Short-term reduction in e-cigarette dependence using a mobile health app

E-cigarette use has increased rapidly among young adults in Saudi Arabia, yet culturally adapted cessation tools remain scarce. Mobile health (mHealth) interventions may offer scalable support, but evidence for vaping-specific digital tools, particularly in Middle Eastern populations, remains limited. We aimed to assess within-person changes in e-cigarette dependence over a 30 day period of using a mobile cessation application among young adult exclusive e-cigarette users in Saudi Arabia, using the Penn State Electronic Cigarette Dependence Index (PS-ECDI) and its item-level behavioral indicator.

A prospective, single-arm, pre-post study was conducted in Jeddah, Saudi Arabia, between 2023 and 2024. Young adults aged 18-40 years who were exclusive e-cigarette users, owned a smartphone, and could read English were recruited through online platforms. Of 272 individuals screened, 123 were enrolled, and 88 participants completed both pre- and post-intervention assessments and were included in the primary analysis. Participants used the Stay Quit Coach (SQC) mobile application for 30 days. The app includes behavioral guidance, craving-management tools, tracking features, and motivational messaging. The primary outcome was change in nicotine dependence as measured by the PS-ECDI. Secondary outcomes included item-level dependence indicators (cravings, urge intensity, use frequency) and behavioral markers of cessation readiness. Repeated-measures ANOVA and paired t-tests evaluated within-person change.

Participants were predominantly aged 18-25 years (63.9%) and male (63.3%). Following 30 days of app use, significant reductions were observed across nearly all dependence indicators. Mean PS-ECDI scores decreased by 43%, accompanied by marked declines in daily use frequency, cravings, withdrawal symptoms, and difficulty refraining in restricted places. Repeated-measures ANOVA demonstrated a significant effect of time on dependence scores (p<0.001). Improvements were consistent across participants, with only minimal worsening observed in a minority.

Use of a structured mobile cessation app was associated with substantial reductions in vaping dependence among young adults in Saudi Arabia. These findings provide early evidence supporting mHealth interventions as accessible, scalable tools for vaping cessation in regions where tailored cessation services are limited. Randomized trials with longer follow-up are needed to evaluate durability and long-term abstinence.