. Author manuscript; available in PMC: 2020 Jun 24.

Published in final edited form as: Circulation. 2015 Aug 13;132(12):1157–1213. doi: 10.1161/CIR.0000000000000232

Table 3.

Description of Studies using mHealth for Smoking Cessation

Study Cited, Design, Primary Outcome, Setting, Quality Rating	Sample Characteristics, Group Size, Study retention	Study Groups & Components	Technology Used	Intervention Duration, # of Intervention Contacts, Intervention Adherence, Interventionist	Primary Outcome
Rodgers, A., et al., 2005¹²² 2-group RCT Primary Outcome: 6 wk. abstinence Secondary outcomes: 12 wk. and 26 wk. abstinence Setting: Community Country: New Zealand	N=1705 Int1: n = 853 Int2: n = 852 Women 58.5% Median age (IQR): 22 yrs. (1930) European ethnicity: 63.0% Maori: 20.8% Pacific Islander: 3.5% Other: 12.7% Baseline Fagerstrom Score (median (IQR)) 5(3–6) Mean (SD) of number of CPD was 15 (3). Average previous quit attempts: 2/person Lost to follow up: 6 wks.: Int1:46 Int2: 35 Retention: 95.2% 26 wks.: Int1: 261 Int2: 179 Retention: 74.2%	Int1: quit day established within 30 days, received personalized texts. Ps received free SMSs for one mo. after quit date. Int2: texts related to appreciation for participating, Ps received one month of free SMSs upon completion (not dependent on quit status). Neither group was advised to cease using other resources for quitting smoking. SMS was an add-on to standard treatment.	SMS	Duration: 26 wks. (6 mo.) Contacts: Int1: 5 SMS/day for the first 5 wks. then 3 SMS wkly until end of 6 mo. Int2: one SMS every 2 wks. Follow-up via phone at 6, 12, and 24 wks. for both groups Interventionist: Int1: Automated, tailored SMS Int2: Automated, non-tailored SMS	ITT (assuming missing = smoking) Abstinence (%) 6 wks. Int1: 239 (28%) Int2: 109 (13%), RR 2.2 (95% CI: 1.79–2.70, p <.001) 12 wks. Int1: 247 (20% Int2: 160 (29%) RR 1.55 (95% CI: 1.30 to 1.84), p <.001 26 wks. Int1: 216 (25%) Int2: 202 (24%) RR 1.07(95% CI 0.91 to 1.26), p = n.s. Of 83 Int1 and 42 Int2 selfreported abstainers at 6 wks. asked to provide saliva for cotinine assay, bioverification confirmed abstinence in: Int1: 17 (20.5% Int2: 6 (14.3%) RR 2.84 (95% CI: 1.12–7.16), p = .02
Brendryen et al., 2008¹²³ Design: 2-group RCT Outcome: 1, 3, 6, 12 month 7 day no puff self-report abstinence Setting: Community Country: Norway	N=290 Int1: n=144 Int2: n=146 Mean age (SD): Int1: 39.5 (11.0) yrs. Int2: 39.7 (10.8) yrs. Women: 50% Mean (SD) cigarettes smoked per day: Int1: 16.6 (7.2) Int2: 17.6 (7.0) College degree: Int1: 49% Int2: 52% Mean (SD) Nicotine Dependence: Int1:4.5 (2.3) Int2:4.6 (2.2) Retention:77.9% Int1: 81.9% Int2: 74.0%	Int1: Happy Endings (HE) group: received HE (internet and mobile phone smoking cessation program) Int2: received 44-pg self-help book	Email, web pages, IVR, SMS, Craving hotline	Duration: 12 mos. Contacts: 1, 3, 6, and 12-mo abstinence reports Intervention adherence: Number of Web & phone responses 1mo: Int1: n= 139 Int2: n = 127 3 mos: Int1: n=135 Int2: n= 131 6 mos: Int1: n=124 Int2: n=120 12 mos: Int1: n=131 Int2: n=123 Discontinued treatment Int1: n=57 (47%) Interventionist: Int1: Automated Int2: booklet	ITT, Missing assumed = smoking 7-day no puff point abstinence 1mo: Int1: 42% Int2: 17% p = .001 3mo: Int1: 35% Int2: 16% p= .001 6mo: Int1: 29% Int2: 14% p = .002 12mo: Int1: 33% Int2: 23% p = .07 Complete case analysis Repeated point abstinence: 1+3mos: Int1: 30% Int2: 12% p =.001 1+3+6mos: Int1: 24% Int2:7% p =.001 1+3+6+12mos: Int1: 20% Int2: 7% p =.002
Brendryen et al., 2008¹²⁴ Design:2-group RCT Outcome: 1, 3, 6, 12 month 7 day no puff self-report abstinence Setting: Community Country: Norway	N=396 Int1: n= 197 Int2: n= 199 Mean age (SD): Int1 35.9(10.0) Int2: 36.4 (10.5) Women: Int1: 50.8% Int2: 19.8% College degree- Int1: 42.1% Int2: 39.7% FTND: Int1 4.8 ± 2.2 Int2 4.9 ± 2.2 Cpd- Int1: 18.3 ± 5.9 Int2: 18.1 ± 5.8 Pre-cessation self-efficacy- Int1: 4.9 ± 1.3 Int2: 5.1 ± 1.3 Retention: Int1: 88% Int2: 84%	Int1: Happy Endings Internet and cell-phone-based smoking cessation program, 400+ contacts by email, webpages, IVR and SMS Int2: 44 pg. self-help booklet Both groups offered NRT	Email, web pages, IVR, SMS	Duration: 54 wks Contacts: 1, 3, 6, and 12-mo abstinence reports NRT adherence: Int1: 93% Int2: 87% P = n.s. Discontinued treatment: Int1: n=45 (23%) Interventionist: Int1: Automated Int2: NA	ITT, Missing assumed = smoking 7-day no puff point prevalence abstinences: 1mo: Int1: 50.3% Int2: 29.6% p = .001 3 mos.: Int1: 44.7% Int2: 28.6% p = .001 6 mos.: Int1: 37.1% Int2: 21.6 P = .001 12mo: Int1: 37.6% Int2: 24.1% p = .005
Free et al., 2009¹²⁵ Design: 2-group RCT Outcome: 4 week and 6 month self-reported abstinence Setting: Community Country: UK	N =200 Mean age (SD):36 (9) yrs. Women: 38% Median # cigarettes smoked: 20/day Manual occupations: 33% Retention: 92%	Int1: received SMS smoking cessation program (txt2stop) comprised of motivation messages and behavioral-change support. Int2: received SMS messages unrelated to quitting smoking	Mobile Phone SMS	Duration: 6 mos. Contacts: Int1 group received daily SMS starting at randomization with a countdown to quit day and then five messages per day for 4 wks. after the quit day. Intervention continued with a maintenance package of 3 SMS per wk. for 26 wks. Int2 group received simple, short, generic SMS every 2 wks. Intervention adherence: Response rate at 4wks was 96%, 6wks: 92% Interventionist: Int1: Automated Int2: Automated	Completer sample, self-report point prevalence abstinence 4wks Int1: 26% Int2: 13% P = 0.02 RR 2.08 (95% CI 1.11 to 3.89), 6 mos. Int1: 8.5% Int2: 6.7% P = 0.6
Free et al., 2011¹²⁶ Design: Single-blind 2-group RCT Outcome: 6 month biochemically verified smoking abstinence Setting: Community Country: UK	N=5800 Int1: n = 2911 Int2: n = 2881 Women: 45% Mean age (SD): Int1: 36.8 (11.0) Int2: 36.9 (11.1) White: Int1: 89% Int2: 88% Previous quit attempts (1–5 times): Int1:,74% Int2: 76% Fagerstrom score ≤5: Int1: 60%) Int2: 60% Retention: 95%	Int1: SMS txt2stop mobile phone smoking cessation program. Set quit date w/in 2 wks., received 5 SMS/day first 5 wks., then 3/wk. for next 26 wks. Participants can text back “crave”, “lapse”, and receive supportive instant message Int2: received SMS unrelated to quitting, every 2 wks., short, SMS related to the importance of participation.	Mobile phone SMS	Duration: 6 mos. Contact: 4 wks. and 6 mos. Intervention adherence: Received entire intervention Int1: n=2509 Int2: n=2734 Interventionist: Int1: Automated Int2:Automated	ITT, missing data multiply imputed 6 mos. Self-reported continuous abstinence biologically verified by postal salivary cotinine or in person exhaled carbon monoxide: Int1: 10.7% Int2: 4.9% p<.0001
Whittaker et al., 2011¹²⁷ Design: 2-group RCT Outcome: 6 month self-reported continuous abstinence Setting: Community Country: New Zealand	N = 226 Predominantly Maori Int1: n = 110 Int2: n = 116 Mean age (SD): Int1: 27.5 (9.5) Int2:16.6 (7.8) Women: Int1 = 53% Int2 = 42%; Retention: Int1 = 63% Int2 = 78%	Int1: quit date prompt and 2 SMS per day, video messages regarding cessation Int2: quit date prompt and 2 SMS per day, video	SMS and Video messaging to mobile phones; internet	Duration: 12 weeks of Contacts: 1–3 messages per day, reducing to alternating days during maintenance Intervention adherence: 29% used the text “crave” function; 16% used the text “relapse” function requesting assistance Interventionist: Int1: Automated Int2: Automated	ITT. Missing assumed = smoking 6 mos. Continuous abstinence Int1: 26.4% Int2: 27.6% p=n.s.
Naughton et al., 2012¹²⁸ 2-group RCT Outcomes: 12-week self-reported and cotinine-validated 7-day point prevalence abstinence and cognitive determinants of quitting Feasibility and acceptability of a tailored self-help SC intervention for pregnant smokers (MiQuit) Setting: Community Country: UK	N= 207 Pregnant Int1: n = 102 Int2: n = 105 White: 100% <21 weeks gestation Mean age (SD): Int1: 27.2 (6.4) yrs. Int2: 26.5 (6.2) yrs. 12 week Retention: Int1: n=86 (84%) Int2: n=89 (85%)	Int1: MiQuit sent a four-day, colored, tailored, self-help leaflet via mail and also received tailored SMS Int2: received a non-tailored leaflet via mail Received no tailored SMS, but did receive assessment SMS at 3 and 7 wks.	SMS	Duration: 11 wks. Total contacts: one four-page leaflet for both intervention groups; 2 assessment SMS, one at 3 wks. and one at 7 wks. 3-month follow-up for acceptability, cognitive determinants of quitting, and smoking outcomes. Int1 also received approximately 80 tailored SMS over 11 wks. 0, 1, or 2 SMS were sent daily at various times over 11 wks. Feasibility: 94% (81/86; 95% CI 89%−99%) of MiQuit participants and 80% ( 71/89; 95% CI 71%88%) of controls received both SMS and the leaflet Acceptability: 9% (95% CI 4%15%) of MiQuit participants opted to discontinue SMS Interventionist: Int1: Automated tailored SMS Int2: Automated assessment SMS	ITT. Missing assumed = smoking 12 wks. Self-reported abstinence: Int1 22.9% Int2 19.6%; OR = 1.22, 95% CI 0.62–2.41; p=n.s. Cotinine-validated abstinence Int1 12.5% Int2 7.8%; OR 1.68, 95% CI 0.66–4.31, p =n.s Process outcomes: Int1 more likely to: set a quit date (p= .049), higher levels of self-efficacy (p= .024), harm beliefs (p= .052), and determination to quit (p= .019)
Ybarra, M., et al., 2012¹²⁹ 2-group RCT Primary Outcome: Bioverified sustained abstinence at 3 mos. Setting: Community Country: Ankara, Turkey	N=151 Int1: n = 76 Int2: n = 75 Mean age (SD) Int1: 36.1 (9.5) yrs. Int2:35.6 (10.3) yrs. Women: Int1: 46.1% Int2: 32.0% Mean CPD (SD): Int1: 18.7 (7.2) Int2: 20.4 (9.2) Fagerstrom score mean (SD): Int1: 4.8 (2.3) Int2: 4.9 (2.5) Retention: Int1: n=46 (61%) Int2: n = 51 (68%)	Int1: 6-wks daily messages aimed at quitting skills. Messages automated except for 2 days and 7 days post quit day in which RAs manually assigned Ps to content “paths” based on whether they had relapsed or had maintained quitting. Int2: 7-page brochure	SMS	Duration: 3 months Int duration: 6 wks Contacts: Int1: Varied by P (dependent upon stage of change and whether relapse occurred. Range is from 912013146.) Int2: no SMS Each group had in-person visits at baseline, 4 wks after quit day, and at 3-mo. F/U Intervention Adherence: NR Interventionist: Int1: Automated + RA manually assigned to content path Int2: NA	ITT Missing assumed = smoking 3-mo. cessation bioverified by carbon monoxide Int1:11% Int2: 5% p= n.s. Secondary outcome: Smoking < 20 Int1: 17% Int2:0% p=0.02
Borland et al., 2013¹³⁰ Design: 5-group RCT Outcome: self-reported continuous abstinence at 6 months Setting: Community	N=3530 Int1: n = 809 Int2: n = 756 Int3: n = 785 Int4: n= 758 Int5: n = 422	Five conditions: Int1: QuitCoach personalized tailored internet-delivered advice program Int2: onQ, an interactive automated SMS program Int3: an integration of both	Internet and SMS	Duration: 7 mos. Contacts: Int. lasted 7 mos., follow-up surveys at 1 mo. and 7 mos.	ITT assuming missing = smoking, LOCF, and Completer analysis 6-mo sustained abstinence: Int1: 9.0% Int2: 8.7%
Country: Australia	Mean age (range): 42.1 (18–80) yrs. Women: 60% Currently smoking: 87.4% Average # cigarettes smoked: 16.9/day Retention: 86.5%	QuitCoach and onQ Int4: a choice of either internet or SMS alone or the combined program Int5: received minimal Int and was offered a simple information website		Intervention adherence: Used intervention: 42.5% Tried it: 14.6% Did not use: 43% Interventionist: Int1: Automated Int2: Automated Int3: Automated Int4: Automated Int5: NA	Int3: 8.7% Int4: 9.1% Int5: 6.2% p = n.s.
Buller et al., 2013¹³¹ Design: Randomized pretest-posttest two-group design Outcome: 7 day point prevalence self-reported abstinence at 6 weeks, 30 day point prevalence abstinence at 12 weeks Setting: Community Country: US	N=102 Mean age (SD): Int1: 25.5 (NR) yrs. Int2: 24.3 (NR) yrs. Women: Int1: 45% Int2: 57% White: Int1: 70% Int2: 76% Cigarettes smoked per day: Int1: 16.8 Int2: 17.1 Attempted to quit in the past yr: Int1: 66% Int2: 71% Retention: 67%	Int1: Smokers received smartphone application (REQ-Mobile) with interactive tools Int2: assigned to the onQ group which received a SMS system	Smart phone application (REQ- Mobile), SMS system (onQ)	Duration: 12 wks. Contacts: Pretest, 6-wk posttest, and 12-wk posttest smoker reported smoking status Intervention adherence: 60% used allocated service Interventionist: Int1: Interactive online Int2: automated SMS	ITT assuming missing = smoking and completer analyses 6 wks (completer analysis, n=66) 7-day point prevalence abstinence Int1: 30% Int2: 58% p = 0.03 12 wks. ITT 30 day point prevalence abstinence Int1: 18% Int2: 31% p = n.s. completers 30 day point prevalence abstinence Int1: 27% Int2: 46% p = n.s.
Haug et al., 2013¹³² Design: 2-group cluster randomized design Outcome: 7-day self-reported abstinence at 6 months Setting: Vocational schools Country: Switzerland	N = 755 in 178 classes Int1: n = 383 in 88 classes Int2: n = 372 in 90 classes Mean age (SD): Int1: 18.2 (2.4) yrs. Int2: 18.3 (2.2) yrs. Women: 49% Smoking status: Occasional = 29%; Daily = 71% Retention at six months: Int1: 79.3% Int2: 71.0%	Int1: Online assessment, weekly SMS assessment, 2 weekly tailored messages, integrated quit day and relapse prevention Int2: No intervention	SMS to mobile phones	Duration: 3 months Contacts: 3 SMS per week Intervention Adherence: 2.4% unsubscribed Mean number of replies to weekly assessment: 6.5 out of a possible 11 possible replies Interventionist: Int1: Automated Int2:Assessment	ITT with 30 imputed data sets mos. day self-reported abstinence Int1: 12.5% Int2: 9.6% OR: 1.03 (0.59 to 1.79), p=n.s.
Shi et al., 2013¹³³ Design: 2-group cluster randomized design Outcome: 7-day self-reported abstinence at 12 weeks Setting: Vocational schools Country: China	N = 179 in 6 schools Int1: n = 92 in 3 schools Int2: n = 87 in 3 schools Mean age (SD): Int1 = 17.6 (NA) yrs. Int2 = 16.9 (NA) yrs. Women: Int1 = 7% Int2 = 2% Smoking status: Occasional = 29% Daily = 71% Retention at 12 weeks: Int1: 83% Int2: 53%	Int1: Tailored daily SMS based on transtheoretical model Int2: Smoking cessation pamphlet	SMS to mobile phones	Duration: 12 weeks Contacts: daily SMS Intervention Adherence: 87 participants completed the intervention, receiving a median 129 messages and sending a median 32 messages Interventionist: Int1: Automated daily SMS Int2: NA	ITT assuming missing=smoking 12 wks. 7 day self-reported abstinence: Int1: 14% Int2: 8% OR: 1.8 (0.7 to 4.2)
Ybarra, M.L., et al., 2013¹¹⁸ Design: 2-group RCT Primary outcome: 3-mo.continuous abstinence, verified by significant other Setting: Community Country: New Zealand	N=164 Int1: n = 101 Int2: n = 63 Mean age (SD): Int1: 21.6 (2.1) yrs. Int2: 21.6 (2.1) yrs. Women Int1: 44% Int2: 28% White: Int1: 65% Int2: 41% Retention at 3 months Int1: 81 of 101, (80%) Int2: 51 of 63 (81%)	Int1: 6-wk SMS (Stop My Smoking) intervention provided tailored SMS based on relapse status and quit day date. Included buddy support and craving support Int2: attention-matched control group with similar number of SMS as intervention, but aimed at improving sleep and physical activity. Not tailored to quit day status. Buddy support and craving support not available	SMS	Duration: 3 months Intervention: 6 wks. Contacts: two F/U appts. 2013 one at 6 wks. and one at 3 mo. Varying # SMS sent per day to each group, which was dependent on time point in the study. Interventionist: Int1: Automated SMS + buddy Int2: Automated SMS	ITT with missing assumed = smoking ITT 4 wks. Quit rate: Int1: 39% Int2: 21%, OR = 3.33, 95% CI: 1.48, 7.45 3 mos. Quit rate: Int1: 40% Int2: 30%, OR = 1.59, 95% CI: 0.78, 3.21
Abroms et al., 2014¹¹⁹ Design: 2-group RCT Outcome: 6 month biochemically validated point prevalence abstinence Setting: Community Country: US	N = 503 Int1: n = 262 Int2: n = 241 Mean age (SD): 35.7 (10.7) yrs. Women: 66% Average # cigs/day: 17.3 Retention: 76% at six months	Int1: Interactive SMS timed and tailored around the user’s quit date. Int2: receive smokefree.gov site until site included SMS, then changed to Clearing the Air website	SMS; internet	Duration: 3 months push SMS followed by 3 months of SMS on request Contacts: 2 SMS per day on average but up to 5/day around quit date Intervention adherence: 85% received at least 1 SMS Mean of 28 SMS received of those who received at least one Interventionist: Int1: Iinteractive SMS Int2: Automated	ITT, missing assumed=smoking point-prevalence abstinence at 6 months bio-verified by saliva cotinine) Int1: 11.1% Int2: 5.0% Relative risk: 2.22, 95% CI (1.16, 4.26) p<0.05
Systematic Reviews and Meta-Analysis
Whittaker, R., et all, 2009¹²⁰ Meta-analysis of MEDLINE, EMBASE, Cinahl, PsycINFO, The Cochrane Library, the National Research Register, and ClinicalTrials register Outcome: self-reported point prevalence abstinence	Four trials split into two analyses N₁ = 1905 Int₁: n₁ = 954 Con₁: n₁ = 951 N₂ = 696 Int₂: n₂ = 348 Con₂: n₂ = 348 Included smokers of any age who wanted to quit and used any type of mobile phone-based intervention. Retention range for all four studies Int: 69–92% Con: 79–92%	Four studies included (in 5 papers) Used the Mantel-Haenszel Risk Ratio fixed-effect method in which there was no evidence of substantial statistical heterogeneity as assessed by the I(2) statistic	Analysis 1 = SMS Analysis 2 = SMS plus internet	Analysis 1 = studies were 6 mos. duration Analysis 2 = studies were 12 mos. duration Intervention contacts varied by study Intervention Adherence: NR	Analysis 1 = When the studies were pooled, Significant increase in short-term self-reported abstinence(RR 2.18, 95% CI: 1.82.65) Analysis 2 = When the data from the internet and mobile phone programs were pooled, there were significant increases in short- and long-term self-reported quitting (RR 2.03, 95% CI 1.40–2.94)
Whittaker, R., et al., 2012¹²¹ Meta-analysis of the Cochrane Tobacco Addiction Group Specialized Register Outcome: 6 mos. Smoking abstinence, allowing 3 lapses or 5 cigarettes	5 randomized or quasi-randomized trials N= 9100 Int1: n = 4730 Int2: n = 4370 Retention at 6 mos.: varied across studies. Int1: 68–94% Int2: 78–97%	Used the Mantel-Haenszel Risk Ratio fixed-effect method. There was substantial statistical heterogeneity as indicated by I(2) statistic I(2) = 79%	3 studies used SMS, which was adapted over the course of the studies for different populations and contexts. One multi-arm study used SMS intervention and an internet QuitCoach separately and in combination. One Study used video messaging delivered via mobile phone	Study duration:≥6 mos. Adherence rates: NR	Mobile phone interventions increase long-term quit rates compared to control programs at 6 mos. (RR 1.71, 95% CI: 1.471.99, > 9000 participants)

Note: CDS = Cigarette Dependence Score, CI = Confidence Interval, CO = Carbon Monoxide, CPD = Cpd, FNDS = Fagerstrom nicotine dependence scale, Int: Intervention group, Con: Control group, IVR= interactive voice response, aOR = adjusted Odds Ratio, OR = Odds Ratio, NRT = Nicotine Replacement Therapy, mo = month, mos. = months, RA = research assistant, NA=not applicable, P = participant, Ps = participants, RCT = Randomized Controlled Trial, SC = Smoking Cessation, SD = Standard Deviation, SMS = Short Message Service, wk = week, wks = week, NR = not report, Automated = without a clinician who generates, tailors, or modifies the output; ITT = intention to treat, LOCF = last observation carried forward, Δ = change or difference