Mobile phone text messaging and app-based interventions for smoking cessation

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

Abstract

Background: Mobile phone-based smoking cessation support (mCessation) offers the opportunity to provide behavioural support to those who cannot or do not want face-to-face support. In addition, mCessation can be automated and therefore provided affordably even in resource-poor settings. This is an update of a Cochrane Review first published in 2006, and previously updated in 2009 and 2012.

Objectives: To determine whether mobile phone-based smoking cessation interventions increase smoking cessation rates in people who smoke.

Search methods: For this update, we searched the Cochrane Tobacco Addiction Group's Specialised Register, along with clinicaltrials.gov and the ICTRP. The date of the most recent searches was 29 October 2018.

Selection criteria: Participants were smokers of any age. Eligible interventions were those testing any type of predominantly mobile phone-based programme (such as text messages (or smartphone app) for smoking cessation. We included randomised controlled trials with smoking cessation outcomes reported at at least six-month follow-up.

Data collection and analysis: We used standard methodological procedures described in the Cochrane Handbook for Systematic Reviews of Interventions. We performed both study eligibility checks and data extraction in duplicate. We performed meta-analyses of the most stringent measures of abstinence at six months' follow-up or longer, using a Mantel-Haenszel random-effects method, pooling studies with similar interventions and similar comparators to calculate risk ratios (RR) and their corresponding 95% confidence intervals (CI). We conducted analyses including all randomised (with dropouts counted as still smoking) and complete cases only.

Main results: This review includes 26 studies (33,849 participants). Overall, we judged 13 studies to be at low risk of bias, three at high risk, and the remainder at unclear risk. Settings and recruitment procedures varied across studies, but most studies were conducted in high-income countries. There was moderate-certainty evidence, limited by inconsistency, that automated text messaging interventions were more effective than minimal smoking cessation support (RR 1.54, 95% CI 1.19 to 2.00; I2 = 71%; 13 studies, 14,133 participants). There was also moderate-certainty evidence, limited by imprecision, that text messaging added to other smoking cessation interventions was more effective than the other smoking cessation interventions alone (RR 1.59, 95% CI 1.09 to 2.33; I2 = 0%, 4 studies, 997 participants). Two studies comparing text messaging with other smoking cessation interventions, and three studies comparing high- and low-intensity messaging, did not show significant differences between groups (RR 0.92 95% CI 0.61 to 1.40; I2 = 27%; 2 studies, 2238 participants; and RR 1.00, 95% CI 0.95 to 1.06; I2 = 0%, 3 studies, 12,985 participants, respectively) but confidence intervals were wide in the former comparison. Five studies compared a smoking cessation smartphone app with lower-intensity smoking cessation support (either a lower-intensity app or non-app minimal support). We pooled the evidence and deemed it to be of very low certainty due to inconsistency and serious imprecision. It provided no evidence that smartphone apps improved the likelihood of smoking cessation (RR 1.00, 95% CI 0.66 to 1.52; I2 = 59%; 5 studies, 3079 participants). Other smartphone apps tested differed from the apps included in the analysis, as two used contingency management and one combined text messaging with an app, and so we did not pool them. Using complete case data as opposed to using data from all participants randomised did not substantially alter the findings.

Authors' conclusions: There is moderate-certainty evidence that automated text message-based smoking cessation interventions result in greater quit rates than minimal smoking cessation support. There is moderate-certainty evidence of the benefit of text messaging interventions in addition to other smoking cessation support in comparison with that smoking cessation support alone. The evidence comparing smartphone apps with less intensive support was of very low certainty, and more randomised controlled trials are needed to test these interventions.

Conflict of interest statement

RW was co‐author of one paper on one of the included studies (Rodgers 2005). She was a co‐investigator on included studies (Baskerville 2018; Free 2009; Free 2011), and principle investigator of a further included study (Whittaker 2011). RW's institution (Auckland UniServices Ltd) received grant money to cover the costs of providing the text messaging intervention for the study described in Free 2011. RW's institution licensed the STOMP text messaging cessation intervention in 2008, however no royalties were received. The licence has since been rescinded. This is not deemed to be a conflict of interest.

HM was co‐author of Whittaker 2011 and received honoraria from Pfizer for speaking at educational events and attending advisory group meetings.

CB was co‐author of Whittaker 2011 and his institution received grant money to cover the costs of providing the text messaging intervention for the study described in Free 2011.

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

YG none known.

RD's institution received grant money to cover the costs of providing the text messaging intervention for the study described in Free 2011.