While smoking rates in the United States have substantially declined over the past six decades, smoking remains high among people with low incomes, leading to health disparities. A smartphone app that delivers real-time, tailored messages may hold the key to helping them quit, according to University of Oklahoma clinical trial results published today in JAMA Network Open.
The clinical trial compared two different smartphone tobacco cessation apps: Smart-T, which was developed by OU researchers, and QuitGuide, a product of the National Cancer Institute. Smart-T is designed to gauge users’ risk for smoking throughout the day and to respond in real time with custom messages depending on what people are experiencing. QuitGuide is a static app that allows users to track their cravings and provides tips for resisting the urge to smoke. After six months of using the apps, those who used Smart-T were nearly twice as likely to have quit smoking than those who used the QuitGuide app.
“Smart-T is like having a tobacco cessation counselor in your pocket. While a combination of behavioral counseling and medication is the most effective way to quit smoking, in-person counseling may not be practical for everyone, especially those facing barriers like transportation or busy schedules. With Smart-T, our motivation is to make the app comparable to standard counseling treatments,” said the study’s lead author, Emily Hébert, DrPH, a member of the TSET Health Promotion Research Center (HPRC) at OU Health Stephenson Cancer Center and an assistant professor of family and preventive medicine in the OU College of Medicine.
During the trial, which enrolled 454 low-income smokers from across the United States, half were randomly assigned to use Smart-T and the other half QuitGuide. Those using Smart-T received up to five prompts a day to provide input about their urges to smoke, whether they were around other smokers, their stress level, their mood and other variables that are known to increase the risk of smoking. Based on their answers, the app’s algorithm created a risk score and then responded with messages tailored to each person’s particular type of risk, such as a suggestion to do a breathing exercise or to use nicotine replacement therapy. Participants in both groups were provided nicotine patches or gum or lozenges.
Not only were Smart-T users significantly more likely to quit smoking after six months compared to those using the QuitGuide app, we also found that they used Smart-T more, found it more helpful, and were more likely to ask for more nicotine therapy if they ran out.”
Emily Hébert, DrPH, member of the TSET Health Promotion Research Center (HPRC), OU Health Stephenson Cancer Center and assistant professor of family and preventive medicine, OU College of Medicine
Participants’ smoking status was verified when they blew into a device connected to the phone, which measures carbon monoxide in their breath. Facial recognition software confirmed the participant was the one using the device. Hébert said this is one of the first trials testing a mobile app to verify participants’ smoking status biochemically.
Next steps are to study Smart-T in larger groups across the United States and with follow-up times longer than six months. “Some people who smoke will not benefit from apps like Smart-T, but low-cost and always-available smartphone interventions could provide a convenient way for low-income adults to quit. We’re really trying to find the best recipe for smoking cessation for everyone,” she said.
About the project
The publication, “Just-in-Time Adaptive Intervention for Smoking Cessation in Low-Income Adults,” can be found at https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2837640.
The Smart-T app was created by Michael Businelle, Ph.D., who is co-leader of the next research phase with Hébert. With Hébert as assistant director, Businelle leads the mHealth Shared Resource, which launched the Insight™ mHealth Platform in 2015 to create and test technology-based interventions. The efforts are part of the TSET Health Promotion Research Center (HPRC), a global leader in mobile health technology that has supported more than 115 studies and attracted $85 million in grants. Businelle is co-director of HPRC and is a professor in the Department of Family and Preventive Medicine in the OU College of Medicine.
The research described in this news release was supported by the National Cancer Institute (grant No. R01CA221819) and used the mHealth Shared Resource, which is partially funded by the NCI (grant No. P30CA225520). Additional support was provided by the Oklahoma Tobacco Settlement Endowment Trust and the Oklahoma Shared Clinical and Translational Resources through an Institutional Development Award from the National Institute of General Medical Sciences (grant No. U54GM104938).
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Journal reference:
Hébert, E. T., et al. (2025). Just-in-Time Adaptive Intervention for Smoking Cessation in Low-Income Adults: A Randomized Clinical Trial. JAMA Network Open. doi.org/10.1001/jamanetworkopen.2025.26691.