Background & Goals
Smoking, including second- and third-hand smoke, is the leading cause of death and disease burden worldwide. One-third of all smokers are located in China, yet Hong Kong has become a leader in tobacco control with just 10.2% of its population categorized as daily smokers, one of the lower smoking prevalence rates. Despite this, the remaining smoking population had substantially low confidence and intention to quit – from 80% to 30% in the past decade.
Nicotine is highly addictive. The unassisted quit rate is about 4-5%, but that can be doubled to 10% with appropriate behavioral supports and increase to as much as 30% with medications such as nicotine replacement therapy. Although smoking cessation treatment is one of the most cost-effective treatments for disease management, only very few smokers (about 20%) used smoking cessation services, even it is free of charge, in Hong Kong and many other countries.
Overall, current smoking cessation services need to be able to respond to the change in smoking epidemic, smoker characteristics, smoking and quitting behaviors, social inequalities, technologies and current and future pandemic in affecting access to services. A more agile, adaptive and scalable cessation service mode is needed. Based on long-term research on tobacco control and smoking cessation, this community-based smoking cessation service model has been established and the effectiveness has been vigorously evaluated in many large scale randomized controlled trials with results published in prestigious journals including Lancet Digital Health, JAMA Internal Medicine, Addiction and Nicotine & Tobacco Research.
The overall structure of the Community-based Smoking Cessation Program (CSCP) is to establish a research and practice platform to improve the smoking cessation services. The CSCP model consists of 4 key parts:
- Proactively approaching smokers for delivering opportunistic smoking cessation interventions;
- Developing brief, effective smoking cessation advices;
- Integrating effective components of smoking cessation service; and
- Promoting and sustaining quitting using mobile-phone information communication technologies (ICTs) for personalized behavioral support.
The overarching goals of the CSCP are to:
- Investigate new models of smoking cessation intervention; and
- Improve the effectiveness and coverage of smoking cessation services.
In the past decade, this model has successfully identified effective intervention components including: brief smoking cessation advice; active referral of smokers to smoking cessation clinics; nicotine replacement therapy (NRT) sampling; financial incentive; real-time chat-based instant messaging support through mobile phones; and chatbot with artificial intelligence for improving motivation to seek help.
The CSCP model is an important platform to scale up the current smoking cessation services and is agile to continue its functioning during the pandemic period. CSCP is also a platform to develop and assess innovative cessation interventions and to build a critical mass of smoking cessation researchers for innovation sustainability.
Evidence of Success
Randomized controlled trials of the CSCP model have demonstrated the effectiveness on improving biochemically validated abstinence, increasing smoking reduction, quit attempt, intention to quit, smoking cessation services use, use of NRT, and reducing smoking relapse.
The model has been successfully integrated into current smoking cessation services to improve efficiency of smoking cessation services. Current smoking cessation services have used a proactive approach to recruit smokers in the community and workplace (e.g. smoking cessation mobile clinics). Brief advice model has been translated into practice for health care professionals in the community. Technology assisted interventions such as chat-based instant messaging support and chatbot are now used by service providers. Medication support (e.g. NRT) to help handling craving now have been mailed to smokers using sampling method developed by CSCP, particularly under the COVID-19 pandemic.
Smoking prevalence has been steadily decreased from 12.4% in 2000, 11.1% in 2010 and 10.2% in 2019. Lung cancer (age standardized, per 100,000 persons) incidence and mortality rates have declined from 34.1 and 26.5 in 2010 to 32.8 and 21.3 in 2019, respectively.