Building Capacity and Promoting Smoking Cessation in the Community Via "Quit to Win" Contest 2019

Not Applicable

• Conditions: Smoking Cessation
• Interventions: Behavioral: AWARD advice; Behavioral: Warning leaflet; Behavioral: Referral card; Behavioral: COSH booklet

• Registration Number: NCT03992742
• Lead Sponsor: The University of Hong Kong

Brief Summary

The present study will examine (1) effectiveness of a combined intervention of AWARD advice, active referral, instant messaging and optional cocktail intervention to increase abstinence using a sequential multiple assignment randomised trial (SMART) and (2) explore the use of CBPR model to build capacity and to engage community partners in taking on this important public health issue for sustainability in the community. In addition, a process evaluation will be conducted to assess the effectiveness of the recruitment activity and how it is linked with the overall program outcomes.

Detailed Description

Although smoking prevalence is decreasing in Hong Kong, there are still 615,000 daily cigarette smokers in Hong Kong in 2017 and half will be killed by smoking which accounts for over 7,000 deaths per year. Smoking also accounts for a large amount of medical cost, long-term care and productivity loss of US$688 million (0.6% Hong Kong GDP). Smoking is a highly addictive behavior and it is difficult for smokers with strong nicotine dependence to quit without assistance. On the other hand, reaching and helping the many smokers who have no intention to quit is a challenge, because they are unlikely to seek professional help from smoking cessation services.

The Quit and Win programme provides an opportunity to reach and encourage a large group of smokers to make quit attempt and maintain abstinence. The Quit and Win model posits that smokers participating in the contest will have higher motivation to quit with incentives and better social support. Studies have found that such quitting contests or incentive programs appeared to reach a large number of smokers and demonstrated a significantly higher quit rate for the quit and win group than for the control group.

We propose to use adaptive design for the QTW 2019 specifically a two-phase adaptive design, i.e., a sequential, multiple assignment, randomized trial (SMART) design. Optional cocktail cessation supports will be provided based on smokers' smoking status and preference. The supports, including multimedia messages, active referral plus financial incentive, phone counseling, social support and medications, are empirically evidence-supported and most have been used in our previous QTW interventions.

Therefore, the present study will examine (1) effectiveness of a combined intervention of AWARD advice, active referral, instant messaging and optional cocktail intervention to increase abstinence using a SMART design and (2) explore the use of CBPR model to build capacity and to engage community partners in taking on this important public health issue for sustainability in the community. In addition, a process evaluation will be conducted to assess the effectiveness of the recruitment activity and how it is linked with the overall program outcomes.

Study Timeline

• Study First Submitted: 2019-06-12
• Study First Submitted QC: 2019-06-18
• Study First Posted: 2019-06-20
• Study Start: 2019-06-21
• Primary Completion: 2020-06-30
• Status Verified: 2020-08
• Last Update Submitted: 2020-08-18
• Last Update Posted: 2020-08-20
• Study Completion: 2021-06-30

Recruitment & Eligibility

• Status: UNKNOWN
• Sex: All
• Target Recruitment: 1200

Inclusion Criteria

• Hong Kong residents aged 18 or above
• Smoke at least 1 cigarette per day in the past 3-month
• Able to communicate in Cantonese (including reading Chinese)
• Exhaled carbon monoxide (CO) 4 ppm or above, assessed by a validated CO Smokerlyzer.
• Intent to quit / reduce smoking
• Able to use instant messaging tool (e.g., WhatsApp, WeChat) for communication.

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Exclusion Criteria

• Smokers who have communication barrier (either physically or cognitively)
• Have participation in other smoking cessation programmes or services

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Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Control Group (subgroup D+E+F)	COSH booklet	Regular instant messaging (RIM) + personalized instant messaging (PIM) + AWARD advice + referral card + warning leaflet+ COSH booklet
Intervention Group (subgroup A+B+C)	AWARD advice	Personalized instant messaging (PIM) + optional cocktail interventions (OCI) + AWARD advice + referral card + warning leaflet+ COSH booklet
Intervention Group (subgroup A+B+C)	Warning leaflet	Personalized instant messaging (PIM) + optional cocktail interventions (OCI) + AWARD advice + referral card + warning leaflet+ COSH booklet
Intervention Group (subgroup A+B+C)	COSH booklet	Personalized instant messaging (PIM) + optional cocktail interventions (OCI) + AWARD advice + referral card + warning leaflet+ COSH booklet
Intervention Group (subgroup A+B+C)	Referral card	Personalized instant messaging (PIM) + optional cocktail interventions (OCI) + AWARD advice + referral card + warning leaflet+ COSH booklet
Control Group (subgroup D+E+F)	AWARD advice	Regular instant messaging (RIM) + personalized instant messaging (PIM) + AWARD advice + referral card + warning leaflet+ COSH booklet
Control Group (subgroup D+E+F)	Warning leaflet	Regular instant messaging (RIM) + personalized instant messaging (PIM) + AWARD advice + referral card + warning leaflet+ COSH booklet
Control Group (subgroup D+E+F)	Referral card	Regular instant messaging (RIM) + personalized instant messaging (PIM) + AWARD advice + referral card + warning leaflet+ COSH booklet

Primary Outcome Measures

Name	Time	Method
Validated abstinence of PIM + OCI vs. RIM + PIM	6-month follow-up	PIM + OCI (subgroup A+B+C) vs. RIM + PIM (subgroup D+E+F) on validated abstinence (exhaled CO \< 4 ppm and salivary cotinine \< 10 ng/ml)
Validated abstinence of OCI vs. RIM in incomplete responders	6-month follow-up	OCI (subgroup A) vs. RIM (subgroup E) in incomplete responders (those who are still smoking at 1-month) on validated abstinence (exhaled CO \< 4 ppm and salivary cotinine \< 10 ng/ml)

Secondary Outcome Measures

Name	Time	Method
Validated abstinence of PIM + OCI vs. RIM + PIM adjusted for potential imbalance of baseline characteristic	6-month follow-up	PIM + OCI (subgroup A+B+C) vs. RIM + PIM (subgroup D+E+F) on validated abstinence (exhaled CO \< 4 ppm and salivary cotinine \< 10 ng/ml) adjusted for potential imbalance of baseline characteristic.
Validated abstinence of OCI vs. RIM in incomplete responders adjusted for potential imbalance of baseline characteristic	6-month follow-up	OCI (subgroup A) vs. RIM (subgroup E) in incomplete responders (those who are still smoking at 1-month) on validated abstinence (exhaled CO \< 4 ppm and salivary cotinine \< 10 ng/ml) adjusted for potential imbalance of baseline characteristic
PIM intervention engagement on validated and self-reported abstinence	3- and 6-month follow-up	Difference between engagement of PIM intervention vs. no engagement of PIM intervention vs. RIM intervention on validated abstinence (exhaled CO \< 4 ppm and salivary cotinine \< 10 ng/ml) and self-reported abstinence.; PIM intervention include subgroup B+C+D, RIM intervention include subgroup E+F.
Smoking reduction rate change from baseline at 3- and 6-month follow-up	3- and 6-month follow-up	Rate of smoking reduction by at least half of baseline amount
Nicotine independence (HSI) on abstinence and intervention engagement	3- and 6-month follow-up	Subgroup analyses of high nicotine independence vs. low nicotine independence on validated abstinence (exhaled CO \< 4 ppm and salivary cotinine \< 10 ng/ml) and self-reported abstinence, and intervention engagement (use of PIM and/or OCI intervention)
OCI intervention engagement on validated and self-reported abstinence	3- and 6-month follow-up	Difference between engagement of OCI intervention vs. no engagement of OCI intervention vs. engagement of PIM intervention vs. no engagement of PIM intervention vs. RIM intervention on validated abstinence (exhaled CO \< 4 ppm and salivary cotinine \< 10 ng/ml) and self-reported abstinence.; OCI intervention include subgroup A, PIM intervention include subgroup B+C+D, RIM intervention include subgroup E+F.
Validated and self-reported abstinence of PIM vs. RIM	3- and 6-month follow-up	PIM (subgroup B+C) vs. RIM (subgroup E+F) on validated abstinence (exhaled CO \< 4 ppm and salivary cotinine \< 10 ng/ml) and self-reported abstinence
Intention to quit analyses on abstinence and intervention engagement	3- and 6-month follow-up	Subgroup analyses of high intention to quit vs. low intention to quit on validated abstinence (exhaled CO \< 4 ppm and salivary cotinine \< 10 ng/ml) and self-reported abstinence, and intervention engagement (use of OCI intervention and/or PIM intervention and/or RIM intervention).
Validated and self-reported abstinence of OCI vs. PIM in incomplete responders	3- and 6-month follow-up	OCI (subgroup A) vs. PIM (subgroup B) in incomplete responders (those who are still smoking with 1-month) on validated abstinence (exhaled CO \< 4 ppm and salivary cotinine \< 10 ng/ml) and self-reported abstinence
Smoking cessation service use	3- and 6-month follow-up	Use of smoking cessation service
Validated and self-reported abstinence of PIM vs. RIM in incomplete responders	3- and 6-month follow-up	PIM (subgroup D) vs. RIM (subgroup E) in incomplete responders (those who are still smoking with 1-month) on validated abstinence (exhaled CO \< 4 ppm and salivary cotinine \< 10 ng/ml) and self-reported abstinence

Trial Locations

Locations (1)

School of Nursing, The University of Hong Kong; 🇭🇰 Hong Kong, Hong Kong