Text-message Outreach to Connect Adolescents and Young Adults to Nicotine Treatment: A Pilot Study i

Lustig E, DiFiore G, Powell M, Leone FT, Schnoll R, Jenssen BP.
Text-message Outreach to Connect Adolescents and Young Adults to Nicotine Treatment: A Pilot Study in Pediatric Primary Care
Acad Pediatr. 2026 Apr 10:103318. doi: 10.1016/j.acap.2026.103318. Epub ahead of print. PMID: 41967674.

Objective: Strategies are needed to increase adolescent and young adult (AYA) engagement in nicotine use treatment. We assessed feasibility, acceptability, and clinical impact of text-message outreach connecting AYA to nicotine use treatment across a large health network.

Methods: This quality improvement pilot study included two phases of text-message outreach following primary care visits. All patients aged 13-22 completed an in-visit confidential electronic health questionnaire assessing past 30-day nicotine use. Phase 1: patients selected whether to receive text outreach about quitting resources. Phase 2: all patients reporting nicotine use who provided a phone number on the electronic questionnaire received automatic text outreach. Treatment options included a text-messaging program (This is Quitting) and/or nicotine replacement therapy. Outcome measures included feasibility (phone number provision), acceptability (treatment interest), and clinical impact (treatment connection).

Results: Among 23,411 AYA screened February-June 2024, 919 (3.9%) reported past 30-day nicotine use. For feasibility, 90% and 91% of AYA who reported nicotine use provided a phone number in each phase, respectively. Acceptability was higher in Phase 1 versus Phase 2 (11% vs. 2%), but clinical impact was similar (2% vs. 1%). Overall, 824 patients who reported nicotine use provided a phone number (90%), 59 expressed treatment interest (6%), and 16 connected to treatment (2%).

Conclusions: Text-message outreach was feasible but achieved low acceptability and clinical impact. Barriers included a high rate of messages blocked as spam, limited interventions for AYA with infrequent nicotine use, and barriers to accessing NRT related to cost and confidentiality.