scholarly journals Optimizing Text Messages to Promote Engagement With Internet Smoking Cessation Treatment: Results From a Factorial Screening Experiment

10.2196/17734 ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. e17734 ◽  
Author(s):  
Amanda L Graham ◽  
George D Papandonatos ◽  
Megan A Jacobs ◽  
Michael S Amato ◽  
Sarah Cha ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Text Messaging ◽  
Text Message ◽  
Smoking Cessation Program ◽  
Smoking Cessation Treatment ◽  
Screening Experiment ◽  
Cessation Intervention ◽  
Cessation Treatment ◽  
Interactive Feature ◽  
Main Effects

Background Smoking remains a leading cause of preventable death and illness. Internet interventions for smoking cessation have the potential to significantly impact public health, given their broad reach and proven effectiveness. Given the dose-response association between engagement and behavior change, identifying strategies to promote engagement is a priority across digital health interventions. Text messaging is a proven smoking cessation treatment modality and a powerful strategy to increase intervention engagement in other areas of health, but it has not been tested as an engagement strategy for a digital cessation intervention. Objective This study examined the impact of 4 experimental text message design factors on adult smokers’ engagement with an internet smoking cessation program. Methods We conducted a 2×2×2×2 full factorial screening experiment wherein 864 participants were randomized to 1 of 16 experimental conditions after registering with a free internet smoking cessation program and enrolling in its automated text message program. Experimental factors were personalization (on/off), integration between the web and text message platforms (on/off), dynamic tailoring of intervention content based on user engagement (on/off), and message intensity (tapered vs abrupt drop-off). Primary outcomes were 3-month measures of engagement (ie, page views, time on site, and return visits to the website) as well as use of 6 interactive features of the internet program. All metrics were automatically tracked; there were no missing data. Results Main effects were detected for integration and dynamic tailoring. Integration significantly increased interactive feature use by participants, whereas dynamic tailoring increased the number of features used and page views. No main effects were found for message intensity or personalization alone, although several synergistic interactions with other experimental features were observed. Synergistic effects, when all experimental factors were active, resulted in the highest rates of interactive feature use and the greatest proportion of participants at high levels of engagement. Measured in terms of standardized mean differences (SMDs), effects on interactive feature use were highest for Build Support System (SMD 0.56; 95% CI 0.27 to 0.81), Choose Quit Smoking Aid (SMD 0.38; 95% CI 0.10 to 0.66), and Track Smoking Triggers (SMD 0.33; 95% CI 0.05 to 0.61). Among the engagement metrics, the largest effects were on overall feature utilization (SMD 0.33; 95% CI 0.06 to 0.59) and time on site (SMD 0.29; 95% CI 0.01 to 0.57). As no SMD >0.30 was observed for main effects on any outcome, results suggest that for some outcomes, the combined intervention was stronger than individual factors alone. Conclusions This factorial experiment demonstrates the effectiveness of text messaging as a strategy to increase engagement with an internet smoking cessation intervention, resulting in greater overall intervention dose and greater exposure to the core components of tobacco dependence treatment that can promote abstinence. Trial Registration ClinicalTrials.gov NCT02585206; https://clinicaltrials.gov/ct2/show/NCT02585206. International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2015-010687

scholarly journals Optimizing Text Messages to Promote Engagement With Internet Smoking Cessation Treatment: Results From a Factorial Screening Experiment (Preprint)

2020 ◽  
Author(s):  
Amanda L Graham ◽  
George D Papandonatos ◽  
Megan A Jacobs ◽  
Michael S Amato ◽  
Sarah Cha ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Text Messaging ◽  
Text Message ◽  
Smoking Cessation Program ◽  
Smoking Cessation Treatment ◽  
Screening Experiment ◽  
Cessation Intervention ◽  
Cessation Treatment ◽  
Interactive Feature ◽  
Main Effects

BACKGROUND Smoking remains a leading cause of preventable death and illness. Internet interventions for smoking cessation have the potential to significantly impact public health, given their broad reach and proven effectiveness. Given the dose-response association between engagement and behavior change, identifying strategies to promote engagement is a priority across digital health interventions. Text messaging is a proven smoking cessation treatment modality and a powerful strategy to increase intervention engagement in other areas of health, but it has not been tested as an engagement strategy for a digital cessation intervention. OBJECTIVE This study examined the impact of 4 experimental text message design factors on adult smokers’ engagement with an internet smoking cessation program. METHODS We conducted a 2×2×2×2 full factorial screening experiment wherein 864 participants were randomized to 1 of 16 experimental conditions after registering with a free internet smoking cessation program and enrolling in its automated text message program. Experimental factors were <i>personalization</i> (on/off), <i>integration</i> between the web and text message platforms (on/off), <i>dynamic tailoring</i> of intervention content based on user engagement (on/off), and <i>message intensity</i> (tapered vs abrupt drop-off). Primary outcomes were 3-month measures of engagement (ie, page views, time on site, and return visits to the website) as well as use of 6 interactive features of the internet program. All metrics were automatically tracked; there were no missing data. RESULTS Main effects were detected for <i>integration</i> and <i>dynamic tailoring</i>. <i>Integration</i> significantly increased interactive feature use by participants, whereas <i>dynamic tailoring</i> increased the number of features used and page views. No main effects were found for <i>message intensity</i> or <i>personalization</i> alone, although several synergistic interactions with other experimental features were observed. Synergistic effects, when all experimental factors were active, resulted in the highest rates of interactive feature use and the greatest proportion of participants at high levels of engagement. Measured in terms of standardized mean differences (SMDs), effects on interactive feature use were highest for Build Support System (SMD 0.56; 95% CI 0.27 to 0.81), Choose Quit Smoking Aid (SMD 0.38; 95% CI 0.10 to 0.66), and Track Smoking Triggers (SMD 0.33; 95% CI 0.05 to 0.61). Among the engagement metrics, the largest effects were on overall feature utilization (SMD 0.33; 95% CI 0.06 to 0.59) and time on site (SMD 0.29; 95% CI 0.01 to 0.57). As no SMD &gt;0.30 was observed for main effects on any outcome, results suggest that for some outcomes, the combined intervention was stronger than individual factors alone. CONCLUSIONS This factorial experiment demonstrates the effectiveness of text messaging as a strategy to increase engagement with an internet smoking cessation intervention, resulting in greater overall intervention dose and greater exposure to the core components of tobacco dependence treatment that can promote abstinence. CLINICALTRIAL ClinicalTrials.gov NCT02585206; https://clinicaltrials.gov/ct2/show/NCT02585206. INTERNATIONAL REGISTERED REPORT RR2-10.1136/bmjopen-2015-010687

scholarly journals Comparing the Efficacy of an Identical, Tailored Smoking Cessation Intervention Delivered by Mobile Text Messaging Versus Email: Randomized Controlled Trial (Preprint)

2018 ◽  
Author(s):  
Inger Torhild Gram ◽  
Dillys Larbi ◽  
Silje Camilla Wangberg
Keyword(s):  
Smoking Cessation ◽  
Text Messaging ◽  
Controlled Trial ◽  
Text Message ◽  
Population Level ◽  
Randomized Controlled ◽  
Cessation Intervention ◽  
Double Blinded ◽  
Time Point

BACKGROUND There is a need to deliver smoking cessation support at a population level, both in developed and developing countries. Studies on internet-based and mobile phone–based smoking cessation interventions have shown that these methods can be as effective as other methods of support, and they can have a wider reach at a lower cost. OBJECTIVE This randomized controlled trial (RCT) aimed to compare, on a population level, the efficacy of an identical, tailored smoking cessation intervention delivered by mobile text messaging versus email. METHODS We conducted a nationwide 2-arm, double-blinded, fully automated RCT, close to a real-world setting, in Norway. We did not offer incentives to increase participation and adherence or to decrease loss to follow-up. We recruited users of the website, slutta.no, an open, free, multi-component Norwegian internet-based smoking cessation program, from May 2010 until October 2012. Enrolled smokers were considered as having completed a time point regardless of their response status if it was 1, 3, 6, or 12 months post cessation. We assessed 7315 participants using the following inclusion criteria: knowledge of the Norwegian language, age 16 years or older, ownership of a Norwegian cell phone, having an email account, current cigarette smoker, willingness to set a cessation date within 14 days (mandatory), and completion of a baseline questionnaire for tailoring algorithms. Altogether, 6137 participants were eligible for the study and 4378 participants (71.33%) provided informed consent to participate in the smoking cessation trial. We calculated the response rates for participants at the completed 1, 3, 6, and 12 months post cessation. For each arm, we conducted an intention-to-treat (ITT) analysis for each completed time point. The main outcome was 7-day self-reported point prevalence abstinence (PPA) at the completed 6 months post cessation. We calculated effect size of the 7-day self-reported PPA in the text message arm compared with the email arm as odds ratios (ORs) with 95% CIs for the 4 time points post cessation. RESULTS At 6 months follow-up, 21.06% (384/1823) of participants in the text message arm and 18.62% (333/1788) in the email arm responded (<italic>P</italic>=.07) to the surveys. In the ITT analysis, 11.46% (209/1823) of participants in the text message arm compared with 10.96% (196/1788) in the email arm (OR 1.05, 95% CI 0.86-1.30) reported to have achieved 7 days PPA. CONCLUSIONS This nationwide, double-blinded, large, fully automated RCT found that 1 in 9 enrolled smokers reported 7-day PPA in both arms, 6 months post cessation. Our study found that identical smoking cessation interventions delivered by mobile text messaging and email may be equally successful at a population level. CLINICALTRIAL ClinicalTrials.gov NCT01103427; https://clinicaltrials.gov/ct2/show/NCT01103427

scholarly journals Comparing the Efficacy of an Identical, Tailored Smoking Cessation Intervention Delivered by Mobile Text Messaging Versus Email: Randomized Controlled Trial

10.2196/12137 ◽  
2019 ◽  
Vol 7 (9) ◽  
pp. e12137 ◽  
Author(s):  
Inger Torhild Gram ◽  
Dillys Larbi ◽  
Silje Camilla Wangberg
Keyword(s):  
Smoking Cessation ◽  
Text Messaging ◽  
Controlled Trial ◽  
Text Message ◽  
Population Level ◽  
Randomized Controlled ◽  
Cessation Intervention ◽  
Double Blinded ◽  
Time Point

Background There is a need to deliver smoking cessation support at a population level, both in developed and developing countries. Studies on internet-based and mobile phone–based smoking cessation interventions have shown that these methods can be as effective as other methods of support, and they can have a wider reach at a lower cost. Objective This randomized controlled trial (RCT) aimed to compare, on a population level, the efficacy of an identical, tailored smoking cessation intervention delivered by mobile text messaging versus email. Methods We conducted a nationwide 2-arm, double-blinded, fully automated RCT, close to a real-world setting, in Norway. We did not offer incentives to increase participation and adherence or to decrease loss to follow-up. We recruited users of the website, slutta.no, an open, free, multi-component Norwegian internet-based smoking cessation program, from May 2010 until October 2012. Enrolled smokers were considered as having completed a time point regardless of their response status if it was 1, 3, 6, or 12 months post cessation. We assessed 7315 participants using the following inclusion criteria: knowledge of the Norwegian language, age 16 years or older, ownership of a Norwegian cell phone, having an email account, current cigarette smoker, willingness to set a cessation date within 14 days (mandatory), and completion of a baseline questionnaire for tailoring algorithms. Altogether, 6137 participants were eligible for the study and 4378 participants (71.33%) provided informed consent to participate in the smoking cessation trial. We calculated the response rates for participants at the completed 1, 3, 6, and 12 months post cessation. For each arm, we conducted an intention-to-treat (ITT) analysis for each completed time point. The main outcome was 7-day self-reported point prevalence abstinence (PPA) at the completed 6 months post cessation. We calculated effect size of the 7-day self-reported PPA in the text message arm compared with the email arm as odds ratios (ORs) with 95% CIs for the 4 time points post cessation. Results At 6 months follow-up, 21.06% (384/1823) of participants in the text message arm and 18.62% (333/1788) in the email arm responded (P=.07) to the surveys. In the ITT analysis, 11.46% (209/1823) of participants in the text message arm compared with 10.96% (196/1788) in the email arm (OR 1.05, 95% CI 0.86-1.30) reported to have achieved 7 days PPA. Conclusions This nationwide, double-blinded, large, fully automated RCT found that 1 in 9 enrolled smokers reported 7-day PPA in both arms, 6 months post cessation. Our study found that identical smoking cessation interventions delivered by mobile text messaging and email may be equally successful at a population level. Trial Registration ClinicalTrials.gov NCT01103427; https://clinicaltrials.gov/ct2/show/NCT01103427

scholarly journals Text Messaging to Enhance Mindfulness-Based Smoking Cessation Treatment: Program Development Through Qualitative Research

10.2196/11246 ◽  
2019 ◽  
Vol 7 (1) ◽  
pp. e11246 ◽  
Author(s):  
Claire A Spears ◽  
Sharrill A Bell ◽  
Charlayne A Scarlett ◽  
Natalie K Anderson ◽  
Cherell Cottrell-Daniels ◽  
...  
Keyword(s):  
Qualitative Research ◽  
Smoking Cessation ◽  
Program Development ◽  
Treatment Program ◽  
Text Messaging ◽  
Smoking Cessation Treatment ◽  
Cessation Treatment

Development of a Pharmacist-Led Opt-Out Cessation Treatment Protocol for Combustible Tobacco Smoking Within Inpatient Settings

2021 ◽  
pp. 001857872199980
Author(s):  
Philip J. Trapskin ◽  
Ann Sheehy ◽  
Paul D. Creswell ◽  
Danielle E. McCarthy ◽  
Amy Skora ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Treatment Protocol ◽  
Implementation Strategies ◽  
Smoking Cessation Intervention ◽  
University Hospital ◽  
Smoking Cessation Treatment ◽  
Cessation Intervention ◽  
Cessation Treatment ◽  
Opt Out ◽  
Inpatient Settings

Background: Although people who smoke cigarettes are overrepresented among hospital inpatients, few are connected with smoking cessation treatment during their hospitalization. Training, accountability for medication use, and monitoring of all patients position pharmacists well to deliver cessation interventions to all hospitalized patients who smoke. Methods: A large Midwestern University hospital implemented a pharmacist-led smoking cessation intervention. A delegation protocol for hospital pharmacy inpatients who smoked cigarettes gave hospital pharmacists the authority to order nicotine replacement therapy (NRT) during hospitalization and upon discharge, and for referral to the Wisconsin Tobacco Quit Line (WTQL) at discharge. Eligible patients received the smoking cessation intervention unless they actively refused (ie, “opt-out”). The program was pilot tested in phases, with pharmacist feedback between phases, and then implemented hospital-wide. Interviews, surveys, and informal mechanisms identified ways to improve implementation and workflows. Results: Feedback from pharmacists led to changes that improved workflow, training and patient education materials, and enhanced adoption and reach. Refining implementation strategies across pilot phases increased the percentage of eligible smokers offered pharmacist-delivered cessation support from 37% to 76%, prescribed NRT from 2% to 44%, and referred to the WTQL from 3% to 32%. Conclusion: Hospitalizations provide an ideal opportunity for patients to make a tobacco quit attempt, and pharmacists can capitalize on this opportunity by integrating smoking cessation treatment into existing inpatient medication reconciliation workflows. Pharmacist-led implementation strategies developed in this study may be applicable in other inpatient settings.

scholarly journals Evaluation of smoking cessation treatment initiated during hospitalization in patients with heart disease or respiratory disease

2018 ◽  
Vol 44 (1) ◽  
pp. 42-48 ◽  
Author(s):  
Thaís Garcia ◽  
Sílvia Aline dos Santos Andrade ◽  
Angélica Teresa Biral ◽  
André Luiz Bertani ◽  
Laura Miranda de Oliveira Caram ◽  
...  
Keyword(s):  
Health Care ◽  
Smoking Cessation ◽  
Heart Disease ◽  
Hospital Discharge ◽  
Respiratory Disease ◽  
Health Care Professionals ◽  
Smoking Cessation Program ◽  
Cognitive Behavioral ◽  
Smoking Cessation Treatment ◽  
Cessation Treatment

ABSTRACT Objective: To evaluate the effectiveness of a smoking cessation program, delivered by trained health care professionals, in patients hospitalized for acute respiratory disease (RD) or heart disease (HD). Methods: Of a total of 393 patients evaluated, we included 227 (146 and 81 active smokers hospitalized for HD and RD, respectively). All participants received smoking cessation treatment during hospitalization and were followed in a cognitive-behavioral smoking cessation program for six months after hospital discharge. Results: There were significant differences between the HD group and the RD group regarding participation in the cognitive-behavioral program after hospital discharge (13.0% vs. 35.8%; p = 0.003); smoking cessation at the end of follow-up (29% vs. 31%; p < 0.001); and the use of nicotine replacement therapy (3.4% vs. 33.3%; p < 0.001). No differences were found between the HD group and the RD group regarding the use of bupropion (11.0% vs. 12.3%; p = 0.92). Varenicline was used by only 0.7% of the patients in the HD group. Conclusions: In our sample, smoking cessation rates at six months after hospital discharge were higher among the patients with RD than among those with HD, as were treatment adherence rates. The implementation of smoking cessation programs for hospitalized patients with different diseases, delivered by the health care teams that treat these patients, is necessary for greater effectiveness in smoking cessation.

scholarly journals Correction: Optimizing Text Messages to Promote Engagement With Internet Smoking Cessation Treatment: Results From a Factorial Screening Experiment

10.2196/21027 ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. e21027
Author(s):  
Amanda L Graham ◽  
George D Papandonatos ◽  
Megan A Jacobs ◽  
Michael S Amato ◽  
Sarah Cha ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Text Messages ◽  
Treatment Results ◽  
Smoking Cessation Treatment ◽  
Screening Experiment ◽  
Cessation Treatment

Can inpatient pharmacists move the needle on smoking cessation? Evaluating reach and representativeness of a pharmacist-led opt-out smoking cessation intervention protocol for hospital settings

2021 ◽  
Author(s):  
Paul D Creswell ◽  
Danielle E McCarthy ◽  
Philip Trapskin ◽  
Ann Sheehy ◽  
Amy Skora ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Academic Medical Center ◽  
Treatment Protocol ◽  
Smoking Cessation Intervention ◽  
Hospital Services ◽  
Smoking Cessation Treatment ◽  
Cessation Intervention ◽  
Cessation Treatment ◽  
Opt Out ◽  
Intervention Protocol

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Hospitalization affords an opportunity to reduce smoking, but fewer than half of patients who smoke receive evidence-based cessation treatment during inpatient stays. This study evaluated a pharmacist-led, electronic health record (EHR)-facilitated opt-out smoking cessation intervention designed to address this need. Methods Analyses of EHR records for adult patients who smoked in the past 30 days admitted to an academic medical center in the upper Midwest were conducted using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. The reach of a pharmacist-led, EHR-facilitated protocol for smoking cessation treatment was assessed by comparing patients’ receipt of nicotine replacement therapy (NRT) and tobacco quitline referral before and after implementation. χ  2 tests, t tests, and multiple logistic regression models were used to compare reach across patient demographic groups to assess treatment disparities and the representativeness of reach. Adoption of the program by hospital services was also assessed. Results Of the 70 hospital services invited to implement the program, 88.6% adopted it and 78.6% had eligible admissions. Treatment reach increased as rates of delivering NRT rose from 43.6% of eligible patients before implementation to 50.4% after implementation (P &lt; 0.0001) and quitline referral rates rose from 0.9% to 11.9% (P &lt; 0.0001). Representativeness of reach by sex and ethnicity improved after implementation, although disparities by race and age persisted after adjustment for demographics, insurance, and primary diagnosis. Pharmacists addressed tobacco use for eligible patients in 62.5% of cases after protocol implementation. Conclusion Smoking cessation treatment reach and representativeness of reach improved after implementation of a proactive, pharmacist-led, EHR-facilitated opt-out smoking cessation treatment protocol in adult inpatient services.

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