Integrating Use of Self-Affirmation Content Into a Mobile App to Promote Quit Attempts With Text-Based Smoking Cessation Intervention Messaging
Phase: NA
Conditions: Number of Quit Attempts
Sponsor: National Cancer Institute (NCI)

(COVER PAGE) 
 
Integrating use of self-affirmation content into a mobile app to promote quit attempts with 
text-based smoking cessation intervention messaging 
 
PI: William M. P. Klein 
 
 
 
 
        Version Date: September 6, 2017 
        Protocol Number: 999917039 
  NCT03027466 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
Integrating use of self-affirmation content into a mobile app to promote quit attempts with 
text-based smoking cessation intervention messaging 
 
PI: William M. P. Klein 
 
 
Precis 
Quitting smoking is challenging and relapse is likely. Smokers may perceive temptation to smoke as 
threatening if they think it suggests that they are unable to meet the challenges of cessation. When 
individuals experience such a threat to their sense of self-identity (e.g., to their sense that they have 
integrity and/ or competence), they often respond defensively. Individuals have a tendency to react 
defensively to information that informs them that their behavior increases risk for a particular disease or 
negative health consequences. Self-affirmation – a process through which individuals focus on their 
strengths and values – can offset threats to the self and promote healthier behaviors, including smoking 
cessation. To the extent that relapse or difficulty quitting is perceived as a threat to self-identity, when 
individuals are presented with the opportunity to self-affirm they may perceive failure as less threatening, 
mitigating the motivation to downplay the importance of quitting. Preliminary evidence suggests that self-
affirmation can be feasibly incorporated into an existing smoking cessation text message-based 
intervention, and may bolster cessation rates among users motivated to quit smoking. Here, we propose to 
extend that research by examining whether the addition of self-affirmation text messages to a smoking 
cessation app (Smoke Free UK) promotes smoking cessation, compared to standard of care (i.e., existing 
app content only). Importantly, self-affirmation material will be incorporated into the current app and will 
not change the goals or nature of the original texting program.  We predict that the individuals in the self-
affirmation condition will be more likely to report being smoke-free at the 1-month and 3-month follow-
ups. 
Introduction 
Quitting smoking is challenging and relapse is likely (Hughes, Keely, & Naud, 2004). Smokers may 
perceive temptation to smoke as threatening if they think it suggests that they are unable to meet the 
challenges of cessation. When individuals experience such a threat to their senseafan itemwea of self-
identity (e.g., to their sense that they have integrity and/ or competence), they often respond defensively 
(Jemmott, Ditto, & Croyle, 1986; Kunda, 1987). For example, when presented with information that 
smoking confers risk for health threats like lung cancer and cardiovascular disease, smokers may discount 
the information as less credible in an attempt to protect their self-identity as a smoker and their sense of 
themselves as good and morally adequate people. If individuals perceive failure as threatening to the self, 
they may be motivated to downplay the importance of quitting, thus leading to fewer subsequent attempts 
to quit.  
Self-affirmation (Steele, 1988) – a process through which individuals focus on their strengths and values 
– can offset threats to the self and promote healthier behaviors (Cohen & Sherman, 2014; Epton et al., 
2015; Sweeney & Moyer, 2015), including smoking cessation (Armitage et al., 2008; Epton et al., 2014; 
Harris et al., 2007).  To the extent that relapse or difficulty quitting is perceived as a threat to self-identity, 
when individuals are presented with the opportunity to self-affirm they may perceive failure as less 
threatening, mitigating the motivation to downplay the importance of quitting. Thus, smokers who self-
affirm may be more successful at quitting, because such temptation may be seen as less threatening to 
competence or self-control. 

Effective smoking cessation treatments, including those delivered via mobile health platforms, have been 
empirically validated and are widely available (Fiore et al., 2008; Fraser et al., 2014; Spohr et al., 2015). 
Preliminary evidence suggests that incorporating a self-affirmation component into a standard text-
message-based smoking cessation intervention is a feasible, low-cost, and potentially efficacious way of 
bolstering the content of that intervention (Taber et al., under review). Specifically, self-affirmation 
content was associated with increased self-reported quit rates among smokers who reported being most 
motivated to quit at baseline.  
Moreover, the scalability of self-affirmation interventions has been demonstrated in other domains (i.e., 
education; Cohen et al., 2006; 2009). Indeed, self-affirmations have promise for dissemination, given that 
affirmation exercises require little time and effort but have lasting effects (Cohen et al., 2009; Logel & 
Cohen, 2012). Although lasting effects from such a “low touch” intervention are surprising, self-
affirmation seems to work not continuously but rather by engaging recursive processes, such that self-
affirmation engages motivation and reduces threat associated with temptation in a way that allows 
individuals to take advantage of resources or infrastructure already in place to facilitate change (Cohen et 
al., 2009). Thus, implementing brief affirmations into an existing, scalable cessation intervention may 
bolster the effectiveness of the intervention by maximizing the likelihood that individuals will engage 
with and benefit from the content of that intervention. 
Here, we propose to extend this line of research by examining whether self-affirmation is an effective 
way of bolstering the content of an existing mobile app intervention intended to facilitate smoking 
cessation. We will incorporate self-affirmation intervention content into a UK-based smoking cessation 
mobile app. Individuals who sign up for the app will be randomly assigned to receive the self-affirmation 
content in addition to the existing app content –at the beginning of the intervention (questionnaire self-
affirmation condition), delivered throughout the course of three-month engagement with the app 
(integrated self-affirmation condition), or both (questionnaire and integrated self-affirmation condition) – 
or to receive only the standard app content (standard of care control condition).  
We predict that inducing self-affirmation will result in additional smoking-related benefits compared to 
standard of care. We expect that those who receive affirmation will be more likely to report being smoke-
free at the 1-month and 3-month follow-ups. The nature of the self-affirmation will either be in the form 
of an affirmation quiz upon enrollment—which is the most frequent way to affirm—or through booster 
texts through the program (or both). The proposed design will allow us to determine whether there are 
unique effects of different types of affirmation, although we do not have specific hypotheses regarding the 
type/nature of the affirmation inductions.  
Study Design and Methods  
Participants (18+ years of age) who download the Smoke Free UK app during a particular period of time 
will be enrolled into the study. Participants will be randomly assigned to one of 4 conditions as part of a 2 
(Integrated affirmation: Affirmation texts present versus absent) X 2 (Baseline affirmation: questionnaire 
present versus absent) design (these affirmations are described below). Those in the control condition will 
receive no changes to the app (standard of care control condition). All participants will have access to the 
“smoke free pro” materials that users typically pay for. We will be able to track usage of these materials 
through https://mixpanel.com/.  
 
Upon enrollment, participants will answer demographic, smoking-related, and mood questions in the app.  
Participants will be sent follow-up surveys at 1- and 3-months. Participants also provide a quit date. 
Participants will be informed that if they agree to participate they will be entered into a lottery for a $100 
Amazon voucher. We expect that 50% of participants will complete each survey.  
 
When participants download the app, they will be given information about the app that describes it as part 
of an “on-going project on smoking cessation” and told that they are “invited to participate in a study 

looking at smoking cessation.” Participants who agree to the terms outlined then provide informed 
consent by selecting “I understand and wish to participate.”  
 
Booster affirmation texts: Participants in the integrated self-affirmation conditions will receive two self-
affirmation text messages per day. Participants will also be informed that they can access the self-
affirmation messages every time they spontaneously report experiencing a craving. These will show up in 
a screen that shows “Tips.” We will be able to assess how many times participants reported experiencing 
a craving and thus saw a craving booster message.  
 
Baseline kindness affirmation quiz: Participants in this condition will complete a standard 5-item kindness 
quiz as part of the consent screen when they enroll in the trial (Reed & Aspinwall, 1998; below). This 
self-affirmation manipulation has been frequently used, has face validity, and is easy to implement 
(McQueen & Klein, 2006). Prior data from this app have shown that approximately 60% of people set 
their quit date for the day they download the app, around 30% quit before they download it, and around 
20% quit after they download it.  
 
Enrollment items: Upon enrollment, participants provide their age, gender, the number of years they’ve 
been smoking, number of cigarettes they smoke each day, the smoking cessation aids (if any) they are 
currently using, and are asked to provide their quit date. For the present study, we are adding four items 
(below) assessing craving level at baseline, readiness to quit, nicotine dependence, and race/ethnicity, for 
exploratory reasons. These measures moderated the effect of booster affirmations on self-reported 
cessation in pilot work.  
 
What's your craving level? Reply: HI, MED, or LOW 
Congratulations! By downloading this app you’ve taken the first step to quit smoking. You are 
stronger than you think so stay positive. Are you ready? Reply: READY or NOT  
 
Follow-up surveys at 1- and 3-months: Data will be collected through surveys sent 1 and 3 months after 
enrollment through the app; participants will have the option to complete the survey through either of 
these modalities (see Appendix C). These questions assess smoking in past month, past week, and current 
number of cigarettes smoked per day, use of other smoking cessation aids, whether participants would 
recommend the app to others, and allow participants to leave a comment. Less than 10% of respondents 
are expected to complete the surveys. 
 
Inclusion and exclusion criteria  
Because the app is designed to assist with smoking cessation, all smokers are eligible to participate. 
Subjects are eligible if they are 18+ years of age. 
 
Criteria for Withdrawal of Subjects from the Study  
Subjects will complete the questionnaires from wherever they choose to access the app. Subjects can 
choose not to complete the study simply by exiting the surveys. We will conduct analyses with and 
without the non-completers to explore how each group differed. Although we anticipate a large sample 
size, we will add additional smokers as needed. Moreover, the informed consent page will inform subjects 
that should they want to withdraw from the study after they have completed the entire survey, they should 
contact Smoke Free UK and request that their data not be included in the final dataset provided to NCI. 
 
No subjects will be withdrawn by the researchers, although data from a given subject may be excluded 
from the study if key response variables are missing (i.e., if the subject chooses not to answer the 
questions necessary to calculate a score for a study outcome). 
 
Data analysis 

Data gathered will be analyzed using ANOVA to determine whether there are significant differences 
among key outcomes between the self-affirmation and standard of care conditions. The primary outcomes 
are number of quit attempts and self-reported smoking status (i.e., how often the participant reports 
smoking after using the app). The intermediate outcomes will include smoking attitudes, number of 
smoke-free days and type of tobacco products (e.g., switching to low nicotine tobacco).    
 
We will attempt to recruit 5000 smokers with the aim of having 500 complete the surveys, thus 
accounting for a 90% attrition rate in completion of the surveys. Because this study will take place 
through an app, we were more conservative in power calculations, given that effect sizes may be smaller 
in online studies compared to laboratory studies (due to less experimental control). Using a small effect 
size estimate (.15), a sample of 500 will yield high (.90) power to detect differences in a study involving 4 
groups (2x2) (calculated with G*Power, a publicly available software package).  
 
Human Subject Protections  
Rationale for Subject Selection: Individuals will only be eligible if they are 18+ years of age. All ethnic 
and race categories will be eligible to participate in the study.  
 
Evaluation of Benefits and Risks/Discomforts: Participants will help contribute to the body of knowledge 
in tobacco control research. Minimal risks include any discomfort participants may feel answering 
questions about quitting smoking (i.e. cravings). Given the minor risks in comparison to the importance 
of the scientific knowledge that may reasonably be expected to result from this study, risks to subjects are 
reasonable. 
 
Adverse Event Reporting and Data Monitoring  
Not applicable; no adverse events are anticipated. This is not a clinical trial, and as such, a data 
monitoring and safety plan is not necessary.  
 
Collection and Storage of Human Specimens or Data 
The anonymized data will be stored on a government server, which can only be accessed by the 
designated user (the PI) and system administrators. No personally identifying information will be 
collected. No human specimens will be collected or stored. Once the protocol is completed, the 
anonymized data will continue to be stored for potential secondary analyses. 
 
Remuneration/Compensation  
Participants who provide an e-mail address will be entered into a lottery to win a $100 Amazon voucher. 
This study does not include any medical procedures, and presents minimal risk. Participants will not 
receive any additional remuneration or compensation for participating in the study.  
 
Consent and Assent Processes and Documents 
Consent will take place entirely online. When participants download the app, they are given information 
about the app that describes it as part of an “on-going project on smoking cessation” and told that they are 
“invited to participate in a study looking at smoking cessation.” Participants who agree to the terms 
outlined then provide informed consent by selecting “I understand and wish to participate.” The 
investigators’ names and contact information will be listed.  
 
Limitations 
We recognize one limitation of this study is the high attrition rate. Although participants will be 
randomized to condition, attrition may be related to quitting success and may not be comparable across 
groups. However, if self-affirmation is successful for the participants who remain in the texting program, 
this has the potential to inform future research about a technique that can work for smokers who are very 
engaged comparable cessation programs. 

 
 
 
References  
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acceptance of health-risk information among UK adult smokers with low socioeconomic 
status. Psychology of Addictive Behavior, 22, 88-95.  
Cohen, G. L., Garcia, J., Apfel, N., & Master, A. (2006). Reducing the racial achievement gap: A social 
   psychological intervention. Science, 313 (5791), 1307-1310. 
Cohen, G. L., Garcia, J., Purdie-Vaughns, V., Apfel, N., & Brzustoski, P. (2009). Recursive processes in     
   self-affirmation: Intervening to close the minority achievement gap. Science, 324(5925), 400-403. 
Cohen, G.L. & Sherman, D.K. (2014). The psychology of change: Self-affirmation and social 
   psychological intervention. Annual Review of Psychology, 65, 333-71.  
Epton, T., Harris, P.R., Kane, R., van Koningsbruggen, G.M., & Sheeran, P. (2015). The impact of self 
   affirmation on health-behavior change: A meta-analysis. Health Psychology, 34(3), 187-96.  
Epton, T., Norman, P., Dadzie, A.S., Harris, P.R., Webb, T.L., & Sheeran, P. (2014). A theory-based 
   online health behaviour intervention for new university students (U@Uni): Results from a randomized 
   controlled trial. BMC Public Health, 14, 563.  
Fiore, M., Jaen, C., & Baker, T. (2008). Treating tobacco use and dependence: 2008 update. U.S. 
    Department of Health and Human Services. URL: http://bphc.hrsa.gov/buckets/treatingtobacco.pdf. 
 Fraser, D., Kobinsky, K., Smith, S.S., Kramer, J., Theobald, W.E., & Baker, T.B. (2014). Five 
    population-based interventions for smoking cessation: a MOST trial. Translational Behavioral 
    Medicine, 4(4), 382-390.  
Harris, P.R., Mayle, K., Mabbott, L., & Napper, L. (2007). Self-affirmation reduces smokers' 
   defensiveness to graphic on-pack cigarette warning labels. Health Psychology, 26(4), 437-46.  
Hughes, J.R., Keely, J., & Naud, S. (2004). Shape of the relapse curve and long-term abstinence among 
   untreated smokers. Addiction, 99(1), 29-38.  
Jemmott, J. B., Ditto, P. H., & Croyle, R. T. (1986). Judging health status: Effects of perceived 
prevalence and personal relevance. Journal of Personality and Social Psychology, 50, 899-905. 
Kunda, Z. (1987). Motivated inference: Self-serving generation and evaluation of casual theories. Journal 
of Personality and Social Psychology, 53, 636-647. 
Logel, C., & Cohen, G. L. (2012). The role of the self in physical health testing the effect of a values 
   affirmation intervention on weight loss. Psychological Science, 23(1), 53-55. 
McQueen, A. & Klein, W.M.P. (2006). Experimental manipulations of self-affirmation: A systematic 
   review. Self and Identity, 5, 289-354.  
Reed, M.B. & Aspinwall, L.G. (1998). Self-affirmation reduces biased processing of health-risk 
   information. Motivation and Emotion, 22(2), 99-132.  
Spohr, S.A., Nandy, R., Gandhirai, D., Vemulapalli, A., Anne, S., & Walters, S.T. (2015). Efficacy of 
    SMS text message interventions for smoking cessation: A meta-analysis. Journal of Substance Abuse 
    Treatment, 56, 1-10.  
Steele, C.M. (1988). The psychology of self-affirmation: Sustaining the integrity of the self. In L. 
   Berkowitz (Ed.), Advances in Experimental Social Psychology (Vol. 21, pp.261-302). New York:  
   Academic Press.  
Sweeney, A.M. & Moyer, A.(2015). Self-affirmation and responses to health messages: A meta-analysis 
   on intentions and behavior. Health psychology, 34(2),149-59.  
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   self-affirmations to promote smoking cessation in a national smoking cessation text messaging 
   program.  
 
 

 
 
 
 
Appendix A 
 
 
Baseline Kindness Affirmations  
Get ready to quit smoking with something positive. These questions refer to behaviors that YOU have 
performed for other people. 
 
1. Have you ever been considerate of another person's feelings? If yes, spend a moment thinking of 
a specific time. Reply: Yes or No 
2. Have you ever attended to the needs of another person? If yes, spend a moment thinking of a 
specific time. Reply: Yes or No 
3. Have you ever forgiven another person when they have hurt you? If yes, spend a moment 
thinking of a specific time. Reply: Yes or No 
4. Have you ever tried not to hurt the feelings of another person? If yes, spend a moment thinking of 
a specific time. Reply: Yes or No 
5. Have you ever been generous and selfless to another person? If yes, spend a moment thinking of a 
specific time. Reply: Yes or No 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
Appendix B 
 
 
 
Booster Affirmations  
 
Affirmation text 
1. 
When you feel like you might relapse, focus on your good experiences. Think about a time you 
made someone laugh. 
2. 
When you feel threatened by a craving to smoke, focus on your strengths. Think of a time you 
worked hard on something you care about. 
3. 
When you feel anxious about staying smokefree, think about a time you were loyal to someone you 
care about. 
4. 
When you feel anxious about quitting smoking, focus on your values! Think of a time you showed 
compassion for another person, even if it was hard. 
5. 
When you can’t take your mind off of smoking a cigarette, think of a time when you tried to add 
some humor to something you were doing. 
6. 
Quitting is hard! When you feel a craving, focus on a positive aspect of yourself. Think of a time 
you helped someone less fortunate than you are. 
7. 
When you feel anxious about quitting smoking, focus on your values! Think of a time you stood up 
for what you believe in, even if it was hard. 
8. 
Quitting is hard! When you feel a craving, think of a time you learned from a mistake. 
9. 
Quitting is hard! When you feel a craving, focus on what you stand for. Think of a time you treated 
people equally, regardless of who they were. 
10. When you feel like you might relapse, focus on your good experiences. Think about a time that you 
learned something new. 
11. When you feel anxious about staying smokefree, think about a time when someone else looked to 
you for advice. 
12. When you feel threatened by a craving to smoke, focus on something important to you. Think of a 
time you helped a friend, even if you felt busy. 
13. When you feel like you might relapse, think of a time you were honest with someone, even when it 
was hard. Reflect on that experience instead! 
14. When you can’t take your mind off of smoking a cigarette, think of a time when you looked out for 
another person’s interests before your own. 
15. When you feel like you might relapse, think of a time you helped someone feel better about a bad 
situation. Reflect on that experience instead! 
 
 
 
 
 
 
 

 
 
 
 
 
 
Control Push Notifications  
 
 
Control Text 
1. 
Keep the golden rule: Not another puff, no matter what 
2. 
Remember the four Ds: Delay, Drink water, Deep breathing, Do something 
3. 
All cravings pass. Your mission is to get through the next 15 minutes without smoking 
4. 
Doing something will improve your mood, relieve stress and distract you from cravings. It 
also stimulates brain chemicals that fight the desire to smoke 
5. 
If you’re having prolonged or severe cravings try nicotine replacement therapy 
6. 
Take extra care of yourself. Drink plenty of water, eat good food, get enough sleep 
7. 
Make a commitment to call someone before you light up  
8 
Get some exercise: take a walk, go for a run. Physical activity helps relieve stress, reduces 
cravings and gets you fitter. It also helps shed any excess weight you may have gained 
9. 
Short on time? No problem, even quick bursts of activity help. Walk up and down stairs a few 
times.  
10 
If physical activity doesn’t feel right do some housework, file papers, call a friend 
11. 
Have a book on hand on a subject you want to learn about. Read a few pages and make notes. 
You’ll be occupying your hands and your mind 
12. 
Go online and read something, anything 
13. 
Picture your lungs filling with fresh, clean, air 
14. 
You’re saving money by not smoking. Spend the new few minutes thinking about all the 
money you saved.  
15. 
Why do you want to stop smoking? Bring some reasons to mind right now.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
Appendix C: Baseline, 1-month and 3-month Follow-Up Questionnaires 
 
 
 
Baseline Demographic Questions  
 
 
1. Please enter your age: text box that allow participant to enter age 
 
2.  Gender: forced choice Male or Female 
 
3. How strong is your desire to smoke, right now? Not at all to Extremely (11 pt. scale)  
 
4.  About how old were you when you started smoking regularly? Free Text 
 
5. On average, how many cigarettes do you smoke a day? Free text  
 
6. Are you currently? using medications, counseling, or aids to help you quit? Yes/No 
 
7. How soon after you wake up do you smoke your first cigarette?  
 
• 
Within 5 minutes 
• 
6 to 30 minutes 
• 
31 to 60 minutes 
• 
After 60 minutes 
 
8. Readiness to Quit (Diclemente et al. 1991) 
 
a.  In the last year, how many times have you quit smoking for at least 24 hours? ______ 
 
b. Are you seriously thinking of quitting smoking? 
• 
Yes, within the next 30 days  
• 
Yes, within the next 6 months  
• 
No, not thinking of quitting  
 
 
 
 
 
 

 
 
 
9. In the past 30 days, how often have you felt… 
 
 
 
 
   
10. How much do you agree or disagree with each of the following statements? 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
 
 
 
 
All of the 
time 
Most of the 
Time 
Some of the time 
A little of the time 
None of the time 
a.  Happy?. 
 
 
 
 
 
b.  Angry? 
 
 
 
 
 
c.  Anxious? 
 
 
 
 
 
d.  Hopeful? 
 
 
 
 
 
e.  Sad? 
 
 
 
 
 
 
All of the 
time 
Most of the 
Time 
Some of 
the time 
A little of 
the time 
None of the 
time 
a. When I feel threatened or anxious I find 
myself thinking about my strengths 
 
 
 
 
 
 
b.  When I feel threatened or anxious I find 
myself thinking about my values. 
 
 
 
 
 
c.  I'm always optimistic about my future  
 
 
 
 
 

 
 
 
 
 
1-month Questionnaire  
 
11. Have you smoked at all in the past month? [users can choose only one] 
No, not a puff 
1-5 cigarettes 
More than 5 cigarettes 
 
12. Have you smoked at all in the past week? [users can choose only one] 
No, not a puff 
1-5 cigarettes 
More than 5 cigarettes  
 
If participants answered yes to question 11 then ask 13-14. If no, then skip to question 15.   
 
13. On average, how many cigarettes do you smoke a day? [users can only choose one] 
None 
1-9 
10-19 
20-29 
30-39 
40+ 
14. How soon after you wake up do you smoke your first cigarette? 
After 60 min 
31-60 min 
6-30 min 
Within 5 min 
 
15. Are you using aids other than this app? [users can choose more than one] 
None 
Electronic cigarette 
NRT (eg. patches/gum/inhaler) 
[If selected] 
On prescription? 
Yes 
No 
Champix/Chantix (Varenicline) 
Zyban 
Group, phone, 1-2-1 behavioural support 
Other app 
Other aid 
 
16. How likely is it that you would recommend this app to a friend or colleague?  
[Likert 0-10;] 
0 = Not at all 
10 = Very much 
 

17. Over the past month, how often did you engage in the activities recommended by the “Tips” (e.g. 
“Think of a time when you helped a friend”)? 
Never 
1-3 times 
4– 6 times 
7 - 9 times 
10 or more times 
 
 
18. In the past 30 days, how often have you felt… 
 
 
 
M
o
s
Most of the 
Time 
Some of the time 
A little of the time 
None of the time 
a.  Happy?. 
 
 
 
 
 
b.  Angry? 
 
 
 
 
 
c.  Anxious? 
 
 
 
 
 
d.  Hopeful? 
 
 
 
 
 
e.  Sad? 
 
 
 
 
 
 
19. Would you like to leave a comment? 
[Text entry field] 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 
 
 
 
 
 
3-month Questionnaire   
 
20. Have you smoked at all in the past month? [users can choose only one] 
No, not a puff 
1-5 cigarettes 
More than 5 cigarettes 
 
21. Have you smoked at all in the past week? [users can choose only one] 
No, not a puff 
1-5 cigarettes 
More than 5 cigarettes  
 
If participants answered yes to question 11 then ask 13-14. If no, then skip to question 15.   
 
22. On average, how many cigarettes do you smoke a day? [users can only choose one] 
None 
1-9 
10-19 
20-29 
30-39 
40+ 
23. How soon after you wake up do you smoke your first cigarette? 
After 60 min 
31-60 min 
6-30 min 
Within 5 min 
 
24. Are you using aids other than this app? [users can choose more than one] 
None 
Electronic cigarette 
NRT (eg. patches/gum/inhaler) 
[If selected] 
On prescription? 
Yes 
No 
Champix/Chantix (Varenicline) 
Zyban 
Group, phone, 1-2-1 behavioural support 
Other app 
Other aid 
 
25. How likely is it that you would recommend this app to a friend or colleague?  
[Likert 0-10;] 
0 = Not at all 

10 = Very much 
 
26. Over the past month, how often did you engage in the activities recommended by the “Tips” (e.g. 
“Think of a time when you helped a friend”)? 
Never 
1-3 times 
4– 6 times 
7 - 9 times 
10 or more times 
 
 
27. In the past 30 days, how often have you felt… 
 
 
 
All of the time 
Most of the 
Time 
Some of the time A little of the time 
None of the time 
a.  Happy?. 
 
 
 
 
 
b.  Angry? 
 
 
 
 
 
c.  Anxious? 
 
 
 
 
 
d.  Hopeful? 
 
 
 
 
 
e.  Sad? 
 
 
 
 
 
 
 
28. Would you like to leave a comment? 
[Text entry field]