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Efficacy of a text messaging (SMS) based smoking cessation intervention for young people: A cluster randomised controlled trial


Haug, Severin; Schaub, Michael P; Venzin, Vigeli; Meyer, Christian; John, Ulrich (2013). Efficacy of a text messaging (SMS) based smoking cessation intervention for young people: A cluster randomised controlled trial. Journal of Medical Internet Research, 15(8):e171.

Abstract

Background: Smoking prevalence remains high, particularly among adolescents and young adults with lower educational levels, posing a serious public health problem. There is limited evidence of effective smoking cessation interventions in this population.
Objective: To test the efficacy of an individually tailored, fully automated text messaging (short message service, SMS)–based intervention for smoking cessation in young people.
Methods: A 2-arm cluster randomized controlled trial, using school class as the randomization unit, was conducted to test the efficacy of the SMS text messaging intervention compared to an assessment-only control group. Students who smoked were proactively recruited via online screening in vocational school classes. Text messages, tailored to demographic and smoking-related variables, were sent to the participants of the intervention group at least 3 times per week over a period of 3 months. A follow-up assessment was performed 6 months after study inclusion. The primary outcome measure was 7-day smoking abstinence. Secondary outcomes were 4-week smoking abstinence, cigarette consumption, stage of change, and attempts to quit smoking. We used regression models controlling for baseline differences between the study groups to test the efficacy of the intervention. Both complete-case analyses (CCA) and intention-to-treat analyses (ITT) were performed. Subgroup analyses were conducted for occasional and daily smokers.
Results: A total of 2638 students in 178 vocational school classes in Switzerland participated in the online screening. Overall, 1012 persons met the inclusion criteria for study participation, and 755 persons (74.6%) participated in the study (intervention: n=372; control: n=383). Of the 372 program participants, 9 (2.4%) unsubscribed from the program during the intervention period. Six-month follow-up data were obtained for 559 study participants (74.0%). The 7-day smoking abstinence rate at follow-up was 12.5% in the intervention group and 9.6% in the control group (ITT: P=.92). No differences between the study groups were observed in 4-week point prevalence abstinence rates. The decrease in the mean number of cigarettes smoked per day from baseline to follow-up was higher in the intervention group than in the control group (ITT: P=.002). No differences between the groups were observed in stage of change (ITT: P=.82) and quit attempts (ITT: P=.38). The subgroup analyses revealed lower cigarette consumption in both occasional and daily smokers in the intervention group compared to the control group. Occasional smokers in the intervention group made more attempts to quit smoking than occasional smokers in the control group.
Conclusions: This study demonstrated the potential of an SMS text message–based intervention to reach a high proportion of young smokers with low education levels. The intervention did not have statistically significant short-term effects on smoking cessation; however, it resulted in statistically significant lower cigarette consumption. Additionally, it resulted in statistically significant more attempts to quit smoking in occasional smokers.

Abstract

Background: Smoking prevalence remains high, particularly among adolescents and young adults with lower educational levels, posing a serious public health problem. There is limited evidence of effective smoking cessation interventions in this population.
Objective: To test the efficacy of an individually tailored, fully automated text messaging (short message service, SMS)–based intervention for smoking cessation in young people.
Methods: A 2-arm cluster randomized controlled trial, using school class as the randomization unit, was conducted to test the efficacy of the SMS text messaging intervention compared to an assessment-only control group. Students who smoked were proactively recruited via online screening in vocational school classes. Text messages, tailored to demographic and smoking-related variables, were sent to the participants of the intervention group at least 3 times per week over a period of 3 months. A follow-up assessment was performed 6 months after study inclusion. The primary outcome measure was 7-day smoking abstinence. Secondary outcomes were 4-week smoking abstinence, cigarette consumption, stage of change, and attempts to quit smoking. We used regression models controlling for baseline differences between the study groups to test the efficacy of the intervention. Both complete-case analyses (CCA) and intention-to-treat analyses (ITT) were performed. Subgroup analyses were conducted for occasional and daily smokers.
Results: A total of 2638 students in 178 vocational school classes in Switzerland participated in the online screening. Overall, 1012 persons met the inclusion criteria for study participation, and 755 persons (74.6%) participated in the study (intervention: n=372; control: n=383). Of the 372 program participants, 9 (2.4%) unsubscribed from the program during the intervention period. Six-month follow-up data were obtained for 559 study participants (74.0%). The 7-day smoking abstinence rate at follow-up was 12.5% in the intervention group and 9.6% in the control group (ITT: P=.92). No differences between the study groups were observed in 4-week point prevalence abstinence rates. The decrease in the mean number of cigarettes smoked per day from baseline to follow-up was higher in the intervention group than in the control group (ITT: P=.002). No differences between the groups were observed in stage of change (ITT: P=.82) and quit attempts (ITT: P=.38). The subgroup analyses revealed lower cigarette consumption in both occasional and daily smokers in the intervention group compared to the control group. Occasional smokers in the intervention group made more attempts to quit smoking than occasional smokers in the control group.
Conclusions: This study demonstrated the potential of an SMS text message–based intervention to reach a high proportion of young smokers with low education levels. The intervention did not have statistically significant short-term effects on smoking cessation; however, it resulted in statistically significant lower cigarette consumption. Additionally, it resulted in statistically significant more attempts to quit smoking in occasional smokers.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Swiss Research Institute for Public Health and Addiction
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:2013
Deposited On:03 Nov 2013 13:12
Last Modified:07 Dec 2017 23:14
Publisher:Gunther Eysenbach
ISSN:1438-8871
Free access at:PubMed ID. An embargo period may apply.
Publisher DOI:https://doi.org/10.2196/jmir.2636
PubMed ID:23956024

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