<ul><li>A randomised controlled trial of mobile phone based smoking cessation support </li></ul><ul><li>Free C, Knight R, ...
<ul><li>Distinct capabilities and advantages of mobile phones as communication channel for health  </li></ul><ul><li>Versa...
<ul><li>BACKGROUND </li></ul><ul><li>Smoking contributes to the death of one in two of those who continue to smoke past 35...
<ul><li>txt2stop is an innovative smoking cessation  support programme </li></ul><ul><li>Originally developed in Auckland,...
<ul><li>MODIFICATIONS FOR THE UK </li></ul><ul><li>Expert input: trained smoking cessation counsellors (youth and adult) a...
<ul><li>THE INTERVENTION </li></ul><ul><li>Regular personalised text messages developed drawing on theories of behaviour c...
<ul><li>THE INTERVENTION:  </li></ul><ul><li>Making a public declaration - state a quit date  </li></ul><ul><li>Self monit...
<ul><li>PILOT TRIAL </li></ul><ul><li>Performed May to November 2006 </li></ul><ul><li>200 participants </li></ul><ul><li>...
<ul><li>RANDOMISATION </li></ul><ul><li>computer based randomisation into intervention or control group </li></ul><ul><li>...
Results <ul><li>RESULTS </li></ul><ul><li>Technical side effective.  </li></ul><ul><li>Follow up at 4 weeks and 6 months <...
<ul><li>RESULTS   </li></ul><ul><li>Doubling of quit rate in short term  </li></ul><ul><li>Relative risk 2.02 (95%CI 1.08-...
<ul><li>MAIN STUDY </li></ul><ul><li>Trial launched 15 th  October 2007  </li></ul><ul><li>5,800 people in the UK recruite...
<ul><li>CHANGES MADE FOR MAIN TRIAL </li></ul><ul><li>Strengthened relapse components (LAPSE function) and increased inter...
Demographics of main trial Registered 10,627 eligible participants of those 55% were randomised SEX n % Female 2606 45% Ma...
<ul><li>Results due spring 2010 </li></ul><ul><li>Implications, if effective:   </li></ul><ul><li>For smoking cessation: <...
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Txt 2 Stop: Mobile Phone-Based Smoking Cessation Support

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A randomised controlled trial of mobile phone-based smoking cessation support. A presentation delivered by Cari Free, of the London School of Hygiene and Tropical Medicine, at the London International Development Centre on 9 October 2009.

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  • e.g. words commonly used in NZ but not here such as Americanised words Cultural such as Surf’s up get your board – not appropriate for London and South East! Generally NZ has much more outdoorsy lifestyle which is very different to UK lifestyle. Diet texts – certain foods used in NZ but not here – All of these things were either changed to be UK specific or taken out
  • Numbers very small so actually not significant in real terms – Main aim of pilot was to prove that the study was feasible in terms of recruiting the participants and ensuring the technology worked – both of which were very successful
  • Focus groups made up of smokers
  • Focus groups made up of smokers
  • Focus groups made up of smokers
  • Txt 2 Stop: Mobile Phone-Based Smoking Cessation Support

    1. 1. <ul><li>A randomised controlled trial of mobile phone based smoking cessation support </li></ul><ul><li>Free C, Knight R, Robertson S, Roberts I, Rodgers A, Whittaker R, Cairns J. </li></ul><ul><li>LSHTM </li></ul><ul><li>CTRU Auckland </li></ul><ul><li>QUIT </li></ul>
    2. 2. <ul><li>Distinct capabilities and advantages of mobile phones as communication channel for health </li></ul><ul><li>Versatility and accessibility offer huge potential </li></ul><ul><li>High penetration </li></ul><ul><li>Part of every day life so always carried with them (so intervention can take place any time) </li></ul><ul><li>Interactive </li></ul><ul><li>Personalised </li></ul><ul><li>‘ Push’ and ‘pull’ content </li></ul><ul><li>Delivery of complex information can be facilitated through the use of video, graphic and audio systems </li></ul><ul><li>Anonymity and confidentiality </li></ul><ul><li>Main costs associated with development, ongoing costs relatively low </li></ul>
    3. 3. <ul><li>BACKGROUND </li></ul><ul><li>Smoking contributes to the death of one in two of those who continue to smoke past 35 years of age </li></ul><ul><li>Mobile phones provide a new channel for individualised programmes to be delivered inexpensively wherever the person is located </li></ul>
    4. 4. <ul><li>txt2stop is an innovative smoking cessation support programme </li></ul><ul><li>Originally developed in Auckland, NZ </li></ul><ul><ul><li>STOMP randomised trial, 1705 participants from throughout New Zealand </li></ul></ul><ul><ul><li>Found a doubling of self reported quit rates at 6 weeks </li></ul></ul><ul><ul><li>Questions re the validity of findings at six months </li></ul></ul><ul><li>- high rate of loss to follow up </li></ul><ul><li>- small proportion biochemically validated </li></ul>
    5. 5. <ul><li>MODIFICATIONS FOR THE UK </li></ul><ul><li>Expert input: trained smoking cessation counsellors (youth and adult) and cognitive experts </li></ul><ul><li>User input: 62 potential participants in series of focus groups (smokers) </li></ul><ul><li>Four types of modification were made: </li></ul><ul><ul><li>changes to words </li></ul></ul><ul><ul><li>changes to culturally specific references </li></ul></ul><ul><ul><li>changes to the framing of text messages </li></ul></ul><ul><ul><li>changes or removal of some texts </li></ul></ul><ul><ul><li>strengthening content </li></ul></ul>
    6. 6. <ul><li>THE INTERVENTION </li></ul><ul><li>Regular personalised text messages developed drawing on theories of behaviour change and MI </li></ul><ul><li>providing smoking cessation information, motivation, distraction, social support </li></ul><ul><li>Algorithm matched participant characteristics with database of over 1000 text messages </li></ul><ul><li>Matched on interests and concerns over quitting (i.e. weight gain) </li></ul>
    7. 7. <ul><li>THE INTERVENTION: </li></ul><ul><li>Making a public declaration - state a quit date </li></ul><ul><li>Self monitoring e.g. review their smoking habits/ triggers. </li></ul><ul><li>Intra-treatment support- ‘buddying’ facility, </li></ul><ul><li>Extra treatment support - texting friends and family. </li></ul><ul><li>Problem solving – e.g. by asking participants to consider and plan alternate actions to smoking. </li></ul><ul><li>Feedback (timing) </li></ul><ul><li>Distraction techniques – text crave, </li></ul><ul><li>Encourage use NRT. </li></ul><ul><li>CBT/ MI approach e.g. </li></ul><ul><ul><li>participants own values and goals e.g. reasons for quitting </li></ul></ul><ul><ul><li>beliefs about ability to achieve their goal to quit - encouraging participants to break their goal into achievable steps. </li></ul></ul><ul><li>Tailored - e.g. peer pressure or weight gain </li></ul>
    8. 8. <ul><li>PILOT TRIAL </li></ul><ul><li>Performed May to November 2006 </li></ul><ul><li>200 participants </li></ul><ul><li>Interested participants were asked to text in their interest to a specified number </li></ul><ul><li>Eligibility criteria: </li></ul><ul><ul><li>Report aged 16 or over </li></ul></ul><ul><ul><li>Smoker who owned a mobile phone </li></ul></ul><ul><ul><li>Expressed an interest in wishing to quit in next month </li></ul></ul><ul><li>Further information then sent via email/mail </li></ul><ul><li>Interested participants to text back their consent </li></ul><ul><li>Baseline data collected by telephone </li></ul>
    9. 9. <ul><li>RANDOMISATION </li></ul><ul><li>computer based randomisation into intervention or control group </li></ul><ul><li>Intervention – participants were asked to set a ‘quit date’. 5 Personalised texts messages were sent to their mobile phones on a daily basis from that date </li></ul><ul><li>Included was a ‘CRAVE’ option and a ‘Quit buddy’ </li></ul><ul><li>Control – received fortnightly text messages </li></ul>
    10. 10. Results <ul><li>RESULTS </li></ul><ul><li>Technical side effective. </li></ul><ul><li>Follow up at 4 weeks and 6 months </li></ul><ul><li>Outcome measures: </li></ul><ul><li>Primary – self reported abstinence (6 mths) Verified by salivary cotinine testing (postal and witnessed) </li></ul><ul><li>Secondary – 4 weeks smoking status. 6 month involvement in car crashes </li></ul>
    11. 11. <ul><li>RESULTS </li></ul><ul><li>Doubling of quit rate in short term </li></ul><ul><li>Relative risk 2.02 (95%CI 1.08-3.76) </li></ul><ul><li>Long term results consistent with results we are looking for in main trial (relative risk 1.28) </li></ul>
    12. 12. <ul><li>MAIN STUDY </li></ul><ul><li>Trial launched 15 th October 2007 </li></ul><ul><li>5,800 people in the UK recruited in less than 21 months </li></ul><ul><li>Funding from MRC </li></ul>
    13. 13. <ul><li>CHANGES MADE FOR MAIN TRIAL </li></ul><ul><li>Strengthened relapse components (LAPSE function) and increased interactivity </li></ul><ul><li>Plain English version was developed </li></ul><ul><li>Increased personalisation: </li></ul><ul><ul><li>Optional text messages about how tobacco companies promote smoking </li></ul></ul><ul><li>Improved data collection methods </li></ul>
    14. 14. Demographics of main trial Registered 10,627 eligible participants of those 55% were randomised SEX n % Female 2606 45% Male 3194 55% Age (16-18) 194 3% (19-34) 2396 41% (>34) 3210 56% Education To age 16 or less 2538 44% > age 16 3262 56% Fagerstrom 5 or less 3488 60% >5 2312 40%
    15. 15. <ul><li>Results due spring 2010 </li></ul><ul><li>Implications, if effective: </li></ul><ul><li>For smoking cessation: </li></ul><ul><ul><ul><li>Huge potential for delivery globally, especially relevant where smoking cessation service infrastructure lacking e.g. China, India </li></ul></ul></ul><ul><ul><li>For health and health care behaviour (combined with systematic review) </li></ul></ul>

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