Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Aug 30, 2025
Date Accepted: Dec 24, 2025
Texting to Recruit Unassisted Tobacco Users at a Large Safety Net Health System into Quitline Service for a Medicaid Value-based Care Program: Pragmatic Randomized Controlled Trial
ABSTRACT
Background:
A growing body of research supports the efficacy of text messaging programs to help tobacco users quit. Texting as a strategy for recruiting them into other evidence-based cessation services, such as quitline coaching, is less well understood.
Objective:
To compare the effects of text messages offering free coaching or free nicotine patches on quitline enrollment by patients identified in electronic health records as unassisted smokers.
Methods:
Participants (N=4171) were adult patients of Los Angeles County Department of Health Services who were identified as smokers, had a cell phone, were willing to receive text messages, had a clinical visit in the past 12 months, and had no documented cessation intervention in the past 24 months. They included 3139 English-speakers and 1032 Spanish-speakers. Participants were stratified by language, then randomly assigned to one of two groups. Group 1 received a text message offering free quitline coaching. Group 2 received a text message offering free nicotine patches. The texts were sent April–May 2022. The outcome measure was quitline enrollment. Data were analyzed in 2024.
Results:
Overall, 1.5% of participants enrolled in the quitline, including 1.3% in Group 1 and 1.6% in Group 2. There was no significant difference between groups (P=.52). However, Spanish-speakers were significantly more likely to enroll than English-speakers, 2.3% vs 1.2% (P<.01).
Conclusions:
A single text message was effective in connecting unassisted smokers with evidence-based quitline services, for both English- and Spanish-speakers but especially the latter. A population health approach of reaching out to tobacco-using patients outside clinical visits can meaningfully supplement provider referral. Research is needed on ways to increase the population health impact of this strategy, such as reaching out to additional groups of patients, using opt-out approaches, increasing the number and variety of messages sent, offering incentives, and offering mobile health treatments besides quitline coaching. Clinical Trial: ClinicalTrials.gov NCT07102290
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