Chat-based Support for Preventing Smoking Relapse

Study Overview
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Brief Summary
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This pilot trial aims to evaluate the effectiveness of chat-based instant messaging support in preventing smoking relapse in recent tobacco abstainers.

Detailed Description
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Smoking cessation is one of the most cost-effective health interventions, which can add up to 10 years of life expectancy (Jha et al., 2013). However, it is very difficult to quit smoking because of the addictive effect of nicotine presents in tobacco products, and smokers typically make multiple attempts before successfully quit smoking. Providing evidence-based treatment could substantially increase the chance of successful quitting. The Coronavirus Disease 2019 (COVID-19) provided new opportunities and challenges in promoting smoking cessation. A growing literature has shown that smoking is linked to poor progression of COVID-19 (Patanavanich & Glantz, 2020), which can be a new warning for motivating smokers to quit smoking. However, social distancing measures and increased stress and anxiety related to fear of contracting COVID-19 may increase the risk of smoking relapse in people who recently quit smoking (Patwardhan, 2020). There are also misinformation or unproven claims that smoking can protect against COVID-19. The social distancing measures also become a barrier for smokers who are interested in quitting to receive treatment from smoking cessation clinics. Therefore, implementing new interventions that can address the challenges in the context of the COVID-19 pandemic is needed. Advance in mobile technologies provides a new avenue for delivering smoking cessation support. A qualitative interview of 21 current smokers in Hong Kong has found that mobile instant messaging app (e.g., WhatsApp) is an acceptable and feasible platform for providing chat support for smoking cessation (Luk et al., 2019). Chat-based support allows a registered nurse or trained counsellor to interact with a smoker individually through mobile instant messaging apps (e.g., WhatsApp and WeChat) and provide real-time, continuous, and personalized smoking cessation information and advice. A randomised trial of 1185 smokers found that the chat-based intervention integrated with brief intervention was effective in increasing smoking cessation (Wang et al., 2019). The trial also provided initial evidence that the intervention can be delivered as a stand-alone treatment or in combination with use of existing cessation treatment, to increase the chance of successful quitting. This study aims to adapt the chat intervention for smoking relapse prevention and evaluate its feasibility and effectiveness in recent tobacco abstainers enrolled in a clinic-based smoking cessation service in Hong Kong.

Official Title
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Chat-based Instant Messaging Support for Preventing Smoking Relapse in the Context of COVID-19 Outbreak: a Pilot Randomised Clinical Trial

Conditions
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Smoking Cessation

Intervention / Treatment
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* Behavioral: Chat-based instant messaging support
* Behavioral: SMS message support
* Behavioral: Self-help booklet


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Hong Kong residents aged 18 years or older Enrolled in a smoking cessation programme under Tung Wah Group of Hospitals Integrated Centre on Smoking Cessation Daily tobacco use before service intake Not using any tobacco product for 3 to 30 days Own a mobile phone with a mobile instant messaging app (WhatsApp or WeChat) installed Able to communicate in Chinese (Cantonese or Mandarin) Exclusion Criteria: Subjects with communication barriers owing to physical or cognitive conditions will be excluded.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention group<br>Chat-based instant messaging support + Self-help booklet | Behavioral: Chat-based instant messaging support<br>* Subjects will receive personalised instant messaging support for 12 weeks after baseline, address the five problems that contributed to smoking relapse: (1) lack of support for cessation, (2) negative mood or depression, (3) strong or prolonged withdrawal symptoms, (4) weight gain, and (5) smoking lapses. Updated information about the negative effect of smoking on risk of COVID-19 infection and prognosis will also be delivered.<br>Behavioral: Self-help booklet<br>* Subjects will receive a standard self-help booklet on smoking relapse prevention.<br>|
| Active Comparator: Control group<br>SMS message support + Self-help booklet | Behavioral: SMS message support<br>* Subjects will receive regular SMS on generic smoking cessation for 3 months.<br>Behavioral: Self-help booklet<br>* Subjects will receive a standard self-help booklet on smoking relapse prevention.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Biochemically-validated tobacco abstinence | Defined by an exhaled carbon monoxide level of 3 parts per million or below | Assessed at 6 months after randomisation | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Self-reported 6-month prolonged tobacco abstinence | Not more than five lapses permitted for 6 months after baseline | Assessed at 6 months after randomisation | 
| Self-reported 7-day point-prevalence tobacco abstinence | Being completely smoke-free in the past 7 days | Assessed at 3 months after randomisation | 
| Self-reported 7-day point-prevalence tobacco abstinence | Being completely smoke-free in the past 7 days | Assessed at 6 months after randomisation | 
| Self-reported relapse rate | Defined as use of tobacco products for 7 consecutive days or longer | Assessed at 3 months after randomisation | 
| Self-reported relapse rate | Defined as use of tobacco products for 7 consecutive days or longer | Assessed at 6 months after randomisation | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Instant messaging, Relapse prevention, WhatsApp, WeChat, Chat intervention, Chinese, Mobile health