Factors Influencing the Use of the Text2Quit Feature in the Virginia Quitline Program

Text messaging interventions for smoking cessation are widely available across the U.S. However, their utilization is less studied. Understanding demographic and regional factors influencing the use of these programs can help optimize their reach and effectiveness.

Individuals aged 18 years and older who used the Text2Quit component of the Virginia Quitline (VAQL) from 2018 to 2022 were analyzed. Quitline users were categorized into two groups: Text2Quit users and non-Text2Quit users. County-level smoking rates and socioeconomic features were obtained from the Behavioral Risk Factor Surveillance System for 2018 to 2022 and the corresponding years of American Community Survey. Logistic regression analysis assessed the association of individual and county-level factors with Text2Quit enrollment.

Of 14,959 VAQL users, 36.58% enrolled in Text2Quit. Those who used Text2Quit were younger (54.18 vs. 57.08 years, p<0.001), more likely to have a college education (45.50% vs. 40.08%, p<0.001), and more likely to live in counties with higher smoking rates (14.89% vs. 13.94%, p<0.001), and have better cellular data coverage (71.58% vs. 66.41%, p<0.001). Logistic regression revealed that increasing age (OR=0.98, p<0.001), lower educational attainment (OR=0.84, p<0.001), and residence in Appalachian counties (OR=0.87, p=0.002) were associated with lower odds of Text2Quit enrollment. Conversely, better county-level cellular data plan coverage (OR=1.04, p<0.001) was significantly associated with increased Text2Quit enrollment.

Text2Quit use differs in demographic and regional aspects, with cellular data coverage being a significant factor in enrollment in this specific cessation program. These findings support the notion that access to technology, such as cellular data coverage, is a health equity issue, particularly in rural areas and Appalachia.