Editor’s note: On the day this review was published, the news release it’s based on was removed from the EurekAlert! site. We have saved the original news release as a pdf.
Using mobile devices to inform, persuade and ultimately change health behaviors is all the rage. A recent meta-analysis suggests that these efforts can be effective when it comes to convincing pregnant smokers to cut back, although it also finds that persuading smokers to stop is less successful.
This news release describes a study that used an experimental design (randomized intervention and control groups) to explore whether text messages would be effective in helping pregnant women to stop smoking. Those messages did not produce any statistically significant reduction in smoking cessation rates, as the study itself makes clear. So it’s concerning to see this news release headlined: “Text messaging program may help pregnant women kick the smoking habit.” A more accurate headline would have been: “Text messaging program not shown to help pregnant women kick the smoking habit.”
The researchers did find a possible benefit in older mothers-to-be and in individuals further along in their pregnancies. However, finding from such smaller subgroups are considered “hypothesis-generating,” meaning they can point to trends that merit further study. They cannot provide conclusive evidence that a treatment provides a health benefit. You can read more about subgroups and their limitations here.
The bottom line here seems to be that the messages were not very influential, although the news release portrays the effort as a success story. And that misleading framing has already been carried through to some news stories about the study. Other journalists looking into the study should tread carefully.
Mothers-to-be smoking while pregnant poses health harms for fetuses and early childhood, yet a reported 10 percent of pregnant women continue to smoke. Figuring out ways to persuade them to stop has merit.
It is not made clear what costs would accompany this kind of mobile health message strategy, and whether the costs would be absorbed by health plans and health care providers that use the service, or by individual patients.
Wide use presumes thousands of app downloads and significant infrastructure costs on the part of those maintaining the service.
It’s assumed there is profit motive, given the licensing agreement.
The release appropriately describes the outcomes in absolute terms. For example, “16 percent of the women who were enrolled in both Text4baby and Quit4baby had quit compared with just 11 percent of women getting just Text4baby.”
But while the body of the release clarifies that this difference between groups was not statistically significant, the headline and lead sentence gloss over this fact. We’ll address that issue below under the Evidence criterion.
There is no mention of harms but it’s hard to imagine there are any harms from voluntarily receiving from 1 to 8 text messages a day. We’ll rate this Not Applicable.
The headline and lead sentence of the release are an exercise in spin. The reduction in smoking rates for the study overall was not statistically significant — full stop. That should have been the headline. It’s not acceptable for the release to bury the lack of statistical significance in the body of the text while claiming benefits in the headline.
The researchers did report statistically significant reduction in smoking rates among smaller subgroups of the main study. However, findings from such limited subgroups should be interpreted very cautiously, and a positive subgroup finding should never be the headline if the overall results of the study were negative.
No disease mongering here. Risks to fetuses from smoking are real.
The release offers information about both funding and conflicts of interest. It notes that the lead author, “Dr. Abroms has stock in Wellpass Inc. (formerly Voxiva, Inc.) and has licensed Text2quit and Quit4baby to Wellpass.” This is a real strength of the release.
The text makes the point that there’s scarce assistance for quitting smoking for pregnant women since some stop-smoking aids carry additional risks. But we think the release should have mentioned some of those alternatives that do exist — quitting cold turkey, gradual quitting, nicotine replacement, medications like bupropion, and counseling. Options that include medications should include consultation with one’s doctor to weigh the risks and benefits of using smoking cessation aids during pregnancy.
Although the release notes that this experiment took place within the confines of an “established” text messaging program (Text4baby), the availability of the “Quit4baby” sub-program, which is the focus of the research, is not clear.
The release notes that very little is available to assist pregnant women with smoking cessation, so a new intervention is noteworthy. The original research article references a small number of pilot studies of attempts to use social media and text messaging to convince pregnant women to stop smoking.
The main message of the release is misleading if not deceptive. However, we’ve already addressed that issue and see no other unjustified statements that would merit a Not Satisfactory rating here.