Smoking Cessation Support Delivered Via Mobile Phone Text Messaging (txt2stop): A Single-Blind, Randomised Trial

Study Questions:

What are the effects of a mobile phone text-messaging smoking cessation program on biochemically verified continuous smoking abstinence for 6 months?


The authors reported the results of a single-blind, randomized trial of smoking cessation advice and support conducted via mobile phone text messages between October 15, 2007 and June 1, 2009, among smokers willing to make a quit attempt who were ages 16 years or older, and who responded to an advertised solicitation to participate. Participants were randomized to a smoking cessation program (txt2stop) or to a control group of text messages unrelated to quitting. Those in the txt2stop program received mobile phone text messages customized for age, education level, and Fagerstrom score for nicotine addiction. Participants set a quit date within 2 weeks of randomization, and then received five text messages a day for the first 5 weeks, and three a day for the next 26 weeks. Messages, developed with the input of smokers and smoking cessation professionals, included motivational and behavior-change techniques that encourage perseverance, provided positive feedback, emphasized the benefits of quitting and the consequences of smoking, and provided advice on how to quit and stay quit. The primary outcome was self-reported continuous smoking abstinence, biochemically verified at 6 months based on intention to treat. Salivary cotinine testing was used to verify self-reported abstinence at 6 months, with a cutoff of 7 ng/ml of cotinine.


The authors assessed 11,914 volunteers for eligibility, and randomized 5,800, of whom 2,915 were allocated to the intervention and 2,885 to the control group. Outcome data were available for 5,524 (95%) of participants. In 6 months, significantly more subjects in the txt2stop group had biochemically verified continuous abstinence, compared with controls (10.7% vs. 4.9%; relative risk [RR], 2.20; 95% confidence interval [CI], 1.80-2.68; p < 0.0001). There was no significant heterogeneity shown in any of the prespecified subgroups, based on age, employment type, Fagerstrom score, or the use of other smoking cessation products or services. The results were similar when participants lost to follow-up were treated as smokers in the analysis (268 of 2,911 [9%] vs. 124 of 2,789 [4%]; RR, 2.14; 95% CI, 1.74-2.63; p < 0.001), as well as if those lost to follow-up were excluded (268 of 2,735 [10%] vs. 124 of 2,789 [4%]; RR, 2.20; 95% CI, 1.79-2.71; p < 0.0001).


The authors concluded that the txt2stop smoking cessation program significantly improved smoking cessation rates at 6 months. They also opined that this program should be considered for inclusion in smoking cessation services.


Previously, smoking cessation support delivered via mobile phone text messaging had been reported to double quit rates. Previous studies lacked biochemical verification, however. In the present study, regardless of the subgroup analyzed or how subjects lost to follow-up were analyzed, the authors demonstrated a more than doubling of the rate of biochemically verified, sustained smoking cessation at 6 months. It should be noted that almost every participant in the study had made previous quit attempts. Although these impressive relative results should inspire optimism, as should the potentially additive effect of this text messaging intervention on top of other smoking cessation approaches, it should be noted that the absolute success rate reported (10.7% verified abstinence at 6 months) suggests that the resistance of tobacco addiction still lacks the sought-after panacea.

Clinical Topics: Prevention, Smoking

Keywords: Volunteers, Nicotine, Cellular Phone, Single-Blind Method, Tobacco Use Cessation Products, Smoking, Cotinine, Tobacco, Behavior, Addictive, Cardiovascular Diseases, Confidence Intervals, Tobacco Use Disorder, Text Messaging, Smoking Cessation

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