Interview conducted by April Cashin-Garbutt, BA Hons (Cantab)
Please can you explain why quitting smoking is a difficult task?
Tobacco smoking involves a physiological addiction to nicotine for a lot of people. Quitting can cause some nasty symptoms due to the withdrawal of nicotine. Also, smoking can become a lifelong social habit that can be really difficult to break, particularly if many of your friends and family smoke.
What methods have previously been available to help people quit smoking?
Many people use the free phone counselling quitlines that are available to provide advice and support. Nicotine replacement therapies (e.g. gum, patches, lozenges) and other medications also help many people to quit.
Please can you outline the mobile phone-based programmes that your recent work reviewed?
Most of the studies in our review involved text messaging interventions. These are generally automated programmes of tailored text messages that provide tips and advice on quitting, reminders of motivations to quit, positive reinforcement, supporting people to identify their cues to smoking and planning to avoid these cues while they are trying to quit.
Some of them also provide extra help on demand – so when people are out and suffering cravings for cigarettes, they can text in and receive an immediate response with tips on how to beat cravings. One study also involved an online quit coach and one used video messages to mobile phones.
Did your review find that these mobile phone-based programmes were effective?
Overall, when we pooled all the results of the five studies together, we found that these interventions can help people stop smoking. The mobile phone interventions increased the proportion of people who were still smokefree at six months more than that seen in control groups (RR 1.71, 95%CI 1.47-1.99).
Did the mobile phone-based programmes work for everyone, or were they more likely to work for some and not others?
Just like other smoking cessation programmes, they do not work for everyone. There does not appear to be any groups that they particularly work or do not work for. Most people take several attempts to quit successfully and so it makes sense to have plenty of effective options for people to choose from.
Why do you think that an earlier systematic review by Cochrane researchers published in 2009 did not find long-term improvements in quit rates for those on mobile phone-based programmes?
In the first review we were only able to identify two studies with 6-month (long-term) outcomes that we could include in a combined analysis – while the short-term findings showed a clear benefit, the long-term findings were more difficult to interpret.
This time, three years later, we have added three more studies. This is really a growing field of study and we are aware of approximately seven more studies that will be able to be included in the future, adding to the weight of the evidence.
Did your review assess the cost-effectiveness of mobile phone-based programmes? How do they compare to other types of programme?
We were not able to assess the cost-effectiveness as the individual studies did not provide this information. We are hoping that there will be more evidence published on this topic in the future.
What impact do you think your review will have?
We feel that this review provides good evidence that mobile phone programmes can be useful, particularly in developed countries with good tobacco control policies as in the included studies.
Smoking cessation service providers should consider text messaging as another option they could potentially offer their clients. This doesn’t mean that all programmes will always be effective, as they do need to be developed in alignment with the evidence of what works to support people to quit.
Also, as yet we have little evidence of how they work in developing countries and little evidence around other types of mobile phone programmes such as smartphone applications.
Do you think technology will feature heavily in future smoking cessation services?
Yes absolutely. I think mobile phones are a great way to reach people to support them to make healthy behaviour changes like quitting smoking. I am sure these types of programmes will only continue to get better and better in the future.
Where can readers find more information?
The Cochrane systematic review is available at: http://www.thecochranelibrary.com/view/0/index.html
They can find out more information on the National Institute for Health Innovation at: www.nihi.auckland.ac.nz
About Robyn Whittaker
Robyn Whittaker is a public health physician at the National Institute for Health Innovation at the University of Auckland in New Zealand. She also works for the Waitemata District Health Board, the organisation responsible for the health of over 550,000 New Zealanders, in Research & Innovation.
Robyn has been developing and researching mobile phone based health interventions for more than eight years. This has included interventions for smoking cessation, the prevention of depression, and weight management.
As a Harkness Fellow in HealthCare Policy & Practice with The Commonwealth Fund (2010/11), she researched the key issues facing the implementation of mobile health. She now leads a team of researchers in Health Technology & Informatics and sits on several national advisory bodies in this area.