Text-messaging programs on phones seem to help smokers quit. The jury’s still out on smartphone apps for smoking cessation when used by patients, but they may help nurses improve screening, several separate studies suggest.

The interactive text-messaging program Text2Quit helped U.S. smokers quit and stay off cigarettes in a 6-month randomized, controlled trial in 503 adults who smoked at least five cigarettes a day, owned a cell phone with an unlimited service plan for short text messaging, and had expressed an interest in quitting cigarettes. Participants already were avid texters, sending or receiving an average of 29 text messages per day before they enrolled in the study.

Dr. Abroms shows a screen shot of smoking cessation text messages.

At the 6-month follow-up, 20% of 241 people in the Text2Quit group said they had not smoked in the prior 7 days, versus 10% of 262 people in the control group, reported Lorien C. Abroms, Sc.D., and her associates.

Laboratory analyses of saliva from 54 members of the intervention group and 32 in the control group showed that nearly a quarter of participants had lied about quitting. Text2Quit still was effective, however, with biochemically confirmed abstinence from smoking in 11% of the intervention group and 5% of the control group (Am. J. Prev. Med. 2014 June 5 [doi: 10.1016/j.amepre.2014.04.010]). Those biochemical quit rates are similar to rates reported in studies of other text-messaging programs for smoking cessation or of telephone quit-line counseling, she said.

The results support a meta-analysis of five studies that found mobile phone–based interventions (predominantly text messaging) for smoking cessation increased 6-month quit rates (Cochrane Database Syst. Rev. 2012;11:CD006611 [doi: 10.1002/14651858]). Most U.S. studies, however, have been small, uncontrolled pilot trials with no biochemical verification of quit rates, said Dr. Abroms, who designed Text2Quit and receives royalties from sales..

What’s involved?

Text2Quit costs $30 for a 4-month subscription unless you have a code from a sponsoring organization. When U.S. smokers call the national quit-line number (1-800-QUIT-NOW), residents of some states get offered Text2Quit. More than 50,000 smokers have enrolled since the program became available in 2011, reported Dr. Abroms of George Washington University, Washington. Other text-messaging programs are available, such as the free SmokefreeTXT program from the National Cancer Institute’s smokefree.gov site.

People randomized to the control group in Dr. Abroms’ trial initially were given a link to smokefree.gov, but after the launch of SmokefreeTXT in 2011, new control group members instead were given a link to the National Cancer Institute’s "Clearing the Air" guidebook on quitting smoking.

Text2Quit consists of automated, bidirectional text messages, with extra support from e-mails and a web portal. The texts prompt users to track their smoking and report on their cravings and smoking status, with the messages to participants tailored by the reasons for quitting, money saved, and use of medications for smoking cessation. The frequency of texts peaked around the smoker’s chosen quit date, with five texts on that date, approximately two per day in the following week, three per week in the next 2 months, and less than one per week after that.

Considering that an estimated 75% of adults around the world have access to cell phones, text-messaging interventions potentially could puff up the number of quitters, she said.

Apps reach far, but may say little

Smartphones aren’t yet as ubiquitous but, still, an estimated 11 million U.S. smokers own a smartphone, Dr. Abroms wrote in a separate study of apps for smoking cessation. We don’t yet know if any of the 400 smoking cessation apps that were available in 2012 work, but her analysis of 98 of the most popular smoking cessation apps found that they seldom include information and strategies that have been proven to help smokers quit.

She and her associates rated 47 apps for iPhones and 51 for Android phones on a 42-point scale, with a top score indicating adherence to the U.S. Public Health Service’s Clinical Practice Guidelines for Treating Tobacco Use and Dependence. The average score was 13. No apps recommended calling a quit line, for example. Only 4% recommended using medications approved for smoking cessation. Only 19% offered practical counseling or advice on how to quit (Am. J. Prev. Med. 2013;45:732-6).

On the other hand, it’s possible that national guidelines that were developed for clinical settings don’t apply to mobile apps. If the apps somehow are effective, their reach could magnify any impact, Dr. Abroms suggested.

"Text messaging programs for smoking cessation have a reasonably good evidence base," according to Dr. Abroms. "The evidence for smartphone apps is still in its early stages. I would not recommend them as a stand-alone intervention, though many with tracking elements may be useful as part of a comprehensive program. Apps that include games could be good as a distraction from smoking."

sboschert@frontlinemedcom.com

On Twitter @sherryboschert

Cessation by text? Interactive app helps smokers quit