Personalized chat-based support for smoking cessation among smokers with mental health symptoms in the workplace: A randomized controlled trial

Addiction, 120(7), 1390–1401. 2025
Yao, Y., Luk, T. T., Lau, O. S., Wu, Y. S., Weng, X., Ng, C. H., Cheung, Y. T. D., Lam, T. H., & Wang, M. P.*

Abstract

Aims: Smoking rates are disproportionately high among people with mental health issues. We evaluated the effectiveness of a chat-based intervention paired with psychological support for workplace smokers with mental health symptoms.

Design and setting: A pragmatic, two-arm, randomized controlled trial in 65 companies in Hong Kong, China.

Participants: 300 employees who smoked daily (84.3% male) with stress (Perceived Stress Scale-4 ≥ 6), anxiety (General Anxiety Disorder-2 ≥ 3) or depressive symptoms (Patient Health Questionnaire-2 ≥ 3).

Interventions: Participants were randomly allocated to either the intervention group (n = 144) or the control group (n = 156). The intervention group received 20 instant messages and chat-based support delivered by trained counselors over 3 months, using Acceptance and Commitment Therapy. The control group received 6 messages on general health. Both groups received a health talk and self-help booklet at baseline, brief phone advice at follow-ups and full-course nicotine replacement therapy for continuing smokers at 6 months.

Measurements: The primary outcome was self-reported 7-day point prevalence abstinence (PPA) at 6 months after intervention initiation. Secondary outcomes included PPA at 1, 3, 9 and 12 months, changes in mental health symptoms and intervention engagement (chatting with counsellors).

Findings: By intention to treat, there was no evidence of a difference in 7-day PPA between intervention and control group at 6 months [16.0% vs. 13.5%, odds ratio (OR) = 1.22, 95% confidence interval (CI) = 0.64-2.32]. At 12 months, there was weak evidence of an intervention benefit (21.5% vs. 13.5%, 1.76, 0.96-3.24), which was statistically significant after adjusting for baseline factors (adjusted OR = 2.61, 1.22-5.58, P = 0.01). A greater reduction in anxiety symptoms over a 12-month period in the intervention group was observed (adjusted b = -0.28, 95% CI = -0.56 to -0.00, P = 0.05).

Conclusions: There appears to be weak evidence for a benefit of a personalised chat-based smoking cessation intervention plus psychological support on promoting smoking abstinence among workplace smokers with mental health symptoms.

Keywords: chat‐based support; instant messaging; mental health; mobile health; smoking cessation; workplace.

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(*Corresponding Author)