Two decades ago, multimedia CD-ROMs were the cutting edge of intervention technology; one decade ago, interactive websites were at the forefront; today, “there’s an app for that.” But is there anything particularly effective about the newest intervention modality? Unlike CDs and websites, interventions that use a mobile platform allow messages to reach users rapidly no matter where they are. Continuing the BASIS Special Series on Addiction and Technology, this week’s ASHES reviews a study evaluating a text-message based intervention for smoking cessation (Naughton et al., 2014).
- Naughton et al. used a randomized controlled trial to compare (1) a conventional smoking cessation intervention delivered within a primary care setting to (2) the combination of the primary care smoking cessation intervention with an SMS-based mobile intervention program, iQuit.
- In the primary care smoking cessation intervention (treatment as usual; TAU), practitioners evaluate patients’ smoking, deliver advice about smoking cessation, agree upon a quit date with their patients, offer cessation aids (e.g., a nicotine patch), and schedule follow-up visits.
- iQuit adds an individually-tailored report and consequent set of text messages to the above intervention. iQuit sends text messages 0-3 times per day, depending on an individualized plan, for 90 days. These messages are tailored to patients’ answers to a set of questions about their smoking; these questions are asked at baseline, 3 weeks, and 7 weeks post-baseline. iQuit also allows users to request texts when they are in potential relapse situations.
- Participants included 602 patients (i.e., 299 in the iQuit condition; 303 in the TAU condition) at 32 general practices in eastern England who smoked cigarettes and were willing to attempt to quit smoking.
- Outcome measures included:
- Past-14 day abstinence, assessed at 4 week follow-up appointment via CO reading;
- Self-reported past-14 day abstinence at 8 weeks;
- Self-reported past-90 day abstinence at 6 months;
- Self-reported past-6 month abstinence at 6 months
- Of the 299 participants who received the iQuit intervention:
- 18.5% used the relapse situation text request feature;
- 18.9% discontinued the receipt of texts at some point during the 90-day trial.
- Figure 1 displays the abstinence rates for participants receiving the conventional primary care intervention (TAU) and those receiving the iQuit individually-tailored messages.
- Participants in the iQuit and TAU conditions did not differ significantly in their abstinence at any given time point.
- Participants in the iQuit condition differed from those in the TAU condition on the two measures of long term abstinence: A greater percentage of participants in the iQuit condition than those in the TAU condition reported 6 month continuous abstinence and qualified for abstinence across all time points.
Figure 1. Abstinence Rates for Patients in the TAU and iQuit Smoking Cessation Conditions
Note. Continuous abstinence for 6 months is operationalized as qualifying for abstinence on each of the other four abstinence measures. *Difference between conditions, p < .05.
- Measures of long term abstinence, on which the conditions differed, relied on self report, which is vulnerable to various biases and recall errors.
- Attrition at each time point ranged from 16-30%. It is possible that those who completed the follow-up measures differed from those who did not in ways that affected study outcomes.
The current study offers evidence that text-message based interventions for smoking cessation might improve smokers’ chances of maintaining abstinence across time. In particular, approximately 20% of the intervention participants in this trial made use of the relapse situation feature of iQuit. The instant availability of help in these instances might be a particularly unique and valuable contribution of mobile platform based interventions such as this one.
- Sarah Nelson
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Naughton, F., Jamison, J., Boase, S., Sloan, M., Gilbert, H., Prevost, A. T., . . . Sutton, S. (2014). Randomized controlled trial to assess the short-term effectiveness of tailored web- and text-based facilitation of smoking cessation in primary care (iQuit in Practice). Addiction, 109, 1184-1193.