Summary: | Introduction
Mobile interventions enable personalized behavioral support that
could improve smoking cessation (SC) in smokers ready to quit. Scalable
interventions, including unmotivated smokers, are needed. We evaluated the effect
of personalized behavioral support through mobile interventions plus nicotine
replacement therapy sampling (NRT-S) on SC in Hong Kong community smokers.
Methods
A total of 664 adult daily cigarette smokers (74.4% male, 51.7% not
ready to quit in 30 days) were proactively recruited from smoking hotspots and
individually randomized (1:1) to the intervention and control groups (each,
n=332). Both groups received brief advice and active referral to SC services. The
intervention group received 1-week NRT-S at baseline and 12-week personalized
behavioral support through SC advisor-delivered Instant Messaging (IM) and
a fully automated chatbot. The control group received regular text messages
regarding general health at a similar frequency. Primary outcomes were carbon
monoxide-validated smoking abstinence at 6 and 12 months post-treatment
initiation. Secondary outcomes included self-reported 7-day point-prevalence
and 24-week continuous abstinence, quit attempts, smoking reduction, and SC
service use at 6 and 12 months.
Results
By intention-to-treat, the intervention group did not significantly increase
validated abstinence at 6 months (3.9% vs 3.0%, OR=1.31; 95% CI: 0.57–3.04) and
12 months (5.4% vs 4.5%, OR=1.21; 95% CI: 0.60–2.45), as were self-reported
7-day point-prevalence abstinence, smoking reduction, and SC service use at 6 and
12 months. More participants in the intervention than control group made a quit
attempt by 6 months (47.0% vs 38.0%, OR=1.45; 95% CI: 1.06–1.97). Intervention
engagement rates were low, but engagement in IM alone or combined with
chatbot showed higher abstinence at 6 months (adjusted odds ratios, AORs=4.71
and 8.95, both p<0.05).
Conclusions
Personalized behavioral support through mobile interventions plus
NRT-S did not significantly improve abstinence in community smokers compared
to text only messaging. The suboptimal intervention engagement needs to be
addressed in future studies.
TRIAL REGISTRATION
ClinicalTrials.gov NCT04001972.
|