The survey data and institutional comparisons played a key role in administrators' decision-making about campus smoking policy. Despite administrators' concerns about students' safety and freedom of choice, student-led advocacy was able to influence policy change.

Background Tobacco use continues to be the leading preventable cause of death, disease, and disability in the United States. Since 2000, Washington state has offered free tobacco “quitline” services to help its residents stop using tobacco. In 2015, the state began offering free access to a tobacco cessation smartphone app to absorb excess quitline demand. Since most publicly funded tobacco cessation programs are designed to provide access to populations disproportionately impacted by tobacco use, it is important to consider who these public health interventions reach. Objective The aim of this study is to understand who used a free cessation app and the extent to which users represented populations disproportionately impacted by tobacco use. Methods This is an observational study of 1280 adult Washington state residents who registered for and activated the cessation app. Demographic data were collected as part of the sign-up process, examined using standard descriptive measures, and assessed against state-level surveillance data for representativeness. Results Participants were primarily non-Hispanic White (978/1218, 80.3%), identified as female (780/1236, 63.1%), were between ages 25-54 years (903/1186, 76.1%), had at least some college education (836/1222, 68.4%), and reported a household income under US $50,000 (742/1055, 70.3%). Fewer respondents were from rural counties (359/1220, 29.4%); identified as lesbian, gay, bisexual, pansexual, queer, questioning, or asexual (LGBQA; 153/1222, 12.5%); were uninsured (147/1206, 12.2%); or were currently pregnant, planning pregnancy, or breastfeeding (42/624, 6.7%). However, relative to available state data for tobacco users, there was high representation of women, 35- to 54-year-olds, college graduates, and LGBQA individuals, as well as individuals with low household income, poor mental health, Medicaid insurance, and those residing in rural counties. Conclusions A diverse population of tobacco users will use a free cessation app, including some demographic groups disproportionately impacted by tobacco use. With high reach and high efficacy, it is possible to address health disparities associated with tobacco use and dependence treatment among certain underserved and at-risk groups.

BACKGROUND Tobacco use continues to be the leading preventable cause of death, disease, and disability. Cessation options have been available direct-to-consumer and through employers, health plans, and publicly sponsored programs such as those offered by states. State-sponsored efforts have included tobacco control policies, public awareness campaigns, and tobacco quitlines. Washington state has been offering quitline services since 2000, and in 2015, the state began offering free access to a smartphone app to absorb excess quitline demand and reach more people with cessation services. Since most publicly funded tobacco cessation programs are designed to provide access to underserved communities and groups disproportionately impacted by tobacco use, effectiveness and reach are both important considerations for these public health interventions. This paper aims to add to this literature. OBJECTIVE To understand who used a free cessation app and the extent to which users represented at-risk and underrepresented populations. METHODS An observational study of 1,280 adult Washington state residents who registered for and activated the cessation app between October 1, 2018 and December 31, 2020. Demographic data were collected as part of sign-up, examined using standard descriptive measures, and assessed against state-level surveillance data for representativeness. RESULTS Participants were primarily non-Hispanic white (80.3%), identified as female (63.1%), were between ages 25-54 (76.1%), had at least some college education (68.4%), and reported a household income under $50,000 (70.3%). A minority of respondents were from rural counties (29.4%), identified as LGBQA (12.5%), were uninsured (12.2%), or were currently pregnant, planning pregnancy, or breastfeeding (6.7%). There was high representation of women, 35-54 year-olds, LGBQA individuals, and college graduates, as well as individuals with low household income, poor mental health, Medicaid insurance, and residences in rural counties. CONCLUSIONS A diverse population of tobacco users will use a free cessation app. Individuals who used the app in this study largely represent the demographic groups most at risk for cigarette smoking and associated premature disease and death. This may have implications for health equity.