Mobile phone-based interventions for smoking cessation

Robyn Whittaker, Hayden McRobbie, Chris Bullen, Anthony Rodgers, Yulong Gu, Robyn Whittaker, Hayden McRobbie, Chris Bullen, Anthony Rodgers, Yulong Gu

Abstract

Background: Access to mobile phones continues to increase exponentially globally, outstripping access to fixed telephone lines, fixed computers and the Internet. Mobile phones are an appropriate and effective option for the delivery of smoking cessation support in some contexts. This review updates the evidence on the effectiveness of mobile phone-based smoking cessation interventions.

Objectives: To determine whether mobile phone-based smoking cessation interventions increase smoking cessation in people who smoke and want to quit.

Search methods: For the most recent update, we searched the Cochrane Tobacco Addiction Group Specialised Register in April 2015. We also searched the UK Clinical Research Network Portfolio for current projects in the UK, and the ClinicalTrials.gov register for ongoing or recently completed studies. We searched through the reference lists of identified studies and attempted to contact the authors of ongoing studies. We applied no restrictions on language or publication date.

Selection criteria: We included randomised or quasi-randomised trials. Participants were smokers of any age who wanted to quit. Studies were those examining any type of mobile phone-based intervention for smoking cessation. This included any intervention aimed at mobile phone users, based around delivery via mobile phone, and using any functions or applications that can be used or sent via a mobile phone.

Data collection and analysis: Review authors extracted information on risk of bias and methodological details using a standardised form. We considered participants who dropped out of the trials or were lost to follow-up to be smoking. We calculated risk ratios (RR) and 95% confidence intervals (CI) for each included study. Meta-analysis of the included studies used the Mantel-Haenszel fixed-effect method. Where meta-analysis was not possible, we presented a narrative summary and descriptive statistics.

Main results: This updated search identified 12 studies with six-month smoking cessation outcomes, including seven studies completed since the previous review. The interventions were predominantly text messaging-based, although several paired text messaging with in-person visits or initial assessments. Two studies gave pre-paid mobile phones to low-income human immunodeficiency virus (HIV)-positive populations - one solely for phone counselling, the other also included text messaging. One study used text messages to link to video messages. Control programmes varied widely. Studies were pooled according to outcomes - some providing measures of continuous abstinence or repeated measures of point prevalence; others only providing 7-day point prevalence abstinence. All 12 studies pooled using their most rigorous 26-week measures of abstinence provided an RR of 1.67 (95% CI 1.46 to 1.90; I(2) = 59%). Six studies verified quitting biochemically at six months (RR 1.83; 95% CI 1.54 to 2.19).

Authors' conclusions: The current evidence supports a beneficial impact of mobile phone-based smoking cessation interventions on six-month cessation outcomes. While all studies were good quality, the fact that those studies with biochemical verification of quitting status demonstrated an even higher chance of quitting further supports the positive findings. However, it should be noted that most included studies were of text message interventions in high-income countries with good tobacco control policies. Therefore, caution should be taken in generalising these results outside of this type of intervention and context.

Conflict of interest statement

RW was co‐author of one paper on one of the included studies (Bramley 2005). She was a co‐investigator on two included studies (Free 2009; Free 2011), and principle investigator of a further included study (Whittaker 2011).

CB and HM were co‐authors of Whittaker 2011.

RB was co‐author of one of the trials (Borland 2013), and he led the development of the intervention.

AR was a lead author (Rodgers 2005), and a co‐author (Free 2009; Free 2011; Whittaker 2011), on included studies.

HM received honoraria from Johnson & Johnson and Pfizer for speaking at educational events and attending advisory group meetings. He has also received investigator initiated research funding from Pfizer.

RW's institution has received grant money to cover the costs of providing the text messaging intervention for the study described in Free 2011, and there is a grant pending to develop this intervention further for a different audience. The institution has also licensed the STOMP intervention described in Rodgers 2005 to HSAGlobal.

All other authors had no other known conflicts of interest.