INTRODUCTION Mobile instant messaging could deliver real-time, personalized, interactive smoking cessation support. Nicotine replacement therapy (NRT) is effective in increasing quit attempts and abstinence but is underused. We assessed the feasibility of mobile chat-based intervention combined NRT sampling (NRT-S) on abstinence. METHODS In this two-arm, single-blinded, randomized controlled trial, adult (≥18 years) daily cigarette smokers were proactively recruited from Hong Kong community settings using ‘foot-in-the-door’ approach during December 2017 to March 2018. All participants received brief advice on quitting, 1-week of NRT-S, active referral to smoking cessation services, and were individually randomized (1:1) at baseline. The intervention group received two months of chat-based support via instant messaging. The control group received general smoking cessation text messages. The primary outcome was smoking abstinence validated by exhaled carbon monoxide (<4 ppm) and salivary cotinine (<10 ng/mL) at 3 and 6 months using intention-to-treat analysis. RESULTS A total of 119 participants (80.7% male, 60.5% aged 30–40 years) were randomized and analyzed. Among the 14 and 13 self-reported quitters at 3 and 6 months respectively, only 3 and 1 had biochemical validation. The 3 months validated abstinence rate was 2/62 (intervention) vs 1/57 (control) (AOR=1.07; 95% CI: 0.08–13.65). At 6 months follow-up (68.9% of participants retained), more participants in the intervention group reported quitting (10/62 vs 3/57; AOR=2.83; 95% CI: 0.70–11.30), smoking reduction (20/62 vs 11/57; AOR=1.74; 95% CI: 0.71–4.26), and quit attempts (56/62 vs 44/57; AOR=2.61; 95% CI: 0.88–7.82). Significantly more NRT-S use (39/62 vs 22/57; AOR=2.27; 95% CI: 1.04–4.96) was observed in the intervention group. Participants engaged in mobile chat support (21/62) reported more NRT-S use (76.2% vs 56.1%), although not statistically significant. CONCLUSIONS Mobile chat-based support plus NRT-S was feasible and showed preliminary evidence of increased quitting, smoking reduction, quit attempts, and NRT-S use in proactively recruited community smokers. TRIAL REGISTRATION ClinicalTrials.gov: NCT03574077.
Background Mobile instant messaging (IM) apps (eg, WhatsApp and WeChat) have been widely used by the general population and are more interactive than text-based programs (SMS text messaging) to modify unhealthy lifestyles. Little is known about IM app use for health promotion, including alcohol reduction for university students. Objective This study aims to explore university student drinkers' perceptions of using IM apps for alcohol reduction as they had high alcohol exposure (eg, drinking invitations from peers and alcohol promotion on campus) and the proportion of IM app use in Hong Kong. Methods A qualitative study was conducted with 20 Hong Kong Chinese university students (current drinkers) with Alcohol Use Disorder Identification test scores of ≥8 recruited using purposive sampling. Semistructured individual interviews were conducted from September to October 2019. Interview questions focused on drinking behaviors, quitting history, opinions toward IM app use as an intervention tool, perceived usefulness of IM apps for alcohol reduction, and opinions on the content and design of IM apps for alcohol reduction. Each interview lasted approximately 1 hour. All interviews were audio-taped and transcribed verbatim. Two researchers independently analyzed the transcripts using thematic analysis with an additional investigator to verify the consistency of the coding. Results Participants considered IM apps a feasible and acceptable platform for alcohol reduction intervention. They preferred to receive IMs based on personalized problem-solving and drinking consequences with credible sources. Other perceived important components of instant messages included providing psychosocial support in time and setting goals with participants to reduce drinking. They further provided suggestions on the designs of IM interventions, in which they preferred simple and concise messages, chat styles based on participants' preferences (eg, adding personalized emojis and stickers in the chat), and peers as counselors. Conclusions Qualitative interviews with Chinese university student drinkers showed high acceptability, engagement, and perceived utility of IM apps for alcohol reduction intervention. IM intervention can be an alternative for alcohol reduction intervention apart from traditional text-based programs. The study has implications for developing the IM intervention for other unhealthy behaviors and highlights important topics that warrant future research, including substance use and physical inactivity. Trial Registration ClinicalTrials.gov NCT04025151; https://clinicaltrials.gov/ct2/show/NCT04025151?term=NCT04025151
BACKGROUND Mobile instant messaging (IM) apps (e.g., WhatsApp and WeChat) were widely used by population and provided an inexpensive alternative for text-based programs (short message service, SMS) to modify adverse lifestyle. Little is known about IM apps use for health promotion, including alcohol reduction for university students. OBJECTIVE This study aimed to explore university student drinkers’ perceptions of using IM apps for alcohol reduction as they had high alcohol exposure and proportion of IM apps use in Hong Kong. METHODS A qualitative study was conducted. 20 Hong Kong Chinese university students (current drinker) were recruited using purposive sampling. Semi-structure individual interviews were conducted from September to October 2019. Each interview lasted around an hour. All interviews were audiotaped and transcribed verbatim. Two researchers independently analyzed the transcripts using thematic analysis with an additional investigator to verify the consistency of the coding. RESULTS Participants considered IM app as a feasible and acceptable platform for providing alcohol reduction intervention. They preferred to receive instant messages based on personalized problem-solving and drinking consequence with credible sources for the IM intervention. Other perceived important components of instant messages included providing psycho-social support in time and setting goals with participants to reduce drinking. They further provided suggestions on the designs of the IM intervention, which they preferred simple and concise messages, chat styles based on participants’ preferences (e.g., personalized emoji and stickers), and peer as counsellors. CONCLUSIONS IM intervention can be an alternative for providing alcohol reduction intervention apart from text-based program. The findings may inform the development of the IM intervention for other adverse health behaviors in future.
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