Effectiveness of a text messaging-based smoking cessation intervention (Happy Quit) in China: a randomised controlled trial

Abstract

BackgroundThe population of China has the highest proportion of cigarette smokers worldwide, accounting for more than 40% of the world's total cigarette consumption. Despite the acceptability, feasibility, and efficacy of mobile phone-based text messaging interventions for smoking in other countries, there is a lack of smoking cessation services in China. Here we assessed the efficacy of a mobile phone-based smoking cessation intervention (Happy Quit) in China. MethodsWe conducted a randomised controlled trial between Aug 17, 2016, and May 27, 2017. This trial was approved by the Second Xiangya Hospital of Central South University Review Board (number S007, 2015, and number S111 [to include the low-frequency messaging intervention], 2016) and registered with ClinicalTrials.gov, number NCT02693626. Participants were smokers who responded to our request (across mainland China) for volunteers, and who were aged 18 years or older and wanted to stop smoking. The participants were randomly assigned to a high-frequency messages intervention group, low-frequency messages intervention group, or control group, with a 5:2:3 ratio. Informed verbal consent was obtained from all participants. The Happy Quit message delivery system automatically sent high-frequency (daily), low-frequency (weekly), or control group texts (eg, texts thanking them for participating in the study, or providing study center contact details) to the participants, according to their allocation. Participants, investigators, and research personnel were masked to treatment allocation. Demographic and smoking characteristics were assessed for each participant to provide baseline data. The primary outcome was biochemically verified continuous smoking abstinence for 24 weeks. Analysis was by intention-to-treat. FindingsA total of 1369 individuals (674 in the high-frequency message groups, 284 in the low-frequency message groups, and 411 in the control group) received 12 weeks' intervention and 12 weeks' follow-up. The three groups had similar baseline characteristics. At 24 weeks, biochemically verified continuous smoking abstinence was 6·5% (44 of 674) in the high-frequency messages group, 6·0% (17 of 284) in the low-frequency messages group and 1·9% (8 of 411) in the control group (odds ratio [OR] for high-frequency messages vs control 3·51 [95% CI 1·64–7·55], p=0·001; for low-frequency messages vs control 3·21 [1·36–7·54], p=0·008). InterpretationOur findings suggest that a mobile phone-based text messaging intervention (Happy Quit), with either high-frequency or low-frequency messaging, is effective to Chinese cigarette smokers. It should be considered for inclusion in smoking cessation services. The strengths of this trial include its large sample size from China and a rigorous measure of abstinence with both self-reported response and biochemical verification. One limitation is that we could not prevent participants from using other smoking cessation services. Additionally, cotinine tests can detect smoking status for a few days only. FundingThe research was supported by funding from the China Medical Board (CMB) Open Competition Program (grant number 15-226).