Background
In 2020, a total of 12.5% of adults in the United States (approximately 30.8 million people) smoked cigarettes [Behavioral interventions and pharmacotherapy have proven to be effective smoking cessation tools. Traditionally, behavioral intervention via counseling has been delivered in person in one-on-one or group sessions or remotely through phone quitlines. Food and Drug Administration (FDA)–approved pharmacotherapy such as nicotine replacement therapy (NRT) is available over the counter and by prescription; bupropion and varenicline are available by prescription. The use of combined behavioral support and pharmacotherapy increases the chance of smoking cessation by 70% to 100% compared with just brief advice or support [Unfortunately, the impact of these interventions is limited; less than one-third of adult cigarette smokers who make a quit attempt use any type of cessation counseling or FDA-approved pharmacotherapy [The rise of mobile smoking cessation interventions seeks to address this shortcoming by leveraging the ubiquitous nature of smartphones; in 2021, a total of 85% of adults in the United States owned a smartphone [More recently, there has been both an increased presence of evidence-based cessation tools in mobile app–based smoking cessation programs and an increase in the rigor with which these programs are assessed, with the publication of several relevant randomized controlled trials (RCTs). BinDhim et al [Although the aforementioned RCTs evaluated behavioral intervention–focused mobile smoking cessation programs, a few RCTs have assessed similar mobile interventions with an enhanced evidence-based component, specifically, the provision of NRT. Hébert et al [Similarly, we performed a remote pilot RCT in which participants were randomized to Pivot (intervention; an app-based smoking cessation program comprising activities and lessons, a personal CO breath sensor, in-app text-based human-provided coaching, NRT, and a moderated web-based community) or the NCI QuitGuide app (control). Participants had access to 12 weeks of NRT. At 6 months, 36% (34/94) of Pivot participants and 27% (25/94) of QuitGuide participants self-reported 7-day PPA (ITT; RR=1.3, 95% CI 0.8-1.9; 