Role of the Experiments
A key question in understanding the feasibility of this app was whether ambivalent smokers would engage with the self-directed, smoking-focused, cognitive, and behavioral experiments if they were not yet ready to commit to quitting smoking. The experiments were designed to teach users specific skills and lessons to help people resist the urge to smoke and encourage a quit attempt. These skills are consistent with the common elements of effective behavioral interventions identified in the US Public Health Service’s Tobacco Treatment Guidelines (ie, problem-solving skills, such as identifying high-risk situations, coping skills for managing urges without smoking, basic educational information, and supportive encouragement to make a quit attempt) [Findings from this study also indicate that most EC participants were willing to try the exercises. Completion rates ranged from 93% of EC users completing the first experiment (clarifying one’s values) to 61% completing the last experiment (making a practice quit attempt). These rates are encouraging. Because the addition of the experiments was the key content difference between the 2 app versions, engagement with the exercises likely drove the favorable trends in the outcomes noted above. This is further supported by the fact that EC participants were less likely than SC participants to read the smoking cessation Quit Guide. This was likely an artifact of the differences in the positioning of this content in the app (it was on the home page in the SC app version and located in the Toolbox linked from the home page in the EC app version), but because EC participants were less likely to view this content, exposure to the Quit Guide cannot explain the more favorable outcomes observed in the EC arm.The graphical user interface for accessing the Quit Guide does not appear to have been an impediment to app usage or behavior change in the EC arm, but it is worth considering if the Quit Guide should be featured more prominently in a future EC version and, if so, whether this would add additional value to users or not.