Text messages boost quitting in tuberculosis
A mobile phone text-message program markedly increased tobacco quitting in adults treated for tuberculosis compared with usual care.
*Cluster randomized clinical trial; Level 1b (OCEBM).

Citation

Zahid M, Rahman F, Danaee M, et al. A mobile health intervention for smoking cessation in people with tuberculosis: a cluster randomized clinical trial. JAMA. Published online December 22, 2025. doi:10.1001/jama.2025.20765. Trial registration: ISRCTN86971818.

Background

Smoking worsens outcomes and increases death risk in people with tuberculosis. Low-cost, widely available quit-support tools could improve recovery where cessation services are limited.

Patients

Adults (≥15 years) with drug-sensitive pulmonary tuberculosis in rural clinics in Bangladesh and Pakistan who smoked daily (tobacco use on ≥25 days in the last month), were willing to quit, and had access to a mobile phone. Excluded: multidrug-resistant or extrapulmonary tuberculosis.

Intervention

Scheduled motivational and behavioral text messages: daily for 2 months, then monthly for 4 months.

Control

Written smoking-cessation information (usual care).

Outcome

Primary: continuous tobacco abstinence at 6 months confirmed by carbon monoxide breath testing. Secondary: self-reported abstinence, tuberculosis treatment adherence and success, deaths.

Follow-up Period

6 months.

Results

Outcome Text-message program Usual care Absolute difference NNT
Continuous abstinence at 6 months (primary) 41.7% (300/720) 15.3% (55/360) +26.4% 4
Self-reported point abstinence at 6 months 55.6% 22.8% +32.8% 4
Deaths by 6 months 3.5% 7.5% -4.0% 25
NNT = number needed to treat to cause one additional benefit (or prevent one death), based on absolute risk difference.
Analyses were intention-to-treat. Tuberculosis treatment adherence and success were similar between groups.

Limitations

Most participants were men, limiting applicability to women. Abstinence beyond 6 months was not measured. There was no attention-matched control, and understanding of messages in people with low education was uncertain.

Funding

National Institute for Health and Care Research (RESPIRE Global Health Research Unit).

Clinical Application

For adults with drug-sensitive pulmonary tuberculosis who smoke, consider adding structured quit-support text messages to usual care to improve quitting and possibly reduce deaths.