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| Name | Class |
|---|---|
| Hong Kong Council on Smoking and Health | OTHER |
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This study aims to explore the effectiveness of a combined intervention using brief cessation advice and personalized chat-based positive psychological support compared with the control group on current smokers who join the Quit to Win Contest.
Smoking is a leading cause of many diseases and deaths globally. Although Hong Kong has a relatively low overall smoking rate of 10.2% (in 2019), health and economic burdens due to smoking are still substantial. The practice of smoking might predispose smokers to COVID-19 infection and poor prognosis. Growing evidence has also suggested that smokers are at higher risk of developing serious respiratory and cardiovascular symptoms in the COVID-19 pandemic than non-smokers. Smoking cessation in the post-COVID-19 era is the key priority to meet the HKSAR Government's target of reducing smoking prevalence to 7.8% by 2025.
Mental health problems are commonly comorbid with smoking and related problems. Our population-based survey amidst the COVID-19 pandemic found current smokers were at higher risk of suffering from anxious symptoms (adjusted OR 1.84 95% CI 1.27, 2.67), depressive symptoms (adjusted OR 2.04 95% CI 1.40, 2.96), and stress symptoms (adjusted β 0.54 95% CI 0.26, 0.82) compared with non-smokers. We also observed mental health burden increased during the COVID-19 pandemic with approximately doubling of the prevalence of anxious symptoms (15.8 vs. 9.3) and depressive symptoms (14.8 vs. 6.3) compared with the pre-COVID-19 pandemic (2017). Mental health can be both precursors and consequences of smoking. Previous studies have suggested that depressive symptoms and low positive affect during and after SC attempts are associated with poor cessation outcomes. This implies that a combined intervention of behavioral and psychological SC intervention is needed, particularly under the circumstance of worsening mental health problems.
Therefore, our study aims to test the effectiveness of a combined intervention using brief cessation advice and personalized chat-based positive psychological support compared with the control group on current smokers who join the Quit to Win Contest.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Intervention group | Experimental |
| |
| Control group | Active Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| AWARD advice | Behavioral | Ask about smoking history; Warn about the high risk; Advise to quit; Refer smokers to smoking cessation services (with a referral card); Do it again |
|
| Measure | Description | Time Frame |
|---|---|---|
| Biochemically validated abstinence | Defined as exhaled CO level <4ppm and saliva cotinine level ≤30 ng/ml Note
| 6-month follow-up |
| Measure | Description | Time Frame |
|---|---|---|
| Biochemically validated abstinence | Defined as exhaled CO level <4ppm and saliva cotinine level ≤30 ng/ml Note
|
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Man Ping Wang, PhD | Contact | +852 3917 6636 | mpwang@hku.hk | |
| Ziqiu Guo, MMed | Contact | +852 3917 6605 | zqguo@hku.hk |
| Name | Affiliation | Role |
|---|---|---|
| Man Ping Wang, PhD | The University of Hong Kong | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hong Kong Council on Smoking and Health (COSH) | Recruiting | Hong Kong | Hong Kong | 852 | China |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 41546550 | Derived | Zeng Y, Wu YS, Luk TT, Zhao SZ, Guo Z, Li Y, Tong HSC, Lai VWY, Cheung YTD, Lam TH, Wang MP. Quitting trajectories of Hong Kong Chinese smokers receiving behavioral smoking cessation interventions: A post hoc analysis of eight randomized controlled trials. Addiction. 2026 Jun;121(6):1568-1579. doi: 10.1111/add.70328. Epub 2026 Jan 17. | |
| 40939935 |
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| Brief leaflet on health warning and smoking cessation | Other | The contents of the leaflet include (1) highlights of the absolute risk of death due to smoking; (2) the whole list of diseases caused by active and second-hand smoking; (3) ten horrible pictorial warnings of health consequences of smoking and second-hand smoking in one page to maximize the impacts; (4) benefits of SC and (5) simple messages to encourage participants to quit smoking and remind them to call the Department of Health SC hotline 183 3183. |
|
| Referral card | Other | The contents consist of brief information and highlights of existing SC services, contact methods, motivation information, and strong supporting messages or slogans. |
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| Self-help smoking cessation booklet | Other | The contents include information about the benefits of quitting, smoking and diseases, methods to quit, how to handle withdrawal symptoms, declaration of quitting, etc. |
|
| Positive psychological support through 3-people group chat using instant messaging apps | Behavioral | Each IM chat group will consist of a trained SC counselor (HKU staff), a peer supporter (former smoker), and a participant (smoker). The 3-month group chat-based intervention will consist of regular messages and real-time support through group chat. Regular messages will generally include goal setting, health warnings, abstinence support, positive psychological exercises, and encouragement and will be delivered in a tapering style. During the real-time chatting, SC counsellors and peer supporters will provide real-time chat-based support, and peer supporters will share their quitting experience as appropriate. |
|
| E-messages via SMS | Behavioral | Regular e-messages via SMS at twice per month within 3 months (total 6). |
|
| 3-month follow-up |
| Self-reported 7-day point prevalence quit rate | Smokers who did not smoke even a puff in the 7 days preceding the follow-up | 3-month follow-up |
| Self-reported 7-day point prevalence quit rate | Smokers who did not smoke even a puff in the 7 days preceding the follow-up | 6-month follow-up |
| Self-reported reduction | Defined by at least 50% reduction in baseline daily number of cigarettes | 3-month follow-up |
| Self-reported reduction | Defined by at least 50% reduction in baseline daily number of cigarettes | 6-month follow-up |
| Self-reported depressive symptoms | Measured by Patient Health Questionnaire-2 (PHQ-2). PHQ-2 ranges from 0-6, a higher score indicates a severer depressive symptom. | 3-month follow-up |
| Self-reported depressive symptoms | Measured by Patient Health Questionnaire-2 (PHQ-2). PHQ-2 ranges from 0-6, a higher score indicates a severer depressive symptom. | 6-month follow-up |
| Self-reported anxious symptoms | Measured by Generalized Anxiety Disorder-2 (GAD-2). GAD-2 ranges from 0-6, a higher score indicates a severer anxious symptom. | 6-month follow-up |
| Self-reported anxious symptoms | Measured by Generalized Anxiety Disorder-2 (GAD-2). GAD-2 ranges from 0-6, a higher score indicates a severer anxious symptom. | 3-month follow-up |
| Self-reported use of smoking cessation service | Use of smoking cessation service at 3- and 6- month follow-up | 3-month follow-up |
| Self-reported use of smoking cessation service | Use of smoking cessation service at 3- and 6- month follow-up | 6-month follow-up |
| Self-rated health | Self-rated health will be measured as a single item with the response items "excellent", "very good", "good", "fair", or "poor". | 3-month follow-up |
| Self-rated health | Self-rated health will be measured as a single item with the response items "excellent", "very good", "good", "fair", or "poor". | 6-month follow-up |
| Self-reported happiness | A single item will measure self-reported happiness with an answer on an 11-point scale (0-10). A higher score indicates a higher level of happiness. | 3-month follow-up |
| Self-reported happiness | A single item will measure self-reported happiness with an answer on an 11-point scale (0-10). A higher score indicates a higher level of happiness. | 6-month follow-up |
| Self-reported quit attempts | Number of quit attempts from baseline at 3-month follow-up | 3-month follow-up |
| Self-reported quit attempts | Number of quit attempts from baseline at 6-month follow-up | 6-month follow-up |
| Self-reported resilience | A single item will measure self-reported resilience with an answer on an 11-point scale (0-10). A higher score indicates a higher level of resilience. | 3-month follow-up |
| Self-reported resilience | A single item will measure self-reported resilience with an answer on an 11-point scale (0-10). A higher score indicates a higher level of resilience. | 6-month follow-up |
| Self-reported optimistic | A single item will measure self-reported optimistic with an answer on an 11-point scale (0-10). A higher score indicates a higher level of optimistic. | 3-month follow-up |
| Self-reported optimistic | A single item will measure self-reported optimistic with an answer on an 11-point scale (0-10). A higher score indicates a higher level of optimistic. | 6-month follow-up |
| Self-reported loneliness | A single item will measure self-reported loneliness with an answer on an 11-point scale (0-10). A higher score indicates a higher level of loneliness. | 3-month follow-up |
| Self-reported loneliness | A single item will measure self-reported loneliness with an answer on an 11-point scale (0-10). A higher score indicates a higher level of loneliness. | 6-month follow-up |
| Self-reported stress | A single item will measure self-reported stress with an answer on an 11-point scale (0-10). A higher score indicates a higher level of stress. | 6-month follow-up |
| Self-reported stress | A single item will measure self-reported stress with an answer on an 11-point scale (0-10). A higher score indicates a higher level of stress. | 3-month follow-up |
| Self-reported social support | A single item will measure self-reported social support with an answer on an 11-point scale (0-10). A higher score indicates a higher level of social support. | 3-month follow-up |
| Self-reported social support | A single item will measure self-reported social support with an answer on an 11-point scale (0-10). A higher score indicates a higher level of social support. | 6-month follow-up |
| Self-reported positive affect | The subscale of the Chinese version International Positive and Negative Affect Schedule Short Form (I-PANAS-SF) will measure self-reported positive affect. The I-PANAS-SF uses a 5-point scale, a higher score indicates a higher level of self-reported positive affect. | 3-month follow-up |
| Self-reported positive affect | The subscale of the Chinese version International Positive and Negative Affect Schedule Short Form (I-PANAS-SF) will measure self-reported positive affect. The I-PANAS-SF uses a 5-point scale, a higher score indicates a higher level of self-reported positive affect. | 6-month follow-up |
| Self-reported negative affect | The subscale of the Chinese version International Positive and Negative Affect Schedule Short Form (I-PANAS-SF) will measure self-reported negative affect. The I-PANAS-SF uses a 5-point scale, a higher score indicates a higher level of self-reported negative affect. | 6-month follow-up |
| Self-reported negative affect | The subscale of the Chinese version International Positive and Negative Affect Schedule Short Form (I-PANAS-SF) will measure self-reported negative affect. The I-PANAS-SF uses a 5-point scale, a higher score indicates a higher level of self-reported negative affect. | 3-month follow-up |
| Guo Z, Luk TT, Weng X, Wu Y, Zhao S, Lai YK, Cheung DYT, Tong HSC, Lai VWY, Lam TH, Wang MP. Behavioral Support by Ex-Smoking Peers Using Instant Messaging for Smoking Cessation: A Randomized Controlled Trial. Chest. 2026 Jan;169(1):300-311. doi: 10.1016/j.chest.2025.07.4110. Epub 2025 Sep 10. |
| ID | Term |
|---|---|
| D016540 | Smoking Cessation |
| ID | Term |
|---|---|
| D015438 | Health Behavior |
| D001519 | Behavior |
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