Effectiveness of Short Message Service Text-Based Smoking Cessation Intervention Among University Students

Sol Ahn, Mercer University College of Pharmacy

A 2009 systemic review article of 64 clinical trials that investigated teen tobacco use cessation stated that there is limited evidence on effective smoking cessation interventions among young people, and that the younger population is less likely to seek treatment compared with older adults. [1]

A 2012 Cochrane review of five randomized clinical trials concluded that there is a benefit of mobile phone-based smoking cessation interventions on long-term outcomes, though results were consistent with findings from three of five included studies crossing the line of no effect. [2]

Effectiveness of Short Message Service Text-Based Smoking Cessation Intervention Among University Students [3]
Design Randomized, single-blind, two-arm, clinical trial; N= 1,590
Objective To determine the effectiveness of a text-based smoking cessation intervention among young people
Study Groups Intervention (n= 827); control (n= 763)
Methods Participants included daily or weekly smokers willing to set a quit date within one month of enrollment. The study used email to invite all college and university students throughout Sweden to participate. The Nicotine Exit (NEXit) core program was initiated with a one- to four-week motivational phase during which participants can choose to set a stop date. The intervention group received 157 text messages based on components of effective smoking cessation interventions for 12 weeks. The control group received one text every two weeks thanking them for participating in the study, with delayed access to the intervention.
Duration October 23, 2014 to April 17, 2015
Primary Outcome Measure Self-reported prolonged abstinence (not having smoked more than five cigarettes over the past eight weeks)
Baseline Characteristics No. (%)
Intervention (n= 827) Control (n= 763)
Female sex 573 (69.3) 522 (68.4)
Age, y
<21 70 (8.5) 74 (9.7)
21-25 372 (45) 326 (42.7)
26-30 181 (21.9) 176 (23.1)
≥31 204 (24.7) 187 (24.5)
Duration of smoking, median (IQR), y 8 (5-13) 8 (5-13)
Quit attempts, median (IQR) 3 (1-4) 3 (1-5)
Previous use of nicotine replacement therapies 0 (0-2) 0 (0-2)
Previous use of prescription cessation drugs 45 (5.4) 52 (6.8)
No. of cigarettes per week
Geometric mean (SD) 48 (43) 48 (45)
Median (range) 63 (1-238) 70 (2-280)
IQR: interquartile range
Results No. (%) p-value
Intervention (n= 827) Control (n= 763)
Self-reported prolonged abstinence 203 (25.9) 105 (14.6) < 0.001
Adverse Events Common Adverse Events: N/A
Serious Adverse Events: N/A
Percentage that Discontinued due to Adverse Events: N/A
Study Author Conclusions With the limitation of assessing only the short-term effect of the intervention, the effects observed in this trial are comparable with those for traditional smoking cessation interventions.

This study shows it is possible to use a proactive recruitment strategy to enroll a large number of young adults in a treatment program. More sophisticated, tailored, text-messaging interventions as well as combination with initial face-to-face-smoking cessation interventions could also be used to potentially increase the effectiveness of the current findings.


[1] Sussman S, Sun P. Youth tobacco use cessation: 2008 update. Tob Induc Dis. 2009;5:3.

[2] Whittaker R, Mcrobbie H, Bullen C, Borland R, Rodgers A, Gu Y. Mobile phone-based interventions for smoking cessation. Cochrane Database Syst Rev. 2012;11:CD006611.

[3] Müssener U, Bendtsen M, Karlsson N, White IR, Mccambridge J, Bendtsen P. Effectiveness of Short Message Service Text-Based Smoking Cessation Intervention Among University Students: A Randomized Clinical Trial. JAMA Intern Med. 2016;176(3):321-8.


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