Texting Smokers Doubles Quit Rates

Caroline Cassels

June 30, 2011

June 30, 2011 — Sending motivational text messages vs "placebo" texts to smokers doubles quit rates, a large randomized trial shows.

The study findings show that biochemically verified continuous abstinence was significantly increased in the active intervention group vs the placebo group at 6 months with rates of 10.7% and 4.9%, respectively.

"Text messages are a very convenient way for smokers to receive support to quit. People described txt2stop as like having a "friend" encouraging them or an "angel on their shoulder." It helped people resist the temptation to smoke, principal investigator, Caroline Free, PhD, Clinical Trials Research Unit, London School of Hygiene and Tropical Medicine, United Kingdom, said in a statement.

The study is published online June 30 in The Lancet.

Mobile Phone Use Widespread

The leading cause of preventable death, tobacco use is estimated to cause more than 5 million deaths annually worldwide. In the United Kingdom alone two-thirds of smokers report they would like to quit.

Motivational texts help smokers quit.

The researchers note that mobile phone technology offers an opportunity to provide personalized smoking cessation support and can be delivered to large numbers of individuals at low cost.

They also point out that 2009 data show that more than two-thirds of the world's population owned a mobile phone and 4.2 trillion text messages were sent.

Previous research has shown that using text messaging to deliver smoking cessation support has been shown to increase self-reported smoking abstinence at 6 weeks, but it is not clear whether these early benefits are maintained in the long term and can be validated biochemically.

To investigate, the researchers recruited 5800 smokers to receive either personalized smoking cessation advice and support, known as txt2stop, or nonmotivational text messages.

Smokers in the txt2stop group (n = 2915) received automatically generated messages encouraging them up to their quit date, advice on keeping weight off while quitting, and help dealing with craving. Those in the "placebo" text group (n = 2885) received messages thanking them for their participation, messages requesting confirmation of contact details, or a range of other texts not related to smoking itself.

The study's primary endpoint was self-reported continuous smoking abstinence, biochemically verified at 6 months via a saliva test.

Effective, Low Cost

Primary outcome data were available for 5524 study participants. The researchers report that quit rates in the txt2stop group was more than double participants in the placebo group. (10.7% vs 4.9%; relative risk, 2.20; 95% confidence interval, 1.80 – 2.68; P < .0001).

"On the basis of these results the intervention was effective on its own and when used alongside other smoking interventions. To scale up the txt2stop intervention for delivery at a national or international level would be technically easy.

"The intervention might require some adaptation, translation into other languages, and local evaluation before delivery to other populations. The intervention is low cost and likely to be highly cost-effective. A cost-effectiveness analysis of text2stop will be reported separately," the study authors write.

In an accompanying editorial, Derrick A. Bennett, PhD, and Jonathan R. Emberson, Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, United Kingdom, point out that due to the rapid growth of the mobile phone sector in poor countries, "the lessons learned from the txt2stop trial could therefore not only provide a new approach to smoking cessation in high-income and middle-income countries but could also provide a useful starting point for implementing behavioral change in resource-poor settings."

Dr. Free, Dr. Bennett, and Dr. Emberson have disclosed no relevant financial relationships.

Lancet. Published online June 30, 2011.

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