This week, the Cochrane Library published a review of mobile messaging-based smoking cessation interventions. The report found that, based on five studies, with a total of more than 9,000 participants, smokers who used mobile messaging interventions were twice as likely to make it six months without smoking than those who didn't.
"We can’t say from the result that this means all text messaging cessation programs work, but we can say these studies have shown that they can work," said Robyn Whittaker, the lead author of the review from the University of Auckland in New Zealand. She told MobiHealthNews that of the five studies looked at, three were pure text messaging interventions, one incorporated text messaging and use of a website, and one used both text and video messaging. In the mixed studies, the Cochrane review looked at the texting intervention specifically. Although not all of the five studies were conclusive, the meta-analysis of the five showed significant results, according to Whittaker.
The participants in the text message interventions all received similar support: automated motivational messages at regular intervals, strategies for avoiding temptations, and quick responses to texts about cravings. Overall, 444 out of 4,730, or about 9 percent, of the participants in the five treatment groups reported being clean after six months, with some self-reports confirmed by analysis of saliva samples. Only 240 out of 4,370 in the various control groups reported the same results (about 5 percent).
Whittaker says this level of success is roughly comparable to other, proven methods of smoking cessation such as telephone quit lines and nicotine substitution therapy. Although this study only looked at effectiveness, Whittaker thinks mobile messaging interventions might have some advantages over those other methods.
"We think that it’s probably cost effective, because it’s cheaper than, for example, a free phone quit line where you’re paying for a phone line to be available to people all the time," she said. She also mentioned the potential value of text message interventions in developing countries where mobile phone use is widespread.
This study was an update of a 2009 Cochrane Library study by the same team. At the time, Whittaker said, there hadn't been enough studies completed to make conclusions about the six-month mark, which she called the gold standard in smoking cessation.
"People find the first weeks are the most difficult, and then it evens out but we still get people dropping out," said Whittaker. "Mostly the six month quit rate will be a longterm quit rate."
Just the increase in available data from 2009 to today makes a statement about the rising prominence of texting-based health interventions. MobiHealthNews wrote about a smaller study last year, and has been following efforts like the Department of Health and Human Service's SmokeFreeTXT and Text2Quit, the paid service developed by Voxiva and offered by Alere.
Whittaker said smartphone app-based cessation strategies are one area where there's still not enough data to do a review, although she did point to an American Journal of Preventative Medicine study from last year. That study showed that most smoking cessation apps didn't follow Public Health Service Guidelines for smoking cessation.
"I think we need more studies so we can say that for sure, but none of these programs are based on really well-proven therapies," she said. "We know that some of them don’t work very well, like acupuncture or hypnosis for smoking cessation. Motivation and support seems to work for people for quitting smoking, and those are the sorts of things that you can provide through mobile phones. So we need to ensure that these things are using what we know."
Whittaker pointed out that many apps are downloaded and never used. Text messaging, on the other hand, proactively engages the user.
"We can more actively deliver messages to people wherever they are at the right time and those messages can be relevant to an individual even though we’re sending them out on a mass basis," she said.