Smoking cessation support for pregnant women: role of mobile technology

Figures & data

Table 2 Study characteristics

Program	Author	Country, sponsor	Study sample/enrollment to date	Design	Outcomes
Quit4Baby (2013–present)	Abroms et al^Citation25	United States, National Institute on Drug Abuse	N=20/enrollment = ∼300a	One-group pretest/posttest pilot study	Abstinence rates: self-reported abstinence 38% quit at 2-week follow-up; 54% quit at 4-week follow–up Feasibility: 88% received right number of messages; 100% read all messages received User satisfaction: average program rating =4.53 (5-point scale); 63% disliked “nothing” about program
MiQuit (2007–present)	Naughton et al^Citation26	United Kingdom, National Health Service	N=207/enrollment =407b	RCT	Abstinence rates: self-reported abstinence 22.9% (vs 19.6% controls) at 3-month follow-up, OR =1.22, 95% CI 0.62–2.41, confirmed abstinence 12.5% (vs 7.8% controls), OR =1.68, 95% CI 0.66–4.31
	Naughton et al^Citation27		N=33	Semistructured interviews/focus groups with people who received and did not receive cessation texts	Feasibility: 94% received both intervention components; 9% discontinued program
	Cooper et al^Citation28		N=400 (aim)	RCT (not yet implemented)	User satisfaction: between 81% and 96% rated various features as helpful
SMAT (2010–present)	van Mierlo et al^Citation29	Canada, Quebec Division, Canadian Cancer Society	N=11 pregnant smokers/enrollment =31c	Observational pilot; one-group longitudinal study	NA for pregnant population
SGR (2013–present)	Pollack et al^Citation30	United States, National Cancer Institute	N=31/enrollment =130d	Two-arm randomized controlled pilot study	Abstinence rates: biochemically confirmed abstinence 13.4% (vs 7.5% controls) (timeframe unspecified) Feasibility: 86% of participants reported reading “all or most” messages; only 12% of all women in SGR arm smoked off-schedule User satisfaction: 78% ranked program 7 (7-point scale)
SmokefreeMOM (2014–present)	Not published	United States, National Cancer Institute	N=307e	NA	NA
Quit for You – Quit for Two (updated 2013)	Not published	Australia, Australian Government/BCM Partnership	10,000–50,000 downloads on Android platform; information is not available for iPhone	NA	NA
SmokeFree (Baby (updated 2015)	Not published	United Kingdom	100–500 downloads on Android platform; information is not available for iPhone	NA	NA

Notes:

a This is the current approximate program enrollment. There is ongoing enrollment as part of a RCT that currently totals ~60 additional participants.

b Those enrolled in RCT.

c Includes subscribers to the pregnant protocol only between November 1, 2013, and January 31, 2015.

d Based on current RCT enrollment.

e Includes active subscribers by end of July. There are 853 total subscribers over time, some of which have now unsubscribed.

Abbreviations: RCT, randomized controlled trial; OR, odds ratio; CI, confidence interval; NA, not applicable; SGR, scheduled gradual reduction.

Table 1 Coding scheme definitions

Category	Definition
Intervention
SMS/text messaging	A text message/SMS program
App	A downloaded mobile application
Content
Smoking cessation	Content related to quitting smoking or information about smoking
General pregnancy	Content related to prenatal health or pregnancy tips
Tools/features
Ability to set quit date	Does the program allow the participant to proactively set a quit date either at onset or during program?
Smoking tracker	Does the program include regular monitoring of smoking status?
Cravings help	Can the participant ask for help during a craving by typing a keyword or using a tool within the program?
Smoked help	Can the participant inform the program they smoked a cigarette and receive advice/tips?
Calculator	Can the participant calculate monetary savings or other smoking-related milestones within the program?
Games or distractions	Can the participant play games or engage in a distraction tool?
Linked media	Are there links to or embedded videos or pictures in the program?
Referrals
Quitline	Does the program provide a direct referral to the quitline number?
NRT	Does the program recommend or discuss NRT for pregnant women?
Implementation features
Interaction
One-way messages	Only the program can send the participant messages
Two-way messages	The program can send participant messages and the participant can send messages to the program
Live help available	The program has a live contact that can talk with participants or answer questions
Theoretical basis/approach	Do the articles explicitly state that they used a behavioral theory or approach?
Tailored messages	Are the messages tailored to/around the participant’s quit date and due date or do they utilize personalized content such as the participant’s name or their motivators for quitting?
Message dose
Fixed	Messages come at a prescribed frequency throughout the program (ie, one message per day)
Decreasing	Message frequency tapers over time throughout the program
Individualized	Message frequency depends on individual characteristics such as quit date, due date, or participant preferences
Varied	Message frequency differs from day to day throughout the program

Abbreviations: SMS, short message service; NRT, nicotine replacement therapy.

Table 3 Program characteristics

Category	Quit4Baby (Abroms et al^Citation25)	MiQuit (Naughton et al^Citation26^–^Citation28)	SMAT (van Mierlo et al^Citation29)	SGR (Pollack et al^Citation30)	Smokefree MOM	Quit for You – Quit for Two	SmokeFree Baby	Total
Intervention
SMS/Text	X	X	X	X	X			5
App						X	X	2
Content
Smoking cessation	X	X	X	X	X	X	X	7
General pregnancy	X				X	X	X	4
Tools/features
Ability to set quit date	X	X	X	X	X	X	X	7
Smoking tracker	X	X		X	X		X	5
Cravings help	X	X	X		X	X	X	6
Smoked help	X	X	X		X			4
Calculator	X					X	X	3
Games or distractions	X	X	X		X	X	X	6
Linked media	X				X		X	3
Referrals
Quitline	X		X		X	X	X	5
NRT							X	1
Implementation features
Two-way interaction	X	X	X	X	X			5
Live help available			X		X			2
Theoretical basis/approach cited	X	X	X	X		NA	NA	4
Tailored messages	X	X	X	X	X	X	X	7
Message dose						NA	NA
Decreasing	X	X	X	X	X			5
Individualized	X	X	X	X	X			5
Varied			X					1
Total	16	12	14	9	15	9	12

Abbreviations: SGR, scheduled gradual reduction; SMS, short message service; NRT, nicotine replacement therapy; NA, not applicable.

AbromsLCJohnsonPRHemingerCLQuit4baby: results from a pilot test of a mobile smoking cessation program for pregnant womenJMIR Mhealth Uhealth201531e1025650765

 PubMed Web of Science ®Google Scholar

NaughtonFPrevostATGilbertHSuttonSRandomized controlled trial evaluation of a tailored leaflet and SMS text message self-help intervention for pregnant smokers (MiQuit)Nicotine Tob Res201214556957722311960

 PubMed Web of Science ®Google Scholar

NaughtonFJamisonJSuttonSAttitudes towards SMS text message smoking cessation support: a qualitative study of pregnant smokersHealth Educ Res201328591192210.1093/her/cyt05723640985

 PubMed Web of Science ®Google Scholar

CooperSFosterKNaughtonFPilot study to evaluate a tailored text message intervention for pregnant smokers (MiQuit): study protocol for a randomised controlled trialTrials2015162925622639

 PubMed Web of Science ®Google Scholar

van MierloTFournierRJean-CharlesAHovingtonJEthierISelbyPI’ll txt u if i have a problem: how the Société́ Canadienne du cancer in Quebec applied behavior-change theory, data mining and agile software development to help young adults quit smokingPLoS One201493e9183224647098

 PubMed Web of Science ®Google Scholar

PollackKILynaPBilheimerAA pilot study testing SMS text delivered scheduled gradual reduction to pregnant smokersNicotine Tob Res201315101773177623569007

 PubMed Web of Science ®Google Scholar