Cost-effectiveness of a text message programme for the prevention of recurrent cardiovascular events Design and rationale of the tobacco, exercise and diet messages (TEXT ME) trial of a text message-based intervention for ongoing prevention of cardiovascular disease in people with coronary disease: a randomised controlled trial protocol Development and Outcomes of a Text Messaging Tobacco Cessation Intervention With Urban Adolescents. Effectiveness of Text Messaging as an Adjuvant to Health Advice in Smoking Cessation Programs in Primary Care. A Randomized Clinical Trial Efficacy of a text messaging (SMS) based smoking cessation intervention for adolescents and young adults: Study protocol of a cluster randomised controlled trial Optimising text messaging to improve adherence to web-based smoking cessation treatment: a randomised control trial protocol Continuous individual support of smoking cessation using text messaging: a pilot experimental study. Efficacy of a Text Message-Based Smoking Cessation Intervention for Young People: A Cluster Randomized Controlled Trial A randomized trial of Text2Quit: a text messaging program for smoking cessation. Use of mobile phone text messaging to deliver an individualized smoking behaviour intervention in Chinese adolescents A randomized controlled trial to assess the efficacy of an interactive mobile messaging intervention for underserved smokers: Project ACTION An Economic Evaluation of a Video- and Text-Based Computer-Tailored Intervention for Smoking Cessation: A Cost-Effectiveness and Cost-Utility Analysis of a Randomized Controlled Trial Text Message Delivered Peer Network Counseling for Adolescent Smokers: A Randomized Controlled Trial Examining the influence of a text message-based sleep and physical activity intervention among young adult smokers in the United States Dissemination of the nurse-administered Tobacco Tactics intervention versus usual care in six Trinity community hospitals: study protocol for a comparative effectiveness trial Cost-effectiveness analysis of a European primary-care physician training in smoking cessation counseling Feasibility of a text-based smoking cessation intervention in rural older adults
Objective To estimate the cost-effectiveness of Tobacco , Exercise and Diet Messages ( TEXT ME ) , a text message-based intervention that provides advice , motivation , information and support to improve health-related behaviours . Methods A lifetime Markov model was used to estimate major vascular events ( myocardial infa rct ions and strokes ) avoided , quality -adjusted life years ( QALYs ) gained , costs to the health system and the incremental cost per QALY gained . The model was informed by data from a r and omised controlled trial of TEXT ME , with evidence from systematic review s and meta-analyses used to estimate the effects of changes in risk factors on the risk of major vascular events . Expected costs and health outcomes were estimated with uncertainty surrounding these characterised using probabilistic sensitivity analysis and a number of scenario analyses . Results For a target population of 50 000 patients with documented coronary heart disease , the intervention is expected to lead to 563 fewer myocardial infa rct ions , 361 fewer strokes and 1143 additional QALYs .  TEXT ME is expected to lead to an overall saving of $ 10.56 million for the health system over the patients ’ lifetimes . The intervention can therefore be considered cost-saving and health-improving . Neither parameter nor structural uncertainty had a significant impact on the conclusion that TEXT ME is cost-effective . Conclusions The provision of TEXT ME is predicted to lead to better health outcomes and an overall saving in costs for the health system . Trial registration number anzctr.org.au identifier : ACTRN12611000161921 Background Although supporting lifestyle change is an effective way of preventing further events in people with cardiovascular disease , providing access to such interventions is a major challenge . This study aims to investigate whether simple reminders about behaviour change sent via mobile phone text message decrease cardiovascular risk . Methods and analysis R and omised controlled trial with 6 months of follow-up to evaluate the feasibility , acceptability and effect on cardiovascular risk of repeated lifestyle reminders sent via mobile phone text messages compared to usual care .  A total of 720 patients with coronary artery disease will be r and omised to either st and ard care or the TEXT ME intervention . The intervention group will receive multiple weekly text messages that provide information , motivation , support to quit smoking ( if relevant ) and recommendations for healthy diets and exercise . The primary end point is a change in plasma low-density lipoprotein cholesterol at 6 months . Secondary end points include a change in systolic blood pressure , smoking status , quality of life , medication adherence , waist circumference , physical activity levels , nutritional status and mood at 6 months . Process outcomes related to acceptability and feasibility of TEXT ME will also be collected . Ethics and dissemination Primary ethics approval was received from Western Sydney Local Health Network Human Research Ethics Committee — Westmead . Results will be disseminated via the usual scientific forums including peer- review ed publications and presentations at international conferences . Clinical trials registration number ACTRN12611000161921 BACKGROUND This paper describes the development of an urban adolescent text messaging tobacco cessation intervention and preliminary findings from a r and omized , controlled trial . The authors successfully adapted a face-to-face intervention into a personalized , automated , and interactive 5-day texting protocol . METHODS Respondent-driven sampling was used beginning at a community substance abuse facility . Seventy-two tobacco-dependent adolescents were r and omized into an automated computer texting program that delivered either the experimental condition of 30 motivational interviewing- and social network counseling-based personalized messages or the attention control condition consisting of a texting program covering general ( non-smoking-related ) health habits . All teens were provided smartphones for the study and were assessed at baseline and at 1 , 3 , and 6 months post intervention . Analyses examined condition × time interactions . RESULTS At 6 months , the experimental condition decreased the number of cigarettes smoked in the past 30 days , increased intentions not to smoke in the future , and increased peer social support compared with controls . Effect sizes were moderate to large . CONCLUSIONS These findings are unique , as they target urban adolescents with a mobile health format and add to the growing literature on the efficacy of text-delivered interventions Introduction Smoking remains a major risk factor for chronic diseases . Health advice is considered one of the most cost-effective interventions ; however , changes produced by counseling tend not to persist over time , it is necessary to implement enforcement mechanisms . Methods R and omized clinical trial to evaluate the effectiveness of a combined program that includes health advice and text messaging to mobile phone ( SMSalud ® ) . Patients were r and omized to one of two interventions : health advice ( control group ) or health advice and text messaging (  intervention group ) . We included 320 smoker patients who met the inclusion criteria : being motivated , aged over 18 years , having a mobile phone , being able to read and send messages . Patients were excluded if they had a history of mental or behavioral disorders , or depression . The primary endpoint was the percentage of patients who had stopped smoking by 6 months and confirmed by CO breath test . Results By 6 months after the start of the program , 24.4 % ( 39/160 ) of patients in the intervention group and 11.9 % ( 19/160 ) of controls had stopped smoking ( OR : 2.3 ; 95 % CI : 1.3 - 4.3 , p = .007 ) . Patients with no dependence or mild dependence were more likely to stop ( 28.3 % , 36/127 vs. 11.4 % , 22/193 ; OR : 3.0 , 95 % CI : 1.7 - 5.5 , p < .001 ) . The rate of continuous abstinence at 12 months was 16.3 % ( 26/160 ) in intervention group patients and 5.6 % ( 9/160 ) in controls ( OR : 3.2 ; 95 % CI : 1.3 - 5.9 ) . ] . Conclusions The combined program is effective for smoking cessation . Patients with less tobacco dependence have a higher probability of success . Implication s Health advice is effective for promoting changes in lifestyle but these changes do not persist over time , so we have to use strengthening mechanisms , as e-health , and specifically , mobile phone based interventions . SMSalud ® is an innovate program that includes text messaging and health advice , and it 's effective for smoking cessation . The only feature that seems to affect the probability of smoking cessation is the degree of tobacco dependence Background Particularly in groups of adolescents with lower educational level the smoking prevalence is still high and constitutes a serious public health problem . There is limited evidence of effective smoking cessation interventions in this group . Individualised text messaging ( SMS ) based interventions are promising to support smoking cessation and could be provided to adolescents irrespective of their motivation to quit . The aim of the current paper is to outline the study protocol of a trial testing the efficacy of an SMS based intervention for smoking cessation in apprentices . Methods / Design A two-arm cluster-r and omised controlled trial will be conducted to test the efficacy of an SMS intervention for smoking cessation  in adolescents and young adults compared to an assessment only control group . A total of 910 daily or occasional ( ≥ 4 cigarettes in the preceding month and ≥ 1 cigarette in the preceding week ) smoking apprentices will be proactively recruited in vocational school classes and , using school class as a r and omisation unit , r and omly assigned to an intervention group ( n = 455 ) receiving the SMS based intervention or an assessment only control group ( n = 455 ) . Individualised text messages taking into account demographic data and the individuals ' smoking behaviours will be sent to the participants of the intervention group over a period of 3 months . Participants will receive two text messages promoting smoking cessation per week . Program participants who intend to quit smoking have the opportunity to use a more intensive SMS program to prepare for their quit day and to prevent a subsequent relapse . The primary outcome measure will be the proportion of participants with 7-day point prevalence smoking abstinence assessed at 6-months follow-up . The research assistants conducting the baseline and the follow-up assessment s will be blinded regarding group assignment . Discussion It is expected that the program offers an effective and inexpensive way to promote smoking cessation among adolescents and young adults including those with lower educational level and independent of their motivation to quit . Trial registration numberIS RCT N : IS RCT Introduction Millions of smokers use the Internet for smoking cessation assistance each year ; however , most smokers engage minimally with even the best design ed websites . The ubiquity of mobile devices and their effectiveness in promoting adherence in other areas of health behaviour change make them a promising tool to address adherence in Internet smoking cessation interventions . Text messaging is used by most adults , and messages can proactively encourage use of a web-based intervention . Text messaging can also be integrated with an Internet intervention to facilitate the use of core Internet intervention components . Methods and analysis We identified four aspects of a text message intervention that may enhance its effectiveness in promoting adherence to a web-based smoking cessation programme : personalisation , integration , dynamic tailoring and message intensity . Phase I will use a two-level full factorial design to test the impact of these four experimental features on adherence to a web-based intervention . The primary outcome is a composite metric of adherence that incorporates general utilisation metrics ( eg , logins , page views ) and specific feature utilisation shown to predict abstinence .  Participants will be N=860 adult smokers who register on an established Internet cessation programme and enrol in its text message programme .  Phase II will be a two-arm r and omised trial to compare the efficacy of the web-based cessation programme alone and in conjunction with the optimised text messaging intervention on 30-day point prevalence abstinence at 9 months . Phase II participants will be N=600 adult smokers who register to use an established Internet cessation programme and enrol in text messaging .  Secondary analyses will explore whether adherence mediates the effect of treatment condition on outcome . Ethics and dissemination This protocol was approved by Chesapeake IRB . We will disseminate study results through peer- review ed manuscripts and conference presentations related to the methods and design , outcomes and exploratory analyses . Trial registration number NCT02585206 INTRODUCTION The objective of this study was to test the feasibility and acceptance of an intervention using text messaging ( short message service [ SMS ] ) for continuous individual support of smoking cessation in young adults . Additionally , the optimal feedback intensity was investigated , and short-term efficacy of the intervention was explored . METHODS In a cafeteria of the University of Greifswald , 575 visitors were screened for smoking status and usage of text messaging .  From these , 194 persons who fulfilled the inclusion criteria of daily smoking and weekly usage of SMS were invited for participation in an SMS-based intervention .  From these , 174 ( 90 % ) consented to participate . The participants were r and omly allocated to one of three study groups : ( a ) control condition without intervention , ( b ) intervention with one weekly SMS feedback ( 1SMS ) , or ( c ) intervention with three weekly SMS feedbacks ( 3SMS ) . In study groups ( b ) and ( c ) , individualized SMS feedbacks were sent to the participants weekly , based on data from the baseline assessment and a weekly SMS assessment of the stages of change according to the transtheoretical model . Program use and acceptance were compared between the two intervention groups differing in support intensity . An exploration of the short-term efficacy of the program was conducted by comparing the three study groups at the end of the 3-month intervention program on smoking variables . RESULTS The median number of replies to the weekly SMS assessment s was 12.5 in the 1SMS group and 13.0 in the 3SMS group ( not significant ) . The acceptance of the program did not differ between the intervention groups . At post assessment , no significant differences between the three study groups emerged on the examined smoking variables . DISCUSSION The high participation and retention rates suggest that SMS-based smoking cessation interventions are attractive for young adults . Support intensity did not affect the acceptance of the program . Longer follow-up periods and larger sample s are required to obtain conclusive results about the efficacy of this intervention approach Background Smoking prevalence remains high , particularly among adolescents and young adults with lower educational levels , posing a serious public health problem . There is limited evidence of effective smoking cessation interventions in this population . Objective To test the efficacy of an individually tailored , fully automated text messaging ( short message service , SMS)–based intervention for  smoking cessation in young people . Methods A 2-arm cluster r and omized controlled trial , using school class as the r and omization unit , was conducted to test the efficacy of the SMS text messaging intervention compared to an assessment -only control group .  Students who smoked were proactively recruited via online screening in vocational school classes .  Text messages , tailored to demographic and smoking-related variables , were sent to the participants of the intervention group at least 3 times per week over a period of 3 months . A follow-up assessment was performed 6 months after study inclusion . The primary outcome measure was 7-day smoking abstinence . Secondary outcomes were 4-week smoking abstinence , cigarette consumption , stage of change , and attempts to quit smoking . We used regression models controlling for baseline differences between the study groups to test the efficacy of the intervention . Both complete-case analyses ( CCA ) and intention-to-treat analyses ( ITT ) were performed . Subgroup analyses were conducted for occasional and daily smokers . Results A total of 2638 students in 178 vocational school classes in Switzerl and participated in the online screening . Overall , 1012 persons met the inclusion criteria for study participation , and 755 persons ( 74.6 % ) participated in the study ( intervention : n=372 ; control : n=383 ) . Of the 372 program participants , 9 ( 2.4 % ) unsubscribed from the program during the intervention period . Six-month follow-up data were obtained for 559 study participants ( 74.0 % ) . The 7-day smoking abstinence rate at follow-up was 12.5 % in the intervention group and 9.6 % in the control group ( ITT : P=.92 ) . No differences between the study groups were observed in 4-week point prevalence abstinence rates . The decrease in the mean number of cigarettes smoked per day from baseline to follow-up was higher in the intervention group than in the control group ( ITT : P=.002 ) . No differences between the groups were observed in stage of change ( ITT : P=.82 ) and quit attempts ( ITT : P=.38 ) . The subgroup analyses revealed lower cigarette consumption in both occasional and daily smokers in the intervention group compared to the control group . Occasional smokers in the intervention group made more attempts to quit smoking than occasional smokers in the control group . Conclusions This study demonstrated the potential of an SMS text message – based intervention to reach a high proportion of young smokers with low education levels . The intervention did not have statistically significant short-term effects on smoking cessation ; however , it result ed in statistically significant lower cigarette consumption . Additionally , it result ed in statistically significant more attempts to quit smoking in occasional smokers . Trial Registration International St and ard R and omized Controlled Trial Number ( IS RCT N ) : 19739792 ; http://www.controlled-trials.com/IS RCT N19739792 ( Archived by WebCite at http://webcitation.org/6IGETTHmr ) BACKGROUND Text messaging programs on mobile phones have shown some promise in helping people quit smoking .  Text2Quit is an automated , personalized , interactive mobile health program that sends text messages to offer advice , support , and reminders about quitting smoking . PURPOSE To evaluate the effect of Text2Quit on biochemically confirmed repeated point prevalence abstinence in the context of an RCT conducted in the U.S. METHODS Participants ( n=503 ) were recruited on the Internet and r and omized to receive Text2Quit or self-help material . Between 2011 and 2013 , participants were surveyed at baseline and at 1 , 3 , and 6 months post-enrollment to assess smoking status . Saliva was collected from participants who reported not smoking in the past 7 days at the 6-month follow-up . An intent to treat analysis was used , and those lost to follow-up were categorized as smokers . All analyses were completed in 2013 . RESULTS Biochemically confirmed repeated point prevalence abstinence favored the intervention group , with 11.1 % abstinent compared to 5.0 % of the control group ( relative risk=2.22 , 95 % CI=1.16 , 4.26 , p<0.05 ) . Similarly , self-reported repeated point prevalence abstinence was higher in the intervention group ( 19.9 % ) than in the control group ( 10.0 % ) ( p<0.01 ) . Effects were found to be uniform across the analyzed demographic subgroups , although suggestive of a larger effect for non-whites than whites . CONCLUSIONS These results provide initial support for the relative efficacy of the Text2Quit program Summary We evaluated the effectiveness of a mobile phone text-messaging based smoking cessation intervention package among Chinese adolescent smokers . Students aged 16–19 years were recruited from six vocational high schools located in Shanghai . We assigned the six schools to an intervention group or a control group by cluster r and omization . The 92 participants in the intervention group were given tailored information via mobile phone text-messaging for 12 weeks . The 87 participants in the control group were provided with a self-help pamphlet about smoking cessation instead . After the intervention , attitudes towards the disadvantages of smoking were significantly improved , and the level of nicotine dependence and cigarette dependence significantly decreased in the intervention group . The intervention group had a relatively higher self-reported 7-day abstinence compared to the control group and 30-day abstinence , but the differences were not significant . However , the intervention group had a significantly higher rate of smoking reduction ( 66 % vs. 35 % ) and moving forward in quitting stages ( 52 % vs. 18 % ) compared to the control group . The interactive and tailored assistance provided by the mobile phone text-messaging  was effective in smoking behaviour intervention in Chinese adolescent smokers Background Despite a significant decrease in smoking prevalence over the past ten years , cigarette smoking still represents the leading cause of preventable morbidity and mortality in the United States . Moreover , smoking prevalence is significantly higher among those with low levels of education and those living at , or below , the poverty level . These groups tend to be confronted with significant barriers to utilizing more traditional smoking cessation intervention approaches . The purpose of the study , Project ACTION ( Adult smoking Cessation Treatment through Innovative Outreach to Neighborhoods ) , is to utilize a mobile clinic model , a network of community sites ( i.e. , community centers and churches ) and an interactive mobile messaging system to reach and deliver smoking cessation treatment to underserved , low-income communities . Methods / Design We are using a group-r and omized design , with the community site as the sampling unit , to compare the efficacy of three smoking cessation interventions : 1 ) St and ard Care - brief advice to quit smoking , nicotine replacement therapy ( NRT ) , and self-help material s ; 2 ) Enhanced Care - st and ard care components plus a cell phone-delivered text/graphical messaging component ; and 3 ) Intensive Care - enhanced care components plus a series of 11 cell phone-delivered proactive counseling sessions . An economic evaluation will also be performed to evaluate the relative cost effectiveness of the three treatment approaches . We will recruit 756 participants ( 252 participants in each of the 3 intervention groups ) . At the time of r and omization , participants complete a baseline assessment , consisting of smoking history , socio-demographic , and psychosocial variables . Monthly cell phone assessment s are conducted for 6 months-post enrollment , and a final 12-month follow-up is conducted at the original neighborhood site of enrollment . We will perform mixed-model logistic regression to compare the efficacy of the three smoking cessation intervention treatment groups . Discussion It is hypothesized that the intensive care approach will most successfully address the needs of the target population and result in the highest smoking cessation rates . In addition to increasing cessation rates , the intervention offers several features ( including neighborhood outreach and use of mHealth technology ) that are likely to reduce treatment barriers while enhancing participant engagement and retention to treatment . Trial registration This r and omized controlled trial is registered with clinical trials.gov registration number NCT00948129 Background Although evidence exists for the effectiveness of web-based smoking cessation interventions , information about the cost-effectiveness of these interventions is limited . Objective The study investigated the cost-effectiveness and cost-utility of two  web-based computer-tailored ( CT ) smoking cessation interventions ( video- vs. text-based CT ) compared to a control condition that received general text-based advice . Methods In a r and omized controlled trial , respondents were allocated to the video-based condition ( N = 670 ) ,  the text-based condition ( N = 708 ) or  the control condition ( N = 721 ) . Societal costs , smoking status , and quality -adjusted life years ( QALYs ; EQ-5D-3L ) were assessed at baseline , six- and twelve-month follow-up . The incremental costs per abstinent respondent and per QALYs gained were calculated . To account for uncertainty , bootstrapping techniques and sensitivity analyses were carried out . Results No significant differences were found in the three conditions regarding demographics , baseline values of outcomes and societal costs over the three months prior to baseline . Analyses using prolonged abstinence as outcome measure indicated that from a willingness to pay of € 1,500 , the video-based intervention was likely to be the most cost-effective treatment , whereas from a willingness to pay of € 50,400 , the text-based intervention was likely to be the most cost-effective . With regard to cost-utilities , when quality of life was used as outcome measure , the control condition had the highest probability of being the most preferable treatment . Sensitivity analyses yielded comparable results . Conclusion The video-based CT smoking cessation intervention was the most cost-effective treatment for smoking abstinence after twelve months , varying the willingness to pay per abstinent respondent from € 0 up to € 80,000 . With regard to cost-utility , the control condition seemed to be the most preferable treatment . Probably , more time will be required to assess changes in quality of life . Future studies with longer follow-up periods are needed to investigate whether cost-utility results regarding quality of life may change in the long run . Trial Registration Nederl and s Trial Register Abstract Although adolescent tobacco use has declined in the last 10 years , African American high school seniors ’ past 30-day use has increased by 12 % , and as they age they are more likely to report lifetime use of tobacco . Very few urban youth are enrolled in evidence d-based smoking prevention and cessation programming . Therefore , we tested a text messaging smoking cessation intervention design ed to engage urban youth through an automated texting program utilizing motivational interviewing-based peer network counseling . We recruited 200 adolescents ( 90.5 % African American ) into a r and omized controlled trial that delivered either the experimental intervention of 30 personalized motivational interviewing-based peer network counseling messages , or the attention control intervention , consisting of text messages covering general ( non-smoking related ) health habits . All adolescents were provided smart phones for the study and were assessed at baseline , and at 1 , 3 , and 6 months post intervention . Utilizing repeated measures general linear models we examined the effects of the intervention while controlling for race , gender , age , presence of a smoker in the home , and mental health counseling . At 6 months , participants in the experimental condition significantly decreased the number of days they smoked cigarettes and the number of cigarettes they smoked per day ; they significantly increased their intentions not to smoke in the future ; and significantly increased peer social support among girls . For boys , participants in the experimental condition significantly reduced the number of close friends in their networks who smoke daily compared to those in the control condition . Effect sizes ranged from small to large . These results provide encouraging evidence of the efficacy of text messaging interventions to reduce smoking among adolescents and our intervention holds promise as a large-scale public health preventive intervention platform Background Sleep and physical activity are two health behaviors associated with improved smoking cessation outcomes . Text message-based interventions have previously been used to promote physical activity and smoking cessation ; however , this type of intervention has not targeted sleep habits . This study examined the effectiveness of a text message-based active control intervention in improving sleep and physical activity habits among a U.S. national sample of young adult smokers participating in a smoking cessation intervention . Methods This study was a secondary analysis of data from the Stop My Smoking USA r and omized controlled trial . Baseline and 3-month follow-up data were collected from 116 young adult smokers ( mean age 21.8 years , SD = 2.1 ) who were r and omized at a 2:1 ratio to receive a 6-week text messaging program focused on either smoking cessation ( n = 72 ) , or improving sleep and physical activity ( n = 44 ) . Three main outcomes were assessed : 1 ) sleep quantity ( on work/school nights , and non-work/non-school nights ) , 2 ) sleep quality , and 3 ) physical activity at follow-up . Multivariable linear regression analysis was used to quantify the differences in these outcomes between the groups . To identify possible effect modification by baseline sleep and physical activity , the sample was stratified by indicators defined for both of these variables . Results At follow-up , sleep quantity and quality were similar for participants in the smoking cessation and sleep/activity groups when assessed among the total sample and those sleeping ≥6 hours/night at baseline . Among short sleepers ( < 6 hours/night at baseline ) , sleep quantity on work/school nights improved for those receiving sleep/activity messages compared to those receiving smoking cessation messages , after adjusting for covariates ( β̂$$ \widehat{\beta } $ $ = 1.373 , 95 % CI [ 0.262 , 2.484 ] ; p = 0.02 ) . Physical activity at follow-up was similar for the two groups , when examined among the total sample and when stratified by baseline activity level . Conclusions This study provides preliminary evidence that a text message-based intervention may be a promising approach for improving sleep quantity among young adult smokers who are short sleepers and interested in quitting smoking . Similar programs should be further explored as a novel approach for improving sleep habits among individuals with insufficient sleep . Trial registration Clinical Trials.gov Background The objectives of this smoking cessation study among hospitalized smokers are to : 1 ) determine provider and patient receptivity , barriers , and facilitators to implementing the nurse-administered , inpatient Tobacco Tactics intervention versus usual care using face-to-face feedback and surveys ; 2 ) compare the effectiveness of the nurse-administered , inpatient Tobacco Tactics intervention versus usual care across hospitals , units , and patient characteristics using thirty-day point prevalence abstinence at thirty days and six months ( primary outcome ) post-recruitment ; and 3 ) determine the cost-effectiveness of the nurse-administered , inpatient Tobacco Tactics intervention relative to usual care including cost per quitter , cost per life-year saved , and cost per quality -adjusted life-year saved . Methods / Design This effectiveness study will be a quasi-experimental design of six Michigan community hospitals of which three will get the nurse-administered Tobacco Tactics intervention and three will provide their usual care . In both the intervention and usual care sites , research assistants will collect data from patients on their smoking habits and related variables while in the hospital and at thirty days and six months post-recruitment . The intervention will be integrated into the experimental sites by a research nurse who will train Master Trainers at each intervention site . The Master Trainers , in turn , will teach the intervention to all staff nurses . Research nurses will also conduct formative evaluation with nurses to identify barriers and facilitators to dissemination . Descriptive statistics will be used to summarize the results of surveys administered to nurses , nurses ’ participation rates , smokers ’ receipt of specific cessation services , and satisfaction with services . General estimating equation analyses will be used to determine differences between intervention groups on satisfaction and quit rates , respectively , with adjustment for the clustering of patients within hospital units . Regression analyses will test the moderation of the effects of the interventions by patient characteristics . Cost-effectiveness will be assessed by constructing three ratios including cost per quitter , cost per life-year saved , and cost per quality -adjusted life-year saved . Discussion Given that nurses represent the largest group of front-line providers , this intervention , if proven effective , has the potential for having a wide reach and thus decrease smoking , morbidity and mortality among inpatient smokers . Trial registration Dissemination of Tobacco Tactics for Hospitalized Smokers Background  Physician training in smoking cessation counseling  has been shown to be effective as a means to increase quit success . We assessed the cost-effectiveness ratio of a smoking cessation counseling training programme . Its effectiveness was previously demonstrated in a cluster r and omized , control trial performed in two Swiss university out patients clinics , in which residents were r and omized to receive training in smoking interventions or a control educational intervention .  Design and methods We used a Markov simulation model for effectiveness analysis . This model incorporates the intervention efficacy , the natural quit rate , and the lifetime probability of relapse after 1-year abstinence . We used previously published results in addition to hospital service and outpatient clinic cost data . The time horizon was 1 year , and we opted for a third-party payer perspective . Results The incremental cost of the intervention amounted to US$ 2.58 per consultation by a smoker , translating into a cost per life-year saved of US$ 25.4 for men and 35.2 for women . One-way sensitivity analyses yielded a range of US$ 4.0 - 107.1 in men and US$ 9.7 - 148.6 in women . Variations in the quit rate of the control intervention , the length of training effectiveness , and the discount rate yielded moderately large effects on the outcome . Variations in the natural cessation rate , the lifetime probability of relapse , the cost of physician training , the counseling time , the cost per hour of physician time , and the cost of the booklets had little effect on the cost-effectiveness ratio . Conclusions Training residents in smoking cessation counseling  is a very cost-effective intervention and may be more efficient than currently accepted tobacco control interventions Text-based interventions are effective for smoking cessation , but have not been tested in rural older adults . The purpose of this study was to compare the feasibility , acceptability and preliminary efficacy of a text-based Scheduled Gradual Reduction ( SGR ) program to a non-SGR text messaging support condition among rural older adults . Adults over 60 years were r and omized to either : ( i ) the SGR program  ( n = 20 ) , a  text-based program to reduce smoking over 4-weeks plus text-based support messages ;  or ( ii ) control  ( n = 20 ) , receipt of text-based support messages only . Participants completed surveys at baseline and end of program to assess feasibility and acceptability of the intervention , and biochemically vali date d 7-day point prevalence cessation was assessed at end of treatment . Most participants ( 81 % ) reported reading all the messages they received . Participants found both interventions useful in quitting smoking ( SGR = 57 % , Control = 63 % ) and would recommend it to a friend ( SGR = 72 % , Control = 79 % ) . Although not statically significant , the SGR group had a higher rate of biochemically vali date d cessation ( SGR = 15 % , Control = 5 % , Cohen d = 0.67 ) . Among those still smoking , the median percent reduction in cigarettes was 33.3 % for both groups . Text-based cessation interventions are feasible , acceptable and can be easily disseminated to rural older adult tobacco users
The intervention can therefore be considered cost-saving and health-improving .
Neither parameter nor structural uncertainty had a significant impact on the conclusion that TEXT ME is cost-effective .
Conclusions The provision of TEXT ME is predicted to lead to better health outcomes and an overall saving in costs for the health system .
Objective To estimate the cost-effectiveness of Tobacco , Exercise and Diet Messages ( TEXT ME ) , a text message-based intervention that provides advice , motivation , information and support to improve health-related behaviours .