Text Messages Promote Smoking Cessation in Disadvantaged Young Adults

A tailored text message intervention for socioeconomically disadvantaged young adults (SDYA) who smoke cigarettes was associated with greater smoking cessation at 12 weeks compared with usual care, according to a study in Preventive Medicine.

The randomized controlled trial compared a tailored text message and web-based intervention with usual-care (ie, referral to online quit resources) for SDYA who smoke cigarettes. Outcomes of interest were differences in self-reported 30-day point prevalence abstinence (PPA) and confidence to quit at week 12.

Eligible participants were SDYA aged 18 to 30 years who: (1) smoked 100 lifetime cigarettes and now smoke every day or some days; (2) reported a subjective financial status of “just meets basic expenses” or “don’t meet basic expenses”; (3) had access to a smartphone with Internet; (4) reported interest in quitting within the next 6 months; and (5) completed a baseline survey.

The intervention, an evidence-based smoking-cessation program based on social cognitive theory, was accessed by participants at BecomeAnEX.org. The participants received daily text messages for the first 4 weeks, with the number of messages varying based on whether they set a quit date. After the initial 4 weeks, the participants received regular text messages for the remaining 8 weeks.

Individuals randomized to the control group (ie, usual care) received an email referral at the end of the baseline survey to a website that provided national cessation resources. After the 12-week assessment, control participants received an email with the option to enroll in the full 12-week study intervention but without weekly check-in surveys.

A total of 437 participants completed the baseline survey from April to June 2020 and were randomized to the intervention (n = 229) and control (n = 208) groups, with 172 participants receiving the intervention and 171 receiving usual care in the control group. The follow-up rate at 12 weeks was 81% in the intervention group vs 87% in the control group (P =.11). Participants had a mean (SD) age of 25.6 (3.3) years; 64% were between 25 and 30 years old; 85% were female and 77% were White. Roughly half of participants reported recent depression (46%) or anxiety (56%) symptoms and alcohol (56%) or marijuana (53%) use.

In the adjusted intent-to-treat analyses, the intervention increased patients’ self-reported 30-day PPA almost 4-fold (adjusted relative risk [RR] 3.93; 95% CI, 2.14-7.24) and self-reported 7-day PPA 3-fold at 12 weeks (adjusted RR 3.03; 95% CI, 1.96-4.67) compared with the effect of usual care in the control group.

Among those who reported cigarette use in the past 30 days, participants in the intervention group reported a small increase in confidence to quit (adjusted b=0.81; 95% CI, 0.08-1.53) and desire to quit (adjusted b=0.65; 95% CI, 0.18-1.11) at the 12-week follow-up compared with participants in the control group. Both cohorts showed similar changes in cigarettes smoked per day, importance of quitting, and readiness to quit.

Participants in the intervention group completed a mean of 4.4 weekly check-in surveys (range, 0-12), with 42 participants (24%) completing at least 9 check-ins. A 9% increase in 30-day PPA was found for each additional check-in completed (RR 1.09; 95% CI, 1.04-1.15), as well as a 0.14 mean increase in confidence to quit (b=0.14; 95% CI, 0.03-0.24). A 7% increase in 7-day PPA also was observed (RR 1.07, 95% CI, 1.03-1.11).

Study limitations include the lack of biochemically verified abstinence and the use of an end-of-treatment outcome assessment instead of the recommended 6-month follow-up. Also, recruitment in spring 2020 may have reflected greater motivation to quit owing to COVID-19.

“Boosting smoking cessation in SDYAs is essential to reducing long-term tobacco-related health disparities in this group,” the researchers stated. “This study demonstrates strong effects of a brief, low-touch tailored text message smoking-cessation intervention on self-reported smoking abstinence, reduction in days smoked, and confidence to quit at 12 weeks. Even if abstinence is not sustained, boosting quit attempts in this group may improve quit success in the future, as well as overall population quit rates.”