Mobile Phone–Based Interventions for Smoking Cessation Among Young People: Systematic Review and Meta-Analysis
Authors: Zhou Xinmei , Wei Xiaowen , Cheng Anqi , Liu Zhao , Su Zheng , Li Jinxuan , Qin Rui , Zhao Liang , Xie Ying , Huang Zhenxiao , Xia Xin , Liu Yi , Song Qingqing , Xiao Dan , Wang Chen 
Published: September 2023

Abstract

Background
Mobile phone–based cessation interventions have emerged as a promising alternative for smoking cessation, while evidence of the efficacy of mobile phone–based smoking cessation programs among young people is mixed.

Objective
This study aimed to determine the efficacy of mobile phone–based interventions compared to usual practice or assessment-only controls on smoking cessation in young people.

Methods
In this systematic review and meta-analysis, we searched Cochrane Library, Embase, PubMed, and Web of Science on March 8, 2023. We included randomized controlled trials that examined the efficacy of mobile phone–based interventions on smoking cessation in young people (age ≤30 years). The risk of bias was assessed with Cochrane Risk of Bias 2.

Results
A total of 13 eligible studies, comprising 27,240 participants, were included in this analysis. The age range of the participants was between 16 and 30 years. Nine studies were SMS text messaging interventions, and 4 studies were app-based interventions. The duration of the smoking cessation intervention varied from 5 days to 6 months. The included studies were conducted in the following countries: the United States, China, Sweden, Canada, Switzerland, and Thailand. The meta-analysis revealed that SMS text messaging interventions significantly improved continuous abstinence rates compared to inactive control conditions (risk ratio [RR] 1.51, 95% CI 1.24-1.84). The subgroup analysis showed pooled RRs of 1.90 (95% CI 1.29-2.81), 1.64 (95% CI 1.23-2.18), and 1.35 (95% CI 1.04-1.76) for continuous abstinence at the 1-, 3-, and 6- month follow-up, respectively. Pooling across 7 studies, SMS text messaging interventions showed efficacy in promoting 7-day point prevalence abstinence (PPA), with an RR of 1.83 (95% CI 1.34-2.48). The subgroup analysis demonstrated a significant impact at the 1- and 3-month follow-ups, with pooled RRs of 1.72 (95% CI 1.13-2.63) and 2.54 (95% CI 2.05-3.14), respectively, compared to inactive control conditions. However, at the 6-month follow-up, the efficacy of SMS text messaging interventions in promoting 7-day PPA was not statistically significant (RR 1.45, 95% CI 0.92-2.28). In contrast, app-based interventions did not show significant efficacy in promoting continuous abstinence or 7-day PPA. However, it is important to note that the evidence for app-based interventions was limited.

Conclusions
SMS text messaging–based smoking cessation interventions compared to inactive controls were associated with abstinence among young people and could be considered a viable option for smoking cessation in this population. More research is needed on smoking cessation apps, especially apps that target young people. Future research should focus on identifying the most effective mobile phone–based cessation approaches and on developing strategies to increase their uptake and intention.