Effectiveness of WhatsApp online group discussion for smoking relapse prevention: protocol for a pragmatic randomized controlled trial.

BACKGROUND AND AIMS: Sustained psychosocial support via online social groups may help former tobacco users maintain abstinence. This study aims to examine the effectiveness of participating in a WhatsApp social group for long-term smoking cessation. DESIGN: Two-arm, open-labelled, pragmatic, individually randomized controlled trial. SETTING: All participants are service users of smoking cessation clinics, and all interventions are delivered via mobile phones. PARTICIPANTS: Participants included 1008 adult quitters who self-report no tobacco use in the past 3-30 days. INTERVENTIONS: The intervention group (n = 504) will join a WhatsApp social group to receive standardized and theory-based reminders of smoking relapse prevention and participate in discussion with other WhatsApp group members using their own mobile phones. All social groups will be led by counselors or specialist nurse practitioners. The control group (n = 504) will receive similar reminders via short messages to their own mobile phones but will not interact with other participants. The intervention duration for both groups is 8 weeks. Both groups will receive a booklet at baseline about how to prevent smoking relapse. MEASUREMENTS: The primary outcome is biochemically validated tobacco abstinence at 12 months after consent. COMMENTS: The findings will provide evidence concerning the utility of operating online social group discussion for prevention of smoking relapse and sustaining long-term abstinence.

Brief handgrip and isometric exercise intervention for smoking cessation: A pilot randomized trial.

INTRODUCTION: Isometric exercises reduce craving, negative affect, and withdrawal symptoms during smoking cessation. This randomized controlled trial (RCT) was the first to test if a brief intervention using a handgrip and isometric exercises including hand pushing/pulling was feasible and efficacious to increase tobacco abstinence at 6-month. METHODS: This was a single-blinded, 2-arm pilot RCT in 6 community-based smoking cessation clinics in Hong Kong. Smokers who consumed 10 or more cigarettes a day and were receiving cessation services were randomized to the exercise group (n = 108) who received a free handgrip and a leaflet about handgrip exercise, and watched a 5-minute video, or to the healthy-diet group (n = 100) who receive a similar dosage of intervention on healthy diet. The primary outcome was self-reported abstinence in the previous 4 weeks at 6-month follow-up. RESULTS: In the exercise group, about 36% reported doing the exercises when craving at 2-month follow-up. No significant difference in quit rate was found between groups (34% vs. 39%, OR = 0.80, P = .40). A posteriori analysis on the exercise group showed that self-reported exercises when craving (49% vs. 26%, OR = 2.69, 1.18-6.15, P = .02) and total adherence (including doing the exercises when craving, once a day, and/or for 2 weeks) (53% vs. 23%, OR = 3.70, 1.15-11.92, P = .03) were significantly associated with self-reported abstinence. CONCLUSIONS: The brief handgrip/isometric exercise intervention was feasible and achieved modest adherence without offering incentives or mandatory reminders. Preliminary evidence of benefits was observed in the intervention group if the exercises were done when craving. IMPLICATIONS: Our study indicates that a brief exercise intervention, including a free handgrip and educational video, was feasible for smokers receiving smoking cessation treatment. It was particularly efficacious in increasing tobacco abstinence when exercise adherence was high. TRIAL REGISTRATION: ClinicalTrial.gov (NCT02844296).