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Intervention Review

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Mobile phone-based interventions for smoking cessation

  1. Robyn Whittaker1,*,
  2. Hayden McRobbie2,
  3. Chris Bullen1,
  4. Ron Borland3,
  5. Anthony Rodgers4,
  6. Yulong Gu1

Editorial Group: Cochrane Tobacco Addiction Group

Published Online: 14 NOV 2012

Assessed as up-to-date: 29 SEP 2012

DOI: 10.1002/14651858.CD006611.pub3


How to Cite

Whittaker R, McRobbie H, Bullen C, Borland R, Rodgers A, Gu Y. Mobile phone-based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD006611. DOI: 10.1002/14651858.CD006611.pub3.

Author Information

  1. 1

    University of Auckland, National Institute for Health Innovation, Auckland, New Zealand

  2. 2

    Barts & The London School of Medicine and Dentistry, Queen Mary University of London, Wolfson Institute of Preventive Medicine, London, UK

  3. 3

    The Cancer Council Victoria, VicHealth Centre for Tobacco Control, Carlton, Vic 3053, Australia

  4. 4

    Clinical Trials Research Unit (CTRU), Department of Medicine, University of Auckland, Auckland, New Zealand

*Robyn Whittaker, National Institute for Health Innovation, University of Auckland, Tamaki Campus, Private Bag 92019, Auckland, 1142, New Zealand. r.whittaker@nihi.auckland.ac.nz.

Publication History

  1. Publication Status: New search for studies and content updated (conclusions changed)
  2. Published Online: 14 NOV 2012

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This is not the most recent version of the article. View current version (10 APR 2016)

 
Characteristics of included studies [ordered by study ID]
Borland 2012

MethodsCountry: Australia


Participants3530 participants in total (control = 422; onQ = 756; QuitCoach = 809; Both = 785; Participant Choice = 758): 60% female; mean age 42.1; 87.4% were currently smoking; participants smoked an average of 16.9 cigarettes per day


InterventionsThe onQ program provides a stream of SMS messages to the person that mixes snippets of advice on strategy and motivational messages. The user can interact with it by indicating their stage of quitting so that appropriate stage-specific messages are sent, and once quit can also call up messages in crisis situations.

QuitCoach is a personalised, automated tailored cessation program delivered via the Internet. It generates letters of advice based on answers to an assessment questionnaire, including suggestions about strategy and motivational messages. It also provides further untailored supplementary resources.

Control: brief information on web- and phone-based assistance available in Australia


OutcomesSelf-reported 6-month sustained abstinence at 7-month follow-up

Intention to quit analysis and sensitivity analysis around treatment of missing data


NotesData from author, not yet published. Only onQ and control arms used in analysis.


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskComputerised random number generator embedded within the baseline survey

Allocation concealment (selection bias)Low riskThis was not a typical RCT as participants were enrolled in a study described to them as being about “the effectiveness of Internet and telephone-based resources in helping smokers quit”, and were only then randomised to a condition which they were offered with no obligation to use.

Blinding (performance bias and detection bias)
All outcomes
Low riskThis was not a typical RCT as participants were enrolled in a study described to them as being about “the effectiveness of Internet and telephone-based resources in helping smokers quit”, and were only then randomised to a condition which they were offered with no obligation to use.

Incomplete outcome data (attrition bias)
All outcomes
Low riskLoss to follow up 475 (13% total) with similar numbers across groups (in control 66, in onQ 89, in QuitCoach 104, in Integrated 121, in Choice 95); 2 excluded as reported to have died at 7 month follow-up

Free 2009

MethodsCountry: UK


Participants200 participants 16yrs and over; smoking daily and interested in quitting; current owner of mobile phone.
Characteristics: 63% male; median age 36yrs; median 20 cigarettes/day; 7% FTND dependence score > 5.


InterventionsSix month programme delivered solely over mobile phone based on programme in Rodgers 2005 but messages adapted for UK population. Participant nominates Quit Date (QD) and receives regular personalised text messages with advice, support and distraction, with a countdown to QD, intensive 4wks of 5 to 6 messages/day then maintenance phase of 1 message/2wks. Messages selected from database matched to participant characteristics. Free month of text messaging from QD. Optional Quit Buddy, and Text Crave (messages on demand). Interactive polls and quizzes.
Control: 1 text message/fortnight


OutcomesPrimary: point prevalence abstinence (no smoking in past 7 days) at 6wks post randomization (approximates 4wks post-QD).
Secondary: point prevalence abstinence and continuous abstinence (<5 cigarettes) at 26 wks. Verification with salivary cotinine in quitters at 26wks.
Intention-to-treat analysis


NotesPilot study - full trial is Free 2011


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskCentral computerised randomization

Allocation concealment (selection bias)Low riskConcealed until after assignment

Blinding (performance bias and detection bias)
All outcomes
Low riskSingle blind (participants not blinded)

Incomplete outcome data (attrition bias)
All outcomes
Low riskLost to follow-up: 4 (control) and 1 (intervention) at 4wks (98% follow-up); 8 (control) and 8 (intervention) at 6 months (92% follow-up).

Free 2011

MethodsCountry: United Kingdom


Participants5800 participants 16yrs and over, willing to make an attempt to quit smoking in the next month and own a mobile phone; 45% are female; mean age is 37; 89% are white; 25% are student/unemployed; 60% have a FTND dependence score of <= 5


InterventionsSix-month programme delivered solely over mobile phone based on programme in Rodgers 2005. Participants in the intervention group were asked to set a quit date within 2 weeks of randomisation. They received five text messages a day for the first 5 weeks and then three a week for the next 26 weeks. The intervention included motivational messages and behaviour-change techniques. The programme was also personalised with an algorithm based on demographic and other information gathered at baseline, such as smokers' concerns about weight gain after quitting. The core programme consisted of 186 messages and the personalised messages were selected from a database of 713 messages. For instance, by texting the word “lapse”, participants would receive a series of three text messages that encouraged them to continue with their quit attempt. Participants could also request the mobile phone number of another trial participant so that they could text each other for support. Participants in the intervention group using pay-as-you-go mobile phone schemes were given a £20 top-up voucher to provide sufficient credit to participate in the intervention.

Control: fortnightly, simple, short, text messages related to the importance of trial participation


OutcomesNo more than 5 cigarettes smoked since the start of the abstinence period at 6 months of follow-up, self reported and verified by postal salivary cotinine testing or a carbon monoxide test in person.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskAn independent telephone randomisation system

Allocation concealment (selection bias)Low riskConcealed until after assignment

Blinding (performance bias and detection bias)
All outcomes
Low riskSingle blind (participants not blinded)

Incomplete outcome data (attrition bias)
All outcomes
Low risk176 intervention and 92 control lost to follow-up (less than 5% total)

Rodgers 2005

MethodsCountry: New Zealand


Participants1705 participants 16yrs and over; smoking daily; want to quit within next month; able to send & receive text messages on own mobile phone.
Characteristics: 58% female; median age 22yrs; 20.8% indigenous NZ (Maori); 3.5% Pacific Islanders; average 15 cigarettes/day; mean FTND dependence score = 5.


InterventionsSix month programme delivered solely over mobile phone. Participant nominates Quit Date (QD) and receives regular personalised text messages with advice, support and distraction, with a countdown to QD, intensive 4wks of 5 to 6 messages/day then maintenance phase of 1 message/2wks. Messages selected from database matched to participant characteristics. Free month of text messaging from QD. Optional Quit Buddy, and Text Crave (messages on demand). Interactive polls and quizzes.
Control: 1 text message/fortnight


OutcomesPrimary: point prevalence abstinence (no smoking in past 7 days) at 6wks post-randomization (approximates 4wks post-QD). Verification with salivary cotinine in small number of quitters at 6wks.
Secondary: point prevalence abstinence at 12wks and 26wks, and continuous abstinence at 26wks.
Intention-to-treat analysis.


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskCentral computerised randomization

Allocation concealment (selection bias)Low riskConcealed until after assignment

Blinding (performance bias and detection bias)
All outcomes
Low riskSingle blind (participants not blinded)

Incomplete outcome data (attrition bias)
All outcomes
High riskLost to follow-up: 35 control (95.9%) and 46 intervention (94.6%) followed up at 6wks; but differential loss to follow-up at 6m (79% control vs 69% intervention). Possibly due to incentive being offered to control group for follow-up, may in turn have affected long-term results of study (by underestimating effect).

Other biasHigh riskThe authors suggest that some participants in the control group may have thought their incentive at follow-up (month of free text messaging) depended on reporting quitting. This could account for an unexpected increase in control group participants reporting quitting from six weeks (109 participants) to six months (202 participants reporting no smoking in the past seven days), which could have led to an underestimation of the effect of the intervention.

Whittaker 2011

MethodsCountry: New Zealand


Participants226 participants 16yrs and over; current daily smokers ready to quit, have a video message-capable phone; 47% female; 24% Maori; mean age = 27; highly addicted cohort due to Hooked on Nicotine Checklist mean scores of 8 (SD 1.9) out of 10


InterventionsThe intervention group received an automated package of video and text messages over 6 months that was tailored to self-selected quit date, role model, and timing of messages. Video messages were video diary-style from a selected 'ordinary' person going through a quit attempt in advance of the participant. Frequency of messages varied from 1/day in the lead up to Quit Day (QD), 2/day from QD for 4 weeks, then reducing to 1 every 2 days for 2 weeks and then 1 every 4 days for about 20 weeks until 6 months after randomization. Extra messages were available on demand to beat cravings and address lapses. Additional website for intervention group participants to review video messages they had been sent (and rate them if desired), change their selected time periods, and change (or add to) their selected role model. 

Control: also set a quit date and received a general health video message sent to their phone every 2 weeks.


OutcomesSelf-reported continuous abstinence - no more than 5 cigarettes smoked since the start of the abstinence period at 6 months of follow-up


Notes


Risk of bias

BiasAuthors' judgementSupport for judgement

Random sequence generation (selection bias)Low riskCentral computerised randomisation

Allocation concealment (selection bias)Low riskConcealed until after assignment

Blinding (performance bias and detection bias)
All outcomes
Low riskSingle blind (participants not blinded)

Incomplete outcome data (attrition bias)
All outcomes
Low risk32% intervention and 22% control lost to follow-up at 6m

 
Characteristics of excluded studies [ordered by study ID]

StudyReason for exclusion

Applegate 2007Abstract describing intervention to increase adherence to the use of nicotine replacement gum in people attempting to quit smoking. Duration 8 weeks.

Bennett 2011Editorial comment on the Free 2011 trial

Brendryen 2008aMobile phone intervention confounded with internet intervention (previously included in Whittaker 2009)

Brendryen 2008bMobile phone intervention confounded with internet intervention (previously included in Whittaker 2009)

Gritz 20113 month follow-up only

Haug 2008Non-randomized feasibility study. Duration 12 weeks

Haug 2009Mainly about acceptability, 3 month follow-up

Kiselev 2011Not focused on smoking cessation

Lazev 2004Not randomized. No control group. Feasibility study for the programme presented in Vidrine 2006.

Naughton 2011Randomized controlled trial with pregnant smokers, follow-up to 3 months

Obermayer 2004Not randomized. No control group.

Riley 2008Small non-randomized study with only 6 weeks follow-up

Snider 2011Not a trial

Vidrine 2006Randomised trial of phone counselling with mobile phones, follow-up only 3 months

Wizner 2009Not focused on smoking cessation

Ybarra 2012aPilot randomised controlled trial, follow-up only 3 months

Ybarra 2012bPilot randomised controlled trial, follow-up only 3 months

Yuhongxia 2011Single-blind randomised control trial, follow-up 24 weeks, but with no details available on the randomisation method or the intervention content. Abstract only, unable to contact authors.

 
Characteristics of ongoing studies [ordered by study ID]
Abroms 2012

Trial name or titleText2Quit

MethodsRandomised controlled trial

ParticipantsApproximately 500 participants in the U.S.

InterventionsAutomated bidirectional text messages, personalisation and interactive components, automated unidrectional emails and a web portal - has been revised since pilot study

OutcomesSix month abstinence

Starting date2011

Contact informationDr Lorien Abroms, George Washington University, Washington DC, USA, lorien@gwu.edu

Notes3 month follow-up published (Abroms 2012), awaiting longer term results.

Ferguson 2012

Trial name or title

MethodsWithin an EMA (ecological momentary assessment) study

ParticipantsCommunity sample of smokers in Australia

InterventionsText message intervention generated by the handheld computer rather than being send over the cell phone network

OutcomesMechanism of action, biochemically verified abstinence at 6 months

Starting date2012

Contact informationStuart Ferguson, University of Tasmania, Australia, Stuart.Ferguson@utas.edu.au

Notes

Gram 2011

Trial name or titleInternet and text messaging intervention in Norway

Methods

Participants

InterventionsInternet based smoking cessation versus internet plus text messaging

Outcomes

Starting date2011

Contact informationProfessor Gram, Faculty of Health Sciences, Institute of Community Medicine, University of Tromsø, Norway, inger.gram@uit.no

Notes

Haug 2012

Trial name or title

MethodsRandomised controlled trial

Participants910 daily or occasional smokers recruited at vocational schools in Switzerland

InterventionsA weekly SMS assessment of smoking related behaviour, two tailored text messages per week, and an optional further integrated quit day preparation and relapse prevention SMS programme

Outcomes7 day point prevalence at 6 months

Starting date2011

Contact informationSeverin Haug, University of Greifswald, Germany, severin.haug@isgf.uzh.ch

Notes

iQUIT in Practice

Trial name or titleIQUIT in Practice, UKCRN 6086

MethodsRandomized efficacy study

Participants600 smokers, recruited in primary care setting in the United Kingdom

InterventionsIntervention participants will receive ‘usual care’ for smoking cessation (level 2) PLUS a printed tailored advice report generated by web-based software, followed by a 90-day program of tailored SMS text messages.

OutcomesCessation at 4 weeks, 8 weeks & 6 months

Starting date2011

Contact informationFelix Naughton, University of Cambridge, UK, Fmen2@medschl.cam.ac.uk

NotesISRCTN 56702353

NCT00502827

Trial name or titleSmoking Cessation for HIV/AIDS Patients: An Innovative Telephone Intervention for HIV-Positive Smokers (NCT00502827)

MethodsRandomised controlled trial

Participants500 HIV positive participants in Texas, USA

Interventions3 month programme of 11 proactive counselling calls

OutcomesFollow up to 52wks

Starting date2004

Contact informationDamon Vidrine, MD Anderson Cancer Centre, dvidrine@mdanderson.org

NotesExpanded programme based on Vidrine 2006. 3 month data published (Chow 2012), awaiting availability of longer term results.

NCT01454999

Trial name or titleCell Phone-Based Expert Systems for Smoking Cessation (TXT)

MethodsRandomized open efficacy study

ParticipantsVeteran population

InterventionsWeb-based computerized, tailored intervention (CTI) for smoking cessation, based on the transtheoretical model of change. Tailored feedback messages based on stage of change will also be sent by cell phone.

Comparison is Web-based tailored intervention without text messages

OutcomesSmoking cessation (self-reported 7 day point prevalence) at 3 months. Stage of change.

Starting dateSeptember 2009

Contact informationPatricia Jordan patricia.jordan@pacifichui.org, Viil Lid viil.lid@va.gov

NotesEstimated completion February 2012

 
Comparison 1. Mobile phone intervention v. control

Outcome or subgroup titleNo. of studiesNo. of participantsStatistical methodEffect size

 1 26wk continuous abstinence59100Risk Ratio (M-H, Fixed, 95% CI)1.71 [1.47, 1.99]