Text Messaging Intervention for Young Smokers Experiencing Homelessness: Lessons Learned from a Rand
Thursday, April 15, 2021
Posted by: Natalia Gromov
Linnemayr
S, Zutshi R, Shadel W, Pedersen E, DeYoreo M, Tucker J.
Text Messaging
Intervention for Young Smokers Experiencing Homelessness: Lessons Learned from
a Randomized Controlled Trial.
JMIR Mhealth Uhealth. 2021 Apr 1;9(4):e23989. doi: 10.2196/23989. PMID:
33792551.
Background.
Smoking rates are significantly higher among young people experiencing
homelessness than in the general population. Despite a willingness to quit,
homeless youth have little success in doing so on their own, and existing cessation
resources tailored to this population are lacking. Homeless youth generally
enjoy the camaraderie and peer support that group-based programs offer, but
continuous in-person support during a quit attempt can be prohibitively
expensive.
Objective.
This study aimed to assess the feasibility and acceptability of an automated
text messaging intervention (TMI) as an adjunct to group-based cessation
counseling and provision of nicotine patches to help homeless youth quit
smoking. This paper outlines the lessons learned from the implementation of the
TMI intervention.
Methods.
Homeless youth smokers aged 18 to 25 years who were interested in quitting
(n=77) were recruited from drop-in centers serving homeless youth in the Los
Angeles area. In this pilot randomized controlled trial, all participants
received a group-based cessation counseling session and nicotine patches, with
52% (40/77) randomly assigned to receive 6 weeks of text messages to provide
additional support for their quit attempt. Participants received text messages
on their own phone rather than receiving a study-issued phone for the TMI. We
analyzed baseline and follow-up survey data as well as back-end data from the
messaging platform to gauge the acceptability and feasibility of the TMI among
the 40 participants who received it.
Results.
Participants had widespread (smart)phone ownership-16.4% (36/219) were
ineligible for study participation because they did not have a phone that could
receive text messages. Participants experienced interruptions in their phone
use (eg, 44% [16/36] changed phone numbers during the follow-up period) but
reported being able to receive the majority of messages. These survey results
were corroborated by back-end data (from the program used to administer the
TMI) showing a message delivery rate of about 95%. Participant feedback points
to the importance of carefully crafting text messages, which led to high
(typically above 70%) approval of most text messaging components of the
intervention. Qualitative feedback indicated that participants enjoyed the
group counseling session that preceded the TMI and suggested including more
such group elements into the intervention.
Conclusions.
The TMI was well accepted and feasible to support smoking cessation among
homeless youth. Given high rates of smartphone ownership, the next generation
of phone-based smoking cessation interventions for this population should
consider using approaches beyond text messages and focus on finding ways to
develop effective approaches to include group interaction using remote
implementation. Given overall resource constraints and in particular the
exigencies of the currently ongoing COVID-19 epidemic, phone-based
interventions are a promising approach to support homeless youth, a population
urgently in need of effective smoking cessation interventions.
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