Building Capacity and Promoting Smoking Cessation in the Community Via "Quit to Win" Contest 2022: Simple Physical Exercise With Instant Messaging Support for Smoking Cessation

Although smoking prevalence is decreasing in Hong Kong, it accounts for over 7,000 deaths per year and a large amount of medical cost, long-term care, and productivity loss of US$ 688 million (0.6% Hong Kong GDP). Quitting is difficult because nicotine is highly addictive. Long-term habitual tobacco smoking could foster a series of physical and psychological dependence on nicotine, and thus induce cravings and nicotine withdrawal symptoms when remaining abstinent.

In addition to pharmacotherapy and behavioral counseling, exercise has shown promising effects on reducing craving, cigarette consumption, withdrawal symptoms, and increasing intention and attempt to quit. Randomized trials on smoking cessation have shown that vigorous or moderate exercise (including aerobics, brisk walking, and weightlifting) increases tobacco abstinence. However, these exercise-based smoking cessation trials were small-scaled with sample sizes ranging from 20 to 543, and mainly targeted the smokers who were motivated to quit (active treatment seekers). Most (15/20) of the vigorous or moderate exercises adopted in the smoking cessation trials required the participants to attend multiple exercise sessions (at least weekly for 5 months) under supervision or self-monitoring using equipment (e.g., pedometers) with a low proportion (<50%) of the participants achieved targeted level of attendance and exercise. The effects were short-term (end of treatment) and long-term (6 months or above) effects were uncertain, and cannot be generated in smokers who had low motivation to quit.

Mobile health (mHealth) is now a part of the World Health Organization's (WHO) strategies on combating smoking (http://www.who.int/tobacco/mhealth/en/) and has been used in many countries given its low cost and popular use. Instant messaging (IM) applications (apps) (e.g., WhatsApp, WeChat) are compatible with smartphones and allow sending interactive messages such as text, photos, video, animation, and files. The widespread availability of IM apps allows healthcare professionals to deliver health information and behavioral interventions through messaging. The QTW Contest 2017 using chat-based psychosocial support through IM apps effectively increased short-term (end of treatment, 3 months) and long-term (6 months since intervention initiation) smoking abstinence.

The chat-based IM support has the potential to support the use of other treatment components. The investigators aimed to test (1) the effectiveness of an integrated intervention of brief cessation advice (AWARD), simple physical exercise with Instant Messaging (IM) support compared with control participants among current smokers; (2) to explore participants' experience and perceptions towards the intervention.