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Efficacy of a text messaging (SMS) based smoking cessation intervention for adolescents and young adults: Study protocol of a cluster randomised controlled trial

Severin Haug12*, Christian Meyer2, Andrea Dymalski1, Sonia Lippke3 and Ulrich John2

* Corresponding author: Severin Haug severin.haug@isgf.uzh.ch

Author Affiliations

1 Research Institute for Public Health and Addiction, Konradstrasse 32, 8031 Zurich, Switzerland

2 University of Greifswald, Institute of Epidemiology and Social Medicine, Walther-Rathenau-Str. 48, 17487 Greifswald, Germany

3 Jacobs Center on Lifelong Learning and Institutional Development, Jacobs University Bremen, Campus Ring 1, 28759 Bremen, Germany

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BMC Public Health 2012, 12:51 doi:10.1186/1471-2458-12-51

The electronic version of this article is the complete one and can be found online at: http://www.biomedcentral.com/1471-2458/12/51

Received: 16 December 2011

Accepted: 19 January 2012

Published: 19 January 2012

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Particularly in groups of adolescents with lower educational level the smoking prevalence is still high and constitutes a serious public health problem. There is limited evidence of effective smoking cessation interventions in this group. Individualised text messaging (SMS) based interventions are promising to support smoking cessation and could be provided to adolescents irrespective of their motivation to quit. The aim of the current paper is to outline the study protocol of a trial testing the efficacy of an SMS based intervention for smoking cessation in apprentices.

Methods/Design

A two-arm cluster-randomised controlled trial will be conducted to test the efficacy of an SMS intervention for smoking cessation in adolescents and young adults compared to an assessment only control group. A total of 910 daily or occasional (≥ 4 cigarettes in the preceding month and ≥ 1 cigarette in the preceding week) smoking apprentices will be proactively recruited in vocational school classes and, using school class as a randomisation unit, randomly assigned to an intervention group (n = 455) receiving the SMS based intervention or an assessment only control group (n = 455). Individualised text messages taking into account demographic data and the individuals' smoking behaviours will be sent to the participants of the intervention group over a period of 3 months. Participants will receive two text messages promoting smoking cessation per week. Program participants who intend to quit smoking have the opportunity to use a more intensive SMS program to prepare for their quit day and to prevent a subsequent relapse. The primary outcome measure will be the proportion of participants with 7-day point prevalence smoking abstinence assessed at 6-months follow-up. The research assistants conducting the baseline and the follow-up assessments will be blinded regarding group assignment.

Discussion

It is expected that the program offers an effective and inexpensive way to promote smoking cessation among adolescents and young adults including those with lower educational level and independent of their motivation to quit.

Trial registration number

ISRCTN: ISRCTN19739792

Background

Tobacco use is a major cause of disease burden and the single most preventable cause of death in the world [1,2]. Although smoking prevalence rates among adolescents of most European countries have declined within the last few years, smoking continues to be a serious problem, particularly in adolescents and young adults with lower educational level [3,4].

There is limited evidence of smoking cessation interventions demonstrating efficacy in adolescents and young adults [5,6]. In a Cochrane review of smoking cessation interventions for smokers who are younger than 20 years, approaches based on the Transtheoretical Model [7] achieved moderate long-term success, whereas the efficacy of psychosocial and pharmacological interventions has not been demonstrated so far [5]. A recent review [6] suggested delivering (1) smoking cessation programs for youth in contexts which are geared to youth such as schools or sports clubs, (2) interventions addressing cognitive-behavioural, motivational and social influence contents, and (3) programs with at least five sessions.

Electronic communication technology such as mobile phone text messaging (SMS) has the potential to deliver smoking cessation support to large population groups. In 2010, 98% of 12-19-year-old adolescents from Switzerland owned a mobile phone; use of the mobile phone was the most frequent leisure time activity in this population group. Furthermore, reading and sending of text messages were the most frequent activities when using the mobile phone [8].

By use of expert system technology that provides information based on individual demographic or smoking-related characteristics, electronic communication technology can be a viable, time- and cost-saving alternative to interpersonal counselling [9,10]. Particularly, SMS provides opportunities for individualised and interactive information delivery that may be accessed easily, independent of time and place.

To date, two randomised controlled studies were conducted to test the efficacy of SMS based smoking cessation interventions in adults motivated to quit smoking [11,12]. Within those studies, conducted in Great Britain and New Zealand, smokers who intended to quit within the subsequent month received motivational messages and behavioural-change support over a period of 26 weeks. The messages were matched to participants' demographic and smoking-related characteristics gathered at baseline. Additionally, participants could request instant messages aimed at craving or lapse situations. Five text messages per day were sent to the participants one week before and over four weeks after a predefined quit date that was negotiated with each participant. After this period, the intervention became less intensive, with the number of messages sent being reduced from five a day to three a week until the end of the 26th week. While intention-to-treat analyses could not reveal a significant intervention effect at the 6-months follow-up in the study by Rodgers et al. [12], Free et al. [13] found significantly higher abstinence rates in the intervention than in the control group (9% vs. 4%).

Within two pilot studies in which young adult smokers, irrespective of their motivation to quit, were proactively invited to an SMS based smoking cessation intervention, high participation and retention rates could be achieved [14,15]. To date, no randomised controlled trials testing the efficacy of smoking cessation interventions employing SMS in adolescents and young adults, or trials testing the efficacy of SMS interventions in smokers irrespective of their motivation to quit, have been reported.

Our aim is to outline the study protocol of a trial testing the efficacy of an SMS based intervention for smoking cessation in apprentices, irrespective of their motivation to quit. Apprentices have been chosen as the target population since evidence revealed high smoking prevalence rates in this subgroup of adolescents and young adults with heterogeneous educational level