Text messaging program doubles smoking cessation rates
ST LOUIS (MD Consult) – A smoking cessation program delivered via mobile phone text messaging doubles smokers' cessation rate, finds the first study to test such a program using biochemical verification.
Investigators enrolled in the randomized trial 5,800 smokers in the United Kingdom who were willing to make a quit attempt. They were randomly assigned in nearly equal numbers to a mobile phone text messaging smoking cessation program (called txt2stop), which delivered motivational messages and messages to support behavior change (eg, encouragement up to the actual quit day, advice on keeping weight off while quitting, and help dealing with cravings), or a control program, which delivered text messages that did not pertain to quitting.
Intervention participants were sent 5 messages daily for the first 5 weeks, then 3 messages weekly for the next 26 weeks. If they used prepaid phones, they were given vouchers to provide sufficient credit to receive intervention messages.
All participants could also use other smoking cessation services or support of their choice, and all were given phone numbers for quitting help lines.
The participants were about 37 years old, on average, and nearly 90% were white. Forty-four percent were aged 16 or younger when they completed their education. Slightly more than half worked in manual labor, or were students or unemployed.
Trial results, reported in the July 2, 2011, issue of The Lancet, showed that the rate of self-reported, continuous abstinence at 6 months, biochemically verified with salivary cotinine testing, was nearly 11% in the txt2stop group, compared with 5% in the control group. The difference corresponded to significant 2.2- fold higher odds for the former.
The findings were similar whether participants who were lost to follow-up were analyzed as smokers (9% vs 4%) or were excluded (10% vs 4%).
Additionally, the benefit of the txt2stop program was consistent across prespecified subgroups.
The intervention group did not higher rates of self-reported involvement in vehicular crashes or thumb pain while texting.
"On the basis of these results the txt2stop intervention should be considered as an addition to existing smoking cessation services. In this trial the intervention was effective on its own and when used alongside other smoking cessation interventions," the investigators write.
"To scale up the txt2stop intervention for delivery at a national or international level would be technically easy. The intervention might require some adaptation, translation into other languages, and local evaluation before delivery to other populations," they add. "The intervention is low cost and likely to be highly cost-effective. A cost-effectiveness analysis of txt2stop will be reported separately."
The authors of an accompanying Comment note that access to cell phone technology has rapidly expanded in poor countries. "The lessons learned from the txt2stop trial could therefore not only provide a new approach to smoking cessation in high-income and middle- income countries, but could also provide a useful starting point for implementing behavioural change in resource-poor settings," they write.
Lancet. 2011;378:49-55
