A Multicomponent Intervention Including Texting to Promote Tobacco Abstinence in Emergency Department Smokers: A Pilot Study

Abstract

Background Emergency department (ED) patients commonly smoke. Current treatment approaches use motivational interviewing, which is effective, but resource-intensive. Mobile health approaches may be more feasible and generalizable. Objective To assess the feasibility of an ED-initiated program of tobacco dependence treatment that employs text messaging. Methods Smokers age 18 or older were randomized to intervention or control arms. Control subjects received a brochure describing the state smokers’ quitline. Intervention subjects received the brochure, four weeks of nicotine patches and gum, with the initial dose administered in the ED, a referral to the quitline, and enrollment in SmokeFreeTxt, a free SMS-messaging service. SmokeFreeTxt delivered 28 days of messages, 2–5 messages/day. Some messages ask subjects to provide data on mood or craving. Follow-up was conducted by phone call. Results 60 subjects were enrolled in May 2014. Of all subjects, 33 (55%) were nonwhite; 78% were insured by Medicaid. All intervention subjects used the texting program, with 24/30 (80%) using the program for all 28 days. At one month, 14/30 subjects (47%) in the intervention arm reported abstinence, vs. 3/30 (10%) in the control arm (P=0.003). At three months, the abstinence rates in the intervention and control arms were, respectively, 9/30 (30%) and 4/30 (13%) (P=0.21). Subjects responding to more assessments of mood or craving were more likely to report abstinence at one month. Conclusion A texting program, combined with pharmacotherapy and a quitline referral, is feasible and may promote tobacco abstinence in ED smokers. A larger trial is planned to assess these results.

SmokefreeTXT for Homeless Smokers: Pilot Randomized Controlled Trial

“…Our results also extend those of prior observational studies of SmokefreeTXT [62,63] and a related NCI SMS text messaging program designed specifically for veterans [64] demonstrating the challenges of sustaining end-user engagement in this program. End of treatment CO-defined brief smoking abstinence rates in our study were comparable with self-reported abstinence rates in these large-scale, noncontrolled, observational studies [62-64] but were notably lower than self-reported abstinence rates in an emergency department-based pilot study of a multicomponent smoking cessation program that included SmokefreeTXT [65].…”

Using Digital Technologies to Reach Tobacco Users Who Want to Quit: Evidence From the National Cancer Institute's Smokefree.gov Initiative

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An Experimental Feasibility Study of a Hybrid Telephone Counseling/Text Messaging Intervention for Post-Discharge Cessation Support Among Hospitalized Smokers in Brazil

“…A multicomponent approach using text messaging in conjunction with phone counseling has good potential for increasing smoking cessation rates. 10,11 A hybrid texting/counseling approach is also an attractive option for lower-income countries. It could eliminate access barriers such as cost, time, travel, and scheduling.…”