Efficacy of SMS Text Message Interventions for Smoking Cessation: A Meta-Analysis

Background: Mobile technology provides new opportunities for health promotion communication. The purpose of this study was to conduct a current and extensive meta-analytic review of SMS (short message service) text message-based interventions for individual smoking cessation.

Methods: Academic Search Complete, PsycINFO, PubMed, and Scopus were reviewed for articles meeting selection criteria: 1) randomized controlled trials, 2) measured smoking cessation, and 3) intervention primarily delivered through SMS text messaging. Three and 6month follow-up of 7-day point prevalence or continuous abstinence was considered from studies meeting criteria. All analyses were conducted with intention-to-treat. Both fixed and random effects models were used to calculate the global outcome measure and confidence intervals.

Results: Thirteen studies were identified that met inclusion criteria. The studies were found to be homogeneous [Q12=12.47, p=0.14]. Odds ratios based on the random effects models suggested that interventions generally increased quit rates compared to controls, 1.36 [95% CI=1.23, 1.51]. Intervention efficacy was higher in studies with a 3month follow-up compared to 6month follow-up. Text plus programs (e.g., text messaging plus Web or in-person intervention modalities) performed only slightly better than text only programs. Pooled results also indicate message frequency schedule can affect quit rates, in which fixed schedules performed better than decreasing or variable schedules. The use of quit status assessment messages was not related to intervention efficacy.

Conclusion: Smoking quit rates for the text messaging intervention group were 36% higher compared to the control group quit rates. Results suggest that SMS text messaging may be a promising way to improve smoking cessation outcomes. This is significant given the relatively wide reach and low cost of text message interventions. Identifying the components that make interventions efficacious will help to increase the effectiveness of such interventions.