A text messaging-based smoking cessation program for adult smokers: randomized controlled trial

Michele Ybarra, A Tülay Bağci Bosi, Josephine Korchmaros, Salih Emri, Michele Ybarra, A Tülay Bağci Bosi, Josephine Korchmaros, Salih Emri

Abstract

Background: Despite promising data in Western countries, there is a dearth of research into the efficacy of text messaging-based smoking cessation programs in other settings, including the Middle East, where smoking prevalence rates are higher.

Objective: This paper reports cessation rates observed in SMS Turkey, a text messaging-based smoking cessation program for adult smokers in Ankara, Turkey.

Methods: This study was a small-scale, parallel-group randomized controlled trial (RCT) conducted in Ankara, Turkey. Participants were adult daily smokers who were seriously thinking about quitting in the next 15 days and living in Ankara, Turkey. The text messaging intervention, SMS Turkey, provided 6 weeks of daily messages aimed at giving participants skills to help them quit smoking. Messages were sent in an automated fashion, except 2 days and 7 days after the initial quit day. On days 2 and 7, the research assistant manually assigned participants to content "paths" based on whether they were still not smoking or had relapsed. The control arm received a brochure that provided similar information about smoking cessation. The main outcome measure was self-reported 3-month sustained abstinence, verified by carbon monoxide (CO) readings. Neither participants nor researchers were blinded to arm assignment.

Results: The 151 participants were randomly assigned to 1 of 2 groups: 76 to the SMS Turkey intervention group and 75 to the brochure control group. Using intention to treat, all 151 participants were included in analyses. Three-month cessation trends were not significantly higher in the intervention group: 11% intervention vs 5% control had quit (χ(2)(1)=1.4, P=.24; R(2)=2.0, 95% CI 0.62-6.3). When the sample was stratified by sex, female intervention participants (14%, n=5) were significantly more likely to have quit at 3 months than female control participants (0%, n=0; χ(2)(1)=3.7, P=.05). Among light smokers (ie, those smoking less than 20 cigarettes per day), intervention participants (17%, n=5) also were significantly more likely to have quit compared to control participants (0%, n=0; χ(2)(1)=5.3, P=.02). We noted no difference in cessation rates for males or heavy smokers. Participants experienced significant technology problems during the study. Some participants received duplicate text messages at least once during the trial; others failed to receive some program messages. Neither receiving duplicate messages (χ(2)(1)=0.12, P=.73), or missing 5 or more program messages (χ(2)(1)=0.75, P=.39) negatively affected quitting rates.

Conclusions: Although the study was not powered to detect statistically significant differences, as the primary aim was to provide estimates of effect size that could be used to better inform a power analysis for a larger trial, findings provide optimism that SMS Turkey may be able to affect quitting rates in environments with high smoking prevalence, such as Ankara, Turkey. The SMS Turkey software program did not work as well as it did 2 years previous. The system will need to be updated to maintain software compatibility with ongoing technology evolution.

Trial registration: Clinicaltrials.gov NCT00912795 https://ichgcp.net/clinical-trials-registry/NCT00912795 (Archived by WebCite® at http://www.webcitation.org/6Ch1cIA8l).

Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
SMS Turkey randomized controlled trial profile.

References

    1. Başkent University National Burden of Disease Project, Final Report. 2004. [2012-06-05]. .
    1. Ministry of Health Turkey Global Adult Tobacco Survey: Turkey report. 2010. [2012-10-05]. .
    1. Pleis JR, Ward BW, Lucas JW. Summary health statistics for U.S. adults: National Health Interview Survey, 2009. Vital Health Stat. 2010 Dec;10(249):1–207.
    1. World Health Organization Turkey marks progress in fight against noncommunicable diseases. 2012. [2012-10-05]. .
    1. World Health Organization 2010 global progress report on the implementation of the WHO Framework Convention on Tobacco Control. 2010. [2012-10-05]. .
    1. WHO Framework Convention on Tobacco Control Status of payments of voluntary assessed contributions (VAC) 2012. [2012-10-05]. .
    1. Devi S. Turkey wins plaudits for tobacco control. Lancet. 2012 May 26;379(9830):1935.
    1. Unalacak M, Altin R, Kart L, Tor M, Ornek T, Altunel H. Smoking prevalence, behaviour, and nicotine addiction among coal workers in Zonguldak, Turkey. J Occup Health. 2004 Jul;46(4):289–95.
    1. Pew Global Attitudes Project Global digital communication: texting, social networking popular worldwide. 2011. [2012-10-05]. .
    1. Central Intelligence Agency The World Factbook: Turkey. 2011. [2012-01-16]. .
    1. Ybarra ML, Bull SS. Current trends in Internet- and cell phone-based HIV prevention and intervention programs. Curr HIV/AIDS Rep. 2007 Dec;4(4):201–7.
    1. Ybarra ML, Eaton WW. Internet-based mental health interventions. Ment Health Serv Res. 2005 Jun;7(2):75–87.
    1. Wei J, Hollin I, Kachnowski S. A review of the use of mobile phone text messaging in clinical and healthy behaviour interventions. J Telemed Telecare. 2011;17(1):41–8. doi: 10.1258/jtt.2010.100322.
    1. Cole-Lewis H, Kershaw T. Text messaging as a tool for behavior change in disease prevention and management. Epidemiol Rev. 2010 Apr;32(1):56–69. doi: 10.1093/epirev/mxq004.
    1. Whittaker R, Borland R, Bullen C, Lin RB, McRobbie H, Rodgers A. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev. 2009;(4):CD006611. doi: 10.1002/14651858.CD006611.pub2.
    1. Free C, Knight R, Robertson S, Whittaker R, Edwards P, Zhou W, Rodgers A, Cairns J, Kenward MG, Roberts I. Smoking cessation support delivered via mobile phone text messaging (txt2stop): a single-blind, randomised trial. Lancet. 2011 Jul 2;378(9785):49–55. doi: 10.1016/S0140-6736(11)60701-0.
    1. Warner KE, Burns DM. Hardening and the hard-core smoker: concepts, evidence, and implications. Nicotine Tob Res. 2003;5(1):37–48. doi: 10.1080/1462220021000060428.
    1. Ghouri N, Atcha M, Sheikh A. Influence of Islam on smoking among Muslims. BMJ. 2006 Feb 4;332(7536):291–4. doi: 10.1136/bmj.332.7536.291.
    1. Nierkens V, Stronks K, de Vries H. Attitudes, social influences and self-efficacy expectations across different motivational stages among immigrant smokers: replication of the Ø pattern. Prev Med. 2006 Oct;43(4):306–11. doi: 10.1016/j.ypmed.2006.05.005.
    1. Yuksel H, Corbett KK. Mixed messages: a qualitative study of the meanings and context of high school students' tobacco use in Turkey. Health Promot Int. 2005 Dec;20(4):360–6. doi: 10.1093/heapro/dai019.
    1. Ybarra ML, Bağci Bosi AT, Bilir N, Holtrop JS, Korchmaros J, Emri S. Interest in technology-based and traditional smoking cessation programs among adult smokers in Ankara, Turkey. Tob Induc Dis. 2011;9(1):10. doi: 10.1186/1617-9625-9-10.
    1. Ybarra ML, Holtrop JS, Bagc? Bosi AT, Bilir N, Korchmaros J, Emri AKS. Feasibility and acceptability of a text messaging based smoking cessation program in Ankara Turkey. J Health Commun. 2012 (forthcoming)
    1. Simpson D. Turkey: upping up the anti. Tob Control. 2003 Sep;12(3):245–6.
    1. Bozkurt AI, Sahinöz S, Ozçirpici B, Ozgür S, Sahinöz T, Acemoglu H, Saka G, Ceylan A, Palanci Y, Ilçin E, Akkafa F. Patterns of active and passive smoking, and associated factors, in the South-east Anatolian Project (SEAP) region in Turkey. BMC Public Health. 2006;6:15. doi: 10.1186/1471-2458-6-15.
    1. Emri S, Basoglu S, Turnagol H, Bacanli S, Tuncer M. Epidemiology of smoking among Turkish adults: a national household survey, 2002. The Second International Symposium on Medical Geology, Nutrition and Cancer; Mar 31 - Apr 3; Istanbul, Turkey. 2003.
    1. Ybarra ML, Holtrop JS, Bağci Bosi AT, Emri S. Design considerations in developing a text messaging program aimed at smoking cessation. J Med Internet Res. 2012;14(4):e103. doi: 10.2196/jmir.2061.
    1. Brown RA. Comorbidity treatment: skills training for coping with depression and negative moods. In: Abrams D, Niaura R, Brown RA, Emmons KM, Goldstein MG, Monti PM, editors. The Tobacco Dependence Treatment Handbook: a guide to best practices. New York: Guilford Press; 2003. pp. 178–228.
    1. Wadland WC, Soffelmayr B, Ives K. Enhancing smoking cessation of low-income smokers in managed care. J Fam Pract. 2001 Feb;50(2):138–44.
    1. Holtrop JS, Stommel M, Corser W, Holmes-Rovner M. Predictors of smoking cessation and relapse after hospitalization for acute coronary syndrome. J Hosp Med. 2009 Mar;4(3):E3–9. doi: 10.1002/jhm.415.
    1. Stead LF, Perera R, Lancaster T. Telephone counselling for smoking cessation. Cochrane Database Syst Rev. 2006;(3):CD002850. doi: 10.1002/14651858.CD002850.pub2.
    1. Zhu SH, Anderson CM, Tedeschi GJ, Rosbrook B, Johnson CE, Byrd M, Gutiérrez-Terrell E. Evidence of real-world effectiveness of a telephone quitline for smokers. N Engl J Med. 2002 Oct 3;347(14):1087–93. doi: 10.1056/NEJMsa020660.
    1. Zhu SH, Stretch V, Balabanis M, Rosbrook B, Sadler G, Pierce JP. Telephone counseling for smoking cessation: effects of single-session and multiple-session interventions. J Consult Clin Psychol. 1996 Feb;64(1):202–11.
    1. Fiore MC, Jaen CR, Baker TB, Bailey WC, Benowitz NL, Curry SJ. Clinical Practice Guideline. Treating Tobacco Use and Dependence: 2008 update. 2008. [2012-01-16]. .
    1. Rosen CS. Is the sequencing of change processes by stage consistent across health problems? A meta-analysis. Health Psychol. 2000 Nov;19(6):593–604.
    1. O'Hea EL, Boudreaux ED, Jeffries SK, Carmack Taylor CL, Scarinci IC, Brantley PJ. Stage of change movement across three health behaviors: the role of self-efficacy. Am J Health Promot. 2004;19(2):94–102.
    1. Fagan P, Eisenberg M, Frazier L, Stoddard AM, Avrunin JS, Sorensen G. Employed adolescents and beliefs about self-efficacy to avoid smoking. Addict Behav. 2003 Jun;28(4):613–26.
    1. Tucker JS, Ellickson PL, Klein DJ. Smoking cessation during the transition from adolescence to young adulthood. Nicotine Tob Res. 2002 Aug;4(3):321–32. doi: 10.1080/14622200210142698.
    1. Borrelli B, Hogan JW, Bock B, Pinto B, Roberts M, Marcus B. Predictors of quitting and dropout among women in a clinic-based smoking cessation program. Psychol Addict Behav. 2002 Mar;16(1):22–7.
    1. Stöffelmayr B, Wadland WC, Pan W. An examination of the process of relapse prevention therapy designed to aid smoking cessation. Addict Behav. 2003 Sep;28(7):1351–8.
    1. Wadland WC, Stöffelmayr B, Berger E, Crombach A, Ives K. Enhancing smoking cessation rates in primary care. J Fam Pract. 1999 Sep;48(9):711–8.
    1. Ramsay J, Hoffmann A. Smoking cessation and relapse prevention among undergraduate students: a pilot demonstration project. J Am Coll Health. 2004;53(1):11–8. doi: 10.3200/JACH.53.1.11-18.
    1. Rodgers A, Corbett T, Bramley D, Riddell T, Wills M, Lin RB, Jones M. Do u smoke after txt? Results of a randomised trial of smoking cessation using mobile phone text messaging. Tob Control. 2005 Aug;14(4):255–61. doi: 10.1136/tc.2005.011577.
    1. SRNT Subcommittee on Biochemical Verification Biochemical verification of tobacco use and cessation. Nicotine Tob Res. 2002 May;4(2):149–59. doi: 10.1080/14622200210123581.
    1. West R, Hajek P, Stead L, Stapleton J. Outcome criteria in smoking cessation trials: proposal for a common standard. Addiction. 2005 Mar;100(3):299–303. doi: 10.1111/j.1360-0443.2004.00995.x.
    1. Substance Abuse and Mental Health Services Administration Results from the 2003 National Survey on Drug Use and Health: national findings. 2004. [2012-06-05]. .
    1. Nierkens V, Stronks K, van Oel CJ, de Vries H. Beliefs of Turkish and Moroccan immigrants in The Netherlands about smoking cessation: implications for prevention. Health Educ Res. 2005 Dec;20(6):622–34. doi: 10.1093/her/cyh026.
    1. Miller WR, Zweben A, DiClemente CC, Rychtarik RG. Motivational Enhancement Therapy Manual: a clinical research guide for therapists treating individuals with alcohol abuse and dependence. 1992. [2012-06-05]. .
    1. May S, West R. Do social support interventions ("buddy systems") aid smoking cessation? A review. Tob Control. 2000 Dec;9(4):415–22.
    1. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. Journal of Personality Assessment. 1988;52(1):30–41. doi: 10.1207/s15327752jpa5201_2.
    1. Sher KJ, Gotham HJ, Erickson DJ, Wood PK. A prospective, high-risk study of the relationship between tobacco dependence and alcohol use disorders. Alcohol Clin Exp Res. 1996 May;20(3):485–92.
    1. Dhalla S, Kopec JA. The CAGE questionnaire for alcohol misuse: a review of reliability and validity studies. Clin Invest Med. 2007;30(1):33–41.
    1. StataCorp . Stata Statistical Software: Release 11. College Station: StataCorp LP; 2009.
    1. Centers for Disease Control and Prevention Women and smoking: a report of the Surgeon General. 2001. [2012-06-05]. .
    1. Nordstrom BL, Kinnunen T, Utman CH, Krall EA, Vokonas PS, Garvey AJ. Predictors of continued smoking over 25 years of follow-up in the normative aging study. Am J Public Health. 2000 Mar;90(3):404–6.
    1. Akala FA, El-Saharty S. Public-health challenges in the Middle East and North Africa. Lancet. 2006 Mar 25;367(9515):961–4. doi: 10.1016/S0140-6736(06)68402-X.
    1. Laxminarayan R, Mills AJ, Breman JG, Measham AR, Alleyne G, Claeson M, Jha P, Musgrove P, Chow J, Shahid-Salles S, Jamison DT. Advancement of global health: key messages from the Disease Control Priorities Project. Lancet. 2006 Apr 8;367(9517):1193–208. doi: 10.1016/S0140-6736(06)68440-7.
    1. Williams GC, McGregor H, Borrelli B, Jordan PJ, Strecher VJ. Measuring tobacco dependence treatment outcomes: a perspective from the behavior change consortium. Ann Behav Med. 2005 Apr;29 Suppl:11–9. doi: 10.1207/s15324796abm2902s_4.
    1. Eysenbach G, CONSORT-EHEALTH Group CONSORT-EHEALTH: Improving and Standardizing Evaluation Reports of Web-based and Mobile Health Interventions . J Med Internet Res. 2011;13(4):e126. doi: 10.2196/jmir.1923.

Source: PubMed

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