Acceptability and feasibility of a mobile health program for smoking cessation in low-resource populations

Cigarette smoking is the leading cause of preventable death in the United States. We evaluate the feasibility and acceptability of a digital contingency management intervention for tobacco cessation among Medicaid beneficiaries with a pilot microrandomized trial. Participants (N = 37; 63.9% annual income <$15,000), self-enrolled across community-based health centers, were incentivized monetarily to submit breath samples twice daily for 4 weeks, with additional incentives for negative samples (≤6 parts per million carbon monoxide). Participants were randomized twice daily with fixed probability to be sent motivational messages or not manually through an app. We evaluate acceptability and feasibility of the program. Using a generalization of regression suitable for a binary outcome, we examine the average effect of delivering a message (vs. no message) on proximal sample submissions and smoking status. Thirty-three participants who completed a posttest assessment (97.1%) reported they would recommend the program to others. Participants submitted 69.5% of the expected samples (1,440 of 2,072 total) where 66.7% (960 of 1,440 total) of submissions were smoke negative. At the postintervention breath test, 61.3% (19 of 31 who submitted a breath sample) had a negative sample (i.e., 51.4% of all 37 participants). After adjusting for previous sample submission, participants were 7% more likely (risk ratio 1.07; 95% confidence interval [1.01, 1.14]) to submit a sample after a motivational message was delivered (vs. not delivered). The results support the incorporation of motivational messages into research involving contingency management for tobacco cessation. (PsycInfo Database Record (c) 2026 APA, all rights reserved).