About a quarter of people who smoke do not smoke every day. While being a non-daily smoker can impact health, including risk for cancer, existing strategies for smoking cessation are not specifically tailored to this population. To better support smoking cessation efforts in non-daily smokers, Bettina Hoeppner, PhD and her team at the Health through Flourishing Program along with colleagues from the Health Promotion and Resiliency Intervention Research (HPRIR) Center, Brown University, and PreviewLabs, have developed a smartphone app called Smiling Instead of Smoking or SiS, a behavioral program that uses positive psychology exercises to increase quitting success.
The SIS app uses daily positive psychology exercises over the course of 7 weeks, and assigns “behavioral challenges” every 2-4 days to coach the user through the steps towards smoking cessation. The SiS app is available for the iPhone at the Apple store or for Android smartphones.
Proof-of-Concept Study
Hoeppner and colleagues tested the SiS app in a proof-of-concept unblinded randomized controlled trial using a remote design with a brief onboarding procedure. A total of 226 non-daily adult smokers were recruited on the web and asked to undertake a quit attempt while using assigned smoking cessation support materials. Participants were randomly assigned to one of three groups, each receiving different smoking cessation materials: the SiS smartphone app, the National Cancer Institute’s smartphone app QuitGuide (QG), or the National Cancer Institute’s smoking cessation brochure, “Clearing the Air” (CtA). In a 15-minute scripted onboarding phone call, participants were introduced to their smoking cessation materials.
Participants received follow-up self-assessment surveys at 2, 6, 12, and 24 weeks after participants’ initially chosen quit date.
SiS participants (n=80) reported higher self-efficacy in terms of their ability to abstain from smoking at the end of treatment compared to the participants in the other two control groups (QG: n=75; P=.02; Cohen d=0.40 and CtA: n=71; P=.007; Cohen d=0.50). Participants using the SiS app group also reported lower craving and higher positive affect than those in the QG and CtA groups; attitudes toward smoking were largely similar across the three groups. Treatment acceptability was comparable across the different groups. In addition, participants used the SiS app on 33 out of 49 days, for 35 to 40 minutes per week, resulting in greater use of the SiS app than the other two smoking cessation strategies (QG and CtA) examined.
Of note, the researchers observed that engaging with the SiS app appeared to help non-daily smokers manage both internal and external cues to smoking. This is especially important given that prior research has highlighted smokers’ susceptibility to smoke in response to environmental cues, a tendency that is stronger in non-daily smokers compared to those who smoke daily.
Randomized Controlled Trial Recruiting Non-Daily Smokers
The SiS app using positive psychology exercises proved more effective in boosting self-efficacy to quit smoking and improving other psychological factors compared to two active and commonly used smoking cessation interventions. This advantage was not due to greater user satisfaction with or likeability of the SiS app, as satisfaction ratings were similar across all three interventions, but instead highlights the value of the app’s content for individuals who smoke less than daily. Feasibility measures showed that SiS users engaged meaningfully with the app and applied the knowledge gained to their daily lives.
These findings strongly support the app’s conceptual framework. Hoeppner and her team are currently conducting a larger randomized controlled trial to further assess its effectiveness in supporting smoking cessation.
Those who would like to learn more about this program or participate in the study can visit the Mass General Brigham Rally website HERE or may go directly to the study’s contact form. This study is being conducted remotely; no in-person visits are required.
Other researchers contributing to this study include Kaitlyn Siegel, Allison Futter, Diadora Finley-Abboud, Alivia Williamson, Christopher Kahler, Elyse Park PhD, and Susanne Hoeppner PhD.
Read More
Hoeppner BB, Siegel KR, Futter AE, Finley-Abboud D, Williamson AC, Kahler CW, Park ER, Hoeppner SS. Smoking Cessation Smartphone App for Nondaily Smoking With Telephone Onboarding: Proof-of-Concept Randomized Controlled Trial. JMIR Mhealth Uhealth. 2025 Jan 15;13:e53971.
Hoeppner BB, Siegel KR, Dickerman SR, Todi AA, Kahler CW, Park ER, Hoeppner SS. Testing the Outcomes of a Smoking Cessation Smartphone App for Nondaily Smokers: Protocol for a Proof-of-concept Randomized Controlled Trial. JMIR Res Protoc. 2023 Feb 14;12:e40867.
Hoepper BB, Siegel KR, Carlon HA, Kahler CW, Park ER, Taylor ST, Simpson HV, Hoeppner SS. Feature-Level Analysis of a Smoking Cessation Smartphone App Based on a Positive Psychology Approach: Prospective Observational Study. JMIR Form Res. 2022 Jul 28;6(7):e38234.
Hoeppner BB, Hoeppner SS, Carlon HA, Perez GK, Helmuth E, Kahler CW, Kelly JF. Leveraging Positive Psychology to Support Smoking Cessation in Nondaily Smokers Using a Smartphone App: Feasibility and Acceptability Study. JMIR Mhealth Uhealth. 2019 Jul 3;7(7):e13436.
Bettina Hoeppner, PhD, MS is the Director of the Health Through Flourishing Program, a statistician in the MGH Clinical Trials Network & Institute and an Associate Professor in Psychology at Harvard Medical School. She is an experimental psychologist, and her research focuses on mHealth technologies, smoking cessation, and engagement in auxiliary addiction services (e.g., mutual help, recovery community centers). The overarching goal of her research is to improve access to care for persons seeking to overcome problematic substance use.
