Personalized chat‐based support for smoking cessation among smokers with mental health symptoms in the workplace: A randomized controlled trial.
Open accessAbstract
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.
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Cites
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Claims the paper makes
15 of 27 cited sources checked · 7 supported · 1 flagged · accuracy not yet measured
- Interpretationcitation
Compared with chat-based smoking cessation treatment alone, the cessation intervention paired with ACT-based psychosocial support resulted in superior cessation outcomes.
“Compared with chat-based smoking cessation treatment alone [22], our cessation intervention paired with ACT-based psychosocial support resulted in superior cessation outcomes.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [22] 22. Guo Z, Weng X, Lau AOS, Ng MCH, Wu YS, Lam TH, et al. Workplace cessation support is associated with more abstinence in a workplace program in Hong Kong: a mixed-methods study. Tob Induc Dis. 2022;20:114. https://doi.org/10.18332/tid/156455 source
The citation is attached to “chat-based smoking cessation treatment alone,” not to the citing authors’ claim about their ACT-based intervention. The Methods (Design; page unavailable) describe this source’s program as a health talk, self-help booklet, and text messages, rather than chat-based treatment alone. (LLM, conf=0.85)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measured
- Premisecitation
A previous cluster RCT involving 1185 community smokers showed that chat-based IM support guided by ACT plus brief cessation interventions significantly increased 6-month validated smoking abstinence rates (8% vs. 5%, P < 0.001) compared to control.
“Our cluster RCT involving 1185 community smokers showed that chat-based IM support guided by ACT plus brief cessation interventions significantly increased 6-month validated smoking abstinence rates (8% vs. 5%, P < 0.001) than control [14].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [14] 14. Wang MP, Luk TT, Wu Y, Li WH, Cheung DY, Kwong AC, et al. Chat- based instant messaging support integrated with brief interventions for smoking cessation: a community-based, pragmatic, cluster- randomised controlled trial. Lancet Digit Health. 2019;1(4):e183-92. https://doi.org/10.1016/S2589-7500(19)30082-2 source
Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
- Study design and conductown data
The drop-out rate was slightly higher than in previous community (23%) and workplace (29%) trials.
“The drop-out rate (36% at 6 months) in this study was slightly higher than those in our previous community trial (23%) [14] and workplace trial (29%) [22].”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [14] 14. Wang MP, Luk TT, Wu Y, Li WH, Cheung DY, Kwong AC, et al. Chat- based instant messaging support integrated with brief interventions for smoking cessation: a community-based, pragmatic, cluster- randomised controlled trial. Lancet Digit Health. 2019;1(4):e183-92. https://doi.org/10.1016/S2589-7500(19)30082-2 source
- cites [22] 22. Guo Z, Weng X, Lau AOS, Ng MCH, Wu YS, Lam TH, et al. Workplace cessation support is associated with more abstinence in a workplace program in Hong Kong: a mixed-methods study. Tob Induc Dis. 2022;20:114. https://doi.org/10.18332/tid/156455 source
The citation [22] is attached to the previous workplace trial’s 29% drop-out rate. Our copy’s Methods (Measures and Statistical analysis; page unavailable) describes six-month follow-up and the handling of missing outcomes, but does not report a 29% drop-out rate. Searches for that figure and for follow-up attrition did not establish the comparison. (LLM, conf=0.72)
Experimental — accuracy not yet measured
- Premisecitation
Smokers less motivated to quit were less likely to use mHealth for quitting.
“These findings align with those from other smoking cessation trials, which have shown that smokers less motivated to quit were less likely to use mHealth for quitting [14,39].”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [14] 14. Wang MP, Luk TT, Wu Y, Li WH, Cheung DY, Kwong AC, et al. Chat- based instant messaging support integrated with brief interventions for smoking cessation: a community-based, pragmatic, cluster- randomised controlled trial. Lancet Digit Health. 2019;1(4):e183-92. https://doi.org/10.1016/S2589-7500(19)30082-2 source
- cites [39] 39. Weng X, Zhao S, Kwong A, Lai V, Lam TH, Wang MP. Exploring per- spectives for developing an adaptive chat-based smoking cessation intervention among continuing smokers in Hong Kong: community- based, qualitative study. Tob Induc Dis. 2021;19(1):19. https://doi. org/10.18332/tid/141410 source
The Results report that low interest was a barrier to engaging with chat-based cessation support. They identify low motivation to quit as a factor in continued smoking, but do not establish that less-motivated smokers were less likely to use mHealth. This was a qualitative interview study of participants from earlier trials, not itself a smoking cessation trial. (LLM, conf=0.83)
Experimental — accuracy not yet measured
- Findingown data
Among intervention group participants, those who engaged in conversation with counselors had higher self-reported abstinence rates at 6 months than those who did not engage (adjusted OR = 3.29, 95% CI = 1.06-10.22).
“They reported 3.40-fold and 2.28-fold higher abstinence rates at 6 months and 12 months than those who were not engaged, with corresponding adjusted ORs of 3.29 (95% CI = 1.06-10.22)and 2.16 (0.81-5.74), respectively (Table 3).”
Quote in the paperSubstantial claim- The authors state this as an assumption: Missing outcomes are assumed to be missing not at random, with participants who had missing outcomes assumed to have continued or returned to their pre-treatment smoking behavior.
- Findingcitation
Engagement in chatting was associated with a 3.4-fold increase in the 6-month abstinence rate.
“Similar to findings from a prior trial [34], engagement in chatting was associated with a 3.4-fold increase in the 6-month abstinence rate, suggesting the importance of improving intervention engagement.”
Quote in the paperSubstantial claim - Findingown data
The usage of NRT was comparable between intervention (9.9%) and control group (8.1%, P = 0.62).
“The usage of NRT was comparable between intervention (9.9%) and control group (8.1%, P = 0.62, see Table S1).”
Quote in the paperNot a substantial claim- The authors state this as an assumption: Missing outcomes are assumed to be missing not at random, with participants who had missing outcomes assumed to have continued or returned to their pre-treatment smoking behavior.
- Findingown data
By intention-to-treat analysis, the primary outcome of self-reported abstinence at 6-month follow-up was 16% (23/144) in the intervention group versus 13.5% (21/156) in the control group (OR = 1.22, 95% CI = 0.64-2.32, P = 0.54).
“Table 2 shows that by intention-to-treat analysis, the primary outcome of self-reported abstinence at 6-month follow-up was 16% (23/144) in the intervention group versus 13.5% (21/156) in the control group (OR = 1.22,95% CI = 0.64-2.32,P = 0.54).”
Quote in the paperSubstantial claim- The authors state this as an assumption: Missing outcomes are assumed to be missing not at random, with participants who had missing outcomes assumed to have continued or returned to their pre-treatment smoking behavior.
- Findingown data
No substantial group differences in socio-demographic characteristics, smoking profile and mental health status were found at baseline.
“No substantial group differences in socio-demographic characteristics, smoking profile and mental health status were found (Table 1).”
Quote in the paperNot a substantial claim - Findingown data
The intervention effect was higher among participants who worked for services companies than other industries (financial, wholesale or retail).
“Our intervention effect was higher among participants who worked for services companies than other industries (financial, wholesale or retail), which may be attributed to their higher intervention engagement (62.5% vs. 27.8%,P = 0.001).”
Quote in the paperNot a substantial claim - Findingown data
Among intervention group participants, those who engaged in conversation with counselors had higher self-reported abstinence rates at 12 months than those who did not engage (adjusted OR = 2.16, 95% CI = 0.81-5.74).
“They reported 3.40-fold and 2.28-fold higher abstinence rates at 6 months and 12 months than those who were not engaged, with corresponding adjusted ORs of 3.29 (95% CI = 1.06-10.22)and 2.16 (0.81-5.74), respectively (Table 3).”
Quote in the paperSubstantial claim- The authors state this as an assumption: Missing outcomes are assumed to be missing not at random, with participants who had missing outcomes assumed to have continued or returned to their pre-treatment smoking behavior.
- Findingown data
The intervention showed greater efficacy among participants reporting one to two mental health symptoms compared to those with three symptoms.
“The intervention showed greater efficacy among participants reporting one to two mental health symptoms, compared to those with three symptoms, suggesting the intervention may be particularly beneficial for smokers with mild mental health presentations.”
Quote in the paperSubstantial claim - Findingown data
In the intervention group, 36.1% of participants (n=52) engaged in chatting with counselors.
“In this group, 36.1% of participants (n = 52) engaged in chatting with counselors.”
Quote in the paperNot a substantial claim - Findingown data
The trial showed that a personalized chat-based smoking cessation intervention combined with psychological support for workplace smokers with mental health symptoms did not achieve the expected effect on smoking abstinence.
“This trial showed that a personalized chat-based smoking cessation intervention combined with psychological support for workplace smokers with mental health symptoms did not achieve the expected effect on smoking abstinence, although there was increasing difference between groups over time.”
Quote in the paperSubstantial claim - Findingown data
The 12-month PPA was marginally higher in the intervention group than the control group (21.5% vs. 13.5%, OR = 1.76, 95% CI = 0.96-3.24, P = 0.07).
“The 12-month PPA was marginally higher in the intervention group than the control group (21.5% vs. 13.5%,OR = 1.76, 95% CI = 0.96-3.24,P = 0.07).”
Quote in the paperSubstantial claim- The authors state this as an assumption: Missing outcomes are assumed to be missing not at random, with participants who had missing outcomes assumed to have continued or returned to their pre-treatment smoking behavior.
- Findingown data
The intervention group also tended to have greater decreases in stress and depressive symptoms from baseline through the 6-and 12-month follow-ups.
“The intervention group also tended to have greater decreases in stress and depressive symptoms from baseline through the 6-and 12-month follow-ups.”
Quote in the paperSubstantial claim - Findingown data
Compared to their control counterparts, participants in the intervention group who were ready to quit within 30 days had a higher PPA at both 6-month and 12-month follow-ups.
“Table 5 shows that, compared to their control counterparts, participants in the intervention group who were ready to quit within 30 days had a higher PPA at both 6-month and 12-month follow-ups.”
Quote in the paperNot a substantial claim- The authors state this as an assumption: Missing outcomes are assumed to be missing not at random, with participants who had missing outcomes assumed to have continued or returned to their pre-treatment smoking behavior.
- Findingown data
On adjusting for nicotine dependence and quit attempts at baseline, the self-reported abstinence at 12-month follow-up was significantly higher in the intervention than control group (adjusted OR = 2.61, 95% CI = 1.22-5.58, P = 0.01).
“On adjusting for nicotine dependence and quit attempts at baseline, the self-reported abstinence at 12-month follow-up was significantly higher in the intervention than control group (adjusted OR = 2.61, 95% CI = 1.22-5.58,P = 0.01).”
Quote in the paperSubstantial claim- The authors state this as an assumption: Missing outcomes are assumed to be missing not at random, with participants who had missing outcomes assumed to have continued or returned to their pre-treatment smoking behavior.
- Findingnone given
There was an increasing difference between groups over time in smoking abstinence.
“This trial showed that a personalized chat-based smoking cessation intervention combined with psychological support for workplace smokers with mental health symptoms did not achieve the expected effect on smoking abstinence, although there was increasing difference between groups over time.”
Quote in the paperSubstantial claim - Findingown data
Our intervention was more effective for participants who were ready to quit in 30 days, with an OR of PPA at 6 months of 2.80 (95% CI = 1.01-7.80).
“Our intervention was more effective for participants who were ready to quit in 30 days, with an OR of PPA at 6 months of 2.80 (95% CI = 1.01-7.80).”
Quote in the paperSubstantial claim - Findingown data
Intervention engagement was higher among participants who worked for services companies than other industries (62.5% vs. 27.8%, P = 0.001).
“Our intervention effect was higher among participants who worked for services companies than other industries (financial, wholesale or retail), which may be attributed to their higher intervention engagement (62.5% vs. 27.8%,P = 0.001).”
Quote in the paperSubstantial claim - Findingown data
A greater reduction in anxiety symptoms over the 12-month follow-up period was observed in the intervention group.
“A greater reduction in anxiety symptoms over the 12-month follow-up period was observed in the intervention group.”
Quote in the paperSubstantial claim - Premisecitation
Smoking rates are disproportionately high among people with mental health problems.
“Smoking rates are disproportionately high among people with mental health issues.”
- Also stated in: § INTRODUCTION · plain
“Despite the decline in tobacco use among the general population globally over the past two decades, smoking remains disproportionately high among people with mental health problems.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [1] 1. World Health Organization. The vicious cycle of tobacco use and mental illness -a double burden on health [internet]; 2021 [cited 2024 May 4]. Available from: https://www.who.int/europe/news/ item/08-11-2021-the-vicious-cycle-of-tobacco-use-and-mental- illness-a-double-burden-on-health
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Also stated in: § INTRODUCTION · plain
- Study design and conductown data
The sensitivity analyses using multiple imputation regression models yielded consistent results.
“The sensitivity analyses using multiple imputation regression models yielded consistent results (Table S2).”
Quote in the paperNot a substantial claim- The authors state this as an assumption: Missing outcomes are assumed to be missing not at random, with participants who had missing outcomes assumed to have continued or returned to their pre-treatment smoking behavior.
- Study design and conductown data
The drop-out rate at 6 months was 36%.
“The drop-out rate (36% at 6 months) in this study was slightly higher than those in our previous community trial (23%) [14] and workplace trial (29%) [22].”
Quote in the paperNot a substantial claim - Study design and conductreasoning
The inability to achieve the planned sample size reduced statistical power.
“The inability to achieve the planned sample size (300/736) during the COVID-19 pandemic reduced statistical power, therefore, uncertain to the definitive conclusions, but suggesting a fully powered trial is worthwhile.”
Quote in the paperSubstantial claim - Study design and conductown data
Sensitivity analyses using multiple imputations and complete case analysis yielded congruent results.
“owing to the incomplete follow-up could not be excluded, but our sensitivity analyses using multiple imputations and complete case analysis yielded congruent results.”
Quote in the paperNot a substantial claim - Interpretationown data
Our ACT-based psychological support had a more pronounced effect on anxiety symptoms compared to stress levels and depressive symptoms.
“Our ACT-based psychological support had a more pronounced effect on anxiety symptoms compared to stress levels and depressive symptoms.”
Quote in the paperSubstantial claim - Study design and conductnone given
All outcome assessors and statistical analysts were blinded to the participant's group allocation.
“All outcome assessors and statistical analysts were blinded to the participant's group allocation.”
Quote in the paperSubstantial claim - Study design and conductown data
The trial did not achieve the planned sample size (300/736) during the COVID-19 pandemic.
“The inability to achieve the planned sample size (300/736) during the COVID-19 pandemic reduced statistical power, therefore, uncertain to the definitive conclusions, but suggesting a fully powered trial is worthwhile.”
Quote in the paperSubstantial claim - Premisecitation
A RCT involving 2415 smokers found that an ACT-based smartphone application intervention significantly increased the odds of achieving a 30-day point prevalence abstinence compared to the quit guide (28.2% vs. 21.1%, P < 0.001).
“A RCT involving 2415 smokers found that an ACT-based smartphone application intervention significantly increased the odds of achieving a 30-day point prevalence abstinence compared to the quit guide (28.2% vs. 21.1%,P < 0.001) [15].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [15] 15. Bricker JB, Watson NL, Mull KE, Sullivan BM, Heffner JL. Efficacy of smartphone applications for smoking cessation: a randomized clinical trial. JAMA Intern Med. 2020;180(11):1472-80. https://doi.org/10. 1001/jamainternmed.2020.4055 source
- Interpretationreasoning
ACT may be particularly effective in relieving anxiety symptoms.
“Together with our findings, this suggests that ACT may be particularly effective in relieving anxiety symptoms, although further research is needed to confirm this.”
Quote in the paperSubstantial claim - Study design and conductown data
The post hoc estimated power of the sample was 49%.
“However, these findings should be interpreted with caution because of the insufficient power (post hoc estimated as 49%) of the sample.”
Quote in the paperSubstantial claim - Interpretationown data
The higher intervention effect among services company participants may be attributed to their higher intervention engagement.
“Our intervention effect was higher among participants who worked for services companies than other industries (financial, wholesale or retail), which may be attributed to their higher intervention engagement (62.5% vs. 27.8%,P = 0.001).”
Quote in the paperNot a substantial claim - Interpretationown data
The intervention may be particularly beneficial for smokers with mild mental health presentations.
“The intervention showed greater efficacy among participants reporting one to two mental health symptoms, compared to those with three symptoms, suggesting the intervention may be particularly beneficial for smokers with mild mental health presentations.”
Quote in the paperSubstantial claim - Interpretationown data
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.
“There appears to be weak evidence for a benefit of a personalised chatbased smoking cessation intervention plus psychological support on promoting smoking abstinence among workplace smokers with mental health symptoms.”
Quote in the paperSubstantial claim- The authors state this as an assumption: Missing outcomes are assumed to be missing not at random, with participants who had missing outcomes assumed to have continued or returned to their pre-treatment smoking behavior.
- Study design and conductown data
The achieved sample (n=300) gives a statistical power level of 0.49 for the originally expected cessation rates of 30% versus 20%.
“The achieved sample (n = 300) gives a statistical power level of 0.49 for the originally expected cessation rates of 30% versus 20%.”
Quote in the paperSubstantial claim - Study design and conductnone given
The study used self-reported smoking abstinence outcomes without biochemical validation.
“The study used self-reported smoking abstinence outcomes without biochemical validation; however, any potential bias in self-reporting is expected to be evenly distributed across both groups.”
Quote in the paperNot a substantial claim- Rests on an assumption: Any potential bias in self-reporting is expected to be evenly distributed across both groups.
- May combine two claims. 20
- Classified as probably not a substantial claim. 16
May combine two claims.
PremisecitationChat-based support via instant messaging apps for smoking cessation, delivered by real people, is both feasible and acceptable.
“Chat-based support via IM apps for smoking cessation, delivered by real people, is both feasible and acceptable [12,13].”
Quote in the paperSubstantial claim2 of 2 sources checked- cites [12] 12. Luk TT, Wong SW, Lee JJ, Chan SS-C, Lam TH, Wang MP. Exploring community smokers' perspectives for developing a chat-based smok- ing cessation intervention delivered through mobile instant messag- ing: qualitative study. JMIR Mhealth Uhealth. 2019;7(1):e11954. https://doi.org/10.2196/11954 source
The Results (Perceived Utility of Instant Messaging for Smoking Cessation; page not available) say participants considered IM a feasible and acceptable platform for cessation support. The Methods (The Proposed Intervention; page not available) describe one-to-one chats with a trained counselor. This was a qualitative assessment of a proposed intervention, so it supports perceived feasibility and acceptability, not a demonstrated finding that delivery is feasible and acceptable. (LLM, conf=0.85)
Experimental — accuracy not yet measured - cites [13] 13. Jiang N, Zhao A, Rogers ES, Cupertino AP, Zhao X, Cartujano- Barrera F, et al. Feasibility and preliminary effects of a social media- based peer-group mobile messaging smoking cessation intervention among Chinese immigrants who amoke: pilot randomized controlled trial. JMIR Mhealth Uhealth. 2024;12:e59496. https://doi.org/10. 2196/59496 source
May combine two claims.
PremisecitationProviding a smoking cessation intervention plus ACT-based psychological support in the workplace could address smoking, potentially improve mental wellbeing, boost productivity and reduce health costs.
“Providing a smoking cessation intervention plus ACT-based psychological support in the workplace could address smoking, potentially improve mental wellbeing [19], boost productivity and reduce health costs [20,21].”
Quote in the paperSubstantial claim1 of 3 sources checked- cites [19] 19. Taylor G, McNeill A, Girling A, Farley A, Lindson-Hawley N, Aveyard P. Change in mental health after smoking cessation: system- atic review and meta-analysis. BMJ. 2014;348(feb13 1):g1151. https://doi.org/10.1136/bmj.g1151 source
- cites [20] 20. World Health Organization. WHO and ILO call for new measures to tackle mental health issues at work [internet]; 2022 [cited 2023 Dec 18]. Available from: https://www.who.int/news/item/28-09-2022- who-and-ilo-call-for-new-measures-to-tackle-mental-health-issues- at-work 21. Berman M, Crane R, Seiber E, Munur M. Estimating the cost of a smoking employee. Tob Control. 2014;23(5):428-33. https://doi. org/10.1136/tobaccocontrol-2012-050888 source
- cites [21] 21. Weng X, Lau OS, Ng CH, Li WHC, Lam TH, Wang MP. Effect of a workplace mobile phone-based instant messaging intervention on smoking cessation: a cluster-randomized controlled trial. Addiction. 2022;117(6):1758-67. https://doi.org/10.1111/add.15804 source
May combine two claims.
InterpretationcitationThe superior cessation outcomes likely reflect the efficacy of the psychological component of the intervention, as psychological support was independently effective in reducing smoking among people with mental health problems.
“This likely reflects the efficacy of the psychological component of the intervention, as psychological support was independently effective in reducing smoking among people with mental health problems [36].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [36] 36. Fredman Stein K, Sawyer K, Daryan S, Allen J, Taylor G. Service-user experiences of an integrated psychological intervention for depres- sion or anxiety and tobacco smoking in improving access to psycho- logical therapies services: a qualitative investigation into mechanisms of change in quitting smoking. Health Expect. 2023;26(1):498-509. https://doi.org/10.1111/hex.13684 source
The Discussion’s summary of findings says participants perceived therapeutic support and individualized strategies as helping them reduce smoking. But this qualitative study examined an integrated smoking-and-mental-health intervention; it did not establish that psychological support was independently effective or that it explained superior cessation outcomes. The Research and practice implications section says a full-scale trial is needed to investigate the components’ effectiveness. Page numbers are not available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measured
May combine two claims.
Findingown dataEngagement in the chat-based IM intervention in this trial was 36.1%, higher than in the community trial (17%) and workplace trial (17.4%).
“Engagement in the chat-based IM intervention in this trial (36.1%) was higher than our chat-based trial in the community (17%) [14] and workplace (17.4%) [22] settings.”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [14] 14. Wang MP, Luk TT, Wu Y, Li WH, Cheung DY, Kwong AC, et al. Chat- based instant messaging support integrated with brief interventions for smoking cessation: a community-based, pragmatic, cluster- randomised controlled trial. Lancet Digit Health. 2019;1(4):e183-92. https://doi.org/10.1016/S2589-7500(19)30082-2 source
- cites [22] 22. Guo Z, Weng X, Lau AOS, Ng MCH, Wu YS, Lam TH, et al. Workplace cessation support is associated with more abstinence in a workplace program in Hong Kong: a mixed-methods study. Tob Induc Dis. 2022;20:114. https://doi.org/10.18332/tid/156455 source
The Methods (Design; page unavailable) describe a workplace program using a health talk, booklet, and 15 text messages, but do not report engagement in a chat-based intervention. A search of our copy for 17.4% and chat-based engagement found no passage supporting the workplace comparison. (LLM, conf=0.75)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationSmoking in indoor workplaces has been comprehensively banned in Hong Kong since 2007, yet 14.7% of companies remain noncompliant.
“Smoking in indoor workplaces has been comprehensively banned in Hong Kong since 2007, yet 14.7% of companies remain noncompliant [16]”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [16] 16. Wang MP, Li WHC, Suen YN, Cheung KC, Lau OS, Lam TH, et al. Association between employer's knowledge and attitude towards smoking cessation and voluntary promotion in workplace: a survey study. Tob Induc Dis. 2017;15(1):44. https://doi.org/10.1186/ s12971-017-0149-4 source
May combine two claims.
PremisecitationA 2022 meta-analysis examining the impact of group ACT on anxiety and depressive symptoms reported a medium-to-large effect size for anxiety (g = 0.52, P < 0.001) and a small-to-medium effect size for depressive symptoms (g = 0.47, P < 0.001).
“A 2022 meta-analysis examining the impact of group ACT on anxiety and depressive symptoms also reported a slightly higher effect size for anxiety (medium-to-large effect size, g = 0.52, P < 0.001) compared to depressive symptoms (small-to-medium effect size, g = 0.47, P < 0.001) [38].”
Quote in the paperSubstantial claim1 of 1 sources checked- cites [38] 38. Borrelli B, Bartlett YK, Tooley E, Armitage CJ, Wearden A. Preva- lence and frequency of mHealth and eHealth use among US and UK smokers and differences by motivation to quit. J Med Internet Res. 2015;17(7):e164. https://doi.org/10.2196/jmir.4420 source
Split into 2 atoms — 0 confirmed, 0 partially supported, 0 disputed, 0 misattributed, 2 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
May combine two claims.
InterpretationcitationThe observed effect for self-reported 7-day PPA at 6 months (16%) in this trial was comparable to previous chat-based IM support in the community (19%), although direct comparison is not feasible.
“The observed effect for self-reported 7-day PPA at 6 months (16%) in this trial was comparable to our previous chat-based IM support in the community (19%) [14], although direct comparison is not feasible owing to the differences in study”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [14] 14. Wang MP, Luk TT, Wu Y, Li WH, Cheung DY, Kwong AC, et al. Chat- based instant messaging support integrated with brief interventions for smoking cessation: a community-based, pragmatic, cluster- randomised controlled trial. Lancet Digit Health. 2019;1(4):e183-92. https://doi.org/10.1016/S2589-7500(19)30082-2 source
May combine two claims.
Findingown dataParticipants in the intervention group who had previous quit attempts (vs. no quit attempt), were ready to quit within 30 days (vs. no readiness to quit within 30 days) and experienced only one to two mental health symptoms (vs. 3 symptoms), had higher PPA than those in the control group.
“Participants in the intervention group who had previous quit attempts (vs.no quit attempt), were ready to quit within 30 days (vs.no readiness to quit within 30 days) and experienced only one to two mental health symptoms (vs. 3 symptoms), had higher PPA than those in the control group.”
Quote in the paperNot a substantial claim- The authors state this as an assumption: Missing outcomes are assumed to be missing not at random, with participants who had missing outcomes assumed to have continued or returned to their pre-treatment smoking behavior.
May combine two claims.
Findingown dataThe 12-month PPA was higher in participants with secondary or below education attainment (vs. tertiary or above), a monthly household income of 25,000 HK$ or more (vs. <HK$25,000), and those working in services or other companies.
“The 12-month PPA was higher in participants with secondary or below education attainment (vs.tertiary or above), a monthly household income of 25 000 HK$ or more (vs.<HK$ 25 000), and those working in services or other companies.”
Quote in the paperNot a substantial claim- The authors state this as an assumption: Missing outcomes are assumed to be missing not at random, with participants who had missing outcomes assumed to have continued or returned to their pre-treatment smoking behavior.
May combine two claims.
Findingown dataSmoking reduction rates and 24-hour quit attempts were similar between intervention and control groups at each follow-up.
“Smoking reduction rates and 24-hour quit attempts were similar between intervention and control groups at each follow-up.”
Quote in the paperNot a substantial claim- The authors state this as an assumption: Missing outcomes are assumed to be missing not at random, with participants who had missing outcomes assumed to have continued or returned to their pre-treatment smoking behavior.
May combine two claims.
Findingown dataThe overall retention rate for telephone follow-up was 71.3% at 1 week, 70.0% at 1 month, 64.0% at 3 months, 64.0% at 6 months and 60.3% at 12 months, without significant differences between the two groups.
“The overall retention rate for telephone follow-up was 71.3% at 1 week, 70.0% at 1 month, 64.0% at 3 months, 64.0% at 6 months and 60.3% at 12 months, without significant differences between the two groups (P = 0.34-0.84).”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationPeople with mental health symptoms are as motivated to quit smoking as those without such symptoms, but their success rate is 25% lower.
“Although people with mental health symptoms are as motivated to quit smoking as those without such symptoms, their success rate is 25% lower [7].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [7] 7. Lasser K, Boyd JW, Woolhandler S, Himmelstein DU, McCormick D, Bor DH. Smoking and mental illness: a population-based prevalence study. Jama. 2000;284(20):2606-10. https://doi.org/10.1001/jama. 284.20.2606 source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationTwo-thirds of people with mental health conditions are current smokers.
“The World Health Organization (WHO) reported that two-thirds of people with mental health conditions are current smokers [1].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [1] 1. World Health Organization. The vicious cycle of tobacco use and mental illness -a double burden on health [internet]; 2021 [cited 2024 May 4]. Available from: https://www.who.int/europe/news/ item/08-11-2021-the-vicious-cycle-of-tobacco-use-and-mental- illness-a-double-burden-on-health
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationAcceptance and commitment therapy (ACT) has been identified as a feasible, acceptable and potentially efficacious intervention for smoking cessation.
“ACT has been identified as a feasible, acceptable and potentially efficacious intervention for smoking cessation [9].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [9] 9. McCallion EA, Zvolensky MJ. Acceptance and commitment therapy (ACT) for smoking cessation: a synthesis. Curr Opin Psychol. 2015;2: 47-51. https://doi.org/10.1016/j.copsyc.2015.02.005 source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataThree sensitivity analyses were used for missing outcomes: complete case analyses, multiple imputations by chained equation models, and ITT analysis.
“We used three sensitivity analyses for the missing outcomes: (1) complete case analyses [excluding participants with missing outcomes on the assumption of missing completely at random (MCAR)]; (2) multiple imputations by chained equation models to impute missing outcomes under the assumption of missing at random (MAR), with inferences drawn from 40 imputed datasets; and (3) ITT analysis”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationMental health issues like anxiety and depression significantly contribute to absenteeism and long-term incapacity.
“Additionally, mental health issues like anxiety and depression significantly contribute to absenteeism and long-term incapacity [17].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [17] 17. Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and inju- ries in 21 regions, 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380(9859):2197-223. https://doi.org/10.1016/S0140-6736(12)61689-4 source
Probably not a substantial claim: may not pass S3 (load-bearing).
InterpretationreasoningThe results may not be generalizable to other regions because of disparities in pandemic severity and corresponding control measures.
“This study was conducted during the COVID-19 pandemic, and the results may not be generalizable to other regions because of disparities in pandemic severity and corresponding control measures.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductnone givenA modified intention-to-treat (mITT) analysis was used, excluding the ineligible participants from the primary analysis.
“A modified intention-to-treat (mITT) analysis was used, excluding the ineligible participants from the primary analysis.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataThe trial protocol was approved by the institutional review board and registered with ClinicalTrial.gov (NCT04772521).
“The trial protocol was approved by the institutional review board of the University of Hong Kong/Hospital Authority Hong Kong West Cluster (UW 12-550), and registered with ClinicalTrial.gov (NCT04772521).”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationAlthough applying ACT principles for smoking cessation in smokers with anxiety and depression has shown initial promise, these interventions have primarily been delivered through face-to-face psychotherapy.
“Although applying ACT principles for smoking cessation in smokers with anxiety and depression has shown initial promise [10,11], these interventions have primarily delivered through face-to-face psychotherapy.”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [10] 10. Davoudi M, Omidi A, Sehat M, Sepehrmanesh Z. The effects of acceptance and commitment therapy on man smokers' comorbid depression and anxiety symptoms and smoking cessation: a random- ized controlled trial. Addict Health. 2017;9(3):129-38.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [11] 11. Kelly MM, Sido H, Forsyth JP, Ziedonis DM, Kalman D, Cooney JL. Acceptance and commitment therapy smoking cessation treatment for veterans with posttraumatic stress disorder: a pilot study. J Dual Diagn. 2015;11(1):50-5. https://doi.org/10.1080/15504263.2014. 992201 source
Classified as probably not a substantial claim.
Study design and conductnone givenThe allocation sequence was computer-generated by a researcher not involved in the participants' recruitment to ensure allocation concealment.
“The allocation sequence was computer-generated by a researcher not involved in the participants' recruitment to ensure allocation concealment.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenSequentially numbered, opaque, sealed envelopes were used to achieve randomization.
“Sequentially numbered, opaque, sealed envelopes were used to achieve randomization.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe possibility of residual and unmeasured confounding affecting the observed association between engagement and smoking abstinence cannot be excluded.
“The possibility of residual and unmeasured confounding affecting the observed association between engagement and smoking abstinence cannot be excluded.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataThe results suggest the intervention is potentially effective for promoting smoking abstinence and mental wellbeing among workplace smokers with mental health symptoms.
“The results suggest our intervention is potentially effective for promoting smoking abstinence and mental wellbeing among workplace smokers with mental health symptoms.”
Quote in the paperSubstantial claimMay combine two claims.
Study design and conductown dataBoth primary analysis excluding ineligible post-randomization cases and sensitivity analysis including all randomized cases yielded consistent results.
“However, both our primary analysis (excluding these cases) and sensitivity analysis (including all randomized cases, see Table S3) yielded consistent results.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductcitationThe multivariable analysis adjusted for baseline variables known to predict abstinence and did not interact with treatment, including nicotine dependence and quit attempts.
“We also presented the results of a multivariable analysis, which adjusted for baseline variables known to predict abstinence and did not interact with treatment, including nicotine dependence and quit attempts [32].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [32] 32. Holmberg MJ, Andersen LW. Adjustment for baseline characteristics in randomized clinical trials. Jama. 2022;328(21):2155-6. https://doi. org/10.1001/jama.2022.21506 source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductreasoningBlinding of participants and interventionists was not possible owing to the nature of the intervention.
“Blinding of participants and interventionists was not possible owing to the nature of the intervention.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
InterpretationreasoningRecruiting only smokers who are ready to quit could enhance the observable effect of the intervention.
“This suggests that recruiting only smokers who are ready to quit could enhance the observable effect of the intervention and should be tested in future.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe authors adhered to the CONSORT reporting guideline.
“We adhered to the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable).
PremisecitationThe workplace is an ideal setting for health intervention.
“The workplace, with its large and accessible audience, is an ideal setting for health intervention [18].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [18] 18. Cahill K, Lancaster T. Workplace interventions for smoking cessation. Cochrane Database Syst Rev. 2014;2014(2):CD003440. https://doi. org/10.1002/14651858.CD003440.pub4 source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataThere were 14 cases that did not meet inclusion criteria and were mistakenly enrolled; they were excluded before intervention initiation, leading to a discrepancy in group sizes (intervention = 144 vs. control = 156).
“There were 14 cases (12 originally assigned to the intervention group and 2 to the control group) that did not meet the inclusion criteria and were mistakenly enrolled in the trial.These cases were immediately excluded before the intervention initiation, leading to a discrepancy in group sizes between the two groups (intervention = 144 vs. control = 156).”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductown dataParticipants were individually randomized 1:1 across the 65 companies by permuted blocks 2, 4 and 6 into the intervention and control groups.
“Participants were individually randomized 1:1 across the 65 companies by permuted blocks 2, 4 and 6 into the intervention and control groups.”
Quote in the paperSubstantial claim
The paper relies on this without support.
No chat-based interventions guided by ACT have been specifically designed for smokers with mental health symptoms.
“Nevertheless, to our knowledge, no chat-based interventions guided by ACT have been specifically designed for smokers with mental health symptoms.”
The authors state this as an assumption.
Missing outcomes are assumed to be missing not at random, with participants who had missing outcomes assumed to have continued or returned to their pre-treatment smoking behavior.
“The mITT analysis based on the assumption of missing not at random (MNAR), with participants who had missing outcomes assumed to have continued or returned to their pre-treatment smoking behavior [31].”
The paper relies on this without support.
Any potential bias in self-reporting is expected to be evenly distributed across both groups.
“The study used self-reported smoking abstinence outcomes without biochemical validation; however, any potential bias in self-reporting is expected to be evenly distributed across both groups.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Percentage does not match the no-prior-attempt subgroup count
MinorThe reported six-month figure of 6 of 56 is 10.7%, rather than 10.5%.
Reported 10.5 · recomputed 10.714286
“No 1/44 (2.3) 6/56 (10.5) 0.20 (0.02,1.71)”
Prior-quit-attempt subgroup has a mismatched 12-month percentage
MinorThe reported 23 abstinent participants out of 79 represent 29.1%, not 27.9%.
Reported 27.9 · recomputed 29.113924
“Yes 19/79 (24.1) 11/76 (14.5) 1.87 (0.82,4.25) 23/79 (27.9) 12/76 (15.8) 2.19 (1.00,4.80)*”
Female control-group abstinence percentage is incorrect
MinorIn the six-month subgroup results, 4 of 22 is 18.2%, not the reported 19.1%.
Reported 19.1 · recomputed 18.181818
“Female 7/25 (28.0) 4/22 (19.1) 1.75 (0.44,7.04)”
Baseline anxiety standard deviations disagree between tables
MinorTable 4 labels its baseline figures as means and standard deviations but gives anxiety standard deviations of 0.15 in both groups. Table 1 gives approximately 1.8 and 1.9 for those same baseline groups.
“Anxiety symptoms Baseline 1.55 ± 0.15 1.38 ± 0.15 0.43 Ref Ref”
“Anxiety symptoms (GAD-2, 0-6) 1.5 ± 1.8 1.5 ± 1.8 1.4 ± 1.9”
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“Recovery from post-disaster PTSD and related trauma symptoms may represent an important opportunity for smoking cessation interventions during the recovery period [68–75].”
- Authors
- 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.
- Affiliations
- University of Hong Kong (HK)
- National University of Singapore (SG)
- The Lok Sin Tong Benevolent Society Kowloon (CN)
- Children's Hospital of Eastern Ontario (CA)
- Beijing Normal University (CN)
- Corresponding author
- Wang, Man Ping
- Venue
- Addiction
- Publisher
- Wiley
- Published
- 2025-02-09
- Volume
- 120
- Issue
- 7
- Pages
- 1390-1401
- ISSN
- 0965-2140 (ISSN-L)
- 1360-0443
- OpenAlex
- W4407349102
- Semantic Scholar
- 60ab3b17def83fe6793e6383daf56513edfdeaa7
- Cited by
- 3
- References
- 37
- Citations by year
- 2026: 1 · 2025: 2
- FWCI
- 1.91
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Addiction (publishedVersion)
- PubMed (publishedVersion)
- The HKU Scholars Hub (University of Hong Kong) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Smoking Behavior and Cessation
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Keywords
- smoking cessation, acceptance and commitment therapy, workplace smoking, psychiatric symptoms, anxiety, depression, stress, nicotine replacement therapy, individualized support, instant messaging, abstinence, employee health
- MeSH terms
- Smokers, Adult, Anxiety, Anxiety Disorders, Counseling, Depression, Female, Hong Kong, Humans, Male, Middle Aged, Stress, Psychological, Smoking Cessation, Workplace, Acceptance and Commitment Therapy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.
Cited sources are checked by gpt-6-sol.
Statistics and arithmetic are recomputed, not judged.
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