The Role of Personalization in Smoking Cessation: Findings from a Randomized Clinical Trial

Mobile technologies can provide an effective way to expand access to smoking cessation support according to findings from a clinical trial conducted in China. The investigation provided evidence of the potential benefits of behavior change theory-based smoking cessation intervention using personalized text messages.

Results demonstrated the intervention was most effective among smokers with low nicotine dependence and strong quitting intention. For the analysis, investigators led by Haoxiang Lin, DrPH, Institute for Global Health and Development, Peking University, compared this approach with an intervention that used non-personalized text messages.

Evaluating Nicotine Dependence and Quitting Intent

They found that biochemically verified continuous abstinence at 6 months was 6.9% in the intervention group and 3% in the control group. Among smokers with low nicotine dependence, the intervention group had significantly better abstinence rates across most indicators after adjusting for covariates.

In the group of participants with moderate and high nicotine dependence, only the biochemically verified 24-hour point prevalence of abstinence at 6 months was statistically significant.

A similar pattern was observed when analyzing quitting intention, and the personalized text message-based intervention was more effective for smokers who had strong quitting intention than for those who had weak quitting intention.

Transtheoretical Model and Protection Motivation Theory

The 2-arm double-blind randomized clinical trial was conducted across 5 cities in China. Adults who smoked daily or weekly were included if they owned a mobile phone and used the WeChat social media app. A total of 722 participants were randomized to the intervention or control group between April 2021-July 2021.

Participants in the Intervention group received a personalized text message smoking cessation intervention based on the transtheoretical model and protection motivation theory which was developed by the study's investigators.

Those in the control group received non-personalized text message smoking cessation intervention developed by the US National Cancer Institute. Both groups received 1-2 text messages through the app, per day for 3 months.

The primary outcome was the biochemically verified 6-month sustained abstinence rate, defined as the self-report of no smoking of any cigarettes after the designated quit date, which was validated biochemically by an expired air carbon monoxide level of less than 6 ppm at each follow-up point.

Investigators stated that universal smoking cessation support can be a challenge for most countries because it requires sufficient resources, but with mobile technology, access can be expanded. Furthermore, these data can inform future interventions aimed at reducing smoking prevalence as well as provide insights for other behavioral interventions.

References:

1. Lin H, Liu Y, Zhang H, Zhu Z, Zhang X, Chang C. Assessment of a Text Message–Based Smoking Cessation Intervention for Adult Smokers in China: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(3):e230301. doi:10.1001/jamanetworkopen.2023.0301