Text-message reminders associated with improved smoking cessation amongst young-adults

1. Amongst Swedish university students who smoked cigarettes and were interested in quitting, using the NEXit motivational text messaging program doubled the rate of self-reported smoking abstinence (with occasional lapses) and improved complete smoking cessation, though to a lesser degree.

2. Motivational text messaging may have a unique role amongst young-adults who are interested in smoking cessation, though the long-term effects of this remain unclear.

Evidence Rating Level: 1 (Excellent) 

Study Rundown: Cigarette smoking is a major cause of morbidity and mortality worldwide. Smoking is often a habit that is adapted by young-adults, and the longer the habit continues, the more difficult it is to quit. Targeted efforts towards the younger population may be helpful in this regard. This randomized clinical trial, conducted in Sweden, was conducted to determine if text-message reminders could be an effective tool to promote smoking cessation.

The results of the study showed that, amongst university students in Sweden who were interested in quitting cigarette smoking, the NEXit motivational text messaging program doubled the rate of self-reported smoking abstinence (with occasional lapses) and improved complete smoking cessation, though to a lesser degree. A strength of the study was a high follow-up rate. Weaknesses of the study included reliance on self-reported abstinence or cessation, having only university students, and lack of generalizability to a much larger and heterogeneous society such as the US.

Click to read the study, published today in JAMA Internal Medicine

Relevant Reading: Comparing tailored and untailored text messages for smoking cessation: a randomized controlled trial among adolescent and young adult smokers.

In-Depth [randomized controlled trial]: This single-blind, 2 arm, clinical trial was conducted in Sweden from 2014–2015 at all but one universities in Sweden (through the respective health centers). Participants were eligible for the study if they were students who smoked cigarettes regularly and were willing to set a quit date within four weeks after enrollment. The intervention group participated in what is called the NEXit core program, which included one- to four-weeks of a motivational phase, followed by 157 motivational text messages over a 12-week period. The control group received text messages every two weeks to thank them for participating in the study.

The two primary outcomes were eight weeks of prolonged smoking abstinence (defined as fewer than five total cigarettes), and four-week point prevalence of complete smoking cessation, both of which were evaluated at a four month follow up. A total of 1590 participants were involved in the study, equally divided in the two groups. Eight weeks of prolonged abstinence was achieved by 25.9% in the intervention group compared to 14.6% in the control group (adjusted OR 2.05; NNT 9). Four-week point prevalence of complete cessation occurred in 20.6% in the intervention group compared to 14.2% in the control group (adjusted OR 1.56; NNT 16).

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