Internet and Mobile Phone-Based Interventions for Smoking Cessation

A Cochrane review [Abstract] 1 included 26 studies with a total of 33 849 subjects. The interventions were predominantly text messaging-based, although several paired text messaging with in-person visits or initial assessments. Automated text messaging interventions were more effective than minimal smoking cessation support (RR 1.54, 95% CI 1.19 to 2.00; 13 trials, n=14 133, I²=71%). Text messaging added to other smoking cessation interventions was more effective than the other smoking cessation interventions alone (RR 1.59, 95% CI 1.09 to 2.33; 4 trials, n=997, I²=0%). Smartphone apps improved the likelihood of smoking cessation (RR 1.00, 95% CI 0.66 to 1.52; 5 trials, n=3079; I²=59%).

Another Cochrane review [Abstract] 2 included 67 studies with over 35 969 participants. There were only 4 RCTs conducted in adolescence or young adults that were eligible for meta-analysis.Adults: A tailored and interactive Internet intervention was better than a non-active control (RR 1.15, 95% CI 1.01 to 1.30, 8 trials, n = 6786, I²=58%). Internet intervention was not better than an active control (RR 0.92, 95% CI 0.78 to 1.09, 5 trials, n = 3806, I²=0%). An Internet programme plus behavioural support was more effective than a non-active control (RR 1.69, 95% CI 1.30 to 2.18, 5 trials, n=2334, I²=60%). There was no difference between the Internet plus behavioural support compared to active control (RR 1.00, 95% CI 0.84 to 1.18, n = 2769, I²=0%). The tailored messages produced higher cessation rates compared to non-tailored control, but the estimate was not precise (RR 1.17, 95% CI 0.97 to 1.41, 3 trials, n = 4040, I²=57%)

A parallel, 2-group, RCT 5 in the United States included 618 adult smokers who signed up for text messages during website registration.Interventions: The treatment arm (WEB+TXT) received access to the website and text messaging. The control arm (WEB) received access to the website alone. Abstinence rates at 9 months were 23.1% among WEB+TXT and 23.2% among WEB (OR 1.00, 95% CI 0.69 to1.45; P = 0.99). Satisfaction metrics favored WEB+TXT.

A review and meta-analysis 3 included 19 488 smoking subjects. The combination of medication and behavioral counseling was associated with a quit rate of 15.2% over 6 months compared with a quit rate of 8.6% with brief advice or usual care. Brief or intensive behavioral support can be delivered effectively in person or by telephone, text messages, or the internet.

A parallel-group, two-arm, superiority, RCT 4 including 905 subjects assessed the short-term (3 months) effectiveness of the national German quitline (up to 6 telephone counselling calls) for smoking cessation. The control group received a self-help brochure. Individuals allocated to the telephone counselling condition were more likely to achieve 7-day point prevalence abstinence at post-assessment compared to those allocated to the self-help brochure condition (41.1% vs. 23.1%; OR = 2.3, 95% CI 1.7, 3.1).

Comment: The quality of evidence is downgraded by study quality (mostly self-reported results).

References

• Whittaker R, McRobbie H, Bullen C et al. Mobile phone text messaging and app-based interventions for smoking cessation. Cochrane Database Syst Rev 2019;(10):CD006611. [PubMed]
• Taylor GMJ, Dalili MN, Semwal M et al. Internet-based interventions for smoking cessation. Cochrane Database Syst Rev 2017;(9):CD007078. [PubMed]
• Rigotti NA, Kruse GR, Livingstone-Banks J, et al. Treatment of Tobacco Smoking: A Review. JAMA 2022;327(6):566-577[PubMed]
• Maspero S, Delle S, Kraus L, et al. Short-term effectiveness of the national German quitline for smoking cessation: results of a randomized controlled trial. BMC Public Health 2024;24(1):588[PubMed]
• Graham AL, Papandonatos GD, Cha S, et al. Effectiveness of an optimized text message and Internet intervention for smoking cessation: A randomized controlled trial. Addiction 2022;117(4):1035-1046[PubMed]