A Text Messaging-Based Smoking Cessation Program for Adult Smokers: Randomized Controlled Trial

Abstract

BackgroundDespite promising data in Western countries, there is a dearth of research into the efficacy of text messaging-based smoking cessation programs in other settings, including the Middle East, where smoking prevalence rates are higher.ObjectiveThis paper reports cessation rates observed in SMS Turkey, a text messaging-based smoking cessation program for adult smokers in Ankara, Turkey.MethodsThis study was a small-scale, parallel-group randomized controlled trial (RCT) conducted in Ankara, Turkey. Participants were adult daily smokers who were seriously thinking about quitting in the next 15 days and living in Ankara, Turkey. The text messaging intervention, SMS Turkey, provided 6 weeks of daily messages aimed at giving participants skills to help them quit smoking. Messages were sent in an automated fashion, except 2 days and 7 days after the initial quit day. On days 2 and 7, the research assistant manually assigned participants to content “paths” based on whether they were still not smoking or had relapsed. The control arm received a brochure that provided similar information about smoking cessation. The main outcome measure was self-reported 3-month sustained abstinence, verified by carbon monoxide (CO) readings. Neither participants nor researchers were blinded to arm assignment.ResultsThe 151 participants were randomly assigned to 1 of 2 groups: 76 to the SMS Turkey intervention group and 75 to the brochure control group. Using intention to treat, all 151 participants were included in analyses. Three-month cessation trends were not significantly higher in the intervention group: 11% intervention vs 5% control had quit (χ2 1=1.4, P=.24; R2=2.0, 95% CI 0.62-6.3). When the sample was stratified by sex, female intervention participants (14%, n=5) were significantly more likely to have quit at 3 months than female control participants (0%, n=0; χ2 1=3.7, P=.05). Among light smokers (ie, those smoking less than 20 cigarettes per day), intervention participants (17%, n=5) also were significantly more likely to have quit compared to control participants (0%, n=0; χ2 1=5.3, P=.02). We noted no difference in cessation rates for males or heavy smokers. Participants experienced significant technology problems during the study. Some participants received duplicate text messages at least once during the trial; others failed to receive some program messages. Neither receiving duplicate messages (χ2 1=0.12, P=.73), or missing 5 or more program messages (χ2 1=0.75, P=.39) negatively affected quitting rates.ConclusionsAlthough the study was not powered to detect statistically significant differences, as the primary aim was to provide estimates of effect size that could be used to better inform a power analysis for a larger trial, findings provide optimism that SMS Turkey may be able to affect quitting rates in environments with high smoking prevalence, such as Ankara, Turkey. The SMS Turkey software program did not work as well as it did 2 years previous. The system will need to be updated to maintain software compati...

Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention

“…Ybarra and colleagues 135 first studied an SMS program delivered in Turkey and more recently studied the effects of their SMS intervention in a study of young adult smokers in the United States. 126 Although the intervention produced significantly higher abstinence rates at 4 weeks, these differences were not sustained at 3 months.…”

Text Messaging for Addiction: A Review

“…Participants were adult daily cigarette smokers who were willing to make a quit attempt (n=151) (Ybarra et al 2012). Smoking prevalence rates in Turkey are higher than in the United States and most adults in Turkey own cellular phones (and a majority regularly uses text messaging), indicating this was an important population in which to evaluate a text messaging-based intervention.…”

“…Difficulties were encountered with the text messaging system despite the fact that it had functioned well in an earlier pilot (Ybarra et al 2013a). At 4-week follow-up, 59/76 (78%) of intervention participants evaluated the acceptability of the program (Ybarra et al 2012). Forty-one (69%) of responders indicated they somewhat or strongly liked the program and 46 (78%) were somewhat or very likely to recommend the program to others; these results are similar to those of the earlier pilot in which software issues did not arise.…”

“…For instance, Whittaker et al (2011) cited problems gaining timely ethics board approval for incentives as a significant reason for achieving only 17% of expected enrollment into their RCT. Furthermore, a 3-month follow-up rate of only 40% was a concern in the Ybarra, et al (2012) study conducted in Turkey; this may be in part because research incentives were not provided, as they are not culturally normative in that country (Ybarra et al 2012). Ongoing efforts need to be made to educate ethics boards about the role and appropriateness of incentives (Volpp et al 2009; Festinger et al 2008; Festinger et al 2005; Dickert & Grady 1999).…”

Assessing the Cross-Cultural Adaptation and Translation of a Text-Based Mobile Smoking Cessation Program in Samoa (TXTTaofiTapaa): Pilot Study (Preprint)

“…The use of mobile has the potential to promote health and gender equity and enhance community agency (1,2). Mobile phones and in particular, text messaging, have been effectively used as behaviour change tools for various health interventions (3,4) and increasingly for smoking cessation support (5)(6)(7)(8). Text messages can present timely cues, behavioural reinforcement and social support all via an inexpensive delivery medium (3).…”