Smoking cessation support by text message: the impact of the text2stop trial

Smoking kills about 6 million people per year globally and around half of current smokers will be killed by their habit if they continue to smoke.

In England, smoking killed around 80,000 adults according to government figures and smoking-related causes accounted for around a third of all deaths in those aged 35 and over.

Reducing smoking is a global health priority and in the UK the government aims to reduce the number of smokers in England by around 210,000 per year, with campaigns to help people quit an important part of this work. A New Zealand study had shown that a service using text messages to encourage smokers to give up had an effect on quit rates at six weeks but, it was unclear if the approach could have a longer-term effect.

School researchers Caroline Free and Rosemary Knight put together a series of focus groups with potential trial participants, smoking cessation counsellors and cognitive behavioural therapists to review the New Zealand messages. Further content was added, which included messages about the physical benefits of giving up smoking and advice on using nicotine replacement therapy.

The txt2stop trial was led by Free, Knight and colleagues based in the School’s Clinical Trials Unit, with collaborators at the University of Auckland. Nearly 6,000 smokers who wanted to quit were randomly allocated to txt2stop, which comprised motivational messages and support, or to a control group, who received bland messages.

Examples of the txt2stop messages include: “This is it! - QUIT DAY, throw away all your fags. today is the start of being quit forever, you can do it.” Whereas the control group received no such motivation: “Being part of this will help others in the future. Thanks for your help!”

At the end of six months a biochemical test was performed to check whether the participants were smoking, which found that txt2stop doubled quit rates. Just over 10% of the txt2stop group had successfully given up, compared to less than 5% in the control group.

After the publication of the results in 2011 the Department of Health asked Free to help develop a new text messaging quit service. The service was launched in January 2012 and by March 2013 more than 34,000 people had joined the programme.

The research findings have been presented all over the world, with the World Health Organization using the txt2stop programme as an example of how to deliver health messages by mobile phone. In April 2013 Costa Rica became the first middle income country to launch a service based on txt2stop.

In the United States commercial company Agile Health launched the Kick Buts programme, based on txt2stop, which was upgraded in 2013 to include a Spanish language version and Facebook integration.