Text messaging-based smoking cessation intervention: A narrative review☆
Introduction
Text messaging, also known as short message service (SMS), is an increasingly available and affordable method of communication for many individuals. In the United States, monthly text messaging increased ten-fold from 19 billion in 2006 to 193 billion in 2011 (CTIA The Wireless Association, 2011). The popularity of text messaging and accessibility to mobile phone technology is likely to increase and become a mainstream way of communication and it has great potential to deliver health care and promote behavior change in many individuals, including vulnerable populations. It has been utilized to increase physical activity (Hurling et al., 2007), to improve outcomes in medication compliance (Andrade et al., 2005), and to manage asthma and diabetes (Kim and Kim, 2008, Ostojic et al., 2005). This popular communication technology may also be promising for smoking cessation (Whittaker et al., 2009, Whittaker et al., 2012).
Tobacco use is the leading cause of preventable disease worldwide (World Health Organization, 2009), and existing interventions aimed to reduce tobacco use rates have limited success. In the United States, 70% of adult smokers want to quit smoking but about 52% actually attempt to quit and only 6% are successful (Centers for Disease Control, 2011, Messer et al., 2008). These rates suggest the need to develop effective and innovative interventions that appeal to smokers and can enhance treatment delivery.
Smoking cessation interventions delivered via text messaging may increase treatment accessibility because it requires minimal effort and resources. A recent economic evaluation showed that text-based smoking cessation interventions are cost effective (Guerriero et al., 2012). While traditional face-to-face smoking cessation interventions can be time-consuming and burdensome to both health care providers and clients, text messaging can ease the burden by providing real-time, proactive, and tailored support in a relevant context. Additionally, text messaging may appeal to traditionally hard-to-reach, at-risk populations who experience barriers to smoking cessation interventions, such as adolescents and young adults, socioeconomically disadvantaged individuals and individuals from ethnic/racial minority backgrounds (Cokkinides et al., 2008, Fagan et al., 2004, Garrett et al., 2011), all of whom who have high rates of mobile phone and text messaging use (Smith, 2011).
Several recent reviews have examined the evidence of efficacy of text messaging as a tool for behavior change for an array of targeted behaviors such as disease prevention and management, including smoking cessation (see reviews by Buhi et al., 2012, Cole-Lewis and Kershaw, 2010, Ehrenreich et al., 2011, Fjeldsoe et al., 2009, Free et al., 2013, Gurman et al., 2012, Krishna et al., 2009, Riley et al., 2011). In order to assess the utility of interventions using text messaging specifically for smoking cessations, we need to broaden our understanding of the specific components of the interventions, for whom and how they can be used, and identify areas to improve already existing interventions. Thus, we closely examined the collective evidence on the components of the text messaging interventions solely focusing on smoking cessation.
Two meta-analyses (Whittaker et al., 2009, Whittaker et al., 2012) to-date reviewed the efficacy of text messaging interventions for smoking cessation through evaluating publications that met stringent inclusion criteria and which excluded non-randomized, feasibility studies. The earlier publication reviewed four studies and found evidence of short-term self-reported quitting (RR 2.18, 95% CI 1.80–2.65) at 4- to 6-week end-of-treatment; however, long-term efficacy could not be determined because of heterogeneity in the outcome measures. Additionally, two of the four studies included in the meta-analysis examined both Internet and text messaging interventions; therefore, making it difficult to attribute the positive treatment effects solely to text messaging. In the subsequent publication, Whittaker et al. (2012) reviewed five studies that primarily used text messaging for smoking cessation and demonstrated evidence supporting efficacy up to six months (RR 1.71, 95% CI 1.47–1.99). The results of these meta-analyses indicate that text messaging intervention may be a promising tool for improving smoking cessation outcomes; however, research synthesizing the components of the interventions to inform clinicians and researchers and improve feasibility and efficacy is lacking. Better understanding of these factors may also improve currently existing interventions. Ybarra, Holtrop, Bosi, and Emri (2012) and Cole-Lewis and Kershaw (2010) have noted that because text messaging is an intervention delivery tool, attention to factors such as how the messages are tailored and provided to various target groups needs to be carefully considered. Thus, this current narrative review attempts to expand upon the meta-analyses which examined the efficacy of smoking cessation interventions by Whittaker et al., 2009, Whittaker et al., 2012 by including a wide-range of smoking cessation interventions that used text messaging as a treatment delivery tool and describe the components of the interventions, such as the theoretical model in which the message contents were based, frequency of the text messages, duration of the interventions, other treatments offered in conjunction with the text messaging intervention, and treatment outcome rates. To examine these components and given the relative novelty of this mode of intervention delivery, we included all available feasibility and acceptability studies to identify trends in the development of such intervention.
Section snippets
Methods
Terms related to text messaging such as, “short message service (SMS)” “text message,” “txt,” “multimedia messaging service (MMS),” “mobile phone,” and “cellular phone” combined with “smoking,” “tobacco,” “cigarette,” and “cessation,” published in English in a peer-reviewed journals were searched using Medline, PsycINFO, Scopus, and Google Scholar in June 2013. Relevant reference lists were also reviewed to uncover additional articles. We identified 142 studies through the searches and first
Results
Table 1 describes the intervention and participant characteristics and Table 2 describes the specific text message components.
Discussion
We conducted a comprehensive narrative review of 15 smoking cessation interventions delivered via text messaging on mobile phones (described in 22 studies). Previous meta-analyses of text messaging interventions for tobacco cessation revealed short-term (Whittaker et al., 2009) and long-term efficacy (Whittaker et al., 2012); however, specific components of the interventions and the description of the commonalities and the differences of the interventions and the participants are not yet
Role of funding sources
Funding for this study was provided by National Institute of Drug Abuse (NIDA) grants (P50DA009241 and R01DA026450) The funding institutions had no role in the study design, collection, analysis or interpretation of the data, writing of the manuscript, or the decision to submit the paper for publication.
Contributors
Dr. Kong and Dr. Krishnan-Sarin conceptualized the study. Dr. Kong and Mr. Ells conducted search of the literature to identify articles and reviewed them for eligibility. Dr. Kong and Dr. Camenga reviewed all eligible studies and coded the content areas. Dr. Kong wrote the first draft of the manuscript and all authors contributed to and have approved the final version.
Conflict of interest
All authors declare no conflicts of interest.
References (61)
- et al.
Racial and ethnic disparities in smoking-cessation interventions: Analysis of the 2005 National Health Interview Survey
American Journal of Preventive Medicine
(2008) - et al.
Behavior change interventions delivered by mobile telephone short-message service
American Journal of Preventive Medicine
(2009) - et al.
Smoking cessation support delivered via mobile phone text messaging (txt2stop): A single-blind, randomised trial
The Lancet
(2011) - et al.
Effectiveness of mobile and internet intervention in patients with obese type 2 diabetes
International Journal of Medical Informatics
(2008) - et al.
Latinos report less use of pharmaceutical aids when trying to quit smoking
American Journal of Preventive Medicine
(2004) Computer-tailored smoking cessation materials: A review and discussion
Patient Education and Counseling
(1999)- et al.
Wireless diffusion and mobile computing: Implications for the digital divide
Telecommunications Policy
(2004) - et al.
Smoking cessation with and without assistance: A population-based analysis
American Journal of Preventive Medicine
(2000) - et al.
Text2Quit: Results from a pilot test of a personalized, interactive mobile health smoking cessation program
Journal of Health Communication
(2012) - et al.
A randomized study of cell phone technology to reinforce alcohol abstinence in the natural environment
Addiction
(2013)
A programmable prompting device improves adherence to highly active antiretroviral therapy in HIV-infected subjects with memory impairment
Clinical Infectious Diseases
Factors associated with use of automated smoking cessation interventions: Findings from the eQuit study
Health Education Research
User preferences for a text message-based smoking cessation intervention
Health Education & Behavior
Population-level effects of automated smoking cessation help programs: A randomized controlled trial
Addiction
Smoking cessation using mobile phone text messaging is as effective in Maori as non-Maori
The New Zealand Medical Journal
A digital smoking cessation program delivered through internet and cell phone without nicotine replacement (Happy Ending): Randomized controlled trial
Journal of Medical Internet Research
Happy ending: A randomized controlled trial of a digital multi-media smoking cessation intervention
Addiction
Mobile phones bridging the digital divide for teens in the US?
Future Internet
Mobile phone-based behavioural interventions for health: A systematic review
Health Education Journal
Use of cessation methods among smokers aged 16–24 years—United States, 2003
Morbidity and Mortality Weekly Report
Quitting smoking among adults—United States, 2001–2010
Morbidity and Mortality Report
Text messaging as a tool for behavior change in disease prevention and management
Epidemiologic Reviews
Use of tobacco cessation treatments among young adult smokers: 2005 National Health Interview Survey
American Journal of Public Health
Preventing smoking relapse using text messages: Analysis of data from the txt2stop trial
Nicotine & Tobacco Research
Are mobile phones and handheld computers being used to enhance delivery of psychiatric treatment? A systematic review
The Journal of Nervous and Mental Disease
Eliminating tobacco-related health disparities: Directions for future research
American Journal of Public Health
The effectiveness of mobile-health technology-based health behaviour change or disease management interventions for health care consumers: A systematic review
PLoS Medicine
Txt2stop: A pilot randomised controlled trial of mobile phone-based smoking cessation support
Tobacco Control
Cigarette smoking — United States, 1965–2008
Morbidity and Mortality Weekly Report
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Funding: This work was supported by the National Institute on Drug Abuse at the National Institutes of Health (P50 DA009241, R01 DA026450). All authors have no conflicts of interest.