SmokefreeTXT for Homeless Smokers: Pilot Randomized Controlled Trial

Area of Science:

• Public Health
• Behavioral Science
• Digital Health

Background:

• Homeless smokers face significant barriers to quitting, including peer influence and lack of social support.
• Short message service (SMS) text messaging interventions offer potential for virtual support to overcome these challenges.

Purpose of the Study:

• To evaluate if a free SMS text messaging program, complementing pharmacotherapy and counseling, enhances smoking abstinence rates in homeless adults.
• To assess the feasibility and participant experience of using an SMS text messaging service for smoking cessation.

Main Methods:

• An 8-week pilot randomized controlled trial (RCT) compared nicotine patch therapy and counseling with or without the SmokefreeTXT SMS service.
• Participants received a mobile phone and plan; SmokefreeTXT users received daily automated messages and on-demand tips.
• Smoking abstinence was the primary outcome, measured by exhaled carbon monoxide, with secondary outcomes including program use, perceptions, and phone retention.

Main Results:

• No significant difference in smoking abstinence was observed between the SMS intervention and control groups.
• While two-thirds of users were satisfied, qualitative feedback indicated messages were impersonal, too frequent, and preferred in-person support.
• Mobile phone retention was low (40%), with theft and practical challenges like charging being significant issues.

Conclusions:

• The SmokefreeTXT intervention, when added to standard care, did not significantly improve smoking abstinence among homeless smokers.
• Future SMS interventions must be tailored to the specific needs of the homeless population and incorporate strategies to improve mobile phone retention.