Mobile phone‐based smoking cessation support (mCessation) offers the opportunity to
provide behavioural support to those who cannot or do not want face‐to‐face support.
In addition, mCessation can be automated and therefore provided affordably even in
resource‐poor settings. This is an update of a Cochrane Review first published in
2006, and previously updated in 2009 and 2012. To determine whether mobile phone‐based
smoking cessation interventions increase smoking cessation rates in people who smoke.
For this update, we searched the Cochrane Tobacco Addiction Group's Specialised Register,
along with clinicaltrials.gov and the ICTRP. The date of the most recent searches
was 29 October 2018. Participants were smokers of any age. Eligible interventions
were those testing any type of predominantly mobile phone‐based programme (such as
text messages (or smartphone app) for smoking cessation. We included randomised controlled
trials with smoking cessation outcomes reported at at least six‐month follow‐up. We
used standard methodological procedures described in the Cochrane Handbook for Systematic
Reviews of Interventions . We performed both study eligibility checks and data extraction
in duplicate. We performed meta‐analyses of the most stringent measures of abstinence
at six months' follow‐up or longer, using a Mantel‐Haenszel random‐effects method,
pooling studies with similar interventions and similar comparators to calculate risk
ratios (RR) and their corresponding 95% confidence intervals (CI). We conducted analyses
including all randomised (with dropouts counted as still smoking) and complete cases
only. This review includes 26 studies (33,849 participants). Overall, we judged 13
studies to be at low risk of bias, three at high risk, and the remainder at unclear
risk. Settings and recruitment procedures varied across studies, but most studies
were conducted in high‐income countries. There was moderate‐certainty evidence, limited
by inconsistency, that automated text messaging interventions were more effective
than minimal smoking cessation support (RR 1.54, 95% CI 1.19 to 2.00; I 2 = 71%;
13 studies, 14,133 participants). There was also moderate‐certainty evidence, limited
by imprecision, that text messaging added to other smoking cessation interventions
was more effective than the other smoking cessation interventions alone (RR 1.59,
95% CI 1.09 to 2.33; I 2 = 0%, 4 studies, 997 participants). Two studies comparing
text messaging with other smoking cessation interventions, and three studies comparing
high‐ and low‐intensity messaging, did not show significant differences between groups
(RR 0.92 95% CI 0.61 to 1.40; I 2 = 27%; 2 studies, 2238 participants; and RR 1.00,
95% CI 0.95 to 1.06; I 2 = 0%, 3 studies, 12,985 participants, respectively) but
confidence intervals were wide in the former comparison. Five studies compared a smoking
cessation smartphone app with lower‐intensity smoking cessation support (either a
lower‐intensity app or non‐app minimal support). We pooled the evidence and deemed
it to be of very low certainty due to inconsistency and serious imprecision. It provided
no evidence that smartphone apps improved the likelihood of smoking cessation (RR
1.00, 95% CI 0.66 to 1.52; I 2 = 59%; 5 studies, 3079 participants). Other smartphone
apps tested differed from the apps included in the analysis, as two used contingency
management and one combined text messaging with an app, and so we did not pool them.
Using complete case data as opposed to using data from all participants randomised
did not substantially alter the findings. There is moderate‐certainty evidence that
automated text message‐based smoking cessation interventions result in greater quit
rates than minimal smoking cessation support. There is moderate‐certainty evidence
of the benefit of text messaging interventions in addition to other smoking cessation
support in comparison with that smoking cessation support alone. The evidence comparing
smartphone apps with less intensive support was of very low certainty, and more randomised
controlled trials are needed to test these interventions. Can programmes delivered
by mobile phones help people to stop smoking? Background Tobacco smoking is a leading
cause of preventable death. Mobile phones can be used to support people who want to
quit smoking. In this review, we have focused on programmes that use text messages
or smartphone apps to do so. Search date We searched for published and unpublished
studies in October 2018. Study characteristics We included 26 randomised controlled
studies (involving over 33,000 people) that compared smoking quit rates in people
who received text messages or smartphone apps to help them quit, with people who did
not receive these programmes. We were interested in studies that measured smoking
for six months or longer. Key results We found that text messaging programmes may
be effective in supporting people to quit, increasing quit rates by 50% to 60%. This
was the case when they were compared to minimal support or were tested as an addition
to other forms of stop‐smoking support. There was not enough evidence to determine
the effect of smartphone apps. Quality and completeness of the evidence Most of the
studies were of high quality, although three studies had high drop out rates. We are
moderately confident in the results of the text messaging interventions, but there
were some issues with unexplained differences between study findings and for some
comparisons there was not much data. We have low confidence in the results concerning
smartphone apps, and more studies are needed in this field.