Text Messaging-Based Interventions for Smoking Cessation: A Systematic Review and Meta-Analysis

Background: Tobacco use is one of the leading preventable global health problems producing nearly 6 million smoking-related deaths per year. Interventions delivered via text messaging ( short message service, SMS) may increase access to educational and support services that promote smoking cessation across diverse populations. Objective: The purpose of this meta-analysis is to ( 1) evaluate the efficacy of text messaging interventions on smoking outcomes, ( 2) determine the robustness of the evidence, and ( 3) identify moderators of intervention efficacy. Methods: Electronic bibliographic databases were searched for records with relevant key terms. Studies were included if they used a randomized controlled trial ( RCT) to examine a text messaging intervention focusing on smoking cessation. Raters coded sample and design characteristics, and intervention content. Summary effect sizes, using random-effects models, were calculated and potential moderators were examined. Results: The meta-analysis included 20 manuscripts with 22 interventions ( N= 15,593; 8128 ( 54%) women; mean age= 29) from 10 countries. Smokers who received a text messaging intervention were more likely to abstain from smoking relative to controls across a number of measures of smoking abstinence including 7-day point prevalence ( odds ratio ( OR)= 1.38, 95% confidence interval ( CI)= 1.22, 1.55, k= 16) and continuous abstinence ( OR= 1.63, 95% CI= 1.19, 2.24, k= 7). Text messaging interventions were also more successful in reducing cigarette consumption relative to controls ( d(+)=0.14, 95% CI= 0.05, 0.23, k= 9). The effect size estimates were biased when participants who were lost to follow-up were excluded from the analyses. Cumulative meta-analysis using the 18 studies ( k= 19) measuring abstinence revealed that the benefits of using text message interventions were established only after only five RCTs ( k= 5) involving 8383 smokers ( OR= 1.39, 95% CI= 1.15, 1.67, P<.001). The inclusion of the subsequent 13 RCTs ( k= 14) with 6870 smokers did not change the established efficacy of text message interventions for smoking abstinence ( OR= 1.37, 95% CI= 1.25, 1.51, P<.001). Smoking abstinence rates were stronger when text messaging interventions ( 1) were conducted in Asia, North America, or Europe, ( 2) sampled fewer women, and ( 3) recruited participants via the Internet. Conclusions: The evidence for the efficacy of text messaging interventions to reduce smoking behavior is well-established. Using text messaging to support quitting behavior, and ultimately long-term smoking abstinence, should be a public health priority.