Version 2 of the Smoking Cessation Smartphone App Smiling Instead of Smoking (SiS)

As rated by app users 6 weeks after their chosen smoking cessation date via open-ended REDCap survey. This survey asks questions concerning feasibility, usefulness, and overall opinions of specific app features. Responses were rated on 4-point Likert-scales with ease-of-use rated with the options 0 = Not easy at all \| 1 = Somewhat easy to use \| 2 = Easy to use \| 3 = Very easy to use, and usefulness rated with the options 0 = Not at all useful \| 1 = Somewhat useful \| 2 = Useful \| 3 = Very useful. For both ease-of-use and usefulness items, scores range from 0 to 3 with higher scores indicating a better opinion of the app features.

Time frame: 6 weeks after chosen smoking cessation date

Population: Of the 99 people still active in the trial at the end-of-treatment visit, 4 had missing data for all ease-of-use and helpfulness ratings, and 1-2 people had missing ratings for some but not all items on this questionnaire.

The 18-item Attitudes Towards Smoking (ATS-18) scale measures attitudes towards smoking in current and former cigarette smokers. It was rated on a 5-point Likert scale, from 1=strongly disagree to 5=strongly agree.. The ATS-18 has 3 sub-scales: Adverse effects of smoking (items 1-10), psychoactive benefits of smoking (items 11-14), and pleasure of smoking (items 15-18). To score, all items per sub-scale were averaged to obtain a mean score within each sub-scale. For each sub-scale, higher scores indicate greater agreement with the specific attitude towards smoking.

Time frame: Baseline, 2-weeks, and 6-weeks post-quit

Population: n=1 had incomplete baseline data, n=4 were missing Week 2 data, n=5 were missing Week 6 data

This 28-item scale assesses the use of 14 coping mechanisms. Each item was rated on a 4-point Likert-scale, where 1=I haven't been doing this at all, 2=I've been doing this a little bit, 3=I've been doing this a medium amount, and 4=I've been doing this a lot. Sub-scales consist of 2 items for each of 14 coping mechanisms with no reversals of coding: (1) Self-distraction, (2) active coping, (3) denial, (4) substance use, (5) use of emotional support, (6) use of instrumental support, (7) behavioral disengagement, (8) venting, (9) positive reframing, (10) planning, (11) humor, (12) acceptance, (13) religion, (14) self-blame. Sub-scale scores range from 2 to 8 with higher scores indicating more frequent use of each specific coping mechanism, regardless of whether they are considered adaptive or maladaptive.

Time frame: Baseline, 2-weeks, and 6-weeks post-quit

Population: n=1 had incomplete baseline data for Brief COPE - Acceptance and Brief COPE denial - Baseline, n=4 were missing Week 2 data (with n=5 incomplete for Brief COPE use of emotional support, Brief COPE use of instrumental support, Brief COPE planning, Brief COPE self-blame), n=5 has incomplete baseline date (with n=6 incomplete for Brief COPE religion, Brief COPE active coping, Brief COPE Self-distraction).

The Commitment to Quitting Smoking Scale (CQSS) asks participants to rate their level of agreement (Likert scale, 1=strongly disagree to 5=strongly agree) on 8-items assessing motivation to quit smoking (e.g., I'm not going to let anything get in the way of my quitting smoking). Scale scores are reported as the average of all items, where higher scores indicate a greater commitment to quitting smoking.

Time frame: Baseline, 2-weeks, and 6-weeks post-quit

Population: n=1 had incomplete baseline data, n=4 were missing Week 2 data, n=5 were missing Week 6 data

This 6-item form assesses the personal importance people place on positive and negative smoking expectancies. Items were rated on slider scales ranging from 0=not at all important to 100=extremely important. Two sub-scale mean scores were calculated: positive expectancies (3 items), and negative smoking expectancies (3 items). On both scales, higher scores indicate a greater importance of the smoking expectancies (positive or negative).

Time frame: Baseline, 2-weeks, and 6-weeks post-quit

Population: n=4 were missing Week 2 data, n=5 were missing Week 6 data

This 10-item scale assesses perceived stress during the past month. Items were rated on a 5-point Likert scale ranging from 0=Never to 4=Very Often. The overall scale score is the total of all 10 items, of which 4 are reverse-coded, so that score totals can range from 0 to 40 with higher scores indicating greater levels of perceived stress. The PSS has two sub-scales that assess perceived helplessness (6 items) and perceived self-efficacy (4 items). Sub-scale scores were calculated as mean scores of all sub-scale items (sub-scale score ranges: 0-4), so that higher scores on the sub-scales indicate higher perceived helplessness or higher perceived self-efficacy, respectively.

Time frame: Baseline, 2-weeks, and 6-weeks post-quit

Population: n=4 were missing Week 2 data, n=5 were missing Week 6 data

This 20-item scale measures positive and negative. Participants were asked to indicate how they felt in the past week, using a 5-point Likert scale ranging from 1=very slightly or not at all to 5=extremely. Scores for 10 positive words and 10 negative words were summed separately and were reported as mean scores (not scale totals) ranging from 1-5, with lower scores indicating low (positive or negative) affect and higher scores indicating high (positive or negative) affect. The 10 items for POSITIVE (PA) affect are attentive, interested, alert, excited, enthusiastic, inspired, proud, determined, strong, and active. The 10 items for NEGATIVE (NA) affect are distressed, upset, hostile, irritable, scared, afraid, ashamed, guilty, nervous, and jittery.

Time frame: Baseline, 2-weeks, and 6-weeks post-quit

Population: n=1 had incomplete baseline data, n=6 were missing Week 2 data, n=5 were missing Week 6 data

This 10-item scale assesses overall nicotine dependence, craving, and smoking withdrawal symptoms. Items were rated on a 7-point Likert-scale ranging from 1=Strongly disagree to 7=Strongly agree. We presented mean instead of total scores for ease in interpretation, so that scale scores can range from 1.0 to 7.0, with higher scores indicating greater smoking urges.

Time frame: Baseline, 2-weeks, and 6-weeks post-quit

Population: Some participants had missing data for follow-up time-points. In the statistical analysis, we used hierarchical linear mixed models with maximum likelihood estimation to handle missing data.

The 12-item Smoking Self-Efficacy Questionnaire (SEQ-12) assesses confidence to abstain from smoking when faced with internal stimuli (6 items; e.g., when I feel very anxious) and external stimuli (6 items; e.g., after a meal). Items were assessed on slider scales ranging from 0=not at all confident to 100=extremely confident and results are presented as mean scale scores, where higher scores indicate greater self-efficacy to abstain from smoking.

Time frame: Baseline, 2-weeks, and 6-weeks post-quit

Population: n=1 had incomplete baseline data, n=4 were missing Week 2 data, n=5 were missing Week 6 data

Two single-item happiness measures were used: In the PAST WEEK, how happy have you felt? and How happy are you feeling RIGHT NOW?. Both items were rated on slider scales ranging from 0=not at all to 100=extremely, such that higher scores indicate greater levels of happiness.

Time frame: Baseline, 2-weeks, and 6-weeks post-quit

Population: n=1 had incomplete baseline data, n=4 were missing Week 2 data, n=7 were missing Week 6 data

The single-item self-efficacy measure asked: How MOTIVATED are you to quit smoking/ stay quit? This item was measured on a slider scale ranging from 0=not at all to 100=extremely motivated, where higher scores indicate a greater motivation to quit smoking or stay quit.

Time frame: Baseline, 2-weeks, and 6-weeks post-quit

Population: n=4 were missing Week 2 data, n=5 were missing Week 6 data

Two single-item measures assessed the pros and cons of being smoke-free: (1) Think about all the things you LIKE/LOVE about quitting/being smoke-free; taken together, how important are those things to you RIGHT NOW? and (2) Think about all the things you DISLIKE/HATE about quitting/being smoke-free; taken together, how important are those things to you RIGHT NOW? Both single-item measures were rated on slider scales ranging from 0=not at all to 100=extremely important, so that higher scores indicate a greater perceived importance of the pros and cons of being smoke-free, respectively.

Time frame: Baseline, 2-weeks, and 6-weeks post-quit

Population: n=4 and n=5 participants had missing data at weeks 2 and 6, respectively. Data was analyzed in a hierarchical mixed model with maximum likelihood estimation to handle missing data.

The single-item self-efficacy measure asked: How CONFIDENT are you that you will be able to quit smoking/stay quit? This item was measured on a slider scale ranging from 0=not at all to 100=extremely confident, so that higher scores indicate greater confidence in the ability to quit smoking or stay quit.

Time frame: Baseline, 2-weeks, and 6-weeks post-quit

Population: n=1 had incomplete baseline data, n=4 were missing Week 2 data, n=5 were missing Week 6 data

Single-item measure: Right now, how strong is your desire/urge to smoke?. This single-item measure was rated on a scale of 0, not at all strong to 100, extremely strong, so that higher scores indicate stronger smoking urges.

Time frame: Baseline, 2-weeks, and 6-weeks post-quit

Population: n=1 participants were missing baseline data for this survey; n=4 and n=6 participants had missing data at weeks 2 and 6, respectively. Data was analyzed in a hierarchical mixed model with maximum likelihood estimation to handle missing data.

This 4-item scale assesses global subjective happiness. Each question is rated on a Likert-scale of 1-7. Scale scores were reported as mean scores in this study, with higher scores indicating higher subjective happiness.

Time frame: Baseline, 2-weeks, and 6-weeks post-quit

Population: n=1 had incomplete baseline data, n=6 were missing Week 2 data, n=5 were missing Week 6 data

App usage, as quantified by the number of days of used during the prescribed period of app use (i.e., 49), based on passively recorded app usage patterns.

Time frame: 6 weeks after chosen smoking cessation date

Participants were asked Have you been abstinent during the past 30 days? in follow-up to providing their current smoking status as I do not smoke at all. The outcome is presented as a % of participants who self-reported 30-day point-prevalence smoking abstinence. Participants were assumed to be smoking if they did not complete surveys.

Time frame: Baseline, 2 weeks post-quit, 6 weeks post-quit, 3-months post-quit, 6-months post-quit