Tobacco Use: Mobile Phone Text Messaging Cessation Interventions

CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to tobacco use cessation.

Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y, Dobson R. Mobile phone text messaging and app-based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019;10(10):CD006611. Available from URL: https://doi.org/10.1002/14651858.CD006611.pub5.

The review included 26 studies overall (search period through October 2018). Mobile phone text messaging interventions were examined in 19 studies. Of these, two studies compared interventions based on differences in text message frequency and were not considered in the CPSTF assessment of effectiveness. The team examined the remaining 17 mobile phone text messaging intervention studies and abstracted supplemental information about study, intervention, and population characteristics.

The CPSTF finding is based on results from the published review, additional information from the subset of 17 studies evaluating the effectiveness of mobile phone text messaging interventions, and expert input from team members and CPSTF. This recommendation updates and replaces the 2011 CPSTF finding of sufficient evidence of effectiveness for mobile phone-based cessation interventions.

The U.S. Preventive Services Task Force (USPSTF) recommends clinicians ask all adults about tobacco use, advise those who use tobacco to quit, and provide them with behavioral interventions and U.S. Food and Drug Administration approved pharmacotherapy for cessation to nonpregnant adults (A grade recommendation, Krist et al., 2021; Patnode et al., 2021).

Smoking Cessation: A Report of the Surgeon General concluded there is sufficient evidence to infer that short text message services about cessation are independently effective in increasing smoking cessation, particularly if they are interactive or tailored to individual text responses (HHS, 2020).

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The systematic review included 17 studies from Whittaker et al., 2019 that evaluated the effectiveness of mobile phone text messaging cessation interventions six or more months following intervention.

• Mobile phone text messaging interventions increased smoking cessation rates by a median of 4.1 percentage points overall (17 studies).
  • Mobile phone text messaging interventions implemented alone increased smoking cessation by a median of 2.3 percentage points (7 studies).
  • Mobile phone text messaging interventions implemented in combination with additional cessation support interventions increased smoking cessation by a median of 4.4 percentage points (10 studies).
  • Studies conducted in the United States increased smoking cessation by a median of 4.4 percentage points (5 studies).

A systematic review of economic evidence has not been conducted.

Based on results from the systematic review, the CPSTF finding should be applicable to the general population of adults in the United States who want to quit smoking.

CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• How do intervention effects vary by participant characteristics, including age (especially adolescents and older adults), income, level of education, and race/ethnicity in U.S. populations and settings?
• How do intervention effects vary by text message content?
• How do mobile phone text messaging interventions that use interactive features and provide tailored guidance compare with text messaging interventions that do not?
• What are the most effective and efficient ways to increase recruitment and enhance retention?
• What is the impact of these intervention approaches on long-term cessation outcomes (12 months or more)?
• Are these interventions effective with clients who want to quit using e-cigarettes?
• Are these interventions effective with clients who want to quit using smokeless tobacco products?

• All of the studies evaluating the effectiveness of mobile phone text messaging interventions were randomized controlled trials (17 studies).
• Five of the included studies were conducted in the United States. The remaining studies came from the United Kingdom, China and Hong Kong, Australia, New Zealand, Spain and Switzerland.
• In 10 studies, mobile phone text messaging interventions were combined with additional interventions, including cessation counseling, web-based content, e-mails, nicotine replacement therapy, printed materials, and a mobile phone app.
• Studies from the United States reported demographic characteristics of participants. Study samples were generally representative across age (18 years and older), gender, racial/ethnic background, and education.

Effectiveness Review

• Logic Model
• Text Description

When starting an effectiveness review, the systematic review team develops an analytic framework. The analytic framework illustrates how the intervention approach is thought to affect public health. It guides the search for evidence and may be used to summarize the evidence collected. The analytic framework often includes intermediate outcomes, potential effect modifiers, potential harms, and potential additional benefits.

A summary evidence table for this Community Guide review is not available because the CPSTF finding is based on the following published systematic review:

Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y, Dobson R. Mobile phone text messaging and app-based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019;10(10):CD006611. Available from URL: https://doi.org/10.1002/14651858.CD006611.pub5.

The number of studies and publications do not always correspond (e.g., a publication may include several studies, or one study may be explained in several publications).

Effectiveness Review

Following are studies from the published review (Whittaker et al.) that evaluated mobile phone text message interventions (alone or in combination with other interventions)

Abroms LC, Boal AL, Simmens SJ, Mendel JA, Windsor RA. A randomized trial of Text2Quit: a text messaging program for smoking cessation. American Journal of Preventive Medicine 2014;47(3):242-50.

Abroms L, Johnson P, Leavitt L, Cleary S, Bushar J, et al. A randomized trial of text messaging for smoking cessation in pregnant women. American Journal of Preventive Medicine 2017;53(6):781-90.

Augustson E, Engelgau M, Zhang S, Cai Y, Cher W, et al. Text to quit China: an mHealth smoking cessation trial. American Journal of Health Promotion 2017;31(3):217-25.

Bock B, Heron K, Jennings E, Morrow K, Cobb V, et al. A text message delivered smoking cessation intervention: the initial trial of TXT-2-Quit: randomized controlled trial. JMIR MHealth and UHealth 2013;1(2):e17.

Borland R, Balmford J, Benda P. Population-level effects of automated smoking cessation help programs: a randomized controlled trial. Addiction 2013;108(3):618-28.

Chan SS, Wong DC, Cheung YT, Leung DY, Lau L, et al. A block randomized controlled trial of a brief smoking cessation counselling and advice through short message service on participants who joined the Quit to Win Contest in Hong Kong. Health Education Research 2015;30(4):609-21.

Cobos-Campos R, deLarrinoa A, Morinigo A, Parraza N, Barandiaran F. Effectiveness of text messaging as an adjuvant to health advice in smoking cessation programs in primary care. A randomized clinical trial. Nicotine & Tobacco Research 2017;19(8):901-7.

Danaher B, Tyler M, Crowley R, Brendryen H, Seeley J. Outcomes and device usage for fully automated Internet interventions designed for a smartphone or personal computer: the MobileQuit smoking cessation randomized controlled trial. JMIR 2019;21(6):e13290.

Ferguson SG, Walters JA. The effect of mobile phone text messages on short and long term quitting in motivated smokers: a randomised controlled trial. Society for Research on Nicotine and Tobacco 21st Annual Meeting; 2015 Feb 25-28; Philadelphia.

Free C, Whittaker R, Knight R, Abramsky T, Rodgers A, et al. Txt2stop: a pilot randomised controlled trial of mobile phone-based smoking cessation support. Tobacco Control 2009;18:88-91.

Free C, Knight R, Robertson S, Whittaker R, Edwards P, et al. Smoking cessation support delivered via mobile phone text messaging (Txt2stop): a single-blind, randomised trial. Lancet 2011;378:49-55.

Haug S, SchaubMP, Venzin V, Meyer C, John U. Efficacy of a text message-based smoking cessation intervention for young people: a cluster randomized controlled trial. Journal of Medical Internet Research 2013;15(8):142-55.

Liao Y, Wu Q, Kelly B, Zhang F, Tang YY, et al. Effectiveness of a text-messaging-based smoking cessation intervention (“Happy Quit”) for smoking cessation in China: a randomized controlled trial. PLOS Medicine 2018;15(12):e1002713.

Naughton F, Jamison J, Boase S, Sloan M, Gilbert H, et al. Randomized controlled trial to assess the short-term effectiveness of tailored web- and text-based facilitation of smoking cessation in primary care (iQuit in Practice). Addiction 2014;109(7):1184-93.

Rodgers A, Corbett T, Bramley D, Riddell T, Wills M, et al. Do u smoke after txt? Results of a randomised trial of smoking cessation using mobile phone text messaging. Tobacco Control 2005;14:255-61.

Squiers L, Augustson E, Brown D, Kelly B, Southwell B, et al. An experimental comparison of mobile texting programs to help young adults quit smoking. Health Systems 2017;6:1-14.

Tseng TY, Krebs P, Schoenthaler A, Wong S, Sherman S, et al. Combining text messaging and telephone counselling to increase varenicline adherence and smoking abstinence among cigarette smokers living with HIV: a randomized controlled trial. AIDS Behavior 2017;21(7):1964-74.

Whittaker R, Dorey E, Bramley D, Bullen C, Denny S, et al. A theory-based video messaging mobile phone intervention for smoking cessation: randomised controlled trial. Journal of Medical Internet Research 2011;13(1):e10.

Yu S, Duan Z, Redmon PB, Eriksen MP, Koplan JP, et al. MHealth intervention is effective in creating smoke-free homes for newborns: a randomized controlled trial study in China. Scientific Reports 2017;7(1):9276.

The quitSTART app is a free smartphone app that aims to help users quit smoking with tailored tips, inspiration, and challenges. It is a product of Smokefree.gov, a smoking cessation resource created by the Tobacco Control Research Branch at the National Cancer Institute in collaboration with the U.S. Food and Drug Administration and input from tobacco control professionals, smoking cessation experts, and ex-smokers.

Effectiveness Review

Refer to the existing systematic review for information about the search strategy:

Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y, Dobson R. Mobile phone text messaging and app-based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019;10(10):CD006611. Available from URL: https://doi.org/10.1002/14651858.CD006611.pub5.

Krist AH, Davidson KW, Mangione CM, Barry MJ, Cabana M, Caughey AB, Donahue K, Doubeni CA, Epling JW, Kubik M, Ogedegbe G. Interventions for tobacco smoking cessation in adults, including pregnant persons: U.S. Preventive Services Task Force recommendation statement. JAMA 2021;325(3):265-79.

Patnode CD, Henderson JT, Coppola EL, Melnikow J, Durbin S, Thomas RG. Interventions for tobacco cessation in adults, including pregnant persons: updated evidence report and systematic review for the U.S. Preventive Services Task Force. JAMA 2021;325(3):280-98.

U.S. Department of Health and Human Services. Smoking Cessation. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2020.

The following considerations for implementation are drawn from Whittaker et al., studies included in the review, the previous CPSTF recommendation for mobile phone text messaging interventions, and expert opinion from CPSTF, as noted below.

• Mobile phone text messaging interventions may require ongoing advertising, service promotion, and interactivity enhancements to attract and engage participants.
• Advertising, cross-promotion, and coordinated web-linkages may help people who use tobacco access evidence-based cessation interventions that suit their needs.
• Implementers may need to address identified barriers including technological concerns (e.g., matching program, network, and client capabilities) and take steps to ensure confidentiality of participant information.
• There are several publicly available mobile phone text messaging interventions with interactive features or tailored content to support people in the United States who want to quit using tobacco. Services are typically accessible through websites, which also offer information and support to help people in their efforts to quit.
  • The smokefree.gov Initiative, managed by the National Cancer Institute, provides people who want to quit smoking with free, evidence-based smoking cessation information and on-demand support. The initiative offers nine text messaging interventions with online or text opt-in for different groups, including pregnant persons, teens, veterans, Spanish speakers, and people not yet ready to quit.
  • The Tips From Former Smokers website is designed to support CDC’s national tobacco education campaign. The website seeks to motivate quit attempts through stories of real people with smoking-related diseases. The website also aims to help people succeed in quitting smoking by connecting them to cessation resources, such as How to Quit Smoking.
  • The Truth Initiative offers two free digital resources. BecomeAnEX aims to help people quit using tobacco, and This Is Quitting is designed to help young people quit using e-cigarettes.

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• Reduce current tobacco use in adults — TU‑01
• Reduce current cigarette smoking in adults — TU‑02
• Reduce current cigarette, cigar, and pipe smoking in adults — TU‑03
• Reduce current tobacco use in adolescents — TU‑04
• Reduce current cigarette smoking in adolescents — TU‑06
• Reduce current cigar smoking in adolescents — TU‑07
• Reduce current use of smokeless tobacco products among adolescents — TU‑08
• Increase past-year attempts to quit smoking in adults — TU‑11
• Increase use of smoking cessation counseling and medication in adults who smoke — TU‑13
• Increase successful quit attempts in adults who smoke — TU‑14