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 nearly all YAs (96%) own mobile phones, mobile phone text messaging is likely to be an effective strategy for tobacco risk communication.

Objective:

The objective of the current paper is to present the results of Project Debunk, a community-based randomized trial aimed to identify specific types of messages that are more effective than others in increasing the perceived risk of NETP use and CTP use 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 long campaigns, consisting of 2 text messages per day. We conducted repeated-measures mixed-effect models predicting perceived CTP and NETP risks.

Results:

A total of 636 participants completed the baseline survey, were randomized to 1 of the 8 conditions (between 73 and 86 participants per condition), and received the text messages from both campaigns. However, 70.12% (446/636) completed all outcome measures at the two-month post-campaign 2 assessment. By the end of both campaigns, participants significantly increased in perceived NETP risk (P<.0001). Although not significant at the 0.007 level, participants increased in perceived CTP risk (P=.008). There was a significant increase at the 0.007 level in perceived NETP risk among participants who received rational messages (P=.005), simple messages (P=.003), and gain-framed messages about NETPs (p=0.003). There was an increase in perceived CTP risk at the 0.05 level of significance 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 regardless of the type of message received. However, with stratification, we observed a significant increase in perceived NETP risk upon exposure to rational, simple, and gain-framed messages. In addition, YAs generally increased in perceived CTP risk, particularly 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).