Effectiveness of Short Message Service Text-Based Smoking Cessation Intervention Among University Students

Abstract

Importance Smoking is globally the most important preventable cause of ill health and death. Mobile telephone interventions and, in particular, short message service (SMS) text messaging, have the potential to overcome access barriers to traditional health services, not least among young people. Objective To determine the effectiveness of a text-based smoking cessation intervention among young people. Design, Setting, and Participants A single-blind, 2-arm, randomized clinical trial (Nicotine Exit [NEXit]) was conducted from October 23, 2014, to April 17, 2015; data analysis was performed from April 23, 2014, to May 22, 2015. Participants included daily or weekly smokers willing to set a quit date within 1 month of enrollment. The study used email to invite all college and university students throughout Sweden to participate. Interventions The NEXit core program is initiated with a 1- to 4-week motivational phase during which participants can choose to set a stop date. The intervention group then received 157 text messages based on components of effective smoking cessation interventions for 12 weeks. The control group received 1 text every 2 weeks thanking them for participating in the study, with delayed access to the intervention. Main Outcomes and Measures The primary outcomes were self-reported prolonged abstinence (not having smoked >5 cigarettes over the past 8 weeks) and 4-week point prevalence of complete smoking cessation shortly after the completion of the intervention (approximately 4 months after the quit date). Results A total of 1590 participants, mainly between 21 and 30 years of age, were randomized into the study; 827 (573 [69.3%] women) were allocated to the intervention group and 763 (522 [68.4%] women) were included in the control group. Primary outcome data were available for 783 (94.7%) of the intervention group and 719 (94.2%) of the control group. At baseline, participants were smoking a median (range) of 63 (1-238) and 70 (2-280) cigarettes per week, respectively. Eight-week prolonged abstinence was reported by 203 participants (25.9%) in the intervention group and 105 (14.6%) in the control group; 4-week point prevalence of complete cessation was reported by 161 (20.6%) and 102 (14.2%) participants, respectively, a mean (SD) of 3.9 (0.37) months after the quit date. The adjusted odds ratios (95% CIs) for these findings were 2.05 (1.57-2.67) and 1.56 (1.19-2.05), respectively. Conclusions and Relevance With the limitation of assessing only the short-term effect of the intervention, the effects observed in this trial are comparable with those for traditional smoking cessation interventions. The simple NEXit intervention has the potential to improve the uptake of effective smoking cessation interventions. Trial Registration isrctn.org Identifier: ISRCTN75766527

User satisfaction with the structure and content of the NEXit intervention, a text messaging-based smoking cessation programme

“…Using the BCT taxonomy suggested by Mitchie et al [10], which includes 43 BCTs previously found to be reliable in coding the context of smoking cessation interventions, the intervention used 32 different BCTs, for example: “provide information on consequences of smoking and smoking cessation”, “prompt review of goals”, and “boost motivation and self-efficacy”. Slightly more than half of the messages clearly combined more than one BCT [5] (see Table 1). As part of the formative development, 10 smoking cessation experts and 10 smokers evaluated and provided comments and suggestions on each message [4].…”

“…To address this, a text messaging-based smoking intervention, the NEXit intervention, was developed, aimed specifically at this group [4, 5]. A text messaging-based intervention was chosen because mobile phones are increasingly being used as a medium for reminders about medication and self-management of chronic diseases, such as diabetes, as well as behavioural change interventions on problematic drinking, obesity, tobacco cessation and sedentary lifestyle [6–9].…”

“…The next step was to test the effectiveness of the intervention in a randomized controlled trial (RCT), which included 1590 participants recruited from all colleges and universities in Sweden. The short-term effect, measured immediately after the 12-week intervention, revealed that 25.9% of smokers in the intervention group had prolonged abstinence (not having smoked in the last 8 weeks) compared with 14.6% in the control group [5]. This does not mean that the intervention was flawless and there is no room for improvement from the individual user’s perspective, so the present study was performed to get information for subsequent revisions, thus adding user knowledge to optimize the text-based intervention.…”

A Text Message�Based Intervention Targeting Alcohol Consumption Among University Students: User Satisfaction and Acceptability Study (Preprint)

“…Most agreed that the variation was valuable, particularly among those who reduced or stopped drinking. One possible conclusion also noted in previous research using a text messagingbased intervention among students who smoked may be that text message-based cessation interventions are more suitable for those who are motivated to use these types of programs, and those who are not fully motivated or not determined to change their lifestyle habits may find other types of support more suitable, for example face-to-face meetings with professionals [17].…”

Nuevas tecnologías en el tratamiento del tabaquismo

“…Destaca que la mayoría de los estudios publicados sobre la efectividad de intervenciones desde teléfonos móviles han sido realizados vía mensajería de texto, dado el amplio uso de éstos en el tiempo en que fueron conducidos los estudios. Una revisión sistemática reciente demuestra un aumento en la abstinencia de consumo de tabaco a 6 meses usando telefonía móvil comparado con población control (RR 1,67 IC 95% 1,46 -1,9; GRADE moderado * ) 5 siendo efectiva en diversos contextos y poblaciones 6,8 . Dentro de las ventajas de la telefonía móvil se encuentra la posibilidad de alcanzar a sectores masivos de la población, su fácil acceso y familiaridad de los usuarios, así como la flexibilidad temporal y geográfica dado que las personas pueden acceder a ellas en el momento y lugar que estimen convenientes.…”