A mobile phone counselling service can help people with HIV to
stop smoking – at least in the short-term, US investigators report in the
online edition of Nicotine & Tobacco
Patients who used the counselling service were four-times
more likely to report abstinence from cigarettes for seven days than
individuals who received standard smoking cessation support.
The mobile phone counselling also significantly increased
the chances of patients reporting total abstinence from cigarettes, but
quitting rates were low.
Patients with HIV are between two and three times more
likely to smoke than individuals in the general population. Smoking-related
diseases are a major cause of illness and death in HIV-infected patients.
Indeed, it has been estimated that stopping smoking could reduce overall
mortality in patients with HIV by 16%, the risk of major cardiovascular disease
by 20%, and the risk of non-AIDS-defining cancers by 34%.
Surprisingly little research had been conducted among
HIV-positive smokers into the efficacy of smoking cessation interventions.
However, the limited data which are available are encouraging, and indicate
that such services are welcome. Moreover, outcomes of a small pilot study
conducted in Houston, Texas, showed that a mobile phone counselling service
helped patients to stop smoking.
The investigators who conducted this pilot wanted to assess
the effectiveness of telephone counselling in a larger and longer study.
They therefore designed a randomised prospective study lasting
three months. It included 474 HIV-positive smokers who wanted to quit. The
patients were recruited from the Thomas Street Health Center in Houston, a
clinic which provides HIV care to a largely disadvantaged urban population.
All the patients received brief advice about how to stop
smoking, written information, and nicotine replacement therapy.
They were then randomised into two groups.
One group of patients received no further support and were the
The other patients were given a mobile phone and a prepaid
telephone number which enabled them to access counselling support. Patients
were provided with eleven counselling sessions over a three-month period. This
counselling was based on a cognitive-behavioural therapy model. Patients were
also given a “hot-line” number to enable them to access support between these
The main outcome of the study was seven-day cigarette
abstinence after three months. Information was also gathered on long-term
abstinence, and 24-hour abstinence was bio-medically assessed by measuring CO2
Most the patients were men (70%) and approximately
three-quarters were African-American. Their average age was 44 years and they
were generally socially disadvantaged, only 24% having a higher education.
At the end of the study, individuals in the mobile phone
support group were over four-times more likely to report a seven-day period of
cigarette abstinence than patients in the control arm (OR = 4.33; 95% CI,
Mobile phone counselling also increased the chances of 24-hour
abstinence (p < 0.001), 30-day abstinence (p = 0.005), and continuous
abstinence (p = 0.005).
For patients in the control arm, the mean duration of total
cigarette abstinence was six days, significantly shorter than the fifteen-day
period reported by individuals who were counselled via the mobile phone service
(p < 0.001).
The proportion of patients who managed to completely stop
smoking was low (control arm, 2% vs. intervention arm, 9%). The investigators
attribute this to changes in prescribing practices for nicotine replacement
therapy that required patients to make multiple trips to the clinic.
“By conducting counselling over the cell phone, we were able
to greatly increase our ability to consistently contact patients and deliver a
relatively intensive intervention,” write the investigators.
The study is set to continue and it is planned to report and
six- and twelve-month outcomes.
“These future analyses will also more fully explore the
relationship between treatment group, smoking outcomes, and the various medical
and psychiatric comorbidities frequently observed among PLWHA [people living
with HIV and AIDS],” comment the authors, “in addition, the effects of
motivation, self-efficacy, stress and other psychosocial variables will be