Research Article: Effectiveness of a text-messaging-based smoking cessation intervention (“Happy Quit”) for smoking cessation in China: A randomized controlled trial

Date Published: December 18, 2018

Publisher: Public Library of Science

Author(s): Yanhui Liao, Qiuxia Wu, Brian C. Kelly, Fengyu Zhang, Yi-Yuan Tang, Qianjin Wang, Honghong Ren, Yuzhu Hao, Mei Yang, Joanna Cohen, Jinsong Tang, Louisa Degenhardt

Abstract: BackgroundChina has the highest global prevalence of cigarette smokers, accounting for more than 40% of the total cigarette consumption in the world. Considering the shortage of smoking cessation services in China, and the acceptability, feasibility, and efficacy of mobile-phone-based text messaging interventions for quitting smoking in other countries, we conducted a mobile-phone-based smoking cessation study in China.Methods and findingsWe conducted a randomized controlled trial in China across 30 cities and provinces from August 17, 2016, to May 27, 2017. Adult smokers aged 18 years and older with the intention to quit smoking were recruited and randomized to a 12-week high-frequency messaging (HFM) or low-frequency messaging (LFM) intervention (“Happy Quit”) or to a control group in a 5:2:3 ratio. The control group received only text messages unrelated to quitting. The primary outcome was biochemically verified continuous smoking abstinence at 24 weeks. Secondary outcomes included (1) self-reported 7-day point prevalence of abstinence (i.e., not even a puff of smoke, for the last 7 days) at 1, 4, 8, 12, 16, 20, and 24 weeks; (2) self-reported continuous abstinence at 4, 12, and 24 weeks; and (3) self-reported average number of cigarettes smoked per day. A total of 1,369 participants received 12 weeks of intervention or control text messages with continued follow-up for 12 weeks. The baseline characteristics of participants among the HFM (n = 674), LFM (n = 284), and control (n = 411) groups were similar. The study sample included 1,295 (94.6%) men; participants had a mean age of 38.1 (SD 9.79) years and smoked an average of 20.1 (SD 9.19) cigarettes per day. We included the participants in an intention-to-treat analysis. Biochemically verified continuous smoking abstinence at 24 weeks occurred in 44/674 participants in the HFM group (6.5%), 17/284 participants in the LFM group (6.0%), and 8/411 participants (1.9%) in the control group; participants in both the HFM (odds ratio [OR] = 3.51, 95% CI 1.64–7.55, p < 0.001) and the LFM (OR = 3.21, 95% CI 1.36–7.54], p = 0.002) intervention groups were more likely to quit smoking than those in the control group. However, there was no difference in quit rate between the HFM and LFM interventions. We also found that the 7-day point quit rate from week 1 to week 24 ranged from approximately 10% to more than 26% with the intervention and from less than 4% to nearly 12% without the intervention. Those who continued as smokers in the HFM group smoked 1 to 3 fewer cigarettes per day than those in the LFM group over the 24 weeks of trial. Among study limitations, the participants were able to use other smoking cessation services (although very few participants reported using them), cotinine tests can only detect smoking status for a few days, and the proportion of quitters was small.ConclusionsOur findings demonstrate that a mobile-phone-based text messaging intervention (Happy Quit), with either high- or low-frequency messaging, led to smoking cessation in the present study, albeit in a low proportion of smokers, and can therefore be considered for use in large-scale intervention efforts in China. Mobile-phone-based interventions could be paired with other smoking cessation services for treatment-seeking smokers in China.Trial NCT02693626.

Partial Text: Cigarette smoking, as a major public health problem, remains the leading preventable cause of death and disability in China and other countries. In 2015, it was estimated that there were 933.1 million daily smokers worldwide, and more than 6 million deaths (accounting for 11.5% of global deaths) were attributable to cigarette smoking, including at least 1 million in China [1]. Over 80% of deaths attributable to smoking were among men, and more than half of all cigarette smoking took place in 4 countries (China, India, the US, and Russia) [2], with China having the highest proportion of smokers, accounting for more than 40% of the world’s total cigarette consumption [3]. In comparison with many countries, especially European countries, smoking remains highly normalized within China, further necessitating the advancement of smoking cessation interventions for Chinese smokers.

Fig 1 shows the flowchart of participants who were screened and participated in the study intervention and follow-up periods. There were 2,561 individuals who were assessed for eligibility between August 17, 2016, and May 27, 2017, of which 1,144 were ineligible, leaving 1,417 eligible for inclusion in this study. Forty-eight were eligible but declined to participate. A total of 1,369 participants were randomly assigned within the trial, with 674 in the HFM group, 284 in the LFM group, and 411 in the control group. At the end of the trial, 1 participant reported using other cessation services, and he was still smoking. By the end of the 24-week trial period, the trial was completed by 83.2%, 74.6%, and 87.1% of participants in the HFM group, LFM group, and control group, respectively. The rates of completion were similar in the HFM group and the control group (p = 0.087). However, the LFM group had a lower completion rate than either the HFM or control group (p < 0.001). The geographical distribution of participants in China is shown in S1 Table. The purpose of this trial was to develop and evaluate a widely applicable smoking cessation program with feasibility, acceptability, and efficacy in a population-based study in China. Encouragingly, our findings showed that smoking cessation supported by a mobile-phone-based text messaging intervention (Happy Quit), with either high- or low-frequency messages, for quitting smoking increased the quit rate at 24 weeks (biochemically verified continuous smoking abstinence at 24 weeks: 44/674 participants in the HFM group [6.5%], 17/284 participants in the LFM group [6.0%], and 8/411 participants [1.9%] in the control group). These findings suggest that the mobile-phone-based text messaging intervention (Happy Quit), with either high- or low-frequency messaging, was effective, and should be considered for large-scale use in China for intervention towards quitting smoking. Source:


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