Preplanned Studies: Comparative Effectiveness of Mobile Health-Based Comprehensive Smoking Cessation Modalities and Traditional Clinic-Delivered Treatments — Beijing Municipality, China, May 2022 to April 2024

Smoking remains a challenge in China with high prevalence rates and low cessation success (1). Effective quit services are scarce in China, limiting their accessibility. Mobile health (mHealth) offers a promising solution to overcome geographical and logistical barriers. From May 2022 to April 2024, we conducted three cohort studies in Beijing, China, to evaluate the effectiveness of two mHealth-based modalities versus traditional clinic-delivered cessation treatments. Participants were grouped into four categories based on their utilization of cessation services: the “Way to Quit” (WQ) group, the WQ+ mailed nicotine replacement therapy (NRT) group, the smoking cessation clinic (SCC) group, and a control group, referred to as the none use group. Follow-up assessments were conducted at 1 and 3 months post-baseline. We included 1,107 eligible participants who completed at least one follow-up. The self-reported 1–3 month prolonged abstinence rates were 21.7% in the WQ group, 19.7% in the WQ+ mailed NRT group, and 29.9% in the SCC group, all significantly higher than the none use group (6.6%; all P<0.001). Adherence to treatment was correlated with higher cessation rates. This study demonstrates that mHealth-based interventions, both alone and in combination with mailed NRT, can improve smoking cessation outcomes. These findings support that mHealth approaches should be used to enhance smoking cessation access and effectiveness in China.

Three prospective cohort studies were conducted at the smoking cessation clinic of Beijing Chaoyang Hospital from May 2022 to April 2024, as part of the public welfare initiative “You Quit, I Support” program. These cohorts were initiated at different times, and tailored to specific smoking cessation services. Current smokers (aged≥18) intending to quit within a month were recruited online, excluding those with mental or psychological conditions. All eligible participants provided either electronic or printed consent forms. These studies received approval from the Institutional Review Board of Beijing Chao-Yang Hospital, Capital Medical University (IRB# 2022-ke-394, 2020-ke-545-3).

Participants were enrolled to receive one of the following free-of-charge services based on the cohort they participated in: the WQ modality (WQ group), the WQ modality supplemented with mailed NRT (WQ+ mailed NRT group), or traditional clinic-delivered treatment (SCC group). The WQ modality provided two months of three WeChat-based interventions (2). The WQ+ mailed NRT modality consisted of the WQ interventions plus a four-week supply of nicotine gum (2 mg/piece, McNeil Sweden AB, Inc., Helsingborg, Sweden) for on-demand use (3). Traditional clinic-delivered treatment included varenicline (Sinobiopharma, Inc., Jiangsu, China) for up to 12 weeks and 6 standardized counseling sessions (4). Participants who did not utilize any of the cessation services offered were classified as the control group (none use group).

Baseline data were collected through an online questionnaire, which included demographic characteristics, smoking history, previous quit attempts, and comorbidities. The Fagerstrom Test for Nicotine Dependence (FTND) was employed to assess nicotine dependence. Follow-up data were obtained via phone or online using WenJuanXing (https://www.wjx.cn/) at 1 and 3 months post-baseline, covering changes in smoking behavior, cessation service utilization, and other relevant factors. Data regarding the usage of the WeChat-based interventions were extracted from the WeChat app platform. Participants self-reported their medication use. The primary outcome was the self-reported prolonged abstinence rate over 1 to 3 months (5). Secondary outcomes included the self-reported 7-day point prevalence of abstinence rate (PPAR) (5), the quit attempt rate, and the smoking reduction rate (≥50% daily smoking reduction from baseline) at the 1-month follow-up.

All statistical analyses were conducted using SPSS software (version 22.0; SPSS, Inc., Chicago, IL, USA). Descriptive data were presented as mean (standard deviation, SD) for continuous variables with normal distribution, median (interquartile range, IQR) for continuous variables without normal distribution, and proportions for categorical variables. Baseline characteristics of participants across the four groups were compared using analysis of variance (ANOVA) for continuous variables and Fisher’s exact test or Kruskal-Wallis test for categorical variables. To adjust for confounding factors, logistic regression was employed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the effectiveness of different modalities and the relationship between treatment adherence and prolonged abstinence. Participants lost to follow-up were classified as continuous smokers. Statistical significance was set at a level of 0.05 (two-tailed).

A total of 2,194 individuals were recruited, of which 1,498 met the eligibility criteria. Ultimately, 1,107 eligible participants who completed at least one follow-up were included in the final analysis (Figure 1). These participants were distributed as follows: 378 in the non-use group (354 from the cohort 1 and 24 from the cohort 2), 368 in the WQ group, 264 in the WQ+ mailed NRT group, and 97 in the SCC group. The majority of participants were male (95.8%; n=1,061), had a college degree or higher (81.3%; n=900), and had comorbidities (39.2%; n=434). On average, participants smoked 17.4±8.2 cigarettes per day for 18.3±8.7 years. Additionally, most participants attempted to quit smoking (70.1%; n=776) using the cold turkey method (62.3%, n=561) (Table 1).

Figure 1. 

Flowchart of screening and enrolling the participants.

Abbreivation: WQ=Way to Quit modality; NRT=nicotine replacement therapy; SSC=smoking cessation clinic.

The self-reported 1–3 month prolonged abstinence rates were 6.6%, 21.7%, 19.7%, and 29.9% for the control group, WQ group, WQ+ mailed NRT group, and SCC group, respectively. After adjusting for age, sex, education, occupation, comorbidities, smoking duration, daily smoking consumption, FTND score, and previous quit attempts, the likelihood of achieving 1–3 month prolonged abstinence increased by 276% (adjusted OR=3.76; 95% CI: 2.33, 6.08) in the WQ group, by 230% (adjusted OR=3.30; 95% CI: 1.95, 5.57) in the WQ+ mailed NRT group, and by 483% (adjusted OR=5.83; 95% CI: 3.18, 10.65) in the SCC group compared to the control group. Additionally, the self-reported 7-day PPAR at 1 month and 3-month follow-ups for all groups using cessation services was higher than that of the control group. The WQ+ mailed NRT group had higher quit attempt and reduction rates at 1 month follow-up (P<0.001) (Table 2).

Intervention adherence significantly increased the participants’ likelihood of quitting. In the WQ group, those who used WeChat intervention for more than 10 days quit smoking 7.94 times more likely than those with less than 10 days (adjusted OR=7.94, 95% CI: 4.45, 14.14). Similarly, in the WQ+ mailed NRT group, participants using WeChat-based intervention for over 10 days and consuming 30+ NRT gum pieces had a 7.29 times higher quit rate than those with lower adherence (adjusted OR=7.29, 95% CI: 2.44, 21.83). This trend aligns with the SCC group, where varenicline extended use correlated with higher smoking quit rate. (P_trend=0.001) (Table 3).