Discussion
PMT, DISEASE
This RCT showed that the behavior change theory–based smoking cessation intervention using personalized text messages was more effective than an intervention using nonpersonalized text messages in both the short and long term and should be considered as an intervention to aid in quitting smoking nationwide. With these findings, the current study joined the recent debate on the effect of mobile interventions on smoking cessation and provided evidence using a robust study design. The study also found new and potentially important information. The primary outcome, biochemically verified 6-month sustained abstinence rate, was relatively low (6.9% in the intervention group) compared with that of Western countries. For example, a British mobile phone text messaging studyNotably, the biochemically verified 24-hour point prevalence of abstinence increased in both groups; however, the increase became slower in the control group than the intervention group after the intervention ended at 3 months. This slower increase may be due to the fact that the personalized intervention improved efficacy and affected the duration of the intervention. Research has found that personalized messages elicit neural activity in self-processing regions, and this self-related activity estimates the success of smoking cessation.We did not provide financial compensation to the participants; however, we provided gifts (a towel, umbrella, or cup) if the participants completed 1 follow-up visit. Our study had a high retention rate, probably due to 3 reasons. First, at the time of the baseline survey, we recorded participants’ full information, including home address, telephone number, family member’s telephone number, and company or organization of employment. If participants could not come to our designated location to complete a follow-up visit, we sent a research staff member to any location of their convenience (normally their home or place of employment). Second, if we could not contact participants by cell phone, we contacted their family member to coordinate a time to complete the follow-up visit. Third, if we tried everything but still could not locate a participant, the local Disease Control and Prevention Center helped us to connect with their community service center to find the individual and complete the follow-up visit. All procedures were explained to participants at baseline.Our findings have policy implications. This study was, to our knowledge, the first double-blind RCT of a mobile smoking cessation intervention in mainland China. On the basis of the study results and because population-level smoking cessation services are limited in China, a mobile cessation intervention should be considered as an addition to existing smoking cessation services. Furthermore, given the low cost of such an intervention, the delivery of interventions at the national or international level would be easy and especially beneficial for countries such as China that have a large number of smokers but no cost-free smoking cessation medications and support.Our study also has theoretical implications; mobile interventions are often limited by insufficient reporting of content, which leaves other researchers unclear regarding which specific factors made an intervention effective. In the context of mobile smoking cessation interventions, inadequate reporting is of particular concern. The current study provides a clear framework for the intervention through the systematic and transparent application of the PMT and TTM. This approach may allow other researchers to benefit from our experience when scaling up their smoking cessation interventions, and the methods used may be equally applicable to the development of interventions targeting other health behaviors.Further trials are needed to determine whether our results generalize to female and younger populations. In addition, studies that compare a mobile smoking cessation intervention with an intervention consisting of both mobile cessation and other counseling services are needed. These studies will be important for public health policy decisions regarding whether health care organizations should provide a mobile cessation intervention as a treatment option for smokers or integrate mobile cessation into a current service.