Stephenson Cancer Center, Oklahoma City, Oklahoma.
Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City.
JAMA Intern Med. 2019 Feb 1;179(2):167-174. doi: 10.1001/jamainternmed.2018.5713.
Limited evidence supports mobile phone-delivered cessation interventions for socioeconomically disadvantaged individuals.
To assess the efficacy of mobile phone-delivered cessation interventions targeted to smokers at neighborhood sites serving racial/ethnic minority and socioeconomically disadvantaged individuals.
DESIGN, SETTING, AND PARTICIPANTS: This group-randomized clinical trial with neighborhood site serving as the sampling unit compared smoking cessation interventions that included (1) nicotine replacement therapy (NRT), (2) NRT plus text messaging, and (3) NRT plus text messaging plus proactive counseling via mobile phone. Recruitment took place at churches, public housing complexes, and community centers located throughout the Houston, Texas, area. A total of 624 current cigarette smokers 18 years or older were enrolled at neighborhood sites from August 13, 2011, through December 12, 2014. Final follow-up was completed on June 12, 2015, and data were analyzed from August 17, 2017, through May 10, 2018, based on intention to treat.
Nicotine replacement therapy consisted of transdermal nicotine patches; NRT plus text messages, transdermal nicotine patches and individually tailored mobile phone text messages; and NRT plus text plus call, transdermal patches, individually tailored mobile phone text messages, and proactive counseling via mobile phone.
The primary outcome was smoking abstinence at 6 months, defined as (1) biochemically verified smoking abstinence (calculated among a subgroup of 377 participants) as determined by saliva cotinine level; and (2) self-reported 30-day abstinence (calculated among all 624 participants).
The study sample included 624 current cigarette smokers (50.6% female; mean [SD] age, 45.8 [12.8] years). Among the 377 participants eligible for biochemical verification, 127 self-reported 30-day abstinence and were asked to provide saliva samples. Of these, 98 samples were returned (participants who did not return samples were coded as smoking). Biochemically verified abstinence rates were 12.0% for NRT, 12.0% for NRT plus text, and 25.5% for NRT plus text plus call. Participants in the NRT plus text plus call group were 2.11 (95% CI, 1.00-4.48) times more likely to be biochemically verified as abstinent compared with the NRT group. No differences in biochemically verified abstinence between the NRT plus text group and the NRT group were observed. Similar associations were observed with the self-report cessation outcomes.
Findings indicate that assignment to an intervention consisting of text messaging alone may not increase cessation rates for socioeconomically disadvantaged smokers. However, text messaging plus proactive counseling may be an efficacious option.
ClinicalTrials.gov identifier: NCT00948129.
有限的证据支持针对社会经济处于不利地位的个体的移动电话戒烟干预措施。
评估针对在为少数族裔和社会经济处于不利地位的个人提供服务的邻里场所吸烟的个体的移动电话戒烟干预措施的效果。
设计、设置和参与者：这项以邻里场所为抽样单位的群组随机临床试验，将戒烟干预措施进行了比较，这些干预措施包括（1）尼古丁替代疗法（NRT），（2）NRT 加短信，以及（3）NRT 加短信加通过移动电话进行主动咨询。招募工作在德克萨斯州休斯顿地区的教堂、公共住房大楼和社区中心进行。共有 624 名 18 岁或以上的当前吸烟者在邻里场所登记，时间为 2011 年 8 月 13 日至 2014 年 12 月 12 日。最终随访于 2015 年 6 月 12 日完成，数据基于意向治疗，于 2017 年 8 月 17 日至 2018 年 5 月 10 日进行分析。
尼古丁替代疗法包括透皮尼古丁贴片；NRT 加短信，透皮尼古丁贴片和个性化的手机短信；NRT 加短信加呼叫，透皮贴片，个性化的手机短信，以及通过移动电话进行主动咨询。
主要结果是 6 个月时的吸烟戒断，定义为（1）生物验证的吸烟戒断（通过唾液可替宁水平计算，在 377 名参与者的亚组中计算）；以及（2）自我报告的 30 天戒断（在所有 624 名参与者中计算）。
研究样本包括 624 名当前吸烟者（50.6%为女性；平均[标准差]年龄为 45.8[12.8]岁）。在 377 名有资格进行生物化学验证的参与者中，有 127 名自我报告 30 天戒断并被要求提供唾液样本。其中，有 98 个样本被退回（未退回样本的参与者被编码为吸烟）。NRT 的生物验证戒断率为 12.0%，NRT 加短信的戒断率为 12.0%，NRT 加短信加呼叫的戒断率为 25.5%。与 NRT 组相比，NRT 加短信加呼叫组的参与者更有可能通过生物验证来判断为戒烟者，其可能性为 2.11（95%置信区间，1.00-4.48）倍。NRT 加短信组与 NRT 组之间在生物验证的戒烟率方面没有差异。自我报告的戒烟结果也存在类似的关联。
研究结果表明，对社会经济处于不利地位的吸烟者进行单独的短信干预可能不会提高戒烟率。但是，短信加主动咨询可能是一种有效的选择。
ClinicalTrials.gov 标识符：NCT00948129。
