Text messages and smoking cessation in pregnancy
Results of a new randomized controlled trial (RCT)—the largest of its kind to date—suggest that text messaging may help some pregnant women quit smoking. The findings point to the best outcomes in the second and third trimesters and in women at least 26 years old.
Published in the American Journal of Preventive Medicine , the data are from an RCT designed to determine whether Quit4baby, an interactive and intensive text messaging program, would promote smoking cessation in pregnant women already enrolled in the Text4baby health text messaging program.
Recruitment for the study was done by sending nearly 40,000 text messages between July 2015 and February 2016 to Text4baby subscribers. A total of 497 women were randomized, 250 to the Text4baby and Quit4baby messages and 247 to only Text4baby as controls.
Quit4baby was adapted from a program for adult smokers call Text2Quit and its messages describe expected outcomes of quitting smoking for mother and baby and getting support from an ex-smoker “quitpal.” Text4baby sends 3 weekly health texts timed to a woman’s due date, and 6 of its standard messages are on smoking cessation. Text4baby has more than 1 million enrollees and is endorsed by a network of partners including the Centers for Disease Control and Prevention and the American College of Obstetrician and Gynecologists.
The primary outcome of the RCT was 7-day biochemically confirmed point prevalence abstinence at 3-month follow-up, defined as a self-report of no smoking in the past 7 days on the 3-month survey and a cotinine level ≤ 13 ng/mL from a saliva sample.
At 1 month, not smoking in the past 7 days was reported by 28.8% of the intervention group and 15.79% of the control group (P < 0.01); at 3 months, the percentages were 35.20% and 22.67%, respectively (P < 0.01). Biochemical verification of smoking status at 3 months showed no significant differences (P = 0.13) but significant differences favoring use of the intervention in older smokers and in the second or third trimester were seen (both P < 0.05). Self-report of late pregnancy 7- and 30-day point prevalence abstinence favored the intervention group (P < 0.001, P < 0.01). At 6-month follow-up and postpartum, no significant differences were observed.
The authors believe the study’s findings “could have clinical importance in large samples” because they point to “the program’s ability to replicate some of the elements of intensive in-person counseling previously found to be effective with pregnant smokers.” Timing of the invitation to quit smoking, they said, is important and they recommend future research on “understanding the optimal timing of the smoking cessation offer, the value of repeated offers throughout pregnancy, and how to assist smokers of all ages.”