Accepted for/Published in: JMIR mHealth and uHealth
Date Submitted: Apr 25, 2021
Open Peer Review Period: Apr 25, 2021 - Apr 29, 2021
Date Accepted: Sep 19, 2021
(closed for review but you can still tweet)
Text messaging smoking cessation intervention for high school students: 6-month outcomes from the NEXit Junior randomized controlled trial with Bayesian analyses
ABSTRACT
Background:
Prevalence of daily or occasional smoking among high school students in Sweden was approximately 20% in 2019, which is problematic since lifestyle behaviors are established in adolescence and track into adulthood. The NEXit Junior trial was conducted in response to a lack of evidence for the effects of text message smoking cessation interventions among high school students in Sweden.
Objective:
To estimate the 3 and 6-months effects of a text messaging intervention among high school students in Sweden on smoking cessation outcomes.
Methods:
A 2-arm, single blind, RCT was employed to estimate the effects of the intervention on smoking cessation in comparison to treatment as usual. Participants were recruited from high schools in Sweden using advertising and by promotion by school staff (2018-01-10 to 2019-01-10). Included were weekly or daily smokers who were willing to make a quit attempt. Prolonged abstinence and point prevalence of smoking cessation was measured 3 and 6 months after randomization.
Results:
Complete case analysis was possible on 57.9% (310/535) of participants at 6 months: 5-month prolonged abstinence OR = 1.27; 95% CI = 0.73; 2.20; P-value = .39, 4-week smoking cessation OR = 1.42; 95% CI = 0.83; 2.46; P-value = .20. Sensitivity analyses using imputation yielded similar findings. Unplanned Bayesian analyses found that the effects of the intervention were in the anticipated direction. The findings are limited by the risk of bias induced by high attrition (42.1%). The trial recruited high school students in a pragmatic setting and included both weekly and daily smokers, thus generalization to the target population is more direct than under more strict study procedures.
Conclusions:
Higher than expected attrition rates to follow-up 6 months after randomization led to null hypothesis tests being underpowered, however unplanned Bayesian analyses found that the effects of the intervention were in the anticipated direction. Future trials of smoking cessation interventions targeting high school students should aim to prepare strategies for increasing retention to mid and long-term follow-up. Clinical Trial: ISRCTN15396225; registration date October 13, 2017 (https://www.isrctn.com/ISRCTN15396225).
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