Intervention combining interactive communication technologies and nicotine replacement therapy sampling for proactively recruited smokers in smoking hotspots in Hong Kong: preliminary analysis of a pragmatic randomized controlled trial

Abstract

Aims: Brief advice combined with active referral to smoking cessation (SC) services increase quitting. We strengthened and assessed the effect of combining interactive communication technologies and nicotine replacement therapy sampling (NRT-S) on SC. Methods: We conducted a two-group, individually-randomized controlled trial in adult daily cigarette smokers proactively recruited in outdoor smoking hotspots in Hong Kong (ClinicalTrials.gov: NCT04001972). Both groups received face-to-face brief advice and referral to SC services using AWARD (Ask, Warn, Advise, Refer, Do-it-again) model. The Intervention group received 1-week free NRT-S at baseline and 12-week personalized behavioral support comprising regular tailored messages on abstinence using Instant Messaging (IM, e.g., WhatsApp), synchronous IM conversations with trained SC advisors, and a web-based Chatbot. The Control group received regular Short-Message-Service messages of similar intensity on general health and reminders for follow-up. Primary outcomes were carbon monoxide-validated smoking abstinence at 6-month and 12-month post-treatment initiation. Results: 664 participants (332 each group, 74.4% male, 36.2% aged >40) were recruited during August 2019 – May 2020. Ongoing follow-ups are expected to end in May 2021. At baseline, participants smoked 11.0 (SD 6.3) cigarettes per day, 51.7% were not ready to quit within 30 days. The two groups showed similar sociodemographic, smoking and quitting-related characteristics (P 0.09 – 0.92). 35.1% were referred to SC services (Intervention 38.9% vs Control 31.3%, P=0.04). Of the Intervention group, 85.4% received 1-week NRT-S, 16.3% engaged in IM conversations, and 10.8% used the chatbot with 524 interactions observed. Conclusions: Technology-enhanced combined interventions plus NRT-S are acceptable to community smokers in Hong Kong.