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Tobacco Use: Mobile Phone Text Messaging Cessation Interventions

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What the CPSTF Found

About The Systematic Review

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 pdf icon [PDF - 236 KB].

Context

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 External Web Site Icon, Krist et al., 2021; Patnode et al., 2021).

Smoking Cessation: A Report of the Surgeon General External Web Site Icon 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).

Summary of Results

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).

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

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.

Evidence Gaps

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?

Study Characteristics

  • 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.