Tobacco Use: Mobile Phone Text Messaging Cessation Interventions

Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends mobile phone text messaging interventions for tobacco smoking cessation to increase the number of adults who successfully quit.

Evidence shows improvements in cessation among adults when measured six or more months following intervention. Mobile phone text messaging interventions were effective when implemented alone or with other interventions. Effective interventions provided tailored content, interactive features, or both.

The full CPSTF Finding and Rationale Statement and supporting documents for Tobacco Use: Mobile Phone Text Messaging Cessation Interventions are available in The Community Guide Collection on CDC Stacks.

Intervention

Mobile phone text messaging interventions deliver evidence-based information, quitting strategies, and behavioral support directly to people who want to quit smoking or using tobacco. Automated text messages support participants’ quit attempts and may change over the course of the intervention. Messages may be one or more of the following:

Tailored for individuals based on computer algorithms that match messages to participant information
Interactive and capable of providing on-demand text responses or behavioral support to participants encountering urges to smoke
Developed or adapted for specific populations and communities

Mobile phone text messaging interventions may be coordinated with other interventions, such as internet-based cessation services, or offered with FDA-approved smoking cessation medications.

About The Systematic Review

CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to tobacco use cessation.

Whittaker R, McRobbie H, Bullen C, Rodgers A, Gu Y, Dobson R. Mobile phone text messaging and app-based interventions for smoking cessation. Cochrane Database of Systematic Reviews 2019;10(10):CD006611. Available from URL: https://doi.org/10.1002/14651858.CD006611.pub5.

The review included 26 studies overall (search period through October 2018). Mobile phone text messaging interventions were examined in 19 studies. Of these, two studies compared interventions based on differences in text message frequency and were not considered in the CPSTF assessment of effectiveness. The team examined the remaining 17 mobile phone text messaging intervention studies and abstracted supplemental information about study, intervention, and population characteristics.

The CPSTF finding is based on results from the published review, additional information from the subset of 17 studies evaluating the effectiveness of mobile phone text messaging interventions, and expert input from team members and CPSTF. This recommendation updates and replaces the 2011 CPSTF finding of sufficient evidence of effectiveness for mobile phone-based cessation interventions.

Study Characteristics

All of the studies evaluating the effectiveness of mobile phone text messaging interventions were randomized controlled trials (17 studies)
Five of the included studies were conducted in the United States. The remaining studies came from the United Kingdom, China and Hong Kong, Australia, New Zealand, Spain and Switzerland
In 10 studies, mobile phone text messaging interventions were combined with additional interventions, including cessation counseling, web-based content, e-mails, nicotine replacement therapy, printed materials, and a mobile phone app
Studies from the United States reported demographic characteristics of participants. Study samples were generally representative across age (18 years and older), sex, racial/ethnic background, and education

Summary of Results

The systematic review included 17 studies from Whittaker et al., 2019 that evaluated the effectiveness of mobile phone text messaging cessation interventions six or more months following intervention.

Mobile phone text messaging interventions increased smoking cessation rates by a median of 4.1 percentage points overall (17 studies)
- Mobile phone text messaging interventions implemented alone increased smoking cessation by a median of 2.3 percentage points (7 studies)
- Mobile phone text messaging interventions implemented in combination with additional cessation support interventions increased smoking cessation by a median of 4.4 percentage points (10 studies)
- Studies conducted in the United States increased smoking cessation by a median of 4.4 percentage points (5 studies)

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

Based on results from the systematic review, the CPSTF finding should be applicable to the general population of adults in the United States who want to quit smoking.

Evidence Gaps

How do intervention effects vary by participant characteristics, including age (especially adolescents and older adults), income, level of education, and race/ethnicity in U.S. populations and settings?
How do intervention effects vary by text message content?
How do mobile phone text messaging interventions that use interactive features and provide tailored guidance compare with text messaging interventions that do not?
What are the most effective and efficient ways to increase recruitment and enhance retention?
What is the impact of these intervention approaches on long-term cessation outcomes (12 months or more)?
Are these interventions effective with clients who want to quit using e-cigarettes?
Are these interventions effective with clients who want to quit using smokeless tobacco products?

Implementation Considerations and Resources

Mobile phone text messaging interventions may require ongoing advertising, service promotion, and interactivity enhancements to attract and engage participants
Advertising, cross-promotion, and coordinated web-linkages may help people who use tobacco access evidence-based cessation interventions that suit their needs
Implementers may need to address identified barriers including technological concerns (e.g., matching program, network, and client capabilities) and take steps to ensure confidentiality of participant information

There are several publicly available mobile phone text messaging interventions with interactive features or tailored content to support people in the United States who want to quit using tobacco. Services are typically accessible through websites, which also offer information and support to help people in their efforts to quit.

The smokefree.gov Initiative, managed by the National Cancer Institute, provides people who want to quit smoking with free, evidence-based smoking cessation information and on-demand support. The initiative offers nine text messaging interventions with online or text opt-in for different groups, including pregnant persons, teens, veterans, Spanish speakers, and people not yet ready to quit
The Tips From Former Smokers website is designed to support CDC’s national tobacco education campaign. The website seeks to motivate quit attempts through stories of real people with smoking-related diseases. The website also aims to help people succeed in quitting smoking by connecting them to cessation resources, such as How to Quit Smoking
The Truth Initiative offers two free digital resources. BecomeAnEX aims to help people quit using tobacco, and This Is Quitting is designed to help young people quit using e-cigarettes

Crosswalks

Healthy People 2030 icon Healthy People 2030 includes the following objectives related to this CPSTF recommendation.