Building Capacity and Promoting Smoking Cessation in the Community Via "Quit to Win" Contest 2018

Building Capacity and Promoting Smoking Cessation in the Community Via "Quit to Win" Contest 2018: a Single-blind Cluster Randomized Controlled Trial on Brief Intervention (AWARD), Active Referral and Financial Incentive for Attending Smoking Cessation (SC) Service to Increase Abstinence

The present study will examine (1) the effectiveness of a combined intervention of face-to-face brief cessation advice (AWARD), active referral of SC service plus financial incentive on encouraging SC services use and (2) explore the use of CBPR model to build capacity and to engage community partners in taking on this important public health issue for sustainability in the community. In addition, a process evaluation will be conducted to assess the effectiveness of the recruitment activity and how it is linked with the overall program outcomes.

Study Overview

• Status: Completed
• Conditions: Smoking Cessation
• Intervention / Treatment: Behavioral: AWARD advice; Behavioral: Warning leaflet; Behavioral: Referral card; Behavioral: COSH booklet; Behavioral: Personalized active referral plus financial incentive

Detailed Description

Although smoking prevalence is decreasing in Hong Kong, there are still 615,000 daily cigarette smokers in Hong Kong in 2017 and half will be killed by smoking which accounts for over 7,000 deaths per year. Smoking also accounts for a large amount of medical cost, long-term care and productivity loss of US$688 million (0.6% Hong Kong GDP). Smoking is a highly addictive behavior and it is difficult for smokers with strong nicotine dependence to quit without assistance. On the other hand, reaching and helping the many smokers who have no intention to quit is a challenge, because they are unlikely to seek professional help from smoking cessation services.

The Quit and Win programme provides an opportunity to reach and encourage a large group of smokers to make quit attempt and maintain abstinence. The Quit and Win model posits that smokers participating in the contest will have higher motivation to quit with incentives and better social support. Studies have found that such quitting contests or incentive programs appeared to reach a large number of smokers and demonstrated a significantly higher quit rate for the quit and win group than for the control group.

SC services utilization rates are markedly low in Hong Kong. The latest Thematic Household Survey reported that only 3.3% daily smokers had ever used SC services. Among never-used smokers, only 3.1% of them were willing to try the SC services. The previous trial in QTW Contest 2016 depicts a similar pattern. Despite over three quarters of participants (77.0%) in the HAR group had chosen an SC service. Among them, only a small percentage (34.9%) actually used the SC service. Most smokers (65.1%) failed to attend the SC service under the HAR intervention. Consequently, better interventions are needed to extend the reach of SC services and smokers who had chosen an SC service but fail to attend.

The previous trial in QTW Contest 2013 showed a small cash incentive with early notifications increased quit attempt by self-directed help, but it did not increase abstinence and the use of formal cessation aids. Therefore, financial incentive-based SC programme focusing on promoting existing SC services use is warranted.

Therefore, the present study will examine (1) the effectiveness of a combined intervention of face-to-face brief cessation advice (AWARD), active referral of SC service plus financial incentive on encouraging SC services use and (2) explore the use of CBPR model to build capacity and to engage community partners in taking on this important public health issue for sustainability in the community. In addition, a process evaluation will be conducted to assess the effectiveness of the recruitment activity and how it is linked with the overall program outcomes.

• Study Type: Interventional
• Enrollment (Actual): 1093
• Phase: Not Applicable

Contacts and Locations

Study Locations

• China
  • Hong Kong
    • Hong Kong, Hong Kong, China, 852
      • Hong Kong Council on Smoking and Health (COSH)

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Hong Kong residents aged 18 or above
• Smoke at least 1 cigarette per day in the past 3 months
• Able to communicate in Cantonese (including reading Chinese)
• Exhaled carbon monoxide (CO) 4 ppm or above, assessed by a validated CO smokerlyzer
• Intent to quit / reduce smoking

Exclusion Criteria:

• Smokers who have difficulties (either physical or cognitive condition) to communicate
• Currently following other smoking cessation programs

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Group A; Personalized active referral plus financial incentive+ AWARD advice + referral card + warning leaflet+ COSH booklet	Behavioral: AWARD advice; Ask about smoking history, Warn about the high risk of smoking, Advise to quit as soon as possible, Refer to the smoking cessation services, and Do it again (if the smokers refused to set quit date).; Other Names: Ask, Warn, Advise, Refer, Do-it-again; Behavioral: Warning leaflet; The 2-sided color printed A4 leaflet, which systematically covers the most important messages to motivate smoking cessation; Other Names: Brief leaflet on health warning and smoking cessation; Behavioral: Referral card; The 3-folded "Smoking Cessation Services" card consists of brief information and highlights of existing smoking cessation services, contact methods, motivation information and strong supporting messages or slogans; Other Names: Smoking Cessation Service Card; Behavioral: COSH booklet; A general smoking cessation self-help booklet; Other Names: COSH self-help smoking cessation booklet; Behavioral: Personalized active referral plus financial incentive; Smokers will be introduced to various SC services in Hong Kong and be motivated to use the services.Written consents will be obtained from smokers who are ready to book the service onsite for transfer of their contact telephone numbers to their chosen service providers. Our research staff will transfer the information to the service providers within a week since the enrollment.Smokers are informed at baseline that they will receive financial incentive (supermarket coupon HK$300) if they attend or use any of the SC services within 3-month.
Experimental: Group B; AWARD advice + COSH booklet	Behavioral: AWARD advice; Ask about smoking history, Warn about the high risk of smoking, Advise to quit as soon as possible, Refer to the smoking cessation services, and Do it again (if the smokers refused to set quit date).; Other Names: Ask, Warn, Advise, Refer, Do-it-again; Behavioral: COSH booklet; A general smoking cessation self-help booklet; Other Names: COSH self-help smoking cessation booklet

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Biochemical validated quit rate	The primary outcomes are biochemically validated quit rates at 3-month in the two groups	3-month follow-up
Biochemical validated quit rate	The primary outcomes are biochemically validated quit rates at 6-month in the two groups	6-month follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Smoking quit rate change from baseline at 3-month follow-up	Self-reported 7-day point prevalence (pp) quit rate at 3-month between the two groups	3-month follow-up
Smoking quit rate change from baseline at 6-month follow-up	Self-reported 7-day point prevalence (pp) quit rate at 6-month between the two groups	6-month follow-up
Smoking reduction rate change from baseline at 3-month follow-up	Rate of smoking reduction by at least half of baseline amount in the two groups	3-month follow-up
Smoking reduction rate change from baseline at 6-month follow-up	Rate of smoking reduction by at least half of baseline amount in the two groups	6-month follow-up
Smoking quit attempt change from baseline at 3-month follow-up	Number of quit attempts at 3-month in the two groups	3-month follow-up
Smoking quit attempt change from baseline at 6-month follow-up	Number of quit attempts at 6-month in the two groups	6-month follow-up
Use of smoking cessation service	Use of smoking cessation at 3 and 6 month follow-up in the two groups	3 and 6 months follow-up
Quit rate for all subjects change from baseline at 3- and 6-month follow-up	the above cessation and reduction outcomes of all subjects participating in Quit to Win contest 2018	3 and 6 months follow-up
Reduction rate for all subjects change from baseline at 3- and 6-month follow-up	the above cessation and reduction outcomes of all subjects participating in Quit to Win contest 2018	3 and 6 months follow-up
Use of smoking cessation service for all subjects	Use of smoking cessation service for all subjects participating in Quit to Win contest 2018	3 and 6 months follow-up

Collaborators and Investigators

• Sponsor: The University of Hong Kong
• Collaborators: Hong Kong Council on Smoking and Health
• Investigators: Principal Investigator: Man Ping Kelvin Wang, PhD, The University of Hong Kong

Publications and helpful links

General Publications

• Weng X, Wu Y, Luk TT, Li WHC, Cheung DYT, Tong HSC, Lai V, Lam TH, Wang MP. Active referral plus a small financial incentive upon cessation services use on smoking abstinence: a community-based, cluster-randomised controlled trial. Lancet Reg Health West Pac. 2021 Jul 5;13:100189. doi: 10.1016/j.lanwpc.2021.100189. eCollection 2021 Aug.
• Weng X, Wang MP, Li HCW, Cheung YTD, Lau CY, Kwong ACS, Lai VWY, Chan SSC, Lam TH. Effects of active referral combined with a small financial incentive on smoking cessation: study protocol for a cluster randomised controlled trial. BMJ Open. 2020 Oct 26;10(10):e038351. doi: 10.1136/bmjopen-2020-038351.
• Luk TT, Weng X, Wu YS, Chan HL, Lau CY, Kwong AC, Lai VW, Lam TH, Wang MP. Association of heated tobacco product use with smoking cessation in Chinese cigarette smokers in Hong Kong: a prospective study. Tob Control. 2021 Nov;30(6):653-659. doi: 10.1136/tobaccocontrol-2020-055857. Epub 2020 Sep 10.

Study record dates

Study Major Dates

• Study Start (Actual): June 16, 2018
• Primary Completion (Actual): June 30, 2019
• Study Completion (Actual): June 30, 2020

Study Registration Dates

• First Submitted: June 11, 2018
• First Submitted That Met QC Criteria: June 11, 2018
• First Posted (Actual): June 21, 2018

Study Record Updates

• Last Update Posted (Actual): September 21, 2021
• Last Update Submitted That Met QC Criteria: September 20, 2021
• Last Verified: September 1, 2021

More Information

Terms related to this study

• Keywords: Smoking cessation; Brief intervention; Financial incentive; Quit to Win; AWARD model; Active referral
• Other Study ID Numbers: QTW 2018

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No