JMIR Publications

ABSTRACT

Background:

Although African Americans have the lowest rates of smoking onset and progression to daily smoking, they are less likely to achieve long-term cessation. Interventions tailored to promote use of cessation resources in African American individuals who smoke are needed. In our past work, we demonstrated the effectiveness of a technology-assisted peer-written message intervention for increasing smoking cessation in non-Hispanic White smokers. In this formative study, we are adapting this intervention to be specific for African American smokers.

Objective:

To report on the qualitative analysis of messages written by African American current and former smokers to peers, in response to hypothetical scenarios of smokers facing cessation challenges.

Methods:

We recruited African American adult current and former smokers (n=41) via Research Match between April 2017 and November 2017. We asked participants to write motivational messages to their peers in response to smoking-related hypothetical scenarios. We also collected data on sociodemographic factors and smoking characteristics. Thematic analysis was conducted to identify cessation strategies suggested by study participants.

Results:

Sixty percent of participants were female. More than half were thinking about quitting (56%) and 29% had set a quit date. Eleven percent of the study participants had used electronic cigarettes in the past 30 days. Themes derived from the qualitative analysis of peer-written messages were: 1) behavioral strategies, 2) seeking help, 3) improvements in quality of life, 4) attitudes and expectations, and 5) mindfulness/religious or spiritual practices. Under the behavioral strategies theme, distraction strategies were the most frequently suggested strategies (referenced 84 times in the 318 messages), followed by use of evidence-based treatments/cessation strategies. Within the seeking help theme, sub-themes included seeking help or support from family/friends or close social networks (referenced 56 times) and healthcare professionals (22 times). The most frequent sub-themes that emerged from improvements in quality-of-life theme included improving one’s health (referenced 22 times) and quality of life (referenced 21 times). Sub-themes that emerged from attitude and expectations theme included practicing positive self-talk (referenced 27 times), autonomy/independence from the smoking habit (referenced 6 times) and financial cost of smoking (referenced 5 times). Two sub themes emerged from the mindfulness, religious or spiritual practices theme; use of self-awareness techniques (referenced 36 times), and religious or spiritual practices to cope (referenced 13 times).

Conclusions:

Our approach to adapt a prior peer-message intervention to African American smokers yielded a set of evidence-based messages that may be suitable for smokers at all phases of motivation (ready to quit or not ready to quit) to quit. In future research, we plan to assess the impact of texting these messages to African American smokers in a smoking cessation trial.