Can programmes delivered by mobile phones help people to stop smoking?

Background

Mobile phones are being used more to support healthy lifestyles. We wanted to know whether they could be used to support people to stop smoking. We reviewed the evidence on the effect of quit smoking programmes delivered by mobile phones to people who want to stop smoking.

Study characteristics

We found 12 studies up to April 2015 that could be included. These studies included 11,885 people who were monitored to see if they managed to quit smoking and if they were still quit six months later.

Key results

When the information from all the studies were combined, smokers who received the support programmes were around 1.7 times more likely to stay quit than smokers who did not receive the programmes (9.3% quit with programmes compared with 5.6% quit with no programmes). Most of the studies were of programmes relying mainly on text messages.

Quality and completeness of the evidence

We are moderately confident in the findings of this review. However, all studies took place in high-income countries and mainly used text messages, so these results may not hold true in people from poorer countries or with other types of mobile phone programmes. There were no published trials of smartphone 'apps' to help people stop smoking that met the inclusion criteria.

Authors' conclusions: 

The current evidence supports a beneficial impact of mobile phone-based smoking cessation interventions on six-month cessation outcomes. While all studies were good quality, the fact that those studies with biochemical verification of quitting status demonstrated an even higher chance of quitting further supports the positive findings. However, it should be noted that most included studies were of text message interventions in high-income countries with good tobacco control policies. Therefore, caution should be taken in generalising these results outside of this type of intervention and context.

Read the full abstract...
Background: 

Access to mobile phones continues to increase exponentially globally, outstripping access to fixed telephone lines, fixed computers and the Internet. Mobile phones are an appropriate and effective option for the delivery of smoking cessation support in some contexts. This review updates the evidence on the effectiveness of mobile phone-based smoking cessation interventions.

Objectives: 

To determine whether mobile phone-based smoking cessation interventions increase smoking cessation in people who smoke and want to quit.

Search strategy: 

For the most recent update, we searched the Cochrane Tobacco Addiction Group Specialised Register in April 2015. We also searched the UK Clinical Research Network Portfolio for current projects in the UK, and the ClinicalTrials.gov register for ongoing or recently completed studies. We searched through the reference lists of identified studies and attempted to contact the authors of ongoing studies. We applied no restrictions on language or publication date.

Selection criteria: 

We included randomised or quasi-randomised trials. Participants were smokers of any age who wanted to quit. Studies were those examining any type of mobile phone-based intervention for smoking cessation. This included any intervention aimed at mobile phone users, based around delivery via mobile phone, and using any functions or applications that can be used or sent via a mobile phone.

Data collection and analysis: 

Review authors extracted information on risk of bias and methodological details using a standardised form. We considered participants who dropped out of the trials or were lost to follow-up to be smoking. We calculated risk ratios (RR) and 95% confidence intervals (CI) for each included study. Meta-analysis of the included studies used the Mantel-Haenszel fixed-effect method. Where meta-analysis was not possible, we presented a narrative summary and descriptive statistics.

Main results: 

This updated search identified 12 studies with six-month smoking cessation outcomes, including seven studies completed since the previous review. The interventions were predominantly text messaging-based, although several paired text messaging with in-person visits or initial assessments. Two studies gave pre-paid mobile phones to low-income human immunodeficiency virus (HIV)-positive populations - one solely for phone counselling, the other also included text messaging. One study used text messages to link to video messages. Control programmes varied widely. Studies were pooled according to outcomes - some providing measures of continuous abstinence or repeated measures of point prevalence; others only providing 7-day point prevalence abstinence. All 12 studies pooled using their most rigorous 26-week measures of abstinence provided an RR of 1.67 (95% CI 1.46 to 1.90; I2 = 59%). Six studies verified quitting biochemically at six months (RR 1.83; 95% CI 1.54 to 2.19).

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