Factors Associated with Enrollment, Adherence, and Retention in a Remotely Delivered Tobacco Cessati

Coffee Z, Hsu CH, Sheffer CE, Giacobbi P Jr, Marano KM, Barraza Y, Gordon JS.
Factors Associated with Enrollment, Adherence, and Retention in a Remotely Delivered Tobacco Cessation Randomized Controlled Trial
Tob Prev Cessat. 2026 Jun 30;12. doi: 10.18332/tpc/216719. PMID: 42427924; PMCID: PMC13347305.

Introduction: Remote tobacco cessation trials can expand access, yet enrollment, adherence, and retention remain challenging. This study aimed to identify individual- and neighborhood-level factors associated with enrollment, adherence, and retention in a two-arm, remotely delivered tobacco cessation randomized controlled trial (RCT). We conducted a secondary analysis of data from RCT NCT05277831.

Methods: Adults who smoke were recruited between October 2022 and July 2024 through quitlines, recruiting firms, and community outreach conducted in Arizona, New York, and West Virginia. Participants were block-randomized to a behavioral cessation intervention or behavioral plus guided imagery intervention. Data were collected using online, self-reported questionnaires. Outcomes included enrollment (Session 1 completion), adherence (≥4/6 sessions), and 3 month retention, using multivariable logistic regression estimated adjusted odds ratios (AORs) for demographic, clinical, and neighborhood disadvantage covariates.

Results: Of 1595 randomized participants, 1209 enrolled (75.8%), 914 (75.6%) were adherent, and 1046(86.5%) were retained at 3 months. The sample (mean age 50 years) was predominantly female (65%) and White (77%); about 35% had high school or lower education. Enrollment was lower among males (AOR=0.76; 95% CI: 0.60-0.97, p=0.03) those with lower education (AOR=0.74; 95% CI: 0.57-0.96, p=0.03), and those from more disadvantaged neighborhoods (AOR=0.99; 95% CI: 0.98-0.99, p=0.02). Adherence was higher with older age (AOR=1.02; 95% CI: 1.01-1.03, p=0.003), but lower with multiple household smokers (AOR=0.90; 95% CI: 0.82-1.00, p=0.05). Non-English primary language (AOR=0.36; 95% CI: 0.14-0.92, p=0.03), having more than one household smoker (AOR=0.88; 95% CI: 0.79-0.98, p=0.02), lack of a high school education (AOR=0.39; 95% CI: 0.23-0.65, p<0.001), and substance use (AOR=0.40; 95% CI: 0.2-0.81, p=0.01) were all associated with lower retention.

Conclusions: Sociodemographic factors influenced enrollment, adherence, and retention, highlighting the importance of continued research to better understand and address engagement challenges in remotely delivered cessation studies.