JMIR Publications

ABSTRACT

Background:

The use of new and emerging tobacco products (NETPs) and conventional tobacco products (CTPs) has been linked to several alarming medical conditions among young adults (YAs). Considering that 96% YAs own mobile phones, text messaging may be an effective strategy for tobacco risk communication.

Objective:

Project Debunk is a community-based randomized trial aimed to identify specific types of messages that effectively improve perceived NETP risk and CTP risk among YAs in community college.

Methods:

With YAs recruited offline from three campuses at the Houston Community College (September 2016 – July 2017), we conducted a 6-month randomized trial with eight arms, based on the combination of three message categories: framing (gain-framed versus loss-framed), depth (simple versus complex), and appeal (emotional versus rational). Participants received fully automated online text messages in two 30-day campaigns (2 messages per day). We conducted repeated-measures mixed-effect models stratified by message type received, predicting perceived CTP and NETP risks. Due to multiple testing with 7 models, an association was deemed significant for p<0.007 (0.05 divided by 7).

Results:

A total of 636 participants completed the baseline survey, were randomized to 1 of 8 conditions (between 73 and 86 participants per condition), and received the messages from both campaigns. By the two-month post-campaign 2 assessment point, 70.12% (446/636) completed all outcome measures. By the end of both campaigns, participants significantly increased in perceived NETP risk over time (P<.0001), but they marginally increased in perceived CTP risk (P=.008). Separately for each group, there was a significant increase in perceived NETP risk among participants who received rational messages (P=.005), those who received emotional messages (P=.006), those who received simple messages (P=.003), and those who received gain-framed messages (p=.003). Although nonsignificant, there was an increase in perceived CTP risk among participants who received emotional messages (P=.010), those who received complex messages (P=.026), and those who received loss-framed messages (P=.012).

Conclusions:

In this trial, YAs increased in perceived NETP risk. However, with stratification, we observed a significant increase in perceived NETP risk upon exposure to rational, emotional, simple, and gain-framed messages. In addition, YAs generally increased in perceived CTP risk, and presented nonsignificant but observable improvement upon exposure to emotional, complex, and loss-framed messages. With the results of this study, researchers and practitioners implementing mobile health (mHealth) programs may take advantage of our tailored messages through larger technology-based programs such as smartphone applications and social media campaigns. Clinical Trial: This trial was registered at the Clinical Trials registry, NCT03457480; https://clinicaltrials.gov/ct2/show/NCT03457480?term=NCT03457480&rank=1 (Archived by WebCite at http://www.webcitation.org/6ykd4IIap).