This study aims to explore the effectiveness of a combined intervention using brief cessation advice and personalized chat-based positive psychological support compared with the control group on current smokers who join the Quit to Win Contest.
Smoking is a leading cause of many diseases and deaths globally. Although Hong Kong has a relatively low overall smoking rate of 10.2% (in 2019), health and economic burdens due to smoking are still substantial. The practice of smoking might predispose smokers to COVID-19 infection and poor prognosis. Growing evidence has also suggested that smokers are at higher risk of developing serious respiratory and cardiovascular symptoms in the COVID-19 pandemic than non-smokers. Smoking cessation in the post-COVID-19 era is the key priority to meet the HKSAR Government's target of reducing smoking prevalence to 7.8% by 2025. Mental health problems are commonly comorbid with smoking and related problems. Our population-based survey amidst the COVID-19 pandemic found current smokers were at higher risk of suffering from anxious symptoms (adjusted OR 1.84 95% CI 1.27, 2.67), depressive symptoms (adjusted OR 2.04 95% CI 1.40, 2.96), and stress symptoms (adjusted β 0.54 95% CI 0.26, 0.82) compared with non-smokers. We also observed mental health burden increased during the COVID-19 pandemic with approximately doubling of the prevalence of anxious symptoms (15.8 vs. 9.3) and depressive symptoms (14.8 vs. 6.3) compared with the pre-COVID-19 pandemic (2017). Mental health can be both precursors and consequences of smoking. Previous studies have suggested that depressive symptoms and low positive affect during and after SC attempts are associated with poor cessation outcomes. This implies that a combined intervention of behavioral and psychological SC intervention is needed, particularly under the circumstance of worsening mental health problems. Therefore, our study aims to test the effectiveness of a combined intervention using brief cessation advice and personalized chat-based positive psychological support compared with the control group on current smokers who join the Quit to Win Contest.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
HEALTH_SERVICES_RESEARCH
Masking
SINGLE
Enrollment
1,094
Ask about smoking history; Warn about the high risk; Advise to quit; Refer smokers to smoking cessation services (with a referral card); Do it again
The contents of the leaflet include (1) highlights of the absolute risk of death due to smoking; (2) the whole list of diseases caused by active and second-hand smoking; (3) ten horrible pictorial warnings of health consequences of smoking and second-hand smoking in one page to maximize the impacts; (4) benefits of SC and (5) simple messages to encourage participants to quit smoking and remind them to call the Department of Health SC hotline 183 3183.
The contents consist of brief information and highlights of existing SC services, contact methods, motivation information, and strong supporting messages or slogans.
Hong Kong Council on Smoking and Health (COSH)
Hong Kong, Hong Kong, China
RECRUITINGBiochemically validated abstinence
Defined as exhaled CO level \<4ppm and saliva cotinine level ≤30 ng/ml Note 1. If participants refuse to have a face-to-face exhaled carbon monoxide test due to the COVID-19 pandemic in Hong Kong. In that case, the outcome will only be validated by a saliva cotinine test device. 2. If participants use NRT, the outcome will be validated by exhaled carbon monoxide only.
Time frame: 6-month follow-up
Biochemically validated abstinence
Defined as exhaled CO level \<4ppm and saliva cotinine level ≤30 ng/ml Note 1. If participants refuse to have a face-to-face exhaled carbon monoxide test due to the COVID-19 pandemic in Hong Kong. In that case, the outcome will only be validated by a saliva cotinine test device. 2. If participants use NRT, the outcome will be validated by exhaled carbon monoxide only.
Time frame: 3-month follow-up
Self-reported 7-day point prevalence quit rate
Smokers who did not smoke even a puff in the 7 days preceding the follow-up
Time frame: 3-month follow-up
Self-reported 7-day point prevalence quit rate
Smokers who did not smoke even a puff in the 7 days preceding the follow-up
Time frame: 6-month follow-up
Self-reported reduction
Defined by at least 50% reduction in baseline daily number of cigarettes
Time frame: 3-month follow-up
Self-reported reduction
Defined by at least 50% reduction in baseline daily number of cigarettes
Time frame: 6-month follow-up
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
The contents include information about the benefits of quitting, smoking and diseases, methods to quit, how to handle withdrawal symptoms, declaration of quitting, etc.
Each IM chat group will consist of a trained SC counselor (HKU staff), a peer supporter (former smoker), and a participant (smoker). The 3-month group chat-based intervention will consist of regular messages and real-time support through group chat. Regular messages will generally include goal setting, health warnings, abstinence support, positive psychological exercises, and encouragement and will be delivered in a tapering style. During the real-time chatting, SC counsellors and peer supporters will provide real-time chat-based support, and peer supporters will share their quitting experience as appropriate.
Regular e-messages via SMS at twice per month within 3 months (total 6).
Self-reported depressive symptoms
Measured by Patient Health Questionnaire-2 (PHQ-2). PHQ-2 ranges from 0-6, a higher score indicates a severer depressive symptom.
Time frame: 3-month follow-up
Self-reported depressive symptoms
Measured by Patient Health Questionnaire-2 (PHQ-2). PHQ-2 ranges from 0-6, a higher score indicates a severer depressive symptom.
Time frame: 6-month follow-up
Self-reported anxious symptoms
Measured by Generalized Anxiety Disorder-2 (GAD-2). GAD-2 ranges from 0-6, a higher score indicates a severer anxious symptom.
Time frame: 6-month follow-up
Self-reported anxious symptoms
Measured by Generalized Anxiety Disorder-2 (GAD-2). GAD-2 ranges from 0-6, a higher score indicates a severer anxious symptom.
Time frame: 3-month follow-up
Self-reported use of smoking cessation service
Use of smoking cessation service at 3- and 6- month follow-up
Time frame: 3-month follow-up
Self-reported use of smoking cessation service
Use of smoking cessation service at 3- and 6- month follow-up
Time frame: 6-month follow-up
Self-rated health
Self-rated health will be measured as a single item with the response items "excellent", "very good", "good", "fair", or "poor".
Time frame: 3-month follow-up
Self-rated health
Self-rated health will be measured as a single item with the response items "excellent", "very good", "good", "fair", or "poor".
Time frame: 6-month follow-up
Self-reported happiness
A single item will measure self-reported happiness with an answer on an 11-point scale (0-10). A higher score indicates a higher level of happiness.
Time frame: 3-month follow-up
Self-reported happiness
A single item will measure self-reported happiness with an answer on an 11-point scale (0-10). A higher score indicates a higher level of happiness.
Time frame: 6-month follow-up
Self-reported quit attempts
Number of quit attempts from baseline at 3-month follow-up
Time frame: 3-month follow-up
Self-reported quit attempts
Number of quit attempts from baseline at 6-month follow-up
Time frame: 6-month follow-up
Self-reported resilience
A single item will measure self-reported resilience with an answer on an 11-point scale (0-10). A higher score indicates a higher level of resilience.
Time frame: 3-month follow-up
Self-reported resilience
A single item will measure self-reported resilience with an answer on an 11-point scale (0-10). A higher score indicates a higher level of resilience.
Time frame: 6-month follow-up
Self-reported optimistic
A single item will measure self-reported optimistic with an answer on an 11-point scale (0-10). A higher score indicates a higher level of optimistic.
Time frame: 3-month follow-up
Self-reported optimistic
A single item will measure self-reported optimistic with an answer on an 11-point scale (0-10). A higher score indicates a higher level of optimistic.
Time frame: 6-month follow-up
Self-reported loneliness
A single item will measure self-reported loneliness with an answer on an 11-point scale (0-10). A higher score indicates a higher level of loneliness.
Time frame: 3-month follow-up
Self-reported loneliness
A single item will measure self-reported loneliness with an answer on an 11-point scale (0-10). A higher score indicates a higher level of loneliness.
Time frame: 6-month follow-up
Self-reported stress
A single item will measure self-reported stress with an answer on an 11-point scale (0-10). A higher score indicates a higher level of stress.
Time frame: 6-month follow-up
Self-reported stress
A single item will measure self-reported stress with an answer on an 11-point scale (0-10). A higher score indicates a higher level of stress.
Time frame: 3-month follow-up
Self-reported social support
A single item will measure self-reported social support with an answer on an 11-point scale (0-10). A higher score indicates a higher level of social support.
Time frame: 3-month follow-up
Self-reported social support
A single item will measure self-reported social support with an answer on an 11-point scale (0-10). A higher score indicates a higher level of social support.
Time frame: 6-month follow-up
Self-reported positive affect
The subscale of the Chinese version International Positive and Negative Affect Schedule Short Form (I-PANAS-SF) will measure self-reported positive affect. The I-PANAS-SF uses a 5-point scale, a higher score indicates a higher level of self-reported positive affect.
Time frame: 3-month follow-up
Self-reported positive affect
The subscale of the Chinese version International Positive and Negative Affect Schedule Short Form (I-PANAS-SF) will measure self-reported positive affect. The I-PANAS-SF uses a 5-point scale, a higher score indicates a higher level of self-reported positive affect.
Time frame: 6-month follow-up
Self-reported negative affect
The subscale of the Chinese version International Positive and Negative Affect Schedule Short Form (I-PANAS-SF) will measure self-reported negative affect. The I-PANAS-SF uses a 5-point scale, a higher score indicates a higher level of self-reported negative affect.
Time frame: 6-month follow-up
Self-reported negative affect
The subscale of the Chinese version International Positive and Negative Affect Schedule Short Form (I-PANAS-SF) will measure self-reported negative affect. The I-PANAS-SF uses a 5-point scale, a higher score indicates a higher level of self-reported negative affect.
Time frame: 3-month follow-up