A WeChat-Based Smoking Cessation Intervention for Chinese Smokers: A Randomized Controlled Trial (Preprint)

BACKGROUND China is the largest tobacco producer and has the highest number of tobacco consumers in the world. Extensive research has demonstrated ways that social media can assist in quitting smoking. WeChat is the most commonly used social media platform in China; however, it has not yet been used for smoking cessation interventions. OBJECTIVE The objectives of this study are (1) to evaluate the effectiveness of a WeChat-based smoking cessation intervention; and (2) to examine a possible synergistic effect of integrating oral health and smoking-related information into a tailored, Transtheoretical Model (TTM) guided smoking cessation intervention. METHODS Eligible adults were recruited through WeChat from July 1 to August 6, 2019, to participate in a 3-arm, single-blinded, randomized controlled trial. 403 participants were enrolled and randomized into three groups: Standard Group (smoking cessation intervention only, n=136), Enhanced Group (smoking cessation + oral health education interventions, n=136), or Waitlist Group (delayed smoking cessation intervention, n=132). The intervention was delivered through WeChat with total of three weeks. Participants were asked to complete questionnaires at baseline and follow-up assessments as well as process evaluation at each intervention week. The primary outcome was Stage of Change, and the secondary outcomes were 7-day Point Prevalence Abstinence (PPA), 24-hour PPA, daily cigarette use, and nicotine dependence at 4 weeks follow-up after intervention comparing intervention groups and control group. The overall attrition rate was 46%. Paired t-tests, McNemar tests, and linear and logistic regression were used to examine differences in smoking cessation outcomes within and between groups. RESULTS Compared to baseline, at follow-up, all groups experienced smokers had significantly greater reduction in nicotine dependence scores (Standard: 1.8; Enhanced: 1.9, and Waitlist: 0.4). At 4-week follow-up, compared to the Waitlist Group, smokers from the Enhanced Group and the Standard Group had significantly lower nicotine dependence scores, lower daily cigarette use, and were more likely to have stage of change progression movement. Participants in Enhanced Group (β=-1.28, 95%CI: -2.13, -0.44) and the Standard Group (β=-1.13, 95%CI: -1.95, -0.30) also reported larger change in nicotine dependence score, compared to participants in the Waitlist Group. CONCLUSIONS This WeChat-based intervention was overall effective for smoking cessation, with enhanced cessation when additionally incorporating an oral health education intervention. Future smoking cessation programs should consider inclusion of oral health education. More broadly, in light of continued social distancing, WeChat could be considered as a platform for smoking cessation and other behavioral interventions.