Associations Between Engagement and Outcomes in the SmokefreeTXT Program: A Growth Mixture Modeling Analysis

Coa, Kisha; Wiseman, Kara P.; Higgins, Bryan; Augustson, Erik

doi:10.1093/ntr/nty073

Cited by 32 publications

(38 citation statements)

References 16 publications

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“…Our findings add to the mixed results seen in prior trials conducted in health care settings of SMS text messaging interventions for smoking cessation [32,58-61]. 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].…”

Section: Discussionsupporting

confidence: 76%

SmokefreeTXT for Homeless Smokers: Pilot Randomized Controlled Trial

Baggett¹,

McGlave²,

Kruse³

et al. 2019

JMIR Mhealth Uhealth

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Background Homeless smokers want to quit smoking but face numerous barriers to doing so, including pervasive smoking among peers and a lack of social support for quitting. An SMS (short message service) text messaging intervention could address these challenges by providing virtual daily support for homeless smokers who are trying to quit but coping with multiple triggers to smoke. Objective This study aimed to assess whether a free SMS text messaging program, added to evidence-based pharmacotherapy and counseling, improved smoking abstinence among homeless adult smokers. Methods From October 2015 to June 2016, we conducted an 8-week pilot randomized controlled trial (RCT) of nicotine patch therapy and weekly in-person counseling with (n=25) or without (n=25) SmokefreeTXT, a free SMS text messaging service administered by the National Cancer Institute (NCI) at Boston Health Care for the Homeless Program. All participants were provided with a mobile phone and a 2-month prepaid voice and text plan at no cost. SmokefreeTXT enrollees were sent 1 to 5 automated SMS text messages daily for up to 8 weeks and could receive on-demand tips for managing cravings, mood symptoms, and smoking lapses. The primary outcome was smoking abstinence, defined as an exhaled carbon monoxide count of <8 parts per million, assessed 14 times over 8 weeks of follow-up, and analyzed using repeated-measures logistic regression with generalized estimating equations. Other outcomes were use of SmokefreeTXT, assessed by data obtained from NCI; perceptions of SmokefreeTXT, assessed by surveys and qualitative interviews; and mobile phone retention, assessed by self-report. Results Of the SmokefreeTXT arm participants (n=25), 88% (22) enrolled in the program, but only 56% (14) had confirmed enrollment for ≥2 weeks. Among 2-week enrollees, the median response rate to interactive messages from SmokefreeTXT was 2.1% (interquartile range 0-10.5%). Across all time points, smoking abstinence did not differ significantly between SmokefreeTXT and control arm participants (odds ratio 0.92, 95% CI 0.30-2.84). Of SmokefreeTXT enrollees who completed exit surveys (n=15), two-thirds were very or extremely satisfied with the program. However, qualitative interviews (n=14) revealed that many participants preferred in-person intervention formats over phone-based, found the SMS text messages impersonal and robotic, and felt that the messages were too frequent and repetitive. Only 40% (10/25) of SmokefreeTXT arm participants retained their study-supplied mobile phone for the 8-week duration of the trial, with phone theft being common. Storing and charging phones were cited as challenges. Conclusions SmokefreeTXT, added to nicotine patch therapy and in-person counseling, did not significantly improve smoking abstinence in this 8-week pilot RCT for homeless smokers. SMS text messaging interventions for this population should be better tuned to the unique circumstances of homelessness and coupled with efforts to promote mobile phone retention over time. Trial Registration ClinicalTrials.gov NCT02565381; https://clinicaltrials.gov/ct2/show/NCT02565381 (Archived by WebCite at http://www.webcitation.org/78PLpDptZ)

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Section: Discussionsupporting

confidence: 76%

SmokefreeTXT for Homeless Smokers: Pilot Randomized Controlled Trial

Baggett¹,

McGlave²,

Kruse³

et al. 2019

JMIR Mhealth Uhealth

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“…Consistent with previous studies [37,41], in this study, daily smoking was a risk factor for poor response and abstinence rates. Longer prequit time was associated with a lower likelihood of dropping out but a lower likelihood of abstinence at quit day.…”

Section: Discussionsupporting

confidence: 91%

“…The need to improve user retention, interaction with SmokefreeMOM until intervention end, and abstinence rates points to engagement as a coveted strategy [41,42]. Engagement strategies could involve incorporating additional keywords the user can text to interact with the intervention or providing congratulatory messages for interaction [43].…”

Section: Discussionmentioning

confidence: 99%

Dropout and Abstinence Outcomes in a National Text Messaging Smoking Cessation Intervention for Pregnant Women, SmokefreeMOM: Observational Study

Kamke¹,

Grenen²,

Robinson³

et al. 2019

JMIR Mhealth Uhealth

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BackgroundPopulation-level text messaging smoking cessation interventions may reduce racial and ethnic differences in smoking among pregnant women.ObjectiveOur objective was to examine racial and ethnic differences in dropout, response, and abstinence rates among users of a US national, publicly available text messaging cessation intervention targeting pregnant women, SmokefreeMOM.MethodsParticipants were online subscribers to SmokefreeMOM who set a prospective quit date within the 9 months before their due date. We examined demographics, smoking frequency, number of cigarettes smoked per day, and prequit time (up to 14 days of preparation time before quit date) as correlates of response rate and abstinence at 8 time points: quit date, day 7, day 14, day 21, day 28, day 35, day 42 (intervention end), and day 72 (1-month follow-up). We conducted survival analysis of time from quit date to dropout by race and ethnicity.ResultsThe mean age of the analytic sample of 1288 users was 29.46 (SD 7.11) years. Of these, 65.81% (848/1288) were white, 16.04% (207/1288) were black, 8.86% (114/1288) were Latina, and 9.29% (120/1288) were multiracial, American Indian/Alaska Native, Native Hawaiian Pacific Islander, or other; 82.68% (1065/1288) had some college education or less. Point-prevalence abstinence was 14.51% (157/1082) on quit day, 3.51% (38/1082) at intervention end, and 1.99% (21/1053) at 1-month follow-up. Black users (hazard ratio 0.68, 95% CI 0.51-0.91) and those with a high school degree or less (hazard ratio 0.66, 95% CI 0.49-0.89) or some college education (hazard ratio 0.75, 95% CI 0.57-0.99) were less likely to drop out than whites or users with a bachelor’s degree or higher. Response and abstinence rates were similar across race, ethnicity, and education.ConclusionsEnrollment was low among racial and ethnic minority women but high among less-educated women. Abstinence at intervention end and 1-month follow-up was lower than that in controlled trials of text messaging cessation interventions for pregnant women (range 7%-20%). Increasing the reach, engagement, and effectiveness of SmokefreeMOM, especially among women with high rates of smoking during pregnancy, must be prioritized.

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“…8 However, although mHealth strategies show potential, maintaining engagement is difficult and user drop-out rates are high when applied in real-world circumstances. 9,10 Thus, there is a need to understand how text-message programmes interact with patient characteristics and clinical factors to result in smoking cessation to optimise future programmes.…”

mentioning

confidence: 99%

“…There is some research which have identified lower smoking quantity, older age, male sex, higher education, and absence of depression as being associated with higher engagement with mHealth programmes, 10,15 and engagement with mHealth programmes has been associated with quitting smoking. 10,16,17 Research on text-message-based smoking cessation programmes has largely focused on assessing efficacy, 7 rather than assessing predictors of efficacy such as certain patient characteristics. The messages themselves guide the participants through the quitting process by providing tips and advice, as well as referring to other sources external to the message programme.…”

mentioning

confidence: 99%

Predictors of Smoking Cessation in a Lifestyle-Focused Text-Message Support Programme Delivered to People with Coronary Heart Disease: An Analysis From the Tobacco Exercise and Diet Messages (TEXTME) Randomised Clinical Trial

et al. 2020

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Background: Studies have demonstrated the effectiveness of text message-based prevention programs on smoking cessation, including our recently published TEXTME randomised controlled trial. However, little is known about the predictors of smoking cessation in this context and if other clinically important factors interact with the program to lead to quitting. Hence, the objective of this study was to first assess the predictors of smoking cessation in TEXTME and then determine if the effect of texting on quitting was modified by interactions with important clinical variables. This will allow us to better understand how text messaging works and thus help optimise future text-message based prevention programs. Methods This sub-analysis used data collected as part of the TEXTME trial which recruited 710 participants (377 current smokers at baseline) between September 2011 and November 2013 from a large tertiary hospital in Sydney, Australia. Smokers at baseline were analysed at 6 months and grouped into those who quit and those who did not. Univariate analyses were performed to determine associations between the main outcome and clinically important baseline factors selected a priori. A multiple binominal logistic regression analysis was conducted to develop a predictive model for the dependent variable smoking cessation. A test of interaction between the intervention group and baseline variables selected a priori with the outcome smoking cessation was performed. Results Univariate analysis identified receiving text-messages, age, and mean number of cigarettes smoked each day as being associated with quitting smoking. After adjusting for age, receiving the text-messaging program (OR 2.34; 95%CI 1.43-3.86; p<0.01) and mean number of cigarettes smoked per day (OR 1.02; 95%CI 1.00-1.04; p=0.03) were independent predictors for smoking cessation. LDL-C showed a significant interaction effect with the intervention (High LDL*Intervention OR 3.77 (95%CI 2.05-6.94); Low LDL*Intervention OR 1.42 (95%CI 0.77-2.60); P=0.03). Conclusions Smoking quantity at baseline is independently associated with smoking cessation and higher LDL-C may interact with the intervention to result in quitting smoking. Those who have a higher baseline risk maybe more motivated towards beneficial lifestyle change including quitting smoking, and thus more likely to respond to mHealth smoking cessation programs. The effect of text-messages on smoking cessation was independent of age, gender, psychosocial parameters, education, and baseline control of risk factors in a secondary prevention cohort.

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Associations Between Engagement and Outcomes in the SmokefreeTXT Program: A Growth Mixture Modeling Analysis

Cited by 32 publications

References 16 publications

SmokefreeTXT for Homeless Smokers: Pilot Randomized Controlled Trial

SmokefreeTXT for Homeless Smokers: Pilot Randomized Controlled Trial

Dropout and Abstinence Outcomes in a National Text Messaging Smoking Cessation Intervention for Pregnant Women, SmokefreeMOM: Observational Study

Predictors of Smoking Cessation in a Lifestyle-Focused Text-Message Support Programme Delivered to People with Coronary Heart Disease: An Analysis From the Tobacco Exercise and Diet Messages (TEXTME) Randomised Clinical Trial

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