Mobile chat-based support plus nicotine replacement therapy sampling to promote smoking cessation for community smokers: A randomized controlled trial

Sheng Zhi Zhao, Yongda Socrates Wu, Siu Long Chau, Daniel Yee Tak Fong, Tai Hing Lam, Man Ping Wang, Sheng Zhi Zhao, Yongda Socrates Wu, Siu Long Chau, Daniel Yee Tak Fong, Tai Hing Lam, Man Ping Wang

Abstract

Introduction: Mobile instant messaging could deliver real-time, personalized, interactive smoking cessation support. Nicotine replacement therapy (NRT) is effective in increasing quit attempts and abstinence but is underused. We assessed the feasibility of mobile chat-based intervention combined NRT sampling (NRT-S) on abstinence.

Methods: In this two-arm, single-blinded, randomized controlled trial, adult (≥18 years) daily cigarette smokers were proactively recruited from Hong Kong community settings using 'foot-in-the-door' approach during December 2017 to March 2018. All participants received brief advice on quitting, 1-week of NRT-S, active referral to smoking cessation services, and were individually randomized (1:1) at baseline. The intervention group received two months of chat-based support via instant messaging. The control group received general smoking cessation text messages. The primary outcome was smoking abstinence validated by exhaled carbon monoxide (<4 ppm) and salivary cotinine (<10 ng/mL) at 3 and 6 months using intention-to-treat analysis.

Results: A total of 119 participants (80.7% male, 60.5% aged 30-40 years) were randomized and analyzed. Among the 14 and 13 self-reported quitters at 3 and 6 months respectively, only 3 and 1 had biochemical validation. The 3 months validated abstinence rate was 2/62 (intervention) vs 1/57 (control) (AOR=1.07; 95% CI: 0.08-13.65). At 6 months follow-up (68.9% of participants retained), more participants in the intervention group reported quitting (10/62 vs 3/57; AOR=2.83; 95% CI: 0.70-11.30), smoking reduction (20/62 vs 11/57; AOR=1.74; 95% CI: 0.71-4.26), and quit attempts (56/62 vs 44/57; AOR=2.61; 95% CI: 0.88-7.82). Significantly more NRT-S use (39/62 vs 22/57; AOR=2.27; 95% CI: 1.04-4.96) was observed in the intervention group. Participants engaged in mobile chat support (21/62) reported more NRT-S use (76.2% vs 56.1%), although not statistically significant.

Conclusions: Mobile chat-based support plus NRT-S was feasible and showed preliminary evidence of increased quitting, smoking reduction, quit attempts, and NRT-S use in proactively recruited community smokers.

Trial registration: ClinicalTrials.gov: NCT03574077.

Keywords: community smokers; instant messaging; mHealth; nicotine replacement therapy sampling; smoking cessation.

Conflict of interest statement

The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported.

© 2021 Zhao S. Z. et al.

Figures

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Figure 1
Study flow diagram

References

    1. World Health Organization . WHO Report on the Global Tobacco Epidemic: Offer help to quit tobacco use. World Health Organization; 2019. Accessed October 6, 2020. .
    1. The Government of the Hong Kong Special Administrative Region - Census and Statistics Department . Thematic Household Survey: Report No. 53. Hong Kong Census and Statistics Department; 2013. Pattern of smoking; pp. 8–33.
    1. Chan SSC, Leung DYP, Chan HCH, Lam TH. An Evaluative Study of the Integrated Smoking Cessation Services of TungWah Group of Hospitals. Tung Wah Group of Hospitals; 2011. May, Accessed October 6, 2020. .
    1. Wang YY, Liu Z, Wu Y, et al. Acupuncture for Smoking Cessation in Hong Kong: A Prospective Multicenter Observational Study. Evid Based Complement Alternat Med. 2016;2016:2865831. doi: 10.1155/2016/2865831.
    1. Wang MP, Li WH, Cheung YT, et al. Brief Advice on Smoking Reduction Versus Abrupt Quitting for Smoking Cessation in Chinese Smokers: A Cluster Randomized Controlled Trial. Nicotine Tob Res. 2017;20(1):67–72. doi: 10.1093/ntr/ntx026.
    1. Wang MP, Suen YN, Li WH, et al. Intervention with Brief Cessation Advice Plus Active Referral for Proactively Recruited Community Smokers: A Pragmatic Cluster Randomized Clinical Trial. JAMA Intern Med. 2017;177(12):1790. doi: 10.1001/jamainternmed.2017.5793.
    1. Fu SS, van Ryn M, Sherman SE, et al. Proactive Tobacco Treatment and Population-Level Cessation: A Pragmatic Randomized Clinical Trial. JAMA Intern Med. 2014;174(5):671. doi: 10.1001/jamainternmed.2014.177.
    1. Fu SS, van Ryn M, Nelson D, et al. Proactive tobacco treatment offering free nicotine replacement therapy and telephone counselling for socioeconomically disadvantaged smokers: a randomised clinical trial. Thorax. 2016;71(5):446–453. doi: 10.1136/thoraxjnl-2015-207904.
    1. Joseph A, Fu S. Proactive Outreach Strategies to Connect Smokers with Tobacco Cessation Treatment. JAMA Intern Med. 2015;175(2):226. doi: 10.1001/jamainternmed.2014.5291.
    1. Free C, Knight R, Robertson S, et al. Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial. Lancet. 2011;378(9785):4955. doi: 10.1016/S0140-6736(11)60701-0.
    1. Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y, Dobson R. Mobile phone text messaging and app-based interventions for smoking cessation. CCochrane Database Syst Rev. 2019;10(10):CD006611. doi: 10.1002/14651858.CD006611.pub5.
    1. Giansanti D. WhatsApp in mHealth: an overview on the potentialities and the opportunities in medical imaging. Mhealth. 2020;6:19. doi: 10.21037/mhealth.2019.11.01.
    1. Luk TT, Wong SW, Lee JJ, Chan SSC, Lam TH, Wang MP. Exploring Community Smokers’ Perspectives for Developing a Chat-Based Smoking Cessation Intervention Delivered Through Mobile Instant Messaging: Qualitative Study. JMIR mHealth uHealth. 2019;7(1):e11954. doi: 10.2196/11954.
    1. Wang MP, Luk TT, Wu Y, et al. Chat-based instant messaging support integrated with brief interventions for smoking cessation: a community-based, pragmatic, cluster-randomised controlled trial. Lancet Digit Health. 2019;1(4):e183–e192. doi: 10.1016/S2589-7500(19)30082-2.
    1. Cheung YTD, Chan CHH, Lai CKJ, et al. Using WhatsApp and Facebook Online Social Groups for Smoking Relapse Prevention for Recent Quitters: A Pilot Pragmatic Cluster Randomized Controlled Trial. J Med Internet Res. 2015;17(10):e238. doi: 10.2196/jmir.4829.
    1. Hartmann-Boyce J, Chepkin SC, Ye W, Bullen C, Lancaster T. Nicotine replacement therapy versus control for smoking cessation. Cochrane Database Syst Rev. 2018;(5):CD000146. doi: 10.1002/14651858.CD000146.pub5.
    1. Miller N, Frieden TR, Liu SY, et al. Effectiveness of a largescale distribution programme of free nicotine patches: a prospective evaluation. Lancet. 2005;365(9474):1849–1854. doi: 10.1016/S0140-6736(05)66615-9.
    1. Shiffman S, Ferguson SG, Rohay J, Gitchell JG. Perceived safety and efficacy of nicotine replacement therapies among US smokers and ex-smokers: relationship with use and compliance. Addiction. 2008;103(8):1371–1378. doi: 10.1111/j.1360-0443.2008.02268.x.
    1. 2008 PHS Guideline Update Panel, Liaisons, and Staff. Treating Tobacco Use and Dependence: 2008 Update U.S. Public Health Service Clinical Practice Guideline Executive Summary. 2008;53(9) Accessed October 6, 2020 .
    1. Chapman S, MacKenzie R. The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences. PLoS Med. 2010;7(2):e1000216. doi: 10.1371/journal.pmed.1000216.
    1. Murray RL, Lewis SA, Coleman T, Britton J, McNeill A. Unplanned attempts to quit smoking: missed opportunities for health promotion? Addiction. 2009;104(11):1901–1909. doi: 10.1111/j.1360-0443.2009.02647.x.
    1. Carpenter MJ, Hughes JR, Gray KM, Wahlquist AE, Saladin ME, Alberg AJ. Nicotine Therapy Sampling to Induce Quit Attempts Among Smokers Unmotivated to Quit: A Randomized Clinical Trial. Arch Intern Med. 2011;171(21):1901. doi: 10.1001/archinternmed.2011.492.
    1. Jardin BF, Cropsey KL, Wahlquist AE, et al. Evaluating the Effect of Access to Free Medication to Quit Smoking: A Clinical Trial Testing the Role of Motivation. Nicotine Tob Res. 2014;16(7):992–999. doi: 10.1093/ntr/ntu025.
    1. Cheung YTD, Li WHC, Wang MP, Lam TH. Delivery of a Nicotine Replacement Therapy Sample at Outdoor Smoking Hotspots for Promoting Quit Attempts: A Pilot Randomized Controlled Trial. Nicotine Tob Res. 2019;22(9) doi: 10.1093/ntr/ntz138.
    1. Freedman JL, Fraser SC. Compliance without pressure: The foot-in-the-door technique. J Pers Soc Psychol. 1966;4(2):195–202. doi: 10.1037/h0023552.
    1. Benowitz N, Bernert JT, Foulds J, et al. Biochemical Verification of Tobacco Use and Abstinence: 2019 Update. Nicotine Tob Res. 2020;22(7):1086–1097. doi: 10.1093/ntr/ntz132.
    1. Guidance on the use of nicotine replacement therapy (NRT) and bupropion for smoking cessation. National Institute for Clinical Excellence; 2002. Accessed October 6, 2020. .
    1. Miller WR. Motivational interviewing: Research, practice, and puzzles. Addict Behav. 1996;21(6):835–842. doi: 10.1016/0306-4603(96)00044-5.
    1. Chan SSC, Wong DCN, Cheung YTD, et al. A block randomized controlled trial of a brief smoking cessation counselling and advice through short message service on participants who joined the Quit to Win Contest in Hong Kong. Health Educ Res. 2015;30(4):609–621. doi: 10.1093/her/cyv023.
    1. Heatherton TF, Kozlowski LT, Frecker RC, Rickert W, Robinson J. Measuring the Heaviness of Smoking: using self-reported time to the first cigarette of the day and number of cigarettes smoked per day. Br J Addict. 1989;84(7):791–799. doi: 10.1111/j.1360-0443.1989.tb03059.x.
    1. Cropsey KL, Trent LR, Clark CB, Stevens EN, Lahti AC, Hendricks PS. How Low Should You Go? Determining the Optimal Cutoff for Exhaled Carbon Monoxide to Confirm Smoking Abstinence When Using Cotinine as Reference. Nicotine Tob Res. 2014;16(10):1348–1355. doi: 10.1093/ntr/ntu085.
    1. Cooke F, Bullen C, Whittaker R, McRobbie H, Chen MH, Walker N. Diagnostic accuracy of NicAlert cotinine test strips in saliva for verifying smoking status. Nicotine Tob Res. 2008;10(4):607–612. doi: 10.1080/14622200801978680.
    1. Cheung YTD, Wang MP, Li HCW, et al. Effectiveness of a small cash incentive on abstinence and use of cessation aids for adult smokers: A randomized controlled trial. Addict Behav. 2017;66:17–25. doi: 10.1016/j.addbeh.2016.11.006.
    1. West R, Hajek P, Stead L, Stapleton J. Outcome criteria in smoking cessation trials: proposal for a common standard. Addiction. 2005;100(3):299–303. doi: 10.1111/j.1360-0443.2004.00995.x.
    1. Vangeli E, Stapleton J, Smit ES, Borland R, West R. Predictors of attempts to stop smoking and their success in adult general population samples: a systematic review. Addiction. 2011;106(12):2110–2121. doi: 10.1111/j.1360-0443.2011.03565.x.
    1. The Government of the Hong Kong Special Administrative Region - Census and Statistics Department . Thematic Household Survey. Report No. 64. Hong Kong Census and Statistics Department; 2018. Personal computer and Internet penetration; pp. 39–86. Accessed October 6, 2020. .
    1. Li WHC, Ho KY, Wang MP, et al. Effectiveness of a Brief Self-determination Theory–Based Smoking Cessation Intervention for Smokers at Emergency Departments in Hong Kong: A Randomized Clinical Trial. JAMA Intern Med. 2019;180(2) doi: 10.1001/jamainternmed.2019.5176.
    1. Lam TH, Abdullah ASM, Chan SSC, Hedley AJ, Hong Kong Council on Smoking and Health Smoking Cessation Health Centre (SCHC) Steering Group Adherence to nicotine replacement therapy versus quitting smoking among Chinese smokers: a preliminary investigation. Psychopharmacology (Berl) 2005;177(4):400–408. doi: 10.1007/s00213-004-1971-y.
    1. Shen C, Wang MP, Wan A, Viswanath K, Chan SSC, Lam TH. Health information exposure from information and communication technologies and its associations with health behaviors: Population-based survey. Prev Med. 2018;113:140–146. doi: 10.1016/j.ypmed.2018.05.018.
    1. Burris JL, Heckman BW, Mathew AR, Carpenter MJ. A mechanistic test of nicotine replacement therapy sampling for smoking cessation induction. Psychol Addict Behav. 2015;29(2):392–399. doi: 10.1037/adb0000035.
    1. Vogt F, Hall S, Marteau T. Understanding why smokers do not want to use nicotine dependence medications to stop smoking: Qualitative and quantitative studies. Nicotine Tob Res. 2008;10(8):1405–1413. doi: 10.1080/14622200802239280.
    1. Ferguson SG, Gitchell JG, Shiffman S, Sembower MA, Rohay JM, Allen J. Providing accurate safety information may increase a smoker’s willingness to use nicotine replacement therapy as part of a quit attempt. Addict Behav. 2011;36(7):713–716. doi: 10.1016/j.addbeh.2011.02.002.
    1. Eysenbach G. The Law of Attrition. J Med Internet Res. 2005;7(1):e11. doi: 10.2196/jmir.7.1.e11.
    1. Prochaska J, DiClemente C. Stage of processes of self-change of smoking: toward an integrative model. J Consult Clin Psychol. 1983;51(3):390–395. doi: 10.1037//0022-006x.51.3.390.
    1. West R, Brown J. Theory of addiction. 2nd ed. Wiley-Blackwell; 2013. ISBN: 9781118484890. Accessed October 6, 2020. .
    1. Baskerville NB, Struik LL, Guindon GE, et al. Effect of a Mobile Phone Intervention on Quitting Smoking in a Young Adult Population of Smokers: Randomized Controlled Trial. JMIR mHealth uHealth. 2018;6(10):e10893. doi: 10.2196/10893.
    1. SRNT Subcommittee on Biochemical Verification Biochemical verification of tobacco use and cessation. Nicotine Tob Res. 2002;4(2):149–159. doi: 10.1080/14622200210123581.

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