Use of mobile health (mHealth) to support patients with tuberculosis (TB) to quit smoking significantly improves smoking cessation outcomes compared with usual care, an international team of researchers has found.

The multicentre cluster randomised clinical trial, jointly led by the universities of York and Edinburgh, evaluated the effectiveness of an mHealth intervention in achieving continuous tobacco abstinence at six months, supported by biochemical verification.

A total of 27 Government-approved TB clinics in Bangladesh and Pakistan were randomised in a 2:1 ratio to deliver either the mHealth intervention or usual care. A total of 9,232 patients were screened, and 1,080 eligible participants were enrolled and randomised.

Participants were aged 15 years or older, had been diagnosed with drug-sensitive pulmonary TB within the previous four weeks, smoked daily, were willing to quit and had access to a mobile phone. The cohort was predominantly male (over 95% in both groups), reflecting smoking patterns in the study countries. Overall retention at six months was 91%.

Patients in the intervention group (n=720) received automated, TB-specific text messages designed to support smoking cessation and adherence to TB treatment. Messages were delivered daily during the first two months and monthly thereafter for four months.

The control group (n=360) received standard written information on tobacco cessation.

mHealth efficacy for TB smoking cessation

At six months, 41.7% of participants in the mHealth group achieved self-reported continuous abstinence from tobacco, which was verified by carbon monoxide breath testing. This was significantly higher than the usual care group at 15.3%, corresponding to a risk ratio of 3.0.

Self-reported point abstinence from tobacco in the previous seven days was also higher in the intervention group at nine weeks (49.0% vs 20.8%) and six months (55.6% vs 85.6%).

TB treatment adherence and treatment success rates were similar between groups, although mortality was lower in the mHealth group than the usual care group (3.5% vs 7.5%).

The authors acknowledged several limitations, including the predominantly male sample, the absence of an attention control and uncertainty around comprehension of messages among participants with limited education.

Nevertheless, they concluded that mHealth was a feasible and effective approach to supporting smoking cessation in people with TB and has the potential for scalable integration within TB programmes.

As the biochemical verification using carbon monoxide testing only reflected recent abstinence, and follow-up did not extend beyond TB treatment completion, future research will assess long-term abstinence and confirm mortality findings, the authors added.

‘Cheap and effective’ smoking cessation support

Commenting on the results, Professor Kamran Siddiqi, study co-lead and professor of public health at the University of York’s Hull York Medical School, said: ‘We know that people who quit smoking can recover from TB faster, so we tested whether sending encouraging and supportive text messages could help patients quit more quickly than the usual written advice.

‘This method of patient help could be particularly useful where face-to-face smoking cessation services are non-existent. Sending mobile phone messages offers a cheap and effective way of helping people to quit in large numbers.’

He added that this approach can help to prevent other tobacco-related conditions over the longer term, including cancer and heart diseases, but ‘also saves lives in the short-term by reducing TB-related deaths’.

Last year, the UK Health Security Agency warned that rates of TB in the UK were continuing to rise, with a 12.6% increase compared to 2024 and particularly high rates in areas such as Leicester and several parts of London.

Reference
Zahid M et al. An mHealth (Mobile Health) Intervention for Smoking Cessation in People with Tuberculosis. A Cluster Randomized Clinical Trial. JAMA 2025;22 Dec:doi:10.1001/jama.2025.20765.