SMS Turkey: Harnessing the Power of Text Messaging to Promote Smoking Cessation (SMS Turkey)

SMS Turkey: Harnessing the Power of TXT Messaging to Promote Smoking Cessation

The purpose of this study is to develop and test a text messaging-based smoking cessation program for adults who are currently smoking and want to quit, living in Turkey.

Study Overview

• Status: Completed
• Conditions: Smoking
• Intervention / Treatment: Behavioral: SMS Turkey

Detailed Description

Smoking has long been recognized as a significant public health concern associated with great morbidity and mortality. Although smoking rates have decreased in high income countries, these trends have not been noted for tow and middle income countries. This is especially true in Turkey, which was ranked 6th in the world in smoking consumption. Between 51-63% of Turkish men and 24-26% of Turkish women 15 years of age and older are smokers. With lung cancer the leading cancer-related cause of death for both men and women, effective and accessible smoking cessation interventions are needed. Cell phone technology represents a unique opportunity to deliver evidenced-based smoking cessation behavioral treatments through a delivery mechanism already widely adopted by adults. An estimated 35 million Turks were using cell phones, making them 1.8 times more common than land lines. Cell phone interventions are a unique delivery method because of their 'always on' capability. The rapid uptake of cell phones allows us to potentially reach those who might otherwise not utilize smoking cessation services.

We designed and evaluated SMS Turkey, an evidenced-based smoking intervention that takes advantage of technologies adopted by adult smokers in Turkey. The primary outcome measure is sustained abstinence 12 weeks after quit day, confirmed with a carbon monoxide (CO) reading of 8 ppm or less. Sustained abstinence was defined as 5 or fewer cigarettes smoked since the quit date, per West et al. Secondary outcome measures included: 7-day and 30-day point prevalence of smoking behavior at 3 months; CO-verified 7-day point prevalence at 4 weeks; and reduction in cigarettes per day for those who are smoking at 3 months.

• Study Type: Interventional
• Enrollment (Actual): 151
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey
  • Ankara, Turkey
    • Hacettepe University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• 18 years of age or older
• Currently smoking every day
• Owning a TXT-capable cell phone
• Sent or received TXT messages at least once in the past year
• Living in Ankara (to ease technology support if necessary)
• Agreement to set quit day in 15 days from enrollment date
• Agreement to verification of smoking cessation using a carbon monoxide breath monitor

Exclusion Criteria:

• No chronic disease.

Study Plan

How is the study designed?

Design Details

• Allocation: RANDOMIZED
• Interventional Model: PARALLEL
• Masking: NONE

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: SMS Turkey; 6-week smoking cessation program delivered via daily text messages	Behavioral: SMS Turkey; 6-week smoking cessation program delivered via daily text messages SMS Turkey: 6-week smoking cessation program delivered via text messaging. SMS Turkey content is guided by the Cognitive Behavioral Therapy (CBT) theory. Content was tailored based on participant's stage in quitting (i.e., pre-quit, quit day, early-quit, late-quit, relapse). Based on the typical relapse trajectory, content paths were created for participants based on whether or not they were smoking 2 days after quit day; and again at 7 days after quit day. Depending on the participant's content path, the total number of messages received ranged from 91 (for those assigned to the encouragement arm) to 146 (for those who relapsed and then were assigned to the late quit messages).; Other Names: Cebiniz birakin diyor
No Intervention: Brochure control; 7-page brochure that provided general information and tips on how to quit smoking

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Carbon Monoxide-verified Continuous Abstinence at 12 Weeks	self-reported continuous abstinence since quit day (<=5 cigarettes) verified with carbon monoxide reading (<=8ppm)	12-weeks post-quit day

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
CO-verified 7-day Point Prevalence Abstinence at 4 Weeks	self-reported continuous abstinence in the past 7 days at 4 weeks (<=5 cigarettes) verified with carbon monoxide reading (<=8ppm)	4 weeks
Self-reported 7-day Point Prevalence Abstinence at 12 Weeks	self-reported smoking abstinence in the past 7 days at 12 weeks (<=5 cigarettes)	12 weeks
Self-reported 30-day Point Prevalence Abstinence at 12 Weeks	self-reported smoking abstinence in the past 30 days at 12 weeks (<=5 cigarettes)	12 weeks

Collaborators and Investigators

• Sponsor: Center for Innovative Public Health Research
• Collaborators: Hacettepe University; Fogarty International Center of the National Institute of Health

Publications and helpful links

General Publications

• Ybarra ML, Bagci Bosi AT, Bilir N, Holtrop JS, Korchmaros J, Emri S. Interest in technology-based and traditional smoking cessation programs among adult smokers in Ankara, Turkey. Tob Induc Dis. 2011 Aug 1;9(1):10. doi: 10.1186/1617-9625-9-10.
• Ybarra ML, Holtrop JS, Bagci Bosi AT, Emri S. Design considerations in developing a text messaging program aimed at smoking cessation. J Med Internet Res. 2012 Jul 24;14(4):e103. doi: 10.2196/jmir.2061.
• Ybarra M, Bagci Bosi AT, Korchmaros J, Emri S. A text messaging-based smoking cessation program for adult smokers: randomized controlled trial. J Med Internet Res. 2012 Dec 27;14(6):e172. doi: 10.2196/jmir.2231. Erratum In: J Med Internet Res. 2015;17(6):e125.
• Ybarra ML, Holtrop JS, Bagci Bosi AT, Bilir N, Korchmaros JD, Salih Emri AK. Feasibility and acceptability of a text messaging-based smoking cessation program in ankara, Turkey. J Health Commun. 2013 Aug;18(8):960-73. doi: 10.1080/10810730.2012.757399. Epub 2013 Apr 29.

Helpful Links

• SMS Turkey study documents and publications

Study record dates

Study Major Dates

• Study Start: December 1, 2010
• Primary Completion (Actual): September 1, 2011
• Study Completion (Actual): September 1, 2011

Study Registration Dates

• First Submitted: May 19, 2009
• First Submitted That Met QC Criteria: May 31, 2009
• First Posted (Estimate): June 3, 2009

Study Record Updates

• Last Update Posted (Estimate): October 5, 2016
• Last Update Submitted That Met QC Criteria: August 11, 2016
• Last Verified: August 1, 2016

More Information

Terms related to this study

• Keywords: Smoking Cessation; technology; developing countries
• Other Study ID Numbers: ISK-NIH-FIC7918; 5R01TW007918 (U.S. NIH Grant/Contract)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO