This review found that mobile phone based support is effective at helping people quit smoking for at least six months. Support was mainly via text messages, although some packages combined this with personalised assessment. Mobile phone support was usually compared with standard cessation advice and treatment, or online support that was not tailored to the individual.
Smoking remains a leading cause of illness and deaths in the UK. Around 20% of adults smoke and two-third of smokers express a desire to quit. NHS Stop Smoking services offer a range of support to people wanting to quit, including mobile phone support. This review lends support to this service.
No studies of smartphone applications met inclusion criteria. This would be a valuable area for further study, together with tailored messages for targeted groups.
Why was this study needed?
In the UK, 22% of adult men and 17% of women are smokers. Smoking is one of the main causes of preventable deaths in the UK, causing an estimated 18% of all deaths and 27% of cancer-related deaths.
Surveys show that around two-thirds of smokers want to quit, but only about a third actually try to quit each year. Smokers in the UK can access a range of services via their GP and the NHS Stop Smoking service including nicotine replacement therapy, such as patches and tablets; support in person, online or via telephone; and medication such as varenicline.
In the UK, 93% of adults own a mobile phone, making them a potentially powerful tool to support smokers who want to quit. This systematic review examined the long-term outcomes of using mobile phones to help people stop smoking.
What did this study do?
This systematic review and meta-analysis pooled the results of 12 randomised controlled trials of mobile phone based smoking cessation interventions in 11,885 people who wanted to quit smoking. Quit rates were assessed at six months’ follow-up or longer if available.
Seven of the studies used text messages only; the other five combined this with in-person assessments.
A variety of comparison interventions were used, including standard (untailored) advice delivered online or in-person, and access to nicotine replacement therapy.
This Cochrane systematic review followed a high quality methodology and the studies were of moderate quality. Three studies were carried out in the UK, four in the US, two each in Australia and New Zealand, and one in Switzerland. There was variability in the study settings and included populations, and possible variation in which cessation treatments were used alongside the texting support.
What did it find?
- People who received mobile phone support were more likely to say they had stopped smoking for seven days or more by six months (relative risk [RR] 1.67, 95% confidence interval [CI] 1.46 to 1.90).
- The six studies using a saliva test to verify whether people had quit at six months also found that mobile phone support increased abstinence compared to control participants (RR 1.83, 95% CI 1.54 to 2.19).
- When analyses was restricted to the seven studies that used text messages alone they still found a similar increased likelihood of quitting (RR 1.69, 95% CI 1.46 to 1.95), suggesting that there was no additional benefit of text messages combined with in-person contact.
- No trials assessing mobile phone apps met the inclusion criteria.
What does current guidance say on this issue?
2008 NICE guidelines recommend a variety of support for people wanting to quit smoking, including nicotine replacement therapy, medication, advice, counselling, group therapy, self-help materials. NHS Stop Smoking services include mobile phone support as part of their services.
What are the implications?
This review provides stronger evidence than previously available that mobile phone based support is effective in helping people to stop smoking. The findings are representative of high income countries, and so are relevant to UK settings. GPs and other primary or community care professionals may want to encourage their service users to take up the mobile phone support already available via NHS Stop Smoking services.
Most of the studies included in this review focused on adults, so there may be a need to tailor the approach to support young people wanting to quit smoking. There were no trials of smartphone applications that met the inclusion criteria, so this is an area for future investigation.
Citation and Funding
Whittaker R, McRobbie H, Bullen C, et al. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev. 2016;(4):CD006611.
Cochrane UK and the Tobacco Addiction Cochrane Review Group are supported by NIHR infrastructure funding.
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