ADEPT - Supporting Smokers to Remain Abstinent After Hospital Discharge using an Automated Digital Support Package

INTERVENTION: In addition to usual care, the ADEPT intervention group will receive smoking cessation support delivered using mobile phones daily over 4 weeks post‐discharge. The intervention ADEPT ‐ an automated package of digital therapies, comprise of text messages that provides motivational and distraction messages, medication [e.g. NRT] reminders and referral to Quitline or GP if desired. All intervention participants will receive a tailored programme of text messages (SMS) via their mobile phone with evidence‐based information on interventions/actions that will reduce risk of subsequent events (e.g., education about risk factors, the impact changes can have on their risk, and getting help for stopping smoking). The intervention will be delivered via SMS, because this medium is readily available to all mobile phone users, is inexpensive, and requires minimal technological ‘know how’. Each participant in the intervention group will receive 3 messages per day for the first week after discharge from hospital, when the risk of relapse to smoking is greatest; 1 message per day for the second week; and 2‐3 messages per week for the remaining two weeks. The intervention will be predominantly unidirectional. All participants will be offered brief training at enrolment on how to read a text message and how to delete or save messages. This will be delivered by the research nurse and be approximately 5 minutes in duration. CONDITION: Smokers PRIMARY OUTCOME: Three months continuous abstinence (Russell Standard) defined as self‐report of smoking not more than five cigarettes from the quit date. Sub group analysis by Maori/non‐Maori will be undertaken to test for heterogeneity of effect. SECONDARY OUTCOME: 7‐day point prevalence assessed: The proportion of participants that have stopped smoking, defined as self‐report of having smoked no cigarettes (not even a puff) in the past seven days, at all time points. Continuous abstinence assessed at one and three months: The proportion of participants that have stopped smoking, defined as self‐report of smoking not more than five cigarettes from the Quit date. Engagement of the intervention (number of messages read, and number of participant contacts to study team) through exit interviews. Participant self‐report of the number of cigarettes smoked per day (or when smoking for non‐daily smokers): If the participant is still smoking, all time points. Participant self‐report of time‐to‐relapse from quit date, defined as return to daily smoking (for daily smokers). Perceptions of acceptability of the intervention through exit interviews with intervention participants. The physical signs and symptoms associated with withdrawal: Measured using the Mood and physical symptoms scale (MPSS) Use of any other smoking cessation methods: Participants will be asked about their use of NRT, non‐NRT methods of cessation such as Zyban (buproprion), clonidine, nortriptyline, varenicline, acupuncture, Quitline etc. INCLUSION CRITERIA: Patients will be eligible for enrollment in the study if they are aged 18 years and over; identify on admission to hospital as being current (daily and non‐daily) cigarette smokers; have a mobile phone recorded in their admission record; can understand and write English; and provide informed consent and agree to be available for follow up over the next 3 months.