Abstract
BackgroundFew smokers receive evidence-based cessation services during primary care visits.ObjectiveWe aimed to assess the feasibility of a proactive text messaging program for primary care patients who smoke.MethodsWe used electronic health records to identify smokers who had a mobile phone number listed from two community health centers in Massachusetts. Between March 2014 and June 2015, patients were screened by their primary care physician and then sent a proactive text message inviting them to enroll by texting back. Patients who opted in were asked about their readiness to quit. The text message program included messages from the QuitNowTXT library and novel content for smokers who were not ready to quit.ResultsAmong 949 eligible smokers, 88 (9.3%) enrolled after receiving a single proactive text message. Compared with those who did not enroll, enrollees were more often female (54/88, 61% vs 413/861, 48.0%, P=.02), but otherwise did not differ in age, race, insurance status, or comorbidities. In all, 28% (19/67) of enrollees reported they were not ready to quit in the next 30 days, 61% (41/67) were ready to quit, and 11% (7/67) already quit. The median time in the program was 9 days (interquartile range 2-32 days). Of current smokers, 25% (15/60) sent one or more keyword requests to the server. These did not differ by readiness to quit.ConclusionsA proactively delivered text messaging program targeting primary care patients who smoke was feasible and engaged both smokers ready to quit and those not ready to quit. This method shows promise as part of a population health model for addressing tobacco use outside of the primary care office.
Highlights
Among US smokers, less than one-third use any assistance—pharmacologic or behavioral—when they try to quit smoking [1]
Other eligibility criteria based on electronic health record IQR (EHR) data included a primary language of English, age 18 years and older, current smoker, and with a mobile telephone number
For smokers who were not ready to quit in the 30 days, 31 novel messages were developed by an expert team of primary care physicians (PCPs), a tobacco cessation counselor, a mobile health manager, and a behavioral scientist
Summary
Among US smokers, less than one-third use any assistance—pharmacologic or behavioral—when they try to quit smoking [1]. Text messaging shows promise as a way to assist smokers to quit by delivering behavioral advice. Prior studies indicate that text messaging interventions for smokers increase tobacco abstinence rates by 36% to 70% [2,3,4,5,6,7,8,9,10,11,12,13]. Most prior text messaging studies recruited motivated smokers through public advertisements, the Internet, or school-based recruitment. The few text messaging studies that recruited smokers from health care settings targeted motivated smokers [14], those already in tobacco treatment programs [15], pregnant smokers [16], or patients with coronary disease [17]. Few smokers receive evidence-based cessation services during primary care visits
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