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Study flow diagram for this update
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Figure 1

Study flow diagram for this update

'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study
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Figure 2

'Risk of bias' summary: review authors' judgements about each 'Risk of bias' item for each included study

Funnel plot of comparison 1. Text messaging versus minimal smoking cessation support, outcome: 1.1 long‐term abstinence (all randomised))
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Figure 3

Funnel plot of comparison 1. Text messaging versus minimal smoking cessation support, outcome: 1.1 long‐term abstinence (all randomised))

Comparison 1 Text messaging versus minimal smoking cessation support, Outcome 1 Long‐term abstinence (all randomised)).
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Analysis 1.1

Comparison 1 Text messaging versus minimal smoking cessation support, Outcome 1 Long‐term abstinence (all randomised)).

Comparison 1 Text messaging versus minimal smoking cessation support, Outcome 2 Long‐term abstinence (complete case).
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Analysis 1.2

Comparison 1 Text messaging versus minimal smoking cessation support, Outcome 2 Long‐term abstinence (complete case).

Comparison 2 Text messaging versus other smoking cessation intervention, Outcome 1 Long‐term abstinence (all randomised).
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Analysis 2.1

Comparison 2 Text messaging versus other smoking cessation intervention, Outcome 1 Long‐term abstinence (all randomised).

Comparison 2 Text messaging versus other smoking cessation intervention, Outcome 2 Long‐term abstinence (complete case).
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Analysis 2.2

Comparison 2 Text messaging versus other smoking cessation intervention, Outcome 2 Long‐term abstinence (complete case).

Comparison 3 Text messaging + other smoking cessation support versus other smoking cessation support alone, Outcome 1 Long‐term abstinence (all randomised).
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Analysis 3.1

Comparison 3 Text messaging + other smoking cessation support versus other smoking cessation support alone, Outcome 1 Long‐term abstinence (all randomised).

Comparison 3 Text messaging + other smoking cessation support versus other smoking cessation support alone, Outcome 2 Long‐term abstinence (complete case).
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Analysis 3.2

Comparison 3 Text messaging + other smoking cessation support versus other smoking cessation support alone, Outcome 2 Long‐term abstinence (complete case).

Comparison 4 High‐frequency versus low‐frequency text messaging, Outcome 1 Long‐term abstinence (all randomised).
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Analysis 4.1

Comparison 4 High‐frequency versus low‐frequency text messaging, Outcome 1 Long‐term abstinence (all randomised).

Comparison 4 High‐frequency versus low‐frequency text messaging, Outcome 2 Long‐term abstinence (complete case).
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Analysis 4.2

Comparison 4 High‐frequency versus low‐frequency text messaging, Outcome 2 Long‐term abstinence (complete case).

Comparison 5 Smartphone app versus lower‐intensity smoking cessation support, Outcome 1 Long‐term abstinence (all randomised).
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Analysis 5.1

Comparison 5 Smartphone app versus lower‐intensity smoking cessation support, Outcome 1 Long‐term abstinence (all randomised).

Comparison 5 Smartphone app versus lower‐intensity smoking cessation support, Outcome 2 Long‐term abstinence (complete case).
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Analysis 5.2

Comparison 5 Smartphone app versus lower‐intensity smoking cessation support, Outcome 2 Long‐term abstinence (complete case).

Comparison 6 CO monitoring + contingency management versus smoking cessation support, Outcome 1 Long‐term abstinence (all randomised).
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Analysis 6.1

Comparison 6 CO monitoring + contingency management versus smoking cessation support, Outcome 1 Long‐term abstinence (all randomised).

Comparison 6 CO monitoring + contingency management versus smoking cessation support, Outcome 2 Long‐term abstinence (complete case).
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Analysis 6.2

Comparison 6 CO monitoring + contingency management versus smoking cessation support, Outcome 2 Long‐term abstinence (complete case).

Comparison 7 Smartphone app + text messaging versus web‐based intervention, Outcome 1 Long‐term abstinence (all randomised).
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Analysis 7.1

Comparison 7 Smartphone app + text messaging versus web‐based intervention, Outcome 1 Long‐term abstinence (all randomised).

Comparison 7 Smartphone app + text messaging versus web‐based intervention, Outcome 2 Long‐term abstinence (complete case).
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Analysis 7.2

Comparison 7 Smartphone app + text messaging versus web‐based intervention, Outcome 2 Long‐term abstinence (complete case).

Summary of findings for the main comparison. Text messaging compared to minimal support for smoking cessation

Text messaging compared to minimal support for smoking cessation

Patient or population: people who smoke
Setting: community
Intervention: text messaging
Comparison: minimal smoking cessation support

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with minimal SC support

Risk with text messaging

Long‐term abstinence (all randomised)

Measured with self‐report and biochemical validation at 6 to 12 months

Study population

RR 1.54
(1.19 to 2.00)

14,133
(13 RCTs)

⊕⊕⊕⊝
Moderatea

6 per 100

9 per 100
(7 to 11)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio; SC: smoking cessation

GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

aDowngraded one level due to inconsistency: substantial unexplained heterogeneity (I2 = 71%).

Figuras y tablas -
Summary of findings for the main comparison. Text messaging compared to minimal support for smoking cessation
Summary of findings 2. Text messaging in addition to other smoking cessation support

Text messaging in addition to other smoking cessation support compared to other smoking cessation support alone for smoking cessation

Patient or population: people who smoke
Setting: community
Intervention: text messaging + other smoking cessation support
Comparison: other smoking cessation support alone

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with other SC support alone

Risk with text messaging + other SC support

Long‐term abstinence (all randomised)

Measured as self‐reported and biochemical validation at 6 to 12 months

Study population

RR 1.59
(1.09 to 2.33)

997
(4 RCTs)

⊕⊕⊕⊝
Moderatea

8 per 100

12 per 100
(9 to 18)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio; SC: smoking cessation

GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

aDowngraded one level due to imprecision: fewer than 300 events overall.

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Summary of findings 2. Text messaging in addition to other smoking cessation support
Summary of findings 3. Smartphone app compared to lower‐intensity support for smoking cessation

Smartphone app compared to lower‐intensity support for smoking cessation

Patient or population: people who smoke
Setting: community

Intervention: smartphone app
Comparison: lower‐intensity smoking cessation support

Outcomes

Anticipated absolute effects* (95% CI)

Relative effect
(95% CI)

№ of participants
(studies)

Certainty of the evidence
(GRADE)

Comments

Risk with lower intensity SC support

Risk with Smartphone app

Long‐term abstinence (all randomised)

Measured with self‐report and biochemical validation at 6 months

Study population

RR 1.00
(0.66 to 1.52)

3079
(5 RCTs)

⊕⊝⊝⊝
Very lowa,b

8 per 100

8 per 100
(5 to 12)

*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).

CI: confidence interval; RCT: randomised controlled trial; RR: risk ratio; SC: smoking cessation

GRADE Working Group grades of evidence
High certainty: we are very confident that the true effect lies close to that of the estimate of the effect.
Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect.
Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect.

aDowngraded one level due to inconsistency: considerable unexplained statistical heterogeneity (I2 = 59%).
bDowngraded two levels due to imprecision: confidence intervals encompass both clinically significant harm and clinically significant benefit.

Figuras y tablas -
Summary of findings 3. Smartphone app compared to lower‐intensity support for smoking cessation
Comparison 1. Text messaging versus minimal smoking cessation support

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Long‐term abstinence (all randomised)) Show forest plot

13

14133

Risk Ratio (M‐H, Random, 95% CI)

1.54 [1.19, 2.00]

2 Long‐term abstinence (complete case) Show forest plot

13

11969

Risk Ratio (M‐H, Random, 95% CI)

1.56 [1.21, 2.02]

Figuras y tablas -
Comparison 1. Text messaging versus minimal smoking cessation support
Comparison 2. Text messaging versus other smoking cessation intervention

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Long‐term abstinence (all randomised) Show forest plot

2

2238

Risk Ratio (M‐H, Random, 95% CI)

0.92 [0.61, 1.40]

2 Long‐term abstinence (complete case) Show forest plot

2

1813

Risk Ratio (M‐H, Random, 95% CI)

0.93 [0.63, 1.36]

Figuras y tablas -
Comparison 2. Text messaging versus other smoking cessation intervention
Comparison 3. Text messaging + other smoking cessation support versus other smoking cessation support alone

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Long‐term abstinence (all randomised) Show forest plot

4

997

Risk Ratio (M‐H, Random, 95% CI)

1.59 [1.09, 2.33]

2 Long‐term abstinence (complete case) Show forest plot

4

796

Risk Ratio (M‐H, Random, 95% CI)

1.63 [1.12, 2.37]

Figuras y tablas -
Comparison 3. Text messaging + other smoking cessation support versus other smoking cessation support alone
Comparison 4. High‐frequency versus low‐frequency text messaging

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Long‐term abstinence (all randomised) Show forest plot

3

12985

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.95, 1.06]

2 Long‐term abstinence (complete case) Show forest plot

3

6798

Risk Ratio (M‐H, Random, 95% CI)

1.04 [1.00, 1.09]

Figuras y tablas -
Comparison 4. High‐frequency versus low‐frequency text messaging
Comparison 5. Smartphone app versus lower‐intensity smoking cessation support

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Long‐term abstinence (all randomised) Show forest plot

5

3079

Risk Ratio (M‐H, Random, 95% CI)

1.00 [0.66, 1.52]

1.1 Comparison: minimal non‐app SC support

2

1645

Risk Ratio (M‐H, Random, 95% CI)

0.82 [0.56, 1.18]

1.2 Comparator: less intensive smartphone app

3

1434

Risk Ratio (M‐H, Random, 95% CI)

1.12 [0.60, 2.09]

2 Long‐term abstinence (complete case) Show forest plot

5

1774

Risk Ratio (M‐H, Random, 95% CI)

1.06 [0.72, 1.54]

2.1 Comparison: minimal non‐app SC support

2

771

Risk Ratio (M‐H, Random, 95% CI)

0.87 [0.62, 1.23]

2.2 Comparator: less intensive smartphone app

3

1003

Risk Ratio (M‐H, Random, 95% CI)

1.18 [0.67, 2.09]

Figuras y tablas -
Comparison 5. Smartphone app versus lower‐intensity smoking cessation support
Comparison 6. CO monitoring + contingency management versus smoking cessation support

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Long‐term abstinence (all randomised) Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 Comparison: counselling, nicotine replacement therapy and monitoring only app

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Comparison: counselling and nicotine replacement therapy

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Long‐term abstinence (complete case) Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2.1 Comparison: counselling, nicotine replacement therapy and monitoring only app

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Comparison: counselling and nicotine replacement therapy

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 6. CO monitoring + contingency management versus smoking cessation support
Comparison 7. Smartphone app + text messaging versus web‐based intervention

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Long‐term abstinence (all randomised) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2 Long‐term abstinence (complete case) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Figuras y tablas -
Comparison 7. Smartphone app + text messaging versus web‐based intervention