
Snell, L., Barnes, A. J., & Nicksic, N. E. (2020) · Journal of Studies on Alcohol and Drugs · doi:10.15288/jsad.2020.81.595 · Cited by 41 · see citing works
van der Aalst, C. M., & de Koning, H. J. (2016) · Lung Cancer · doi:10.1016/j.lungcan.2016.02.001 · Cited by 40 · see citing works
Thrul, J., Meacham, M. C., & Ramo, D. E. (2018) · Tobacco Prevention & Cessation · doi:10.18332/tpc/90649 · Cited by 37 · see citing works
Jorenby, D. E., Smith, S. S., Fiore, M. C., & Baker, T. B. (2016) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2016.10.041 · Cited by 36 · see citing works
Herbeć, A., Brown, J., Shahab, L., & West, R. (2018) · Addictive Behaviors Reports · doi:10.1016/j.abrep.2018.07.003 · Cited by 29 · see citing works
Bricker, J. B., Levin, M., Lappalainen, R., Mull, K., Sullivan, B., & Santiago-Torres, M. (2021) · JMIR mHealth and uHealth · doi:10.2196/32847 · Cited by 28 · see citing works
Self-citationKarekla, M., & Savvides, S. N. (2021) · Translational Behavioral Medicine · doi:10.1093/tbm/ibz128 · Cited by 25 · see citing works
Mak, Y. W., Leung, D. Y. P., & Loke, A. Y. (2020) · BMC Public Health · doi:10.1186/s12889-020-09820-0 · Cited by 24 · see citing works
Vickerman, K. A., Carpenter, K., Miles, L., Hsu, J. M., Watt, K. A., Brandon, T. H., Hart, J. T., Javitz, H. S., & Wagener, T. L. (2022) · Nicotine & Tobacco Research · doi:10.1093/ntr/ntac129 · Cited by 19 · see citing works
Farris, S. G., DiBello, A. M., Heggeness, L. F., Reitzel, L. R., Vidrine, D. J., Schmidt, N. B., & Zvolensky, M. J. (2015) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2015.12.003 · Cited by 10 · see citing works
Vickerman, K. A., Carpenter, K., Miles, L. N., Hsu, J. M., Watt, K. A., Brandon, T. H., Hart, J. T., Javitz, H. S., & Wagener, T. L. (2021) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2021.100845 · Cited by 10 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Krotter, A., Diego, G. A., Menéndez, A. G., González‐Roz, A., Secades‐Villa, R., & Pérez, Á. G. (2024) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2024.100773 · Cited by 25 · see citing works
Santiago‐Torres, M., Mull, K. E., Sullivan, B. M., Cupertino, A. P., Salloum, R. G., Triplette, M., Zvolensky, M. J., & Bricker, J. B. (2025) · JMIR Formative Research · doi:10.2196/69311 · Cited by 4 · see citing works
Self-citationSantiago-Torres, M., Mull, K. E., Sullivan, B. M., Prochaska, J. J., Zvolensky, M. J., & Bricker, J. B. (2024) · Depression and Anxiety · doi:10.1155/2024/1055801 · Cited by 3 · see citing works
Self-citationRethinking Recovery: Psychological Flexibility and Growth Across Diverse Recovery Approaches
Pyke, N. M., Perkins, D. R., & Sandoz, E. K. (2026) · Behavioral Sciences · doi:10.3390/bs16030366 · Cited by 1 · see citing works
Acceptance and Commitment Therapy (ACT) for Smoking Cessation: A Scoping Review
Liu, J., Pei, Y., Ma, H., Liu, X., Zhang, X., Xia, W., & Yang, Q. (2026) · Nursing Research · doi:10.1097/nnr.0000000000000900
- Authors
- Santiago-Torres, M., Mull, K. E., Sullivan, B. M., & Bricker, J. B.
- Affiliations
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, Washington, USA
- Fred Hutch Cancer Center (US)
- University of Washington (US)
- Venue
- Substance Use & Misuse
- Publisher
- Informa UK Limited
- Published
- 2023-12-14
- Volume
- 59
- Issue
- 4
- Pages
- 591-600
- ISSN
- 1082-6084 (ISSN-L)
- 1532-2491
- PMC
- PMC12360788
- OpenAlex
- W4389791146
- Cited by
- 5
- References
- 54
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 2
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Substance Use & Misuse (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Cancer Institute (R01 CA192849)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Keywords
- smoking cessation, electronic cigarettes, acceptance and commitment therapy, mobile application, acceptance of emotions, app engagement, mediation analysis
- MeSH terms
- Humans, Smoking Cessation, Tobacco Products, Mobile Applications, Acceptance and Commitment Therapy, Electronic Nicotine Delivery Systems
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
