COVID-19 Brief Advice and Chat-based Support for Smoking Cessation Via "Quit to Win" Contest 2020

Smoking is detrimental to the immune system and can cause respiratory tract infection.
Growing evidence has suggested that compared to non-smokers, COVID-19 patients who have a
history of smoking are at a higher risk of developing severe respiratory and cardiovascular
symptoms, consequently may require mechanical ventilation and intensive care. A case series
of 1,099 COVID-19 patients in China has found that ever smokers, compared with never smokers,
were more likely to have severe COVID-19 disease upon hospital admission and be admitted to
intensive care unit, need to use mechanical ventilation, and die. The result is corroborated
by a multivariable analysis of 78 COVID-19 pneumonia cases in China, which identified smoking
as the only preventable risk factor for disease progression. While the link between smoking
and the COVID-19 needs further research, smokers appear to be at a greater risk of suffering
from serious symptoms due to COVID-19.

The practice of smoking might also predispose smokers to COVID-19 infection. Smoking behavior
is characterized by inhalation and the hand-to-mouth movements which increase the possibility
of transmission of virus from contaminated fingers and cigarettes to mouth. In Hong Kong,
where smoking is banned in indoor public areas and workplace, smokers often gather and smoke
at smoking hotspots outdoor, where ashtrays are available. This increases their risk of
infection since the smokers are in close contact with each other and have to remove their
mask to smoke. Exhaling smoke also aids the spreading the virus in the air. However,
misleading information that smoking can prevent COVID-19 infection is widespread on social
media.

Public health strategies (e.g., social distancing, staying at home and working from home) may
motivate some smokers to reduce or to quit smoking due to the inconvenience to smoke indoor
and to buy cigarettes from retail outlets. However, home confinement may result in social
isolation and psychological distress (anxiety and stress) both increasing the need for
smoking. Some smokers who are not used to smoke at home might be prompted to smoke at home to
cope with their craving during lockdown or work from home, which may also expose their family
members from second-hand smoke.

Our RCT in QTW Contest 2017 evaluated the effectiveness of a chat-based intervention
delivered through a mobile instant messaging application (WhatsApp) plus active referral to
SC services to increase quitting. Chat-based intervention resulted in higher abstinence rate
compared with the control group at 6-month follow-up. In QTW Contest 2019, we evaluated the
effectiveness of a combined intervention of AWARD advice, active referral, instant messaging
and optional cocktail intervention to increase abstinence. The preliminary result showed that
the personalized instant messaging (PIM) group and regular instant messaging (RIM) group had
similar abstinence rate at 6-month follow-up.

Therefore, the present study will examine (1) the effectiveness of a combined brief advice
and personalized chat-based support on COVID-19 related smoking messages and (2) explore the
use of CBPR model to build capacity and to engage community partners in taking on this
important public health issue for sustainability in the community. In addition, a process
evaluation will be conducted to assess the effectiveness of the recruitment activity and how
it is linked with the overall program outcomes.