NIHR Signal Mobile phone support helps smokers quit

Published on 28 June 2016

This review found that mobile phone based support is effective at helping people quit smoking for at least six months. Support was mainly via text messages, although some packages combined this with personalised assessment. Mobile phone support was usually compared with standard cessation advice and treatment, or online support that was not tailored to the individual.

Smoking remains a leading cause of illness and deaths in the UK. Around 20% of adults smoke and two-third of smokers express a desire to quit. NHS Stop Smoking services offer a range of support to people wanting to quit, including mobile phone support. This review lends support to this service.

No studies of smartphone applications met inclusion criteria. This would be a valuable area for further study, together with tailored messages for targeted groups.

Mobile phone support helps smokers quit

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Why was this study needed?

In the UK, 22% of adult men and 17% of women are smokers. Smoking is one of the main causes of preventable deaths in the UK, causing an estimated 18% of all deaths and 27% of cancer-related deaths.

Surveys show that around two-thirds of smokers want to quit, but only about a third actually try to quit each year. Smokers in the UK can access a range of services via their GP and the NHS Stop Smoking service including nicotine replacement therapy, such as patches and tablets; support in person, online or via telephone; and medication such as varenicline.

In the UK, 93% of adults own a mobile phone, making them a potentially powerful tool to support smokers who want to quit. This systematic review examined the long-term outcomes of using mobile phones to help people stop smoking.

What did this study do?

This systematic review and meta-analysis pooled the results of 12 randomised controlled trials of mobile phone based smoking cessation interventions in 11,885 people who wanted to quit smoking. Quit rates were assessed at six months’ follow-up or longer if available.

Seven of the studies used text messages only; the other five combined this with in-person assessments.

A variety of comparison interventions were used, including standard (untailored) advice delivered online or in-person, and access to nicotine replacement therapy.

This Cochrane systematic review followed a high quality methodology and the studies were of moderate quality. Three studies were carried out in the UK, four in the US, two each in Australia and New Zealand, and one in Switzerland. There was variability in the study settings and included populations, and possible variation in which cessation treatments were used alongside the texting support.

What did it find?

  • People who received mobile phone support were more likely to say they had stopped smoking for seven days or more by six months (relative risk [RR] 1.67, 95% confidence interval [CI] 1.46 to 1.90).
  • The six studies using a saliva test to verify whether people had quit at six months also found that mobile phone support increased abstinence compared to control participants (RR 1.83, 95% CI 1.54 to 2.19).
  • When analyses was restricted to the seven studies that used text messages alone they still found a similar increased likelihood of quitting (RR 1.69, 95% CI 1.46 to 1.95), suggesting that there was no additional benefit of text messages combined with in-person contact.
  • No trials assessing mobile phone apps met the inclusion criteria.

What does current guidance say on this issue?

2008 NICE guidelines recommend a variety of support for people wanting to quit smoking, including nicotine replacement therapy, medication, advice, counselling, group therapy, self-help materials. NHS Stop Smoking services include mobile phone support as part of their services.

What are the implications?

This review provides stronger evidence than previously available that mobile phone based support is effective in helping people to stop smoking. The findings are representative of high income countries, and so are relevant to UK settings. GPs and other primary or community care professionals may want to encourage their service users to take up the mobile phone support already available via NHS Stop Smoking services.

Most of the studies included in this review focused on adults, so there may be a need to tailor the approach to support young people wanting to quit smoking. There were no trials of smartphone applications that met the inclusion criteria, so this is an area for future investigation.

Citation and Funding

Whittaker R, McRobbie H, Bullen C, et al. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev. 2016;(4):CD006611.

Cochrane UK and the Tobacco Addiction Cochrane Review Group are supported by NIHR infrastructure funding.

Bibliography

ASH. Smoking statistics. Action on smoking and health; 2016.

Cancer Research UK. Tobacco statistics. Accessed June 2016.

NICE. Stop smoking services. PH10. London: National Institute for Health and Care Excellence; 2008.

NICE. Smoking: brief interventions and referrals. PH1. London: National Institute for Health and Care Excellence; 2006.

NICE. Smoking: workplace interventions. PH5. London: National Institute for Health and Care Excellence; 2007.

NICE. The clinical effectiveness and cost effectiveness of bupropion (Zyban) and Nicotine Replacement Therapy for smoking cessation. TA39. London: National Institute for Health and Care Excellence; 2002.

NICE. Varenicline for smoking cessation. TA123. London: National Institute for Health and Care Excellence; 2007.

NHS. Smokefree NHS. Accessed June 2016.

NHS Choices. Stop smoking treatments. 2014.

Why was this study needed?

In the UK, 22% of adult men and 17% of women are smokers. Smoking is one of the main causes of preventable deaths in the UK, causing an estimated 18% of all deaths and 27% of cancer-related deaths.

Surveys show that around two-thirds of smokers want to quit, but only about a third actually try to quit each year. Smokers in the UK can access a range of services via their GP and the NHS Stop Smoking service including nicotine replacement therapy, such as patches and tablets; support in person, online or via telephone; and medication such as varenicline.

In the UK, 93% of adults own a mobile phone, making them a potentially powerful tool to support smokers who want to quit. This systematic review examined the long-term outcomes of using mobile phones to help people stop smoking.

What did this study do?

This systematic review and meta-analysis pooled the results of 12 randomised controlled trials of mobile phone based smoking cessation interventions in 11,885 people who wanted to quit smoking. Quit rates were assessed at six months’ follow-up or longer if available.

Seven of the studies used text messages only; the other five combined this with in-person assessments.

A variety of comparison interventions were used, including standard (untailored) advice delivered online or in-person, and access to nicotine replacement therapy.

This Cochrane systematic review followed a high quality methodology and the studies were of moderate quality. Three studies were carried out in the UK, four in the US, two each in Australia and New Zealand, and one in Switzerland. There was variability in the study settings and included populations, and possible variation in which cessation treatments were used alongside the texting support.

What did it find?

  • People who received mobile phone support were more likely to say they had stopped smoking for seven days or more by six months (relative risk [RR] 1.67, 95% confidence interval [CI] 1.46 to 1.90).
  • The six studies using a saliva test to verify whether people had quit at six months also found that mobile phone support increased abstinence compared to control participants (RR 1.83, 95% CI 1.54 to 2.19).
  • When analyses was restricted to the seven studies that used text messages alone they still found a similar increased likelihood of quitting (RR 1.69, 95% CI 1.46 to 1.95), suggesting that there was no additional benefit of text messages combined with in-person contact.
  • No trials assessing mobile phone apps met the inclusion criteria.

What does current guidance say on this issue?

2008 NICE guidelines recommend a variety of support for people wanting to quit smoking, including nicotine replacement therapy, medication, advice, counselling, group therapy, self-help materials. NHS Stop Smoking services include mobile phone support as part of their services.

What are the implications?

This review provides stronger evidence than previously available that mobile phone based support is effective in helping people to stop smoking. The findings are representative of high income countries, and so are relevant to UK settings. GPs and other primary or community care professionals may want to encourage their service users to take up the mobile phone support already available via NHS Stop Smoking services.

Most of the studies included in this review focused on adults, so there may be a need to tailor the approach to support young people wanting to quit smoking. There were no trials of smartphone applications that met the inclusion criteria, so this is an area for future investigation.

Citation and Funding

Whittaker R, McRobbie H, Bullen C, et al. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev. 2016;(4):CD006611.

Cochrane UK and the Tobacco Addiction Cochrane Review Group are supported by NIHR infrastructure funding.

Bibliography

ASH. Smoking statistics. Action on smoking and health; 2016.

Cancer Research UK. Tobacco statistics. Accessed June 2016.

NICE. Stop smoking services. PH10. London: National Institute for Health and Care Excellence; 2008.

NICE. Smoking: brief interventions and referrals. PH1. London: National Institute for Health and Care Excellence; 2006.

NICE. Smoking: workplace interventions. PH5. London: National Institute for Health and Care Excellence; 2007.

NICE. The clinical effectiveness and cost effectiveness of bupropion (Zyban) and Nicotine Replacement Therapy for smoking cessation. TA39. London: National Institute for Health and Care Excellence; 2002.

NICE. Varenicline for smoking cessation. TA123. London: National Institute for Health and Care Excellence; 2007.

NHS. Smokefree NHS. Accessed June 2016.

NHS Choices. Stop smoking treatments. 2014.

Mobile phone-based interventions for smoking cessation

Published on 12 April 2016

Whittaker, R.,McRobbie, H.,Bullen, C.,Rodgers, A.,Gu, Y.

Cochrane Database Syst Rev Volume 4 , 2016

BACKGROUND: Access to mobile phones continues to increase exponentially globally, outstripping access to fixed telephone lines, fixed computers and the Internet. Mobile phones are an appropriate and effective option for the delivery of smoking cessation support in some contexts. This review updates the evidence on the effectiveness of mobile phone-based smoking cessation interventions. OBJECTIVES: To determine whether mobile phone-based smoking cessation interventions increase smoking cessation in people who smoke and want to quit. SEARCH METHODS: For the most recent update, we searched the Cochrane Tobacco Addiction Group Specialised Register in April 2015. We also searched the UK Clinical Research Network Portfolio for current projects in the UK, and the ClinicalTrials.gov register for ongoing or recently completed studies. We searched through the reference lists of identified studies and attempted to contact the authors of ongoing studies. We applied no restrictions on language or publication date. SELECTION CRITERIA: We included randomised or quasi-randomised trials. Participants were smokers of any age who wanted to quit. Studies were those examining any type of mobile phone-based intervention for smoking cessation. This included any intervention aimed at mobile phone users, based around delivery via mobile phone, and using any functions or applications that can be used or sent via a mobile phone. DATA COLLECTION AND ANALYSIS: Review authors extracted information on risk of bias and methodological details using a standardised form. We considered participants who dropped out of the trials or were lost to follow-up to be smoking. We calculated risk ratios (RR) and 95% confidence intervals (CI) for each included study. Meta-analysis of the included studies used the Mantel-Haenszel fixed-effect method. Where meta-analysis was not possible, we presented a narrative summary and descriptive statistics. MAIN RESULTS: This updated search identified 12 studies with six-month smoking cessation outcomes, including seven studies completed since the previous review. The interventions were predominantly text messaging-based, although several paired text messaging with in-person visits or initial assessments. Two studies gave pre-paid mobile phones to low-income human immunodeficiency virus (HIV)-positive populations - one solely for phone counselling, the other also included text messaging. One study used text messages to link to video messages. Control programmes varied widely. Studies were pooled according to outcomes - some providing measures of continuous abstinence or repeated measures of point prevalence; others only providing 7-day point prevalence abstinence. All 12 studies pooled using their most rigorous 26-week measures of abstinence provided an RR of 1.67 (95% CI 1.46 to 1.90; I2 = 59%). Six studies verified quitting biochemically at six months (RR 1.83; 95% CI 1.54 to 2.19). AUTHORS' CONCLUSIONS: The current evidence supports a beneficial impact of mobile phone-based smoking cessation interventions on six-month cessation outcomes. While all studies were good quality, the fact that those studies with biochemical verification of quitting status demonstrated an even higher chance of quitting further supports the positive findings. However, it should be noted that most included studies were of text message interventions in high-income countries with good tobacco control policies. Therefore, caution should be taken in generalising these results outside of this type of intervention and context.

Expert commentary

This review clearly shows that support programmes provided by mobile phones can help people to quit smoking. It is worth noting that this evidence is primarily based on text-messaging interventions evaluated in high income countries with strong tobacco control policies. Evaluations of text-messaging in low income countries and of app-based interventions should be a high research priority. In the meantime, clinicians and policymakers should be confident that text-messaging programme would be a helpful option to offer people interested in quitting.

Dr Jamie Brown, SSA Senior Research Fellow, Deputy Director, Tobacco and Alcohol Research Group, University College London

Expert commentary

Clearly, advice and support for smoking cessation, delivered in text messages which are underpinned by theories of behaviour change is effective, and this effect occurs irrespective of whether other support is used. We already knew that carefully-designed, ‘self-help’smoking cessation interventions work; this review reassures us that these are also useful when delivered digitally. Advice is most likely to be followed and cessation effects greatest when message contents resonate maximally with recipients, so text-based cessation interventions for key subgroups such as pregnant smokers or those with recent, sudden smoking-related adverse events (e.g. heart attack) are required.

Tim Coleman, Professor of Primary Care, University Of Nottingham