Real-time Smoking Cessation Instant Messaging Support Using a Large Language Model (LLM)-Based Chatbot Via "Quit to Win" 2025 (QTW2025)
Building Capacity and Promoting Smoking Cessation in the Community Via "Quit to Win" Contest 2025: Real-time Smoking Cessation Instant Messaging Support Using a Large Language Model (LLM)-Based Chatbot
The goal of this trial is to learn if chatbot-based instant messaging works to help smoking cessation in general adult smokers. It will also learn about the experience, attitude, and perception of using an LLM-based chatbot. The main questions it aims to answer are:
- Will LLM-based chatbot smoking cessation intervention have a higher validated abstinence rate than the control group?
- Will LLM-based chatbot smoking cessation intervention have a higher self-reported abstinence rate, smoking reduction rate, and smoking cessation services use rate than the control group?
Researchers will compare LLM-based chatbot smoking cessation intervention to a usual care group (brief advice based on AWARD and personalized active referral) to see if chatbot-based instant messaging support works to promote smoking cessation.
Participants in the intervention group will receive:
- AWARD advice
- Personalized active referral
- 12 weeks of chatbot-based instant messaging support (via WhatsApp)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Although smoking prevalence is decreasing in Hong Kong (1982: 23.3%; 2023: 9.1%), it accounts for over 7,000 deaths per year and a large amount of medical cost, long-term care and productivity loss of US$ 688 million (0.6% Hong Kong GDP). Quitting is difficult because nicotine is highly addictive. Long-term habitual tobacco smoking could foster a series of physical and psychological dependence on nicotine, and thus induce cravings and nicotine withdrawal symptoms when remaining abstinent. Tradition "one-intervention-for-all" approach cannot work optimally for overall smoking population because of the individual differences in the background characteristic and variations in response to the intervention. Intervention approaches that account for personalization and variation should be explored.
Preliminary studies suggest that AI-based chatbots can deliver structured counseling to support tobacco cessation through personalised, empathetic, and authentic conversations, thus enhancing the effectiveness of smoking cessation interventions. When integrated into social media, AI chatbots can provide timely, targeted responses and connect users with a resources on widely used platforms. A 2023 meta-analysis involving 58,796 participants further highlighted the promise of chatbots for tobacco cessation (RR=1.29, 95%CI 1.13-1.46).
In late 2022, the release of ChatGPT revolutionized AI and large language models by offering unprecedented reasoning and conversational capabilities, which enables the development of more sophisticated, human-like chatbots. Although ChatGPT (and the GenAI in general) was trained as a general-purpose virtual assistant, its tasks-specific performance can be significantly enhanced through prompt engineering. Leveraging this approach, we developed an LLM-based chatbot to autonomously deliver smoking cessation support via WhatsApp according to established protocols. Our previous rule-based chatbot effectively prevented smoking relapse, and a pilot trial with an LLM-based chatbot for youth smokers (n=154) showed feasibility, achieving an 80.2% retention rate. These findings support the implementation of GenAI chatbots as promising tools for brief smoking cessation interventions in adult smokers.
Therefore, our study aims to test the effectiveness of a comprehensive intervention using brief cessation advice, personalized active referral, and chatbot-based instant messaging support compared with the control group on current smokers who join the Quit to Win Contest.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Hong Kong
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Hong Kong, Hong Kong, Hong Kong, 999077
- Hong Kong Council on Smoking and Health (COSH)
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Adult
- Older Adult
Accepts Healthy Volunteers
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
- Exhaled carbon monoxide level ≥4 part per million or a positive salivary cotinine test
- Intention to quit/reducing smoking
- Have instant messaging tool (WhatsApp) installed
- Able to use the instant messaging tool (e.g., WhatsApp) for communication
Exclusion Criteria:
- Smokers who have communication barriers (either physical or cognitive).
- Smokers who are currently participating in other smoking cessation programs or services.
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: Single
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Experimental: Intervention group
|
The contents include information about the benefits of quitting, smoking and diseases, methods to quit, how to handle withdrawal symptoms, declaration of quitting, etc.
AWARD advice include Ask about smoking history, Warn about the high risk, Advise to quit, Refer smokers to smoking cessation services (with a referral card), and Do it again.
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.
The contents consist of brief information and a highlight of existing smoking cessation services, contact methods, motivation information and strong supporting messages or slogans.
Smokers will be introduced to various SC services in Hong Kong (using the referral card) and be motivated to use these services.
Well-trained SC ambassadors will assist smoker to choose favourite/most convenient or preferred type of services.
Research staff will assist participants in booking or re-booking the SC services at the 1- and 2-month follow-ups (after very brief questionnaire surveys).
Participants' contact information will be forwarded to SC services providers within seven days, and providers are expected to contact the participants within 1-2 weeks.
Research staff will also monitor SC services use of the participants at each follow-up (1-, 2-, 3- and 6- month) and assist participants to book or re-book the appointments if necessary at 1- and 2- month follow-up.
We shall liaise with the existing service providers and seek their assistance in helping our smokers in helping our smokers in a timely manner.
Participants in the intervention group will receive 12 weeks of instant messaging support delivered by the LLM-based chatbot accessible via WhatsApp platform.
The chatbot, powered by GPT-4o model (or more advanced model available) using prompt-engineering and agent-based techniques, will deliver brief theory-based, structured SC intervention alongside freeform, on-demand support.
The structured intervention session deploys the 5As model (Ask, Advise, Assess, Assist, and Arrange follow-up) and 5Rs model (Relevance, Risks, Rewards, Roadblocks, Repetition), as used in our previous telephone-counselling trials and recommended by WHO for brief SC intervention.
WhatsApp messages on follow-up survey reminders.
|
|
Active Comparator: Control group
|
The contents include information about the benefits of quitting, smoking and diseases, methods to quit, how to handle withdrawal symptoms, declaration of quitting, etc.
AWARD advice include Ask about smoking history, Warn about the high risk, Advise to quit, Refer smokers to smoking cessation services (with a referral card), and Do it again.
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.
The contents consist of brief information and a highlight of existing smoking cessation services, contact methods, motivation information and strong supporting messages or slogans.
Smokers will be introduced to various SC services in Hong Kong (using the referral card) and be motivated to use these services.
Well-trained SC ambassadors will assist smoker to choose favourite/most convenient or preferred type of services.
Research staff will assist participants in booking or re-booking the SC services at the 1- and 2-month follow-ups (after very brief questionnaire surveys).
Participants' contact information will be forwarded to SC services providers within seven days, and providers are expected to contact the participants within 1-2 weeks.
Research staff will also monitor SC services use of the participants at each follow-up (1-, 2-, 3- and 6- month) and assist participants to book or re-book the appointments if necessary at 1- and 2- month follow-up.
We shall liaise with the existing service providers and seek their assistance in helping our smokers in helping our smokers in a timely manner.
WhatsApp messages on follow-up survey reminders.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Biochemically validated abstinence
Time Frame: 6-month follow-up
|
Defined as exhaled CO level <4ppm and saliva cotinine level ≤30 ng/ml
|
6-month follow-up
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Biochemically validated abstinence
Time Frame: 3-month follow-up
|
Defined as exhaled CO level <4ppm and saliva cotinine level ≤30 ng/ml
|
3-month follow-up
|
|
Self-reported 7-day point prevalence abstinence
Time Frame: 3- and 6-month follow-ups
|
Smokers who did not smoke even a puff in the 7 days preceding the follow-up
|
3- and 6-month follow-ups
|
|
Self-reported reduction
Time Frame: 1-, 2-, 3- and 6-month follow-ups
|
Defined by at least 50% reduction in baseline daily number of cigarettes
|
1-, 2-, 3- and 6-month follow-ups
|
|
Self-reported use of smoking cessation service
Time Frame: 1-, 2-, 3- and 6-month follow-ups
|
Use of smoking cessation service at 1-, 2-, 3- and 6-month follow-ups.
|
1-, 2-, 3- and 6-month follow-ups
|
Collaborators and Investigators
Sponsor
Investigators
- Principal Investigator: Man Ping Wang, PhD, The University of Hong Kong
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- QTW2025
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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