title: Text Messaging-Based Interventions for Smoking Cessation: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Tobacco use is one of the leading preventable global health problems producing nearly 6 million smoking-related deaths per year. Interventions delivered via text messaging (short message service, SMS) may increase access to educational and support services that promote smoking cessation across diverse populations.
  
  
  OBJECTIVE
  The purpose of this meta-analysis is to (1) evaluate the efficacy of text messaging interventions on smoking outcomes, (2) determine the robustness of the evidence, and (3) identify moderators of intervention efficacy.
  
  
  METHODS
  Electronic bibliographic databases were searched for records with relevant key terms. Studies were included if they used a randomized controlled trial (RCT) to examine a text messaging intervention focusing on smoking cessation. Raters coded sample and design characteristics, and intervention content. Summary effect sizes, using random-effects models, were calculated and potential moderators were examined.
  
  
  RESULTS
  The meta-analysis included 20 manuscripts with 22 interventions (N=15,593; 8128 (54%) women; mean age=29) from 10 countries. Smokers who received a text messaging intervention were more likely to abstain from smoking relative to controls across a number of measures of smoking abstinence including 7-day point prevalence (odds ratio (OR)=1.38, 95% confidence interval (CI)=1.22, 1.55, k=16) and continuous abstinence (OR=1.63, 95% CI=1.19, 2.24, k=7). Text messaging interventions were also more successful in reducing cigarette consumption relative to controls (d+=0.14, 95% CI=0.05, 0.23, k=9). The effect size estimates were biased when participants who were lost to follow-up were excluded from the analyses. Cumulative meta-analysis using the 18 studies (k=19) measuring abstinence revealed that the benefits of using text message interventions were established only after only five RCTs (k=5) involving 8383 smokers (OR=1.39, 95% CI=1.15, 1.67, P<.001). The inclusion of the subsequent 13 RCTs (k=14) with 6870 smokers did not change the established efficacy of text message interventions for smoking abstinence (OR=1.37, 95% CI=1.25, 1.51, P<.001). Smoking abstinence rates were stronger when text messaging interventions (1) were conducted in Asia, North America, or Europe, (2) sampled fewer women, and (3) recruited participants via the Internet.
  
  
  CONCLUSIONS
  The evidence for the efficacy of text messaging interventions to reduce smoking behavior is well-established. Using text messaging to support quitting behavior, and ultimately long-term smoking abstinence, should be a public health priority.
authors.affiliation: Centers for Behavioral and Preventive Medicine, The Miriam Hospital, Providence, RI, United States. lori_scott-sheldon@brown.edu.
authors.forename: Lori A J
authors.identifier: http://orcid.org/0000-0003-1524-3374
authors.initials: LA
authors.lastname: Scott-Sheldon
authors.forename: Ryan
authors.identifier: http://orcid.org/0000-0003-2436-5664
authors.initials: R
authors.lastname: Lantini
authors.forename: Ernestine G
authors.identifier: http://orcid.org/0000-0002-0557-704X
authors.initials: EG
authors.lastname: Jennings
authors.forename: Herpreet
authors.identifier: http://orcid.org/0000-0001-8878-4927
authors.initials: H
authors.lastname: Thind
authors.forename: Rochelle K
authors.identifier: http://orcid.org/0000-0003-1598-667X
authors.initials: RK
authors.lastname: Rosen
authors.forename: Elena
authors.identifier: http://orcid.org/0000-0003-4636-8698
authors.initials: E
authors.lastname: Salmoirago-Blotcher
authors.forename: Beth C
authors.identifier: http://orcid.org/0000-0002-4530-7618
authors.initials: BC
authors.lastname: Bock
keywords: cigarette smoking; intervention; meta-analysis; smoking cessation; text messaging