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.

• Instant Messaging IM (Behavioral), also known as Instant messaging interaction: Smokers can communicate with counsellors in real-time through instant messaging (social media). Our counsellors will trigger the conversation and invite the smokers to response after initial contact. Counsellors will keep contact with the smokers to offer help, positive encouragement, reflections and reminders about SC according to smokers' personal needs and to encourage them to seek SC services. Details of successfully booked SC appointment (e.g. SC services address, contact information, date, appointment number etc.) will be delivered to the smokers using IM. All smokers will receive a reminder-to-attend IM messages 1-3 days before the appointment date.
• Regular messages (Behavioral), also known as Regular messages focusing active referral and encouragement: Regular messages, including: harm of smoking, benefit of smoking cessation, importance of adherence to smoking cessation appointment and encouragement on abstinence will be sent to smokers after initial contact via social media.
• AWARD advice (Behavioral), also known as Ask, Warn, Advise, Refer, Do-it-again: Ask about smoking history, Warn about the high risk of smoking, Advise to quit as soon as possible, Refer to the smoking cessation services, and Do it again (if the smokers refused to set quit date).
• Referral card (Behavioral), also known as Smoking Cessation Service Card: The 3-folded "Smoking Cessation Services" card consists of brief information and highlights of existing smoking cessation services, contact methods, motivation information and strong supporting messages or slogans
• Brief advice (Behavioral), also known as Brief smoking cessation advice: Very brief, minimal and general smoking cessation advice
• COSH booklet (Behavioral), also known as COSH self-help smoking cessation booklet: A general smoking cessation self-help booklet
• Placebo Messages (Behavioral): Placebo messages will be sent via smart phones (e.g. social media) to remind subjects to take follow-up calls before each follow-up time points.
• Warning Leaflet (Behavioral): The leaflet will include the information about the health risks of smoking.

Primary outcomes

• Biochemical validated quit rate at 6-month follow-up [6-month follow-up]: Biochemically validated quit rates at 6-month in the two groups

Secondary outcomes

• Biochemical validated quit rate [3-month follow-up]: Biochemically validated quit rates at 3-month in the two groups
• Smoking quit rate change from baseline at 3-month follow-up [3-month follow-up]: The primary outcomes are self-reported 7-day point prevalence (pp) quit rate at 3-month between the two groups
• Smoking quit rate change from baseline at 6-month follow-up [6-month follow-up]: The primary outcomes are self-reported 7-day point prevalence (pp) quit rate at 6-month between the two groups
• Smoking reduction rate change from baseline at 3-month follow-up [3-month follow-up]: Rate of smoking reduction by at least half of baseline amount in the two groups
• Smoking reduction rate change from baseline at 6-month follow-up [6-month follow-up]: Rate of smoking reduction by at least half of baseline amount in the two groups
• Smoking quit attempt change from baseline at 3-month follow-up [3-month follow-up]: Number of quit attempts at 3-month in the two groups
• Smoking quit attempt change from baseline at 6-month follow-up [6-month follow-up]: Number of quit attempts at 6-month in the two groups
• Quit rate for all subjects change from baseline at 3- and 6-month follow-up [3 and 6 months follow-up]: the above cessation and reduction outcomes of all subjects participating in Quit to Win contest 2017
• Reduction rate for all subjects change from baseline at 3- and 6-month follow-up [3 and 6 months follow-up]: the above cessation and reduction outcomes of all subjects participating in Quit to Win contest 2017
• Use of smoking cessation service [3 and 6 months follow-up]: Use of smoking cessation at 3 and 6 month follow-up in the two groups
• Use of smoking cessation service for all subjects [3 and 6 months follow-up]: Use of smoking cessation service for all subjects participating in Quit to Win contest 2017

Sex: All, ages: 18 Years to any

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

• Results publication: 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. PMID 41546550
• Results publication: Li Y, Luk TT, Cheung YTD, Zhao S, Zeng Y, Tong HSC, Lai VWY, Wang MP. Engagement With a Mobile Chat-Based Intervention for Smoking Cessation: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2024 Jun 3;7(6):e2417796. doi: 10.1001/jamanetworkopen.2024.17796. PMID 38922618
• Results publication: Wang MP, Luk TT, Wu Y, Li WH, Cheung DY, Kwong AC, Lai V, Chan SS, Lam TH. Chat-based instant messaging support integrated with brief interventions for smoking cessation: a community-based, pragmatic, cluster-randomised controlled trial. Lancet Digit Health. 2019 Aug;1(4):e183-e192. doi: 10.1016/S2589-7500(19)30082-2. Epub 2019 Jul 31. PMID 33323188

• Man Ping Kelvin Wang, PhD, Principal investigator, The University of Hong Kong