Mobile-based Positive Psychological Support for Smoking Cessation Via "Quit to Win" Contest 2021 (QTW 2021)

Building Capacity and Promoting Smoking Cessation in the Community Via "Quit to Win" Contest 2021: Mobile-based Positive Psychological Support on Smoking Cessation

This study aims to explore the effectiveness of a combined intervention using brief cessation advice and personalized chat-based positive psychological support compared with the control group on current smokers who join the Quit to Win Contest.

Study Overview

• Status: Recruiting
• Conditions: Smoking Cessation
• Intervention / Treatment: Behavioral: AWARD advice; Other: Brief leaflet on health warning and smoking cessation; Other: Referral card; Other: Self-help smoking cessation booklet; Behavioral: Positive psychological support through 3-people group chat using instant messaging apps; Behavioral: E-messages via SMS

Detailed Description

Smoking is a leading cause of many diseases and deaths globally. Although Hong Kong has a relatively low overall smoking rate of 10.2% (in 2019), health and economic burdens due to smoking are still substantial. The practice of smoking might predispose smokers to COVID-19 infection and poor prognosis. Growing evidence has also suggested that smokers are at higher risk of developing serious respiratory and cardiovascular symptoms in the COVID-19 pandemic than non-smokers. Smoking cessation in the post-COVID-19 era is the key priority to meet the HKSAR Government's target of reducing smoking prevalence to 7.8% by 2025.

Mental health problems are commonly comorbid with smoking and related problems. Our population-based survey amidst the COVID-19 pandemic found current smokers were at higher risk of suffering from anxious symptoms (adjusted OR 1.84 95% CI 1.27, 2.67), depressive symptoms (adjusted OR 2.04 95% CI 1.40, 2.96), and stress symptoms (adjusted β 0.54 95% CI 0.26, 0.82) compared with non-smokers. We also observed mental health burden increased during the COVID-19 pandemic with approximately doubling of the prevalence of anxious symptoms (15.8 vs. 9.3) and depressive symptoms (14.8 vs. 6.3) compared with the pre-COVID-19 pandemic (2017). Mental health can be both precursors and consequences of smoking. Previous studies have suggested that depressive symptoms and low positive affect during and after SC attempts are associated with poor cessation outcomes. This implies that a combined intervention of behavioral and psychological SC intervention is needed, particularly under the circumstance of worsening mental health problems.

Therefore, our study aims to test the effectiveness of a combined intervention using brief cessation advice and personalized chat-based positive psychological support compared with the control group on current smokers who join the Quit to Win Contest.

• Study Type: Interventional
• Enrollment (Anticipated): 1094
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Man Ping Wang, PhD; Phone Number: +852 3917 6636; Email: mpwang@hku.hk
• Study Contact Backup: Name: Ziqiu Guo, MMed; Phone Number: +852 3917 6605; Email: zqguo@hku.hk

Study Locations

• China
  • Hong Kong
    • Hong Kong, Hong Kong, China, 852
      • Recruiting
      • Hong Kong Council on Smoking and Health (COSH)
      • Contact: Fung Wong; Phone Number: +852 2180 5186
      • Principal Investigator: Man Ping Kelvin Wang, PhD
      • Sub-Investigator: Tai Hing Lam, MD, MSc
      • Sub-Investigator: Ho Cheung William Li, PhD
      • Sub-Investigator: Yee Tak Derek Cheung, PhD
      • Sub-Investigator: Xue Weng, PhD
      • Sub-Investigator: Ziqiu Guo, MMed
      • Sub-Investigator: Yuen Kwan Agnes Lai, PhD

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 tobacco stick (includes HTP) per day or use e-cigarette daily in the past 3-month
• Able to communicate in Chinese
• Saliva cotinine 30 ng/ml or above
• Intent to quit/reduce smoking
• Able to use the instant messaging tool (e.g., WhatsApp, WeChat) for communication

Exclusion Criteria:

• Smokers who have communication barrier (either physically or cognitively)
• Smokers who are currently participating in other SC programmes or services

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: Intervention group	Behavioral: AWARD advice; Ask about smoking history; Warn about the high risk; Advise to quit; Refer smokers to smoking cessation services (with a referral card); Do it again; Other: Brief leaflet on health warning and smoking cessation; The contents of the leaflet include (1) highlights of the absolute risk of death due to smoking; (2) the whole list of diseases caused by active and second-hand smoking; (3) ten horrible pictorial warnings of health consequences of smoking and second-hand smoking in one page to maximize the impacts; (4) benefits of SC and (5) simple messages to encourage participants to quit smoking and remind them to call the Department of Health SC hotline 183 3183.; Other: Referral card; The contents consist of brief information and highlights of existing SC services, contact methods, motivation information, and strong supporting messages or slogans.; Other: Self-help smoking cessation booklet; The contents include information about the benefits of quitting, smoking and diseases, methods to quit, how to handle withdrawal symptoms, declaration of quitting, etc.; Behavioral: Positive psychological support through 3-people group chat using instant messaging apps; Each IM chat group will consist of a trained SC counselor (HKU staff), a peer supporter (former smoker), and a participant (smoker). The 3-month group chat-based intervention will consist of regular messages and real-time support through group chat. Regular messages will generally include goal setting, health warnings, abstinence support, positive psychological exercises, and encouragement and will be delivered in a tapering style. During the real-time chatting, SC counsellors and peer supporters will provide real-time chat-based support, and peer supporters will share their quitting experience as appropriate.
Active Comparator: Control group	Behavioral: AWARD advice; Ask about smoking history; Warn about the high risk; Advise to quit; Refer smokers to smoking cessation services (with a referral card); Do it again; Other: Brief leaflet on health warning and smoking cessation; The contents of the leaflet include (1) highlights of the absolute risk of death due to smoking; (2) the whole list of diseases caused by active and second-hand smoking; (3) ten horrible pictorial warnings of health consequences of smoking and second-hand smoking in one page to maximize the impacts; (4) benefits of SC and (5) simple messages to encourage participants to quit smoking and remind them to call the Department of Health SC hotline 183 3183.; Other: Referral card; The contents consist of brief information and highlights of existing SC services, contact methods, motivation information, and strong supporting messages or slogans.; Other: Self-help smoking cessation booklet; The contents include information about the benefits of quitting, smoking and diseases, methods to quit, how to handle withdrawal symptoms, declaration of quitting, etc.; Behavioral: E-messages via SMS; Regular e-messages via SMS at twice per month within 3 months (total 6).

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Biochemically validated abstinence	Defined as exhaled CO level <4ppm and saliva cotinine level ≤30 ng/ml Note; If participants refuse to have a face-to-face exhaled carbon monoxide test due to the COVID-19 pandemic in Hong Kong. In that case, the outcome will only be validated by a saliva cotinine test device.; If participants use NRT, the outcome will be validated by exhaled carbon monoxide only.	6-month follow-up

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Biochemically validated abstinence	Defined as exhaled CO level <4ppm and saliva cotinine level ≤30 ng/ml Note; If participants refuse to have a face-to-face exhaled carbon monoxide test due to the COVID-19 pandemic in Hong Kong. In that case, the outcome will only be validated by a saliva cotinine test device.; If participants use NRT, the outcome will be validated by exhaled carbon monoxide only.	3-month follow-up
Self-reported 7-day point prevalence quit rate	Smokers who did not smoke even a puff in the 7 days preceding the follow-up	3-month follow-up
Self-reported 7-day point prevalence quit rate	Smokers who did not smoke even a puff in the 7 days preceding the follow-up	6-month follow-up
Self-reported reduction	Defined by at least 50% reduction in baseline daily number of cigarettes	3-month follow-up
Self-reported reduction	Defined by at least 50% reduction in baseline daily number of cigarettes	6-month follow-up
Self-reported depressive symptoms	Measured by Patient Health Questionnaire-2 (PHQ-2). PHQ-2 ranges from 0-6, a higher score indicates a severer depressive symptom.	3-month follow-up
Self-reported depressive symptoms	Measured by Patient Health Questionnaire-2 (PHQ-2). PHQ-2 ranges from 0-6, a higher score indicates a severer depressive symptom.	6-month follow-up
Self-reported anxious symptoms	Measured by Generalized Anxiety Disorder-2 (GAD-2). GAD-2 ranges from 0-6, a higher score indicates a severer anxious symptom.	6-month follow-up
Self-reported anxious symptoms	Measured by Generalized Anxiety Disorder-2 (GAD-2). GAD-2 ranges from 0-6, a higher score indicates a severer anxious symptom.	3-month follow-up
Self-reported use of smoking cessation service	Use of smoking cessation service at 3- and 6- month follow-up	3-month follow-up
Self-reported use of smoking cessation service	Use of smoking cessation service at 3- and 6- month follow-up	6-month follow-up
Self-rated health	Self-rated health will be measured as a single item with the response items "excellent", "very good", "good", "fair", or "poor".	3-month follow-up
Self-rated health	Self-rated health will be measured as a single item with the response items "excellent", "very good", "good", "fair", or "poor".	6-month follow-up
Self-reported happiness	A single item will measure self-reported happiness with an answer on an 11-point scale (0-10). A higher score indicates a higher level of happiness.	3-month follow-up
Self-reported happiness	A single item will measure self-reported happiness with an answer on an 11-point scale (0-10). A higher score indicates a higher level of happiness.	6-month follow-up
Self-reported quit attempts	Number of quit attempts from baseline at 3-month follow-up	3-month follow-up
Self-reported quit attempts	Number of quit attempts from baseline at 6-month follow-up	6-month follow-up
Self-reported resilience	A single item will measure self-reported resilience with an answer on an 11-point scale (0-10). A higher score indicates a higher level of resilience.	3-month follow-up
Self-reported resilience	A single item will measure self-reported resilience with an answer on an 11-point scale (0-10). A higher score indicates a higher level of resilience.	6-month follow-up
Self-reported optimistic	A single item will measure self-reported optimistic with an answer on an 11-point scale (0-10). A higher score indicates a higher level of optimistic.	3-month follow-up
Self-reported optimistic	A single item will measure self-reported optimistic with an answer on an 11-point scale (0-10). A higher score indicates a higher level of optimistic.	6-month follow-up
Self-reported loneliness	A single item will measure self-reported loneliness with an answer on an 11-point scale (0-10). A higher score indicates a higher level of loneliness.	3-month follow-up
Self-reported loneliness	A single item will measure self-reported loneliness with an answer on an 11-point scale (0-10). A higher score indicates a higher level of loneliness.	6-month follow-up
Self-reported stress	A single item will measure self-reported stress with an answer on an 11-point scale (0-10). A higher score indicates a higher level of stress.	6-month follow-up
Self-reported stress	A single item will measure self-reported stress with an answer on an 11-point scale (0-10). A higher score indicates a higher level of stress.	3-month follow-up
Self-reported social support	A single item will measure self-reported social support with an answer on an 11-point scale (0-10). A higher score indicates a higher level of social support.	3-month follow-up
Self-reported social support	A single item will measure self-reported social support with an answer on an 11-point scale (0-10). A higher score indicates a higher level of social support.	6-month follow-up
Self-reported positive affect	The subscale of the Chinese version International Positive and Negative Affect Schedule Short Form (I-PANAS-SF) will measure self-reported positive affect. The I-PANAS-SF uses a 5-point scale, a higher score indicates a higher level of self-reported positive affect.	3-month follow-up
Self-reported positive affect	The subscale of the Chinese version International Positive and Negative Affect Schedule Short Form (I-PANAS-SF) will measure self-reported positive affect. The I-PANAS-SF uses a 5-point scale, a higher score indicates a higher level of self-reported positive affect.	6-month follow-up
Self-reported negative affect	The subscale of the Chinese version International Positive and Negative Affect Schedule Short Form (I-PANAS-SF) will measure self-reported negative affect. The I-PANAS-SF uses a 5-point scale, a higher score indicates a higher level of self-reported negative affect.	6-month follow-up
Self-reported negative affect	The subscale of the Chinese version International Positive and Negative Affect Schedule Short Form (I-PANAS-SF) will measure self-reported negative affect. The I-PANAS-SF uses a 5-point scale, a higher score indicates a higher level of self-reported negative affect.	3-month follow-up

Collaborators and Investigators

• Sponsor: The University of Hong Kong
• Collaborators: Hong Kong Council on Smoking and Health

Study record dates

Study Major Dates

• Study Start (Actual): June 12, 2021
• Primary Completion (Actual): June 30, 2022
• Study Completion (Anticipated): June 30, 2023

Study Registration Dates

• First Submitted: May 26, 2021
• First Submitted That Met QC Criteria: May 26, 2021
• First Posted (Actual): June 1, 2021

Study Record Updates

• Last Update Posted (Actual): August 17, 2022
• Last Update Submitted That Met QC Criteria: August 14, 2022
• Last Verified: August 1, 2022

More Information

Terms related to this study

• Keywords: mobile health; smoking cessation; positive psychological support; peer supporter
• Other Study ID Numbers: QTW 2021

Plan for Individual participant data (IPD)

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

Drug and device information, study documents

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