One veteran, testing an early version of a new smoking cessation website, described what happened when a craving hit mid-session. "At one point during the survey, I was thinking about having a cigarette. I came from outside to get it accomplished. The craving subsided," he said. "Reading all the material, I got caught up. So it changed my thought process." He never lit the cigarette.
Researchers built Vet WebQuit, a web-based program designed for veterans who smoke and also live with conditions like PTSD, depression, or anxiety, hoping for exactly this kind of moment. A new study published in JMIR Formative Research looked at whether the tool actually works the way it's supposed to, not in terms of quit rates yet, but in terms of a more basic question of whether veterans can use it and want to.
Veterans with mental health disorders smoke at strikingly high rates, sometimes as high as 68%, compared to about 15% of the general population. They also quit far less often. Part of the reason is that most smoking cessation treatments were never built with their specific struggles in mind. Standard programs, often rooted in cognitive behavioral therapy, teach people to avoid their triggers. That works reasonably well when the trigger is a bar or a friend who smokes. It works a lot less well when the trigger is a flashback, a wave of anger, or an anxious afternoon that won't let up. You can't avoid your own psychological stressors.
Vet WebQuit is built around a different idea, drawn from Acceptance and Commitment Therapy, or ACT. Instead of teaching veterans to suppress or outrun difficult emotions, ACT teaches them to make space for those feelings but act in line with what actually matters to them. The program walks users through building a quit plan, practicing mindfulness, mapping out their personal smoking triggers, and tying their decision to quit back to their values and the life they want to live.
To find out whether the program actually landed, a research team including Dr. Jaimee Heffner and Dr. Jonathan Bricker in the Public Health Sciences Division at Fred Hutch Cancer Center, alongside colleagues at the VA Bedford Healthcare System recruited 16 veterans with mental health diagnoses and asked them to use the WebQuit site while narrating their thoughts out loud. Facilitators watched as each veteran set up a quit plan, tracked cravings, and worked through an ACT exercise, then asked what felt intuitive, what felt confusing, and what they'd change.
Most of what came back was positive. Nearly everyone said the site was easy to move through. A few features stood out repeatedly: the clear split between internal triggers (like anger or anxiety) and external ones (like being around other smokers), the inclusion of the serenity prayer, and short mindfulness exercises veterans said they could actually use in the middle of a craving rather than after the fact.
The criticisms were specific and useful. The biggest one was visual: several veterans didn't realize certain text was clickable, since the hyperlinks blended into the surrounding paragraphs and looked like ordinary words. Audio exercises had a similar problem. Veterans wanted a heads up on how long a recording would run before they committed to pressing play. Beyond navigation, some pushed for harder facts on what smoking does to the lungs, something that seemed to motivate them more than general health warnings, and for content addressing triggers specific to their lives, like nightmares, boredom, and isolation, rather than generic smoking cues.
One detail that surprised the team was how much imagery shaped the experience. Veterans consistently gravitated toward photos of nature and the American flag, but pushed back on anything that looked like combat, jets, or helicopters included.
Dr. Jaimee Heffner, the senior author on the study, put it this way: "This work highlights the importance of user-centered design as part of a cultural tailoring process when developing tobacco cessation interventions for veterans. Information about what the participants liked (e.g., veteran-centric design and content, like the red, white, and blue color palette) and disliked (e.g. images that were suggestive of military combat, like jets or helicopters) about prototype intervention materials will help to make the program more engaging and effective for veterans."
This study can't say whether Vet WebQuit actually helps veterans quit smoking long term. That's a separate question, and one the researchers plan to tackle next. The sample here was also small, just 16 people from a single VA site, so it's not yet clear whether these reactions hold up across a more varied population of veterans.
A tool that veterans find easy to use, culturally recognizable, and genuinely relevant to what triggers their smoking has a much better shot at being used at all, especially for people who face long waitlists and limited access to in-person cessation counseling. Getting the details right now, down to the color of a hyperlink or the choice of a photo, is what makes the bigger test worth running.
Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium Members Drs. Jaimee Heffner and Jonathan Bricker contributed to this research.
Kelly, M. M., Dempsey, A., Ameral, V., Petrakis, B. A., Reilly, E. D., Quigley, K., Bricker, J. B., & Heffner, J. L. (2026). Web-Based Acceptance and Commitment Therapy Tobacco Cessation Program for Veterans With Mental Health Disorders: Adaptation and Usability Testing. JMIR formative research, 10, e75394.
Science Spotlight writer Darya Moosavi is a postdoctoral research fellow within Johanna Lampe's research group at Fred Hutch. Darya studies the nuanced connections between diet, gut epithelium, and gut microbiome in relation to colorectal cancer using high-dimensional approaches.