Do Young Smokers Prefer Apps or Face-to-Face Therapy—and How Does Cannabis Fit In? | Research

The takeaway

Younger students preferred app-based smoking cessation therapy, while cannabis dependence was associated with perceiving fewer disadvantages of smoking—suggesting co-occurring cannabis use may reduce motivation to quit tobacco.

Young people who smoke and use cannabis, cessation program designers choosing between digital and in-person formats, and researchers studying co-occurring substance use motivation.

What the researchers found

This study enrolled 98 young adult smokers from the University of Granada into either an app-based cognitive-behavioral therapy (CBT) program or a traditional face-to-face CBT program for smoking cessation. The participants self-selected their format, which is itself informative: younger participants and students were more likely to choose the app.

The study used the decisional balance framework—weighing perceived advantages versus disadvantages of smoking—to assess motivation for change. Here's where it gets interesting with cannabis: cannabis dependence was associated with perceiving fewer disadvantages of smoking. In other words, young smokers who were also dependent on cannabis were less motivated to quit tobacco because they saw fewer downsides to smoking.

Sex addiction and other substance addictions showed similar patterns, while compulsive buying showed the opposite pattern (more perceived disadvantages of smoking). This suggests that co-occurring addictive behaviors may systematically alter how young people evaluate their smoking—and that cannabis dependence specifically may dampen quit motivation.

The treatment preference data also matters practically: younger people gravitating toward apps suggests that digital cessation tools may have better uptake in this demographic.

Why it matters

Understanding what undermines quit motivation in young smokers is essential for designing effective cessation programs. The finding that cannabis dependence reduces perceived disadvantages of smoking suggests these co-occurring conditions may need to be addressed together—young people who don't see smoking as problematic are unlikely to engage with cessation programs.

The numbers in context

N = 98 (35 app-based, 63 face-to-face). Younger participants more likely to choose app-based therapy. Cannabis dependence associated with fewer perceived disadvantages of smoking. Compulsive buying associated with more perceived disadvantages.

How the study worked

Observational study of 98 young adult smokers at the University of Granada. 35 self-selected into app-based CBT, 63 into face-to-face CBT. Measures: nicotine dependence (FTND), behavioral and substance addictions (MULTICAGE CAD-4), cannabis dependence (SDS), and motivation (Decisional Balance Questionnaire). Logistic and stepwise regression analyses.

Who was studied

N=98 young adults, mostly students, from the University of Granada.

What this study cannot tell us

Small sample from a single Spanish university—limited generalizability. Self-selection into treatment format (not randomized). The study can't determine whether cannabis dependence causes reduced quit motivation or whether both reflect a common underlying factor. Spanish young adult smoking patterns may differ from other countries. The decisional balance framework captures perceived pros/cons but may not predict actual quit behavior.

How to read the evidence

Small observational study with self-selected treatment groups—generates hypotheses about treatment preferences and motivational patterns but can't establish causal relationships.

When this study was published

Published in 2025 with data from the University of Granada, Spain.

The bigger picture

This connects to the broader cessation literature. RTHC-00166 found 80% of young vapers wanted help quitting but disagreed on methods—a preference diversity that this study's app vs. face-to-face split also reflects. RTHC-00154 and RTHC-00156 examined how cannabis use affects nicotine cessation outcomes; this study adds the motivational dimension, showing that cannabis dependence may reduce the perceived need to quit in the first place.

Replication

Not stated in abstract.

Funding

Not reported in abstract.

Conflicts of interest

Not reported in abstract.

Questions still open

Would addressing cannabis dependence first increase tobacco quit motivation? Do app-based programs produce comparable quit rates to face-to-face therapy in this population? Is the cannabis-motivation link specific to tobacco smoking or would it apply to vaping cessation too?

Read the original research

Young Smokers' Therapy Preferences: App-Based vs. Face-to-Face Treatment in the Context of Co-Addictions.

Healthcare (Basel, Switzerland), 13(18)

Healthcare (Basel, Switzerland) is a peer-reviewed journal focusing on health-related research.

View on PubMed ↗Publisher’s paper ↗

Citation

López-Torrecillas, Francisca; Arcos-Rueda, María Del Mar; Cobo-Rodríguez, Beatriz; Muñoz-López, Lucas. (2025). Young Smokers' Therapy Preferences: App-Based vs. Face-to-Face Treatment in the Context of Co-Addictions.. Healthcare (Basel, Switzerland), 13(18). https://doi.org/10.3390/healthcare13182326