Promoting Smoking Cessation in the Community Via Quit to Win Contest 2012: Aa Cluster Randomized Controlled Trial of 18 Districts in Hong Kong

According to the report of Census & Statistics Department (2011a), there are still 659,300 daily smokers (11.1%) in Hong Kong and smoking kills over 7,000 people per year (Lam et al., 2001). Smoking also led to an annual medical cost, long-term care and productivity loss of US$688 million in 1998 (McGhee et al., 2006), which was equivalent to 0.6% of GDP in the region (Census & Statistics Department, 2011b). Smoking is addictive, and it is difficult for motivated smokers to quit without assistance. On the other hand, many smokers may not be ready to quit or wanted to quit on their own, and it is difficult to reach them.

The Quit and Win programme provided another opportunity to reach large group of smokers, and it aims to widespread quit attempts among smokers via incentives in order to boost up the number of quitters (Cahill & Perera, 2011). Although such competitions appear to reach large cohorts of smokers, there is still insufficient evidence of its effectiveness in helping smokers to achieve complete cessation (Cahill & Perera, 2009).

In 2009, we conducted a 3-armed randomized controlled trial to compare the effectiveness of two additional interventions of a 3-minute brief telephone advice (TEL group) and 8 of SMS messages (SMS group) to the usual care of smoking cessation self-help material (Control group) in the Quit to Win Contest 2009 [cite the final report]. More than one thousand participants were successfully recruited in a period of 2 months, with an overall self-reported quit rate of 21.6% among the contestants. However, no statistical significant evidence was found for the additional brief telephone advice or the SMS messages in increasing the quit rate. In 2010, we conducted another RCT on the Quit to Win Contest 2010 to compare the effectiveness of an on-site face-to-face brief smoking cessation advice vs. self-help materials (control) to achieve quit rate and changes in smoking behaviors. Once again, we recruited over one thousand participants during a period of 2.5 months. A higher quit rate was observed in the intervention group (18.4%) than the control group (13.8%) at 6-month follow-up, although it was marginally statistical insignificant (p = 0.08) (Wong et al., 2012). To conclude, both Quit to Win Contests in Hong Kong have successfully reached and captured the interest of a large number of smokers in the community who otherwise may not even think about quitting smoking. On the other hand, additional smoking cessation interventions seem to boost up the quit rate among smokers who joined the Quit to Win contest, and a dose-response relationship may appear among the additional interventions.

The theory of The Health Action Process Approach (HAPA) suggests that one's intention of behaviour change can be fostered by knowing that the new behaviour has positive outcomes as opposed to the negative outcomes that accompany the current behaviour; and planning (action planning and coping planning) serves as an operative mediator between intentions and behaviour (Schwarzer, 2008). Previous evidence has shown the applicability of the HAPA in changing people's health behaviours, e.g., physical exercise, breast self-examination, seat belt use, dietary behaviours, and dental flossing; and its generalizability has been confirmed by Schwarzer (2008). A theory-based health education card (pocket size), which was guided by the HAPA, will be developed and distributed to the participants as a reminder and like a 'homework assignment' to be completed at home, for the purpose of enhancing their intention and practice of the suggested behaviour (quitting smoking).

Short-Message Service (SMS) is one of the new methods of communication in the recent decade and an expanding number of studies were conducted in 2000s since it is in a self-help mode, inexpensive (in terms of manpower), can be readily disseminated, and available immediately upon request. Research evidences suggested that the SMS-delivered health intervention (including smoking cessation) have positive short-term outcomes (Fjeldsoe et al., 2009). Specifically, the intervention may increase the intention of quitting (Yu, 2010, Ybarra, 2011), but the use of such program was under-utilized (Andrews et al., 2012). In 2009, we conducted a RCT to test the additional effect of 8 SMS smoking cessation advice toward smokers who participated in a Quit to Win contest towards self-help material [cite the final report]. Although the results did not support the additional effect of SMS smoking cessation advice, it may due to the deficient number of SMS messages provided.