Promoting Smoking Cessation in the Community Via "Quit to Win" Contest 2017

Although smoking prevalence is decreasing in Hong Kong, there are still 641,300 daily smokers (10.5%) 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.

Smoking cessation services in Hong Kong are under-used with most of the adult daily smokers (79.6%) who had never used smoking cessation services. Among these smokers, only 2.4% were willing to use the services. Our previous RCT in previous QTW Contest 2015 evaluated the effects of low-intensity active referral (LAR) vs. very brief general SC advice (VBA) on quitting. LAR included onsite AWARD counselling and collection of smokers' personal contact information for SC services providers to connect with the smokers. Findings at 3-month follow-up of this RCT suggested the LAR intervention resulted in significantly higher self-reported quit rate than VBA in the control group (18.7% vs. 14.0%. P<0.001). Our RCT in previous QTW Contest 2016 evaluated the effects of a higher intensity and personalized active referral (HAR) vs. low intensity text messaging (SMS) vs. very brief SC advice (VBA; control group) on encouraging smoking cessation (SC) service use and increasing the quit rate. Findings at 6-month follow-up of the QTW 2016 RCT showed that the intervention group with HAR had a significantly higher self-reported quit rate than VBA (the control group) (17.0% vs. 11.2%, P = 0.02). Text messaging group also had significantly higher self-reported quit rate than the control group (17.1 % vs. 11.2%, P = 0.02).

However, these SMS-based RCTs could not provide real-time responses from the counsellors, which might weaken the smokers' intention to quit and lower the intensity of social support. In the present proposal, we hope to enrich the SMS-based intervention by using social media such as WhatsApp or WeChat etc., which can provide an interactive platform and develop a semi-personalized interactive IM system that can tailor for the smokers according to their characteristics, needs and demand.

Therefore, the present study will examine (1) the effectiveness of regular messages and semi-personalized instant messaging with AWARD brief advice and active referral to smoking cessation (SC) services 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.

Inclusion criteria

• Hong Kong residents aged 18 or above
• Smoke at least 1 cigarette per day in the past 3 months
• 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
• Using a cell phone with instant messaging tool (e.g. WhatsApp, WeChat)
• Able to use instant messaging tool (e.g. WhatsApp, WeChat) for communication

Exclusion criteria

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