Integrating Social Determinants of Health with Tobacco Treatment for Individuals with Opioid Use Dis
Thursday, September 15, 2022
Posted by: Natalia Gromov
Kathuria
H, Shankar D, Cobb V, et al.
Integrating Social
Determinants of Health with Tobacco Treatment for Individuals with Opioid Use
Disorder: Feasibility and Acceptability Study of Delivery Through Text
Messaging.
JMIR Form Res. 2022;6(9):e36919. Published 2022 Sep 1. doi:10.2196/36919
Background. Individuals
with opioid use disorder (OUD) have a high prevalence of smoking and frequently
experience unmet social determinants of health (SDOH), which may be barriers to
smoking cessation. Hospitalization is an opportunity to encourage smoking
cessation. Unfortunately, many clinicians do not provide tobacco treatment to
support the maintenance of cessation achieved during hospitalization.
Interventions are required to support these high-risk individuals after
hospital discharge.
Objective. This
study aimed to test the feasibility and acceptability of a 28-day SMS text
messaging program tailored to individuals with OUD, which provides smoking
cessation support and addresses unmet SDOH needs.
Methods. From
July to December 2019, we enrolled 25 individuals who were hospitalized with
tobacco dependence and OUD at our large safety net hospital. The SMS text
messaging program was initiated during hospitalization and continued for 28
days. Participants were enrolled in either the ready to quit within 30 days or
the not ready to quit within 30 days program based on their readiness to quit.
Automated SMS text messages were sent twice daily for 4 weeks. The topics
included health and cost benefits of quitting, both general and opioid specific
(16 messages); managing mood and stress (8 messages); motivation, coping
strategies, and encouragement (18 messages); addressing medication
misconceptions (5 messages); links to resources to address substance use (2
messages providing links to the Massachusetts Substance Use Helpline and Boston
Medical Center resources), tobacco dependence (1 message providing a link to
the Massachusetts Quitline), and unmet SDOH needs (6 messages assessing SDOH
needs with links to resources if unmet SDOH needs were identified).
Questionnaires and interviews were conducted at baseline and at 2 and 4 weeks
after enrollment.
Results. The
participants were 56% (14/25) female, 36% (9/25) African American, 92% (23/25)
unemployed, and 96% (24/25) Medicaid insured. Approximately 84% (21/25)
activated the program, and none of the participants unsubscribed. Approximately
57% (12/21) completed either the 2- or 4-week questionnaires. Program
satisfaction was high (overall mean 6.7, SD 0.8, range 1-7). Many perceived
that the SMS text messaging program provided social support, companionship, and
motivation to stop smoking. Messages about the health benefits of quitting were
well received, whereas messages on how quitting cigarettes may prevent relapse
from other substances had mixed views, highlighting the importance of tailoring
interventions to patient preferences.
Conclusions. SMS
text messaging to promote smoking cessation and address SDOH needs may be an
effective tool for improving quit rates and health outcomes in individuals with
tobacco dependence and OUD. Our study adds to the growing body of evidence that
SMS text messaging approaches are feasible and acceptable for providing tobacco
treatment to all individuals who smoke, even among low-income populations who
have OUD and are not ready to quit.
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