A study published Online First and in this week's Lancet shows that smokers are twice as likely to quit their habit when receiving motivational text messages compared with those receiving placebo texts. The trial is the first such study to verify quit rates using biochemical testing. The study is by Dr Caroline Free, Clinical Trials Research Unit, London School of Hygiene and Tropical Medicine, London, UK, and colleagues, and was part-funded by the UK Medical Research Council.
The trial randomly allocated 5800 UK smokers who were willing to quit to either the txt2stop intervention (2915 smokers) or to a control group receiving only non-motivational texts (2885 smokers). Motivational texts included encouragement up to the actual quit day, advice on keeping weight off while quitting, and help dealing with craving. For example, the craving text read: "Cravings last less than 5 minutes on average. To help distract yourself, try sipping a drink slowly until the craving is over." Participants in the intervention group using pay-as-you-go mobile phone schemes were given a £20 top-up voucher to provide sufficient credit to participate in the intervention. Non-motivational texts simply thanked people for their participation, requested confirmation of contact details, or said a range of other things not connected to smoking itself. Abstinence from smoking was confirmed by testing the saliva of participants, who posted off their samples for analysis. Participants reporting abstinence whose test showed that they were smokers were counted as smokers in the analysis.
Participants in the txt2stop group were more than twice as likely to report biochemically-verified quitting than those in the control group (10•7% v 4•9% respectively). The authors conclude: "On the basis of these results the txt2stop intervention should be considered as an addition to existing smoking cessation services. In this trial the intervention was effective on its own and when used alongside other smoking cessation interventions. To scale up the txt2stop intervention for delivery at a national or international level would be technically easy. The intervention might require some adaptation, translation into other languages, and local evaluation before delivery to other populations. The intervention is low cost and likely to be highly cost-effective. A cost-effectiveness analysis of txt2stop will be reported separately."
Dr Free adds*: "Text messages are a very convenient way for smokers to receive support to quit. People described txt2stop as like having a 'friend' encouraging them or an 'angel on their shoulder'. It helped people resist the temptation to smoke."
In a linked Comment, Dr Derrick A Bennett and Dr Jonathan R Emberson Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, UK, point out that due to the rapid growth of the mobile phone sector in poor countries, "the lessons learned from the txt2stop trial could therefore not only provide a new approach to smoking cessation in high-income and middle-income countries, but could also provide a useful starting point for implementing behavioural change in resource-poor settings."
For more information or to interview Dr Caroline Free please contact the LSHTM Press Office. T) +44 (0) 207 927 2802 E) paula.fentiman@lshtm.ac.uk
Dr Derrick A Bennett, Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, UK. T) +44 (0) 1865 743949 E) derrick.bennett@ctsu.ox.ac.uk
Notes to editors: A case study and video footage are available on request.
*A quote direct from Dr Free and not found in the text of the Article
Journal
The Lancet