Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jul 11, 2025
Date Accepted: Apr 27, 2026
In Person vs. Online Recruitment to an mHealth Smoking Cessation Intervention for Food Insecure Adults: Sociodemographic Paradoxes and Enrollment Differences in a Secondary Analysis of a Randomized Controlled Trial
ABSTRACT
Background:
Opportunities for targeting individuals seeking food assistance for smoking cessation treatment can include in-person efforts at food distribution centers and online recruitment. The extent to which participants may differ based on these recruitment methods is unclear.
Objective:
Using screening, enrollment, and baseline data from an ongoing smoking cessation randomized controlled trial that enrolled people seeking food assistance, participants recruited in-person vs. online were compared on accrual, eligibility, and enrollment rates, as well as sociodemographic, smoking-related, and psychosocial characteristics.
Methods:
Participants recruited in-person (n=178) and online (n=324) completed a brief eligibility questionnaire and a baseline assessment. Responses were compared using chi-squared and Fisher’s exact tests (categorical variables) and t-tests (continuous variables).
Results:
Monthly accrual rates were higher online (>60/month) than in-person (<8/month). Although individuals screened eligible at similar rates whether recruited online or in-person (78.4% vs. 80.1%, P=.50), eligible online recruits were more likely to enroll (70.9% vs. 46.1%, P<.001). Online recruits endorsed greater food insecurity (M=4.5, SD=2.9 vs. M=3.0, SD=2.3, P<.001) and were more likely to be educated beyond high school/GED (69% vs. 49%, P<.001), to have annual household income ≥$20,000 (46% vs. 36%, P=.004), and to be non-Hispanic White (77% vs. 50%, P<.001). Online recruits scored lower on motivation to quit smoking (Contemplation Ladder; M=7.2, SD=2.4 vs. M=8.0, SD=2.8, P<.001) and reported lower smoking cessation self-efficacy (M=20.5, SD=8.0 vs. M=23.2, SD=8.6, P<.001). Online recruits reported lower subjective social status (M=4.6, SD=2.0 vs. M=5.9, SD=2.2, P<.001), greater financial strain (M=17.9, SD=6.3 vs. M=16.2, SD=6.6, P=.004), more depressive symptoms (M=8.6, SD=6.3 vs. M=7.4, SD=6.1, P=.04), greater loneliness (M=6.0, SD=2.1 vs. M=5.0, SD=2.1, P<.001), less resilience (M=19.5, SD=5.1 vs. M=20.5, SD=4.3, P=.02), less alcohol misuse (27% vs. 37%, P=.02), and more past-30-day cannabis use (25% vs. 15%, P=.02).
Conclusions:
A multi-pronged recruitment approach that involves both community-based and online methods may be needed to effectively target the wide spectrum of individuals seeking support for food insecurity. Clinical Trial: Clinical Trials Registry NCT05004662; https://clinicaltrials.gov/ct2/show/NCT05004662. Registered August 13, 2021
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