A new meta-analysis suggests that well-designed smartphone apps can outperform minimal support and may strengthen standard smoking cessation treatments.
Study: Efficacy of smartphone apps used alone or with traditional interventions for smoking cessation: a systematic review and meta-analysis. Image credit: Kaspars Grinvalds/Shutterstock.com
In a recent systematic review published in BMJ Evidence-Based Medicine, researchers evaluated the efficacy of smartphone applications as tools or aids for smoking cessation (SC). The review employed a meta-analytic approach, analyzing data from 31 randomized controlled trials (RCTs) involving over 12,000 participants.
Review findings revealed that using apps for SC support generally outperformed having minimal or no cessation support, which, in some trials, consisted solely of brief advice. More importantly, the data suggest that smartphone apps may provide additional benefit when used alongside traditional cessation interventions. When smartphone apps were used alongside traditional interventions, specifically pharmacotherapy and behavioural support, abstinence rates were higher than with conventional methods alone, though the certainty of this evidence was low.
While the review highlights the low certainty of some evidence, especially in cases where participant data were self-reported, and substantial heterogeneity and variable participant engagement existed across studies, these findings suggest that digital tools grounded in psychological and behavioral theories offer a scalable and accessible way to enhance public health efforts to reduce tobacco use.
Traditional quit methods do work
Decades of research and global surveys have identified tobacco use as the leading cause of preventable death worldwide. Yet, the resources available to help people quit are often limited by cost, geography, and healthcare system capacity.
Traditionally, cessation interventions have involved face-to-face behavioral counseling and medications like nicotine replacement therapy, bupropion, or varenicline. While these interventions have proven capable of inducing smoking cessation (SC), they reportedly suffer from low use 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 therapy cannot, such as 24/7 availability, progress tracking, and interactive engagement.
Unfortunately, their efficacy has not yet been firmly established by previous scientific reviews, which are often hindered by small sample sizes, short follow-up periods, inconsistent user engagement, or the rapid obsolescence of the software being tested.
Meta-analysis compares apps, treatments, and psychological frameworks
The present systematic review aims to address this knowledge gap, thereby informing future consumer (smoker) choice and public health recommendations by collating literature (randomized controlled trials, RCTs) on the topic published through 15 August 2025. The review aimed to determine not only if apps work better than willpower alone, but also if they enhance traditional medical treatments and whether specific psychological approaches within the apps make a difference.
The review employed a meta-analytic approach adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Potential publications were obtained from several online scientific databases, including PubMed and the Cochrane Library, using a custom keyword search targeting randomized controlled trials involving smokers aged 15 and older who intended to quit.
Included trials (31 studies, n = 12,802 participants) were categorised into three specific comparisons:
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Apps vs. minimal/no support: Comparing app users to those receiving only brief advice or no intervention.
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Combined interventions: Comparing patients using apps plus traditional methods (counseling or medication) against those using traditional methods alone.
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Psychological frameworks: Comparing apps based on psychological-behavioural theories (PBT, such as cognitive behavioral therapy, CBT, or acceptance and commitment therapy, ACT) against apps delivering behavioural support aligned with clinical guidelines but without explicitly defined theoretical frameworks.
The analyses’ primary outcomes of interest were the six-month continuous abstinence rate, defined as self-reported abstinence with no more than five cigarettes over six months and none in the preceding seven days, a commonly used clinical outcome in cessation trials. Secondary outcomes of interest included point prevalence abstinence (PPA), whether a person had abstained from smoking for the past seven days at various check-in points.
Added benefits seen when apps support treatment
The review analyses underscore the potential benefits of digital health (SC apps) for helping smokers quit, with all three comparisons suggesting improvements in cessation outcomes; however, many estimates were based on a small number of trials, showed high heterogeneity, and reflected wide variation in app engagement and adherence.
Smokers using smartphone apps alone showed a significantly higher rate of success compared to those with no or minimal support. The data indicated a relative risk (RR) of 2.85 for six-month continuous abstinence. In absolute terms, this translated into an additional 40 quitters per 1,000 individuals.
When apps were added to standard interventions, six-month abstinence rates increased. However, these findings were characterised by substantial heterogeneity and low certainty, limiting confidence in the magnitude of effect. This effect was also observed when apps were paired 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 grounded in psychological-behavioural theories showed distinct advantages for short-term abstinence outcomes. Most notably, PBT-based apps showed a 36 % increase in 7-day abstinence at the six-month mark, with similarly strong effects observed at three months, supported by high-certainty evidence. However, these findings do not imply that all commercially available cessation apps are equally effective, as many widely used apps have not been evaluated in randomized trials. Evidence for long-term continuous abstinence outcomes in this comparison remained very limited.
Digital quit tools may aid public health efforts
The present systematic review and meta-analysis support the use of mobile apps as potentially useful adjuncts for smoking cessation, highlighting their promise as scalable, low-cost tools that may 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 inconsistencies between studies, high attrition rates, reliance on self-reported data, and variability in sustained user engagement, the review underscores that the combination of pharmacotherapy and digital apps warrants further investigation in larger, higher-quality trials with longer follow-up and biochemical validation as a promising frontier in the quest to kick the cigarette habit.
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