Can interventions delivered by mobile phones help people to stop smoking?

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

Published Online:

November 14, 2012

Combined, evidence from five studies included in this review finds that interventions delivered by mobile phones can help people stop smoking, though the results from individual studies varied. The interventions included in this review mainly use text messaging to provide motivation, support and tips for quitting. There are no published studies on smartphone applications designed to help people stop smoking.

Abstract (click to read)

Background:

Innovative and effective smoking cessation interventions are required to appeal to those who are not accessing traditional cessation services. Mobile phones are widely used and are now well-integrated into the daily lives of many, particularly young adults. Mobile phones are a potential medium for the delivery of health programmes such as smoking cessation.

Objectives:

To determine whether mobile phone-based interventions are effective at helping people who smoke, to quit.

Search strategy:

For the most recent update, we searched the Cochrane Tobacco Addiction Group Specialised Register in May 2012. We also searched UK Clinical Research Network Portfolio for current projects in the UK and the ClinicalTrials register for on-going or recently completed studies. We searched through the reference lists of identified studies and attempted to contact the authors of ongoing studies, with no restrictions placed on language or publication date.

Selection criteria:

We included randomized or quasi-randomized trials. Participants were smokers of any age who wanted to quit. Studies were those examining any type of mobile phone-based intervention. 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:

Information on risk of bias and methodological details was extracted using a standardised form. Participants who dropped out of the trials or were lost to follow-up were considered to be smoking. We calculated risk ratios (RR) for each included study. Meta-analysis of the included studies was undertaken using the Mantel-Haenszel fixed-effect method. Where meta-analysis was not possible, summary and descriptive statistics are presented.

Main results:

Five studies with at least six month cessation outcomes were included in this review. Three studies involve a purely text messaging intervention that has been adapted over the course of these three studies for different populations and contexts. One study is a multi-arm study of a text messaging intervention and an internet QuitCoach separately and in combination. The final study involves a video messaging intervention delivered via the mobile phone. When all five studies were pooled, mobile phone interventions were shown to increase the long term quit rates compared with control programmes (RR 1.71, 95% CI 1.47 to 1.99, over 9000 participants), using a definition of abstinence of no smoking at six months since quit day but allowing up to three lapses or up to five cigarettes. Statistical heterogeneity was substantial as indicated by the I² statistic (I² = 79%), but as all included studies were similar in design, intervention and primary outcome measure, we have presented the meta-analysis in this review.

Authors' conclusions:

The current evidence shows a benefit of mobile phone-based smoking cessation interventions on long-term outcomes, though results were heterogenous with findings from three of five included studies crossing the line of no effect. The studies included were predominantly of text messaging interventions. More research is required into other forms of mobile phone-based interventions for smoking cessation, other contexts such as low income countries, and cost-effectiveness.

This record should be cited as:

Whittaker R, McRobbie H, Bullen C, Borland R, Rodgers A, Gu Y. Mobile phone-based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD006611. DOI: 10.1002/14651858.CD006611.pub3

Assessed as up to date:

September 29, 2012

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective are mobile phone-based interventions at helping smokers to quit?

Bottom line:

The interventions in this review included: a purely text message-based programme with automated proactive text messages and some reactive components (for help with cravings) and interactive (polls/quizzes) components; and an automated email/daily internet page and mobile phone text/audio message programme with proactive and reactive components. Text message mobile phone programmes were effective in the short term (6 weeks) only, and a combined internet and mobile phone programme was effective for up to 12 months (in terms of self-reported quitting).

Caveat:

In this review, only one study attempted biochemical verification of quitting at 6 months, and one at 6 weeks. In programmes aimed at young people, where minimal direct contact and anonymity appear to be desired elements, attempting verification may have adverse effects on the collection of follow-up data.

Context:

Innovative effective smoking cessation interventions are required to appeal to those who are not accessing traditional cessation services. Mobile phones are widely used and are now well-integrated into the daily lives of many, particularly young adults. Mobile phones are a potential medium for the delivery of health programmes, such as smoking cessation.

Cochrane Systematic Review:

Whittaker R et al. Mobile phone-based interventions for smoking cessation. Cochrane Reviews 2009, Issue 4. Article No. CD006611. DOI: 10.1002/14651858.CD006611.pub2. This review contains 4 studies involving 2601 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Lungs & airways > Smoking cessation > Non-pharmacological interventions

Lungs & airways > Smoking cessation > Psychological approaches

Tobacco, drugs, & alcohol dependence > Tobacco > Non-pharmacological interventions

Tobacco, drugs, & alcohol dependence > Tobacco > Psychological approaches

Cochrane Summaries

Independent high-quality evidence for health care decision making

Can interventions delivered by mobile phones help people to stop smoking?

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