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Wu YS, Cheung YTD, Lee JJJ, Wong CKH, Ho SY, Li WHC, Yao Y, Lam TH, Wang MP. Effect of Adding Personalized Instant Messaging Apps to a Brief Smoking Cessation Model in Community Smokers in Hong Kong: Pragmatic Randomized Clinical Trial. J Med Internet Res 2024; 26:e44973. [PMID: 38739429 PMCID: PMC11130779 DOI: 10.2196/44973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 09/28/2023] [Accepted: 03/26/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND While text messaging has proven effective for smoking cessation (SC), engagement in the intervention remains suboptimal. OBJECTIVE This study aims to evaluate whether using more interactive and adaptive instant messaging (IM) apps on smartphones, which enable personalization and chatting with SC advisors, can enhance SC outcomes beyond the provision of brief SC advice and active referral (AR) to SC services. METHODS From December 2018 to November 2019, we proactively recruited 700 adult Chinese daily cigarette users in Hong Kong. Participants were randomized in a 1:1 ratio. At baseline, all participants received face-to-face brief advice on SC. Additionally, they were introduced to local SC services and assisted in selecting one. The intervention group received an additional 26 personalized regular messages and access to interactive chatting through IM apps for 3 months. The regular messages aimed to enhance self-efficacy, social support, and behavioral capacity for quitting, as well as to clarify outcome expectations related to cessation. We developed 3 sets of messages tailored to the planned quit date (within 30 days, 60 days, and undecided). Participants in the intervention group could initiate chatting with SC advisors on IM themselves or through prompts from regular messages or proactive inquiries from SC advisors. The control group received 26 SMS text messages focusing on general health. The primary outcomes were smoking abstinence validated by carbon monoxide levels of <4 parts per million at 6 and 12 months after the start of the intervention. RESULTS Of the participants, 505/700 (72.1%) were male, and 450/648 (69.4%) were aged 40 or above. Planning to quit within 30 days was reported by 500/648 (77.2%) participants, with fewer intervention group members (124/332, 37.3%) reporting previous quit attempts compared with the control group (152/335, 45.4%; P=.04). At the 6- and 12-month follow-ups (with retention rates of 456/700, 65.1%, and 446/700, 63.7%, respectively), validated abstinence rates were comparable between the intervention (14/350, 4.0%, and 19/350, 5.4%) and control (11/350, 3.1% and 21/350, 6.0%) groups. Compared with the control group, the intervention group reported greater utilization of SC services at 12 months (RR 1.26, 95% CI 1.01-1.56). Within the intervention group, engaging in chat sessions with SC advisors predicted better validated abstinence at 6 months (RR 3.29, 95% CI 1.13-9.63) and any use of SC services (RR 1.66, 95% CI 1.14-2.43 at 6 months; RR 1.67, 95% CI 1.26-2.23 at 12 months). CONCLUSIONS An IM-based intervention, providing support and assistance alongside brief SC advice and AR, did not yield further increases in quitting rates but did encourage the utilization of SC services. Future research could explore whether enhanced SC service utilization leads to improved long-term SC outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT03800719; https://clinicaltrials.gov/ct2/show/NCT03800719.
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Affiliation(s)
- Yongda Socrates Wu
- School of Nursing, The University of Hong Kong, Hong Kong, China (Hong Kong)
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | | | - Jay Jung Jae Lee
- School of Nursing, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - William Ho Cheung Li
- School of Nursing, The University of Hong Kong, Hong Kong, China (Hong Kong)
- Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Ying Yao
- School of Nursing, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China (Hong Kong)
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Zhao SZ, Weng X, Luk TT, Wu Y, Cheung DYT, Li WHC, Tong H, Lai V, Lam TH, Wang MP. Adaptive interventions to optimise the mobile phone-based smoking cessation support: study protocol for a sequential, multiple assignment, randomised trial (SMART). Trials 2022; 23:681. [PMID: 35982468 PMCID: PMC9387009 DOI: 10.1186/s13063-022-06502-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) is promising in developing personalised smoking cessation interventions. By using an adaptive trial design, we aim to evaluate the effectiveness of personalised mHealth intervention in increasing smoking cessation. METHODS This study is a two-arm, parallel, accessor-blinded Sequential Multiple-Assignment Randomised Trial (SMART) that randomises 1200 daily cigarette smokers from 70 community sites at two timepoints. In the first phase, participants receive brief cessation advice plus referral assistance to smoking cessation services and are randomly allocated to receive personalised instant messaging (PIM) or regular instant messaging (RIM). In the second phase, PIM participants who are non-responders (i.e. still smoking at 1 month) are randomised to receive either optional combined interventions (multi-media messages, nicotine replacement therapy sampling, financial incentive for active referral, phone counselling, and family/peer support group chat) or continued-PIM. Non-responders in the RIM group are randomised to receive PIM or continued-RIM. Participants who self-report quitting smoking for 7 days or longer at 1 month (responders) in both groups continue to receive the intervention assigned in phase 1. The primary outcomes are biochemical abstinence validated by exhaled carbon monoxide (< 4 ppm) and salivary cotinine (< 10 ng/ml) at 3 and 6 months from treatment initiation. Intention-to-treat analysis will be adopted. DISCUSSION This is the first study using a SMART design to evaluate the effect of adaptive mHealth intervention on abstinence in community-recruited daily smokers. If found effective, the proposed intervention will inform the development of adaptive smoking cessation treatment and benefits smokers non-responding to low-intensity mHealth support. TRIAL REGISTRATION ClinicalTrials.gov NCT03992742 . Registered on 20 June 2019.
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Affiliation(s)
- Sheng Zhi Zhao
- School of Nursing, The University of Hong Kong, Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Xue Weng
- School of Nursing, The University of Hong Kong, Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong. .,Institute of Advanced Studies in Humanities and Social Sciences, Beijing Normal University, Zhuhai, China.
| | - Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Yongda Wu
- School of Nursing, The University of Hong Kong, Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - Derek Yee Tak Cheung
- School of Nursing, The University of Hong Kong, Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong
| | - William Ho Cheung Li
- The Nethersole School of Nursing, Chinese University of Hong Kong, Ma Liu Shui, Hong Kong
| | - Henry Tong
- Hong Kong Council on Smoking and Health, Wan Chai, Hong Kong
| | - Vienna Lai
- Hong Kong Council on Smoking and Health, Wan Chai, Hong Kong
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Pokfulam, Hong Kong
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong.
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Pisinger C, Toxværd CG, Rasmussen M. Are financial incentives more effective than health campaigns to quit smoking? A community-randomised smoking cessation trial in Denmark. Prev Med 2022; 154:106865. [PMID: 34740676 DOI: 10.1016/j.ypmed.2021.106865] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 10/20/2021] [Accepted: 10/30/2021] [Indexed: 11/18/2022]
Abstract
The aim of this community-randomised smoking cessation (SC) trial was to investigate both recruitment and SC-rates in three municipalities offering financial incentives (FIM) to smokers who stop smoking when attending a municipal SC-program and compare these with three municipalities investing in a campaign (CAM) that should encourage smokers to use the SC-program. Furthermore, in a non-randomised matched control design we investigated whether there was a difference in recruitment and SC-rates in the three FIM and the three CAM, comparing each with three matched control municipalities (MCM). Each municipality received approx. $16,000. The FIM rewarded persons who were abstinent when attending the municipal SC-program. The CAM spent the money on a campaign recruiting smokers to the SC-program. Two of three FIM were only partly active in recruiting smokers in the intervention year 2018. An intention-to-treat (ITT) approach was used in analyses. Complete case analyses and multiple imputation were used to address loss to follow-up. No difference in recruitment was found between the CAM and the FIM (p = 0.954), in adjusted analyses. In ITT analyses, FIM achieved significantly higher odds of validated abstinence from smoking at one-year follow-up (OR (95%CI): 1.63(1.1-2.4)), but not of self-reported continuous abstinence after six months than CAM. Compared with no intervention, campaigns increased the recruitment of smokers to the SC-program while financial incentives increased six months abstinence rates. In a randomised trial, no difference was demonstrated in the effect of financial incentives and campaigns to recruit smokers to a SC-program and financial incentives seemed superior to help smokers staying smoke-free for a year. TRIAL REGISTRATION: ClinicalTrials.Gov ID: NCT03849092.
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Affiliation(s)
- Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark; University of Copenhagen, Faculty of Health Sciences, Department of Public Health, Denmark; Danish Heart Foundation, Copenhagen, Denmark.
| | - Cecilie Goltermann Toxværd
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark.
| | - Mette Rasmussen
- WHO-CC, Clinical Health Promotion Centre, The Parker Institute, Bispebjerg & Frederiksberg Hospital, The Capital Region of Denmark, Denmark; Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden.
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Weng X, Wu Y, Luk TT, Li WHC, Cheung DYT, Tong HSC, Lai V, Lam TH, Wang MP. Active referral plus a small financial incentive upon cessation services use on smoking abstinence: a community-based, cluster-randomised controlled trial. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2021; 13:100189. [PMID: 34527982 PMCID: PMC8358160 DOI: 10.1016/j.lanwpc.2021.100189] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 05/19/2021] [Accepted: 05/27/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Many smokers do not use existing free or low-cost smoking cessation services, cost-effective interventions to increase use are needed. METHODS We did a 2-armed cluster randomised controlled trial (cRCT) in Hong Kong, China, to evaluate the effectiveness of active referral plus a small financial incentive on abstinence. Chinese adult smokers who smoked at least 1 cigarette per day were proactively recruited from 70 community sites (clusters). Random allocation was concealed until the recruitment started. The intervention group received an offer of active referral to cessation services at baseline plus an incentive (HK$300/US$38) after using any cessation services within 3 months. The control group received general brief cessation advice. The primary outcomes were biochemically validated abstinence at 3 and 6 months. Operating costs in real-world implementation was calculated. Trial Registry: ClinicalTrials.gov NCT03565796. FINDINGS Between June and September 2018, 1093 participants were randomly assigned to the intervention (n=563) and control (n=530) groups. By intention-to-treat, the intervention group showed higher validated abstinence than the control group at 3 months (8.4% vs. 4.5%, risk ratio [RR] 1.88, 95% CI 1.01-3.51, P=0.046) and 6 months (7.5% vs. 4.5%, RR 1.72, 95% CI 1.01-2.93, P=0.046). Average cost per validated abstinence was lower in the intervention (US$ 421) than control (US$ 548) group. INTERPRETATION This cRCT has first shown that a simple, brief, and low-cost intervention with active referral plus a small monetary incentive was effective in increasing smoking abstinence and smoking cessation service use in community smokers. FUNDING Hong Kong Council on Smoking and Health.
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Affiliation(s)
- Xue Weng
- School of Nursing, the University of Hong Kong, Hong Kong SAR, China
| | - Yongda Wu
- School of Nursing, the University of Hong Kong, Hong Kong SAR, China
| | - Tzu Tsun Luk
- School of Nursing, the University of Hong Kong, Hong Kong SAR, China
| | | | | | | | - Vienna Lai
- Hong Kong Council on Smoking and Health, Hong Kong SAR, China
| | - Tai Hing Lam
- School of Public Health, the University of Hong Kong, Hong Kong SAR, China
| | - Man Ping Wang
- School of Nursing, the University of Hong Kong, Hong Kong SAR, China
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Zhao SZ, Wu YS, Chau SL, Fong DYT, Lam TH, Wang MP. Mobile chat-based support plus nicotine replacement therapy sampling to promote smoking cessation for community smokers: A randomized controlled trial. Tob Induc Dis 2021; 19:32. [PMID: 33927586 PMCID: PMC8078100 DOI: 10.18332/tid/133373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 01/23/2021] [Accepted: 02/15/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Mobile instant messaging could deliver real-time, personalized, interactive smoking cessation support. Nicotine replacement therapy (NRT) is effective in increasing quit attempts and abstinence but is underused. We assessed the feasibility of mobile chat-based intervention combined NRT sampling (NRT-S) on abstinence. METHODS In this two-arm, single-blinded, randomized controlled trial, adult (≥18 years) daily cigarette smokers were proactively recruited from Hong Kong community settings using ‘foot-in-the-door’ approach during December 2017 to March 2018. All participants received brief advice on quitting, 1-week of NRT-S, active referral to smoking cessation services, and were individually randomized (1:1) at baseline. The intervention group received two months of chat-based support via instant messaging. The control group received general smoking cessation text messages. The primary outcome was smoking abstinence validated by exhaled carbon monoxide (<4 ppm) and salivary cotinine (<10 ng/mL) at 3 and 6 months using intention-to-treat analysis. RESULTS A total of 119 participants (80.7% male, 60.5% aged 30–40 years) were randomized and analyzed. Among the 14 and 13 self-reported quitters at 3 and 6 months respectively, only 3 and 1 had biochemical validation. The 3 months validated abstinence rate was 2/62 (intervention) vs 1/57 (control) (AOR=1.07; 95% CI: 0.08–13.65). At 6 months follow-up (68.9% of participants retained), more participants in the intervention group reported quitting (10/62 vs 3/57; AOR=2.83; 95% CI: 0.70–11.30), smoking reduction (20/62 vs 11/57; AOR=1.74; 95% CI: 0.71–4.26), and quit attempts (56/62 vs 44/57; AOR=2.61; 95% CI: 0.88–7.82). Significantly more NRT-S use (39/62 vs 22/57; AOR=2.27; 95% CI: 1.04–4.96) was observed in the intervention group. Participants engaged in mobile chat support (21/62) reported more NRT-S use (76.2% vs 56.1%), although not statistically significant. CONCLUSIONS Mobile chat-based support plus NRT-S was feasible and showed preliminary evidence of increased quitting, smoking reduction, quit attempts, and NRT-S use in proactively recruited community smokers. TRIAL REGISTRATION ClinicalTrials.gov: NCT03574077.
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Affiliation(s)
- Sheng Zhi Zhao
- School of Nursing, The University of Hong Kong, Hong Kong
| | | | - Siu Long Chau
- School of Nursing, The University of Hong Kong, Hong Kong
| | | | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong
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Karelitz JL, McClure EA, Wolford-Clevenger C, Pacek LR, Cropsey KL. Cessation classification likelihood increases with higher expired-air carbon monoxide cutoffs: a meta-analysis. Drug Alcohol Depend 2021; 221:108570. [PMID: 33592559 PMCID: PMC8026538 DOI: 10.1016/j.drugalcdep.2021.108570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/05/2021] [Accepted: 01/10/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Expired-air carbon monoxide (CO) is commonly used to biochemically verify smoking status. The CO cutoff and CO monitor brand may affect the probability of classifying smokers as abstinent, thus influencing conclusions about the efficacy of cessation trials. No systematic reviews have tested this hypothesis. Therefore, we performed a meta-analysis examining whether the likelihood of smoking cessation classification varied due to CO cutoff and monitor brand. METHODS Eligible studies (k = 122) longitudinally assessed CO-verified cessation in adult smokers in randomized trials. Primary meta-regressions separately assessed differences in quit classification likelihood due to continuous and categorical CO cutoffs (Low, 3-4 parts per million [ppm]; [SRNT] Recommended, 5-6 ppm; Moderate, 7-8 ppm; and High, 9-10 ppm); exploratory analyses compared likelihood outcomes between monitor brands: Bedfont and Vitalograph. RESULTS The likelihood of quit classification increased 18% with each 1 ppm increase above the lowest cutoff (3 ppm). Odds of classification as quit significantly increased between each cutoff category and High: 261% increase from Low; 162% increase from Recommended; and 150% increase from Moderate. There were no differences in cessation classification between monitor brands. CONCLUSIONS As expected, higher CO cutoffs were associated with greater likelihood of cessation classification. The lack of CO monitor brand differences may have been due to model-level variance not able to be followed up in the present dataset. Researchers are advised to report outcomes using a range of cutoffs-including the recommended range (5-6 ppm)-and the CO monitor brand/model used. Using higher CO cutoffs significantly increases likelihood of quit classification, possibly artificially elevating treatment strategies.
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Affiliation(s)
- Joshua L Karelitz
- Division of Cancer Control and Population Sciences, UPMC Hillman Cancer Center, University of Pittsburgh, 5150 Centre Ave, Suite 4C, Pittsburgh, PA, 15232, USA; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 5150 Centre Ave, Suite 4C, Pittsburgh, PA, 15232, USA.
| | - Erin A McClure
- Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, 67 President St, MSC 861, Charleston, SC, 29425, USA; Hollings Cancer Center, Medical University of South Carolina, 67 President St, MSC 861, Charleston, SC, 29425, USA
| | - Caitlin Wolford-Clevenger
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1670 University Blvd Birmingham, AL, 35233, USA
| | - Lauren R Pacek
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, 2068 Erwin Road, Room 3038, Durham, NC, 27705, USA
| | - Karen L Cropsey
- Department of Psychiatry and Behavioral Neurobiology, University of Alabama at Birmingham, 1670 University Blvd Birmingham, AL, 35233, USA
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Aonso-Diego G, González-Roz A, Martínez-Loredo V, Krotter A, Secades-Villa R. Episodic future thinking for smoking cessation in individuals with substance use disorder: Treatment feasibility and acceptability. J Subst Abuse Treat 2021; 123:108259. [PMID: 33612193 DOI: 10.1016/j.jsat.2020.108259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 11/09/2020] [Accepted: 12/10/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Smokers with substance use disorders (SUD) smoke approximately four times more than the general population. Current efforts are focused on improving smoking cessation treatments for this population. Episodic future thinking (EFT), a novel intervention aimed at decreasing impulsive choice, has shown promising results for reducing cigarette demand in experimental settings. This feasibility study sought to examine the feasibility and preliminary EFT effects on delay discounting (DD) and nicotine intake reductions throughout treatment. METHOD Smokers in substance use treatment (N = 29; 75.9% males) received an 8-week cognitive-behavioral treatment (CBT) + EFT for smoking cessation. The study assessed feasibility through successful recruitment rates, retention, and adherence to treatment. Participants' satisfaction acted as our acceptability measure. We computed nonparametric range tests to analyze changes in continuous variables. RESULTS Among interested individuals, 42 (43.75%) met the inclusion criteria, and 29 entered the treatment program. Rate of treatment completion was 65.5% (19/29). Mean (SD) sessions attended were 7(1.11), and mean patient satisfaction rating with treatment was 8.83/10. The study observed low compliance with EFT, with 15.8% (3/19) of patients practicing at least 50% of the requested times. CONCLUSIONS CBT + EFT is acceptable for the SUD population. However, future studies should implement some adjustments to improve the adherence and feasibility of EFT, such as reducing the number of practices and temporal intervals in EFT events. Given the small sample size, and the absence of a control group, future larger scale trials are needed to elucidate EFT effects on DD and smoking cessation.
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Affiliation(s)
- Gema Aonso-Diego
- Department of Psychology, University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain.
| | - Alba González-Roz
- Department of Psychology, University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
| | | | - Andrea Krotter
- Department of Psychology, University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
| | - Roberto Secades-Villa
- Department of Psychology, University of Oviedo, Plaza Feijoo, s/n, 33003 Oviedo, Spain
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Okoli CTC, Abufarsakh B, Otachi JK. Quit and win contests in community-dwelling mental and behavioral health populations: A systematic review and pilot feasibility findings. Public Health Nurs 2021; 38:517-527. [PMID: 33427320 DOI: 10.1111/phn.12865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/23/2020] [Accepted: 12/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with mental illnesses (MI) benefit from incentives to promote tobacco cessation. "Quit and Win" contests are community-based approaches that incentivize cessation. However, little is known about "Quit and Win" contest effectiveness among people with MI. AIM To examine the utility of "Quit and Win" contests among people with MI. METHOD This study had two phases: (a) a systematic literature review to explore the potential effectiveness of "Quit and Win" contests for people with MI and (b) a pilot feasibility study of implementing a "Quit and Win" contest among people with MI from a community mental health program (CMHP). RESULTS In phase 1, no reviewed study specifically included people with MI in their sample. Of the four cohort and five randomized controlled studies in the review, the mean reported participant quit rates at the end of "Quit and Win" contests were 76.8% and 28.3%, respectively. In phase 2, within a CMHP, four out of seven participants completed a "Quit and Win" contest, and one individual achieved cessation. CONCLUSION People with MI may benefit from incentive-based tobacco cessation programs. Implementing a "Quit and Win" contests within a CMHP is important and requires more studies to determine feasibility and effectiveness.
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Affiliation(s)
| | | | - Janet K Otachi
- University of Kentucky College of Social Work, Lexington, KY, USA
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Breen RJ, Ferguson SG, Palmer MA. Higher incentive amounts do not appear to be associated with greater quit rates in financial incentive programmes for smoking cessation. Addict Behav 2020; 110:106513. [PMID: 32590220 DOI: 10.1016/j.addbeh.2020.106513] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 05/27/2020] [Accepted: 06/08/2020] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Financial incentive (FI) programmes can promote smoking cessation. While foundational research suggests higher FI amounts may better produce outcomes, confirmation is needed. Further, the optimal amount(s) needed to cost-effectively promote change is unclear. Our objective was to reconfirm whether higher amounts are associated with greater quitting through review of previous programmes, before assessing whether non-linear trends and obvious inflections in this relationship exist which may highlight optimal amounts. METHODS Four databases were searched for controlled or randomised controlled studies which detailed FI programmes for smoking cessation in adults. RESULTS Twenty-six studies were included. Programmes varied in length (3.0-52.0 weeks, median = 12.0), FI provision timing, and longest follow-up (5.5-24.0 months, median = 6.0). The odds ratio of quitting at longest follow-up ranged from 0.32 to 5.89. Maximum FI amounts were between US$106.19 and $4,027.92. Quit rates and amounts were not significantly correlated. Subsequent comparisons to reduce between-study variations were non-significant. Further analyses revealed no evidence of non-linear fits, changes in inflection, or cut-points. CONCLUSIONS While higher FI amounts were not associated with greater quitting within this review, the limited data available and variations in target populations and programme designs unrelated to the amount have undoubtedly influenced results. Findings suggest information on this relationship and optimal FI amounts are not determinable through current evidence. As this information is important for cost-effectiveness evaluations and real-world viability, further investigation is necessary. Laboratory research could provide valuable initial insight. Trials comparing programme efficacy under the identified amounts could then be implemented.
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Affiliation(s)
- Rachel J Breen
- College of Health and Medicine, University of Tasmanian, Australia.
| | | | - Matthew A Palmer
- College of Health and Medicine, University of Tasmanian, Australia
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Weng X, Wang MP, Li HCW, Cheung YTD, Lau CY, Kwong ACS, Lai VWY, Chan SSC, Lam TH. Effects of active referral combined with a small financial incentive on smoking cessation: study protocol for a cluster randomised controlled trial. BMJ Open 2020; 10:e038351. [PMID: 33109654 PMCID: PMC7592296 DOI: 10.1136/bmjopen-2020-038351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 09/26/2020] [Accepted: 09/29/2020] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Evidence-based smoking cessation treatments are effective but underutilised, accentuating the need for novel approaches to increase use. This trial investigates the effects of active referral combined with a financial incentive to use smoking cessation services on smoking abstinence among community smokers. METHODS AND ANALYSIS This ongoing study is a two-arm, assessor-blinded, pragmatic, cluster randomised controlled trial with follow-ups at 1, 2, 3 and 6 months after randomisation. We aim to enrol 1134 daily smokers from 70 community sites (clusters) in Hong Kong. All participants receive Ask, Warn, Advise, Refer, Do-it-again (AWARD) guided advice and a self-help booklet at baseline. Additionally, participants in the intervention group receive an offer of referral to smoking cessation services at baseline and a small financial incentive (HK$300≈US$38) contingent on using any of such services within 3 months. The primary outcomes are bioverified abstinence (exhaled carbon monoxide <4 ppm and salivary cotinine <10 ng/mL) at 3 and 6 months. Secondary outcomes include self-reported 7-day point prevalence of abstinence, smoking reduction rate, quit attempts and the use of smoking cessation services at 3 and 6 months. Intention-to-treat approach and regression models will be used in primary analyses. ETHICS AND DISSEMINATION This protocol has been approved by the Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (IRB reference number: UW 18-318). The results of this trial will be submitted for publication in peer-reviewed journals, and the key findings will be presented at national and international conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry NCT03565796.
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Affiliation(s)
- Xue Weng
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong, China
| | | | | | - Ching Yin Lau
- School of Nursing, University of Hong Kong, Hong Kong, China
| | | | | | | | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China
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Weng X, Luk TT, Suen YN, Wu Y, Li HCW, Cheung YTD, Kwong ACS, Lai VWY, Chan SSC, Lam TH, Wang MP. Effects of simple active referrals of different intensities on smoking abstinence and smoking cessation services attendance: a cluster-randomized clinical trial. Addiction 2020; 115:1902-1912. [PMID: 32149425 DOI: 10.1111/add.15029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/06/2020] [Accepted: 02/28/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Proactive brief cessation advice by a lay counsellor combined with a referral to a smoking cessation service (active referral) is effective in increasing service use and quitting in community smokers. We compared the effect of two modified approaches to referrals on the cessation outcomes in community smokers. DESIGN Three-arm cluster-randomized trial. SETTING General community in Hong Kong. PARTICIPANTS Daily cigarette smokers (n = 1163; 77.7% male). INTERVENTIONS Participants were randomized to receive on-site active referral (OSR, n = 395), where lay counsellors helped participants make appointments with a smoking cessation service of their choice plus tailored reminders; mobile text messaging referral (TMR, n = 385), where participants were encouraged to use a smoking cessation service via text messages; or brief cessation advice only (control, n = 383). MEASUREMENTS The primary outcome was a self-reported 7-day point-prevalence abstinence at 6 months post-treatment initiation. Secondary outcomes included 7-day point-prevalence abstinence at 3 and 18 months, biochemically validated abstinence, smoking reduction and the use of cessation services at 3, 6 and 18 months. FINDINGS Using intention-to-treat analysis, the OSR (17.7%) and TMR (17.1%) groups had significantly higher self-reported abstinence than the control (12.0%) group at 6 months [odds ratio (OR) for OSR versus control = 1.58, 95% confidence interval (CI) = 1.06-2.36; OR for TMR versus control = 1.52, 95% CI = 1.01-2.28; both P < 0.05]. The corresponding validated abstinence rates at 6 months were 7.6, 7.8 and 3.9% (OR for TMR versus control = 2.02, 95% CI = 1.07-3.81; OR for TMR versus control = 2.07, 95% CI = 1.10-3.92; both P < 0.05). Self-reported and validated abstinence were similar at 18 months. OSR groups had higher rates of smoking cessation service use than the control group at all follow-ups (all P < 0.001). The smoking reduction rates were similar in continuing smokers. CONCLUSIONS Simple active referrals (in person or via text messaging) to smoking cessation services increased abstinence rates among smokers in Hong Kong compared with general brief cessation advice. On-site active referral increased the use of smoking cessation services compared with general brief cessation advice.
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Affiliation(s)
- Xue Weng
- School of Nursing, the University of Hong Kong, Pokfulam, Hong Kong
| | - Tzu Tsun Luk
- School of Nursing, the University of Hong Kong, Pokfulam, Hong Kong
| | - Yi Nam Suen
- Department of Psychiatry, the University of Hong Kong, Pokfulam, Hong Kong
| | - Yongda Wu
- School of Nursing, the University of Hong Kong, Pokfulam, Hong Kong
| | | | | | | | | | | | - Tai-Hing Lam
- School of Public Health, the University of Hong Kong, Pokfulam, Hong Kong
| | - Man Ping Wang
- School of Nursing, the University of Hong Kong, Pokfulam, Hong Kong
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Cheung YTD, Chan CHH, Ho KS, Tang C, Lau CWH, Li WHC, Wang MP, Lam TH. Effectiveness of nicotine replacement therapy sample at outdoor smoking hotspots for initiating quit attempts and use of smoking cessation services: a protocol for a cluster randomised controlled trial. BMJ Open 2020; 10:e036339. [PMID: 32269028 PMCID: PMC7170641 DOI: 10.1136/bmjopen-2019-036339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION More than half of the smoking population in Hong Kong are unmotivated to quit. Only about 2% of tobacco users in the territory have ever used cessation aids such as nicotine replacement therapy (NRT). The present study aims to assess the effectiveness of delivering 1-week free NRT sample plus brief intervention to smokers at outdoor smoking hotspots on quit attempts and use of smoking cessation services. METHODS AND ANALYSIS This is a two-arm, pragmatic, multisite, cluster randomised controlled trial (RCT) on the effectiveness of increasing quit attempts, use of cessation service and recruitment outcomes. Trained smoking cessation ambassadors will approach smokers at outdoor smoking hotspots, and deliver brief smoking cessation advice. Recruitment sessions are randomised to intervention or control group (allocation ratio 1:1). Participants in the intervention group (n=550) will receive 1-week free NRT sample (either patch or gum), brief medication advice from an onsite nurse and cessation service referral, whereas participants in control group (n=275) will only receive the brief advice and service referral. The primary outcomes are the proportion of participants who enrol in any cessation service in Hong Kong within 1 month of the recruitment, and the proportion of participants who report quit attempts at 1-month follow-up. Secondary outcomes include self-reported use of NRT, self-reported 7-day tobacco abstinence, 30-day abstinence at 3 months and 6 months, biochemically validated abstinence at 6 months, perceived importance, difficulty and confidence to quit (scale 0-10), and Incremental Behavior Change towards Smoking Cessation. Process outcomes include number of smokers who will be approached, will accept the brief smoking cessation advice or be recruited to participate in the RCT. ETHICS AND DISSEMINATION The Institutional Review Board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster approved the trial (UW 18-118). Findings will be disseminated through funding website, publication and conference presentations. TRIAL REGISTRATION NUMBER NCT03717051.
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Affiliation(s)
| | - Ching Han Helen Chan
- Integrated Centre on Smoking Cessation, Tung Wah Group of Hospitals, Hong Kong, Hong Kong
| | - Kin Sang Ho
- Integrated Centre on Smoking Cessation, Tung Wah Group of Hospitals, Hong Kong, Hong Kong
| | - Celeste Tang
- Integrated Centre on Smoking Cessation, Tung Wah Group of Hospitals, Hong Kong, Hong Kong
| | | | | | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, Hong Kong
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, Hong Kong
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Ho KY, Li WHC, Lam KKW, Wang MP, Xia W, Ho LY, Ho LLK, Lam TH, Chan SSC. Promoting smoking cessation among community-living female smokers by training smoking cessation and reduction ambassadors. J Public Health (Oxf) 2020; 42:53-61. [PMID: 30608601 DOI: 10.1093/pubmed/fdy223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/18/2018] [Accepted: 12/08/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Females are less willing than males to seek help from smoking cessation services; the present study examined how the use of these services by females could be enhanced by training young female ambassadors to deliver a brief intervention. METHODS We collaborated with the Hong Kong Girl Guides Association. Fifty of the association's Girl Guides served as smoking cessation and reduction ambassadors to deliver a brief intervention to at least two female smokers. The effectiveness of the intervention was evaluated by a one-group pre-test and repeated post-test design. We undertook data collection at baseline and at 1, 3 and 6 months. RESULTS In all, 106 female smokers received the brief intervention. At 6-month follow-up, the self-reported abstinence was 12.2%; the biochemically verified prevalence of quitting was 5.7%. Approximately 7% of participants were motivated to use smoking cessation services between baseline and 6 months. CONCLUSIONS This study supports the effectiveness of a brief intervention in promoting smoking cessation for community-living female smokers in Hong Kong. However, the intervention could be enhanced by further promoting the use of smoking cessation services to female smokers.
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Affiliation(s)
- Ka Yan Ho
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - William Ho Cheung Li
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - Katherine Ka Wai Lam
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - Wei Xia
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - Lok Yin Ho
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - Laurie Long Kwan Ho
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, G/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong, China
| | - Sophia Siu Chee Chan
- School of Nursing, The University of Hong Kong, 4/F, William M.W. Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China
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Cheung YTD, Lam TH, Li WHC, Wang MP, Chan SSC. Feasibility, Efficacy, and Cost Analysis of Promoting Smoking Cessation at Outdoor Smoking "Hotspots": A Pre-Post Study. Nicotine Tob Res 2019; 20:1519-1524. [PMID: 28655173 DOI: 10.1093/ntr/ntx147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/21/2017] [Indexed: 11/13/2022]
Abstract
Introduction To motivate smokers to quit, there is a need for enhanced smoking cessation (SC) recruitment and for innovative and proactive approaches to SC. This study evaluated the feasibility, efficacy, and cost of promoting SC in public outdoor areas where smokers gather to smoke (smoking hotspots). Methods We selected 14 smoking hotspots in Hong Kong for SC promotion in 2015. University students were trained as SC ambassadors to deliver brief SC intervention, and to recruit smokers for telephone follow-up. The proportion of smokers accepting the intervention components was recorded. Self-reported abstinence in the past 7 days and knowledge of smoking and health were assessed at the 6-month follow-up. The average costs of each smoker receiving our intervention and quitting were also compared. Results Of 3,080 smokers approached, 1,278 (41.5%) accepted the souvenir and 920 (29.9%) received brief advice. Of the 210 (6.8%) who consented to the follow-up, 24.5% were aged 15-29 and 46.4% were aged 30-49. Of the 151 smokers successfully contacted within 1 month after recruitment, 16 (10.6%; 1.3% of the 1,278 who received any form of intervention) reported abstinence, and their overall knowledge improved. The average costs for a smoker to receive brief advice, consent to follow up by telephone, attempt to quit, and quit successfully at the 6-month follow-up were US$30, US$132, US$601, and US$1,626, respectively. Conclusions Promoting SC at smoking hotspots could be a feasible way to achieve satisfactory quitting outcomes at low cost and is useful in the absence of the strengthening of tobacco policies. Implications Our study indicates that outdoor smoking hotspots are feasible platforms for promoting SC and recruiting smokers for cessation services; satisfactory outcomes can be achieved at a reasonable cost. Our promotion was particularly useful for recruiting young smokers and those who want to quit. It is feasible and efficacious to raise smokers' awareness of SC when other tobacco control policies not feasible. Indoor smoking bans or other substantial tobacco control policies could enhance the efficiency with which SC is promoted.
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Affiliation(s)
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Pokfulam, Hong Kong
| | | | - Man Ping Wang
- School of Nursing, University of Hong Kong, Pokfulam, Hong Kong
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Cheung YTD, Cheung Li WH, Wang MP, Lam TH. Delivery of a Nicotine Replacement Therapy Sample at Outdoor Smoking Hotspots for Promoting Quit Attempts: A Pilot Randomized Controlled Trial. Nicotine Tob Res 2019; 22:1468-1475. [DOI: 10.1093/ntr/ntz138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/05/2019] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Outdoor smoking hotspots are convenient venues for promoting smoking cessation. This randomized controlled trial aimed to obtain proof-of-concept evidence of the feasibility and preliminary effectiveness on quit attempts of delivering a 1-week free nicotine replacement therapy sample (NRTS) to smokers.
Methods
This pilot parallel, single-blinded, two-group (1:1) randomized controlled trial proactively recruited adult smokers in outdoor smoking hotspots in Hong Kong. Smokers consuming at least 10 cigarettes per day and fit for NRT use were individually randomized to receive either a 1-week NRT gum/patch and brief advice lasting 10 minutes (NRTS, n = 50), or receive only brief advice (control, n = 50). The primary outcomes were any self-reported quit attempts (stop smoking for at least 24 hours) at 1- and 3-month telephone follow-up. Risk ratios from log-binomial regression models were used to assess the associations.
Results
The NRTS increased quit attempts at 1-month (14% vs. 10%; adjusted risk ratio = 1.25, 95% CI = 0.43 to 3.61) and 3-month follow-up (26% vs. 12%; adjusted risk ratio = 2.17, 95% CI = 0.89 to 5.27), but the differences were not significant. Trial participation rate was about 81.3%. Around 54% of the intervention group participants used the NRT sample by the first month. The NRT users reported generally positive feedback about the usefulness of NRT sample for smoking cessation. Major factors of not using NRT included bad gum taste and their perception that NRT was not useful.
Conclusions
Delivering NRTS to smokers in outdoor smoking hotspots was feasible and efficacious in increasing NRT use. Additional post-recruitment support to sustain the use of NRT and cessation services is needed.
Implications
Our study supported that smokers at outdoor smoking hotspots can be approached for a brief smoking cessation intervention including an onsite delivery of NRTS. Delivering NRTS and a brief advice on using NRT to these smokers was feasible and efficacious to increase NRT use. A larger trial on the benefits on quit attempts and long-term abstinence is warranted.
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Affiliation(s)
| | | | - Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong, China
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Wang MP, Luk TT, Wu Y, Li WH, Cheung DY, Kwong AC, Lai V, Chan SS, Lam TH. Chat-based instant messaging support integrated with brief interventions for smoking cessation: a community-based, pragmatic, cluster-randomised controlled trial. LANCET DIGITAL HEALTH 2019; 1:e183-e192. [DOI: 10.1016/s2589-7500(19)30082-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 07/02/2019] [Accepted: 07/03/2019] [Indexed: 12/17/2022]
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Notley C, Gentry S, Livingstone‐Banks J, Bauld L, Perera R, Hartmann‐Boyce J. Incentives for smoking cessation. Cochrane Database Syst Rev 2019; 7:CD004307. [PMID: 31313293 PMCID: PMC6635501 DOI: 10.1002/14651858.cd004307.pub6] [Citation(s) in RCA: 94] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Financial incentives, monetary or vouchers, are widely used in an attempt to precipitate, reinforce and sustain behaviour change, including smoking cessation. They have been used in workplaces, in clinics and hospitals, and within community programmes. OBJECTIVES To determine the long-term effect of incentives and contingency management programmes for smoking cessation. SEARCH METHODS For this update, we searched the Cochrane Tobacco Addiction Group Specialised Register, clinicaltrials.gov, and the International Clinical Trials Registry Platform (ICTRP). The most recent searches were conducted in July 2018. SELECTION CRITERIA We considered only randomised controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to smoking cessation incentive schemes or control conditions. We included studies in a mixed-population setting (e.g. community, work-, clinic- or institution-based), and also studies in pregnant smokers. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. The primary outcome measure in the mixed-population studies was abstinence from smoking at longest follow-up (at least six months from the start of the intervention). In the trials of pregnant women we used abstinence measured at the longest follow-up, and at least to the end of the pregnancy. Where available, we pooled outcome data using a Mantel-Haenzel random-effects model, with results reported as risk ratios (RRs) and 95% confidence intervals (CIs), using adjusted estimates for cluster-randomised trials. We analysed studies carried out in mixed populations separately from those carried out in pregnant populations. MAIN RESULTS Thirty-three mixed-population studies met our inclusion criteria, covering more than 21,600 participants; 16 of these are new to this version of the review. Studies were set in varying locations, including community settings, clinics or health centres, workplaces, and outpatient drug clinics. We judged eight studies to be at low risk of bias, and 10 to be at high risk of bias, with the rest at unclear risk. Twenty-four of the trials were run in the USA, two in Thailand and one in the Phillipines. The rest were European. Incentives offered included cash payments or vouchers for goods and groceries, offered directly or collected and redeemable online. The pooled RR for quitting with incentives at longest follow-up (six months or more) compared with controls was 1.49 (95% CI 1.28 to 1.73; 31 RCTs, adjusted N = 20,097; I2 = 33%). Results were not sensitive to the exclusion of six studies where an incentive for cessation was offered at long-term follow up (result excluding those studies: RR 1.40, 95% CI 1.16 to 1.69; 25 RCTs; adjusted N = 17,058; I2 = 36%), suggesting the impact of incentives continues for at least some time after incentives cease.Although not always clearly reported, the total financial amount of incentives varied considerably between trials, from zero (self-deposits), to a range of between USD 45 and USD 1185. There was no clear direction of effect between trials offering low or high total value of incentives, nor those encouraging redeemable self-deposits.We included 10 studies of 2571 pregnant women. We judged two studies to be at low risk of bias, one at high risk of bias, and seven at unclear risk. When pooled, the nine trials with usable data (eight conducted in the USA and one in the UK), delivered an RR at longest follow-up (up to 24 weeks post-partum) of 2.38 (95% CI 1.54 to 3.69; N = 2273; I2 = 41%), in favour of incentives. AUTHORS' CONCLUSIONS Overall there is high-certainty evidence that incentives improve smoking cessation rates at long-term follow-up in mixed population studies. The effectiveness of incentives appears to be sustained even when the last follow-up occurs after the withdrawal of incentives. There is also moderate-certainty evidence, limited by some concerns about risks of bias, that incentive schemes conducted among pregnant smokers improve smoking cessation rates, both at the end of pregnancy and post-partum. Current and future research might explore more precisely differences between trials offering low or high cash incentives and self-incentives (deposits), within a variety of smoking populations.
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Affiliation(s)
- Caitlin Notley
- University of East AngliaNorwich Medical SchoolNorwichUK
| | - Sarah Gentry
- University of East AngliaNorwich Medical SchoolNorwichUK
| | | | - Linda Bauld
- University of EdinburghUsher Institute, College of Medicine and Veterinary MedicineEdinburghUK
| | - Rafael Perera
- University of OxfordNuffield Department of Primary Care Health SciencesOxfordUK
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Luk TT, Li WHC, Cheung DYT, Wong SW, Kwong ACS, Lai VWY, Chan SSC, Lam TH, Wang MP. Chat-based instant messaging support combined with brief smoking cessation interventions for Chinese community smokers in Hong Kong: Rationale and study protocol for a pragmatic, cluster-randomized controlled trial. Contemp Clin Trials 2019; 77:70-75. [PMID: 30593882 DOI: 10.1016/j.cct.2018.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/17/2018] [Accepted: 12/25/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Novel approaches to engage community smokers in smoking cessation are needed as smokers typically lack motivation to quit or use evidence-based tobacco dependence treatment. Mobile instant messaging apps (e.g., WhatsApp, Facebook Messenger) are widely used but under-studied as a mobile health modality for delivering smoking cessation support. This paper presents the rationale and study design of a trial which aims to evaluate the effectiveness of a chat-based intervention using mobile instant messaging combined with brief interventions for community smokers. METHODS This is a two-arm, parallel, accessor-blinded, pragmatic cluster-randomized controlled trial on an estimated 1172 daily cigarette smokers aged ≥18 years proactively recruited from 68 community sites (cluster) throughout Hong Kong. Subjects in intervention group received three months of chat-based, instant messaging support guided by acceptance and commitment therapy and other behavioural change techniques, integrated with brief advice and active referral to a smoking cessation service using the AWARD (Ask, Warn, Advise, Refer, Do-it-again) intervention model. Control group received brief advice to quit plus a self-help booklet at baseline. Outcomes were assessed at 1-, 2-, 3- and 6-month after baseline. The primary outcome is abstinence validated by exhaled carbon monoxide (<4 ppm) and salivary cotinine (<10 ng/mL) at 6-month after baseline. Primary analyses will be based on intention-to-treat. COMMENTS This is the first trial examining the effectiveness of a chat-based cessation support programme combined with brief interventions in promoting abstinence. The intervention model can be adapted for other behavioural change treatments and more advanced digital smoking cessation intervention.
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Affiliation(s)
- Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong
| | | | | | - Sze Wing Wong
- School of Nursing, The University of Hong Kong, Hong Kong
| | | | | | | | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong.
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Weng X, Wang MP, Suen YN, Li WHC, Wu Y, Cheung DYT, Kwong ACS, Lai VWY, Chan SSC, Lam TH. Comparing different intensities of active referral to smoking cessation services in promoting smoking cessation among community smokers: a study protocol of a cluster randomized controlled trial. BMC Public Health 2018; 18:830. [PMID: 29973191 PMCID: PMC6033206 DOI: 10.1186/s12889-018-5782-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 06/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Actively referring smokers to smoking cessation (SC) services could increase quitting and is scalable for the population. The objective of this study is to compare 2 different intensities of SC active referral for smokers in the community of Hong Kong. METHODS/DESIGN This is a single-blind, parallel 3-armed cluster randomized controlled trial (cRCT) consisting of high-intensity SC active referral (HAR Group), low-intensity SC referral by text messaging on promoting SC services use (Text Group) and a control group receives general very brief advice. Biochemically validated daily smokers will be proactively recruited in the community from 68 clusters (recruitment sessions). The primary outcome is self-reported 7-days point prevalence abstinence (PPA) at the 3- and 6- month follow-ups. Secondary outcomes are SC service use, smoking reduction rate (SRR, daily cigarette consumption reduced by ≥50%; excluding quitters) and biochemically validated quit rate (exhaled CO < 4 ppm and salivary cotinine < 10 ng/ml). Outcome assessors and data analysts will be blinded to group allocation. Intention-to-treat principle and Generalized Estimating Equation (GEE) regressions will be used for data analysis. DISCUSSION This will be the first trial on evaluating the efficacy of the 2 different intensities of SC active referral on smoking cessation in community smokers. It is anticipated that the results from this trial can provide evidence to the effectiveness of high-intensity active referral to SC services and low intensity SC referral by using text messaging in achieving smoking abstinence. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02804880 , June 17, 2016.
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Affiliation(s)
- Xue Weng
- School of Nursing, University of Hong Kong, 4/F, William MW Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR
| | - Man Ping Wang
- School of Nursing, University of Hong Kong, 4/F, William MW Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR.
| | - Yi Nam Suen
- Department of Psychiatry, University of Hong Kong, 2/F, New Clinical Building, Queen Mary Hospital, 102 Pokfulam Road, Pokfulam, Hong Kong SAR
| | - William Ho Cheung Li
- School of Nursing, University of Hong Kong, 4/F, William MW Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR
| | - Yongda Wu
- School of Nursing, University of Hong Kong, 4/F, William MW Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR
| | - Derek Yee Tak Cheung
- School of Nursing, University of Hong Kong, 4/F, William MW Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR
| | - Antonio Cho Shing Kwong
- Hong Kong Council on Smoking and Health, Unit 44-2-03, 44/F, Hopewell Centre, 183 Queen's Road East, Wanchai, Hong Kong SAR
| | - Vienna Wai Yin Lai
- Hong Kong Council on Smoking and Health, Unit 44-2-03, 44/F, Hopewell Centre, 183 Queen's Road East, Wanchai, Hong Kong SAR
| | - Sophia Siu Chee Chan
- School of Nursing, University of Hong Kong, 4/F, William MW Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, G/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong SAR
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Wang MP, Suen YN, Li WHC, Lam COB, Wu SYD, Kwong ACS, Lai VW, Chan SS, Lam TH. Intervention With Brief Cessation Advice Plus Active Referral for Proactively Recruited Community Smokers: A Pragmatic Cluster Randomized Clinical Trial. JAMA Intern Med 2017; 177:1790-1797. [PMID: 29059277 PMCID: PMC5820734 DOI: 10.1001/jamainternmed.2017.5793] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Most smoking cessation (SC) clinics are costly, passive, and underused. OBJECTIVE To compare the SC effect of a combined intervention involving brief, model-guided SC advice plus active referral to SC services (active referral group) with those of brief, model-guided SC advice only (brief advice group) and general SC advice only (control group). DESIGN, SETTING, AND PARTICIPANTS A single-blind, 3-arm, pragmatic cluster randomized clinical trial was conducted including 1226 adult daily smokers in the general Hong Kong community proactively recruited to participate in the Quit-to-Win Contest held in 2015. The study was conducted from June 20 to September 24, 2015. Participants were randomly allocated to the active referral (n = 402), brief advice (n = 416), and control (n = 408) groups. Intention-to-treat analysis was used. INTERVENTIONS Brief telephone counseling was offered to the active referral and brief advice groups at 1 and 2 months. Interventions were delivered by SC ambassadors who had undergone a short training period. MAIN OUTCOMES AND MEASURES The primary outcome was the self-reported past 7-day point prevalence of abstinence (PPA) at 6 months. The secondary outcomes were carbon monoxide level-validated abstinence, smoking reduction, and SC service use. RESULTS Participants included 991 (80.8%) men; mean (SD) age was 42.0 (14.8) years. The response rate was 68.2% at 3 and 72.3% at 6 months. The corresponding PPAs were 18.9% and 17.2% in the active referral group-higher than in the brief advice (8.9% and 9.4%; both P ≤ .001) or control (14.0% and 11.5%; P = .03 at 6 months) groups. Compared with the other 2 groups, the active referral group had significantly higher validated abstinence rates (10.2% at 3 months and 9.0% at 6 months, all P < .05) with odds ratios of 2.84 (95% CI, 1.57-5.15) and 2.61 (95% CI, 1.46-4.68) at 3 months, and 1.85 (95% CI, 1.06-3.23) and 1.81 (95% CI, 1.04-3.16) at 6 months in the brief advice and control groups, respectively. The SC service use rate was significantly higher in the active referral group (25.1%) than in either brief advice (2.4%) or control (3.4%) groups at 6 months (P < .001). CONCLUSIONS AND RELEVANCE An intervention involving brief advice and active referral delivered to smokers in the community by volunteers can increase quitting in places where SC services are available but underused. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02539875.
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Affiliation(s)
- Man Ping Wang
- School of Nursing, University of Hong Kong, Hong Kong
| | - Yi Nam Suen
- Department of Psychiatry, University of Hong Kong, Hong Kong
| | | | | | | | | | - Vienna W Lai
- Hong Kong Council on Smoking and Health, Hong Kong
| | - Sophia S Chan
- School of Nursing, University of Hong Kong, Hong Kong
| | - Tai Hing Lam
- School of Public Health, University of Hong Kong, Hong Kong
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Chan SSC, Cheung YTD, Wong YMB, Kwong A, Lai V, Lam TH. A Brief Smoking Cessation Advice by Youth Counselors for the Smokers in the Hong Kong Quit to Win Contest 2010: a Cluster Randomized Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2017; 19:209-219. [PMID: 28755244 DOI: 10.1007/s11121-017-0823-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Smoking cessation counseling by healthcare professionals is effective, but very few healthcare professionals can deliver these interventions in the busy clinical settings. This study aimed to evaluate the effectiveness of a brief smoking cessation advice delivered by briefly-trained youth counselors at the enrolment of an incentive-based smoking cessation campaign. The study design was a cluster 2-arm randomized controlled trial of 831 Chinese adult smokers who were recruited in public areas to participate in the Hong Kong Quit to Win Contest 2010. The intervention group (n = 441) received a 5-min quitting advice from the youth counselors, who were mainly undergraduate nursing students, and a 12-page self-help smoking cessation booklet at the enrolment, while the control group (n = 390) only received the same booklet. Biochemically confirmed quitters at 6-month follow-up could join a lucky draw that offered HK$10,000 (US$1282) cash prize to three winners and HK$4000 gift vouchers to the other 10 winners. Primary outcome was self-reported smoking abstinence at 6-month follow-up. By intention-to-treat, the intervention group had a non-significantly higher self-reported (18.4 versus 13.8%, OR = 1.40, 95% CI 0.96-2.04, p = 0.08) and validated quit rate (9.1 versus 6.7%, OR = 1.40, 95% CI 0.84-2.33, p = 0.20) than the control group at 6-month follow-up. The analysis with multiple imputation for missing data also found similar results. We concluded that the brief on-site advice by trained youth counselors had a modest effect on smoking cessation, but the effect was not significant. Future studies with larger sample size and results from higher participation of the biochemical validation to confirm the effectiveness are warranted.
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Affiliation(s)
- Sophia Siu Chee Chan
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China
| | - Yee Tak Derek Cheung
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 4/F William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China.
| | - Yee Man Bonny Wong
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Antonio Kwong
- Hong Kong Council on Smoking and Health, Hong Kong, China
| | - Vienna Lai
- Hong Kong Council on Smoking and Health, Hong Kong, China
| | - Tai-Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
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