Smoking Cessation
Conditions
Keywords
Cellular Phone, Mobile Phone, Cognitive Behavior Therapy, Technology, Smoking cessation, young adults
Brief summary
The investigators developed a text messaging-based smoking cessation program called SMS (Stop My Smoking) USA. It was tailored for the unique needs and smoking habits of young adults. The investigators hypothesized that those in the SMS USA intervention would be significantly more likely to be quit at 6-months compared to the attention-matched control group.
Detailed description
About one in four young adults are current smokers. Although over half report the desire to quit or cut down, quit rates in this age group have remained stagnant in the last ten years. Text messaging may represent a compelling intervention delivery method for smoking cessation for young adults because it is a medium they have widely adopted. Cell phone interventions also are unique because of their 'always on' capability - interventions are never far from the young adult's reach and they are received automatically instead of requiring the participant to initiate contact in order to receive the information. Dr. Ybarra, along with Drs. Holtrop and Graham, have developed SMS Turkey, an innovative behavioral intervention that uses text messaging to deliver CBT-based smoking cessation information to participants daily. Successful use of text messaging to deliver smoking cessation programs has been reported by Rodgers and colleagues in New Zealand and a replication study they are leading in the United Kingdom. These data provide optimism for the feasibility of text messaging-based smoking cessation programs in the United States. Using qualitative methods to inform design and content, and quantitative methods to assess the feasibility of the program, we propose to design and test SMS (Stop My Smoking) USA, a cell-phone based smoking cessation program for young adults ages 18-25. This innovative smoking cessation program uses technology widely adopted by young adults, an under-targeted population, to deliver a proactive, cognitive behavioral therapy (CBT)-based intervention. Our multidisciplinary team of researchers brings together expertise in Internet health and the design of tailored smoking cessation interventions.
Interventions
BEHAVIORALSMS USA
Intervention participants receive text messages daily pre-and post-quit. Everyone receives messages 14 days prior to the Quit day, and through the day after Quit. Then, participants are 'pathed' to particular messages based upon their self-reported smoking status at Day 2 and Day 7 post quit, respectively. Those who are successful at quitting receive messages aimed at relapse prevention whereas those who have slipped receive messages aimed at getting the person to recommit to quitting and trying again.
Sponsors
Michigan State University
The University of Texas Health Science Center, Houston
National Cancer Institute (NCI)
Center for Innovative Public Health Research
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Subject)
Eligibility
Sex/Gender
ALL
Age
18 Years to 25 Years
Healthy volunteers
Yes
Inclusion criteria
* 28 cigarettes or more per week (at least 4/day) and on at least 6 days/week. * Owning a text-capable cell phone and cognizant of how to send and receive text messages * Currently enrolled or intending to enroll in an unlimited text messaging plan * Enrolled with a cell phone carrier that was compatible with the program software * Agree to verification of smoking cessation status by a significant other * Able to read and write in English * Informed consent
Exclusion criteria
None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Continuous Abstinence at 3-months Assessed in Accordance With the NIH Behavior Change Consortium's Recommendations | 3-months post-quit | Continuous abstinence is defined as 5 or fewer cigarettes smoked since one's quit date. The question was asked based upon West et al., 2005: Have you smoked at all, even just a puff, since \[insert quit date\]? If yes, the respondent will be probed for how many cigarettes were smoked. Responses will be categorized into one of three options: A) No, not a puff; B) 1-5 cigarettes; C) More than 5 cigarettes. Self-reported cessation is confirmed by a significant other. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Point Prevalence | 4-weeks post-quit | A cigarette, even just a puff, within the last 7 days (yes/no). |
| Continuous Abstinence at 4-weeks Post-quit | 4 weeks post-quit | Smoking five or fewer cigarettes since quit day at 4 weeks post-quit as verified by a significant other |
Countries
United States
Participant flow
Recruitment details
Participants were recruited nationally through online advertisements (e.g. Craigslist) between May 3, 2011 and August 4, 2011. Smokers expressed their interest by completing an online screener form, which was then e-mailed to the project coordinator.
Pre-assignment details
Of the 1,916 people who expressed interest, 585 (31%) were eligible for the study. Of these 585, contact was not made with 49% (n = 284). Fifteen percent (n=90) declined to participate. 211 eligible participants consented to participate and were randomized into the study. 47 terminated after randomization (i.e. did not complete enrollment process)
Participants by arm
| Arm | Count |
|---|---|
| Smoking Cessation Text Messaging 6-week smoking cessation program delivered via daily text messages. Stop My Smoking (SMS) USA is a text messaging-based smoking cessation program tailored to the experiences of young adult smokers. Content was tailored based on participant's stage of quitting (i.e. pre-quit, quit day, early-quit, late-quit, relapse). Based on the typical trajectory, content paths were created for participants based on whether or not they were smoking 2 days after quit day; and again at 7 days after quit day. The intervention group had access to Text Buddy (another person in the program that a participant was assigned to so they could text one another for support anonymously and Text Crave (immediate, on demand messages aimed at helping the participant through a craving). | 101 |
| The Control Group Control group participants received a text-messaging program that was similar to the intervention program on the number of text messages received per day across the 6 weeks. Message content was aimed at improving one's sleep and exercise habits within the context of how it would help the participant quit smoking. Messages were not tailored based on quitting stage (e.g., Pre-Quit vs. Early Quit) nor were Text Buddy and Text Crave components available to this group. | 63 |
| Total | 164 |
Baseline characteristics
| Characteristic | Smoking Cessation Text Messaging | The Control Group | Total |
|---|---|---|---|
| Age, Continuous | 21.6 years STANDARD_DEVIATION 2.1 | 21.6 years STANDARD_DEVIATION 2.1 | 21.6 years STANDARD_DEVIATION 2.1 |
| Average number of cigarettes smoke per day | 12.4 number of cigarettes per day STANDARD_DEVIATION 6.3 | 11.9 number of cigarettes per day STANDARD_DEVIATION 5.7 | 12.2 number of cigarettes per day STANDARD_DEVIATION 6.1 |
| Confidence of one's ability to quit | 6.7 units on a scale STANDARD_DEVIATION 2.2 | 6.5 units on a scale STANDARD_DEVIATION 2.6 | 6.6 units on a scale STANDARD_DEVIATION 2.4 |
| Current Employment Status Not Working | 36 participants | 35 participants | 71 participants |
| Current Employment Status Working ≤ 30 hr | 24 participants | 12 participants | 36 participants |
| Current Employment Status Working > 30 hr | 41 participants | 16 participants | 57 participants |
| Currently Enrolled in College, University, or Junior College No | 58 participants | 38 participants | 96 participants |
| Currently Enrolled in College, University, or Junior College Yes | 43 participants | 25 participants | 68 participants |
| Depressive Symptomatology | 7.8 units on a scale STANDARD_DEVIATION 6.2 | 9.3 units on a scale STANDARD_DEVIATION 6.4 | 8.3 units on a scale STANDARD_DEVIATION 6.3 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 22 Participants | 8 Participants | 30 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 79 Participants | 55 Participants | 134 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Importance of Quitting | 8.7 units on a scale STANDARD_DEVIATION 1.5 | 8.9 units on a scale STANDARD_DEVIATION 1.3 | 8.8 units on a scale STANDARD_DEVIATION 1.4 |
| Income <$35,000 | 85 participants | 57 participants | 142 participants |
| Income >$35,000 | 16 participants | 6 participants | 22 participants |
| Married/living with someone No | 72 participants | 46 participants | 118 participants |
| Married/living with someone Yes | 29 participants | 17 participants | 46 participants |
| Nicotine dependent No | 11 participants | 4 participants | 15 participants |
| Nicotine dependent Yes | 90 participants | 59 participants | 149 participants |
| Number of text messages received on an average day | 60 text messages per day | 50 text messages per day | 50 text messages per day |
| Number of text messages sent on an average day | 50 units on a scale | 45 units on a scale | 50 units on a scale |
| Planning on using an evidence-based quitting aid No | 75 participants | 52 participants | 127 participants |
| Planning on using an evidence-based quitting aid Yes | 26 participants | 11 participants | 37 participants |
| Race (NIH/OMB) American Indian or Alaska Native | 1 Participants | 2 Participants | 3 Participants |
| Race (NIH/OMB) Asian | 2 Participants | 2 Participants | 4 Participants |
| Race (NIH/OMB) Black or African American | 13 Participants | 9 Participants | 22 Participants |
| Race (NIH/OMB) More than one race | 16 Participants | 8 Participants | 24 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 1 Participants | 1 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 4 Participants | 0 Participants | 4 Participants |
| Race (NIH/OMB) White | 65 Participants | 41 Participants | 106 Participants |
| Resistance self-efficacy | 10.6 units on a scale STANDARD_DEVIATION 4 | 10.5 units on a scale STANDARD_DEVIATION 4 | 10.55 units on a scale STANDARD_DEVIATION 4 |
| Sex: Female, Male Female | 44 Participants | 28 Participants | 72 Participants |
| Sex: Female, Male Male | 57 Participants | 35 Participants | 92 Participants |
| Social support from family | 15.3 units on a scale STANDARD_DEVIATION 4.3 | 15.9 units on a scale STANDARD_DEVIATION 3.6 | 15.5 units on a scale STANDARD_DEVIATION 4.1 |
| Social support from friends | 16.1 units on a scale STANDARD_DEVIATION 4 | 16.6 units on a scale STANDARD_DEVIATION 3.1 | 16.3 units on a scale STANDARD_DEVIATION 3.7 |
| Social support from special person | 15.1 units on a scale STANDARD_DEVIATION 5.4 | 16.3 units on a scale STANDARD_DEVIATION 3.9 | 15.6 units on a scale STANDARD_DEVIATION 4.9 |
| Tenure with current cell phone number (months) | 44.8 Months STANDARD_DEVIATION 28.2 | 46.4 Months STANDARD_DEVIATION 31.6 | 45.4 Months STANDARD_DEVIATION 29.5 |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | — / — | — / — |
| other Total, other adverse events | 0 / 101 | 0 / 63 |
| serious Total, serious adverse events | 0 / 101 | 0 / 63 |
Outcome results
Primary
Continuous Abstinence at 3-months Assessed in Accordance With the NIH Behavior Change Consortium's Recommendations
Continuous abstinence is defined as 5 or fewer cigarettes smoked since one's quit date. The question was asked based upon West et al., 2005: Have you smoked at all, even just a puff, since \[insert quit date\]? If yes, the respondent will be probed for how many cigarettes were smoked. Responses will be categorized into one of three options: A) No, not a puff; B) 1-5 cigarettes; C) More than 5 cigarettes. Self-reported cessation is confirmed by a significant other.
Time frame: 3-months post-quit
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Smoking Cesssation Via Text Messaging | Continuous Abstinence at 3-months Assessed in Accordance With the NIH Behavior Change Consortium's Recommendations | 40 participants |
| Attention Matched Control | Continuous Abstinence at 3-months Assessed in Accordance With the NIH Behavior Change Consortium's Recommendations | 19 participants |
95% CI: [0.82, 3.21]
Secondary
Continuous Abstinence at 4-weeks Post-quit
Smoking five or fewer cigarettes since quit day at 4 weeks post-quit as verified by a significant other
Time frame: 4 weeks post-quit
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Smoking Cesssation Via Text Messaging | Continuous Abstinence at 4-weeks Post-quit | 34 participants |
| Attention Matched Control | Continuous Abstinence at 4-weeks Post-quit | 13 participants |
95% CI: [1.48, 7.45]
Secondary
Point Prevalence
A cigarette, even just a puff, within the last 7 days (yes/no).
Time frame: 4-weeks post-quit
| Arm | Measure | Value (NUMBER) |
|---|---|---|
| Smoking Cesssation Via Text Messaging | Point Prevalence | 44 participants |
| Attention Matched Control | Point Prevalence | 17 participants |
95% CI: [1.22, 5.3]