JMIR Publications

ABSTRACT

Background:

Smoking rates are significantly higher among youth experiencing homelessness (YEH) than in the general population. Despite a willingness to quit, YEH have little success in doing so on their own, and existing cessation resources tailored to this population are lacking. YEH 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 YEH quit smoking. This paper outlines the lessons learned from the implementation of the TMI intervention.

Methods:

YEH smokers who were interested in quitting (n = 77) were recruited from drop-in centers serving YEH in the Los Angeles area. In this pilot randomized controlled trial, all participants received a group-based cessation counseling session and nicotine patches; with n = 40 randomly assigned to receive six weeks of text messages to provide additional support for their quit attempt. Participants were sent the text messages to their own phone, rather than receiving a study-issued phone for the TMI. We analyzed baseline and follow up survey data, as well as backend 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 – only 14% were ineligible for study participation because they either did not have a phone that could receive text messages or did not want to receive messages. Participants experienced interruptions in their phone use but reported being able to receive the majority of messages. These survey results were corroborated by backend 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. Participants reported enjoying the group counseling session that preceded the TMI, and suggested to include more such group elements into the intervention.

Conclusions:

The TMI was well accepted and feasible to support smoking cessation among YEH. 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 YEH, a population urgently in need of effective smoking cessation interventions. Clinical Trial: We report on implementation lessons, i.e. do not make use of the randomized controlled trial aspect of the underlying parent study that is registered with the ClinicalTrials.gov Identifier: NCT03874585