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Guo N, Luk TT, Wu YS, Guo Z, Chu JCL, Cheung YTD, Chan CHH, Kwok TTO, Wong VYL, Wong CKH, Lee JJ, Kwok YK, Viswanath K, Lam TH, Wang MP. Effect of mobile interventions with nicotine replacement therapy sampling on long-term smoking cessation in community smokers: A pragmatic randomized clinical trial. Tob Induc Dis 2023; 21:44. [PMID: 36969982 PMCID: PMC10037427 DOI: 10.18332/tid/160168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/26/2022] [Accepted: 01/31/2023] [Indexed: 03/26/2023] Open
Abstract
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.
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Affiliation(s)
- Ningyuan Guo
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Tzu Tsun Luk
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | | | - Ziqiu Guo
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | | | | | - Ching Han Helen Chan
- Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation, Hong Kong, China
| | - Tyrone Tai On Kwok
- Technology-Enriched Learning Initiative, The University of Hong Kong, Hong Kong, China
| | - Victor Yiu Lun Wong
- Technology-Enriched Learning Initiative, The University of Hong Kong, Hong Kong, China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, School of Clinical Medicine, The University of Hong Kong, Hong Kong, China
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, China
- Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong, China
| | - Jung Jae Lee
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Yu Kwong Kwok
- School of Science and Technology, Hong Kong Metropolitan University, Hong Kong, China
| | - Kasisomayajula Viswanath
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, United States
- Department of Social and Behavioral Sciences, T.H. Chan School of Public Health, Harvard University, Boston, United States
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China
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