Txt2Stop

Text speak is a real fav of mine, since I feel like one of the cognoscenti most of the time, largely due to the efforts of my daughters.  No surprise then that this study using text messaging to help people quit smoking in this issue of the Lancet is one I also chose for this week's podcast. 

Almost 6000 smokers who had agreed to make an attempt to kick the habit were recruited to this study. About half of them received text messages containing motivational messages and behavioral change support, while the other half got texts unrelated to smoking cessation.  (have a nice day?   or some such?).  At six months, study subjects were queried as to whether they were smoking or not, and this was verified using saliva testing for the metabolite of cigarette smoking known as cotinine. The very low number of folks who refused saliva tested were assessed using carbon monoxide levels.

Turns out that using text messaging to underpin smoking cessation efforts was able to increase the successful quit rate by a factor of two, that is, twice as many subjects who got the intervention messages still weren't smoking at the six month assessment.  The authors conclude (with typical British understatement) that text messaging should be included as part of any smoking cessation program.  Uh, yeah.  I would agree.  And further good news is that this beneficial effect of texting was seen regardless of the age or sex of participants.  Go, grandpa!  We know that smoking cessation is helpful no matter what so any strategy to reach and help more smokers is good news indeed.

Let's turn to the content of the texts for a moment.  Those who got the intervention texts received five messages a day for the first five weeks after the day they quit smoking, then 3 per week for the next 26 weeks.  Messages encouraged subjects to persevere (be calm and carry on, anyone?), to focus on their success thus far, to reflect on how others would approve of their behavior, and how to deal with cravings.  They also addressed specific concerns such as weight gain and promised help dealing with that, too.  Messages were selected from a large database and were personalized for each participant based on their responses to the intake questionnaire, and subjects were also provided with the cell number of another study subject so support could be elicited and given.

Control subjects got text messages telling them how valuable their participation in the trial was and thanking them for taking part. 

Study subjects also were able to use other methods along with the text messages to assist their cessation efforts, such as counseling and nicotine replacement.  The study did not break out all these categories, however, so it's not possible to say what the most effective strategy is, but based on previous research I'm guessing that the multipronged approach is most likely to meet with success, and now, that should include text messaging support. 

Other topics this week include the risk of congestive heart failure in people with type 1 diabetes, also in the Lancet, the utility of CT in reducing lung cancer deaths in people at high risk in NEJM, and prevention of melanoma using sunscreen in JAMA.  Until next week, y'all live well.