HM International Blog

In a review of four clinical trials, researchers found that smoking-cessation programs that included text-messaged advice doubled the chances that smokers would be able to kick the habit for up to a year.

The programs, conducted in New Zealand, the UK and Norway, used text messages as a way to give smokers daily advice and encouragement. The programs also offered support when quitters needed it the most; if they found themselves craving nicotine, for example, they could text “crave” to the program and get immediate advice on what to do.

Two of the studies looked at programs that only involved text messages, finding that the service doubled the odds that smokers would quit over six weeks.

The other two studies focused on a program in Norway that used text messages, emails and a dedicated Web site; it found that smokers who used the program were twice as likely to report abstinence for up to one year.

The findings appear in the Cochrane Library, a publication of the international research organization the Cochrane Collaboration.

Kicking the smoking habit is notoriously difficult, and text messaging is no magic bullet. Most of the roughly 2,600 smokers across the studies did not succeed in quitting, regardless of whether they had text-message help.

But text messages could serve as one more tool in the smoking-cessation arsenal, according to lead researcher Dr. Robyn Whittaker, of the University of Auckland in New Zealand.

“We know that stopping smoking can be really difficult and most people take several attempts to quit successfully,” Whittaker told Reuters Health in an email. “And so I think it is important to be able to offer lots of different options for extra support.”

Text messaging may be effective for some people, in part, because they can get help right at the time when cravings strike, according to Whittaker.

“The frequent messages can also act as a good reminder and motivation to keep going,” Whittaker added.

One of the programs in the study, called Txt2Quit, is already up and running in New Zealand, with government funding. Smokers seeking to quit can sign up for the free 26-week program, which automatically sends users two to three text messages per day shortly before their designated “quit date,” and for one month afterward. After that, they receive three text messages a week.

A recent study of people who participated in the program’s first year found that one-third were abstinent four weeks after their quit date. That figure dropped to 16 percent after 22 weeks.

It’s estimated that only about 5 percent of smokers are able to kick the habit without any help.

NEW YORK (Reuters Health) – Two drugs used to prevent malaria in travelers appear to have a lower risk of side effects than a third commonly prescribed medication, according to a research review published Tuesday.

The review looked at eight clinical trials of various anti-malaria drugs — including mefloquine, atovaquone-proguanil and the antibiotic doxycycline. All three are considered drugs of choice for travelers heading to most malaria-endemic regions.

However, the study found, both atovaquone-proguanil — sold under the brand-name Malarone — and doxycycline appear to have fewer side effects.

With these two drugs, there is lower risk of nausea, stomach pain and other gastrointestinal side effects, and also neurological and psychiatric side effects, such as dizziness, sleep disturbances, anxiety and depression.

There were no severe side effects — problems that were life-threatening or required hospitalization — in any of the studies.

The investigators did, however, find published case reports linking mefloquine to 22 deaths, including five suicides. No other anti-malaria drugs have been linked to deaths when taken at prescribed doses, the researchers note in their review, published in the Cochrane Library, a publication of the Cochrane Collaboration, an international organization that evaluates medical research.

Despite the higher risk of side effects with mefloquine, the findings do not necessarily mean that travelers should avoid this drug, according to the researchers.

Doctors prescribe anti-malaria medications based on a number of factors — including which country travelers are visiting — and mefloquine may still be appropriate, particularly for people who have taken it before without problems.

“The main message is that you have to take some malaria chemoprophylaxis (preventive treatment) if you go to an endemic area,” lead researcher Dr. Frederique Jacquerioz, of Tulane University in New Orleans, noted in a written statement. “It’s one of the best preventive measures we have.”

Caused by a mosquito-borne parasite, malaria is endemic in large areas of Africa, Asia and South and Central America, where it kills about 1 million people a year.

An estimated 10,000 to 30,000 travelers develop malaria every year, of whom about 150 die.

When it came to side effects, however, Malarone was about half as likely as mefloquine to cause gastrointestinal side effects, and 14 percent to 50 percent less likely to have a neurological or psychiatric side effect.

In one study, 69 of 493 Malarone users developed some type of neuropsychiatric side effect — including dizziness, insomnia or strange dreams. That compared with 139 of 483 mefloquine users.

Similarly, doxycycline users had a 16 percent lower risk of neurological or psychiatric symptoms.

Still, severe reactions to mefloquine are rare, noted Dr. Andrea Boggild of Toronto General Hospital in Canada, who was not involved in the study. In a written statement, Boggild said that severe neurological and psychiatric symptoms develop in just one out of every 6,000 to 10,000 people who take the drug.

Boggild advised people who are planning a trip to a malaria-endemic area to talk with a healthcare provider who specializes in travel medicine about how to best protect themselves.